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Background Diagnostic mammography projections (DxMM) have been traditionally used in the assessment of women recalled after a suspicious screening mammogram. Digital breast tomosynthesis (DBT) reduces the tissue overlap effect, thus improving image assessment. Some studies have suggested DBT might replace DxMM with at least equivalent performance. Objective To evaluate the replacement of DxMM with DBT in women recalled at screening. Methods We searched PubMed, EMBASE, and the Cochrane Library databases to identify diagnostic paired cohort studies or RCTs comparing DBT vs DxMM, published in English that: reported accuracy outcomes, recruited women recalled for assessment at mammography screening, and included a reference standard. Subgroup analysis was performed over lesion characteristics. We provided pooled accuracy estimates and differences between tests using a quadrivariate model. We assessed the certainty of the evidence using the GRADE approach. Results We included ten studies that reported specificity and sensitivity. One study included 7060 women while the remaining included between 52 and 738 women. DBT compared with DxMM showed a pooled difference for the sensitivity of 2% (95% CI 1%–3%) and a pooled difference for the specificity of 6% (95%CI 2%–11%). Restricting the analysis to the six studies that included women with microcalcification lesions gave similar results. In the context of a prevalence of 21% of breast cancer (BC) in recalled women, DBT probably detects 4 (95% CI 2–6) more BC cases and has 47 (95%CI 16–87) fewer false‐positive results per 1000 assessments. The certainty of the evidence was moderate due to risk of bias. Conclusion The evidence in the assessment of screen‐recalled findings with DBT is sparse and of moderate certainty. DBT probably has higher sensitivity and specificity than DxMM. Women, health care providers and policymakers might value as relevant the reduction of false‐positive results and related fewer invasive diagnostic procedures with DBT, without missing BC cases., This systematic review found that in women of average risk of breast cancer with suspicious lesions at mammography screening, DBT probably has higher specificity difference (6%) than diagnostic views of 2D mammography in women recalled for assessment (moderate certainty evidence). The sensitivity is also probably higher with DBT; however, the difference was not so large (2%). The clinical impact of these results in a screening program is a probable reduction of 47 false positive results, including related invasive procedures, and most likely a small increase of 4 additional true BC lesions per 1000 women recalled for assessment. Our results were consistent in women with calcified lesions, but with a larger imprecision in the sensitivity differences. These results were taken into account by the GDG, together with other considerations (ie, feasibility) to issue a conditional recommendation in favor of DBT which is available on the ECIBC website (https://healthcare‐quality.jrc.ec.europa.eu/european‐breast‐cancer‐guidelines/diagnosis/DBT).

IntroductionIn past years, the urgency of putting people in the centre of health care research has clearly been established in the public discourse. However, the depth of patient inclusion is still limited. In our COMPAR-EU project (Horizon 2020) we aim to move forward by investigating effectiveness of self-management interventions (SMIs) through the lens of the patients themselves. We do so developing of core outcome sets (COS) for SMIs for adults living with type 2 diabetes, obesity, heart failure or COPD. We now go one step further by reviewing if and how the RCTs on SMIs are reporting on those outcomes, with a focus on which patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) are being used.MethodsAfter developing our COS we searched Pubmed, Embase, Cinahl, PsycINFO and Cochrane for RCTs on SMIs for people of 18 years and older living with TYPE 2 DIABETES, COPD, HEART FAILURE and Obesity. Articles and abstracts were screened by two independent reviewers and information extracted for, among other, outcomes (guided by the four COSs) and the PREM and PROM instruments used. We analysed whether all outcomes included in our COS were measured in the literature and the variability and concentration in the use of specific PREMs and PROMs for each outcome and disease.ResultsPREMs and PROMs where both highlighted by patients as being important. For type 2 diabetes we reviewed 697 RCTs on SMIs, which used PROMs for 17 of the 23 outcomes in our COS (some were not susceptible to be measured by PROM/PREM or they were not reported in the literature). For obesity, we reviewed 517 RCTs on SMIs, which used PROMs for the 10 of the 15 outcomes included in our COS.For heart failure we reviewed 288 RCTs on SMIs, which used PROMs for the 19 outcomes in our COS.For COPD we reviewed 252 RCTs on SMIs, which used PROMs for the 10 outcomes in our COS.PREMs were less used in the literature.DiscussionsOur research confirms that the use of PROMs, is extensive, but some outcomes relevant to patients are still not regularly included in effectiveness research, specially those related to experiences of care (PREMs).ConclusionsThere are significant advances in the use of PROMs, the use of PREMs is still more limited in self-management research. Lessons learnedThe way in which research measures effectiveness often is mismatched with patient preferences. Our COMPAR-EU COS for type 2 diabetes, obesity, heart failure and COPD, and literature review can help align research with patient preferences.LimitationsAs any literature review, ours could face limitations in search and extraction and our participatory process due to the small sample of patient and other stakeholders. Several mitigation strategies have been applied. Suggestions for future researchWe suggest expanding the measure of the relevant outcomes to patients in effectiveness research, and the specific PREM and PROM instruments to do so, therefore facilitating comparability.

Five biologicals have been approved for severe eosinophilic asthma, a well-recognized phenotype. Systematic reviews (SR) evaluated the efficacy and safety of benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab (alphabetical order) compared to standard of care for severe eosinophilic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated for each of the biologicals. The risk of bias and the certainty of the evidence were assessed using GRADE. 19 RCTs (three RCTs for benralizumab, three RCTs for dupilumab, three RCTs for mepolizumab, five RCTs for omalizumab and five RCTs for reslizumab), including subjects 12 to 75 years old (except for omalizumab including also subjects 6-11 years old), ranging from 12 to 56 weeks were evaluated. All biologicals reduce exacerbation rates with high certainty of evidence: benralizumab incidence rate ratio (IRR) 0.53 (95% CI 0.39 to 0.72), dupilumab (IRR) 0.43 (95% CI 0.32 to 0.59), mepolizumab IRR 0.49 (95% CI 0.38 to 0.66), omalizumab (IRR) 0.56 (95% CI 0.40 to 0.77) and reslizumab (IRR) 0.46 (95% CI 0.37 to 0.58). Benralizumab, dupilumab and mepolizumab reduce the daily dose of oral corticosteroids (OCS) with high certainty of evidence. All evaluated biologicals probably improve asthma control, QoL and FEV1 , without reaching the minimal important difference (moderate certainty). Benralizumab, mepolizumab and reslizumab slightly increase drug-related adverse events (AE) and drug-related serious AE (low to very low certainty of evidence). The incremental cost-effectiveness ratio per quality-adjusted life year value is above the willingness to pay threshold for all biologicals (moderate certainty). Potential savings are driven by decrease in hospitalizations, emergency and primary care visits. There is high certainty that all approved biologicals reduce the rate of severe asthma exacerbations and for benralizumab, dupilumab and mepolizumab for reducing OCS. There is moderate certainty for improving asthma control, QoL, FEV1 . More data on long-term safety are needed together with more efficacy data in the paediatric population.

Self-management interventions (SMIs) may improve outcomes in Chronic Obstructive Pulmonary Disease (COPD). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study systematically describes intervention components and characteristics in randomized controlled trials (RCTs) related to COPD self-management using the COMPAR-EU taxonomy as a framework, identifying components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Overall, 235 RCTs published between 2010 and 2018, from a systematic review were coded using the taxonomy, which includes 132 components across four domains: intervention characteristics, expected patient (or caregiver) self-management behaviours, patient relevant outcomes, and target population characteristics. Risk of bias was also assessed. Interventions mainly focused on physical activity (67.4%), and condition-specific behaviours like breathing exercise (63.5%), self-monitoring (50.8%), and medication use (33.9%). Support techniques like education and skills-training, self-monitoring, and goal setting (over 35% of the RCTs) were mostly used for this. Emotional-based techniques, problem-solving, and shared decision-making were less frequently reported (less than 15% of the studies). Numerous SMIs components were insufficiently incorporated into the design of COPD SMIs or insufficiently reported. Characteristics like mode of delivery, intensity, location, and providers involved were often not described. Only 8% of the interventions were tailored to the target population’s characteristics. Outcomes that are considered important by patients were hardly taken into account. There is still a lot to improve in both the design and description of SMIs for COPD. Using a framework such as the COMPAR-EU SMI taxonomy may contribute to better reporting and to better informing of replication efforts. In addition, prospective use of the taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective SMIs in COPD.

There is a rapid increase in trials assessing healthcare interventions consisting of a combination of drugs (polytherapies) or multiple components. In the latter type of interventions (also known as complex interventions), the aspect of complexity is of paramount importance. For example, nonpharmacological interventions, such as psychological interventions or self-management interventions, usually share common components that relate to the nature of intervention, who delivers it, or where and how. In a network of trials, there is often the need to identify the most effective (or safest) component and/or combination of components. Four key meta-analytical approaches have been presented in the literature to handle complex interventions. These include (a) the single-effect model, (b) the full interaction model, (c) the additive main effects model, and (d) the two-way interaction model. In this chapter, we present and discuss the advantages and limitations of these approaches. We illustrate these methods using a network that assesses the relative effects of self-management interventions on waist size in patients with type 2 diabetes.

There is a rapid increase in trials assessing healthcare interventions consisting of a combination of drugs (polytherapies) or multiple components. In the latter type of interventions (also known as complex interventions), the aspect of complexity is of paramount importance. For example, nonpharmacological interventions, such as psychological interventions or self-management interventions, usually share common components that relate to the nature of intervention, who delivers it, or where and how. In a network of trials, there is often the need to identify the most effective (or safest) component and/or combination of components. Four key meta-analytical approaches have been presented in the literature to handle complex interventions. These include (a) the single-effect model, (b) the full interaction model, (c) the additive main effects model, and (d) the two-way interaction model. In this chapter, we present and discuss the advantages and limitations of these approaches. We illustrate these methods using a network that assesses the relative effects of self-management interventions on waist size in patients with type 2 diabetes.

The loss of muscle mass with aging and consequent muscle weakness results in compensatory gait motions. Although these compensatory motions increase the cost of walking, they appear to be an attempt by the elderly to maintain safe ambulation. However, the relationship between the affected muscles and compensatory motions in the gait cycle is unclear. This study examined gait compensation in young subjects whose muscles were weakened with Muscle Activity Restriction Taping Technique, which restricts the muscle’s belly by tightening the lower limb(s). The study included different walking speeds (regular/slow) and restrictions (calf muscles/both calf and thigh muscles). It revealed that there was an active kinematic compensation chain, in which the non-restricted or less-restricted joints compensated for the affected joint to prevent foot drop, knee hyperextension in the terminal stance phase, and knee hyperflexion in the loading response phase, and to maintain the step length. Furthermore, joints could compensate for themselves when the muscles acting on the other joints were unable to assist, as observed on an ankle joint that compensated for itself to prevent foot drop when the knee and hip flexor muscles were restricted. Moreover, the observed compensation strategies agreed with a previously reported simulation on the gait compensations appearing along with muscle weakness. This study includes a comparison of these compensation strategies with those reported for the elderly. The results of this study provide an understanding of the mechanisms of gait compensation against limitations of gait ability.

Background A large body of evidence suggests that self-management interventions (SMIs) may improve outcomes in chronic obstructive pulmonary disease (COPD). However, accurate comparisons of the relative effectiveness of SMIs are challenging, partly due to heterogeneity of outcomes across trials and uncertainty about the importance of these outcomes for patients. We aimed to develop a core set of patient-relevant outcomes (COS) for SMIs trials to enhance comparability of interventions and ensure person-centred care. Methods We undertook an innovative approach consisting of four interlinked stages: i) Development of an initial catalogue of outcomes from previous EU-funded projects and/or published studies, ii) Scoping review of reviews on patients and caregivers’ perspectives to identify outcomes of interest, iii) Two-round Delphi online survey with patients and patient representatives to rate the importance of outcomes, and iv) Face-to-face consensus workshop with patients, patient representatives, health professionals and researchers to develop the COS. Results From an initial list of 79 potential outcomes, 16 were included in the COS plus one supplementary outcome relevant to all participants. These were related to patient and caregiver knowledge/competence, self-efficacy, patient activation, self-monitoring, adherence, smoking cessation, COPD symptoms, physical activity, sleep quality, caregiver quality of life, activities of daily living, coping with the disease, participation and decision-making, emergency room visits/admissions and cost effectiveness. Conclusion The development of the COPD COS for the evaluation of SMIs will increase consistency in the measurement and reporting of outcomes across trials. It will also contribute to more personalized health care and more informed health decisions in clinical practice as patients’ preferences regarding COPD outcomes are more systematically included.

This systematic review evaluates the efficacy and safety of omalizumab for chronic spontaneous urticaria (CSU). PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CSU-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Ten RCTs including 1620 subjects aged 12 to 75 years old treated with omalizumab for 16 to 40 weeks were evaluated. Omalizumab 150 mg does not result in clinically meaningful improvement (high certainty) of the urticaria activity score (UAS)7 (mean difference (MD) -5; 95%CI -7.75 to -2.25), and the itch severity score (ISS)7 (MD -2.15; 95% CI -3.2 to -1.1) does not increase (moderate certainty) quality of life (QoL) (Dermatology Life Quality Index (DLQI); MD -2.01; 95%CI -3.22 to -0.81) and decreases (moderate certainty) rescue medication use (MD -1.68; 95%CI -2.95 to -0.4). Omalizumab 300 mg results in clinically meaningful improvements (moderate certainty) of the UAS7 (MD -11.05; 95%CI -12.87 to -9.24), the ISS7 (MD -4.45; 95%CI -5.39 to -3.51), and QoL (high certainty) (DLQI; MD -4.03; 95% CI -5.56 to -2.5) and decreases (moderate certainty) rescue medication use (MD -2.04; 95%CI -3.19 to -0.88) and drug-related serious AEs (RR 0.77; 95%CI 0.20 to 2.91).

This systematic review evaluates the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled moderate-to-severe atopic dermatitis (AD). Pubmed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important AD-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. Seven RCTs including 1845 subjects >12 years treated with dupilumab 16 to 52 weeks were evaluated. For adults, there is high certainty that dupilumab decreases SCORAD (MD -30,72; 95% CI -34,65% to -26,79%) and EASI-75 (RR 3.09; 95% CI 2.45 to 3.89), pruritus (RR 2.96; 95% CI 2.37 to 3.70), rescue medication (RR 3.46; 95% CI 2.79 to 4.30), sleep disturbance (MD -7.29; 95% CI -8.23 to -6.35) and anxiety/depression (MD -3.08; 95% CI -4.41 to -1.75) and improves quality of life (MD -4.80; 95% CI -5.55 to -4.06). The efficacy for adolescents is similar. Dupilumab-related adverse events (AEs) slightly increase (low certainty). The evidence for dupilumab-related serious AE is uncertain. The incremental cost-effectiveness ratio ranged from 28 500 pound (low certainty) to 124 541 US$ (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population.Registration: PROSPERO (CRD42020153645).

Background: A key impact measure of COVID-19 pandemic is the case fatality rate (CFR), but estimating it during an epidemic is challenging as the true number of cases may remain elusive. Objective: To estimate the CFR applying a delay-adjusted method across countries, exploring differences to simple methods and potential correlation to country level variables. Methods: Secondary analysis of publicly available data from countries with ≥500 cases by April 30th. We calculated CFR adjusting for delay time from diagnosis to death and using simple methods for comparison. We performed a random effects meta-analysis to pooling CFRs for all countries and for those with high testing coverage and low positivity rate. We explored correlation of adjusted CFR with age structure and health care resources at country level. Results: We included 107 countries and the Diamond Princess cruise-ship. The overall delay adjusted CFR was 2.8% (95%CI: 2.1 to 3.1) while naive CFR was 5.1% (95%CI: 4.1 to 6.2). In countries with high testing coverage/low positivity rate the pooled adjusted CFR was 2.1% (95%CI: 1.5 to 3.0), there was a correlation with age over 65 years (β = 0.12; 95%CI: 0.06 to 0.18), but not with number of physician or critical care beds. Naive method underestimated the CFR of the CFR with a median of 1.3% across countries. Conclusion: Our best estimation of CFR across countries is 2% and varies according to the aged population size. Modelers and policy makers may consider these results to assess the impact of lockdowns or other mitigation policies.

Dupilumab, a fully human monoclonal antibody against interleukin-4 receptor α, is approved as add-on maintenance treatment for inadequately controlled type 2 severe asthma. This systematic review evaluated the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled severe asthma. PubMed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations. Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. Three RCTs including 2735 subjects >12 years old and 24-52 weeks of follow-up were included. Dupilumab reduced with high certainty severe asthma exacerbations (Incidence rate ratio 0.51; 95% CI 0.45-0.59) and the percentage use of oral corticosteroid use (mean difference (MD) -28.2 mg/d; 95% CI -40.7 to -15.7). Asthma control (ACQ-5), quality of life (AQLQ) and rescue medication use [puffs/d] improved, without reaching the minimal important clinical difference: ACQ-5 MD -0.28 (95% CI -0.39 to -0.17); AQLQ MD +0.28 (95% CI 0.20-0.37); and rescue medication MD -0.35 (95% CI -0.73 to +0.02). FEV1 increased (MD +0.15; 95% CI +0.11 to +0.18) (moderate certainty). There was an increased rate of dupilumab-related adverse events (AEs) (moderate certainty) and of drug-related serious AEs (low certainty). The incremental cost-effectiveness ratio of dupilumab versus standard therapy was 464 000$/QALY (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population.

Allergic asthma is a frequent asthma phenotype. Both IgE and type 2 cytokines are increased, with some degree of overlap with other phenotypes. Systematic reviews assessed the efficacy and safety of benralizumab, dupilumab and omalizumab (alphabetical order) vs standard of care for patients with uncontrolled severe allergic asthma. PubMed, Embase and Cochrane Library were searched to identify RCTs and health economic evaluations, published in English. Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. All three biologicals reduced with high certainty the annualized asthma exacerbation rate: benralizumab incidence rate ratios (IRR) 0.63 (95% CI 0.50 - 0.81); dupilumab IRR 0.58 (95%CI 0.47 - 0.73); and omalizumab IRR 0.56 (95%CI 0.42 - 0.73). Benralizumab and dupilumab improved asthma control with high certainty and omalizumab with moderate certainty; however, none reached the minimal important difference (MID). Both benralizumab and omalizumab improved QoL with high certainty, but only omalizumab reached the MID. Omalizumab enabled ICS dose reduction with high certainty. Benralizumab and omalizumab showed an increase in drug-related adverse events (AEs) with low to moderate certainty. All three biologicals had moderate certainty for an ICER/QALY value above the willingness to pay threshold. There was high certainty that in children 6-12 years old omalizumab decreased the annualized exacerbation rate [IRR 0.57 (95%CI 0.45-0.72)], improved QoL [relative risk 1.43 (95%CI 1.12 -1.83)], reduced ICS [mean difference (MD) -0.45 (95% CI -0.58 to -0.32)] and rescue medication use [ MD -0.41 (95%CI -0.66 to -0.15)].

HIV-associated neurocognitive disorders (HAND) have historically been characterized as a subcortical condition that does not affect semantic memory; however, recent evidence suggests that the cortical regions that support semantic memory may be affected in HIV.The current study examined the effects of HAND on semantic memory in 85 HIV+ individuals with HAND, 193 HIV+ individuals without HAND, and 181 HIV- individuals who completed the Boston Naming Test (BNT) and the Famous Faces subtest of the Kauffman Adolescent and Adult Intelligence Test (KAIT-FF).Linear regressions revealed a significant adverse effect of HAND on total scores on the BNT and the KAIT-FF (all ps.01). Analyses of BNT errors showed that individuals with HAND committed more semantically related errors as compared to the other two study groups (all ps.05). However, there were no group differences in rates of visually based errors, which are more commonly observed in traditional subcortical diseases (all ps.10).Results indicate that HAND may impose adverse effects on individuals' object naming and identification abilities suggestive of mild semantic deficits that parallel traditional cortical diseases such as Alzheimer's disease.

Activity recognition, a key component in pervasive healthcare monitoring, relies on classification algorithms that require labeled data of individuals performing the activity of interest to train accurate models. Labeling data can be performed in a lab setting where an individual enacts the activity under controlled conditions. The ubiquity of mobile and wearable sensors allows the collection of large datasets from individuals performing activities in naturalistic conditions. Gathering accurate data labels for activity recognition is typically an expensive and time-consuming process. In this paper we present two novel approaches for semi-automated online data labeling performed by the individual executing the activity of interest. The approaches have been designed to address two of the limitations of self-annotation: (i) The burden on the user performing and annotating the activity, and (ii) the lack of accuracy due to the user labeling the data minutes or hours after the completion of an activity. The first approach is based on the recognition of subtle finger gestures performed in response to a data-labeling query. The second approach focuses on labeling activities that have an auditory manifestation and uses a classifier to have an initial estimation of the activity, and a conversational agent to ask the participant for clarification or for additional data. Both approaches are described, evaluated in controlled experiments to assess their feasibility and their advantages and limitations are discussed. Results show that while both studies have limitations, they achieve 80% to 90% precision.

Patients with dementia often suffer from stress episodes that escalate to anxiety. This paper presents a feasibility study of using environmental smart microphones to detect anxiety in patients with dementia. It is based on the identified auditory manifestations of anxiety. To have a better understanding of the anxiety manifestations in patients with dementia, 70 diagnosed patients were observed in-situ and 4 caregivers were interviewed. The design of an environmental smart microphone called AnxiCare has been developed and it is introduced. Feasibility interviews regarding the use of AnxiCare were conducted with caregivers at a care residence in Spain. Results from the observations, interviews and a preliminary validation are presented.

Data annotation is the process of segmenting and labelling any type of data (images, audio or text). It is an important task for producing reliable datasets that can be used to train machine learning algorithms for the purpose of Activity Recognition. This paper presents the work in progress towards a semi-automated approach for collecting and annotating audio data from simple sounds that are typically produced at home when people perform daily activities, for example the sound of running water when a tap is open. We propose the use of an app called ISSA (Intelligent System for Sound Annotation) running on smart microphones to facilitate the semi-automated annotation of audible activities. When a sound is produced, the app tries to classify the activity and notifies the user, who can correct the classification and/or provide additional information such as the location of the sound. To illustrate the feasibility of the approach, an initial version of ISSA was implemented to train an audio classifier in a one-bedroom apartment.

The elderly gait encompasses several disorders, including a lower minimum toe clearance (MTC) to the ground, which is a potential cause of tripping and falling while walking. Devices that assist in the MTC could reduce such risks. However, the development of effective assistive methods and their evaluation in the elderly might jeopardize their safety. To address this, young adults could take the place of the elderly. We present Muscle Activity Restriction Taping Technique (MARTT) that was devised to simulate the healthy-elderly gait characteristics in the young adults, particularly the lower MTC, by restricting the activity of lower-limb muscles. Two different restriction approaches, one that restricts muscles at the shank and the other at the shank and thigh, simultaneously, were tested at different walking speeds. Both approaches achieved a reduction in the MTC, regardless of the walking speed. The MTC was reduced to a median value lower than 10.1 mm, which is within the range of the MTC values reported for the elderly. The reduction of the MTC significantly increased toe contact to the ground. With the restriction of the shank muscles, the toe-contact frequency was more than twice as that in normal walking, and with the restriction of both the shank and thigh muscles, more than five times. In addition, MARTT reproduced the lower step length, the lower single support phase, and the joint motion compensation characteristic of the elderly gait, in the youth.

The criteria for differentiating symptomatic from asymptomatic HIV-associated neurocognitive disorder require evaluation of (1) cognitive impairment, (2) daily functioning declines, and (3) whether the functional declines are attributable to cognitive versus physical problems. Many providers rely only on self-report to evaluate these latter criteria. However, the accuracy of patient-provided information may be limited. This study evaluated the validity of self-assessment for HIV-associated neurocognitive disorder (HAND) diagnoses by comparing objective findings with self-report of criteria 2 and 3 above. Self-reports were used to stratify 277 cognitively impaired HIV+ individuals into functionally dependent (n = 159) and independent (n = 118) groups, followed by group comparisons of objective functional problems. The dependent group was then divided into those who self-attributed their functional dependence to only cognitive (n = 80) versus only physical (n = 79) causes, for further comparisons on objective findings. The functionally dependent group was significantly worse than the independent group on all objective disability characteristics except severity of cognitive impairment, while those who attributed their dependence to physical (versus cognitive) factors were similar on all objective physical, cognitive, and functioning variables. Of note, 28% of physical attributors showed no physical abnormalities on neuromedical examinations. Results suggest that patient report is consistently associated with objective measures of functional loss; in contrast, patient identification of physical versus cognitive causes is poorly associated with objective criteria. These findings caution against relying solely on patient self-report to determine whether functional disability in cognitively impaired HIV+ individuals can be attributed to strictly physical causes.

Objective As the prevalence of older adults living with HIV disease increases, questions are emerging regarding the extent to which older age amplifies the adverse effects of HIV on employment status and functioning. This cross-sectional study sought to (1) investigate the combined effects of HIV and older age on employment status, (2) identify clinicodemographic correlates of employment status among older HIV+ persons, and (3) examine the combined effects of HIV and age on workplace performance among employed participants. Method The sample was 358 HIV+ (163 older, 195 younger) and 193 HIV- (94 older, 99 younger) adults, who completed a comprehensive neurocognitive research assessment that included measures of employment status and current workplace functioning. Results We observed main effects of HIV and age on employment status, but no interaction. The older HIV+ sample demonstrated particularly high rates of disability, rather than elective retirement or unemployment. Among older HIV+ adults significant predictors of employment status included age, global neurocognitive functioning, combination antiretroviral therapy status, age at HIV infection, and hepatitis C coinfection. Finally, self-reported work functioning of older HIV+ adults differed only from the younger HIV- group. Conclusion Findings suggest that older age and HIV disease have additive adverse effects on employment status, but not work functioning, and that employment status is associated with both neurocognitive and medical risk factors among older HIV+ adults. Further longitudinal research is needed to elucidate specific disease and demographic characteristics that may operate as protective factors for retaining gainful employment among older HIV+ adults. (PsycINFO Database Record

To contextualize sexual initiation and barriers to the use of contraceptives by adolescents as well as the acquisition of adequate knowledge regarding contraception and sexually transmitted diseases.This quantitative and qualitative study evaluated adolescents living in three cities with high pregnancy rates in Peru: Iquitos, Huamanga, and Lima. Subjects were invited to participate in the study via Facebook. Questionnaires were then used to select adolescents who met the inclusion criteria, and interviews were conducted to obtain detailed data regarding the study topic.A total of 33 women and 23 men aged 18 to 19 years participated in the study. The age of onset of sexual activity ranged from 14 to 16 years; the main reasons for sexual initiation were sexual desire among men and pressure from the partner among women; in most cases, the sexual partner was an occasional companion for men and a boyfriend for women. The barriers related to the use of contraceptives were the financial stability of the partner, responsibility of the female partner when using contraceptives, limited capacity to negotiate choices, fear of abandonment by the male partner for demanding the use of contraceptives, and the reduction of sexual sensitivity with the use of condoms.The barriers identified in this study limit the use of contraceptives and indicate the need to develop specific strategies to strengthen the interpersonal skills of adolescents and provide accurate information about the risks of unprotected sex.. Contextualizar el inicio sexual y las barreras individuales hacia el uso de anticonceptivos en adolescentes, con conocimiento adecuados sobre anticoncepción y enfermedades de transmisión sexual.Se desarrolló un estudio cuanticualitativo en adolescentes procedentes de ciudades con altas tasas de embarazo: Iquitos, Huamanga y Lima. La convocatoria se realizó a través de Facebook, luego se aplicaron encuestas para seleccionar a los adolescentes que cumplían los criterios de inclusión y, finalmente, se realizaron entrevistas para abordar el tema en profundidad.. Participaron 33 mujeres y 23 varones adolescentes urbanos, con edades entre 18 y 19 años. La edad de inicio sexual osciló entre los 14 y 16 años; las principales razones de inicio sexual en los varones fue el deseo sexual; en las mujeres fue la presión de la pareja; la persona con la que se iniciaron fue, principalmente, una pareja ocasional en los varones, y en las mujeres fue "su enamorado". Se identificaron barreras individuales en relación al uso de anticonceptivos como la estabilidad de la pareja, la responsabilidad de la mujer al usar anticonceptivos, la limitada capacidad de negociación y temor al abandono del varón por exigir su uso, además de la reducción de la sensibilidad sexual generada por el uso del condón.Estas barreras limitan el uso de anticonceptivos, sugiriendo la necesidad de desarrollar estrategias específicas para fortalecer las habilidades interpersonales del adolescente que se extienden más allá de ofrecer información acerca de los riesgos del sexo sin protección.

Older adults can suffer from neogogenerative diseases, which makes them dependent on trained personnel in geriatric centers. The main contribution of this paper is a conceptual model that seeks to delineate the implications for the design of a data visualization tool for older adults's care centers. The proposed model is created through grounded theory. The results obtained in the qualitative analysis emphasize the primary role of staff in identifying the contextual factors involved in the care and monitoring process of older adults in geriatric centers.

When manipulating textiles and thin objects, one challenging task is to push (tuck) of textiles into small openings. Further, for a number of manufacturing tasks it poses an obstacle to automation. However, current robot grippers are almost exclusively designed for grasping objects, or imitate the human hand with very fine mechanisms that break easily, so that they cannot withstand the loads required by the pushing task. Further, as textiles are very thin, even grippers with pressure pads cannot easily confirm if a textile was grasped successfully or if the gripper is empty. In this research, we present a gripper design that can detect the successful grasping of thin objects via active perception, can sustain significant pushing loads in order to perform tucking tasks and can perform dexterous grasping and in-hand manipulation. The gripper is open-source and can be 3D printed. We demonstrate the gripper's performance experimentally, its precision when controlling its grasp force, and the maximum grasping force.

Older adults can suffer from neurodegenerative diseases, which can make them dependent on family members or trained personnel in geriatric centers. In this work, we aimed at identifying the main information elements needed for decision making in geriatric centers. We present the results of a qualitative study using grounded theory as the analytic lens for a contextual study carried out with workers of a geriatric center. The main contribution of this paper is a set of information elements that are needed for different types of decisions taken at a geriatric center. The results of this work can be used for designing better interfaces for the decision making support in geriatric centers.

INTRODUCTION: Dementia is a syndrome characterised by a decline in memory, language, and problem-solving thataffects the ability of patients to perform everyday activities. Patients with dementia tend to experience episodes of anxietyand remain for extended periods, which affects their quality of life.OBJECTIVES: To design AnxiDetector, a system capable of detecting patterns of sounds associated before and during themanifestation of anxiety in patients with dementia.METHODS: We conducted a non-participatory observation of 70 diagnosed patients in-situ, and conducted semi-structuredinterviews with four caregivers at a residential centre. Using the findings from our observation and caregiver interviews, wedeveloped the AnxiDetector prototype and tested this in an experimental setting where we defined nine classes of audio torepresent two groups of sounds: (i) Disturbance which includes audio files that characterise sounds that trigger anxiety inpatients with dementia, and (ii) Expression which includes audio files that characterise sounds expressed by the patientsduring episodes of anxiety. We conducted two experimental classifications of sounds using (i) a Neural Network modeltrained and (ii) a Support Vector Machine model. The first evaluation consists of a binary discriminating between the twogroups of sounds; the second evaluation discriminates the nine classes of audio. The audio resources were retrieved frompublicly available datasets.RESULTS: The qualitative results present the views of the caregivers on the adoption of AnxiDetector. The quantitativeresults from our binary discrimination show a classification accuracy of 98.1% and 99.2% for the Deep Neural Network andSupport Vector Machine models, respectively. When classifying the nine classes of sound, our model shows a classificationaccuracy of 92.2%. Whereas, the Support Vector Machine model yielded an overall classification accuracy of 93.0%.CONCLUSION: In this paper, we presented the outcomes from an observational study in-site at a residential care centre,qualitative findings from interviews with caregivers, the design of AnxiDetector, and preliminary qualitative results of amethodology devised to detect relevant acoustic events associated with anxiety in patients with dementia. We conclude bysignalling future plans to conduct in-situ validation of the effectiveness of AnxiDetector for anxiety detection.

While moderate exposure to stress at work can act as productivity booster, prolonged exposure not only decreases productivity, but it can also lead to an array of health related problems. Therefore, monitoring stress levels and more importantly correlated stressors, becomes prerequisite for a productive workforce. Considering that verbal interaction is an integral part of workplace environments, we report the results of our study that investigates correlation between perceived stress levels and verbal interaction. 28 workers were monitored over 6 weeks through their smartphones during their daily, real-world behaviour, capturing both verbal interaction and perceived stress levels. Results show that more than half of participants show correlation between perceived stress levels and verbal interaction, while this correlation is observed for over 90% of highly stressed participants.

The reduced foot-ground clearance manifested in the healthy elderly is a major cause of tripping, potentially resulting in the loss of balance and falling. Hence, there is a critical need to study the foot-ground clearance deficiencies in the elderly. However, such studies are limited by the risks posed by experimental conditions to the health and safety of this population. As a solution, the present study proposes a new Muscle Activity Restriction Taping Technique (MARTT) to simulate the reduced foot-ground clearance of the elderly in healthy young adults. MARTT aims to restrict the range of contraction of the tibialis anterior and gastrocnemius muscles involved in the ankle's dorsal and plantar flexion, respectively. The effectiveness of MARTT in simulating the reduced foot-ground clearance in continuous walking was verified in three young adults during treadmill and overground walking. The results revealed that MARTT could successfully simulate the reduced clearance, specifically the minimum toe clearance (MTC), and other gait characteristics of the healthy elderly, such as reduced single-support phase, shortened step length, and lower walking speed.

IL-2, a cytokine with pleiotropic effects, is critical for immune cell activation and peripheral tolerance. Although the therapeutic potential of IL-2 has been previously suggested in autoimmune diseases, the mechanisms whereby IL-2 mitigates autoimmunity and prevents organ damage remain unclear. Using an inducible recombinant adeno-associated virus vector, we investigated the effect of low systemic levels of IL-2 in lupus-prone MRL/Faslpr/lpr (MRL/lpr) mice. Treatment of mice after the onset of disease with IL-2-recombinant adeno-associated virus resulted in reduced mononuclear cell infiltration and pathology of various tissues, including skin, lungs, and kidneys. In parallel, we noted a significant decrease of IL-17–producing CD3+CD4−CD8− double-negative T cells and an increase in CD4+CD25+Foxp3+ immunoregulatory T cells (Treg) in the periphery. We also show that IL-2 can drive double-negative (DN) T cell death through an indirect mechanism. Notably, targeted delivery of IL-2 to CD122+ cytotoxic lymphocytes effectively reduced the number of DN T cells and lymphadenopathy, whereas selective expansion of Treg by IL-2 had no effect on DN T cells. Collectively, our data suggest that administration of IL-2 to lupus-prone mice protects against end-organ damage and suppresses inflammation by dually limiting IL-17–producing DN T cells and expanding Treg.