Onchocerca lupi is an emerging, zoonotic filarioid nematode associated with ocular disease in companion animals in North America and the Old World. The areas where this parasite is assumed to be endemic in the USA comprise southwestern states. Thus far, all cases reported outside of the southwest are associated with travel or animal movement.An 11-year-old, castrated male Pitbull dog from McAllen, Hidalgo County, southern Texas, with no travel history, was diagnosed with a perforating corneal ulceration of the right eye. Enucleation was performed and tissues submitted for histopathology.cox1 gene of the mitochondrial DNA, followed by sequencing and phylogenetic analysis. Altogether, these results confirmed the identification of the nematode specimens as O. lupi, phylogenetically belonging to haplotype 1.Histologically, sections of two filarioid nematodes were observed. DNA was extracted from formalin-fixed paraffin-embedded tissue using a commercial kit. We performed PCR targeting the O. lupi in a dog from Hidalgo County, southern Texas, USA. Our finding suggests Texas as an additional state where this zoonotic nematode is endemic. Further investigations are required to understand the epidemiology of this parasite along the USA/Mexico border.We report the first autochthonous case of  Onchocerca lupi (Nematoda: Onchocercidae) is an emerging, zoonotic parasite in North America and areas of the Old World [O. lupi adults, including regimens of macrocyclic lactones, melarsomine, and the combination of both with tetracyclines. Recurrence of ocular nodules are not uncommon [ld World –4. Infecld World , 5, 6. Cuncommon .O. lupi in humans may be variable according to the site of infection. To date, there have been seven confirmed zoonotic onchocerciasis cases by O. lupi in the USA. Six of these cases involved children [O. lupi infections have been reported from Arizona, New Mexico, and Texas. While this parasite is considered endemic in Arizona and New Mexico, from where multiple cases have been reported in companion animals, humans and wildlife [The presentation of zoonotic onchocerciasis by children , 3. An awildlife , 8, the wildlife , 9, 10. wildlife –13.Dirofilaria immitis, during pre-anesthetic work-up, despite somewhat compliant chemoprophylaxis with an ivermectin-based monthly product. An enucleation was performed, and the eye was fixed in 10% neutral buffered formalin and submitted to the Texas A&M Veterinary Medical Diagnostic Laboratory for histological processing and examination.In August 2020, an 11-year-old, castrated male Pitbull dog from McAllen, Hidalgo County, southern Texas, was presented to the veterinarian with a history of ocular irritation for approximately 2–3 weeks. It was diagnosed with a perforating corneal ulceration of the right eye. The dog was born in McAllen and had never left the Rio Grande Valley, Texas. The animal tested antigen-positive for heartworm, cox1) gene was amplified using the forward primer COIintF: 5′-TGA TTG GTG GTT TTG GTA A-3′ and reverse primer COIintR: 5′-ATA AGT ACG AGT ATC AAT ATC- 3′ [Genomic DNA was extracted using a Qiagen FFPE Tissue DNA extraction kit  according to the manufacturer’s instructions. Polymerase chain reaction (PCR) was performed in 25 µl reactions containing 0.25 μM of each primer, 1 × GoTaq® Green Master Mix , and 2.5 µl of DNA template. The cytochrome oxidase c subunit 1 , and showed 99.9–100% maximum identity with O. lupi sequences available in GenBank. Phylogenetic analysis clustered the Texas isolate with all previous isolates from North America, and some European isolates, belonging to O. lupi “genotype 1”  were reported infected and may serve as wild reservoirs in the western USA [O. lupi in southern Texas and neighboring Mexico. Other wild carnivores that are known or postulated to be O. lupi hosts, such as wolves (Canis lupus) and certain foxes , are not present in southern Texas. However, the widely distributed gray fox (Urocyon cinereoargenteus) is reported in this region and across areas where O. lupi is endemic in North America [It is necessary to better understand the epidemiology of tern USA  and may  America  and therO. lupi [Simulium have been reported from South Texas, USA, especially within the Rio Grande Valley and the neighboring Mexican state of Tamaulipas and up the Rio Grande, along the USA/Mexico border [Simulium tribulatum, postulated as a putative vector of O. lupi, and other Onchocerca species in southern California [Simulium mediovittatum, and Simulium meridionale. Ideally, however, xenomonitoring in Texas could include screening of dipterans other than simuliids, such as biting midges (Ceratopogonidae: Culicoides) and sand flies (Psychodidae: Phlebotominae).Regarding the dipteran vectors, black flies (Simuliidae) have been considered the putative intermediate host for O. lupi ; howevero border , 22. Amolifornia , 23, SimO. lupi case in southern Texas suggests that this parasite is endemic in the region, and transmission may occur locally. There is a need for epidemiological surveillance of companion animals, wildlife, and dipteran vectors along the USA/Mexico border. It is important to raise awareness of public health and medical specialists and authorities as humans in this region might be at risk of infection.This unequivocal autochthonous


Health monitoring during offshore saturation diving is complicated due to restricted access to the divers, the desire to keep invasive procedures to a minimum, and limited opportunity for laboratory work onboard dive support vessels (DSV). In this pilot study, we examined whether measuring salivary biomarkrers in samples collected by the divers themselves might be a feasible approach to environmental stress assessment. Nine saturation divers were trained in the passive drool method for saliva collection and proceeded to collect samples at nine time points before, during, and after an offshore commercial saturation diving campaign. Samples collected within the hyperbaric living chambers were decompressed and stored frozen at −20°C onboard the DSV until they were shipped to land for analysis. Passive drool samples were collected without loss and assayed for a selection of salivary biomarkers: secretory immunoglobulin A (SIgA), C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukins IL-6, IL-8, IL-1β, as well as cortisol and alpha-amylase. During the bottom phase of the hyperbaric saturation, SIgA, CRP, TNF-α, IL-8 and IL-1β increased significantly, whereas IL-6, cortisol and alpha-amylase were unchanged. All markers returned to pre-dive levels after the divers were decompressed back to surface pressure. We conclude that salivary biomarker analysis may be a feasible approach to stress assessment in offshore saturation diving. The results of our pilot test are consonant with an activation of the sympathetic nervous system related to systemic inflammation during hyperbaric and hyperoxic saturation. The humquestion . Since bBlood biomarkers are extensively used in clinical care. Blood biomarkers also reflect the oxidant-antioxidant balance involved in local and systemic pathologies, e.g., diabetes, cancer, inflammatory disorders, cardiovascular, and neurological conditions . With adThe study material was collected during a commercial offshore saturation diving campaign in the Norwegian North Sea, in the fall of 2019. The protocol was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK), approval number 2018/1184. The participants provided their informed consent prior to inclusion, and all procedures were conducted according to the Declaration of Helsinki principles for ethical human experimentation.Nine certified and experienced saturation divers, all male, were considered eligible and recruited as participants after passing a mandatory pre-saturation medical examination. The medical examination was performed in accordance with NORSOK U-100 Standards  and ensu2 (ppO2)≤40kPa, pCO2≤1kPa, pCO<0.5Pa, relative humidity 40–60%, and temperature 22–33°C. The divers kept regular meals throughout the saturation, choosing their individual diets from daily selections from the vessel galley.Heliox saturation diving was conducted according to NORSOK U-100 Standards . The satvia umbilicals from the DSV to maintain a breathing gas ppO2 of 60–80kPa, and hot water supply to the divers’ suits to preserve their body temperature. Daily bell-runs lasted for up to 8h, during which the divers spent a maximum of 6h in the water interspersed by breaks inside the bell for restitution and hydration. Their work consisted of installation of blind flange plugs, pipe support installation, seal replacements, bell mouth installation, and inspection work. The divers described the workload as relatively light compared to deeper and longer saturations, with most of their work performed standing on the ocean floor. At the end of their work assignment, the decompression back to ambient surface pressure lasted approximately 4days 4h, during which the ppO2 in the living chambers were kept at 50kPa until 13 msw, and gradually reduced to reach 21kPa at the end of the decompression.To facilitate continuous underwater activity, the divers were organized into four teams of three divers working overlapping 12-h shifts, with consecutive teams starting their shift every 6h. Each diver worked the same shift for the duration of his saturation. A pressurized diving bell was used to transport the dive team from the living chambers on the DSV to work on the ocean floor. During work excursions (bell-runs), the divers’ environment was monitored and controlled by diving supervisors via a decompression lock, frozen at −20°C onboard the DSV and shipped frozen to NTNU at the end of the diving campaign. There the samples were stored at −80°C until they were shipped to Salimetrics’ SalivaLab  on dry ice for analysis.The participants were trained in the passive drool method and supplied with instructions for later reference before they proceeded to collect saliva into 2ml SalivaBio cryovials ; first during the pre-saturation medical examination (Day 0), then seven times during hyperbaric heliox saturation: three during the bottom phase  and four during decompression , and finally post-saturation when the divers were back at surface pressure (Day 15). Samples in the pressure chambers were taken before bell-runs at the beginning of the divers’ work shifts, 1–2h after breakfast without brushing their teeth prior to the collection. Due to the continuous rotation with a new team starting their shift every 6h, each individual participant of the same diving team collected all his samples at the same time of day, whereas participants on successive teams did their sample collections at 6h intervals. The saliva samples were transferred out to the vessel hospital Samples were assayed in duplicate at the Salimetrics’ SalivaLab using the Salimetrics Salivary Assay Kits for C-Reactive Protein , Secretory Immunoglobin A , Interleukins 1β (IL-1β), 6 (IL-6), 8 (IL-8), and Tumor necrosis factor alpha (TNF-α) , Cortisol , and Alpha-amylase (Cat. No. 1-1902), according to the manufacturer’s protocol. The assay data, with volumes, range, and sensitivity for each analyte, are shown in p>0.05), either directly or after the data were transformed. A non-parametric analysis was applied if the data were still non-normal after transformation. For each biomarker, the differences within divers between the three time points were assessed by a one-way repeated measures ANOVA, with post-hoc Bonferroni adjustment for multiple comparisons. Differences were considered significant at p<0.05. Homogeneity of the data was assessed by the Mauchly test with p>0.05. If the assumption of sphericity was violated, a Greenhouse–Geisser correction was applied. Friedman’s test was applied for non-normal data, and pairwise comparisons were made with Bonferroni’s correction for multiple comparisons.Prior to the statistical analysis, data from saliva samples obtained during saturation were split into two groups: one for the bottom phase and one for the decompression. Means were calculated at baseline I in , 2, bottSalivary biomarkers were assayed before, during, and after offshore saturation diving. The saliva samples were collected by the divers themselves during a commercial diving campaign and transferred from the DSV to shore for analysis. The biomarkers were chosen to cover pro- and anti-inflammatory responses and oxidative stress: CRP, TNF-α, IL-6, IL-8, IL-1β, and SIgA as well as generalized stress responses: cortisol and alpha-amylase . The salp=0.005), CRP (p=0.005), TNF-α (p<0.0005), IL-8 (p=0.002), and IL-1β (p<0.0005) increased, whereas IL-6 was unchanged . The patients/participants provided their written informed consent to participate in this study.RM, AH, SD, and IE designed the study. IE collected the material. RM and AH performed the statistical analysis. All authors collaborated on the interpretation of results and writing and approval of the final manuscript.via an integral part dedicated to research on Health, Safety, and Environment (HSE) in the petroleum sector.This study is part of a Knowledge-Building Project for Industry, placed at NTNU, Norway and funded by the Norwegian Research Council and Equinor on behalf of PRSI Pool through the Large-scale Programme for Petroleum Research (PETROMAKS2), project no. 280425, Transport and boarding on the Deep Arctic for IE were sponsored by the TechnipFMC.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Following Salvatore and the WHO, in this article, we provide the first long-term estimates of malnutrition rates for Chile per birth cohort, measured through stunting rates of adult males born from the 1870s to the 1990s. We used a large sample of military records, representative of the whole Chilean population, totalling over 38 thousand individuals. Our data suggest that stunting rates were very high for those born between the last three decades of the nineteenth century and the first two decades of the twentieth century. In addition, stunting rates increased from the 1870s to the 1900s. Thereafter, there was a clear downward trend in stunting rates (despite some fluctuations), reaching low levels of malnutrition, in particular, from the 1960s . The continuous decrease in stunting rates from the 1910s was mainly due to a combination of factors, the importance of which varied over time, namely: Improved health ; increased energy consumption ; a decline in poverty rates ; and a reduction in child labour . In Salvatore’s  recent sFollowing Salvatore’s methodology, and with the aim of testing it in new case studies, in this article we estimate malnutrition rates for Chilean males born from the 1870s to the 1990s, using a large adult height sample of military records taken from Llorca-Jaña et al. ,6, and wThe main aim of this article is to provide the first long-run estimates of male’s malnutrition rates in Chile for cohorts per decade of birth at a national level, thus making an important contribution to the literature on Chilean living standards. By adding new estimates of malnutrition, we are providing a different aspect of the evolution of living standards in Chile from the nitrate era. We are also adding evidence for those interested purely in economic growth, since those who escape malnutrition can join the labour force . In addiStandards of living should not be measured only by economic variables, and the more variables we have on biological welfare, the better . For exaThis gap is of consequence since anthropometric measurements, such as height, body mass index, and birth weight, all influenced by populational nutritional status, have gained importance as indicators of standards of living which adequately capture measures of inequality . We knowOne recent and valuable study has been provided by Núñez and Pérez . HoweverMoreover, we have contrasted our new malnutrition estimates with newly available information on mortality rates   malnutrition rates declined from 15–19% for those born during the 1870s–1900s to some 2% for those born during the 1990s, a remarkable achievement for a middle-income country. This dramatic fall in malnutrition rates is important since it is well known that when this happens, in any country, ceteris paribus, there is an increase in cognition and labour productivity (thus in economic growth), a reduction in mortality and a decrease in the prevalence of infectious diseases, leading to an increase in life expectancy: Stunting rates are effective predictors of the risk of morbidity and mortality ,32,33,34The two standard anthropometric measures of malnutrition rates are height-for-age and weight-for-age, usually used for children , but in our case applied to adult heights. There is no long-term series of malnutrition estimates based on weight-for-age data for Chile (weight data is scarce for any period before the 1990s), thus we need, necessarily, to resort to height-for-age information. It is believed that a low height-for-age is a result of stunting or in other words, a retardation of “normal” growth . Height-Following Salvatore’s  study foThe physical stature of these adults was a direct result of their nutritional status during childhood, and that is why we provide the data per decade of birth, a usual procedure in anthropometric history. Malnutrition during childhood is believed to be the result of many factors apart from insufficient nutrition: Diseases, environmental insults, and excessive  labour ,32,33,34We have contrasted our data against the boys’ growth standards from the World Health Organization, which have been published from 1983 . SimilarIn 1994, only six years after the publication of Avendaño and Valenzuela, the Chilean health service started to officially use the CDC standards to evaluate the growth of Chilean children, changing to the WHO tables in 2007 ,41. In tWe agree with Salvatore  that nonAccording to the latest WHO height-by-age distribution , a normaSimilar to Salvatore, we noted that this distribution of stature for 18-year-old boys is similar to the adults, since most of the physical growth takes place from birth to the age of 18. Prolonged malnutrition during childhood and adolescence leads to adult stunting . TherefoStunting rates calculated from adult populations  could be lower than stunting rates estimated from data on children, as provided by Núñez and Pérez. They are not entirely comparable, but the long-term trends of the series produced by these alternative methodologies should show similar patterns, and this is why we have included here a comparison with the recent series of Núñez and Pérez.Finally, our methodology is based on information for men only: Ideally, we would have also provided data for women, as we intend to do in future research projects. A larger dataset would also allow us to provide data per regions of birth.Archivo Histórico del Ejército . It includes adult males born across the whole of Chile, including all of the provinces. We decided to exclude soldiers aged 17, to follow Salvatore [We have resorted to a large database of military records used by Llorca-Jaña et al. ,6, totalEqually important, there was no significant minimum height requirement (MHR) before the measurement: There is not any truncation to the left. A visual inspection of the data shows that there are many observations below these referential MHR, and that there was no particular truncation at either 155 or 160 cm. The histogram of the data shows a quasi-normal distribution. More importantly for us, these MHR values fall below the WHO benchmark of 2 SDs from the mean. The data are representative of the entire Chilean population at that time, per socio-economic groups (including literacy rates and occupations) and per region of birth. All of the men included in our database were born in Chile, distributed across the whole of the country, and in a fairly representative fashion regarding the actual distribution of the national censuses of the time [Following Salvatore , we estiAlthough there is clearly a downward long-term trend from the 1900s to the 1990s, our series showed a mild increase in stunting rates for those born in the 1940s, if compared to the 1930s, but a renewed decline during the 1950s and 1960s, followed by another mild increase in the 1970s, and then further decreases during the 1980s and 1990s, when our series ends. The low level of our stunting rates estimates for the 1960s–1990s are in line with the data of Núñez and Pérez , but theIn support of our estimates, according to Monckeberg , total mRegarding our estimates of stunting rates shown in As seen in A second finding that calls for an explanation is the increase in stunting rates from the 1870s to the 1900s, a period for which we have no infant mortality records. Yet, surprising as it may be (given booming exports and high economic growth), this fact is consistent with the increasing general mortality in Chile during the last decades of the nineteenth century , a largeThirdly, we need to explain the falling stunting rates from the 1900s to the 1930s, in particular, since we are at odds here with Núñez and Pérez . Their dNext, and despite a mild increase in stunting rates during the 1940s (in comparison with the 1930s), it is clear that there is another marked downward trend between the 1940s and the 1990s (a continuation of the decreasing trend which started in the 1900s), as was also suggested by the data of Núñez and Pérez. Before entering into this long-term declining trend in stunting rates, it is useful to refer to the mild increase in stunting rates during the 1940s shown by our data. This could be explained in terms of a fall in the national per capita agricultural production, combined with inflation and a deterioration of real wages, which could have impacted on the nutritional status of the population. During this decade social conflict escalated, with an unprecedented number of strikes .The downward trend which started in the 1910s and continued up to the 1990s is in line with continuous improvements in both the infant and general mortality in the country , with inTo support these schemes, 1937 saw the passing of the law known as “Mother and son”, whose benefits were perceived by a continuously larger share of Chilean children during the 1940s and 1950s, ensuring the provision of some basic medicines and foodstuffs ,68,71,72One marked difference between our estimates and those of Núñez and Pérez  is that An important factor behind the fall in stunting rates from the 1940s is milk consumption, which increased significantly within the low SES, in particular, during the 1950s and 1960s, in part due to the above-mentioned government policies to promote milk consumption in schools ,70,73,76Our very low estimate of stunting rates in the 1960s is further supported by Moreno , who hasWe have stressed elsewhere that during the 1940s–1960s real wages increased. In addition, there were marked improvements in the national coverage of drinking water services, sewerage facilities, and electricity, up to the 1990s ,80. FromAnother important difference between our estimates and those of Núñez and Pérez is that for them, stunting rates are (implicitly) close to zero for those born from the 1960s onwards, while our estimates for those born during the 1960s, 1970s, and 1980s are 3%, 5%, and 3%, respectively. Our data would suggest that there was some room for further improvement in the nutritional status of the population during these decades, as well as in health provision. In 1960, the first national survey on malnutrition was undertaken, by the US Interdepartmental Committee of Nutrition for National Defence. It concluded that the diet of Chilean children was still insufficient . The 197Furthermore, the late 1970s were marked by an increase in poverty . It is dAnother important variable is the poverty rate: Those from low SES are more likely to be food insecure and to suffer infectious diseases, while diseases themselves prevent a better nutrition . Figure Moreover, linked to poverty, child labour was not fully eradicated from the country until the late 1990s. As late as 1978, a new legislation had to be passed to ensure the abolition of child labour for those younger than 14, but it was still legal to employ youngsters aged 14–17 . FinallyUsing a novel methodology, recently proposed by Salvatore , we haveThereafter, despite the usual fluctuations of any long-term series, there was a clear downward trend from the 1910s to the 1990s. The gradual decrease in stunting rates from the 1910s was due to a combination of factors, whose importance varied over time, namely: Improved health ; increased energy consumption ; a decline in poverty rates ; and a reduction in child labour from the 1920s .The emergence of a welfare state from the mid-1920s was a turning point in the development of public policies to tackle malnutrition. However, the Chilean state had already started to consider malnutrition as a national problem, and evolved national programmes to tackle it, as well as supporting private initiatives . The first sanitary code of the country was promulgated in the late 1910s, while milk programs started even earlier, in 1902, although with little coverage. However, it was in the 1920s that the Chilean state intensified efforts to combat malnutrition, launching nationwide measures to improve the nutrition and health of the Chilean population, including the formal training of nutritionists from the 1930s, although the seeds of this development were planted two decades earlier.Our new evidence provides further support to the idea that Chilean standards of living improved significantly during the period of industrialisation led by the state. The increased life expectancy of Chileans, and the low mortality rates among the elderly nowadays  may be lYet, despite these undeniable improvements, moderate and severe stunting were not fully eradicated in Chile during the period covered by this study, not even by the 1990s. The persistence of some social evils persisted: A delayed nutrition transition ; persistent inequality in both health and education ,85; inco


This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory.People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups . Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week.Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: ‘No heavy drinking’ , ‘Constant heavy drinking’  and ‘Decreasing heavy drinking’ . Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking.Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking. Negative life events entail elevated stress levels and usually imply disruptions to daily life and habits, including changes in behaviours such as alcohol consumption.The relationship between divorce and alcohol consumption is bidirectional and multifaceted, partly because risky alcohol use can be both a driver and a consequence of divorce. Previous studies have suggested that heavy drinking increases the risk of divorce,Severe illness of a spouse or other family member is another source of stresswithin the group of people who experience negative life events. Previous studies that have followed individuals through the life events, with both pre-measurements and post-measurements, have focused on the changes in mean levels of alcohol consumption,Taken together, previous findings suggest that people who experience negative life events are more likely to have heavy alcohol consumption habits compared with people who do not. However, less is known about various patterns of heavy drinking The Finnish Retirement and Aging Study (FIREA) is an ongoing cohort established in 2013. The eligible population included all public sector employees whose individual retirement date was between 2014 and 2019 and who worked in the year 2012 in 1 of 27 municipalities in southwest Finland or in 9 selected cities or 5 hospital districts around Finland (n=10 629).By the end of 2019, 6783 participants had responded to at least one survey. For our purposes, the study population was limited to participants who reported a negative life event  in any of the surveys. Participants who reported their alcohol consumption in both the survey before and after the event were included in the analytical sample . To allow comparison with those who did not experience these life events, we derived a so-called ‘control group’ that consisted of FIREA participants who did not report divorce or severe illness or death in the family and who reported their alcohol consumption in two consecutive surveys to resemble the eligibility criteria for the other groups (n=3354); see flow chart in 10.1136/jech-2021-217204.supp1Supplementary dataFor each individual respondent, we centred the data around the first life event  that occurred. There were three possible study waves before each life event , and three possible waves after . Each participant may have taken part in maximum six study waves. On average, participants provided information on alcohol consumption at 3.9 (SD=0.8) study waves for the event of illness, 4.0 (SD=0.9) for death and 3.9 (SD=0.9) for divorce. The difference between each study wave was on average 1 year. For those in the ‘control group’, there was no life event, but a mock event year was randomly assigned for each participant enabling to organise the data in a similar manner as in the divorce and severe illness or death in the family groups.Negative life events within the past 12 months were self-reported through a structured questionnaire that included 12 items. We used two types of negative life events: (1) severe illness in the family (spouse/child) and/or death in the family (spouse/child), and (2) divorce.Participants reported their habitual frequency and amount of beer, wine and spirits consumption, in weekly units of alcohol. One unit corresponds to 12 g of pure alcohol, or the equivalent of 33 cL of beer, 12 cL of wine, or 4 cL of spirits.http://www.qgis.org/en/site/), data on the cumulative residential neighbourhood disadvantage for each time point were linked to the participants’ home addresses by the latitude and longitude coordinates. A cumulative socioeconomic disadvantage score weighted by residential time at each location was calculated for each participant. The summary score of neighbourhood socioeconomic disadvantage was dichotomised into low (≤0) and high (>0), in accordance with earlier studies.Characteristics previously shown to be associated with heavy alcohol consumption or negative life events were included as covariates. Information was taken from the last questionnaire before the life event of interest. Information about the participants’ date of birth, sex and occupational title was obtained from Keva. The main indicator of socioeconomic status (SES) was occupational status. Occupational titles were coded according to the International Standard Classification of Occupations (ISCO) and categorised into three groups: high , intermediate , and low . Another socioeconomic indicator was neighbourhood socioeconomic disadvantage, based on neighbourhood characteristics from Statistics Finland Grid Databases. The socioeconomic composition for each grid (250×250 m) included average annual income of households, mean number of years of education of residents above 18 years and proportion unemployed among adult residents in the labour force.Anxiety was measured with the short six-item form of the State-Trait Anxiety Inventory,The number of social network ties was assessed using the social convoy model,We used complete case analysis. Prevalence of heavy drinking in each study wave was calculated separately for those experiencing divorce, severe illness or death in the family, as well as for those not experiencing these life events. To illustrate changes and heterogeneity in heavy drinking in the years preceding and following the specific life events, we used latent trajectory analysis, a family of statistical methods used to identify distinctive groups of individuals who show similar developmental trajectories over time.10.1136/jech-2021-217204.supp2Supplementary dataTo examine the characteristics of individuals in the different trajectory groups, we used multinomial logistic regression analyses. The reference group was the ‘No heavy drinking’ group for both life events. Analyses were adjusted for age and gender.10.1136/jech-2021-217204.supp3Supplementary data10.1136/jech-2021-217204.supp4Supplementary dataThis study investigated trajectories of heavy alcohol consumption surrounding negative interpersonal life events among older individuals working in the municipal sector: severe illness or death of a family member and divorce. Overall, results suggest that for most working people in their 60s going through these life events, there is often no change in drinking behaviours with regard to initiating or giving up heavy alcohol consumption. A vast majority (75%–82%) reported no heavy alcohol consumption neither before nor after the event in question. Similarly, about one-tenth reported heavy drinking both before and after divorce or illness/death in the family.An important finding, however, was that for both types of life events, one trajectory indicated elevated probability of heavy drinking 2–3 years before the event, but then decreasing. This may be indicative of an anticipatory effect, in that the likelihood of heavy drinking is elevated prior to the event, perhaps because of elevated stress levels or anticipatory grief.We found some indications of gender differences. Previous studies suggest that consequences of losing family members are potentially stronger among women than men,Furthermore, results showed that for both life events, those belonging to the ‘Constant heavy drinking’ group were more likely to be men, reported more depression and had higher occupational status  compared with the ‘No heavy drinking’ trajectory. Similar characteristics have been reported in other studies.Several strengths and limitations need to be considered when interpreting the findings. A major strength is the annual data collections that allow detailed descriptions of change surrounding the life event. Another strength is that the respondents, due to the narrow age span (60–65 years), are rather homogeneous regarding the life phase they are in. Furthermore, we used the current UK guidelines for defining heavy drinking,Limitation to consider when interpreting these results is, for example, the limited sample size in some trajectory groups , leading to statistical uncertainty and wide CIs, which may restrict the generalisability of our findings. Another limitation that may restrict generalisability and oversimplify reality is that the identification of a certain number of distinct alcohol trajectories ‘forces’ all individuals in the sample into one of these trajectories. Previous studies on alcohol trajectories have suggested that trajectory groups may not be as distinct as the models suggest.within the categories may occur. Depression was more common in the ‘Constant heavy drinking’ group, suggesting that comorbidity between substance use and depressive/anxiety disorder may add to the vulnerability of this group.In conclusion, our findings suggest that most people who experience divorce or severe illness or death in the family in their 60s have unchanged drinking patterns when it comes to heavy alcohol consumption. In other words, people tend to keep their heavy, or non-heavy, alcohol consumption habits when going through these life events, although increases or decreases People who experience severe illness or death in the family or divorce are more likely to report heavy alcohol consumption compared with people without these experiences.Little is known about various patterns of heavy drinking before and after these life events within the group of people who experience them.For most working people in their 60s going through severe illness or death in the family or divorce, there was no change in drinking behaviours regarding initiating or giving up heavy drinking.A vast majority reported no heavy drinking neither before nor after the event, but about one-tenth reported heavy drinking both before and after, and another one-tenth had elevated probability of heavy drinking before the event, but then decreasing.Trajectories of heavy drinking were more common among men.


Data on the association of hypomagnesemia and the rate of infections in kidney transplant recipients (KTRs) are sparse. Methods: We conducted a single-center retrospective cohort study of KTRs transplanted between 2005 and 2015. Laboratory data, including serum Mg2+ (median time of the Mg2+ measurement from KT: 29 days), rate of infections including mainly urinary tract infections (UTI), and common transplant-related viral infections  in the early phase after KT were recorded. The primary outcome was the incidence of infections within one year after KT, while secondary outcomes were hospitalization due to infection, incidence rates of long-term (up to two years) infections, and all-cause mortality. Results: We enrolled 376 KTRs of whom 229 patients (60.9%) suffered from Mg2+ deficiency defined as a serum Mg2+ < 0.7 mmol/L. A significantly higher incidence rate of UTIs and viral infections was observed in patients with versus without Mg2+ deficiency during the first year after KT . After adjustment for potential confounders, serum Mg2+ deficiency remained an independent predictor of both UTIs and viral infections (odds ratio (OR): 1.73, 95% CI: 1.04–2.86, p = 0.035 and OR: 2.05, 95% CI: 1.23–3.41, p = 0.006). No group differences according to Mg2+ status in hospitalizations due to infections and infection incidence rates in the 12–24 months post-transplant were observed. In the Cox regression analysis, Mg2+ deficiency was not significantly associated with all-cause mortality . Conclusions: KTRs suffering from Mg2+ deficiency are at increased risk of UTIs and viral infections in the first year after KT. Interventional studies investigating the effect of Mg2+ supplementation on Mg2+ deficiency and viral infections in KTRs are needed.Introduction: Magnesium (Mg Patients were excluded if age was <18 years, they had combined organ transplantation , or KT follow-up took place at another center. Data were collected after last KT if the patient had more than one KT during the observation period. Data on baseline patient characteristics, primary renal disease, comorbidities, renal replacement therapy (RRT), cytomegalovirus (CMV)-status, transplantation-related data, as well as data on delayed graft function and laboratory findings were collected. Induction (IL2-receptor antagonists (IL-2Ra) or anti-thymocyte globulin (ATG)), maintenance immunosuppression , mycophenolic acid (MPA) and azathioprine (AZA)) or mTOR inhibitors ) therapies were also recorded. All patients received a standardized corticosteroid therapy with an initial dose of 500 mg prednisolone at the day of transplantation and subsequent tapering to 5 mg per day at month three after KT.Male and female patients aged above 18 years were eligible for inclusion in the study if: (1) they received at least one kidney allograft, (2) had a serum MgAll data were derived retrospectively from the KT and electronic medical records of our center and the Austria Dialysis and Transplantation Registry (OEDTR), as stated previously . The dat5 cfu/mL). CMV, polyoma, and EBV quantitation were done using a real-time polymerase chain reaction (rtPCR) procedure validated by the Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine at the Medical University of Graz. Additionally, if PCR was not available, CMV infections identified by the pp65 antigenemia assay method were also collected.Data on the most common transplant-related infections, namely urinary tract infections (UTIs) and viral infections, including CMV, polyomavirus (polyoma), and Epstein–Barr virus (EBV), were recorded from 0–12 and 12–24 months after KT. Severe infections requiring hospitalization, defined by the principal diagnosis in the physician’s letter after discharge from the hospital, were also recorded. The diagnostic criteria of UTI in the study were the presence of a positive urine culture . Mg2+ deficiency was defined as Mg2+ < 0.7 mmol/L, whereas Mg2+ levels ≥ 0.7 mmol/L were considered as sufficient using a single Mg2+ measurement. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) Creatinine Equation [2+ measurements.Serum MgEquation . Serum lPre-transplant diabetes mellitus (DM) was defined according to the American Diabetes Association (ADA) Guidelines  or as anDelayed graft function was defined as acute kidney injury (AKI) that occurred in the first week of KT, which necessitated dialysis intervention .The primary outcome of this study was the incidence of UTIs and viral infections  within one year after KT. Secondary outcomes were hospitalization due to infection, incidence rates of long-term (up to two years) infections, as well as all-cause mortality.All-cause mortality data were requested from the database of the Main Association of Austrian Social Insurance Institutions . Data on infection-related mortality during the first year after KT, including those with death due to sepsis, were also collected from OEDTR.2+ deficient and non-deficient patients were assessed either with the Mann–Whitney U or χ2 test. To identify factors associated with infections, a logistic regression analysis was performed using clinical and known risk factors and possible confounders , dialysis modality , dialysis vintage (<1 vs. ≥1 year), living kidney donation, donor and recipient CMV seropositivity, glomerulonephritis (GN) as primary renal disease, maintenance immunosuppression (defined as highest tertile of tacrolimus and cyclosporine A serum level at the time of the Mg2+ measurement), nicotine abuse, diabetes mellitus (DM), delayed graft function, eGFR, albumin, and previous KT). To further analyze the influence of Mg2+ deficiency on the incidence of infections, the analyses for Mg2+ deficiency were adjusted for all variables listed above. Additionally, logistic regression analyses were performed to identify possible risk factors leading to an Mg2+ deficiency and to test the influence of the induction therapy on infection risk. Kaplan–Meier and Cox proportional hazard regression analyses were performed to assess the influence of Mg2+ deficiency on overall mortality. Results are presented as either odds ratios  or hazard ratios  with the respective 95% confidence intervals (CIs). A p-value < 0.05 was considered statistically significant, and all analyses were performed using SAS version 9.4 .Continuous parameters are summarized as the median and interquartile range (IQR), whereas categorical parameters are presented as absolute and relative frequencies. Differences between Mg2+ concentration of the whole study population was 0.67 (IQR 0.61–0.74) mmol/L, measured after a median time of 29 days (IQR: 20–45) after KT. A total of 229 patients (60.9%) had magnesium deficiency with a median serum Mg2+ concentration of 0.63 (IQR 0.58–0.66) mmol/L. KTRs with a Mg2+ deficiency had significantly higher rates of donor CMV seropositivity than patients without a deficiency . Other than that, the study groups were similar regarding clinical characteristics, underlying kidney diseases, comorbidities, and medication  were male, and the median age was 52.0 years (IQR 41.0–62.0). Detailed patient characteristics and laboratory findings of the study population are shown in dication .Data of clinical and laboratory variables were available in >95% of all study participants, except for bicarbonate, which was just available in n = 339 (90.2%).2+ sufficient patients had significantly worse kidney function based on creatinine and eGFR measurements . A significant correlation between Mg2+ levels and eGFR  was observed.Mg2+ measurement, most patients (88.0%) used tacrolimus. The percentage of patients with an Mg2+ deficiency was significantly higher in patients with higher tacrolimus levels .At the time of the Mgn = 52 (15.2%) KTRs received oral Mg2+ supplementation (2+ supplementation between patients with and without Mg2+ deficiency was observed (p = 0.424).In total, entation . No statDuring the first year after KT, UTI was observed in 204 (54.3%), CMV in 182 (48.4%), EBV in 96 (25.5%), and polyoma in 33 (8.8%) patients. In total, 236 (62.8%) patients had a viral infection. The incidences for all infection types were lower during the second year after KT: 69 (19.0%) patients had UTI, 31 (8.5%) CMV, 5 (1.4%) polyoma, and 10 (2.7%) EBV for a total of 41 (11.3%) patients with a viral infection.2+ deficiency . Moreover, a significantly higher incidence rate of viral infections was observed in patients with Mg2+ deficiency in the first year after KT . There were significantly lower incidence rates of UTI and viral infections between the 12–24-month time period as compared to the first year after KT (McNemar test: both p < 0.001). However, no significant differences in the infection incidence rates 12–24 months post-transplant were observed between the study groups . A total of 72 (19.1%) patients required hospital admission due to infection during the first year, and 27 (7.4%) in the second year after KT. The incidence rates of UTI and viral infections at the two time intervals after KT according to the study groups (Mg2+ < 0.7 mmol/L and Mg2+ levels ≥ 0.7 mmol/L) are shown in There was significant difference in UTI incidence rates within the first 12 months between the patients with and without Mg2+ deficiency, the univariable logistic regression analysis 12 months after KT revealed significant associations with both UTIs and viral infections compared to Mg2+ sufficiency . Age at the time of KT, female sex, BMI, and delayed graft function were significantly associated with higher UTI incidence, while higher eGFR, living kidney donation, and serum albumin levels were associated with a decreased incidence of UTIs within 12 months after KT   .n = 242), Mg2+ deficiency remained significantly associated with higher incidences of viral infections during the first year after KT  but not for UTIs . A similar analysis in patients receiving ATG (n = 50) did not show significant associations, likely due to the small number of observations.In a subgroup analysis for patients receiving IL2Ra (p < 0.001), CRP levels > 5 mg/dL , high CNI serum levels , and donor CMV seropositivity  were associated with the presence of Mg2+ deficiency. All factors investigated for the risk of hypomagnesemia are shown in In the univariable analysis, serum phosphorus level < 2.6 mg/dL , BMI , DM , delayed graft function  and donor CMV seropositivity  were associated with an increased risk of all-cause mortality. In contrast, glomerulonephritis as primary renal disease , serum albumin level  and eGFR at the time of the Mg2+ measurement  were associated with decreased risk of all-cause mortality. Sex, maintenance immunosuppression, hemodialysis, living kidney donation, recipient CMV serostatus, and smoking status were not associated with an increased risk of all-cause mortality.During the first year after transplantation, 12 (3.2%) patients died, five of which had an infection as a likely cause of death. During a median follow-up period of 6.7 (IQR 4.9–9.3) years, 67 (17.8%) patients died due to any cause. In Cox regression analysis, Mg2+ deficiency in more than sixty percent of KTRs within three months post-transplant and found that Mg2+ deficiency is associated with an increased incidence of UTIs and viral infections within the first year after KT, independent of potential confounders.Opportunistic infections are a common and significant cause of morbidity, graft loss, reduced quality of life, and mortality among KTRs ,24,25. A2+ in the immune system and a possible regulatory function in acquired immunity by regulating the proliferation and development of lymphocytes [2+ and the inflammatory response in animal models [2+ concentration led to impaired CD8+ T-cell response to influenza A virus infection, reduced T-cell activity, and exacerbated mortality [2+ controls the expression of the activating receptor natural killer group 2 member D (NKG2D) and is required for the cytotoxic activity of NK and CD8+ T-cells [2+ may restore the cytotoxicity of CD8+ T-cells in patients with mutations in interleukin-2-inducible T-cell kinase (ITK) and magnesium transporter 1 (MAGT1) [2+ might also indirectly influence T-cell receptor signaling by binding several protein kinases [Hypomagnesaemia is a known risk factor for new-onset DM after transplantation (NODAT)  and seemphocytes . Severall models ,32,33. Iortality . In huma T-cells . Moreove (MAGT1) . Additio kinases .2+ supplementation increases insulin sensitivity and metabolic control in type 2 DM patients [2+ should be explored further in mechanistic studies.Data from clinical studies on metabolic syndrome revealed a direct link between hypomagnesemia and inflammation, indicating its role in more complex inflammatory processes ,38. T-cepatients , but notpatients ,44. Impopatients . In our 2+ deficiency in this setting, to our knowledge, only one study has investigated the potential impact of Mg2+ on infection complications after KT. In their well-designed, single-center prospective cohort study, Van Laecke and colleagues investigated 873 KTRs and found a dose-dependent association between a single baseline serum Mg2+ concentration and incidence of severe infections in KTRs [2+ deficiency and infections among KTRs and provide additional evidence on the role of Mg2+ on infections in an independent cohort of KTRs.Recent clinical data revealed worse mortality rates in patients with pneumonia and hypomagnesemia admitted to the intensive care unit (ICU) . In pedi in KTRs . However in KTRs . This in in KTRs . Neverth2+ deficiency remained an independent risk factor of UTIs and viral infections in the univariable analysis and after adjustment for possible confounders (even including maintenance immunosuppression therapy). However, the percentage of Mg2+ deficiency was higher in patients with the highest tertile of serum tacrolimus concentrations. Adverse events of CNIs include renal Mg2+ wasting leading to Mg2+ deficiency [2+ exists, a comprehensive approach investigating the associations between immunosuppression, Mg2+, and particularly viral infections after KT is warranted.Current immunosuppression strategies block T-lymphocytes primarily to prevent cellular rejection. The use of mTORi among KTRs seems to be associated with a reduced risk of CMV infections compared to those treated with a regular dose of CNI alone. Moreover, a combination of mTORi and a reduced dose of CNI also revealed the same effect. Interestingly, polyoma infections were not influenced by the different immunosuppression regimens ,50. In oficiency . Thus, Cficiency ,52. Sinc2+ deficiency. This observation might also be in line with the present knowledge on the effect of Mg2+ on the immune function, significantly affecting the NK and CD8+ T-cell function [Importantly, there was also a significant difference in the incidence of UTIs during the first year after KT between the patients with and without Mgfunction ,18. Basifunction . Howeverfunction .2+ deficiency had lower serum phosphate levels and better kidney function compared with patients without Mg2+ deficiency. Hypophosphatemia is a common finding in KTRs, especially in those with immediate graft function and a high pre-transplant serum PTH level due to the significant urinary phosphorus loss driven by the effects of high levels of PTH and FGF-23 [2+ and phosphate levels may be a marker of a better tubular graft function. Nevertheless, serum phosphate levels start to normalize within the first few months after KT due to the reduced FGF-23 levels [2+ levels and accelerated graft function decline or development of renal lesions involving innate immune pathways has been discussed [2+ and phosphate may lead to better nutritional status and indirectly improve immune function, especially within the first year after KT. However, prospective studies on this issue are needed.In our cohort, patients with Mgd FGF-23 . The con3 levels , while hiscussed . However2+ on CV-related morbidity and mortality through decreased CV risk as a beneficial effect of Mg2+ supplementation [2+ status among KTRs are lacking. In our analysis, no statistically significant association between baseline serum Mg2+ concentration and all-cause mortality was observed.Hypomagnesaemia is a known predictor of CV and all-cause mortality in dialysis patients ,57,58. Aentation . To our 2+ deficiency was significantly associated with higher incidence of viral infections, but not with UTIs during the first year after KT in patients receiving IL2Ra in a multivariate analysis. This might be explained due to the high incidence rate of UTIs in the first 6 months after KT, which is a time period with a higher effect rate of IL2Ra. This result may allude to the significant effect of IL2Ra on UTIs. In contrast, a similar analysis in patients receiving ATG did not show these results in our patient cohort. However, these observations need to be interpreted with caution due to small number of observations (n = 50 in the ATG group) as well as missing data, and a possible link should be investigated more extensively. On the other hand, recent evidence shows the decline of infection risk in KTRs that received lower ATG doses [2+ is found intracellular, and only around 1% is present in the blood, representing a small fraction of the total body reserves. Thus, serum Mg2+ concentration may not represent intracellular Mg2+ availability, which is an overall limitation on studies interpreting data using serum Mg2+ measurements. Current methods estimating intracellular Mg2+ concentration are invasive and expensive with low evidence level on their efficacy. Nevertheless, serum Mg2+ measurement is the most available and commonly used test to access Mg2+ status [2+ is bound to albumin and other serum proteins. In our cohort, only a small proportion of KTRs (24.3%) had a serum albumin level < 3.5 g/dL. Additionally, serum Mg2+ concentration can be influenced by many factors, including pH, azotemia, insulin resistance, post-transplantation volume expansion, low dietary Mg2+ intake, or time of blood sample taken [2+ measurement, and the question arises as to the variability within an individual patient. However, hypomagnesemia is an extensively described phenomenon in KTRs due to several pathophysiological and clinical factors [2+ in link with infection complications should be addressed in future studies. Nevertheless, to the best of our knowledge, this is the first study addressing the impact of serum Mg2+ on opportunistic infections and UTIs among KTRs managed in an ambulatory setting or admitted to the ward due to reasons not associated with infection-related complications.Some limitations should be considered when interpreting the results. First, given the design of the study as a single-center analysis based on retrospectively collected data, missing data were unavoidable. In the early years of the observation period, CMV PCR testing was not widely available, and a pp65 antigenemia assay was frequently used to identify CMV infections. However, in this period, this semi-quantitative fluorescent assay based on the detection of CMV infected cells in peripheral blood was the standard diagnostic approach to identify CMV infections in KTRs . NotablyTG doses . AdditioTG doses . Third, le taken ,66. In t factors ,42, and  factors . The pos2+ deficiency was independently associated with UTIs and viral infections in the early phase after KT. Our findings have implications for both research and clinical practice. The independent association between Mg2+ deficiency and UTIs and viral infections highlights the need to explore the immunological effects of Mg2+ in KTRs in more detail. Specific risk factors for Mg2+ deficiency, particularly different immunosuppressive strategies, may further be characterized and used for more intensive serum Mg2+ controlling to improve its potential effects not only on infection risk but on CV risk factors as well. In clinical praxis, the critical evaluation and potential use of reduced CNI regimes and correction of serum Mg2+ level might be beneficial to preventing viral infections among KTRs. The current results support the hypothesis that Mg2+ plays an important role in adaptive immunity among KTRs. Further, especially interventional studies on Mg2+ and opportunistic infections in KTRs are warranted, at best designed as randomized placebo-controlled trials on Mg2+ supplementation in KTRs with Mg2+ deficiency.In our study involving KTRs, Mg


Abusive head trauma (AHT) is a serious health problem affecting more than 3000 infants annually in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that health care providers counsel new parents about the dangers of AHT. Previous studies demonstrate that parental education is effective at reducing AHT events. South Carolina law requires hospitals to offer all new parents with the opportunity to watch an educational video about AHT. This mandate is addressed in different ways at the several delivery centers within a large South Carolina health care system with a range of viewing methods utilized, from DVD players to mobile workstations to personal devices. Frequent technical barriers and workflow inefficiencies resulted in low rates of compliance with this mandate at several campuses. To improve compliance of parent viewing of this educational video, the health care system standardized video viewing protocol across all campuses by implementing the use of iPads for parental education. Existing literature suggests that patient education can be improved in the hospital setting by utilizing tablet computers, but our literature search identified a gap in research around the education of parents and caregivers during hospitalization for childbirth. We used the implementation of an iPad-based parental education delivery protocol to evaluate whether tablet computers can improve compliance with delivering new parent education in the hospital setting.The objective of this study was to evaluate whether the standardized use of iPads to deliver education in the mother–baby unit resulted in improved rates of parents’ acceptance of the opportunity to view an educational video about AHT.We interviewed physicians and nurses to determine what previous protocols were in place to educate new parents before a standardized iPad-based protocol was implemented across 6 campuses of a large South Carolina health care system. A retrospective study was conducted by review of 5231 records from across the 6 campuses to determine the pre- and postintervention compliance rates of viewing the AHT educational video by parents in the mother–baby unit.P<.001) across sites from an average of 41.93% (SD 46.24) to 99.73% (SD 0.26) (φ=0.510). As much as 4 of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001). The remaining 2 locations that showed no significant difference (P>.05) had very high rates of preintervention compliance.Compliance increased overall (Following the implementation of a standardized iPad-based protocol to deliver new parent education, there was a significant improvement in the percentage of new parents who viewed an educational video about AHT in the mother–baby unit. Based on these results, other health care providers should consider iPads to be a feasible and effective method for delivering hospital-based education to families in the mother–baby unit. Abusive head trauma (AHT) in infants, commonly including “shaken baby syndrome,” is a serious and preventable cause of morbidity and mortality in the first year of life. The Centers for Disease Control and Prevention (CDC) estimates the annual incidence of AHT to be 31-35 per 100,000 infants . These nThe American Academy of Pediatrics (AAP) recommends that physicians discuss the risks of AHT with all new parents starting during the birth hospitalization. The AAP specifically recommends that physicians discuss safe ways for parents to cope with the stress of inconsolable infants, provide education on the developmental timeline of crying and other stressful infant behaviors, and the specific dangers of shaking, slamming, or hitting infants ,4. CDC rDespite this consensus on the need to provide early parental education on AHT, there is limited evidence from which to base hospital policies and procedures as to exactly what form this education should take or how it should be provided. The United States Preventive Services Task Force performed a systematic analysis concluding that there is a paucity of evidence to determine if interventions in a primary care setting can prevent child abuse and neglect . NeverthTablet computers, such as the iPad, are an effective means of easily conveying information to patients in a hospital setting. Prior studies have shown that, when testing patient retention of knowledge, the use of tablets is as effective as verbal education by a nurse ,12 and sSouth Carolina state law requires that all hospitals provide an opportunity for each newborn baby’s parents/caregivers to view a video on the impact of shaking infants and children . It is nThe law further stipulates that hospitals must ask parents/caregivers to view the video and sign a document attesting that the hospital offered the education . ParentsI have been offered the opportunity to view the video presentations on safe sleep practices, Sudden Unexpected Infant Death (SUID), and the dangers associated with shaking infants and small children. I have also been given information about the importance of learning infant CPR. I voluntarily sign this statement acknowledging that I have received, read and understood the information and been offered the opportunity to view the videos.If a parent refuses to watch the video, the nurses assess and document the reason for refusal including if the video was seen during pregnancy or a previous childbirth. At this time nurses also assess if there is a communication deficit such as language barriers or technical difficulties which would not allow for proper viewing of the video.Hospitals must be compliant with the law and provide an opportunity for video viewing and document the offering of education or reason for refusal. While the video itself is a standardized presentation provided by the state, there is little flexibility in the content of information conveyed, unless a specific request is placed by the hospital system for approval of a different video. Hospitals are, however, given freedom with regard to exactly when, where, and how the video is shown. Thereby an opportunity exists to determine if technology can assist in the delivery of the required parent education. Therefore, the purpose of this paper is to evaluate a quality improvement intervention of delivery of parent education on AHT via iPads within 6 different hospitals within a health care system.To improve compliance, defined as parental viewing of the state-mandated video, a quality improvement effort was initiated by digitally converting the video and offering iPads for viewing to standardize information delivery at multiple birth facilities within a large health care system. The implementation was enacted in the same manner at all 6 campuses of the health care system for standardization.In the past, the video was only available in DVD format (Method O). Barriers to showing the video included inability of nursing staff to locate the DVD and missing or dysfunctional equipment to view the video. The alternative method was to have parents view the video using a workstation on wheels which allowed nurses to access the video in the Care Plan portion of their Epic chart. When this method did not work or was unavailable, the parents were provided a link to view the video on their personal phone, or they would have access to the video from a nurse’s hospital-issued phone.Nurses were informed of the new implementation method, reviewed Department of Health and Environmental Control (DHEC) requirements, and discussed administration of the video during staff meetings and “huddles” during their shift. All nursing staff had previous experience with using iPads and did not require training on using the iPads. This intervention was limited to iPads and did not include other tablets. A handout was provided at nursing stations for troubleshooting in the event there were issues with the video or the iPad. The video was also added to the discharge checklist sheet provided to parents to ensure the parents would be able to visualize that the video needed completion before discharge.Starting in December 2018, communication boards in patient rooms began to include a check off for viewing the required baby education videos. The communication boards were reviewed by the physicians and nurses before discharge as a second check to ensure completion and to attempt to improve compliance.While the documentation of delivering education in electronic health record (EHR) by nursing staff was unchanged between Method O and Method N, an additional reminder to ensure the educational video was provided was added in the EHR summary tab. In addition to the paper attestation being scanned to the chart, an electronic flowsheet was developed, where nurses documented offering the video and when/whether video was viewed. This improved visibility of the education for physicians and nurses to easily see the workflow during hospitalization. This also allowed reports to be run from the EHR to track compliance rates over time.As a University of South Carolina institutional review board–approved retrospective study, data from patients of the 6 campuses were obtained through chart reviews of EHRs to determine newborn educational video compliance. Data were gathered starting in July 2018 and ending in May 2019. However, we found high rates of inconsistent or incomplete documentation during the period of review. The 6 locations yielded 6387 occasions where new parents were offered the AHT video. Events with missing information, such as location, department, date, nurse ID, or compliance were excluded from the study, leaving 5231 records for analysis (comprising 81.90% of data collected). Data for a minimum of 2 weeks prior to the intervention were used to obtain compliance rates before implementation of iPads for each campus, except for campuses 3 and 4, which did not have consistent preintervention data. Data after the intervention were collected for 9 months. The EHR system used by all campuses in the health system was Epic. Discourse with leading stakeholders and implementers of the program provided a platform to gain contextual information regarding the implementation process and barriers of the use of iPads for educational material.Once a parent or caregiver agreed to watch the educational video, this was documented as “Yes” in the flowsheet tab of the EHR reporting system, which we operationally defined as compliance. The compliance data were extracted from 6 hospitals within the health care system by the internal data support team. Dates of Method N implementation can be found in These dates were used as a comparison point to evaluate whether there was an improvement in compliance of parents viewing the video after the implementation of iPads (Method N) compared with Method O. An initial review of the data revealed that a large portion of the extracted data included null values that were evaluated by the data support core. Any portions of the data, for either Method O or Method N, that were incomplete were not included in analysis.A 1-sided Fisher exact test, a statistical analysis used to assess associations between categorical variables, was performed to determine if the use of iPads to deliver the AHT video significantly increased compliance rates overall and at each of the locations. The Fisher exact test was chosen due to the expected frequency being less than 5 in some of the categories . DiscussP<.001) across sites from an average of 41.93% (SD 46.24) to 99.73% (SD 0.26) (φ=.510). Two out of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001), with 2 campuses showing an increase in compliance that was not statistically significant (P>.05). Two campuses showed close to 100% compliance  after the iPad intervention, but data for compliance rates prior to the intervention were limited. Two sites showed little or incomplete data for the period prior to the intervention, therefore inferential statistics were not conducted for those data (only descriptive). However, those data were included in the overall analyses. For a complete listing of EHR data collection, compliance rates, significance, and effect size, refer to EHR data from the 6 locations were assessed to determine compliance rates for viewing the educational AHT video. Results showed that compliance increased overall , has made delivering the educational video easier and quicker.This study was designed to assess the use of iPads in providing AHT prevention education. After the implementation of iPads to provide this educational material, compliance rates increased at all sites, with all nearing 100% after the intervention . Compliance rates of parents watching the video increased from less than 30% to 99% in campuses 1-4 after enacting the iPad intervention. Campuses 5 and 6 demonstrated very high compliance rates before the intervention, and as such, there was no significant difference in compliance rates before and after the intervention for these 2 campuses, with compliance rates remaining near 100% . This study demonstrated that compliance rates for watching the AHT education video were near 100% at all campuses after the implementation of iPads.Unique aspects of the structure and implementation of the intervention were helpful in conducting this study. Engaging staff in process change decisions has the potential to facilitate early adoption of new patient care methods, and likely resulted in a successful implementation. Additionally, the use of iPads to show patient educational material was a smooth transition due to most staff members being familiar with the use of the device. This allowed each campus to incorporate and edit their respective workflows to suit their campuses the best. A significant hurdle for incorporating changes in hospitals or medical centers is factoring in and attempting to change currently used and long-existing procedures. Workflow interruptions have been found to result in decreased ability of health care providers to manage workload . HoweverThe use of iPads to improve delivery of educational material is not a new concept. Specifically, iPads have been useful in the health care setting as a mode of delivering patient education, including education on anticoagulant medication to hospitalized patients, educational materials for patients in acute care, and improvement of inpatients’ engagement in their care and patient education in the hospital -23. ManyThe compliance with viewing the educational video in the mother–baby unit was widely variable across the 6 sites prior to the implementation of the iPads. Following the intervention, the compliance rates at all sites were near 100%. While we cannot say with certainty that this increase in compliance at most sites was due to the implementation of the iPads, the timing of the increase in compliance rates coincides with the iPad intervention. Although the precise reason for this increase in compliance rates following the intervention remains unclear, a potential theory is that the use of iPads increased ease and efficiency for nurses in their workflow to deliver the educational material, as compared with the original method. Nurses and key leaders in initiating the intervention have reported that the portability of the iPad, along with the advantages of needing less equipment, has made delivering the educational video easier and quicker. To further support this theory, one study demonstrated that nursing staff workflow would allow for delivering a tablet to the patient bedside and retrieving it in a time that is consistent with time between rooms .In our study, all campuses achieved a high compliance rate following the intervention. However, campuses 5 and 6 showed that compliance rates were high both before and after the iPad implementation, as noted previously. Interviews with nurses provide several potential explanations for these unexpected results. At campus 5, a grant had been in place for 4 years to promote further patient engagement with the video in the hospital which provided funding to send each patient home with their own educational DVD, as well as extra training for the staff on the topic of AHT and the importance of patient education. It was reported that during the period of this grant, the compliance rates increased to nearly 90%. This grant ended immediately prior to the implementation of the intervention of the iPads for this study. Thus, nurses and facilitators believed that the pre-existing project focusing on AHT education was the reason for the already high compliance rates of patients watching the video prior to the iPad intervention in campus 5.Similar results for campus 6 may be explained by its comparatively low delivery volumes. Notably, this campus has a slower pace for the nurses working in the mother–baby unit, according to key leaders who oversaw this intervention. Nursing staff were not pressed for time, which allowed them the ability to provide the educational video regardless of whether it was provided through the TV/DVD method or through the iPad. As such, compliance did not significantly change by incorporating the iPad intervention at this campus. This shows that this intervention may be relatively more effective and necessary in hospitals and medical centers that have a higher workflow, higher patient volume, or are generally busier.While our study showed an increase in compliance rates after the implementation of the iPads, the results should be viewed in light of the limitations. One of these limitations included missing or null data that were not incorporated in data analysis or results, limiting the overall number of records evaluated. In addition, data collection revealed that 2 of the 6 campuses, campuses 3 and 4, were not accurately recording compliance rates prior to the intervention. This resulted in 18% of the data collected not being included in statistical analysis.An important consideration is that the periods accessed for the preintervention data were nonstandardized and differed by campus. Some campuses had an exact date of implementation, while others had a week to 2-week range for the date of implementation. While this is not believed to have affected the results significantly, it is still to be considered when looking at the results of this study.It is important to continue to maintain high compliance of the delivery of this educational material in order to monitor the long-term impact of this intervention. To do this, it is important to monitor nursing staff at regular intervals to ensure delivery of this education via iPads, reassessing workflow to better incorporate this education, ensuring documentation consistency, and involving physicians in the process. Future studies could include assessing documented reasons for refusal, further assessment of nursing workflow by determining the time spent by nursing staff at patient bedside, and the number of interruptions experienced in nursing workflow between the 2 methods. Furthermore, retention of information could be assessed in parents/caregivers who accepted education to determine effectiveness of the education itself, while studies could monitor long-term AHT rates in the community to determine if this education potentially had an impact. Participants’ demographics could also be collected and assessed in future studies to determine if variables such as education level and familiarity with iPads confounded results. Additionally, it is important to note that there is currently insufficient economic data to support the use of digital health interventions in patient education, as noted in current literature ,28. WhilAnother avenue to look toward is the incorporation of the video in other languages. While the Spanish version of the educational material is currently offered along with the English version, expanding the languages offered and assessing if the appropriate language video affected rate of viewing would also be worthy of study. Perhaps most importantly, alongside long-term use of this intervention, monitoring AHT cases in the geographical areas covered by the health system would be useful to follow to determine if the increased compliance of delivering this education has resulted in a decrease in AHT cases.Based on these results, other health care systems may consider iPads or other tablet devices as a feasible and effective method for delivering hospital-based education to patients and families. This intervention has allowed the hospital system to show that they have been compliant with the law as well as meet the guidelines of patient education before discharge.


To analyze the use of YouTube videos as educational tools for four physical examinations of the shoulder: the Neer, Hawkins, empty can, and drop arm tests.Video-based education, which is accompanied by text-based education, can be an effective education method, especially in learning medical skills. Medical students and doctors in training often use YouTube videos to share medical education materials, and more systematic review of the reliability of these videos is required.A search of YouTube was conducted using four keywords: ‘Neer test,’ ‘Hawkins test,’ ‘empty can test,’ and ‘drop arm test.’ Two physicians reviewed each video and recorded a variety of characteristics . In addition, they scored and categorized the videos into four groups: ‘very useful,’ ‘somewhat useful,’ ‘not useful,’ and ‘misleading.’ Videos containing inappropriate content were classified as ‘misleading.’ Finally, the correlations of each video’s usefulness with viewers’ preferences and the upload source were analyzed.A total of 400 videos were assessed and 200 videos were adopted which yield eligible criteria. Out of 200 videos, 51 videos were very useful and 32 were misleading. Significant correlations were observed between the video’s usefulness and the uploaded source, as well as between the video’s usefulness and viewers’ preferences, such as the number of views, views per day, and number of likes. The proportion of videos classified as ‘very useful’ was highest (58.6%) among those uploaded by physicians and lowest (12.7%) among those uploaded by individuals. Videos uploaded by individuals had significantly lower values reflecting viewer preferences than did videos uploaded by physicians.YouTube videos could be used as learning sources for shoulder physical examinations after the application of appropriate filtering processes, such as review of the upload source and viewers’ preferences. By takiet al., Owing to the simplicity of providing online content, a large number of medical multimedia materials are available on the internet in a variety of formats. As virtual simulation is used before performing actual procedures on real patients, videos with three-dimensional (3D) images and audio are potentially excellent educational aids for manual procedures, such as physical examinations. Several previous authors have argued that video-based education improves learning outcomes among medical students. In a randomized, controlled, assessor-blinded trial, video instruction group of medical students significantly improved performance of venepuncture as measured by checklist score than non-video instruction group, with scores of 14.15 and 9.18, respectively, out of a total of 18 points (Pan www.google.com), accounting for 60% of all videos available online. Although similar websites such as Yahoo Video, MetaCafe, DropShots, and others are available for video sharing, the most popular video-hosting website is YouTube (www.youtube.com) , we selected the following keywords, which were used most frequently to search for the physical examinations: ‘Neer test,’ ‘Hawkins test,’ ‘empty can test,’ and ‘drop arm test.’We selected four specific examinations of the shoulder: the Neer, Hawkins, empty can, and drop arm tests. Various search terms can be derived to find YouTube clips of these examinations. For example, searches for the Neer test can be performed using keywords such as ‘Neer’s sign test,’ ‘Neer impingement test,’ and ‘Neer test.’ Using Google Trends . The only search filter used was ‘relevance,’ which is the default filter for a normal YouTube search.et al., Using methods described previously , and consensus was reached after discussion.The intra- and inter-rater reliability of the scoring system was assessed. Two physicians evaluated all videos and used a table of random numbers to randomly select five videos per examination for re-evaluation by one researcher two weeks after the initial assessment. Intra- and inter-rater reproducibility was assessed using the weighted kappa coefficient.post-hoc analysis by Dunnett T3 test, and categorical variables were compared with Fisher’s exact test. Statistical significance was defined as P<0.05.Data were analyzed with SPSS software . Continuous variables were compared using one-way analysis of variance test with A total of 100 videos from the first five pages of search results for each examination were reviewed in March 2015. After applying the exclusion criteria, a total of 206 videos were identified. Because six videos became inaccessible during the study period, a total of 200 videos were finally assessed and analyzed: 53 videos for the Neer test, 40 videos for the Hawkins test, 49 videos for the empty can test, and 58 videos for the drop arm test .Figure 1A total of 400 videos were evaluated and adopted 200 videos which yield eligible criteria. Out of 200 assessed videos, 51 (25.5%) videos were ‘very useful,’ 108 (54%) videos were ‘somewhat useful,’ and 32 (16%) videos were ‘misleading.’ Nine (4.5%) videos were categorized as ‘not useful.’Post-hoc analysis . Video usefulness was correlated significantly with the upload source (P<0.001). The proportion of ‘very useful’ videos was largest among those uploaded by physicians (58.6%) and smallest among those uploaded by individuals (12.7%). Videos uploaded by individuals accounted for a larger proportion of those with misleading content (17.9%) than did videos uploaded by physicians . Inter-rater reliability was calculated for each examination using a weighted kappa score; these values showed very good agreement .A weighted kappa score for intra-rater reliability was obtained by using 20 randomly selected videos, five for each of the four examinations  videos assessed in this study were posted by individual users; physicians uploaded only 14.5% of videos. Whereas 58.6% of videos uploaded by physicians were very useful, this rate dropped to 12.7% for videos uploaded by individuals. Despite the relatively small proportion, videos uploaded by professionals had the highest quality. These results correspond to those of previous studies, which suggested that the upload source was a predictor of quality (Singh In order for YouTube video to provide credibility as objectivity and accuracy, videos with a higher score could be considered to be of educational significance. Because approximately 87% of YouTube videos uploaded by individuals were included in the ‘somewhat useful,’ ‘not useful,’ or ‘misleading’ group, they were evaluated as less useful in the context of the educational value of YouTube videos. Considering that most of the videos are uploaded by individuals, it is important to select accurate videos by filtering system so that YouTube videos can be useful as educational tools.Even those videos uploaded by the physicians may contain misleading content that can confuse novices. In the present study, ‘misleading’ videos accounted for around 1/6 of the total number of videos analyzed, and only three videos with misleading content were uploaded by physicians: one video for the empty can test and two videos for the drop arm test. Those videos also had titles that did not match the contents, raising the possibility of confusing the viewer with inappropriate knowledge of shoulder physical examinations. We also found less viewer preference for the three misleading videos uploaded by physicians than for useful videos uploaded by physicians. Some of the misleading videos uploaded by individuals and medical websites had inappropriate content, including practitioners’ demonstration of incorrect actions or ambiguous shoulder postures, and included video advertisements.Considering our results, extra care should be taken when using YouTube clips. In this regard, filtering YouTube videos based on viewers’ preferences and the upload source can lead to the identification of reliable educational videos on shoulder physical examinations.et al., This study has a few limitations. First, no validated tool for the evaluation of video quality exists. We created a scoring system based on a review of the relevant literature, which was somewhat subjective and not validated. To ensure consistency, we assessed the scoring system by two physicians in the form of a checklist and obtained significant intra-rater and inter-rater agreement. Two reviewers would not be enough to prove the reliability. Second, this study was performed in a cross-sectional manner. The exclusion of six videos because of their disappearance during the study period highlights the temporary character of YouTube. YouTube is a dynamic repository of video information and search results may vary over time (Lee In this study, significant relationships between video usefulness and viewers’ preferences were revealed. Video usefulness was also correlated with the upload source, with higher-quality content seen among clips uploaded by official hospitals and university-affiliated organizations.YouTube could be used as an effective informational resource if an appropriate selection process is applied. Review of the upload source and viewers’ responses could help to identify higher-quality videos on shoulder physical examinations.


Obtaining accurate global motion is a crucial step for video stabilization. This paper proposes a robust and simple method to implement global motion estimation. We don’t extend the framework of 2D video stabilization but add a “plug and play” module to motion estimation based on feature points. Firstly, simple linear iterative clustering (SLIC) pre-segmentation is used to obtain superpixels of the video frame, clustering is performed according to the superpixel centroid motion vector and cluster center with large value is eliminated. Secondly, in order to obtain accurate global motion estimation, an improved K-means clustering is proposed. We match the feature points of the remaining superpixels between two adjacent frames, establish a feature points’ motion vector space, and use improved K-means clustering for clustering. Finally, the richest cluster is being retained, and the global motion is obtained by homography transformation. Our proposed method has been verified on different types of videos and has efficient performance than traditional approaches. The stabilization video has an average improvement of 0.24 in the structural similarity index than the original video and 0.1 higher than the traditional method. Video filmed on portable cameras frequently suffers from annoying jitters owing to the unsteady motion. Fixed monitoring devices also suffer annoying jitters due to the harsh environment. Video stabilization is the process of improving video quality by removing jitters. This goal can be achieved by using sophisticated sensors and gyroscopes, but they are expensive and inconvenient to deploy. Conversely, digital video stabilization (DVS) does not require additional hardware. It is a convenient and economical solution for different vision tasks.Obtaining an accurate global motion estimation is a critical step in many vision tasks. In 3D reconstruction, Nachimson et al.  used poiIn the 2D methods, Karimi et al.  and Xie We first introduce superpixels into the video stabilization, which enables our approach to share higher efficiency and robustness over existing traditional 2D methods in the global motion estimation step. Besides, our method has an average structural similarity of 0.1 higher than that of the traditional 2D stabilization methods among the different types of videos in the public video stabilization dataset.We propose a simple and “plug and play” module that can obtain accurate global motion estimation. It can be directly used in the motion estimation step based on feature point stabilization.We improve the K-means clustering, which enables the initial point even distribution and adaptive K. By combining superpixels and improved K-means clustering, we perform a coarse-to-fine elimination of local motion, which overcomes the main challenge of 2D traditional video stabilization—the stabilization of multi-object and large foreground occlusions videos.The algorithms of 2D methods are robust and practical but are hard to attack the unstable video with multi objects and large occlusion. The algorithms of 2.5D methods are effective but take a long time. Motivated by the limits of the current 2D methods, we propose a simple and robust algorithm to obtain an accurate global motion estimation. Our method is inspired by Wu et al.  and Koh The paper is organized as follows—Video stabilization can be roughly divided into 2D, 2.5D, and 3D methods. We will briefly review it in the following. The result of video stabilization can be illustrated in The 2D methods use an affine or a homography matrix to represent the global motion of two adjacent frames. Xu et al.  used oriThe 2.5D methods generally store and smooth the feature trajectory. Lee et al.  was the The 3D methods need to reconstruct the real motion of the camera and then smooth it. The earliest Buehler et al.  used imaSome researches presented novel global motion estimation methods; however, most of them are based on the 2.5D model, and it is time-consuming. Liu et al  proposedOur proposed video stabilization is the first to introduce superpixels into the video frame and combine SLIC and K-means clustering to obtain accurate global motion estimation. In the video, the background and the object are usually in motion, and the combination of block and frame difference is not effective in filtering local motion blocks. Therefore, we use superpixel to replace the block, and cluster the centroid motion of the superpixels to eliminate local motion blocks.Superpixel is an image segmentation technology proposed and developed by Ren et al. . It refeTo eliminate local motion blocks faster and more accurately, we first use SLIC  to segmeBefore performing SLIC segmentation on the image, the color image needs to be converted into a 5-dimensional feature vector in the Lab color space and XY coordinates, where Equation .(1)Ks=1N pixels, pre-segmented into ith pixel, j represents the cluster center of the jth category, m represents the relative importance of space and pixel color. We sets m = 30. The distance metric can be written as shown in Equation , Whe, WheK=2,Although the potential local motion blocks are eliminated, two types of mismatches will inevitably occur when matching feature points. The first is the mismatch of feature points in two adjacent frames, and the second is that the matching points fall on the object instead of the background due to the existence of local motion. RANSAC can solve the first mismatch, and the second mismatch has no effective solution. K-means clustering is a practical and simple method, which is often used in image processing. Khan et al.  proposedn represents the number of matching feature points, In the step of detecting and matching feature points, we use SURF features  to perfoK adaptively. There are a total of K categories. The initial cluster centers g represents the index of the matching point closest to the origin of the feature motion space.To get as accurate a motion estimation as possible, we make two improvements to K-means. The first is to make the initial cluster centers as evenly distributed as possible, and the second is to adjust the value of quations –12),dCKEquation .(14)IntFor efficient clustering, we can select the optimal number Equation .(15)a=IFrom the analysis above and the overall framework in The traditional 2D method of using feature points for motion estimation generally consists of three steps: feature point extraction, RANSAC to eliminate mismatches, and calculation of the transformation matrix. We only need to change the eliminate mismatches step to our proposed method to get accurate motion estimation.In this section, first, we will compare the proposed method with typical methods that use feature points and a single matrix for video stabilization. The proposed method improves the video quality by computing accurate global motion using SLIC segment and K-means clustering. To verify the effectiveness of our method, we present a set of comparative experiments. Next, we will show the proposed method’s performances on shaky videos with large object occlusion and multi-object motion. Similarly, we prove the effectiveness of our method through analysis with the traditional 2D methods.In order to prove that our proposed method is more effective than the previous video stabilization method based feature points, we used four groups of 19 videos in total . Moreovehttps://github.com/francocurotto/Video-Stabilization (accessed on 2 April 2021). Thanks to the authors of Dong [http://Real-timeDVS.blogspot.com/ (accessed on 2 April 2021).As shown in  of Dong , they prXu  uses RANThese data come from different public data sets, which can be obtained publicly on the website ,41. We sIn We use the same filter to filter the obtained motion vector and obtain a stable video through motion compensation. Through the display in Among the methods that use feature points for motion estimation, most of them use RANSAC to eliminate mismatches ,17 and sTo our knowledge, we are the first to use superpixels for video stabilization. Although it is more effective than the existing method of using 2D feature detection for motion estimation, it also faces parallax and motion blur. This is also a problem faced by many video stabilization methods.This paper proposes a robust and simple method to address the problem of obtaining accurate global motion estimation in video stabilization. We show how to combine SLIC segment and improved K-means clustering to remove local motion from coarse to fine through the analysis of the motion vector. We show how to add this module to existing 2D motion estimation based feature matching, which is usually ignored in the previous 2D approach.Our study shows that our proposed method can obtain stabilized videos that are better than previous 2D approaches in a measurement that considers average SSIM. In addition, our method also has a useful video stabilization effect on shaking videos with large foreground occlusion and multi-object motion. By stabilizing different types of shaking videos, we find that the proposed method can be used for various video applications, including portable shooting equipment, video surveillance systems, and many vehicle imaging systems.In our implementation, the number of superpixels is set adaptively under the video frame size, the centroid motion of the superpixels is calculated, and the motion space is established. Then setting K to 2 is used for coarse clustering, and blocks with a large amount of motion are eliminated. Feature points detect on the remaining superpixels, calculate the matching feature points’ movement, establish the feature movement space, use the improved K-means clustering method to cluster the feature movement, and save the points with a large number of clusters to obtain accurate background features point and perform motion estimation. Our proposed method’s two drawbacks are that we use a single matrix to estimate global motion, which is not suited for processing shaky videos with parallax. And our method is based on feature detection. There will be feature point positioning errors when the video contains motion blur. For strict real-time application, this may imply adaptive frame’s SLIC segment, not each frame’s segment. So in future works, we will focus on those challenging situations. In addition, a better way to apply superpixels to the field of video stabilization is also future work.