bluuebunny/crossref_metadata_2025 huggingface dataset:
A Home Education Service to Increase Knowledge of Treatment Options and Improve Attitudes to Living Donor Kidney Transplantation
Authors: Hobson Orla , Lumsdaine Jen , Sherif Ahmed , Oniscu Gabriel C.
Published: December 2022

Introduction: Lack of knowledge about living donor kidney transplant and difficulties in approaching potential donors constitute barriers for many patients and may contribute to inequality of access. Project Aims: Renal Education and Choices at Home was a UK single-centre pilot of home education; an initiative aiming to overcome barriers by increasing knowledge among patients and support networks and by facilitating living donation discussion in the patient's home. Design: This was a pre-post comparison of knowledge, attitude, and ability to communicate about transplant. Pre-visit knowledge about treatment options and attitudes towards transplant were measured using a validated questionnaire, repeated 4–6 weeks post-visit, to assess the session's impact, along with an evaluation survey, to determine how patients perceived the session. Results: From November 2018 to February 2020, a nurse specialist delivered living donor transplant education sessions in the homes of 86 patients, attended by 141 additional invitees. Home visits led to a significant improvement in knowledge about renal therapies, including living donor transplantation. The evaluation of the home visits by patients and invitees was overwhelmingly positive. Of the 86 patients visited, 46 (53%) had at least one potential donor initiating the assessment process following the visit. Overall, 78 potential donors initiated the assessment process. Conclusion: Home education contributed to addressing recognised barriers, in a way that was well received by patients and was novel in our health system. Home education may be particularly beneficial for patients affected by known barriers to living donor transplantation such as socio-economic deprivation.
Evaluation methodology for deep learning imputation models
Authors: Boursalie Omar , Samavi Reza , Doyle Thomas E.
Published: December 2022

There is growing interest in imputing missing data in tabular datasets using deep learning. Existing deep learning–based imputation models have been commonly evaluated using root mean square error (RMSE) as the predictive accuracy metric. In this article, we investigate the limitations of assessing deep learning–based imputation models by conducting a comparative analysis between RMSE and alternative metrics in the statistical literature including qualitative, predictive accuracy, statistical distance, and descriptive statistics. We design a new aggregated metric, called reconstruction loss (RL), to evaluate deep learning–based imputation models. We also develop and evaluate a novel imputation evaluation methodology based on RL. To minimize model and dataset biases, we use a regression imputation model and two different deep learning imputation models: denoising autoencoders and generative adversarial nets. We also use two tabular datasets from different industry sectors: health care and financial. Our results show that the proposed methodology is effective in evaluating multiple properties of the deep learning–based imputation model’s reconstruction performance.
Adult-Generated Dentate Granule Cells in Epilepsy: Loyal Gatekeepers or Evil Changelings?
Authors: Drake Austin W. , Danzer Steve C.
Published: December 2022

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Feasibility and impact of a bespoke pre-hospital point of care ultrasound teaching and training programme at London’s air ambulance service
Authors: Naeem Salman , Durrands Thomas , Christian Michael , Nevin Daniel ,   The LAA PoCUS group
Published: December 2022

Introduction:

Point-of-care ultrasound has seen an increase in its use in pre-hospital emergency care. There is lack of literature around the training requirement for point-of-care ultrasound of pre-hospital clinicians. This service evaluation assesses the effectiveness of a bespoke hybrid teaching programme.

Methods:

This is a service evaluation of the point-of-care ultrasound teaching programme at London’s Air Ambulance from 1 April to 28 May 2021. Subjects’ knowledge, image interpretation and confidence were assessed at two different points. Data were gathered using REDCap and exported to Excel for analysis. Mean values and delta were calculated, and t-test was applied for statistical significance.

Results:

In total, 57 participants were included; out of which 11 were excluded, as they did not complete a post-course survey. Of these, 41.3% participants were point-of-care ultrasound naïve. Mean pre- and post-course scores were 76.5% and 81.7%, respectively, with an average delta improvement of 5.2% (95% confidence interval = 4.70%–5.68%) which was statistically significant ( p < 0.002). There was a statistically significant mean improvement of pre- and post-course scores between point-of-care ultrasound naïve and point-of-care ultrasound experienced groups ( p = 0.014). Confidence in using point-of-care ultrasound showed mean overall improvement from 2.36/4 to 3.34/4, a mean difference of 0.98 (95% confidence interval = 0.61–1.34), which was statistically significant ( p = 0.0039).

Conclusion:

Our service evaluation highlighted that a hybrid teaching model used by London’s Air Ambulance was feasible and had shown significant improvement in the knowledge, image interpretation and confidence of both the point-of-care ultrasound naïve and the PoCUS experienced cohort of clinicians.
Juxtaposing Acquired and Required Skills: Latent Class Analysis of Self-Assessment Scales in an International Survey
Authors: Lounek Vítězslav , Ryška Radim
Published: December 2022

Ensuring comparability of Likert-style items across different countries is a widespread challenge for authors of large-scale international surveys. Using data from the EUROGRADUATE Pilot Survey, this study employs a series of latent class analyses to explore which response patterns emerge from self-assessment of acquired and required skills of higher education graduates and how these patterns vary between eight participating countries. Results show that countries differ in the number of classes which most accurately fit the data structure. The effort to overcome national specifics by combining the levels of acquired and required skills into a single measurement of skill surplus/deficit reduces heterogeneity of patterns across countries and slightly increases comparability, yet the notion that respondents understand the scale in the same way across countries (measurement invariance) is not supported.
Impact of elexacaftor/tezacaftor/ivacaftor on depression and anxiety in cystic fibrosis
Authors: Zhang Lijia , Albon Dana , Jones Marieke , Bruschwein Heather
Published: December 2022

Background:

Cystic fibrosis (CF) is associated with worsening of depression and anxiety symptoms. Elexacaftor/tezacaftor/ivacaftor (Trikafta®), a cystic fibrosis transmembrane regulator (CFTR) modulator approved in 2019, significantly improves lung function, decreases pulmonary exacerbations, and improves quality of life. Studies are needed to evaluate the effects of Trikafta on symptoms of anxiety and depression.

Research Question:

Do adults with CF report a change in depression and anxiety symptoms after Trikafta initiation?

Study Design and Methods:

A retrospective chart review was conducted of patients with CF ( n = 127) receiving care from January 2015 through February 2022. Data collected included demographics, annual PHQ-9 and GAD-7 scores, FEV1 percent predicted at each visit, BMI, consistency and timeline of Trikafta use, mental health diagnoses, counseling/psychotherapy use, psychiatric medication use, prescriber of psychiatric medications, number of psychiatric emergency department visits and psychiatric hospital admissions, and sleep disturbances.

Results:

Of the 127 patients screened for eligibility, 100 patients were included. Data collected yielded 563 PHQ-9, 563 GAD-7, and 560 ppFEV1 data points. No significant changes in average PHQ-9 or GAD-7 scores were found after Trikafta initiation or due to the COVID-19 pandemic. However, 22% of patients initiated or had a change in psychiatric medications, and patients with changes in psychiatric medications had significantly higher PHQ-9 and GAD-7 scores than patients not prescribed psychiatric medications. Trikafta use improved lung function by an average of 5.23% ( p = 8.56e−08). Around a quarter (23%) of all patients reported sleep issues after initiating Trikafta.

Interpretation:

No significant changes in average PHQ-9 and GAD-7 scores were found after Trikafta initiation. A quarter of patients required a change in psychiatric medications, and significant differences in depression and anxiety scores were found between patients with a change in psychiatric medications and those not prescribed medication. Twenty-three percent of patients reported a prevalence of sleep issues after Trikafta initiation.
The dialectics of hope and critique: Reflections on Colombia's new government
Authors: Hernández Vidal Nathalia , Gualdrón Ramírez Miguel
Published: December 2022

A year ago, many would have considered the idea of Gustavo Petro and Francia Márquez becoming the President and the Vice President of Colombia a delirium in a country with 200 years of right-wing political domination. In this contention piece, we reflect on critical points of their government's agenda, some of its challenges, and their strategies to face them. To do that, we draw from the election's extensive press coverage and our own experience as scholar-activists in Colombia and the United States. We also combine our interdisciplinary analytical lenses (Sociology, Philosophy, Feminist Political Ecology, and Critical Race Feminism) to shed light on the complexity of this current political conjecture, the interplay between hope and despair, and the general affective politics that traverses our understanding.
“Land imaginaries” in Western Canada: (financial) neoliberalism, agrarianism, and the contemporary politics of agricultural land
Authors: Beingessner Naomi , Magnan André , Wendimu Mengistu
Published: December 2022

This article examines contemporary political controversies over agricultural land in the prairie region of Canada. We suggest that contemporary land politics reflect elements of continuity and change in a distinctive “land imaginary” connected to the region’s history and recent restructuring. While neoliberalism, and more recently, financialization, have been the main drivers of restructuring in recent decades, certain strands of agrarianism continue to shape social relations in the agricultural sector. We present three case studies, the first of which examines the controversy over institutional investment in farmland, focusing on the Canada Pension Plan’s large-scale purchase of Saskatchewan land. The second case study examines conflicts over the deregulation of government-run community pastures, with implications for the ranching sector, environmental conservation, and the future of native prairie. Our third case study focuses on the proposed sale and land-use conversion of government-owned pasture land in Alberta, dubbed “Potatogate”. We examine the role of farmers, ranchers, governments, NGOs, and private interests in shaping debates over land ownership and use. We argue that these conflicts reveal a tension between (financial) neoliberalism and agrarian arguments and values, with significant differences across agricultural sub-sectors.
Different drug approaches to COVID-19 treatment worldwide: an update of new drugs and drugs repositioning to fight against the novel coronavirus
Authors: Oliver Josidel Conceição , Silva Evandro Neves , Soares Letícia Martins , Scodeler Gislaine Cristina , Santos Ana de Souza , Corsetti Patrícia Paiva , Prudêncio Carlos Roberto , de Almeida Leonardo Augusto
Published: December 2022

According to the World Health Organization (WHO), in the second half of 2022, there are about 606 million confirmed cases of COVID-19 and almost 6,500,000 deaths around the world. A pandemic was declared by the WHO in March 2020 when the new coronavirus spread around the world. The short time between the first cases in Wuhan and the declaration of a pandemic initiated the search for ways to stop the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or to attempt to cure the disease COVID-19. More than ever, research groups are developing vaccines, drugs, and immunobiological compounds, and they are even trying to repurpose drugs in an increasing number of clinical trials. There are great expectations regarding the vaccine’s effectiveness for the prevention of COVID-19. However, producing sufficient doses of vaccines for the entire population and SARS-CoV-2 variants are challenges for pharmaceutical industries. On the contrary, efforts have been made to create different vaccines with different approaches so that they can be used by the entire population. Here, we summarize about 8162 clinical trials, showing a greater number of drug clinical trials in Europe and the United States and less clinical trials in low-income countries. Promising results about the use of new drugs and drug repositioning, monoclonal antibodies, convalescent plasma, and mesenchymal stem cells to control viral infection/replication or the hyper-inflammatory response to the new coronavirus bring hope to treat the disease.
How to win trust: The case of P2P financial fraud in China
Authors: Lo T Wing , Kan Wan Sang
Published: December 2022

Originally, the establishment of peer-to-peer lending (P2P) helped poor people to solve short-term financial problems or had a charitable nature. Along with its development, it became a financial method that helps people invest. It has been developing rapidly in China since 2007 and was claimed as a Ponzi scheme since many investors have been deceived. That is, P2P in China is viewed more as a fraud rather than a formal financial method. Although some studies have explored the overall picture of P2P, this study filled the research gaps by i) using court cases and media reports for analysis, and ii) adopting trust theory and the concept of guanxi, to explore the trust relationship in the P2P. To investigate the process and mechanism in P2P, the present study aimed to examine the situation of P2P investment in China and the trust-building process between investors and P2P companies by using trust theory. A case study method was adopted using published court and media cases. A thematic analysis approach was used to analyse the data. The results demonstrate that investors were guaranteed high financial returns by the companies, and they profited from their initial investments. However, they were commonly deceived in subsequent investments after their trust in the P2P companies was established through the initial gain. The results also reveal a trust-building process between investors and P2P companies through the quality of search, experience and credence as adopted in trust theory. The study complements the trust theory with Chinese cultural concepts such as authority and guanxi and reveals how these are applied in Chinese business malpractices.
The influence of Indigenous status on the issue of police cautions
Authors: Weatherburn Don , Thomas Brendan
Published: December 2022

Over the last 20 years, a body of research has emerged in the United States (US) revealing that the country’s sentencing courts to treat young male African American (and Hispanic) offenders more harshly than white offenders, even after adjusting for relevant legal and contextual factors. Similar research in Australia has generally found that the effect of Indigenous status on adult bail/sentencing outcomes is either non-significant, or significant, but very small. The aim of this study is to explore the impact of race, age, and gender on police decisions to prosecute rather than caution to a juvenile offender. We employ a multilevel model with random intercepts to explore the impact of race, age, and gender on police decisions to prosecute rather than caution to a juvenile offender. The first level controls for offender/offence factors a police officer may legally consider when deciding whether or not to caution a young offender. The second level controls for the police patrol to which the police officer is attached. After adjusting for the effects of legally relevant factors, we find Indigenous juvenile offenders (regardless of sex) are more likely to be prosecuted than cautioned, compared with their non-Indigenous counterparts. There is also wide variation across local area commands in willingness to caution juvenile offenders. We conclude that further research is needed to obtain a better understanding of the factors responsible for racial disparity in the use of police cautions.
Historical growth of concept networks in Wikipedia
Authors: Ju Harang , Zhou Dale , Blevins Ann S , Lydon-Staley David M , Kaplan Judith , Tuma Julio R , Bassett Dani S
Published: December 2022

Philosophers of science have long questioned how collective scientific knowledge grows. Although disparate answers have been posited, empirical validation has been challenging due to limitations in collecting and systematizing large historical records. Here, we introduce new methods to analyze scientific knowledge formulated as a growing network of articles on Wikipedia and their hyperlinks. We demonstrate that in Wikipedia, concept networks in subdisciplines of science do not grow by expanding from their central core to reach an ancillary periphery. Instead, science concept networks in Wikipedia grow by creating and filling knowledge gaps. Notably, the process of gap formation and closure may be valued by the scientific community, as evidenced by the fact that it produces discoveries that are more frequently awarded Nobel prizes than other processes. To determine whether and how the gap process is interrupted by paradigm shifts, we operationalize a paradigm as a particular subdivision of scientific concepts into network modules. Hence, paradigm shifts are reconfigurations of those modules. The approach allows us to identify a temporal signature in structural stability across scientific subjects in Wikipedia. In a network formulation of scientific discovery, our findings suggest that data-driven conditions underlying scientific breakthroughs depend as much on exploring uncharted gaps as on exploiting existing disciplines and support policies that encourage new interdisciplinary research.
Government-Controlled Mass Media as an Obstacle to Health Policy Making: The Case of Iran
Authors: Aghaei Atefeh , Mowlaei Mohammad Mahdi
Published: December 2022

In government-controlled media, serving governments’ economic, political, or ideological interests often diverts media health policies from their primary target of promoting public health, making them ineffective. Understanding the growth of this diversion in countries’ political and social contexts over a long period demands a multi-layer historical analysis. Thus, to explore the roots of this diversion in government-controlled media, we examined the development process of health policy making in Iranian mass media. We conducted and analyzed interviews with 21 media experts and health policy makers through causal layered analysis, including litany, system, discourse, and metaphor layers. Results indicate that the “absence of stable management” and “health programs’ low quality” undermined achievements of health policy making, including establishing the Health Policy Council and two health channels. We identified “lack of comprehensive strategy,” “policymakers’ inadequate knowledge,” “insufficient financing,” and “extensive government intervention” as underlying social causes of ineffective health programs. In addition, the Islamic ideological approach to health issues has been revealed as the dominant discourse. Interview data imply that conflicts between modern medicine and Iran's traditional medical knowledge make it difficult for media health policy makers to achieve their strategic aims. This study provides insights into the challenges of health policy making in government-controlled mass media.
Self-Powered Fine Dust Filtration Using Triboelectrification-Induced Electric Field
Authors: Kim Young-Jun , Kim Hyoung Taek , Lee Jeong Hwan , Suh In-Yong , Kim Sang-Woo
Published: December 2022

Particulate matter (PM) in the environment can adversely affect the health of living things. However, high removal efficiency and low-pressure loss are crucial design challenges for any air filtration system. To circumvent the challenge, here, we demonstrate a novel triboelectric (TE) air filtration system that is based on a rotation-type triboelectric nanogenerator (TENG) and a filter comprising two sets of plates: primary and secondary, that are placed in the airflow channel. When the TENG charges the two plate sets with opposite charges, the flowing air particles are charged at the primary plates and are collected, due to an electric field, at the secondary plates. The TE filter has demonstrated a PM2.5 removal efficiency of ~ 99.97% for the fine dust particles, and it remains stable even after several washing cycles. The pressure loss is almost two orders less than the high-efficiency particulate air filter. Since the airflow itself can drive the TENG, the TE filter can potentially be integrated with any air conditioning system for fine dust filtration in offices, automobiles, etc.
Cryptococcus neoformans endocarditis in an immunocompetentpatient a case report
Authors: McGuire Colin N. , Walter Dylan J.
Published: December 2022

Background

Cryptococcus neoformans is an invasive fungal infection commonly affecting immunocompromised patients as pneumonia or meningitis. More rarely, case reports describe Cryptococcus neoformans endocarditis, though nearly exclusively among patients with active immunosuppression, implanted cardiac devices or prosthetic valves.

Case presentation

We report the case of a patient with underlying substance abuse disorder and systolic heart failure presenting with fever, altered mental status, and shower emboli subsequently found to have native tricuspid valve vegetations and blood cultures positive for cryptococcus neoformans in the absence of immunosuppression.

Conclusions

Historically, Cryptococcus neoformans fungemia manifests clinically as pneumonia or meningitis among the immunosuppressed. There have been rare reports of endocarditis in this population and even fewer reports of native valve endocarditis exist. The present case along with mortality reported in prior literature, suggest suspicion must be maintained in the absence of immunosuppression, even in patients with native valves.
Association of LDL to HDL ratio with new-onset atrial fibrillation after on-pump coronary artery bypass graft surgery
Authors: Yu Ming-Huan , Zhang Ren-Jian-Zhi , Yu Xin-Yi , Shi Jian-Wei , Liu Zhi-Gang
Published: December 2022

Objective

This study aims to analyze the association between preoperative LDL/HDL ratio and new-onset atrial fibrillation (AF) after on-pump coronary artery bypass grafting (on-pump CABG), evaluate the clinic value of preoperative LDL/HDL ratio to identify postoperative rhythm.

Methods

A retrospective study of consecutive patients (n = 2052) who underwent on-pump CABG at TEDA International Cardiovascular Hospital (Tianjin, China), from June 1, 2020, to December 30, 2021, was conducted. The association between preoperative LDL/HDL and new-onset POAF was analyzed by Lowess curve and univariate logistic regression. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate the identification capacity of preoperative LDL/HDL level for new-onset POAF.

Results

In studied populations, the incidence of new-onset POAF was about 29.24%. The lowess curve showed that the association between preoperative LDL/HDL ratio and POAF after on-pump CABG was similar to a linear relationship. With the increasement of preoperative LDL/HDL ratio, the incidence of POAF increased simultaneously. ROC analysis showed that preoperative LDL/HDL ratio could identify postoperative arrhythmia after on-pump CABG (AUC = 0.569,95% CI = 0.529–0.608, P = 0.006) among female patients, the best preoperative LDL/HDL ratio cutoff of 2.11, which was considered a predictive factor of incident POAF, showed a sensitivity of 83.60% (95% CI = 0.775–0.886) and a specificity of 30.02% (95% CI = 0.257–0.346).

Conclusion

Preoperative LDL/HDL ratio is associated with new-onset POAF, but there is a difference in different sex. Preoperative LDL/HDL level can help to identify postoperative rhythm in females.
Transformation of Rasch model logits for enhanced interpretability
Authors: Ekstrand Joakim , Westergren Albert , Årestedt Kristofer , Hellström Amanda , Hagell Peter
Published: December 2022

Background

The Rasch model allows for linear measurement based on ordinal item responses from rating scales commonly used to assess health outcomes. Such linear measures may be inconvenient since they are expressed as log-odds units (logits) that differ from scores that users may be familiar with. It can therefore be desirable to transform logits into more user-friendly ranges that preserve their linear properties. In addition to user-defined ranges, three general transformations have been described in the literature: the least measurable difference (LMD), the standard error of measurement (SEM) and the least significant difference (LSD). The LMD represents the smallest possible meaningful unit, SEM relates the transformed scale values to measurement uncertainty (one unit on the transformed scale represents roughly one standard error), and LSD represents a lower bound for how coarse the transformed scale can be without loss of valid information. However, while logit transformations are relatively common in the health sciences, use of LMD, SEM and LSD transformations appear to be uncommon despite their potential role.

Methods

Logit transformations were empirically illustrated based on 1053 responses to the Epworth Sleepiness Scale. Logit measures were transformed according to the LMD, SEM and LSD, and into 0–10, 0-100, and the original raw score (0–24) ranges. These transformations were conducted using a freely available Excel tool, developed by the authors, that transforms logits into user-defined ranges along with the LMD, SEM and LSD transformations.

Results

Resulting LMD, SEM and LSD transformations ranged 0-34, 0-17 and 0-12, respectively. When considering these relative to the three user-defined ranges, it is seen that the 0-10 range is narrower than the LSD range (i.e., loss of valid information), and a 0-100 range gives the impression of better precision than there is, since it is considerably wider than the LMD range. However, the 0-24 transformation appears reasonable since it is wider than the LSD, but narrower than the LMD ranges.

Conclusions

It is suggested that LMD, SEM and LSD transformations are valuable for benchmarking in deciding appropriate ranges when transforming logit measures. This process can be aided by the Excel tool presented and illustrated in this paper.
Exploring factors that influence HRQoL for people living with Parkinson’s in one region of Ireland: A cross-sectional study
Authors: Cassidy Irene , Doody Owen , Meskell Pauline
Published: December 2022

Background

The diversity of symptoms associated with Parkinson’s and their impact on functioning have led to an increased interest in exploring factors that impact Health-Related Quality of Life (HRQoL). Although the experience of Parkinson’s is unique, some symptoms have a greater impact than others, e.g. depression. Moreover, as the risk of Parkinson’s increases with age, the financial and public health impact of this condition is likely to increase, particularly within the context of a globally ageing population. In Ireland, research is ongoing in the pursuit of causes and effective treatments for Parkinson’s; however, its impact on everyday living, functioning, and HRQoL is largely under-examined. This study aims to describe factors that influence HRQoL for people with Parkinson’s (PwP) in one region of Ireland.

Methods

A cross-sectional postal survey was conducted among people living with Parkinson’s (n = 208) in one area of Ireland. This survey included socio-demographic questions, Nonmotor Symptoms Questionnaire for Parkinson’s disease (NMSQuest), the Geriatric Depression Scale (GDS-15), and the Parkinson’s disease Questionnaire (PDQ-39). Statistical analysis was conducted using SPSS, IBM version 25 (SPSS Inc., Chicago, II, USA).

Results

Participants reflected a predominantly older population who were married, and lived in their own homes (91%). Participants diagnosed the longest reported poorer HRQoL regarding mobility, activities of daily living, emotional well-being, social support, cognition, communication domains and overall HRQoL. Lower HRQoL correlated with higher depression scores p < 0.001 and participants in the lower HRQoL cohort experienced 2.25 times more non-motor symptoms (NMSs) than participants with higher HRQoL. Hierarchical multiple linear regression analysis predicted Geriatric Depression Scale (GDS15) score, NMS burden, and years since diagnosis to negatively impact HRQoL. Principal component analysis (PCA) also indicated that for the population in this study, components measuring 1) independence/dependence 2) stigma 3) emotional well-being, and 4) pain were central to explaining core aspects of participants’ HRQoL.

Conclusions

Findings highlighted the negative impact of longer disease duration, NMS burden, depression, mobility impairments, and perceived dependence on HRQoL for PwP. The positive influence of perceived independence, social engagement along with close supportive relationships were also identified as key components determining HRQoL. Findings emphasised the importance of long-term healthcare commitment to sustaining social and community supports and therapeutic, rehabilitative initiatives to augment HRQoL for PwP.
Reinforcement learning using Deep $$Q$$ networks and $$Q$$ learning accurately localizes brain tumors on MRI with very small training sets
Authors: Stember J. N. , Shalu H.
Published: December 2022

Background

Supervised deep learning in radiology suffers from notorious inherent limitations: 1) It requires large, hand-annotated data sets; (2) It is non-generalizable; and (3) It lacks explainability and intuition. It has recently been proposed that reinforcement learning addresses all three of these limitations. Notable prior work applied deep reinforcement learning to localize brain tumors with radiologist eye tracking points, which limits the state-action space. Here, we generalize Deep Q Learning to a gridworld-based environment so that only the images and image masks are required.

Methods

We trained a Deep $$Q$$
Q
network on 30 two-dimensional image slices from the BraTS brain tumor database. Each image contained one lesion. We then tested the trained Deep Q network on a separate set of 30 testing set images. For comparison, we also trained and tested a keypoint detection supervised deep learning network on the same set of training/testing images.

Results

Whereas the supervised approach quickly overfit the training data and predictably performed poorly on the testing set (11% accuracy), the Deep $$Q$$
Q
learning approach showed progressive improved generalizability to the testing set over training time, reaching 70% accuracy.

Conclusion

We have successfully applied reinforcement learning to localize brain tumors on 2D contrast-enhanced MRI brain images. This represents a generalization of recent work to a gridworld setting naturally suitable for analyzing medical images. We have shown that reinforcement learning does not over-fit small training sets, and can generalize to a separate testing set.
Potentially preventable hospitalizations and super-utilization of inpatient services among patients with chronic kidney disease in Hawaiʻi
Authors: Prabhudesai Devashri , Davis James , Chen John J. , Lim Eunjung
Published: December 2022

Background

Chronic kidney disease (CKD) is linked to high morbidity and mortality and increased hospitalization burden. If appropriately managed in the outpatient setting, ambulatory care-sensitive conditions (ACSCs) do not lead to hospitalization. Hospitalizations due to ACSCs are considered as potentially preventable hospitalizations. Patients with recurrent hospitalizations are considered as super-utilizers of inpatient services. The aim of this study is to determine prevalence of potentially preventable hospitalizations and super-utilization of inpatient services among patients with CKD in Hawaiʻi.

Methods

Hawaiʻi statewide inpatient data (2015–2017) were used to identify adult CKD patients with hospitalizations during a 12-month period from the first recorded date of CKD. The associations between the potentially preventable hospitalizations and super-utilization and other key patient demographic and clinical variables (sex, age, ethnicity, insurance type, Charlson comorbidity index (CCI), county of residence, and homelessness indicator) were analyzed using bivariate analysis. Multivariable logistic regression was utilized to assess the associations between the potentially preventable hospitalizations and patient variables.

Results

Approximately 2% of patients reported potentially preventable hospitalizations, and a total of 12.3% patients reported super-utilization. Out of all CKD-specific ACSC hospitalizations, 74.2% were due to heart failure and 25.8% were due to hyperkalemia. Patients who reported super-utilization were more likely to report potentially preventable hospitalization (OR: 5.98, 95%CI: 4.50–7.93) than patients who did not report super-utilization.

Conclusion

This study showed prevalence of potentially preventable hospitalizations and high inpatient utilization among CKD patients in Hawaiʻi. Heart failure and hyperkalemia were the two major causes of CKD-specific ACSC hospitalizations in this cohort. Effective strategies should be employed to improve the outpatient CKD management to reduce hospitalizations and in turn reduce cost.
Fatal thrombolysis-related intracerebral haemorrhage associated with amyloid-β-related angiitis in a middle-aged patient – case report and literature review
Authors: Reisz Zita , Troakes Claire , Sztriha Laszlo K. , Bodi Istvan
Published: December 2022

Background

Amyloid-β-related angiitis (ABRA) is a rare complication of cerebral amyloid angiopathy, characterized by amyloid-β deposition in the leptomeningeal and cortical vessels with associated angiodestructive granulomatous inflammation. The clinical presentation is variable, including subacute cognitive decline, behavioural changes, headaches, seizures and focal neurological deficits, which may mimic other conditions. Here, we present a case with fatal thrombolysis-related haemorrhage associated with ABRA in a middle-aged patient.

Case presentation

A 55-year-old man was admitted to hospital with sudden onset left-sided cheek, arm and hand sensory loss, blurred vision, and worsening headache, with a National Institutes of Health Stroke Scale (NIHSS) score of 3. An acute CT head scan showed no contraindications, and therefore the decision was made to give intravenous thrombolysis. Post-thrombolysis, he showed rapid deterioration with visual disturbances, headache and confusion, and a repeat CT head scan confirmed several areas of intracerebral haemorrhage. No benefit from surgical intervention was expected, and the patient died four days after the first presentation. Neuropathological examination found acute ischemic infarcts of three to five days duration in the basal ganglia, insular cortex and occipital lobe, correlating with the initial clinical symptoms. There were also extensive recent intracerebral haemorrhages most likely secondary to thrombolysis. Furthermore, the histological examination revealed severe cerebral amyloid angiopathy associated with granulomatous inflammatory reaction, consistent with ABRA.

Conclusions

Presentation of ABRA in a middle-aged patient highlighted the difficulties in recognition and management of this rare condition. There is emerging evidence that patients with CAA may have increased risk of fatal intracerebral haemorrhages following thrombolysis. This may be further increased by a coexisting CAA-related inflammatory vasculopathy which is potentially treatable with steroid therapy if early diagnosis is made.
A pilot study of viscoelastic agent to prevent recurrent vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy
Authors: Qiu Chang-Yu , Shi Yuan-Yuan , Zhao Hong-Wei , Gong Yu-Bo , Nie Chuang , Wang Meng-Ge , Jia Rui , Zhao Jun , Wang Xin , Luo Ling
Published: December 2022

Background

To evaluate the possibilty of preventing recurrent vitreous hemorrhage (RVH) after vitrectomy in proliferative diabetic retinopathy (PDR) patients with unabsorbed vitreous hemorrhage (VH) by intravitreal injection of viscoelastic agent (VA) at the end of the surgery and compared its effect with triamcinolone acetonide (TA).

Methods

This was a pilot prospective, observational study. PDR patients with VH who underwent vitrectomy were assigned to 3 groups according to the tamponade applicated at the end of the surgery, including VA group (intravitreally injected 1 ml VA if the retina was prone to bleed during the operation), TA group (intravitreally injected 2 mg TA when there was much exudates), or balanced salt solution (BSS) group (no tamponade). Then postoperative follow-up was performed routinely until 6 months after surgery. The primary outcome was the incidence of RVH, secondary outcome were the best-corrected visual acuity (BCVA) and introcular pressure (IOP). Cataract formation and other complication were also assessed.

Results

A total of 68 eyes, from 68 patients, were included. 18,18,32 eyes were enrolled in the VA group, TA group and BSS group, respectively. The integral incidence of RVH after vitrectomy was 5.6%, 5.6% and 12.5% respectively (P = 0.602). There was no early RVH in VA or TA group, whereas 3 early RVHs were identified in BSS group, however there was no significant difference (P = 0.171). Every group had one late RVH case. In all groups, final BCVA showed significant improvement compared to baseline. BCVA at any postoperative visit showed no significant differences among 3 groups. Mean IOP was higher 1 week after surgery in VA group compared with the other groups; however, in other times the differences were not significant. No cataract formation and other complication was noted in 3 groups.

Conclusion

Intravitreal injection of VA or TA at the end of vitrectomy for PDR patients with unabsorbed VH tend to reduce the incidence of early RVH after vitrectomy similarly. As VA was preferred to applicate in the eyes that were prone to bleed, intravitreal injection of VA at the end of vitrectomy might be a promising method for preventing RVH in PDR patients.
Corneal epithelial ingrowth after perforating corneal injury: a case report
Authors: Quintin Adrien , Hamon Loïc , Flockerzi Fidelis A. , Schlötzer-Schrehardt Ursula , Dias Blak Matthias , Seitz Berthold
Published: December 2022

Background

Epithelial ingrowth is a rare complication after ocular perforation and can become manifest many years after the primary trauma.

Case presentation

A 49-year-old patient presented with a positive Seidel test of unclear origin at her left eye, as well as a sharply defined anterior-stromal corneal scar at both eyes. Prior operations included a bilateral laser-assisted blepharoplasty 3 months earlier. The patient indicated to have been on holiday to France 5 months earlier, during an ongoing oak processionary moth caterpillars infestation.

The examination using confocal microscopy confirmed a corneal perforation at the left eye and revealed corneal epithelial ingrowth capped with scarred stroma in both eyes. We performed a penetrating keratoplasty at the left eye. The scarred and perforated host cornea was divided into 4 pieces for further investigation: microbiology (negative), virology (negative), histology and transmission electron microscopy (TEM). Histology revealed differently structured epithelium, centrally inverted into the stroma through defects in Bowman’s layer. TEM revealed full thickness corneal perforation with an epithelial plug extending to the lower third of the cornea, but without evidence of epithelial cell migration into the anterior chamber.

Our differential diagnosis of the unclear positive Seidel test with epithelial ingrowth was as follows: (1) corneal perforation by hairs of the oak processionary moth caterpillar, although no hairs could be found histologically; (2) corneal perforation during laser-assisted blepharoplasty, which may be supported by the presence of pigmented cells on the posterior surface of Descemet´s membrane, pointing to a possible iris injury.

Conclusion

Consequently, we highlighted that contact lenses can be useful, safe and inexpensive protective devices in upper eyelid procedures to protect the cornea against mechanical iatrogenic trauma.
The mediating and moderating role of psychological resilience between occupational stress and mental health of psychiatric nurses: a multicenter cross-sectional study
Authors: Chen Shu-Yan , Yan Shi-Rui , Zhao Wei-Wei , Gao Ying , Zong Wei , Bian Cheng , Cheng Yin , Zhang Yan-Hong
Published: December 2022

Background

The particular occupational stress of psychiatric nurses has a negative impact on their mental health. There is evidence that psychological resilience can promote mental health; however, the relationship between resilience in occupational stress and mental health of psychiatric nurses is unclear, and mental health was assessed from a psychopathological perspective, neglecting the role of positive psychology. Therefore, this study was based on a dual-factor model of mental health, describing mental health in terms of both positive well-being and psychiatric symptoms. We aimed to investigate the level of psychiatric nurses' mental health and whether resilience plays a mediating or moderating role between occupational stress and mental health in psychiatry nurses.

Methods

A cross sectional survey of 450 psychiatric nurses in five hospitals in Jiangsu Province was conducted using a convenience sampling method, of which 413 were valid questionnaires with an effective rate of 91.8%. The evaluation included the Chinese Nurses’ Stress Scale, the Connor-Davidson Resilience Scale, the Warwick-Edinburgh Mental Well-being Scale, and the General Health Questionnaire. Descriptive and Spearman correlation analyses were performed using SPSS25.0 while mediating and moderating effects were performed using SmartPLS3.0.

Results

Based on a dual-factor model of mental health, this study found that psychiatric nurses had a low general state of mental health, with 54.5% positive mental health, 7% vulnerable, 21.8% symptomatic but content, and 16.7% completely troubled. In addition, we found that resilience plays a mediating role in stress and mental health [β = -0.230, 95% CI of (-0.310, -0.150)] and does not play a moderating role [β = -0.018, 95%CI (-0.091, 0.055)].

Conclusions

Psychiatric nurses are in a poor state of mental health, and psychological resilience partly mediates occupational stress and mental health. This study suggests that attention should be paid to both positive and negative aspects of psychiatric nurses' mental health, and strategies should be developed to reduce occupational stress and develop psychological resilience.
Physical impairments among adults in Denmark: a register-based study
Authors: Nikolajsen Helene , Larsen Camilla Marie , Holsgaard-Larsen Anders , Juul-Kristensen Birgit , Hestbaek Lise
Published: December 2022

Background

Knowledge of the prevalence and socio-demographic characteristics of physical impairments is limited. This study aimed to determine the prevalence of physical impairments among adults in Denmark, both in total and according to nine common diagnostic subgroups, describe the socio-demographic and socio-economic profile, and compare the data with those of the general adult population.

Methods

This descriptive, cross-sectional, register-based study evaluated the general socio-demographic and socio-economic variables, including sex, age, geographical region, origin, educational level, occupation, marital status, and disability level, of adults with physical impairments extracted by diagnosis from the Danish National Patient Register and Statistics Denmark by 31 December 2018. These data were compared with those of the general adult population in Denmark extracted from Statistics Denmark by January 2019.

Results

In total, 606,857 adults with physical impairments were identified. Of the nine selected diagnoses, osteoarthritis (69.4%) was the most prevalent, followed by acquired brain injury (29.0%), rheumatoid arthritis (6.7%), multiple sclerosis (2.6%), spinal cord injury (1.5%), cerebral palsy (1.2%), amputation (0.7%), muscular dystrophy (0.5%), and poliomyelitis (< 0.1%). There were large variations in the socio-demographic and socio-economic profile between the nine diagnostic subgroups. The adults with physical impairments were more often women, were older, were less often immigrants and employed adults, had a lower educational level, and were more commonly married than the general adult population. Only the geographical region did not differ.

Conclusion

The nine subgroups with diagnoses related to the musculoskeletal system represent 13% of the adult Danish population. The socio-demographic and socio-economic profile varied largely between the nine diagnostic subgroups, and almost all variables differed significantly between adults with physical impairments and the general adult population in Denmark. These findings reveal patterns and trends on socio-demographic and socio-economic variables essential for future planning at a societal level, including the healthcare and social sectors.
Identifying potential factors associated with PCR testing for COVID-19 among Australian young people: cross-sectional findings from a longitudinal study
Authors: Islam Md Irteja , Chadwick Verity , Martiniuk Alexandra
Published: December 2022

Background

Testing has played a crucial role in reducing the spread of COVID-19. Though COVID-19 symptoms tend to be less severe in adolescents and young adults, their highly social lifestyles can lead to increased transmission of the virus. In this study, we aimed to provide population-based estimates of polymerase chain reaction testing (PCR) for the COVID-19 pandemic and identify factors associated with PCR testing in Australian youth using the latest survey data from the Longitudinal Study of Australian Children (LSAC).

Methods

We used the latest wave (9C1) of the LSAC, collected from 16 to 21-year-old Australians via an online survey between October and December 2020. In total, 2291 youths responded to the questions about COVID-19 testing including factors related to the coronavirus restriction period (CRP) in Australia. Both bivariate and multivariate logistic regression analyses were performed to identify variables (sociodemographic factors and factors related to CRP) associated with COVID-19 testing.

Results

During the study period, 26% (n = 587) of Australian youth aged between 16 and 21 years were tested for COVID-19. The strongest predictor of COVID-19 testing was living in major cities (aOR 1.82, 95% CI:1.34–2.45; p < 0.01). Increased age (aOR 1.97, 1.00–3.89; p < 0.05) and having a pre-existing medical condition (aOR 1.27, 1.02–1.59; p < 0.05) were also significantly associated with a higher likelihood of COVID-19 testing.

Conclusion

Age, remoteness and having a pre-existing medical illness were associated with PCR COVID-19 testing among Australian youth aged between 16 and 21 years in the first year of the COVID-19 pandemic. More research is warranted to identify factors associated with other COVID-19 testing methods and address the specific barriers that may limit COVID-19 testing in this age group.