The impact of Covid-19 pandemic on the research portfolio and approval turnaround time at the Kenya Medical Research Institute.

BACKGROUND: The Covid-19 pandemic led to an unprecedented impact on many sectors globally including research. We assessed the impact of the Covid-19 pandemic on the research portfolio, and on the approval turnaround time for research protocols submitted to the Scientific and Ethics Review Unit (SERU), at the Kenya Medical Research Institute (KEMRI). METHODS: We compared research protocols submitted between October 01, 2019 and March 31, 2020 (Period 1), to those submitted between April 1 and September 30, 2020 (Period 2). A document review tool was used to extract data from the 198 research protocols reviewed and approved over the two periods. RESULTS: In the two periods under review, the single largest percentage of protocols (89/198, 45.4%) involved infectious and parasitic diseases, and the single largest percentage of study designs was cross-sectional (75/198, 38%). Before the pandemic, the median time taken to review KEMRI-linked protocols was 87 days and for non-KEMRI linked protocols it was 121 days. During the pandemic, approval turnaround time dropped for both KEMRI and non-KEMRI protocols to 66 days and 92 days, respectively, due to the streamlined processes at the KEMRI SERU. CONCLUSION: The research portfolio was minimally affected by the pandemic. The adoption of email submission, and faster-than-usual processing and review protocols during the pandemic reduced the approval turnaround time.

Can soil health in degraded woodlands of a semi-arid environment improve after thirty years?

In natural habitats, especially in arid and semi-arid areas that are fragile ecosystems, vegetation degradation is one of the most important factors affecting the variability of soil health. Studying physicochemical and biological parameters that serve as indicators of soil health offers important information on the potential risk of land degradation and the progression of changes in soil performance and health during recovery periods. This study specifically examines the impact of vegetation degradation on soil health indicators and the duration needed to improve the physical, chemical, and biological parameters in a semi-arid mountainous area site types with the dominance of Quercus macranthera Fisch & C.A. Mey and Carpinus orientalis Miller in northern Iran. In different years (2003, 2013, and 2023), litter and soil samples (at depths of 0-10, 10-20, and 20-30 cm) were collected in different types of degraded sites. Additionally, in 2023, a non-degraded site was chosen as a control and similar samples were collected. A total of 48 litter (12 samples for each of the study site types) and 144 soil (4 study site types × 3 depths × 12 samples) samples were collected. In order to investigate the spatial changes of soil basal respiration (or CO2 emission), which is involved in global warming, from each site type, 50 soil samples were taken along two 250-meter transects. The findings showed that litter P and Mg contents in the non-degraded site were 1.6 times higher than in degraded site types (2003). Following vegetation degradation, soil fertility indicators decreased by 2-4 times. The biota population was lower by about 80 % under the degraded site types (2003) than in the non-degraded site, and the density of fungi and bacteria in the degraded site types was almost half that of the non-degraded site types. Geostatistics showed the high variance (linear model) of CO2 emissions in areas without degradation. In addition, vegetation degradation significantly reduced soil carbon and nitrogen mineralization. Although soil health indicators under the degraded vegetation have improved over time (30 years), results showed that even thirty years is not enough for the full recovery of a degraded ecosystem, and more time is needed for the degraded area to reach the same conditions as the non-degraded site. Considering the time required for natural restoration in degraded site types, it is necessary to prioritize the conservation of vegetation and improve the ecosystem restoration process with adequate interventions.

Patient-Reported Dry Eye Treatment and Burden of Care.

OBJECTIVES: Dry eye is a common condition that can decrease the quality of life. This survey-based study of persons with dry eye investigated self-reported treatments (initial, current), out-of-pocket expenses, time spent on self-management, sources of care, and sources of information about their condition. METHODS: Online dry eye newsletters and support groups were emailed a link to an electronic survey asking members to participate. Survey respondents were not required to answer every question. RESULTS: In total, 639 persons with self-reported dry eye responded (86% women, 14% men [n=623]; mean ± SD age, 55 ± 14 years [n=595]). Artificial tears were the most reported intervention (76% initially, 71% currently). The median (interquartile range) out-of-pocket treatment cost annually was $500 ($200-$1,320 [n=506]). In addition, 55% (n=544) estimated 5 to 20 min daily on self-management; 22% spent an hour or more. Ophthalmologists provided most dry eye care (67%, n=520). Only 48% (n=524) reported that their primary source of dry eye information came from their eye care clinician. CONCLUSIONS: Artificial tears are the primary treatment for dry eye. Ophthalmologists provide most dry eye care, but half of patients report that their eye care provider is not their primary source of information. Almost one fourth of patients spend an hour or more daily on treatments.

The effect of roast profiles on the dynamics of titratable acidity during coffee roasting.

Coffee professionals have long known that the "roast profile," i.e., the temperature versus time inside the roaster, strongly affects the flavor and quality of the coffee. A particularly important attribute of brewed coffee is the perceived sourness, which is known to be strongly correlated to the total titratable acidity (TA). Most prior work has focused on laboratory-scale roasters with little control over the roast profile, so the relationship between roast profile in a commercial-scale roaster and the corresponding development of TA to date remains unclear. Here we investigate roast profiles of the same total duration but very different dynamics inside a 5-kg commercial drum roaster, and we show that the TA invariably peaks during first crack and then decays to its original value by second crack. Although the dynamics of the TA development varied with roast profile, the peak TA surprisingly exhibited almost no statistically significant differences among roast profiles. Our results provide insight on how to manipulate and achieve desired sourness during roasting.

Temporal Gestures in Different Temporal Perspectives.

Temporal perspectives allow us to place ourselves and temporal events on a timeline, making it easier to conceptualize time. This study investigates how we take different temporal perspectives in our temporal gestures. We asked participants (n = 36) to retell temporal scenarios written in the Moving-Ego, Moving-Time, and Time-Reference-Point perspectives in spontaneous and encouraged gesture conditions. Participants took temporal perspectives mostly in similar ways regardless of the gesture condition. Perspective comparisons showed that temporal gestures of our participants resonated better with the Ego- (i.e., Moving-Ego and Moving-Time) versus Time-Reference-Point distinction instead of the classical Moving-Ego versus Moving-Time contrast. Specifically, participants mostly produced more Moving-Ego and Time-Reference-Point gestures for the corresponding scenarios and speech; however, the Moving-Time perspective was not adopted more than the others in any condition. Similarly, the Moving-Time gestures did not favor an axis over the others, whereas Moving-Ego gestures were mostly sagittal and Time-Reference-Point gestures were mostly lateral. These findings suggest that we incorporate temporal perspectives into our temporal gestures to a considerable extent; however, the classical Moving-Ego and Moving-Time classification may not hold for temporal gestures.

Sex-specific trends in incidence of first myocardial infarction among people with and without diabetes between 1985 and 2016 in a German region.

BACKGROUND: The reduction of myocardial infarction (MI) and narrowing the gap between the populations with and without diabetes are important goals of diabetes care. We analyzed time trends for sex-specific incidence rates (IR) of first MI (both non-fatal MI and fatal MI) as well as separately for first non-fatal MI and fatal MI in the population with and without diabetes. METHODS: Using data from the KORA myocardial infarction registry (Augsburg, Germany), we estimated age-adjusted IR in people with and without diabetes, corresponding relative risks (RR), and time trends from 1985 to 2016 using Poisson regression. RESULTS: There were 19,683 people with first MI (34% fatal MI, 71% men, 30% with diabetes) between 1985 and 2016. In the entire study population, the IR of first MI decreased from 359 (95% CI: 345-374) to 236 (226-245) per 100,000 person years. In men with diabetes, IR decreased only in 2013-2016. This was due to first non-fatal MI, where IR in men with diabetes increased until 2009-2012, and slightly decreased in 2013-2016. Overall, fatal MI declined stronger than first non-fatal MI corresponding to IRs. The RR of first MI substantially increased among men from 1.40 (1.22-1.61) in 1985-1988 to 2.60 (2.26-2.99) in 1997-2000 and moderately decreased in 2013-2016: RR: 1.75 (1.47-2.09). Among women no consistent time trend for RR was observed. Time trends for RR were similar regarding first non-fatal MI and fatal MI. CONCLUSIONS: Over the study period, we found a decreased incidence of first MI and fatal MI in the entire study population. The initial increase of first non-fatal MI in men with diabetes needs further research. The gap between populations with and without diabetes remained.

The effect of donation frequency on donor health in blood donors donating plasma by plasmapheresis: study protocol for a randomized controlled trial.

BACKGROUND: The demand for plasma products is growing, necessitating an increase in plasma collection by plasmapheresis. While the 20th edition of the European Guidelines permits plasma donors in Europe to donate with 96-h donation intervals, the potential short- and long-term consequences of high-frequency plasma donations on donor health remain unknown. This study aims to measure the effect of plasma donation frequency on plasma protein composition, including total serum protein (TSP) and immunoglobulin G (IgG), in Norwegian male blood donors. METHODS: This randomized controlled trial (RCT) included 120 male blood donors who were randomized into two intervention groups and one control group: high-frequency plasma donors (HFPDs) who donated 650 mL of plasma 3 times every 2 weeks, whereas regular-frequency plasma donors (RFPDs) who donated 650 mL of plasma 1 time every 2 weeks. The control group consisted of whole blood donors. The primary outcomes are the concentrations of TSP and IgG. DISCUSSION: The findings from this study may have implications for recommendations related to donor health and plasma donation frequencies and may contribute to supporting the strategic independence of plasma products in Norway and Europe without compromising donor health. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05179200 . Registered December 20th, 2021.

Electromagnetic fields regulate iron metabolism in living organisms: A review of effects and mechanism.

The emergence, evolution, and spread of life on Earth have all occurred in the geomagnetic field, and its extensive biological effects on living organisms have been documented. The charged characteristics of metal ions in biological fluids determine that they are affected by electromagnetic field forces, thus affecting life activities. Iron metabolism, as one of the important metal metabolic pathways, keeps iron absorption and excretion in a relatively balanced state, and this process is precisely and completely controlled. It is worth paying attention to how the iron metabolism process of living organisms is changed when exposed to electromagnetic fields. In this paper, the processes of iron absorption, storage and excretion in animals (mammals, fish, arthropods), plants and microorganisms exposed to electromagnetic field were summarized in detail as far as possible, in order to discover the regulation of iron metabolism by electromagnetic field. Studies and data on the effects of electromagnetic field exposure on iron metabolism in organisms show that exposure profiles vary widely across species and cell lines. This process involves a variety of factors, and the complexity of the results is not only related to the magnetic flux density/operating frequency/exposure time and the heterogeneity of the observed object. A systematic review of the biological regulation of iron metabolism by electromagnetic field exposure will not only contributes to a more comprehensive understanding of its biological effects and mechanism, but also is necessary to improve human awareness of the health related risks of electromagnetic field exposure.

Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings.

BACKGROUND AND PURPOSE: The use of MR imaging in emergency settings has been limited by availability, long scan times, and sensitivity to motion. This study assessed the diagnostic performance of an ultrafast brain MR imaging protocol for evaluation of acute intracranial pathology in the emergency department and inpatient settings. MATERIALS AND METHODS: Sixty-six adult patients who underwent brain MR imaging in the emergency department and inpatient settings were included in the study. All patients underwent both the reference and the ultrafast brain MR protocols. Both brain MR imaging protocols consisted of T1-weighted, T2/T2*-weighted, FLAIR, and DWI sequences. The ultrafast MR images were reconstructed by using a machine-learning assisted framework. All images were reviewed by 2 blinded neuroradiologists. RESULTS: The average acquisition time was 2.1 minutes for the ultrafast brain MR protocol and 10 minutes for the reference brain MR protocol. There was 98.5% agreement on the main clinical diagnosis between the 2 protocols. In head-to-head comparison, the reference protocol was preferred in terms of image noise and geometric distortion (P < .05 for both). The ultrafast ms-EPI protocol was preferred over the reference protocol in terms of reduced motion artifacts (P < .01). Overall diagnostic quality was not significantly different between the 2 protocols (P > .05). CONCLUSIONS: The ultrafast brain MR imaging protocol provides high accuracy for evaluating acute pathology while only requiring a fraction of the scan time. Although there was greater image noise and geometric distortion on the ultrafast brain MR protocol images, there was significant reduction in motion artifacts with similar overall diagnostic quality between the 2 protocols.

No-Show Rates in a Urogynecology Clinic.

IMPORTANCE: No-show appointments, or scheduled appointments that patients do not attend without giving notice of cancellation, are a prevalent problem in the outpatient setting. OBJECTIVE: The objective of this study was to compare the proportion of patients by decades of life who "no-show" to their urogynecology appointments. STUDY DESIGN: This retrospective cohort included women 20 years and older who did not show to their urogynecologic clinical encounters at an academic practice between January 1, 2022, and December 31, 2022. Demographics and visit history were recorded. The primary outcome was the proportion of patients by decade of age who were a "no-show" to their appointments. All decades were compared with women in their 70s, the decade with the most patients seen. Secondary outcomes included descriptive data of patients. Descriptive statistics and χ2 analyses were used. RESULTS: The cohort of 450 no-show encounters (composed of 391 patients), out of 6729 encounters, demonstrated an overall no-show rate of 6.7%. Baseline demographics of "no-show" patients were 67.3% White and 27.4% Black. The odds of women in their 20s-50s who no-show was 2-3 times higher than women in their 70s (P < 0.01). The highest no-show rates occurred in 20s (12.6%) and 40s (11.8%). Forty-six patients missed multiple appointments. The odds of a Black patient having multiple no-shows was 3.15 times higher than the odds of a White patient. CONCLUSIONS: No-show rates are low in this urogynecology practice. Younger women are more likely to no-show. This knowledge can facilitate potential double bookings necessary for urgent appointments and to maximize resource utilization.

IWNeXt: an image-wavelet domain ConvNeXt-based network for self-supervised multi-contrast MRI reconstruction.

Objective.Multi-contrast magnetic resonance imaging (MC MRI) can obtain more comprehensive anatomical information of the same scanning object but requires a longer acquisition time than single-contrast MRI. To accelerate MC MRI speed, recent studies only collect partial k-space data of one modality (target contrast) to reconstruct the remaining non-sampled measurements using a deep learning-based model with the assistance of another fully sampled modality (reference contrast). However, MC MRI reconstruction mainly performs the image domain reconstruction with conventional CNN-based structures by full supervision. It ignores the prior information from reference contrast images in other sparse domains and requires fully sampled target contrast data. In addition, because of the limited receptive field, conventional CNN-based networks are difficult to build a high-quality non-local dependency.Approach.In the paper, we propose an Image-Wavelet domain ConvNeXt-based network (IWNeXt) for self-supervised MC MRI reconstruction. Firstly, INeXt and WNeXt based on ConvNeXt reconstruct undersampled target contrast data in the image domain and refine the initial reconstructed result in the wavelet domain respectively. To generate more tissue details in the refinement stage, reference contrast wavelet sub-bands are used as additional supplementary information for wavelet domain reconstruction. Then we design a novel attention ConvNeXt block for feature extraction, which can capture the non-local information of the MC image. Finally, the cross-domain consistency loss is designed for self-supervised learning. Especially, the frequency domain consistency loss deduces the non-sampled data, while the image and wavelet domain consistency loss retain more high-frequency information in the final reconstruction.Main results.Numerous experiments are conducted on the HCP dataset and the M4Raw dataset with different sampling trajectories. Compared with DuDoRNet, our model improves by 1.651 dB in the peak signal-to-noise ratio.Significance.IWNeXt is a potential cross-domain method that can enhance the accuracy of MC MRI reconstruction and reduce reliance on fully sampled target contrast images.

Enhancing compound confidence in suspect and non-target screening through machine learning-based retention time prediction.

The retention time (RT) of contaminants of emerging concern (CECs) in liquid chromatography-high-resolution mass spectrometry (LC-HRMS) is crucial for database matching in non-targeted screening (NTS) analysis. In this study, we developed a machine learning (ML) model to predict RTs of CECs in NTS analysis. Using 1051 CEC standards, we evaluated Random Forest (RF), XGBoost, Support Vector Regression (SVR), and Artificial Neural Network (ANN) with molecular fingerprints and chemical descriptors to establish an optimal model. The SVR model utilizing chemical descriptors resulted in good predictive capacity with R2ext = 0.850 and r2 = 0.925. The model was further validated through laboratory NTS compound characterization. When applied to examine CEC occurrence in a large wastewater treatment plant, we identified 40 level S1 CECs (confirmed structure by reference standard) and 234 level S2 compounds (probable structure by library spectrum match). The model predicted RTs for level S2 compounds, leading to the classification of 153 level S2 compounds with high confidence (ΔRT <2 min). The model served as a robust filtering mechanism within the analytical framework. This study emphasizes the importance of predicted RTs in NTS analysis and highlights the potential of prediction models. Our research introduces a workflow that enhances NTS analysis by utilizing RT prediction models to determine compound confidence levels.

The effects of mnemonic variability and spacing on memory over multiple timescales.

The memory benefit that arises from distributing learning over time rather than in consecutive sessions is one of the most robust effects in cognitive psychology. While prior work has mainly focused on repeated exposures to the same information, in the real world, mnemonic content is dynamic, with some pieces of information staying stable while others vary. Thus, open questions remain about the efficacy of the spacing effect in the face of variability in the mnemonic content. Here, in two experiments, we investigated the contributions of mnemonic variability and the timescale of spacing intervals, ranging from seconds to days, to long-term memory. For item memory, both mnemonic variability and spacing intervals were beneficial for memory; however, mnemonic variability was greater at shorter spacing intervals. In contrast, for associative memory, repetition rather than mnemonic variability was beneficial for memory, and spacing benefits only emerged in the absence of mnemonic variability. These results highlight a critical role for mnemonic variability and the timescale of spacing intervals in the spacing effect, bringing this classic memory paradigm into more ecologically valid contexts.

Association of Medicaid Reimbursement Policies with Provision of Long-Acting Reversible Contraception in the Postpartum Period, 2012-2018.

Background: To address reimbursement challenges associated with long-acting reversible contraception (LARC) in the postpartum period, state Medicaid programs have provided additional payments ("carve-outs"). Implementation has been heterogeneous, with states providing separate payments for the device only, procedure only, or both the device and procedure. Methods: Claims data were drawn from 210,994 deliveries in the United States between 2012 and 2018. Using generalized estimating equations, we assess the relationship between Medicaid carve-out policies and the likelihood of LARC placement at (1) 3 days postpartum, (2) 60 days postpartum, and (3) 1 year postpartum, in Medicaid and commercially insured populations. Results: Among Medicaid beneficiaries, the likelihood of receiving LARC was higher in states with any carve-out, compared with states without carve-outs, at 3 days (adjusted odds ratio [aOR] 1.49 [95% confidence interval: 1.33-1.67], p < 0.001), 60 days (aOR: 1.40 [95% CI: 1.35-1.46], p < 0.001), and 1 year postpartum (aOR: 1.15 [95% CI: 1.11-1.20], p < 0.001). Adjustments were made for geographic region, seasonality, and patient age. Heterogeneity was observed by carve-out type; device carve-outs were consistently associated with greater likelihood of postpartum LARC placement, compared with states with no carve-outs. Similar trends were observed among commercially insured patients. Conclusion: Findings support the effectiveness of Medicaid carve-outs on postpartum LARC provision, particularly for device carve-outs, which were associated with increased postpartum LARC placement at 3 days, 60 days, and 1 year postpartum. This outcome suggests that policies to address cost-related barriers associated with LARC devices may prove most useful in overcoming barriers to immediate postpartum LARC placement, with the overarching aim of promoting reproductive autonomy.

Nocturnal Pressure Controlled Ventilation Improves Sleep Efficiency in Patients Receiving Mechanical Ventilation.

BACKGROUND: Patients receiving mechanical ventilation commonly experience sleep fragmentation. The present meta-analysis compared the effects of pressure controlled ventilation (PCV) and pressure support ventilation (PSV) on sleep quality. METHODS: We conducted a search of the PubMed, Embase, and Cochrane Library databases for studies published before November 2023. In this meta-analysis, individual effect sizes were standardized, and the pooled effect size was determined by using random-effects models. The primary outcome was sleep efficiency. The secondary outcomes were wakefulness, percentages of REM (rapid eye movement) sleep and stages 3 and 4 non-REM sleep, the fragmentation index, and the incidence of apneic events. RESULTS: This meta-analysis examined 4 trials that involved 67 subjects. Sleep efficiency was significantly higher in the PCV group than in the PSV group (mean difference 15.57%, 95% CI 8.54%-22.59%). Wakefulness was significantly lower in the PCV group than in the PSV group (mean difference -18.67%, 95% CI -30.29% to -7.04%). The percentage of REM sleep was significantly higher in the PCV group than in the PSV group (mean difference 2.32%, 95% CI 0.20%-4.45%). Among the subjects with a tendency to develop sleep apnea, the fragmentation index was significantly lower in those receiving PCV than PSV (mean difference -40.00%, 95% CI -51.12% to -28.88%). The incidence of apneic events was significantly lower in the PCV group than in the PSV group (risk ratio 0.06, 95% CI 0.01-0.45). CONCLUSIONS: Compared with PSV, PCV may improve sleep quality in patients receiving nocturnal mechanical ventilation.

Enzymatic extraction of anthocyanins from the pomace of aronia (Aronia melanocarpa).

Efficient extraction of natural pigments is a key focus in enhancing the utilization of by-products for applications in the food industry. In this study, an enzymatic extraction method using Pectinex Ultra SP-L, Pectinex XXL, Novoshape, and Celluclast was used to investigate natural pigment production from the pomace of aronia, a commercially important plant. The method's performance was monitored using high-performance liquid chromatography with diode-array detection by measuring total and individual anthocyanin levels. Pectinex XXL (0.5%) yielded the highest total anthocyanin extraction (2082.41 ± 85.69 mg/100 g) in the single enzyme treatment, followed by Pectinex Ultra SP-L (0.05%), Celluclast (0.01%), and Novoshape (0.1%). Combining Pectinex XXL (0.25%) with Celluclast (0.01%) increased the extraction ratio of total anthocyanins (2 323.04 ± 61.32 mg/100 g) by ∼50.7% compared with that obtained using the solvent extraction method. This study demonstrated an effective enzymatic extraction method for application in the food industry.

Short and long term effect of anti-reflux mucosectomy with cap-assisted endoscopic mucosal resection for refractory gastroesophageal disease.

BACKGROUND AND AIMS: Anti-reflux mucosectomy with cap-assisted endoscopic mucosal resection (ARMS-C) is a safe and effective treatment for managing refractory gastroesophageal reflux disease (GERD). This study aimed to investigate the short and long-term outcomes of ARMS-C. METHODS: This study was conducted from 2018 to 2022, during which 115 eligible patients underwent ARMS-C. The primary endpoints of this study were to evaluate the GERD-Q questionnaire score and determine the number of patients who reduced their proton pump inhibitor (PPI) dosage or discontinued PPI usage. The secondary endpoints included the evaluation of the DeMeester score, acid exposure time (AET), gastroesophageal flap valve grade (GEFV), lower esophageal sphincter pressure, the rate of successful esophageal peristalsis, and GERD-Q questionnaires. Additionally, we analyzed the long-term efficacy of ARMS-C. RESULTS: Out of the 120 patients, 115 underwent ARMS-C, 96 were followed up for at least six months after the procedure, and 22 were followed up for at least two years. The primary outcome showed a significant improvement in GERD-Q scores, decreasing from 10.67 to 7.55 (p < 0.001). Out of the 96 patients, 36 were able to reduce or completely stop using PPIs. The DeMeester score, GEFV, AET, and the proportion of intact peristalsis also demonstrated improvement. As for the long-term efficacy of ARMS-C, 86% of patients showed improvement in symptoms, and no serious adverse effects were reported after the procedure. CONCLUSION: ARMS-C is a safe and effective endoscopic technique to treat refractory GERD patients.

Current Status of Anti-Reflux Surgery as a Treatment for GERD.

Anti-reflux surgery (ARS) is an efficient treatment option for gastroesophageal reflux disease (GERD). Despite growing evidence of the efficacy and safety of ARS, medications including proton pump inhibitors (PPIs) remain the most commonly administered treatments for GERD. Meanwhile, ARS can be an effective treatment option for patients who need medications continuously or for those who are refractory to PPI treatment, if proper candidates are selected. However, in practice, ARS is often regarded as a last resort for patients who are unresponsive to PPIs. Accumulating ARS-related studies indicate that surgery is equivalent to or better than medical treatment for controlling typical and atypical GERD symptoms. Furthermore, because of overall reduced medication expenses, ARS may be more cost-effective than PPI. Patients are selected for ARS based on endoscopic findings, esophageal acid exposure time, and PPI responsiveness. Although there is limited evidence, ARS may be expanded to include patients with normal acid exposure, such as those with reflux hypersensitivity. Additionally, other factors such as age, body mass index, and comorbidities are known to affect ARS outcomes; and such factors should be considered. Nissen fundoplication or partial fundoplication including Dor fundoplication and Toupet fundoplication can be chosen, depending on whether the patient prioritizes symptom improvement or minimizing postoperative symptoms such as dysphagia. Furthermore, efforts to reduce and manage postoperative complications and create awareness of the long-term efficacy and safety of the ARS are recommended, as well as adequate training programs for new surgeons.

Positive affect and heart rate variability: a dynamic analysis.

Traditional survey methods can provide noisy data arising from recall, memory and other biases. Technological advances (particularly in neuroscience) are opening new ways of monitoring physiological processes through non-intrusive means. Such dense continuous data provide new and fruitful avenues for complementing self-reported data with a better understanding of human dynamics and human interactions. In this study, we use a survey to collect positive affect (feelings) data from more than 300 individuals over a period of 24 h, and at the same time, map their core activities (5000 recorded activities in total) with measurements of their heart rate variability (HRV). Our results indicate a robust correlation between the HRV measurements and self-reported affect. By drawing on the neuroscience and wellbeing literature we show that dynamic HRV results are what we expect for positive affect, particularly when performing activities like sleep, travel, work, exercise and eating. This research provides new insights into how to collect HRV data, model and interpret it.