The Inclusion of Health Data Standards in the Implementation of Pharmacogenomics Systems: A Scoping Review

Background: Despite potential benefits, the practice of incorporating pharmacogenomics (PGx) results in clinical decisions has yet to diffusewidely. In this study,we conducted a review of recent discussions on data standards and interoperability with a focus on sharing PGx test results among health systems. Materials & methods:We conducted a literature search for PGx clinical decision support systems between 1 January 2012 and 31 January 2020. Thirty-two out of 727 articles were included for the final review. Results: Nine of the 32 articles mentioned data standards and only four of the 32 articles provided solutions for the lack of interoperability. Discussions: Although PGx interoperability is essential for widespread implementation, a lack of focus on standardized data creates a formidable challenge for health information exchange. Conclusion: Standardization of PGx data is essential to improve health information exchange and the sharing of PGx results between disparate systems. However, PGx data standards and interoperability are often not addressed in the system-level implementation

Artificial Intelligence–Powered Smartphone App to Facilitate Medication Adherence: Protocol for a Human Factors Design Study

Background: Medication Guides consisting of crucial interactions and side effects are extensive and complex. Due to the exhaustive information, patients do not retain the necessary medication information, which can result in hospitalizations and medication nonadherence. A gap exists in understanding patients’ cognition of managing complex medication information. However, advancements in technology and artificial intelligence (AI) allow us to understand patient cognitive processes to design an app to better provide important medication information to patients. Objective: Our objective is to improve the design of an innovative AI- and human factor–based interface that supports patients’ medication information comprehension that could potentially improve medication adherence. Methods: This study has three aims. Aim 1 has three phases: (1) an observational study to understand patient perception of fear and biases regarding medication information, (2) an eye-tracking study to understand the attention locus for medication information, and (3) a psychological refractory period (PRP) paradigm study to understand functionalities. Observational data will be collected, such as audio and video recordings, gaze mapping, and time from PRP. A total of 50 patients, aged 18-65 years, who started at least one new medication, for which we developed visualization information, and who have a cognitive status of 34 during cognitive screening using the TICS-M test and health literacy level will be included in this aim of the study. In Aim 2, we will iteratively design and evaluate an AI-powered medication information visualization interface as a smartphone app with the knowledge gained from each component of Aim 1. The interface will be assessed through two usability surveys. A total of 300 patients, aged 18-65 years, with diabetes, cardiovascular diseases, or mental health disorders, will be recruited for the surveys. Data from the surveys will be analyzed through exploratory factor analysis. In Aim 3, in order to test the prototype, there will be a two-arm study design. This aim will include 900 patients, aged 18-65 years, with internet access, without any cognitive impairment, and with at least two medications. Patients will be sequentially randomized. Three surveys will be used to assess the primary outcome of medication information comprehension and the secondary outcome of medication adherence at 12 weeks. Results: Preliminary data collection will be conducted in 2021, and results are expected to be published in 2022. Conclusions: This study will lead the future of AI-based, innovative, digital interface design and aid in improving medication comprehension, which may improve medication adherence. The results from this study will also open up future research opportunities in understanding how patients manage complex medication information and will inform the format and design for innovative, AI-powered digital interfaces for Medication Guides

Rethinking Thorne-\.Zytkow Object Formation: The Fate of X-ray Binary LMC X-4 and Implications for Ultra-long Gamma-ray Bursts

We present a start-to-end simulation aimed at studying the long-term fate of high mass X-ray binaries and whether a Thorne-\.Zytkow object (T\.ZO) might ultimately be produced. We analyze results from a 3D hydrodynamical simulation that models the eventual fate of LMC X-4, a compact high mass X-ray binary system, after the primary fills its Roche lobe and engulfs the neutron star companion. We discuss the outcome of this engulfment within the standard paradigm of T\.ZO formation. The post-merger angular momentum content of the stellar core is a key ingredient, as even a small amount of rotation can break spherical symmetry and produce a centrifugally supported accretion disk. Our findings suggest the inspiraling neutron star, upon merging with the core, can accrete efficiently via a disk at high rates ($\approx 10^{-2}M_\odot/{\rm s}$), subsequently collapsing into a black hole and triggering a bright transient with a luminosity and duration typical of an ultra-long gamma-ray burst. We propose that the canonical framework for T\.ZO formation via common envelope needs to be revised, as the significant post-merger accretion feedback will unavoidably unbind the vast majority of the surrounding envelope

The cortisol awakening response predicts same morning executive function: results from a 50-day case study

A relationship between individual differences in trait estimates of the cortisol-awakening response (CAR) and indices of executive function (EF) has been reported. However, it is difficult to determine causality from such studies. The aim of the present study was to capitalise upon state variation in both variables to seek stronger support for causality by examining daily co-variation. A 50 days researcher–participant case study was employed, ensuring careful adherence to the sampling protocol. A 24-year-old healthy male collected saliva samples and completed an attention-switching index of EF on the morning of each study day. Subsidiary control measures included wake time, sleep duration, morning fatigue, and amount of prior day exercise and alcohol consumption. As the CAR preceded daily measurement of EF, we hypothesised that, over time, a greater than average CAR would predict better than average EF. This was confirmed by mixed regression modelling of variation in cortisol concentrations, which indicated that the greater the increase in cortisol concentrations from 0 to 30 min post-awakening (CAR) the better was subsequent EF performance at 45 min post-awakening (t = 2.29, p = 0.024). This effect was independent of all potential confounding measures. Results are discussed in terms of implications for the understanding of the relationship between the CAR and the cognitive function, and the previously suggested role of the CAR in “boosting” an individual’s performance for the day ahead

Description of small and large-scale cross laminated timber fire tests

A large-scale fire test was conducted on a compartment constructed from cross laminated timber (CLT). The internal faces of the compartment were lined with non-combustible board, with the exception of one wall and the ceiling where the CLT was exposed directly to the fire inside the compartment. Extinction of the fire occurred without intervention. During the fire test, measurements were made of incident radiant heat flux, gas phase temperature, and in-depth temperature in the CLT. In addition, gas flow velocities and gas phase temperatures at the opening were measured, as well as incident heat fluxes at the facade due to flames and the plume leaving the opening. The fuel load was chosen to be sufficient to attain flashover, to achieve steady-state burning conditions of the exposed CLT, but to minimize the probability of uncertain behaviors induced by the specific characteristics of the CLT. Ventilation conditions were chosen to approximate maximum temperatures within a compartment. Wood cribs were used as fuel and, following decay of the cribs, self-extinction of the exposed CLT rapidly occurred. In parallel with the large-scale test, a small scale study focusing on CLT self-extinction was conducted. This study was used to establish: the range of incident heat fluxes for which self-extinction of the CLT can occur; the duration of exposure after which steady-state burning occurred; and the duration of exposure at which debonding of the CLT could occur. The large-scale test is described, and the results from both the small and large-scale tests are compared. It is found that self-extinction occurred in the large-scale compartment within the range of critical heat fluxes obtained from the small scale tests

Interventions to improve linkage along the HIV-tuberculosis care cascades in low- and middle-income countries: A systematic review and meta-analysis.

INTRODUCTION: In support of global targets to end HIV/AIDS and tuberculosis (TB) by 2030, we reviewed interventions aiming to improve TB case-detection and anti-TB treatment among people living with HIV (PLHIV) and HIV testing and antiretroviral treatment initiation among people with TB disease in low- and middle-income countries (LMICs). METHODS: We conducted a systematic review of comparative (quasi-)experimental interventional studies published in Medline or EMBASE between January 2003-July 2021. We performed random-effects effect meta-analyses (DerSimonian and Laird method) for interventions that were homogenous (based on intervention descriptions); for others we narratively synthesized the intervention effect. Studies were assessed using ROBINS-I, Cochrane Risk-of-Bias, and GRADE. (PROSPERO #CRD42018109629). RESULTS: Of 21,516 retrieved studies, 23 were included, contributing 53 arms and 84,884 participants from 4 continents. Five interventions were analyzed: co-location of test and/or treatment services; patient education and counselling; dedicated personnel; peer support; and financial support. A majority were implemented in primary health facilities (n = 22) and reported on HIV outcomes in people with TB (n = 18). Service co-location had the most consistent positive effect on HIV testing and treatment initiation among people with TB, and TB case-detection among PLHIV. Other interventions were heterogenous, implemented concurrent with standard-of-care strategies and/or diverse facility-level improvements, and produced mixed effects. Operational system, human resource, and/or laboratory strengthening were common within successful interventions. Most studies had a moderate to serious risk of bias. CONCLUSIONS: This review provides operational clarity on intervention models that can support early linkages between the TB and HIV care cascades. The findings have supported the World Health Organization 2020 HIV Service Delivery Guidelines update. Further research is needed to evaluate the distinct effect of education and counselling, financial support, and dedicated personnel interventions, and to explore the role of community-based, virtual, and differentiated service delivery models in addressing TB-HIV co-morbidity

Discrete bands of petroleum hydrocarbons and molecular organic markers identified within massive coral skeletons

The tissues of corals deposit an aragonite exoskeleton beneath their outer living film at a rate dependent on growth and hence on environmental conditions. This typically results in annual (seasonal) bands being formed within colonies. By analysing molecular organic markers within these bands, our research suggests that coral skeletons record contamination from oil and potentially could be used to investigate other anthropogenic and biogenic organic inputs. Our analyses of sections from within corals (Porites lutea) sampled from the Gulf coasts of Kuwait and Saudi Arabia demonstrate discrete bands of oil contamination which, using selected terpenoid biomarkers, can be source-indexed to specific oil fields (i.e. Kuwait, Iranian or Arabian crude oils). Together with dating using microscopic and X-ray inspection, this offers the potential to investigate contamination during recent years. Further research is, however, necessary to elucidate degradation mechanisms during, and following, the occlusion process of organics within coral skeletons

Single-cell deconvolution of head and neck squamous cell carcinoma

Complexities in cell-type composition have rightfully led to skepticism and caution in the interpretation of bulk transcriptomic analyses. Recent studies have shown that deconvolution algorithms can be utilized to computationally estimate cell-type proportions from the gene expression data of bulk blood samples, but their performance when applied to tumor tissues, including those from head and neck, remains poorly characterized. Here, we use single-cell data (~6000 single cells) collected from 21 head and neck squamous cell carcinoma (HNSCC) samples to generate cell-type-specific gene expression signatures. We leverage bulk RNA-seq data from \u3e500 HNSCC samples profiled by The Cancer Genome Atlas (TCGA), and using single-cell data as a reference, apply two newly developed deconvolution algorithms (CIBERSORTx and MuSiC) to the bulk transcriptome data to quantitatively estimate cell-type proportions for each tumor in TCGA. We show that these two algorithms produce similar estimates of constituent/major cell-type proportions and that a high T-cell fraction correlates with improved survival. By further characterizing T-cell subpopulations, we identify that regulatory T-cells (