Unlocking human-like conversations: Scoping review of automation techniques for personalized healthcare interventions using conversational agents.

BACKGROUND: Conversational agents (CAs) offer a sustainable approach to deliver personalized interventions and improve health outcomes. OBJECTIVES: To review how human-like communication and automation techniques of CAs in personalized healthcare interventions have been implemented. It is intended for designers and developers, computational scientists, behavior scientists, and biomedical engineers who aim at developing CAs for healthcare interventions. METHODOLOGY: A scoping review was conducted in accordance with PRISMA Extension for Scoping Review. A search was performed in May 2023 in Web of Science, Pubmed, Scopus and IEEE databases. Search results were extracted, duplicates removed, and the remaining results were screened. Studies that contained personalized and automated CAs within the healthcare domain were included. Information regarding study characterization, and human-like communication and automation techniques was extracted from articles that met the eligibility criteria. RESULTS: Twenty-three studies were selected. These articles described the development of CAs designed for patients to either self-manage their diseases (such as diabetes, mental health issues, cancer, asthma, COVID-19, and other chronic conditions) or to enhance healthy habits. The human-like communication characteristics studied encompassed aspects like system flexibility, personalization, and affective characteristics. Seven studies used rule-based models, eleven applied retrieval-based techniques for content delivery, five used AI models, and six integrated affective computing. CONCLUSIONS: The increasing interest in employing CAs for personalized healthcare interventions is noteworthy. The adaptability of dialogue structures and personalization features is still limited. Unlocking human-like conversations may encompass the use of affective computing and generative AI to help improve user engagement. Future research should focus on the integration of holistic methods to describe the end-user, and the safe use of generative models.

Diagnostic accuracy and the first genotype-phenotype correlation in glycogen storage disease type V.

BACKGROUND: Glycogen storage disease type V (GSDV) is an autosomal recessive metabolic condition caused by pathogenic PYGM variants. This is an underdiagnosed condition as it presents with exercise intolerance in children. We reviewed the GSDV cases of a tertiary hospital center to assess diagnostic timing/accuracy, as well as potential clinical/analytical predictors of such factors. METHODS: We retrospectively reviewed all GSDV cases with follow-up in both Pediatric and Adult Metabolic Diseases consultations. We included 28 cases and assessed their hospital record for clinical information. RESULTS: Over 90% of our cases had late diagnoses, with more than 50% being diagnosed in adulthood despite symptom onset in preschool (very late diagnosis). Diagnostic age was lower in patients exhibiting myoglobinuria. Interestingly, patients with a positive family history of GSDV had similar rates of very late diagnoses, likely since the index case was already detected very late in life. Finally, we observe that the R50* variant is associated with increased myoglobinuria and CK elevation, in a dosage-dependent manner. CONCLUSION: We concluded that GSDV is severely underdiagnosed, and that some clinical and analytical aspects of the condition can be more indicative of this diagnosis. Furthermore, we propose for the first time a genotype-phenotype correlation in GSDV. IMPACT: GSDV is a pediatric-onset metabolic disorder that is mostly diagnosed late in the adult age and commonly misdiagnosed. We observed the first genotype-phenotype correlation in GSDV, regarding the common R50* variant. Awareness of GSDV for pediatricians and the overall medical community is vital.

Clinical and Laboratory Findings on Glycogen Storage Disease Type V: Results from a Retrospective Observational Study in a Tertiary Hospital.

Introduction - Glycogen storage disease type V (GSDV, MIM #232600) is an autosomal recessive metabolic myopathy caused by pathogenic variants in the PYGM gene. The characteristic symptoms of exercise intolerance, myalgia, and cramps, which improve after a few minutes of rest, are frequently unrecognized in affected children. When there is clinical suspicion, the initial approach with a forearm exercise test has diagnostic value by detecting low post-exercise plasma lactate-to-ammonia ratio values. The diagnostic algorithm is followed by genetic testing if the results suggest myophosphorylase deficiency. Methods - This was a retrospective observational study conducted based on reviewing medical records of patients with GSDV in a tertiary hospital. We assessed demographic variables, including the timing of onset and diagnosis, relevant clinical characteristics, and whether genetic testing was performed, including its results. Results/Case Report - Our goal was to review the GSDV cases in our center to assess our cohort's diagnostic timing and clinical and genetic characteristics. We identified 28 patients from 24 families, three with consanguinity. The mean age at the time of the study was 43 years. While most (26/28; 93%) recalled their first symptoms in childhood/adolescence, only 25% (7/28) were diagnosed then. All patients had exercise intolerance and CK elevation, while about half reported the second wind phenomenon. Genetic testing was performed in 22 patients, revealing biallelic PYGM variants (9 homozygous, 13 compound heterozygous) as the most common (p.R50*). Conclusion - GSDV is rare and presents in the pediatric age, with subtle manifestations often underestimated for decades. A late diagnosis may negatively impact the psychosocial development of affected children. It is essential to recognize some unique features that facilitate diagnosis: history of exercise intolerance, the second wind sign, and high resting serum CK levels. Identifying the disease-causing variants in PYGM is currently the gold standard for diagnosis as it is less invasive than performing a muscle biopsy, and may promptly diagnose the condition and avoid wrongful labelling of patients.

Immunological mechanisms of fecal microbiota transplantation in recurrent Clostridioides difficile infection.

Fecal microbiota transplantation (FMT) is a successful method for treating recurrent Clostridioides difficile (C. difficile) infection (rCDI) with around 90% efficacy. Due to the relative simplicity of this approach, it is being widely used and currently, thousands of patients have been treated with FMT worldwide. Nonetheless, the mechanisms underlying its effects are just beginning to be understood. Data indicate that FMT effectiveness is due to a combination of microbiological direct mechanisms against C. difficile, but also through indirect mechanisms including the production of microbiota-derived metabolites as secondary bile acids and short chain fatty acids. Moreover, the modulation of the strong inflammatory response triggered by C. difficile after FMT seems to rely on a pivotal role of regulatory T cells, which would be responsible for the reduction of several cells and soluble inflammatory mediators, ensuing normalization of the intestinal mucosal immune system. In this minireview, we analyze recent advances in these immunological aspects associated with the efficacy of FMT.

Antimicrobial action of ozonated water and photodynamic therapy with sonic activation in root canals infected with Enterococcus faecalis.

Background: New protocols are constantly being tested in the search for complete disinfection of root canals without the undesirable effects of sodium hypochlorite. This study evaluated the antimicrobial effect of ozonated water and photodynamic therapy (PDT) with sonic activation in root canals infected with Enterococcus faecalis. Material and Methods: Seventy single-rooted canals of human teeth were prepared and contaminated with E. faecalis for 21 days. The teeth were divided into six experimental groups (n=10): ozonized water without (O + S-) and with sonic activation (O + S +); PDT without (PDT + S-) and with sonic activation (PDT + S +); PDT + ozonized water without (PDT + O + S-) and with sonic activation (PDT + O + S +); and two control groups, one positive (n = 5) and one negative (n = 5). Microbial collections were performed before and shortly after treatment, counted in the log of colony-forming units and tested for significant difference between these counts, if any (Student's t-test). The ANOVA two-way test was applied to evaluate whether the Treatment factor (Ozone, PDT and Ozone + PDT) and the Sonic factor (With and without sonic activation) had any effect on microbial reduction. Results: In all protocols, there was a significant microbial reduction (p=0.025), whereas in the groups in which sonic activation was used, the microbial reduction was significantly greater (p=0.001). Conclusions: The treatments significantly reduced the number of microorganisms in the root canals. Sonic activation helped to increase the microbial reduction in infected root canals. Key words:Endodontics, ozone, photodynamic therapy, enterococcus faecalis.

Pattern of Disinfection of Root Canal Dentin by Alternated Acid-Base Irrigating Regimen.

OBJECTIVE: To quantify Enterococcus faecalis density in root canal dentin after chemomechanical preparation (CMP) using alternated irrigating regimen. METHODOLOGY: Root canals (RC) were contaminated with E. faecalis (ATCC 19433) for 3 weeks and evident biofilms were obtained. After initial sampling (S1), the CMP was aided by irrigants: saline solution (control; n=12), a conventional regimen (CR) (group 1; n=12) using 5.25% NaOCl and a final rinse with 17% EDTA, and an alternating regimen (AR) of intercalated use of NaOCl and EDTA (group 2, n=12), followed by a second sampling (S2). After 2 weeks, S3 was obtained. Two roots were analyzed by scanning electron microscopy. Each root was divided into cervical, mild, and apical segments and sampling of the superficial (n=90) and deep (n=90) dentin layers was obtained using Gates-Glidden burs. The E. faecalis density (CFU/mg) in log10 was categorized as residual (0 > 0.2), moderate (0.2 ≥ 0.5), or elevated (> 0.5). The prevalence of positive samples in BHI and BHI-A was analyzed by Pearson's chi-square test. The data were normalized by a log10 transformation of CFU and were analyzed by one-way ANOVA and Tukey's tests. RESULTS: Biofilms were observed only in the control root canal walls. Topographically, the controls and CR showed similar distributions of E. faecalis in the dentin. Microbiologically positive root canals harbored much E. faecalis in the adjacent dentin (p < 0.05). Irrigating saline provided moderate density of E. faecalis in the dentin while CR and AR resulted in a residual density of microorganisms (p < 0.05). CONCLUSIONS: The Enterococcus faecalis density in dentin was influenced by the irrigating regimen and the microbiological status of the root canal. The CMP aided by the alternating regimen interfered with the recolonization of the root canal and topographic distribution of Enterococcus in root dentin.

Caustic Esophageal Stenosis: A Case Report of Endoscopic Dilation With a Dynamic Stent.

INTRODUCTION: The management of esophageal strictures has evolved from surgical treatment to the endoscopic dilation and, more recently, esophageal stenting. CLINICAL CASE: We describe a case of a two-year-old boy with a double stenosis of the esophagus resulting from accidental ingestion of strong alkaline liquid. After several unsuccessful endoscopic dilations for three years and even topical mitomicin, it was decided to place a dynamic stent developed by the Digestive Surgery and Endoscopic Unit of the Bambino Gesù Hospital, Rome. The stent is a custom silicon device built coaxially on a nasogastric tube that is inserted after stricture dilations, by endoscopic guidance, and then fixed outside the nose. The device was removed after seven weeks with good clinical outcome (no dysphagia more than a year of follow-up). CONCLUSION: This case confirms that the dynamic stent is a simple device that may avoid aggressive surgical substitution in cases of refractory strictures.

INTRODUÇÃO: O tratamento das estenoses esofágicas tem evoluído desde a correção cirúrgica, à dilatação endoscópica e, mais recentemente, à colocação de stents esofágicos. CASO CLÍNICO: Descrevemos o caso de um doente que aos dois anos ingeriu acidentalmente um cáustico e desenvolveu duas estenoses esofágicas recidivantes. Após numerosas dilatações endoscópicas e aplicação tópica de mitomicina, ao fim de três anos, foi decidido colocar um stent dinâmico, desenvolvido pela Unidade de Cirurgia e Endoscopia do Hospital Bambino Gesù, Roma. O dispositivo consiste numa sonda nasogástrica com uma área de maior calibre (stent) que foi posicionada por via endoscópica na zona das estenoses e fixada por via nasal. O dispositivo foi retirado passadas sete semanas com melhoria clínica sustentada (ausência de disfagia mais de um ano após). CONCLUSÃO: Este caso demonstra que o "stent" dinâmico é tecnicamente simples e permite evitar uma solução cirúrgica mutilante em casos de estenose esofágica de difícil controlo.

Tracheitis - A Rare Extra-Intestinal Manifestation of Ulcerative Colitis in Children.

INTRODUCTION: Inflammatory bowel disease may cause both intestinal and extraintestinal manifestations. Respiratory symptoms in ulcerative colitis are rare and tracheal involvement is exceedingly rare in children. CASE 1: Sixteen year-old female with a 4-week-complaint of abdominal pain, bloody diarrhea, fever and cough. The investigation was consistent with the diagnosis of concomitant ulcerative colitis/coinfection to Escherichia coli. On day 4 respiratory signs persisted so azithromycin and inhaled corticosteroids were added. By day 6 she progressed to respiratory failure and was diagnosed with necrotic tracheitis so started on intravenous steroids with fast clinical improvement. CASE 2: Twelve-year-old male adolescent with ulcerative colitis and sclerosing cholangitis started dry cough and throat pain 10 days after diagnosis. Laboratory investigations showed increased inflammatory signs and normal chest X-ray. He started treatment with azithromycin without clinical improvement and on day five he presented dyspnea and fever. Laryngeal fibroscopy suggested tracheitis and so systemic steroids where added with fast clinical and analytic improvement. DISCUSSION: Tracheitis should be suspected if there are persistent respiratory symptoms even when exams are normal. Early recognition and early treatment are essential for a good prognosis preventing progression to respiratory failure.

INTRODUÇÃO: A doença inflamatória intestinal pode ser causa de complicações intestinais e extraintestinais. As manifestações respiratórias de colite ulcerosa são raras e o envolvimento traqueal é extremamente raro em crianças. CASO 1: Adolescente do sexo feminino, de dezasseis anos de idade, com queixas de dor abdominal, diarreia sanguinolenta, febre e tosse seca com 4 semanas de evolução. A investigação realizada foi compatível com o diagnóstico de colite ulcerosa/co-infecção a Escherichia coli. No 4ª dia de internamento, por persistência das queixas respiratórias, iniciou azitromicina e corticoterapia inalada. Dois dias mais tarde evoluiu para insuficiência respiratória; foi-lhe diagnosticada traqueíte necrotizante pelo que iniciou corticóides endovenosos com rápida melhora clínica. CASO 2: Adolescente do sexo masculino de 12 anos de idade com colite ulcerosa e colangite esclerosante que inicia queixas de odinofagia e tosse seca 10 dias após o diagnóstico. O estudo analítico revelou aumento dos parâmetros inflamatórios e radiografia de tórax normal. Nesta altura inicia azitromicina, sem melhora clínica, iniciando, no quinto dia de doença, dispnéia e febre. A fibroscopia laríngea foi sugestiva de traqueíte pelo que iniciou corticoterapia sistémica com rápida melhoria clínica e analítica. DISCUSSÃO: A traqueíte é uma entidade que deve ser equacionada em doentes com doença inflamatória intestinal na presença de sintomas respiratórios persistentes, mesmo com estudo complementar normal. O seu reconhecimento e tratamento precoces são essenciais para um prognóstico favorável e prevenção da progressão para insuficiência respiratória.

Tratamento compensatório da mordida cruzada dentoalveolar em adultos utilizando o arco auxiliar de expansão / Compensatory treatment of dentoalveolar crossbite in adult patients using the auxiliary expansion arch

Nos indivíduos adultos e adolescentes com maturação óssea avançada, a correção da deficiência transversal da maxila torna-se um desafio para o ortodontista. O tratamento dessa má oclusão, cuja característica dentária predominante é a mordida cruzada posterior, é controverso e suscita muitas dúvidas. O objetivo deste trabalho é apresentar uma alternativa de tratamento para expansão dentoalveolar, no qual a expansão cirúrgica não é a opção mais indicada, ou o paciente recusa submeter-se a procedimentos cirúrgicos. O arco auxiliar de expansão, também conhecido como arco de cavalgada (Jockey Arch), é um método auxiliar para a expansão dentoalveolar nos casos onde a mordida cruzada é diagnosticada somente como dentária ou nos casos em que há envolvimento esquelético com grau leve promovendo uma compensação por meio de inclinações dentárias para vestibular. Este trabalho observou a efetividade do aparelho em quatro casos clínicos, demonstrando a correção da atresia dentoalveolar superior por meio de uma mecânica simplificada e eficiente. Contudo, faz-se necessária a realização de mais estudos para avaliar a efetividade do aparelho e, principalmente, a estabilidade da expansão dentária realizada por meio do arco auxiliar de expansão...

In adults and adolescents with advanced bone maturation the treatment of transverse maxillary deficiency becomes a challenge for orthodontists. The treatment of this dental malocclusion, characterized mainly by posterior crossbite, is controversial and raises many questions. The objective of this paper is to present an alternative treatment for dentoalveolar expansion for cases in which the surgical expansion is not the first option or the patient refuses to submit to surgical procedures. The auxiliary expansion arch, also known as Jockey Arch, is an aid for dentoalveolar expansion in cases where the crossbite is diagnosed only as dental or when there is mild skeletal involvement, promoting compensation through dental inclinations buccal method. This study has observed the effectiveness of the device in four cases, showing the correction of maxillary dentoalveolar constriction through a simple mechanics. However, further studies are required to evaluate the effectiveness of the device and mainly the stability of dental expansion conducted at the Jockey arch...

Ensuring the quality of occupational safety risk assessment.

In work environments, the main aim of occupational safety risk assessment (OSRA) is to improve the safety level of an installation or site by either preventing accidents and injuries or minimizing their consequences. To this end, it is of paramount importance to identify all sources of hazards and assess their potential to cause problems in the respective context. If the OSRA process is inadequate and/or not applied effectively, it results in an ineffective safety prevention program and inefficient use of resources. An appropriate OSRA is an essential component of the occupational safety risk management process in industries. In this article, we performed a survey to elicit the relative importance for identified OSRA tasks to enable an in-depth evaluation of the quality of risk assessments related to occupational safety aspects on industrial sites. The survey involved defining a questionnaire with the most important elements (tasks) for OSRA quality assessment, which was then presented to safety experts in the mining, electrical power production, transportation, and petrochemical industries. With this work, we expect to contribute to the main question of OSRA in industries: "What constitutes a good occupational safety risk assessment?" The results obtained from the questionnaire showed that experts agree with the proposed OSRA process decomposition in steps and tasks (taxonomy) and also with the importance of assigning weights to obtain knowledge about OSRA task relevance. The knowledge gained will enable us, in the near future, to build a framework to evaluate OSRA quality for industrial sites.

Integration of human factors principles in LARG organizations--a conceptual model.

Nowadays many companies are undergoing organizational transformations in order to meet the changing market demands. Thus, in order to become more competitive, supply chains (SC) are adopting new management paradigms to improve SC performance: lean, agile, resilient and green (LARG paradigms). The implementation of new production paradigms demands particular care with the issues related with Human Factors to avoid health and safety problems to workers and losses to companies. Thus, the successful introduction of these new production paradigms depends among others on a Human Factors oriented approach. This work presents a conceptual framework that allows integrating ergonomic and safety design principles during the different implementation phases of lean, agile, resilient and green practices.

The nexus between OSH and subcontracting.

Subcontracting of specialized functions to external companies (e.g. cleaning or maintenance) is actually very common within several industries. These external companies' are called contractors and their contracting is often designated as outsourcing. Frequently contractors involve other companies (the sub-contractors) to assist them in fulfilling the contract, resulting in a complex chain of organizations focused on interchange of work - the contracting chain. Therefore in the same work site can coexist workers form the client-company and workers from the contractors and/or subcontractors. Since contractors perform their job in client's facilities, they can be exposed to hazards that are unknown to them. On other hand, workers of the client company can also be exposed to hazardous situations derived from the work performed by the contractors. The paper discusses how adequate occupational safety and health conditions can be assured when dealing with this kind of dynamic labor networks. Two case-studies and several examples coming from international literature will be presented.

Fuzzy approach for reducing subjectivity in estimating occupational accident severity.

Quantifying or, more generally, estimating the severity of the possible consequences of occupational accidents is a decisive step in any occupational risk assessment process. Because of the lack of historic information (accident data collection and recording are incipient and insufficient, particularly in construction) and the lack of practical tools in the construction industry, the estimation/quantification of occupational accident severity is a notably arbitrary process rather than a systematic and rigorous assessment. This work proposes several severity functions (based on a safety risk assessment) to represent biomechanical knowledge with the aim of determining the severity level of occupational accidents in the construction industry and, consequently, improving occupational risk assessment quality. We follow a fuzzy approach because it makes it possible to capture and represent imprecise knowledge in a simple and understandable way for users and specialists.

An exploratory study of the Work Ability Index (WAI) and its components in a group of computer workers.

OBJECTIVE: The objective of this paper is to present a study on the assessment of the work ability of a group of aged computers workers. The study was developed with the goal of creating a decision making framework oriented towards the maintenance of the health and working ability of aged workers. PARTICIPANTS: Fifty computer workers participated in this study. They were administrative secretaries and computer technicians working mainly with office computers. METHODS: The method used to assess the work ability was the Work Ability Index (WAI). RESULTS: 78% of the participants had good or excellent work ability and only 2% a poor one. The average WAI score was 40.5 (SD=5.761; min=27; max=49). This study confirms the decrease in work ability of workers while aging. The group overall work ability was slightly higher than the reference values develop by the Finnish Institute of Occupational Health. CONCLUSIONS: The assessment of work ability is fundamental to make age-friendly workplaces. WAI is one tool designed to perform such assessment. The results obtained could assist the early identification of situations where employees are struggling with their work ability, thus helping to prioritize ergonomic interventions devoted to improve the working conditions, and allowing the continued employment of aging workers on their current job.

FAST ERGO_X - a tool for ergonomic auditing and work-related musculoskeletal disorders prevention.

Work-related musculoskeletal disorders associated with repetitive and strenuous working conditions continue to represent one of the biggest occupational problems in companies. Despite the variety of efforts to control them, including engineering design changes, organizational modifications and working methods training programs, work-related musculoskeletal disorders account for a huge amount of human suffering and economic costs to companies and to healthcare systems. This paper presents an ergonomic analysis tool, FAST ERGO_X, designed to support ergonomic auditing activities related with work-related musculoskeletal disorders. This tool can be used to analyze workplaces regarding potential ergonomic risk factors. The FAST ERGO_X is a fuzzy expert system designed to help the identification, assessment and control of the risk factors present in the work system, due to lack of adequate ergonomics. Based on objective and subjective data, the system evaluates the risk factors that can lead to the development of work-related musculoskeletal disorders, and presents the findings resulting from such evaluation. The system also presents recommendations to eliminate or at least reduce the risk factors present in the work situation under analysis.