Usability and effectiveness of an individualized, tablet-based, multidomain exercise program for people with dementia delivered by nursing assistants: Protocol for an evaluation of the InCoPE-App

BACKGROUND: The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic’s impact. OBJECTIVE: Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program. METHODS: We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program. RESULTS: Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants. CONCLUSIONS: To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic. TRIAL REGISTRATION: German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024069 INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/3624

Clinical skills of veterinary students - a cross-sectional study of the self-concept and exposure to skills training in Hannover, Germany

Background: Students of veterinary medicine should achieve basic professional competences required to practise their profession. A main focus of veterinary education is on developing clinical skills. The present study used the guidelines of the "Day-One Skills" list of European Association of Establishments for Veterinary Education (EAEVE) to create an online questionnaire for assessing the skills acquired by students at the University of Veterinary Medicine Hannover (TiHo). The theoretical and practical veterinary knowledge levels of the students and postgraduates are determined and compared. Results: In two batches, 607 people responded (response batch 1, 23.78%; response batch 2, 23.83%). From 49 defined skills, 28 are actually practised during training at the university and 21 activities are known only theoretically. Furthermore, the students showed great willingness to use simulators and models in a clinical skills lab. Conclusions: The results of this survey highlight that the opening of a clinical skills lab at the University of Veterinary Medicine Hannover and its incorporation into the study programme are ideal tools to promote practical competences and foster the motivation to learn

Historical Spruce Abundance in Central Europe: A Combined Dendrochronological and Palynological Approach

Spruce is the most cultivated tree species in modern forestry in Central Europe, since it has the ability to grow on many soil types with profitable biomass accumulation. However, even-aged and uniform spruce forests are affected by recurring droughts and associated biotic stressors leading to large-scale diebacks across Central Europe causing controversies among foresters and nature conservationists. We investigate the role of spruce in historical woodlands by using 15666 spruce timbers from historical buildings and on the basis of pollen-based land cover estimates using the REVEALS model from 157 pollen sites in southern Central Europe. Start and end dates of the spruce timber samples and their dendrological characteristics (age, growth rates and stem diameters) were used to obtain information on past forest structures. Tree rings and REVEALS estimates are combined at a spatial scale of 1° × 1° resolution, grouped in four sub-regions, and a temporal resolution of 100-year time windows starting from 1150 to 1850 CE. We found that spruce dominates the species assemblage of construction timber with almost 41% and that the harvest age varies little through time, whereas a declining trend in growth rates and stem diameters are observed toward times before modern forestry. Temporal and regional differences in spruce abundance and building activity were found highlighting periods of (i) land abandonment and forest expansion in the 14th century, (ii) increased wood consumption during the 16th century due to population increase and beginning industrial developments, (iii) a forest recovery during and after the Thirty years' war, and (iv) afforestation efforts from the 1650s onwards. Furthermore, this study shows that spruce was constantly present in the study area in most studied sub-regions for the last 800 years. We demonstrate the need of combining tree-ring and pollen data to identify spatiotemporal patterns in spruce abundance and utilization.publishedVersio

Pesticides in Agricultural Soils: Major Findings from Various Monitoring Campaigns in Switzerland

Synthetic pesticides are widely applied in modern agriculture, where they are used against diseases, pests, and weeds to secure crop yield and quality. However, their intensive application has led to widespread contamination of the environment, including soils. Due to their inherent toxicity, they might pose a risk to soil health by causing harm to non-target organisms and disrupting ecosystem services in both agricultural and other exposed soils. Following the Swiss National Action Plan on the reduction of pesticide risks, Agroscope has conducted several soil monitoring studies that are briefly presented here. All of them resort to different multi-residue trace analytical approaches to simultaneously quantify up to about 150 modern pesticides by either accelerated solvent, or Quick, Easy, Cheap, Efficient, Rugged, Safe (QuEChERS) extraction, followed by separation and detection with liquid chromatography-triple quadrupole mass spectrometry. While partly still in progress, our investigations led to the following major findings this far: Multiple pesticides are commonly present in soils, with individual concentrations in agricultural soils often reaching up to a few tens of µg/kg. Pesticide occurrence and concentrations in agricultural soils primarily depend on land use, land use history and cultivated crops. Pesticides can prevail much longer than predicted by their half-lives, and were found in soils even decades after conversion from conventional to organic farming. Corresponding residual fractions can be in the order of a few percent of the originally applied amounts. We further found negative associations of pesticide residues with the abundance of beneficial soil life, underpinning their potential risk to the fertility of agricultural soils. Traces of pesticides are also detected in soils to which they were never applied, indicating contamination, e.g., via spray drift or atmospheric deposition. These results confirm the general notion of both scientists and legislators that prospective risk assessments (RA; as executed during registration and use authorization) should be confirmed and adjusted by retrospective RA (e.g., by environmental monitoring studies of currently used compounds) to jointly lead to an overall reduced environmental risk of pesticides

β2-Adrenoceptor Deficiency Results in Increased Calcified Cartilage Thickness and Subchondral Bone Remodeling in Murine Experimental Osteoarthritis

Purpose: Recent studies demonstrated a contribution of adrenoceptors (ARs) to osteoarthritis (OA) pathogenesis. Several AR subtypes are expressed in joint tissues and the β2-AR subtype seems to play a major role during OA progression. However, the importance of β2-AR has not yet been investigated in knee OA. Therefore, we examined the development of knee OA in β2-AR-deficient (Adrb2-/- ) mice after surgical OA induction. Methods: OA was induced by destabilization of the medial meniscus (DMM) in male wildtype (WT) and Adrb2-/- mice. Cartilage degeneration and synovial inflammation were evaluated by histological scoring. Subchondral bone remodeling was analyzed using micro-CT. Osteoblast (alkaline phosphatase - ALP) and osteoclast (cathepsin K - CatK) activity were analyzed by immunostainings. To evaluate β2-AR deficiency-associated effects, body weight, sympathetic tone (splenic norepinephrine (NE) via HPLC) and serum leptin levels (ELISA) were determined. Expression of the second major AR, the α2-AR, was analyzed in joint tissues by immunostaining. Results: WT and Adrb2-/- DMM mice developed comparable changes in cartilage degeneration and synovial inflammation. Adrb2-/- DMM mice displayed elevated calcified cartilage and subchondral bone plate thickness as well as increased epiphyseal BV/TV compared to WTs, while there were no significant differences in Sham animals. In the subchondral bone of Adrb2-/- mice, osteoblasts activity increased and osteoclast activity deceased. Adrb2-/- mice had significantly higher body weight and fat mass compared to WT mice. Serum leptin levels increased in Adrb2-/- DMM compared to WT DMM without any difference between the respective Shams. There was no difference in the development of meniscal ossicles and osteophytes or in the subarticular trabecular microstructure between Adrb2-/- and WT DMM as well as Adrb2-/- and WT Sham mice. Number of α2-AR-positive cells was lower in Adrb2-/- than in WT mice in all analyzed tissues and decreased in both Adrb2-/- and WT over time. Conclusion: We propose that the increased bone mass in Adrb2-/- DMM mice was not only due to β2-AR deficiency but to a synergistic effect of OA and elevated leptin concentrations. Taken together, β2-AR plays a major role in OA-related subchondral bone remodeling and is thus an attractive target for the exploration of novel therapeutic avenues

Pesticides in Agricultural Soils: Major Findings from Various Monitoring Campaigns in Switzerland

Synthetic pesticides are widely applied in modern agriculture, where they are used against diseases, pests, and weeds to secure crop yield and quality. However, their intensive application has led to widespread contamination of the environment, including soils. Due to their inherent toxicity, they might pose a risk to soil health by causing harm to non-target organisms and disrupting ecosystem services in both agricultural and other exposed soils. Following the Swiss National Action Plan on the reduction of pesticide risks, Agroscope has conducted several soil monitoring studies that are briefly presented here. All of them resort to different multi-residue trace analytical approaches to simultaneously quantify up to about 150 modern pesticides by either accelerated solvent, or Quick, Easy, Cheap, Efficient, Rugged, Safe (QuEChERS) extraction, followed by separation and detection with liquid chromatography-triple quadrupole mass spectrometry. While partly still in progress, our investigations led to the following major findings this far: Multiple pesticides are commonly present in soils, with individual concentrations in agricultural soils often reaching up to a few tens of µg/kg. Pesticide occurrence and concentrations in agricultural soils primarily depend on land use, land use history and cultivated crops. Pesticides can prevail much longer than predicted by their half-lives, and were found in soils even decades after conversion from conventional to organic farming. Corresponding residual fractions can be in the order of a few percent of the originally applied amounts. We further found negative associations of pesticide residues with the abundance of beneficial soil life, underpinning their potential risk to the fertility of agricultural soils. Traces of pesticides are also detected in soils to which they were never applied, indicating contamination, e.g., via spray drift or atmospheric deposition. These results confirm the general notion of both scientists and legislators that prospective risk assessments (RA; as executed during registration and use authorization) should be confirmed and adjusted by retrospective RA (e.g., by environmental monitoring studies of currently used compounds) to jointly lead to an overall reduced environmental risk of pesticides

Widespread Occurrence of Pesticides in Organically Managed Agricultural Soils—the Ghost of a Conventional Agricultural Past?

Pesticides are applied in large quantities to agroecosystems worldwide. To date, few studies assessed the occurrence of pesticides in organically managed agricultural soils, and it is unresolved whether these pesticide residues affect soil life. We screened 100 fields under organic and conventional management with an analytical method containing 46 pesticides (16 herbicides, 8 herbicide transformation products, 17 fungicides, seven insecticides). Pesticides were found in all sites, including 40 organic fields. The number of pesticide residues was two times and the concentration nine times higher in conventional compared to organic fields. Pesticide number and concentrations significantly decreased with the duration of organic management. Even after 20 years of organic agriculture, up to 16 different pesticide residues were present. Microbial biomass and specifically the abundance of arbuscular mycorrhizal fungi, a widespread group of beneficial plant symbionts, were significantly negatively linked to the amount of pesticide residues in soil. This indicates that pesticide residues, in addition to abiotic factors such as pH, are a key factor determining microbial soil life in agroecosystems. This comprehensive study demonstrates that pesticides are a hidden reality in agricultural soils, and our results suggest that they have harmful effects on beneficial soil life

Performance of artificial intelligence for colonoscopy regarding adenoma and polyp detection: a meta-analysis

BACKGROUND AND AIMS One fourth of colorectal neoplasia is missed at screening colonoscopy, representing the main cause of interval colorectal cancer (CRC). Deep learning systems with real-time computer-aided polyp detection (CADe) showed high accuracy in artificial settings, and preliminary randomized clinical trials (RCT) reported favourable outcomes in clinical setting. Aim of this meta-analysis was to summarise available RCTs on the performance of CADe systems in colorectal neoplasia detection. METHODS We searched MEDLINE, EMBASE and Cochrane Central databases until March 2020 for RCTs reporting diagnostic accuracy of CADe systems in detection of colorectal neoplasia. Primary outcome was pooled adenoma detection rate (ADR), Secondary outcomes were adenoma per colonoscopy (APC) according to size, morphology and location, advanced APC (AAPC), as well as polyp detection rate (PDR), Polyp-per-colonoscopy (PPC), and sessile serrated lesion per colonoscopy (SPC). We calculated risk ratios (RR), performed subgroup, and sensitivity analysis, assessed heterogeneity, and publication bias. RESULTS Overall, 5 randomized controlled trials (4354 patients), were included in the final analysis. Pooled ADR was significantly higher in the CADe groups than in the control group (791/2163, 36.6% vs 558/2191, 25.2%; RR, 1.44; 95% CI, 1.27-1.62; p10 mm adenomas (RR, 1.46; 95% CI, 1.04-2.06), as well as for proximal (RR, 1.59; 95% CI, 1.34-1.88) and distal (RR, 1.68; 95% CI, 1.50-1.88), and for flat (RR: 1.78 95% CI 1.47-2.15) and polypoid morphology (RR, 1.54; 95% CI, 1.40-1.68). Regarding histology, CADe resulted in a higher SPC (RR, 1.52; 95% CI,1.14-2.02), whereas a nonsignificant trend for AADR was found (RR, 1.35; 95% CI, 0.74 – 2.47; p = 0.33; I 2:69%). Level of evidence for RCTs was graded moderate. CONCLUSIONS According to available evidence, the incorporation of Artificial Intelligence as aid for detection of colorectal neoplasia results in a significant increase of the detection of colorectal neoplasia, and such effect is independent from main adenoma characteristics

Sex-Specific Genetic Associations for Barrett's Esophagus and Esophageal Adenocarcinoma

Acknowledgments We thank Dr Stuart MacGregor for his input on the study proposal and review of prior versions of this manuscript. We also thank all patients and controls for participating in this study. The MD Anderson controls were drawn from dbGaP (study accession: phs000187.v1.p1). Genotyping of these controls were done through the University of Texas MD Anderson Cancer Center (UTMDACC) and the Johns Hopkins University Center for Inherited Disease Research (CIDR). We acknowledge the principal investigators of this study: Christopher Amos, Qingyi Wei, and Jeffrey E. Lee. Controls from the Genome-Wide Association Study of Parkinson Disease were obtained from dbGaP (study accession: phs000196.v2.p1). This work, in part, used data from the National Institute of Neurological Disorders and Stroke (NINDS) dbGaP database from the CIDR: NeuroGenetics Research Consortium Parkinson’s disease study. We acknowledge the principal investigators and coinvestigators of this study: Haydeh Payami, John Nutt, Cyrus Zabetian, Stewart Factor, Eric Molho, and Donald Higgins. Controls from the Chronic Renal Insufficiency Cohort (CRIC) were drawn from dbGaP (study accession: phs000524.v1.p1). The CRIC study was done by the CRIC investigators and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Data and samples from CRIC reported here were supplied by NIDDK Central Repositories. This report was not prepared in collaboration with investigators of the CRIC study and does not necessarily reflect the opinions or views of the CRIC study, the NIDDK Central Repositories, or the NIDDK. We acknowledge the principal investigators and the project officer of this study: Harold I Feldman, Raymond R Townsend, Lawrence J. Appel, Mahboob Rahman, Akinlolu Ojo, James P. Lash, Jiang He, Alan S Go, and John W. Kusek. The following UK hospitals participated in sample collection through the Stomach and Oesophageal Cancer Study (SOCS) collaboration network: Addenbrooke’s Hospital, University College London, Bedford Hinchingbrooke Hospital, Peterborough City Hospital, West Suffolk Norfolk and Norwich University Hospital, Churchill Hospital, John Hospital, Velindre Hospital, St Bartholomew’s Hospital, Queen’s Burton, Queen Elisabeth Hospital, Diana Princess of Wales, Scunthorpe General Hospital, Royal Devon & Exeter Hospital, New Cross Hospital, Belfast City Hospital, Good Hope Hospital, Heartlands Hospital, South Tyneside District General Hospital, Cumberland Infirmary, West Cumberland Hospital, Withybush General Hospital, Stoke Mandeville Hospital, Wycombe General Hospital, Wexham Park Hospital, Southend Hospital, Guy’s Hospital, Southampton General Hospital, Bronglais General Hospital, Aberdeen Royal Infirmary, Manor Hospital, Clatterbridge Centre for Oncology, Lincoln County Hospital, Pilgrim Hospital, Grantham & District Hospital, St Mary’s Hospital London, Croydon University Hospital, Whipps Cross University Hospital, Wansbeck General Hospital, Hillingdon Hospital, Milton Keynes General Hospital, Royal Gwent Hospital, Tameside General Hospital, Castle Hill Hospital, St Richard’s Hospital, Ipswich Hospital, St Helens Hospital, Whiston Hospital, Countess of Chester Hospital, St Mary’s Hospital IOW, Queen Alexandra Hospital, Glan Clwyd Hospital, Wrexham Maelor Hospital, Darent Valley Hospital, Royal Derby Hospital, Derbyshire Royal Infirmary, Scarborough General Hospital, Kettering General Hospital, Kidderminster General Hospital, Royal Lancaster Infirmary, Furness General Hospital, Westmorland General Hospital, James Cook University Hospital, Friarage Hospital, Stepping Hill Hospital, St George’s Hospital London, Doncaster Royal Infirmary, Maidstone Hospital, Tunbridge Hospital, Prince Charles Hospital, Hartlepool Hospital, University Hospital of North Tees, Ysbyty Gwynedd, St. Jame’s University Hospital, Leeds General Infirmary, North Hampshire Hospital, Royal Preston Hospital, Chorley and District General, Airedale General Hospital, Huddersfield Royal Infirmary, Calderdale Royal Hospital, Torbay District General Hospital, Leighton Hospital, Royal Albert Edward Infirmary, Royal Surrey County Hospital, Bradford Royal Infirmary, Burnley General Hospital, Royal Blackburn Hospital, Royal Sussex County Hospital, Freeman Hospital, Royal Victoria Infirmary, Victoria Hospital Blackpool, Weston Park Hospital, Royal Hampshire County Hospital, Conquest Hospital, Royal Bournemouth General Hospital, Mount Vernon Hospital, Lister Hospital, William Harvey Hospital, Kent and Canterbury Hospital, Great Western Hospital, Dumfries and Galloway Royal Infirmary, Poole General Hospital, St Hellier Hospital, North Devon District Hospital, Salisbury District Hospital, Weston General Hospital, University Hospital Coventry, Warwick Hospital, George Eliot Hospital, Alexandra Hospital, Nottingham University Hospital, Royal Chesterfield Hospital, Yeovil District Hospital, Darlington Memorial Hospital, University Hospital of North Durham, Bishop Auckland General Hospital, Musgrove Park Hospital, Rochdale Infirmary, North Manchester General, Altnagelvin Area Hospital, Dorset County Hospital, James Paget Hospital, Derriford Hospital, Newham General Hospital, Ealing Hospital, Pinderfields General Hospital, Clayton Hospital, Dewsbury & District Hospital, Pontefract General Infirmary, Worthing Hospital, Macclesfield Hospital, University Hospital of North Staffordshire, Salford Royal Hospital, Royal Shrewsbury Hospital, and Manchester Royal Infirmary. Conflict of interest The authors disclose no conflicts. Funding This work was primarily funded by the National Institutes of Health (NIH) (R01CA136725). The funders of the study had no role in the design, analysis, or interpretation of the data, nor in writing or publication decisions related to this article. Jing Dong was supported by a Research Training Grant from the Cancer Prevention and Research Institute of Texas (CPRIT; RP160097) and the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin (AHW). Quinn T. Ostrom was supported by RP160097. Puya Gharahkhani was supported by a grant from National Health and Medical Research Council of Australia (1123248). Geoffrey Liu was supported by the Alan B. Brown Chair in Molecular Genomics and by the CCO Chair in Experimental Therapeutics and Population Studies. The University of Cambridge received salary support for Paul D. Pharoah from the NHS in the East of England through the Clinical Academic Reserve. Brian J. Reid was supported by a grant (P01CA91955) from the NIH/National Cancer Institute (NCI). Nicholas J. Shaheen was supported by a grant (P30 DK034987) from NIH. Thomas L. Vaughan was supported by NIH Established Investigator Award K05CA124911. Michael B. Cook was supported by the Intramural Research Program of the NCI, NIH, Department of Health and Human Services. Douglas A. Corley was supported by the NIH grants R03 KD 58294, R21DK077742, and RO1 DK63616 and NCI grant R01CA136725. Carlo Maj was supported by the BONFOR-program of the Medical Faculty, University of Bonn (O-147.0002). Jesper Lagergren was supported by the United European Gastroenterology (UEG) Research Prize. David C. Whiteman was supported by fellowships from the National Health and Medical Research Council of Australia (1058522, 1155413).Peer reviewedPostprin