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Comorbid chronic conditions are common among people with type 2 diabetes. We developed an artificial intelligence algorithm, based on reinforcement learning (RL), for personalized diabetes and multimorbidity management, with strong potential to improve health outcomes relative to current clinical practice.

We modeled glycemia, blood pressure, and cardiovascular disease (CVD) risk as health outcomes, using a retrospective cohort of 16,665 patients with type 2 diabetes from New York University Langone Health ambulatory care electronic health records in 2009-2017. We trained an RL prescription algorithm that recommends a treatment regimen optimizing patients' cumulative health outcomes using their individual characteristics and medical history at each encounter. The RL recommendations were evaluated on an independent subset of patients.

The single-outcome optimization RL algorithms, RL-glycemia, RL-blood pressure, and RL-CVD, recommended consistent prescriptions as that observed by clinicians in 86.1%, 82.9%, and 98.4% of the encounters, respectively. For patient encounters in which the RL recommendations differed from the clinician prescriptions, significantly fewer encounters showed uncontrolled glycemia (A1c > 8% in 35% of encounters), uncontrolled hypertension (blood pressure > 140mmHg in 16% of encounters), and high CVD risk (risk > 20% in 25% of encounters) under RL algorithms compared with those observed under clinicians (43%, 27%, and 31% of encounters, respectively; all p<0.001).

A personalized RL prescriptive framework for type 2 diabetes yielded high concordance with clinicians' prescriptions, and substantial improvements in glycemia, blood pressure, and CVD risk outcomes.

A personalized RL prescriptive framework for type 2 diabetes yielded high concordance with clinicians' prescriptions, and substantial improvements in glycemia, blood pressure, and CVD risk outcomes.

Despite featuring in prominent theoretical models, the role of "feeling fat" in certain eating and weight disorder presentations remains poorly understood. This study compared levels of feeling fat between people categorized with referable bulimia nervosa (BN) symptoms, binge-eating disorder (BED) symptoms, and overweight/obesity, and examined the unique associations of feeling fat on measures of eating pathology and functional impairment within each of these subgroups.

Data were analyzed from 977 participants who met criteria referable to BN symptoms (n = 419), BED symptoms (n = 346), or overweight/obesity without ED psychopathology (n = 212) based on self-report symptom frequency.

Analysis of variance revealed that feeling fat levels were highest in the referable BN group, followed by the referable BED group, and then the overweight/obese subgroup. Multiple regressions revealed that feeling fat contributed additional variance to functional impairment and key cognitive (e.g., eating concerns) and behavioural (e.g., dietary restraint) symptoms only among those who met criteria referable to BN.

Overall, findings suggest that the experience of feeling fat may be an important component of body image particularly among individuals with BN-type symptoms. Present findings may also have implications for the assessment and treatment of feeling fat among different eating and weight disorder presentations.

Cross-sectional descriptive study, Level V.

Cross-sectional descriptive study, Level V.

This study aims to explore whether orthorexia nervosa, like other eating disorders, is associated with difficulties identifying, describing, and regulating one's own emotions among a sample of Lebanese adults.

A cross-sectional study was conducted during October 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. MK-5348 molecular weight All participants above 18years of age were allowed to participate in this study. A total of 787 Lebanese adults out of 920 (85.54%) completed an online survey including Arabic versions of the ORTO-R measure of orthorexia, the Toronto Alexithymia Scale, the Difficulty in Emotion Regulation Scale, and the Eating Attitudes Test.

After making sure that all norms are verified, hierarchical linear regressions were conducted to evaluate the association between disordered eating attitudes (EAT scores) and ON (model 1), and after controlling for difficulties in emotion regulation (DERS score) (model 2). Model 1 accounted for 15.1% of the variance of ON (adj. R

 = 0.151, F(1, 786) = 140.06, p < 0.001) and showed that higher levels of disordered eating (higher EAT scores) (β = 0.15) were significantly associated with more ON tendencies and behaviors. When adding the DERS total score to the model, Model 2 was a much better fit with 17.7% of the variance of ON (adj. R

 = 0.177, F(2, 786) = 84.44, p < 0.001), with higher levels of emotion dysregulation (higher DERS scores) (β = 0.06) and more disordered eating attitudes (higher EAT scores) (β = 0.13) were associated with higher levels of ON (Table5).

The present research suggests that people with high ON tendencies experience troubles recognizing, regulating, and describing their emotions, similarly to other disordered eating.

5.

5.Acute upper gastrointestinal bleeding (UGIB) is the most common indication for urgent endoscopy, but the correct timing of endoscopy in these patients is still debated. Our systematic review with meta-analysis was aimed at investigating the potential clinical benefit of very early endoscopy for UGIB patients. We performed an electronic literature search of PubMed, Scopus, Web of Science and the Cochrane Library up to 23rd May 2020 and considered only randomised controlled trials (RCTs) comparing management of UGIB patients by very early vs early endoscopy. Only five RCTs were considered eligible for quantitative analysis, with a total population of 926 cases (468 in the very early endoscopy arm and 458 in the early). The meta-analysis showed no statistically significant benefit for very early endoscopy compared to early endoscopy in terms of risk of rebleeding, mortality, ICU admission, blood transfusion, surgery and length of hospital stay. However, our results showed a significantly higher need for haemostatic treatment when very early endoscopy was performed (RR 1.