Dream Content Discovery from Reddit with an Unsupervised Mixed-Method Approach (preprint)

Dreaming is a fundamental but not fully understood part of human experience that can shed light on our thought patterns. Traditional dream analysis practices, while popular and aided by over 130 unique scales and rating systems, have limitations. Mostly based on retrospective surveys or lab studies, they struggle to be applied on a large scale or to show the importance and connections between different dream themes. To overcome these issues, we developed a new, data-driven mixed-method approach for identifying topics in free-form dream reports through natural language processing. We tested this method on 44,213 dream reports from Reddit's r/Dreams subreddit, where we found 217 topics, grouped into 22 larger themes: the most extensive collection of dream topics to date. We validated our topics by comparing it to the widely-used Hall and van de Castle scale. Going beyond traditional scales, our method can find unique patterns in different dream types (like nightmares or recurring dreams), understand topic importance and connections, and observe changes in collective dream experiences over time and around major events, like the COVID-19 pandemic and the recent Russo-Ukrainian war. We envision that the applications of our method will provide valuable insights into the intricate nature of dreaming.

Neurorehabilitation of severe acquired brain injury in the time of COVID-19: impact of the absence of caregivers.

INTRODUCTION: During the COVID-19 pandemic, several restrictions were imposed to limit the circulation of the infection within communities. Hospitals denied access to the family and friends of inpatients, and thus to caregivers. This observational study evaluated the impact of the physical absence of caregivers during the lockdown period due to the COVID-19 emergency on the rehabilitation of inpatients with severe acquired brain injury (sABI). METHODS: The functional outcome at discharge was measured in 25 inpatients with sABI through the Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Levels of Cognitive Functioning scale (LCF) after neuropsychological rehabilitation in an Adult Inpatient Neurorehabilitation Unit for Patients with sABI. Fourteen patients were directly assisted by their informal caregivers physically present in the neurorehabilitation ward. Eleven patients were indirectly supported via remote connection because during the lockdown period (from March to July 2020) caregivers could not be admitted to the rehabilitation hospital. The Caregiving Impact on Neuro-Rehabilitation Scale (CINRS) was also used to evaluate both the change since the admission and the impact of the caregiver from the perspective of the cognitive therapist. Demographic characteristics, time since injury, injury severity (duration of impaired consciousness measured by the time to follow commands), level of functioning at the beginning of the rehabilitation, and duration of the rehabilitation treatment were comparable between the groups. RESULTS: Both groups improved after the treatment; however, the improvement was consistently greater in the group directly assisted by the caregivers. The results showed that although the caregivers ensured their virtual presence at distance, their physical absence played a role in hindering the functional outcome of the patients. CONCLUSIONS: The role of the caregiver of patients with sABI is underlined in being not only a person handing out generic aid, cares, and affection, but also an integral part of the rehabilitation process.

How the COVID-19 Pandemic Affected Attendance at a Tertiary Orthopedic Center Emergency Department: A Comparison between the First and Second Waves.

Italy was the first European country to face the SARS-CoV-2 virus (COVID-19) pandemic in 2020. The country quickly implemented strategies to contain contagions and re-organize medical resources. We evaluated the COVID-19 effects on the activity of a tertiary-level orthopedic emergency department (ED) during the first and second pandemic waves. We retrospectively collected and compared clinical radiological data of ED admissions during four periods: period A, first pandemic wave; period B, second pandemic wave; period C, three months before the COVID-19 outbreak; period D, same timeframe of the first wave but in 2019. During period A, we found a reduction in ED admissions (-68.2% and -59.9% compared with periods D and C) and a decrease in white codes (non-urgent) (-7.5%) compared with pre-pandemic periods, with a slight increase for all other codes: +6.3% green (urgent, not critical), +0.8% yellow (moderately critical) and +0.3% red (highly urgent, risk of death). We observed an increased rate of fracture diagnosis in period A: +14.9% and +13.3% compared with periods D and C. Our study shows that the COVID-19 pandemic caused a drastic change in the ED patient flow and clinical radiological activity, with a marked reduction in admissions and an increased rate of more severe triage codes and diagnosed fractures.

Urban form and COVID-19 cases and deaths in Greater London: an urban morphometric approach (preprint)

The COVID-19 pandemic generated a considerable debate in relation to urban density. This is an old debate, originated in mid 19th century's England with the emergence of public health and urban planning disciplines. While popularly linked, evidence suggests that such relationship cannot be generally assumed. Furthermore, urban density has been investigated in a spatially coarse manner (predominantly at city level) and never contextualised with other descriptors of urban form. In this work, we explore COVID-19 and urban form in Greater London, relating a comprehensive set of morphometric descriptors (including built-up density) to COVID-19 deaths and cases, while controlling for socioeconomic, ethnicity, age, and co-morbidity. We describe urban form at individual building level and then aggregate information for official neighbourhoods, allowing for a detailed intra-urban representation. Results show that: i) control variables significantly explain more variance of both COVID-19 cases and deaths than the morphometric descriptors; ii) of what the latter can explain, built-up density is indeed the most associated, though inversely. The typical London neighbourhood with high levels of COVID-19 infections and deaths resembles a suburb, featuring a low-density urban fabric dotted by larger free-standing buildings and framed by a poorly inter-connected street network.

Harnessing the Potential of Google Searches for Understanding Dynamics of Intimate Partner Violence Before and After the COVID-19 Outbreak.

Most social phenomena are inherently complex and hard to measure, often due to under-reporting, stigma, social desirability bias, and rapidly changing external circumstances. This is for instance the case of Intimate Partner Violence (IPV), a highly-prevalent social phenomenon which has drastically risen in the wake of the COVID-19 pandemic. This paper explores whether big data-an increasingly common tool to track, nowcast, and forecast social phenomena in close-to-real time-might help track and understand IPV dynamics. We leverage online data from Google Trends to explore whether online searches might help reach "hard-to-reach" populations such as victims of IPV using Italy as a case-study. We ask the following questions: Can digital traces help predict instances of IPV-both potential threat and actual violent cases-in Italy? Is their predictive power weaker or stronger in the aftermath of crises such as COVID-19? Our results suggest that online searches using selected keywords measuring different facets of IPV are a powerful tool to track potential threats of IPV before and during global-level crises such as the current COVID-19 pandemic, with stronger predictive power post outbreaks. Conversely, online searches help predict actual violence only in post-outbreak scenarios. Our findings, validated by a Facebook survey, also highlight the important role that socioeconomic status (SES) plays in shaping online search behavior, thus shedding new light on the role played by third-level digital divides in determining the predictive power of digital traces. More specifically, they suggest that forecasting might be more reliable among high-SES population strata. Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-022-09619-2.

Needle-Free Jet Injectors and Nanosuspensions: Exploring the Potential of an Unexpected Pair.

Needle-free liquid jet injectors are medical devices used to administer pharmaceutical solutions through the skin. Jet injectors generate a high-speed stream of liquid medication that can puncture the skin and deliver the drug to the underlying tissues. In this work, we investigated the feasibility of using liquid jet injectors to administer nanosuspensions, assessing the impact of the jet injection on their pharmaceutical and physicochemical properties. For this purpose, the model drug diclofenac was used to prepare a set of nanosuspensions, stabilized by poloxamer 188, and equilibrated at different pHs. The hydrodynamic diameter and morphology of the nanocrystals were analyzed before and after the jet injection across porcine skin in vitro, together with the solubility and release kinetics of diclofenac in a simulated subcutaneous environment. The efficacy of the jet injection (i.e., the amount of drug delivered across the skin) was evaluated for the nanosuspension and for a solution, which was used as a control. Finally, the nanosuspension was administered to rats by jet injector, and the plasma profile of diclofenac was evaluated and compared to the one obtained by jet injecting a solution with an equal concentration. The nanosuspension features were maintained after the jet injection in vitro, suggesting that no structural changes occur upon high-speed impact with the skin. Accordingly, in vivo studies demonstrated the feasibility of jet injecting a nanosuspension, reaching relevant plasma concentration of the drug. Overall, needle-free jet injectors proved to be a suitable alternative to conventional syringes for the administration of nanosuspensions.

EULAR points to consider for the use of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs).

OBJECTIVES: To develop evidence-based Points to Consider (PtC) for the use of imaging modalities to guide interventional procedures in patients with rheumatic and musculoskeletal diseases (RMDs). METHODS: European Alliance of Associations for Rheumatology (EULAR) standardised operating procedures were followed. A systematic literature review was conducted to retrieve data on the role of imaging modalities including ultrasound (US), fluoroscopy, MRI, CT and fusion imaging to guide interventional procedures. Based on evidence and expert opinion, the task force (25 participants consisting of physicians, healthcare professionals and patients from 11 countries) developed PtC, with consensus obtained through voting. The final level of agreement was provided anonymously. RESULTS: A total of three overarching principles and six specific PtC were formulated. The task force recommends preference of imaging over palpation to guide targeted interventional procedures at peripheral joints, periarticular musculoskeletal structures, nerves and the spine. While US is the favoured imaging technique for peripheral joints and nerves, the choice of the imaging method for the spine and sacroiliac joints has to be individualised according to the target, procedure, expertise, availability and radiation exposure. All imaging guided interventions should be performed by a trained specialist using appropriate operational procedures, settings and assistance by technical personnel. CONCLUSION: These are the first EULAR PtC to provide guidance on the role of imaging to guide interventional procedures in patients with RMDs.

The impact of COVID-19 on people with multiple sclerosis: A comparison of Italian and United States cohorts.

BACKGROUND/OBJECTIVES: The present cross-national study addressed the relationship among three pandemic-related variables and multiple sclerosis (MS) disability outcomes among people with MS in Italy and the United States (US). METHODS: This cross-sectional web-based study was administered to 708 patients with MS from the US and Italy in late Spring through mid-Summer of 2020. Pandemic-related variables assessed worry, self-protection, and post-traumatic growth. The Performance Scales© assessed MS disability. Multivariate multiple regression models addressed, separately by country, the relationship among worry, protection, and post-traumatic growth with MS disability, after covariate adjustment. RESULTS: The Italian sample (n = 292) was younger and less disabled than the US group (n = 416). After covariate adjustment, all three pandemic-related variables were associated with MS disability outcomes in the US sample, but only worry and post-traumatic growth were associated in the Italian sample. Worse cognitive and depression symptoms were associated with worry, and lesser mobility disability was associated with endorsed growth in both countries. More disability variables were associated with worry and growth in the Italian sample. CONCLUSIONS: The pandemic's negative aspects were associated with worse disability in both countries, and reported post-traumatic growth was associated with lesser disability. These findings may suggest directions for clinical intervention.

Plasmonic Nanomaterials for Colorimetric Biosensing: A Review

In the last few decades, plasmonic colorimetric biosensors raised increasing interest in bioanalytics thanks to their cost-effectiveness, responsiveness, and simplicity as compared to conventional laboratory techniques. Potential high-throughput screening and easy-to-use assay procedures make them also suitable for realizing point of care devices. Nevertheless, several challenges such as fabrication complexity, laborious biofunctionalization, and poor sensitivity compromise their technological transfer from research laboratories to industry and, hence, still hamper their adoption on large-scale. However, newly-developing plasmonic colorimetric biosensors boast impressive sensing performance in terms of sensitivity, dynamic range, limit of detection, reliability, and specificity thereby continuously encouraging further researches. In this review, recently reported plasmonic colorimetric biosensors are discussed with a focus on the following categories: (i) on-platform-based (localized surface plasmon resonance, coupled plasmon resonance and surface lattice resonance);(ii) colloid aggregation-based (label-based and label free);(iii) colloid non-aggregation-based (nanozyme, etching-based and growth-based).

Impact of COVID-19 pandemic on pediatric endoscopy: A multicenter study on behalf of the SIGENP Endoscopy Working Group.

BACKGROUND: Aim of the present report was to investigate the repercussions of COVID-19 pandemic on the procedural volumes and on the main indications of pediatric digestive endoscopy in Italy. METHODS: An online survey was distributed at the beginning of December 2020 to Italian digestive endoscopy centers. Data were collected comparing two selected time intervals: the first from 1st of February 2019 to 30th June 2019 and the second from 1st February 2020 to 30th June 2020. RESULTS: Responses to the survey came from 24 pediatric endoscopy Units. Globally, a reduction of 37.2% was observed between 2019 and 2020 periods with a significant decrease in median number of procedures (111 vs 57, p < 0.001). Both the median number of procedures performed for new diagnoses and those for follow-up purposes significantly decreased in 2020 (63 vs 36, p < 0.001 and 42 vs 21, p< 0.001, respectively). We reported a drastic reduction of procedures performed for suspected Celiac Disease and Functional Gastrointestinal Disorders (55.1% and 58.0%, respectively). Diagnostic endoscopies for suspected IBD decreased of 15.5%, whereas procedures for Mucosal Healing (MH) assessment reduced of 48.3%. CONCLUSIONS: Our study provides real-world data outlining the meaningful impact of COVID-19 on pediatric endoscopy practice in Italy.

Epidemic dreams: dreaming about health during the COVID-19 pandemic.

The continuity hypothesis of dreams suggests that the content of dreams is continuous with the dreamer's waking experiences. Given the unprecedented nature of the experiences during COVID-19, we studied the continuity hypothesis in the context of the pandemic. We implemented a deep-learning algorithm that can extract mentions of medical conditions from text and applied it to two datasets collected during the pandemic: 2888 dream reports (dreaming life experiences), and 57 milion tweets (waking life experiences) mentioning the pandemic. The health expressions common to both sets were typical COVID-19 symptoms (e.g. cough, fever and anxiety), suggesting that dreams reflected people's real-world experiences. The health expressions that distinguished the two sets reflected differences in thought processes: expressions in waking life reflected a linear and logical thought process and, as such, described realistic symptoms or related disorders (e.g. nasal pain, SARS, H1N1); those in dreaming life reflected a thought process closer to the visual and emotional spheres and, as such, described either conditions unrelated to the virus (e.g. maggots, deformities, snake bites), or conditions of surreal nature (e.g. teeth falling out, body crumbling into sand). Our results confirm that dream reports represent an understudied yet valuable source of people's health experiences in the real world.

Epidemic Dreams: Dreaming about health during the COVID-19 pandemic (preprint)

The continuity hypothesis of dreams suggests that the content of dreams is continuous with the dreamer's waking experiences. Given the unprecedented nature of the experiences during COVID-19, we studied the continuity hypothesis in the context of the pandemic. We implemented a deep-learning algorithm that can extract mentions of medical conditions from text and applied it to two datasets collected during the pandemic: 2,888 dream reports (dreaming life experiences), and 57M tweets mentioning the pandemic (waking life experiences). The health expressions common to both sets were typical COVID-19 symptoms (e.g., cough, fever, and anxiety), suggesting that dreams reflected people's real-world experiences. The health expressions that distinguished the two sets reflected differences in thought processes: expressions in waking life reflected a linear and logical thought process and, as such, described realistic symptoms or related disorders (e.g., nasal pain, SARS, H1N1); those in dreaming life reflected a thought process closer to the visual and emotional spheres and, as such, described either conditions unrelated to the virus (e.g., maggots, deformities, snakebites), or conditions of surreal nature (e.g., teeth falling out, body crumbling into sand). Our results confirm that dream reports represent an understudied yet valuable source of people's health experiences in the real world.

Relevance of VEGF and CD147 in different SARS-CoV-2 positive digestive tracts characterized by thrombotic damage.

Several evidence suggests that, in addition to the respiratory tract, also the gastrointestinal tract is a main site of severe acute respiratory syndrome CoronaVirus 2 (SARS-CoV-2) infection, as an example of a multi-organ vascular damage, likely associated with poor prognosis. To assess mechanisms SARS-CoV-2 responsible of tissue infection and vascular injury, correlating with thrombotic damage, specimens of the digestive tract positive for SARS-CoV-2 nucleocapsid protein were analyzed deriving from three patients, negative to naso-oro-pharyngeal swab for SARS-CoV-2. These COVID-19-negative patients came to clinical observation due to urgent abdominal surgery that removed different sections of the digestive tract after thrombotic events. Immunohistochemical for the expression of SARS-CoV-2 combined with a panel of SARS-CoV-2 related proteins angiotensin-converting enzyme 2 receptor, cluster of differentiation 147 (CD147), human leukocyte antigen-G (HLA-G), vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 was performed. Tissue samples were also evaluated by electron microscopy for ultrastructural virus localization and cell characterization. The damage of the tissue was assessed by ultrastructural analysis. It has been observed that CD147 expression levels correlate with SARS-CoV-2 infection extent, vascular damage and an increased expression of VEGF and thrombosis. The confirmation of CD147 co-localization with SARS-CoV-2 Spike protein binding on gastrointestinal tissues and the reduction of the infection level in intestinal epithelial cells after CD147 neutralization, suggest CD147 as a possible key factor for viral susceptibility of gastrointestinal tissue. The presence of SARS-CoV-2 infection of gastrointestinal tissue might be consequently implicated in abdominal thrombosis, where VEGF might mediate the vascular damage.

MEDTEC Students against Coronavirus: Investigating the Role of Hemostatic Genes in the Predisposition to COVID-19 Severity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the coronavirus disease 2019 (COVID-19) pandemic. Besides virus intrinsic characteristics, the host genetic makeup is predicted to account for the extreme clinical heterogeneity of the disease, which is characterized, among other manifestations, by a derangement of hemostasis associated with thromboembolic events. To date, large-scale studies confirmed that genetic predisposition plays a role in COVID-19 severity, pinpointing several susceptibility genes, often characterized by immunologic functions. With these premises, we performed an association study of common variants in 32 hemostatic genes with COVID-19 severity. We investigated 49,845 single-nucleotide polymorphism in a cohort of 332 Italian severe COVID-19 patients and 1668 controls from the general population. The study was conducted engaging a class of students attending the second year of the MEDTEC school (a six-year program, held in collaboration between Humanitas University and the Politecnico of Milan, allowing students to gain an MD in Medicine and a Bachelor's Degree in Biomedical Engineering). Thanks to their willingness to participate in the fight against the pandemic, we evidenced several suggestive hits (p < 0.001), involving the PROC, MTHFR, MTR, ADAMTS13, and THBS2 genes (top signal in PROC: chr2:127192625:G:A, OR = 2.23, 95%CI = 1.50-3.34, p = 8.77 × 10-5). The top signals in PROC, MTHFR, MTR, ADAMTS13 were instrumental for the construction of a polygenic risk score, whose distribution was significantly different between cases and controls (p = 1.62 × 10-8 for difference in median levels). Finally, a meta-analysis performed using data from the Regeneron database confirmed the contribution of the MTHFR variant chr1:11753033:G:A to the predisposition to severe COVID-19 (pooled OR = 1.21, 95%CI = 1.09-1.33, p = 4.34 × 10-14 in the weighted analysis).

Bowel ischemia as onset of COVID-19 in otherwise asymptomatic patients with persistently negative swab.

BACKGROUND: Asymptomatic patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can develop hypercoagulable conditions and acute vascular events. The objective of this study is to determine whether SARS-CoV-2 was present in resected specimens from patients with acute bowel ischemia, but asymptomatic for Coronavirus Disease 2019 (COVID-19) and with persistently real-time polymerase chain reaction negative pharyngeal swab. METHODS: Three consecutive patients presented severe abdominal symptoms due to extensive ischemia and necrosis of the bowel, with co-existent thrombosis of abdominal blood vessels. None had the usual manifestations of COVID-19, and repeated pharyngeal swabs tested negative. They underwent emergency surgery with intestinal resection. Immunohistochemical testing for SARS-CoV-2 on resected tissue was performed. RESULTS: All tested samples were strongly positive for SARS-CoV-2. CONCLUSIONS: This is the first case report in which patients with severe intestinal symptoms presented a marked SARS-CoV-2 positivity in the resected tissues, without any usual clinical manifestations of COVID-19. These results suggest that the patients might be infected with SARS-CoV-2 presenting acute abdominal distress but without respiratory or constitutional symptoms.

How epidemic psychology works on Twitter: evolution of responses to the COVID-19 pandemic in the U.S

Disruptions resulting from an epidemic might often appear to amount to chaos but, in reality, can be understood in a systematic way through the lens of “epidemic psychology”. According to Philip Strong, the founder of the sociological study of epidemic infectious diseases, not only is an epidemic biological;there is also the potential for three psycho-social epidemics: of fear, moralization, and action. This work empirically tests Strong’s model at scale by studying the use of language of 122M tweets related to the COVID-19 pandemic posted in the U.S. during the whole year of 2020. On Twitter, we identified three distinct phases. Each of them is characterized by different regimes of the three psycho-social epidemics. In the refusal phase, users refused to accept reality despite the increasing number of deaths in other countries. In the anger phase (started after the announcement of the first death in the country), users’ fear translated into anger about the looming feeling that things were about to change. Finally, in the acceptance phase, which began after the authorities imposed physical-distancing measures, users settled into a “new normal” for their daily activities. Overall, refusal of accepting reality gradually died off as the year went on, while acceptance increasingly took hold. During 2020, as cases surged in waves, so did anger, re-emerging cyclically at each wave. Our real-time operationalization of Strong’s model is designed in a way that makes it possible to embed epidemic psychology into real-time models (e.g., epidemiological and mobility models).

Impact of coronavirus disease 2019 (COVID-19) outbreak on radiology research: An Italian survey.

PURPOSE: To understand how COVID-19 pandemic has changed radiology research in Italy. METHODS: A questionnaire (n = 19 questions) was sent to all members of the Italian Society of Radiology two months after the first Italian national lockdown was lifted. RESULTS: A total of 327 Italian radiologists took part in the survey (mean age: 49 ± 12 years). After national lockdown, the working-flow came back to normal in the vast majority of cases (285/327, 87.2%). Participants reported that a total of 462 radiological trials were recruiting patients at their institutions prior to COVID-19 outbreak, of which 332 (71.9%) were stopped during the emergency. On the other hand, 252 radiological trials have been started during the pandemic, of which 156 were non-COVID-19 trials (61.9%) and 96 were focused on COVID-19 patients (38.2%). The majority of radiologists surveyed (61.5%) do not conduct research. Of the radiologists who carried on research activities, participants reported a significant increase of the number of hours per week spent for research purposes during national lockdown (mean 4.5 ± 8.9 h during lockdown vs. 3.3 ± 6.8 h before lockdown; p = .046), followed by a significant drop after the lockdown was lifted (3.2 ± 6.5 h per week, p = .035). During national lockdown, 15.6% of participants started new review articles and completed old papers, 14.1% completed old works, and 8.9% started new review articles. Ninety-six surveyed radiologists (29.3%) declared to have submitted at least one article during COVID-19 emergency. CONCLUSION: This study shows the need to support radiology research in challenging scenarios like COVID-19 emergency.

Home-Based Resistance Training for Older Subjects during the COVID-19 Outbreak in Italy: Preliminary Results of a Six-Months RCT.

BACKGROUND: The aim of this study was to evaluate the effect of a six-month home-based resistance-training program on muscle health and physical performance in healthy older subjects during the unique condition of home confinement caused by the COVID-19 pandemic. METHODS: This was a randomized-controlled study that enrolled older participants that were allocated to either an experimental group performing the six-months exercise prescription (EXE) or a control group (CON). At the beginning (PRE), and after 6 months (POST), participants were assessed for muscle strength, balance, gait assessment and body composition by dual energy X-ray absorptiometry and magnetic resonance imaging. Normality distribution of data was checked with the D'Agostino and Pearson test and changes between PRE and POST were assessed by paired Student's t-test while percentage and absolute changes between groups at POST were tested by unpaired t-test. RESULTS: Nine participants were included for the final analysis: EXE, n = 5 (age: 66 ± 4; BMI: 27.5 ± 3.7) and CON, n = 4 (age: 71 ± 9; BMI: 24.2 ± 4.1). Significant PRE-to-POST changes were observed in the EXE group only in the chair-stand test (+19.8%, p = 0.048 and ES:1.0, moderate) and in total fat mass (+5.0%, p = 0.035 and ES:1.4, large) with no between-group differences. Moreover, EXE had significantly higher absolute thigh CSA values than CON at POST (14.138 ± 2977 vs. 9039 ± 1015, p = 0.0178, ES = 1.7). No other within- and between-group differences were detected. CONCLUSIONS: The home-based resistance-training program during the lockdown period, caused by the COVID-19 outbreak, determined only within-group improvement in lower limb muscle strength but not in muscle mass and composition in older subjects. Home confinement may partially explain the increase in total body fat due to a reduced daily PA regime and altered diet pattern.