Conectar
by Orit Wonderman Bar Sela, Shay Ofir Geva, Gaby S. Pell, Yiftach Roth, Jason Friedman, Afnan Muhana, Silvi Frenkel-Toledo, Nachum Soroker
Unidirectional transcranial magnetic stimulation (udTMS; e.g., via Figure-of-8 coil) depolarizes mainly neurons whose axonal orientation aligns with the direction of the induced electric field. A novel dual H-coil (T360°) TMS system (BrainsWayTM, Israel) generates a rotational magnetic field aimed to recruit a larger neuronal population by induction of a multidirectional electric field (rfTMS). This study aimed to comparatively assess the neurophysiological properties of motor evoked potentials (MEPs) elicited from the first dorsal interosseous (FDI) muscle following udTMS (via Figure-of-8 and H7 coils) vs. multidirectional rfTMS. In this study, 10 healthy adult subjects received TMS via the three coil configurations in a random order. The results showed that rfTMS elicited larger MEPs at a lower resting motor threshold (rMT) compared to the unidirectional coils. These findings suggest that rfTMS is likely to recruit larger populations of neurons compared to conventional udTMS coil configurations. This may be advantageous in efforts to enhance motor recovery following brain damage by treatments using TMS.
The carbon footprint of end-to-end healthcare deliveries by the National Health Service in England totalled 25.0 megatons of carbon dioxide equivalent (CO2e) in 2019. Optimal and sustainable healthcare can lead to better health outcomes as well as a lower environmental footprint.
To evaluate the potential impact of prevention and effective management of type 2 diabetes mellitus (T2DM) in adults on both the clinical outcomes and greenhouse gas (GHG) emissions in the UK healthcare setting.
We incorporated an environmental module into the existing IQVIA core diabetes model to estimate the impact of improving clinical outcomes on GHG emissions over a lifetime horizon. We assessed two hypothetical scenarios: (1) preventing progression from pre-diabetes to T2DM through diet and exercise versus no intervention and natural disease progression to T2DM; and (2) well-controlled T2DM using interventions with clinical benefit on glycosylated haemoglobin (HbA1c), and renal and cardiovascular outcomes versus uncontrolled T2DM.
Preventing progression to T2DM led to 6.357 additional undiscounted life years and 67% less kg CO2e emissions compared with subsequent natural progression to T2DM for a person with pre-diabetes over a lifetime (emissions of 9586 kg CO2e over 37.115 years vs 28 716 kg CO2e over 30.758 years, respectively). Well-controlled T2DM led to 1.947 additional undiscounted life years and 21% less kg CO2e emissions per patient over a lifetime compared with uncontrolled T2DM (emissions of 14 545 kg CO2e over 22.772 years vs 18 516 kg CO2e over 20.825 years, respectively). In both scenarios, the GHG emission savings were primarily due to reduced emissions related to avoidance of treating complications of T2DM including cardiovascular, renal and eye diseases.
Effective prevention and management of T2DM through implementation of evidence-based clinical guidelines can improve patient outcomes while reducing the healthcare-related environmental impacts.
To characterise the reporting practices of sequential multiple assignment randomised trials (SMARTs) in human health research.
Scoping review of protocol and primary analysis papers describing SMARTs published between January 2009 and February 2024.
SMARTs are innovative trial designs that allow for multiple stages of randomisation to treatment, with randomization potentially based on a patient’s response(s) to previous treatment(s). They are uniquely designed to develop sequential adaptive interventions (dynamic treatment regimes (DTRs)) to support personalized clinical decision-making over time. Previous reviews have identified inconsistencies in how the design, implementation and results of SMARTs have been reported in published studies. A comprehensive assessment of SMART reporting practices is lacking and necessary for developing standardised SMART-specific reporting guidelines.
We systematically searched multiple databases for SMART-related protocol and primary analysis papers published between January 2009 and February 2024. Title, abstract and full-text screenings were performed by pairs of reviewers, with disagreements resolved by consensus. Data extraction included study characteristics, design elements and analytical approaches for embedded or tailored DTRs. Results were synthesised qualitatively and presented descriptively.
From 5486 screened studies, 103 (59 protocol papers, 16 primary analysis papers, 14 protocol papers with corresponding primary analysis papers) met the inclusion criteria. Most studies targeted adults (62.7% protocols, 62.5% primary analyses, 42.9% protocol+primary analyses) and were primarily conducted in the USA. Behavioural and mental health constituted the most frequent therapeutic domain. While intervention descriptions and re-randomisation criteria were consistently reported, operational characteristics such as blinding (protocols: 64.4%, primary analyses: 62.5%, protocols+primary analyses: 71.4%) and randomisation details (protocols: 55.9%, primary analyses: 37.5%, protocols+primary analyses: 50.0%) were inconsistently documented. Only 46.7% of primary analyses evaluated embedded DTRs, and none explored deeply tailored DTRs.
Despite the increased adoption of SMART designs, substantial reporting variability persists. Most primary analyses underuse the capability of SMARTs to generate data for developing DTRs. SMART-specific standardised reporting guidelines can help accelerate the scientific and clinical impact of SMARTs.
by Cindy Xinyu Ji, Majid Sorouri, Mohammad Abdollahi, Omalbanin Paknejad, Ali R. Mani
Network physiology is a multidisciplinary field that offers a comprehensive view of the complex interactions within the human body, emphasising the critical role of organ system connectivity in health and disease. This approach has the potential to provide pathophysiological insights into complex and emerging diseases. This study aims to evaluate the effectiveness of physiological network mapping in predicting outcomes for COVID-19 patients, using data from the first wave of the pandemic. Routine clinical and laboratory data from 202 patients with COVID-19 were retrospectively analysed. Twenty-one physiological variables representing various organ systems were used to construct organ network connectivity through correlation analysis. Parenclitic network analysis was also employed to measure deviations in individual patients’ organ system correlations from the reference physiological interactions observed in survivors. We observed distinct features in the correlation network maps of non-survivors compared to survivors. In non-survivors, there was a significant correlation between the level of consciousness and the liver enzyme cluster, a relationship not present in the survivor group. This relationship remained significant even after adjusting for age and degree of hypoxia. Additionally, a strong correlation along the BUN–potassium axis was identified in non-survivors, suggesting varying degrees of kidney damage and impaired potassium homeostasis in non-survivors. These findings highlight the potential of network physiology as a valuable tool for uncovering complex inter-organ interactions in emerging diseases, with applications that could support clinicians, researchers, and policymakers in future epidemics.
by Véronique Gille, Flore Gubert, Camille Saint-Macary, Stéphanie Dos Santos, Franck Houffoué, Hugues Kouadio, Epiphane Marahoua, Petanki Soro, Alexander van Geen
Lead (Pb) exposure is a major global health concern, particularly for young children, yet awareness of the risks is low. Pb-based paint remains a significant source of exposure in many low- and middle-income countries, despite existing regulations. We investigate whether personalized information on lead in paint can increase awareness and encourage preventive behaviors. As part of a pilot study in Abidjan, Ivory Coast, painted surfaces in pregnant women’s homes were tested using a low-cost Pb detection kit, followed by confirmatory testing with an X-ray fluorescence (XRF) device. Among the final sample of 153 women, those living in homes that tested positive for Pb were 33-35 percentage points more likely to acknowledge their exposure risk. This increased awareness led to self-reported behavioral changes among mothers of young children, including a higher likelihood of preventing children from ingesting paint chips and washing their hands more frequently. We find no impact on self-reported home-cleaning or renovation behaviors. Our findings highlight the potential of personalized information to drive behavioral change in environmental health.
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