Big data is a concept that deals with large or complex data sets by using data analysis tools(e.g.,data mining,machine learning)to analyze information extracted from several sources systematically.Big data has attract...Big data is a concept that deals with large or complex data sets by using data analysis tools(e.g.,data mining,machine learning)to analyze information extracted from several sources systematically.Big data has attracted wide attention from academia,for example,in supporting patients and health professionals by improving the accuracy of decision-making,diagnosis and disease prediction.This research aimed to perform a Bibliometric Performance and Network Analysis(BPNA)supported by a Scoping Review(SR)to depict the strategic themes,thematic evolution structure,main challenges and opportunities related to the concept of big data applied in the healthcare sector.With this goal in mind,4857 documents from the Web of Science covering the period between 2009 to June 2020 were analyzed with the support of SciMAT software.The bibliometric performance showed the number of publications and citations over time,scientific productivity and the geographic distribution of publications and research fields.The strategic diagram yielded 20 clusters and their relative importance in terms of centrality and density.The thematic evolution structure presented the most important themes and how it changes over time.Lastly,we presented the main challenges and future opportunities of big data in healthcare.展开更多
Internet of Things(IoT)is a key technology trend that supports our digitalized society in applications such as smart countries and smart cities.In this study,we investigate the existing strategic themes,thematic evolu...Internet of Things(IoT)is a key technology trend that supports our digitalized society in applications such as smart countries and smart cities.In this study,we investigate the existing strategic themes,thematic evolution structure,key challenges,and potential research opportunities associated with the IoT.For this study,we conduct a Bibliometric Performance and Network Analysis(BPNA),supplemented by an exhaustive Systematic Literature Review(SLR).Specifically,in BPNA,the software SciMAT is used to analyze 14,385 documents and 30,381 keywords in the Web of Science(WoS)database,which was released between 2002 and 2019.The results reveal that 31 clusters are classified according to their importance and development,and the conceptual structures of key clusters are presented,along with their performance analysis and the relationship with other subthemes.The thematic evolution structure describes the important cluster(s)over time.For the SLR,23 documents are analyzed.The SLR reveals key challenges and limitations associated with the IoT.We expect the results will form the basis of future research and guide decision-making in the IoT and other supporting industries.展开更多
The intestinal tract(i.e.,the gut),is where the body’s nutrients are absorbed,and is simultaneously inhabited by numerous microbes.An increasing body of literature suggests a crucial role for the gut microbiome in mo...The intestinal tract(i.e.,the gut),is where the body’s nutrients are absorbed,and is simultaneously inhabited by numerous microbes.An increasing body of literature suggests a crucial role for the gut microbiome in modulating systemic inflammatory disease.Psoriasis is a chronic systemic inflammatory disease and its pathogenesis is related to the interaction between genetic susceptibility,immune response and environmental triggers.The omics era has allowed physicians to assess different aspects of psoriasis pathogenesis such as the microbiome,infectome,and autoinfectome.Furthermore,diet appears to play an important role in modulating disease activity,perhaps by influencing gut microbes.Given these observations,we aimed to summarize the current knowledge regarding skin-microbiome-gut-nutrients and psoriasis.展开更多
With the emergence of SARS-CoV-2,various non-pharmaceutical interventions were adopted to control virus transmission,including school closures.Subsequently,the introduction of vaccines mitigated not only disease sever...With the emergence of SARS-CoV-2,various non-pharmaceutical interventions were adopted to control virus transmission,including school closures.Subsequently,the introduction of vaccines mitigated not only disease severity but also the spread of SARSCoV-2.This study leveraged an adapted SIR model and non-linear mixed-effects modeling to quantify the impact of remote learning,school holidays,the emergence of Variants of Concern(VOCs),and the role of vaccinations in controlling SARS-CoV-2 spread across 16 German federal states with an age-stratified approach.Findings highlight a significant inverse correlation(Spearman's ρ=0.92,p<0.001)between vaccination rates and peak incidence rates across all age groups.Model-parameter estimation using the observed number of cases stratified by federal state and age allowed to assess the effects of school closure and holidays,considering adjustments for vaccinations and spread of VOCs over time.Here,modeling revealed significant(p<0.001)differences in the virus's spread among pre-school children(0-4),children(5-11),adolescents(12-17),adults(18-59),and the elderly(60+).The transition to remote learning emerged as a critical measure in significantly reducing infection rates among children and adolescents(p<0.001),whereas an increased infection risk was noted among the elderly during these periods,suggesting a shift in infection networks due to altered caregiving roles.Conversely,during school holiday periods,infection rates among adolescents mirrored those observed when schools were open.Simulation exercises based on the model provided evidence that COVID-19 vaccinations might serve a dual purpose:they protect the vaccinated individuals and contribute to the broader community's safety.展开更多
The basic reproduction number of an infectious agent is the average number of infections one case can generate over the course of the infectious period,in a naïve,uninfected population.It is well-known that the e...The basic reproduction number of an infectious agent is the average number of infections one case can generate over the course of the infectious period,in a naïve,uninfected population.It is well-known that the estimation of this number may vary due to several methodological issues,including different assumptions and choice of parameters,utilized models,used datasets and estimation period.With the spreading of the novel coronavirus(2019-nCoV)infection,the reproduction number has been found to vary,reflecting the dynamics of transmission of the coronavirus outbreak as well as the case reporting rate.Due to significant variations in the control strategies,which have been changing over time,and thanks to the introduction of detection technologies that have been rapidly improved,enabling to shorten the time from infection/symptoms onset to diagnosis,leading to faster confirmation of the new coronavirus cases,our previous estimations on the transmission risk of the 2019-nCoV need to be revised.By using time-dependent contact and diagnose rates,we refit our previously proposed dynamics transmission model to the data available until January 29th,2020 and re-estimated the effective daily reproduction ratio that better quantifies the evolution of the interventions.We estimated when the effective daily reproduction ratio has fallen below 1 and when the epidemics will peak.Our updated findings suggest that the best measure is persistent and strict self-isolation.The epidemics will continue to grow,and can peak soon with the peak time depending highly on the public health interventions practically implemented.展开更多
Background:The 2014 Ebola epidemic in West Africa has attracted public interest worldwide,leading to millions of Ebola-related Internet searches being performed during the period of the epidemic.This study aimed to ev...Background:The 2014 Ebola epidemic in West Africa has attracted public interest worldwide,leading to millions of Ebola-related Internet searches being performed during the period of the epidemic.This study aimed to evaluate and interpret Google search queries for terms related to the Ebola outbreak both at the global level and in all countries where primary cases of Ebola occurred.The study also endeavoured to look at the correlation between the number of overall and weekly web searches and the number of overall and weekly new cases of Ebola.Methods:Google Trends(GT)was used to explore Internet activity related to Ebola.The study period was from 29 December 2013 to 14 June 2015.Pearson’s correlation was performed to correlate Ebola-related relative search volumes(RSVs)with the number of weekly and overall Ebola cases.Multivariate regression was performed using Ebola-related RSV as a dependent variable,and the overall number of Ebola cases and the Human Development Index were used as predictor variables.Results:The greatest RSV was registered in the three West African countries mainly affected by the Ebola epidemic.The queries varied in the different countries.Both quantitative and qualitative differences between the affected African countries and other Western countries with primary cases were noted,in relation to the different flux volumes and different time courses.In the affected African countries,web query search volumes were mostly concentrated in the capital areas.However,in Western countries,web queries were uniformly distributed over the national territory.In terms of the three countries mainly affected by the Ebola epidemic,the correlation between the number of new weekly cases of Ebola and the weekly GT index varied from weak to moderate.The correlation between the number of Ebola cases registered in all countries during the study period and the GT index was very high.Conclusion:Google Trends showed a coarse-grained nature,strongly correlating with global epidemiological data,but was weaker at country level,as it was prone to distortions induced by unbalanced media coverage and the digital divide.Global and local health agencies could usefully exploit GT data to identify disease-related information needs and plan proper communication strategies,particularly in the case of health-threatening events.展开更多
Atopic dermatitis is a chronic,relapsing,non-contiguous,exudative eczema/dermatitis,which represents a complex,multi-factorial disorder,due to an impairment of the stratum corneum barrier.Currently available drugs hav...Atopic dermatitis is a chronic,relapsing,non-contiguous,exudative eczema/dermatitis,which represents a complex,multi-factorial disorder,due to an impairment of the stratum corneum barrier.Currently available drugs have a low skin bioavailability and may give rise to severe adverse events.Nanotechnologies,including nanoparticles,liposomes,nano-gels,nano-mixtures,nano-emulsions and other nano-carriers,offer unprecedented solutions to these issues,enabling:i)the management of different clinical forms of atopic dermatitis,especially the recalcitrant ones,i)a better bio-availability and trans-dermal drug targeted delivery at the inflammation site,ii)dose control,iii)significant improvements both in clinical symptoms and immune responses,iv)with less adverse events being reported and a better safety profile.However,some nano-sized structures could amplify and even worsen symptoms in particularly susceptible individuals.Furthermore,most studies included in the present systematic review have been conducted in-vitro or in-vivo,with few randomized controlled clinical trials(RCTs).Future investigations should adopt this design in order to enable scholars achieving robust findings and evidence.Therefore,given the above-mentioned shortcomings,further research in the field is urgently warranted.展开更多
Background:After the declaration of COVID-19 pandemic on March 11th,2020,local transmission chains starting in different countries including Canada are forcing governments to take decisions on public health interventi...Background:After the declaration of COVID-19 pandemic on March 11th,2020,local transmission chains starting in different countries including Canada are forcing governments to take decisions on public health interventions to mitigate the spread of the epidemic.Methods:We conduct data-driven and model-free estimations for the growth rates of the COVID-19 epidemics in Italy and Canada,by fitting an exponential curve to the daily reported cases.We use these estimates to predict epidemic trends in Canada under different scenarios of public health interventions.Results:In Italy,the initial growth rate(0.22)has reduced to 0.1 two weeks after the lockdown of the country on March 8th,2020.This corresponds to an increase of the doubling time from about 3.15 to almost 7 days.In comparison,the growth rate in Canada has increased from 0.13 between March 1st and 13th,to 0.25 between March 13th to 22nd.This current growth rate corresponds to a doubling time of 2.7 days,and therefore,unless further public health interventions are escalated in Canada,we project 15,000 cases by March 31st.However,the case number may be reduced to 4000 if escalated public health interventions could instantly reduce the growth rate to 0.1,the same level achieved in Italy.Interpretation:Prompt and farsighted interventions are critical to counteract the very rapid initial growth of the COVID-19 epidemic in Canada.Mitigation plans must take into account the delayed effect of interventions by up to 2-weeks and the short doubling time of 3e4 days.展开更多
Background:Street children are forced to spend a lot of time away from their homes and some of them do not have homes at all,due to economic and family problems,which makes them exposed to many health problems,such as...Background:Street children are forced to spend a lot of time away from their homes and some of them do not have homes at all,due to economic and family problems,which makes them exposed to many health problems,such as the hepatitis C virus(HCV)infection.Iran,like many other countries in the world,experiences the burden of street children,however,the rate of HCV among street children is virtually unknown.This study aimed to determine the prevalence of HCV among street children in Iran.Main body:This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.The study protocol of this review was registered in PROSPERO under identification term CRD42018082336.A comprehensive literature search was conducted to identify published studies reporting on the prevalence of HCV among street children in Iran.Several international scholarly databases,including Web of Science,PubMed^(■)/MEDLINE^(■),Embase,Scopus®,Google Scholar and Directory of Open Access Journals,as well as Iranian databases such as MagIran and Barakathns were searched.Studies published between 1988 and December 2017 with any of the following keywords were selected:(street OR homeless OR labour)AND(children OR child OR infant)AND(hepatitis C OR hepatitis C virus OR HCV OR viral hepatitis OR hepatitis OR hepacivirus)AND Iran.Moreover,a grey literature search was performed in order to obtain other potentially relevant studies.The search was carried out without any language restrictions.Four studies,surveying a total of 1691 street children,conducted between 2006 and 2017 were found to be eligible for inclusion in the review and therefore analysed.Three studies were conducted in Tehran and one in Isfahan.The prevalence of HCV among street children in Iran was found to be high,at 2.4%(95%CI:1.8-3.3).Conclusions:Since the prevalence of HCV among street children in Iran is quite high,health decision-and policy-makers should pay more attention to street children and widen support channels,both social and economic.Further studies should be conducted among street children in different cities of Iran to add to the knowledge base of HCV among street children in the country.The health system should provide facilities for street children to be screened to quickly diagnose illnesses and prevent them from developing complications.展开更多
基金financed in part by the Coordenacao de Aperfeicoamento de Pessoal de Nível Superior-Brazil(CAPES)-Finance Code 001the Spanish Ministry of Science and Innovation under grants PID2019-105381 GA-100(iScience).
文摘Big data is a concept that deals with large or complex data sets by using data analysis tools(e.g.,data mining,machine learning)to analyze information extracted from several sources systematically.Big data has attracted wide attention from academia,for example,in supporting patients and health professionals by improving the accuracy of decision-making,diagnosis and disease prediction.This research aimed to perform a Bibliometric Performance and Network Analysis(BPNA)supported by a Scoping Review(SR)to depict the strategic themes,thematic evolution structure,main challenges and opportunities related to the concept of big data applied in the healthcare sector.With this goal in mind,4857 documents from the Web of Science covering the period between 2009 to June 2020 were analyzed with the support of SciMAT software.The bibliometric performance showed the number of publications and citations over time,scientific productivity and the geographic distribution of publications and research fields.The strategic diagram yielded 20 clusters and their relative importance in terms of centrality and density.The thematic evolution structure presented the most important themes and how it changes over time.Lastly,we presented the main challenges and future opportunities of big data in healthcare.
基金financed in part by the Coordenaçao de Aperfeiçoamento de Pessoal de Nível Superior-Brazil(CAPES)-Finance Code 001 and the Spanish Ministry of Science and Innovation under grants PID2019-105381 GA-100(iScience)。
文摘Internet of Things(IoT)is a key technology trend that supports our digitalized society in applications such as smart countries and smart cities.In this study,we investigate the existing strategic themes,thematic evolution structure,key challenges,and potential research opportunities associated with the IoT.For this study,we conduct a Bibliometric Performance and Network Analysis(BPNA),supplemented by an exhaustive Systematic Literature Review(SLR).Specifically,in BPNA,the software SciMAT is used to analyze 14,385 documents and 30,381 keywords in the Web of Science(WoS)database,which was released between 2002 and 2019.The results reveal that 31 clusters are classified according to their importance and development,and the conceptual structures of key clusters are presented,along with their performance analysis and the relationship with other subthemes.The thematic evolution structure describes the important cluster(s)over time.For the SLR,23 documents are analyzed.The SLR reveals key challenges and limitations associated with the IoT.We expect the results will form the basis of future research and guide decision-making in the IoT and other supporting industries.
文摘The intestinal tract(i.e.,the gut),is where the body’s nutrients are absorbed,and is simultaneously inhabited by numerous microbes.An increasing body of literature suggests a crucial role for the gut microbiome in modulating systemic inflammatory disease.Psoriasis is a chronic systemic inflammatory disease and its pathogenesis is related to the interaction between genetic susceptibility,immune response and environmental triggers.The omics era has allowed physicians to assess different aspects of psoriasis pathogenesis such as the microbiome,infectome,and autoinfectome.Furthermore,diet appears to play an important role in modulating disease activity,perhaps by influencing gut microbes.Given these observations,we aimed to summarize the current knowledge regarding skin-microbiome-gut-nutrients and psoriasis.
基金funded by the European Union Horizon 2021 EUVABECO(grant 101132545).
文摘With the emergence of SARS-CoV-2,various non-pharmaceutical interventions were adopted to control virus transmission,including school closures.Subsequently,the introduction of vaccines mitigated not only disease severity but also the spread of SARSCoV-2.This study leveraged an adapted SIR model and non-linear mixed-effects modeling to quantify the impact of remote learning,school holidays,the emergence of Variants of Concern(VOCs),and the role of vaccinations in controlling SARS-CoV-2 spread across 16 German federal states with an age-stratified approach.Findings highlight a significant inverse correlation(Spearman's ρ=0.92,p<0.001)between vaccination rates and peak incidence rates across all age groups.Model-parameter estimation using the observed number of cases stratified by federal state and age allowed to assess the effects of school closure and holidays,considering adjustments for vaccinations and spread of VOCs over time.Here,modeling revealed significant(p<0.001)differences in the virus's spread among pre-school children(0-4),children(5-11),adolescents(12-17),adults(18-59),and the elderly(60+).The transition to remote learning emerged as a critical measure in significantly reducing infection rates among children and adolescents(p<0.001),whereas an increased infection risk was noted among the elderly during these periods,suggesting a shift in infection networks due to altered caregiving roles.Conversely,during school holiday periods,infection rates among adolescents mirrored those observed when schools were open.Simulation exercises based on the model provided evidence that COVID-19 vaccinations might serve a dual purpose:they protect the vaccinated individuals and contribute to the broader community's safety.
基金This research was funded by the National Natural Science Foundation of China(grant numbers:11631012(YX,ST),61772017(ST))by the Canada Research Chair Program(grant number:230720(JW)the Natural Sciences and Engineering Research Council of Canada(Grant number:105588-2011(JW).
文摘The basic reproduction number of an infectious agent is the average number of infections one case can generate over the course of the infectious period,in a naïve,uninfected population.It is well-known that the estimation of this number may vary due to several methodological issues,including different assumptions and choice of parameters,utilized models,used datasets and estimation period.With the spreading of the novel coronavirus(2019-nCoV)infection,the reproduction number has been found to vary,reflecting the dynamics of transmission of the coronavirus outbreak as well as the case reporting rate.Due to significant variations in the control strategies,which have been changing over time,and thanks to the introduction of detection technologies that have been rapidly improved,enabling to shorten the time from infection/symptoms onset to diagnosis,leading to faster confirmation of the new coronavirus cases,our previous estimations on the transmission risk of the 2019-nCoV need to be revised.By using time-dependent contact and diagnose rates,we refit our previously proposed dynamics transmission model to the data available until January 29th,2020 and re-estimated the effective daily reproduction ratio that better quantifies the evolution of the interventions.We estimated when the effective daily reproduction ratio has fallen below 1 and when the epidemics will peak.Our updated findings suggest that the best measure is persistent and strict self-isolation.The epidemics will continue to grow,and can peak soon with the peak time depending highly on the public health interventions practically implemented.
文摘Background:The 2014 Ebola epidemic in West Africa has attracted public interest worldwide,leading to millions of Ebola-related Internet searches being performed during the period of the epidemic.This study aimed to evaluate and interpret Google search queries for terms related to the Ebola outbreak both at the global level and in all countries where primary cases of Ebola occurred.The study also endeavoured to look at the correlation between the number of overall and weekly web searches and the number of overall and weekly new cases of Ebola.Methods:Google Trends(GT)was used to explore Internet activity related to Ebola.The study period was from 29 December 2013 to 14 June 2015.Pearson’s correlation was performed to correlate Ebola-related relative search volumes(RSVs)with the number of weekly and overall Ebola cases.Multivariate regression was performed using Ebola-related RSV as a dependent variable,and the overall number of Ebola cases and the Human Development Index were used as predictor variables.Results:The greatest RSV was registered in the three West African countries mainly affected by the Ebola epidemic.The queries varied in the different countries.Both quantitative and qualitative differences between the affected African countries and other Western countries with primary cases were noted,in relation to the different flux volumes and different time courses.In the affected African countries,web query search volumes were mostly concentrated in the capital areas.However,in Western countries,web queries were uniformly distributed over the national territory.In terms of the three countries mainly affected by the Ebola epidemic,the correlation between the number of new weekly cases of Ebola and the weekly GT index varied from weak to moderate.The correlation between the number of Ebola cases registered in all countries during the study period and the GT index was very high.Conclusion:Google Trends showed a coarse-grained nature,strongly correlating with global epidemiological data,but was weaker at country level,as it was prone to distortions induced by unbalanced media coverage and the digital divide.Global and local health agencies could usefully exploit GT data to identify disease-related information needs and plan proper communication strategies,particularly in the case of health-threatening events.
文摘Atopic dermatitis is a chronic,relapsing,non-contiguous,exudative eczema/dermatitis,which represents a complex,multi-factorial disorder,due to an impairment of the stratum corneum barrier.Currently available drugs have a low skin bioavailability and may give rise to severe adverse events.Nanotechnologies,including nanoparticles,liposomes,nano-gels,nano-mixtures,nano-emulsions and other nano-carriers,offer unprecedented solutions to these issues,enabling:i)the management of different clinical forms of atopic dermatitis,especially the recalcitrant ones,i)a better bio-availability and trans-dermal drug targeted delivery at the inflammation site,ii)dose control,iii)significant improvements both in clinical symptoms and immune responses,iv)with less adverse events being reported and a better safety profile.However,some nano-sized structures could amplify and even worsen symptoms in particularly susceptible individuals.Furthermore,most studies included in the present systematic review have been conducted in-vitro or in-vivo,with few randomized controlled clinical trials(RCTs).Future investigations should adopt this design in order to enable scholars achieving robust findings and evidence.Therefore,given the above-mentioned shortcomings,further research in the field is urgently warranted.
基金This research was funded by the Canada Research Chair Program(grant number:230720(JW))the Natural Sciences and Engineering Research Council of Canada(grant number:105588-2011(JW))+1 种基金the CIHR 2019 Novel Coronavirus(COVID-19)rapid research program(JW)LP is funded by the Wellcome Trust and Royal Society(grant number:202562/Z/16/Z).
文摘Background:After the declaration of COVID-19 pandemic on March 11th,2020,local transmission chains starting in different countries including Canada are forcing governments to take decisions on public health interventions to mitigate the spread of the epidemic.Methods:We conduct data-driven and model-free estimations for the growth rates of the COVID-19 epidemics in Italy and Canada,by fitting an exponential curve to the daily reported cases.We use these estimates to predict epidemic trends in Canada under different scenarios of public health interventions.Results:In Italy,the initial growth rate(0.22)has reduced to 0.1 two weeks after the lockdown of the country on March 8th,2020.This corresponds to an increase of the doubling time from about 3.15 to almost 7 days.In comparison,the growth rate in Canada has increased from 0.13 between March 1st and 13th,to 0.25 between March 13th to 22nd.This current growth rate corresponds to a doubling time of 2.7 days,and therefore,unless further public health interventions are escalated in Canada,we project 15,000 cases by March 31st.However,the case number may be reduced to 4000 if escalated public health interventions could instantly reduce the growth rate to 0.1,the same level achieved in Italy.Interpretation:Prompt and farsighted interventions are critical to counteract the very rapid initial growth of the COVID-19 epidemic in Canada.Mitigation plans must take into account the delayed effect of interventions by up to 2-weeks and the short doubling time of 3e4 days.
基金This study was part of a PhD thesis supported by the School of Health Management,Iran University of Medical Sciences(ID:IUMS/SHMIS_1396/9423557001).
文摘Background:Street children are forced to spend a lot of time away from their homes and some of them do not have homes at all,due to economic and family problems,which makes them exposed to many health problems,such as the hepatitis C virus(HCV)infection.Iran,like many other countries in the world,experiences the burden of street children,however,the rate of HCV among street children is virtually unknown.This study aimed to determine the prevalence of HCV among street children in Iran.Main body:This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.The study protocol of this review was registered in PROSPERO under identification term CRD42018082336.A comprehensive literature search was conducted to identify published studies reporting on the prevalence of HCV among street children in Iran.Several international scholarly databases,including Web of Science,PubMed^(■)/MEDLINE^(■),Embase,Scopus®,Google Scholar and Directory of Open Access Journals,as well as Iranian databases such as MagIran and Barakathns were searched.Studies published between 1988 and December 2017 with any of the following keywords were selected:(street OR homeless OR labour)AND(children OR child OR infant)AND(hepatitis C OR hepatitis C virus OR HCV OR viral hepatitis OR hepatitis OR hepacivirus)AND Iran.Moreover,a grey literature search was performed in order to obtain other potentially relevant studies.The search was carried out without any language restrictions.Four studies,surveying a total of 1691 street children,conducted between 2006 and 2017 were found to be eligible for inclusion in the review and therefore analysed.Three studies were conducted in Tehran and one in Isfahan.The prevalence of HCV among street children in Iran was found to be high,at 2.4%(95%CI:1.8-3.3).Conclusions:Since the prevalence of HCV among street children in Iran is quite high,health decision-and policy-makers should pay more attention to street children and widen support channels,both social and economic.Further studies should be conducted among street children in different cities of Iran to add to the knowledge base of HCV among street children in the country.The health system should provide facilities for street children to be screened to quickly diagnose illnesses and prevent them from developing complications.
