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Deep learning (DL)-based Human Activity Recognition (HAR) using wearable inertial measurement unit (IMU) sensors can revolutionize continuous health monitoring and early disease prediction. However, most DL HAR models are untested in their robustness to real-world variability, as they are trained on limited lab-controlled data. In this study, we isolated and analyzed the effects of the subject, device, position, and orientation variabilities on DL HAR models using the HARVAR and REALDISP datasets. The Maximum Mean Discrepancy (MMD) was used to quantify shifts in the data distribution caused by these variabilities, and the relationship between the distribution shifts and model performance was drawn. Our HARVAR results show that different types of variability significantly degraded the DL model performance, with an inverse relationship between the data distribution shifts and performance. The compounding effect of multiple variabilities studied using REALDISP further underscores the challenges of generalizing DL HAR models to real-world conditions. Analyzing these impacts highlights the need for more robust models that generalize effectively to real-world settings. The MMD proved valuable for explaining the performance drops, emphasizing its utility in evaluating distribution shifts in HAR data.

In this paper, we address Zero-shot learning for sensor activity recognition using word embeddings. The goal of Zero-shot learning is to estimate an unknown activity class (i.e., an activity that does not exist in a given training dataset) by learning to recognize components of activities expressed in semantic vectors. The existing zero-shot methods use mainly 2 kinds of representation as semantic vectors, attribute vector and embedding word vector. However, few zero-shot activity recognition methods based on embedding vector have been studied; especially for sensor-based activity recognition, no such studies exist, to the best of our knowledge. In this paper, we compare and thoroughly evaluate the Zero-shot method with different semantic vectors: (1) attribute vector, (2) embedding vector, and (3) expanded embedding vector and analyze their correlation to performance. Our results indicate that the performance of the three spaces is similar but the use of word embedding leads to a more efficient method, since this type of semantic vector can be generated automatically. Moreover, our suggested method achieved higher accuracy than attribute-vector methods, in cases when there exist similar information in both the given sensor data and in the semantic vector; the results of this study help select suitable classes and sensor data to build a training dataset.

BackgroundUlcerative colitis (UC) has a large impact on patients' lives. Clinical course studies of population-based cohorts contribute to our understanding of the disease as it progresses. We reviewed the clinical course of UC as reported in adult population-based longitudinal cohort studies.MethodsA MEDLINE literature search to identify all adult population-based studies published up to June 2010 with data on the clinical course of UC was performed. Demographic and clinical data were reviewed.ResultsTwenty-two studies reporting data from seven prospective longitudinal cohorts were identified. Extension from initial location varied from 10%–19% of the patients after 5 years of disease and from 11%–28% after 10 years in two of the cohorts. Disease activity appeared to improve over the disease course. The majority of patients had relapses in the first years of disease. The cumulative relapse rate varied from 67%–83% after 10 years of disease. From 1962–2004 a decreasing trend in the proportion of colectomies was observed. Most colectomies were performed during the first 2 years of disease and in patients with pancolitis. Salycilates were the most consumed medication followed by systemic steroids, immunosuppressors, and antitumor necrosis factors, with the latter two showing a substantial increased intake over time. Mortality increased with disease duration.ConclusionsThis review shows how the clinical course of UC has changed over time and alerts to the need for more prospective cohort studies to evaluate long-term outcomes especially to study the impact of biologic agents on UC.

Crohn's disease (CD) is a chronic inflammatory bowel disease known to carry a high risk of disabling and many times requiring surgical interventions. This article describes a decision-tree based approach that defines the CD patients' risk or undergoing disabling events, surgical interventions and reoperations, based on clinical and demographic variables. This multicentric study involved 1547 CD patients retrospectively enrolled and divided into two cohorts: a derivation one (80%) and a validation one (20%). Decision trees were built upon applying the CHAIRT algorithm for the selection of variables. Three-level decision trees were built for the risk of disabling and reoperation, whereas the risk of surgery was described in a two-level one. A receiver operating characteristic (ROC) analysis was performed, and the area under the curves (AUC) Was higher than 70% for all outcomes. The defined risk cut-off values show usefulness for the assessed outcomes: risk levels above 75% for disabling had an odds test positivity of 4.06 [3.50-4.71], whereas risk levels below 34% and 19% excluded surgery and reoperation with an odds test negativity of 0.15 [0.09-0.25] and 0.50 [0.24-1.01], respectively. Overall, patients with B2 or B3 phenotype had a higher proportion of disabling disease and surgery, while patients with later introduction of pharmacological therapeutic (1 months after initial surgery) had a higher proportion of reoperation. The decision-tree based approach used in this study, with demographic and clinical variables, has shown to be a valid and useful approach to depict such risks of disabling, surgery and reoperation.

Inflammation is the driving force in inflammatory bowel disease (IBD) and its link to oxidative stress and carcinogenesis has long been accepted. The antioxidant system of the intestinal mucosa in IBD is compromised resulting in increased oxidative injury. This defective antioxidant system may be the result of genetic variants in antioxidant genes, which can represent susceptibility factors for IBD, namely Crohn's disease (CD) and ulcerative colitis (UC). Single nucleotide polymorphisms (SNPs) in the antioxidant genes SOD2 (rs4880) and GPX1 (rs1050450) were genotyped in a Portuguese population comprising 436 Crohn's disease and 367 ulcerative colitis patients, and 434 healthy controls. We found that the AA genotype in GPX1 is associated with ulcerative colitis (OR = 1.93, adjusted P-value = 0.037). Moreover, we found nominal significant associations between SOD2 and Crohn's disease susceptibility and disease subphenotypes but these did not withstand the correction for multiple testing. These findings indicate a possible link between disease phenotypes and antioxidant genes. These results suggest a potential role for antioxidant genes in IBD pathogenesis and should be considered in future association studies.

Abstract Background: Inflammatory bowel diseases’ (IBD) increasing incidence and prevalence place a heavy health and economic burden on society. Objectives: This study assesses the burden and cost of IBD in Portugal to support the definition of health policies, resource allocation, and patient care. Methods: The burden of disease was expressed using disability-adjusted life years (DALY). Costs were estimated considering the societal perspective, using a prevalence-based model and prices established by law. An expert panel composed of 5 expert Portuguese gastroenterologists and a patient-reported study were conducted to support the cost analysis and fill in information gaps. Results: In Portugal, with a prevalence of 24,069 IBD patients and an incidence of 15/100,000, the burden of disease was estimated at 6,067 DALYs: 507 resulting from premature deaths and 5,560 from disability. Total cost was estimated at EUR 146 million per year, with direct costs representing 59%. Average yearly cost per IBD patient is EUR 6,075, where 60% is related to Crohn’s disease and 40% to ulcerative colitis (UC). Conclusion: This study estimates the annual health burden and cost of IBD in Portugal, thus generating information with the intent to raise awareness of the need to advance health policies as well as better clinical and economic decisions in this pathology.

Background and Aim: Aeromonas are Gram-negative rods known to cause a spectrum of diseases. Inflammatory bowel disease (IBD) is an idiopathic complex condition resulting from interaction of multiple factors. Aeromonas infection in association with IBD is still largely unknown. We aim to look for the significance of Aeromonas infection and for significant differences between IBD and non-IBD patients. Methods: A retrospective observational analysis was performed of all patients positive for Aeromonas in stool cultures, during a 10-year period, from a tertiary and university hospital. Results: Fifty patients were included, 56% male with a mean age of 42.1 years. Thirty-eight (76%) were non-IBD and 12 (24%) IBD patients. IBD patients were more frequently under immunosuppressors. Two patients were asymptomatic and 44% developed mild, 44% moderate, and 16.7% severe infection. The main strains isolated were Aeromonas hydrophila/caviae. Bacterial co-isolation was found in 4 non-IBD and histological findings of cytomegalovirus in 2 IBD patients. Non-IBD patients presented more frequently with fever and IBD patients with bloody diarrhea and abdominal pain. There was higher tendency for severe infection rate in IBD patients with higher antimicrobial therapy use. Steroids were exclusively used in the IBD group. From IBD, 4 patients had the diagnosis of ulcerative colitis and 9 of Crohn’s disease with colonic involvement. Of these patients, 5 received IBD diagnosis after the acute episode of Aeromonas infection. Conclusions: Clinical presentation of Aeromonas infection differs between IBD and non-IBD patients. Non-IBD patients had milder severity of infection with less use of antibiotics. Aeromonas infection seems to greatly contribute to IBD manifestation.

Inflammatory bowel disease (IBD) is increasingly prevalent within western societies. Its complex and chronic facets in addition to its increasing prevalence place a great economic burden on our healthcare systems. Our aim was to estimate the national prevalence of IBD through predictive models. We used prevalence data which spans the years 2003–2007 to estimate prevalence until 2030 by means of four forecasting methods. Prevalence rates are estimated to be 4–6-times higher in 2030 when compared with 2003 with an average annual percent change of 5%. IBD is poised to have a substantial impact on healthcare systems in the near future, given its rapidly increasing prevalence. Forecasting methods will allow for a proactive stance on the development of health policies that will be needed to provide high quality and cost-effective care to these patients, while ensuring the economic viability of healthcare systems.

Background: This systematic review and meta-analysis aims to assess composite and aggregate outcomes of observational studies in Crohn’s disease and to evaluate whether the number and type of variables included affect the frequency of the outcome. Methods: MEDLINE [via PubMed], Scopus and Web of Science were searched to identify observational studies that enrolled patients with Crohn’s disease and evaluated a composite or aggregate outcome. The proportion of patients achieving the outcome was determined and a random-effects meta-analysis was performed to evaluate how the frequency of each outcome varies according to the reporting of predefined variables. Results: From 10,257 identified records, 46 were included in the qualitative analysis and 38 in the meta-analysis. The frequency for composite and aggregate outcomes was 0.445 [95% confidence interval (CI): 0.389–0.501] and 0.140 (95% CI: 0.000–0.211), respectively. When comparing composite outcomes by number of included variables, the frequency was 0.271 (95% CI: 0.000–0.405) and 0.698 (95% CI: 0.651–0.746), for one and six variables, respectively. The frequency of the composite outcome varied according to the identity of the variables being reported. Specific pairs of predefined variables had a significant effect in the frequency of composite outcomes. Conclusion: Composite outcomes with increasing number of predefined variables show an increase in frequency. Outcomes including variables such as ‘Surgery’ and ‘Steroids’ had higher frequencies when compared with the ones that did not include these variables. These results show that the frequency of composite outcomes is dependent on the number and type of variables being reported.

Introduction:Although patient-centered care can be found in the mission statement of nearly every hospital, it is not always put into practice, and COVID-19 brings new challenges even to the best-organized hospitals and well-developed health care systems. Methods:In the current COVID-19 pandemic, inflammatory bowel disease (IBD) patients have a potentially higher risk of complications from this infectious disease due to the use of immunosuppressant and/or biologic treatments and due to flares of this chronic illness, which often require urgent care and sometimes hospitalization. Moreover, patients undergoing biologic intravenous (IV) treatment visit the hospital for scheduled IV infusions. Discussion: In hospitals like ours, where COVID-19 patients are treated, the organization of “clean circuits” is essential to minimize the risks of infection for non-COVID-19 patients, such as patients in IBD infusion units. In our hospital, the IBD infusion unit is located within the gastroenterology department, which, under normal circumstances, is very advantageous for patients but in the current context is not. Our goal was to maximize adherence to biologic IV treatment and clinical safety at a time of profound changes in gastroenterology activity and in a department with daily increases in the number of COVID-19 patients. Conclusion:To this end, we initiated proactive COVID-19 testing in IBD patients undergoing biologic IV treatment and changed the location of the infusion unit to a “COVID-free” institution, maintaining the care of these patients by the dedicated IBD team of our department. The purpose of this report is to show that a patient-centered care strategy allowed us to reach very high levels of patient comfort, satisfaction, and compliance with therapeutics.