bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonopioid Substance Use among Patients Who Recently Initiated Office-based Buprenorphine Treatment
Authors: Dugosh Karen L. , Lent Michelle R. , Burkley S. Brook , Millard Conor M.K. , McKay James R. , Kampman Kyle M.
Published: April 2023

Objectives

Medications for opioid use disorder (MOUDs) like buprenorphine are a first-line treatment for individuals who have opioid use disorder (OUD); however, these medications are not designed to impact the use of other classes of drugs. This descriptive study provides up-to-date information about nonopioid substance use among patients who recently initiated office-based buprenorphine treatment for OUD using data from 2 ongoing clinical trials.

Methods

The study sample was composed of 257 patients from 6 federally qualified health centers in the mid-Atlantic region who recently (i.e., within the past 28 days) initiated office-based buprenorphine treatment between July 2020 and May 2022. After the screening and informed consent processes, participants completed a urine drug screen and psychosocial interview as a part of the study baseline assessment. Descriptive analyses were performed on urine drug screen results to identify the prevalence and types of substances detected.

Results

More than half of participants provided urine specimens that were positive for nonopioid substances, with marijuana (37%, n = 95), cocaine (22%, n = 56), and benzodiazepines (11%, n = 28) detected with the highest frequencies.

Conclusions

A significant number of participants used nonopioid substances after initiating buprenorphine treatment, suggesting that some patients receiving MOUDs could potentially benefit from adjunctive psychosocial treatment and supports to address their nonopioid substance use.
Hypertension prevalence by degrees of urbanization and altitude in Peru: pooled analysis of 186 906 participants
Authors: Mendoza-Quispe Daniel , Chambergo-Michilot Diego , Moscoso-Porras Miguel , Bernabe-Ortiz Antonio
Published: April 2023

Objective:

Few studies, using countrywide data, examined how hypertension prevalence varies at diverse degrees of urbanization and altitude. This study examined the association between urbanization and altitude, including the potential interaction between those variables, with hypertension prevalence in Peru.

Methods:

Cross-sectional analysis of the Peruvian Demographic and Health Survey (2014–2019). Hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg or self-reported diagnosis) was the outcome. Exposures were altitude levels, and urbanization assessed with four indicators (urban/rural; type of place of residence; population density level; and population size level).

Results:

Among 186 906 participants (mean age ± standard deviation: 40.6 ± 17.9; 51.1% women), pooled hypertension prevalence was 19% [95% confidence interval (CI) 18.7–19.3], which was higher in urban compared with rural areas (prevalence ratio: 1.09; 95% CI 1.05–1.15). Compared with countryside, hypertension was higher in towns (prevalence ratio: 1.09; 95% CI 1.04–1.15), small cities (prevalence ratio: 1.07; 95% CI 1.02–1.13) and large cities (prevalence ratio: 1.19; 95% CI 1.12–1.27). Compared with least density settings (1–500 inhabitants/km2), hypertension was higher in the highest density (≥10 001 inhabitants/km2) settings (prevalence ratio: 1.12; 95% CI 1.07–1.18). Population size was not associated with hypertension. Compared with low altitude, hypertension was lower above 2500 m (prevalence ratio 0.91; 95% CI 0.87–0.94) and above 3500 m (prevalence ratio 0.89; 95% CI 0.84–0.95). Interaction between exposures had varying patterning.

Conclusion:

Hypertension in Peru is more prevalent at urban than rural areas, especially in large cities and in more densely populated areas above 10 001 inhabitants/km2, and less prevalent at altitudes above 2500 m.
Online calculators for predicting the risk of anastomotic stricture after hepaticojejunostomy for bile duct injury after cholecystectomy: a multicenter retrospective study
Authors: Chen Jiangming , Chen Zixiang , Yan Xiyang , Liu Xiaoliang , Fang Debao , Miao Xiang , Tong Zhong , Wang Xiaoming , Lu Zheng , Hou Hui , Wang Cheng , Geng Xiaoping , Liu Fubao
Published: April 2023

Background:

Anastomotic stricture is a common underlying cause of long-term morbidity after hepaticojejunostomy (HJ) for bile duct injury (BDI) following cholecystectomy. However, there are no methods for predicting stricture risk. This study was aimed at establishing two online calculators for predicting anastomotic stricture occurrence (ASO) and stricture-free survival (SFS) in this patient population.

Methods:

The clinicopathological characteristics and follow-up information of patients who underwent HJ for BDI after cholecystectomy from a multi-institutional database were reviewed. Univariate and multivariate analyses of the risk factors of ASO and SFS were performed in the training cohort. Two nomogram-based online calculators were developed and validated by internal bootstrapping resamples (n=1000) and an external cohort.

Results:

Among 220 screened patients, 41 (18.64%) experienced anastomotic strictures after a median follow-up of 110.7 months. Using multivariate analysis, four variables, including previous repair, sepsis, HJ phase, and bile duct fistula, were identified as independent risk factors associated with both ASO and SFS. Two nomogram models and their corresponding online calculators were subsequently developed. In the training cohort, the novel calculators achieved concordance indices (C-indices) of 0.841 and 0.763 in predicting ASO and SFS, respectively, much higher than those of the above variables. The predictive accuracy of the resulting models was also good in the internal (C-indices: 0.867 and 0.821) and external (C-indices: 0.852 and 0.823) validation cohorts.

Conclusions:

The two easy-to-use online calculators demonstrated optimal predictive performance for identifying patients at high risk for ASO and with dismal SFS. The estimation of individual risks will help guide decision-making and long-term personalized surveillance.
Impact of Weight on Ventricular Assist Device Outcomes in Dilated Cardiomyopathy Patients in Pediatric Centers: An ACTION Registry Study
Authors: Kwiatkowski David M. , Shezad Muhammad , Barnes Aliessa P. , Ploutz Michelle S. , Law Sabrina P. , Zafar Farhan , Morales David LS. , O’Connor Matthew J. ,   on behalf of the ACTION Network Investigators
Published: April 2023

Ventricular assist device (VAD) options vary for children in different weight groups. This study evaluates contemporary device usage and outcomes for children based on weight. Data from the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry were examined for patients with dilated cardiomyopathy (DCM) in 4 weight cohorts: <8 kg, 8–20 kg, 21–40 kg, and >40 kg, for devices implanted 3/2013–10/2020. Adverse event rates and ultimate outcome (deceased, alive on device, transplanted, or ventricular recovery) were analyzed. 222 DCM patients were identified with 24% in cohort 1, 23% in cohort 2, 15% in cohort 3, and 38% in cohort 4. Of 272 total implants, paracorporeal pulsatile devices were most common (95%) in cohorts 1 and 2 and intracorporeal continuous devices (81%) in cohorts 3 and 4. Stroke was noted in 17%, 12%, 6%, and 4% of cohorts, respectively (Cohort 1 vs. 4 and 2 vs. 4 – p = 0.01; other comparisons – not significant). Incidences of major bleeding, device malfunction, and infection was not different. All cohorts had >90% positive outcomes. Stroke incidence was higher in smaller cohorts, but other outcomes were similar. Positive outcomes were attained in over 90% across all weight groups, demonstrating excellent outcomes using current VADs in this DCM population.
Does Tracheostomy Improve Outcomes in Those Receiving Venovenous Extracorporeal Membrane Oxygenation?
Authors: Boudreaux Joel C. , Urban Marian , Thompson Shaun L. , Castleberry Anthony W. , Moulton Michael J. , Siddique Aleem
Published: April 2023

Patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) often require extended periods of ventilation. We examined the role of tracheostomy on outcomes of patients supported with VV-ECMO. We reviewed all patients at our institution who received VV-ECMO between 2013 and 2019. Patients who received a tracheostomy were compared with VV-ECMO–supported patients without tracheostomy. The primary outcome measure was survival to hospital discharge. Secondary outcome measures included length of intensive care unit (ICU) and hospital stay and adverse events related to the tracheostomy procedure. Multivariable analysis was performed to identify predictors of in-hospital mortality. We dichotomized patients receiving tracheostomy into an “early” and “late” group based on median days to tracheostomy following ECMO cannulation and separate analysis was performed. One hundred and fifty patients met inclusion criteria, 32 received a tracheostomy. Survival to discharge was comparable between the groups (53.1% vs. 57.5%, p = 0.658). Predictors of mortality on multivariable analysis included Respiratory ECMO Survival Prediction (RESP) score (odds ratio [OR] = 0.831, p = .015) and blood urea nitrogen (BUN) (OR = 1.026, p = 0.011). Tracheostomy performance was not predictive of mortality (OR = 0.837, p = 0.658). Bleeding requiring intervention occurred in 18.7% of patients following tracheostomy. Early tracheostomy (<7 days from the initiation of VV-ECMO) was associated with shorter ICU (25 vs. 36 days, p = 0.04) and hospital (33 vs. 47, p = 0.017) length of stay compared with late tracheostomy. We conclude that tracheostomy can be performed safely in patients receiving VV-ECMO. Mortality in these patients is predicted by severity of the underlying disease. Performance of tracheostomy does not impact survival. Early tracheostomy may decrease length of stay.
Adsorption and Clearance of the Novel Fluorescent Tracer Agent MB-102 During Continuous Renal Replacement Therapy: In Vitro Results
Authors: Jang Soo M. , Shieh Jeng-Jong , Riley Ivan R. , Dorshow Richard B. , Mueller Bruce A.
Published: April 2023

MB-102 is a novel fluorescent tracer agent that is exclusively removed from the body by glomerular filtration. This agent can be detected transdermally to provide a real-time measurement of glomerular filtration rate at the point-of-care and is currently in clinical studies for such. MB-102 clearance during continuous renal replacement therapy (CRRT) is unknown. Its plasma protein binding (~0%), molecular weight (~372 Da) and volume of distribution (15–20 L) suggest that it may be removed by renal replacement therapies. To determine the disposition of MB-102 during CRRT, an in vitro study assessing the transmembrane clearance (CLTM) and adsorptive clearance of MB-102 was conducted. A validated in vitro bovine blood continuous hemofiltration (HF) and continuous hemodialysis (HD) models were performed using two types of hemodiafilters to evaluate CLTM of MB-102. For HF, three different ultrafiltration rates were evaluated. For HD, four different dialysate flow rates were evaluated. Urea was used as a control. No MB-102 adsorption to the CRRT apparatus or either of hemodiafilters was observed. MB-102 is readily removed by HF and HD. Dialysate and ultrafiltrate flow rates directly influence MB-102 CLTM. Hence MB-102 CLTM should be measurable for critically ill patients receiving CRRT.
START-Play Physical Therapy Intervention Indirectly Impacts Cognition Through Changes in Early Motor-Based Problem-Solving Skills
Authors: Koziol Natalie A. , Kretch Kari S. , Harbourne Regina T. , Lobo Michele A. , McCoy Sarah W. , Molinini Rebecca , Hsu Lin-Ya , Babik Iryna , Cunha Andrea Baraldi , Willett Sandra L. , Bovaird James A. , Dusing Stacey C.
Published: April 2023

Purpose:

This study tested whether the Sitting Together and Reaching to Play (START-Play) physical therapy intervention indirectly impacts cognition through changes in perceptual-motor skills in infants with motor delays.

Methods:

Participants were 50 infants with motor delays randomly assigned to START-Play plus Usual Care Early Intervention (UC-EI) or UC-EI only. Infants' perceptual-motor and cognitive skills were assessed at baseline and 1.5, 3, 6, and 12 months post-baseline.

Results:

Short-term changes in sitting, fine motor skills, and motor-based problem-solving, but not reaching, predicted long-term changes in cognition. START-Play indirectly impacted cognition through motor-based problem-solving but not sitting, reaching, or fine motor skills.

Conclusions:

This study provided preliminary evidence that early physical therapy interventions that blend activities across developmental domains and are supported by an enriched social context can place infants on more optimal developmental trajectories.
Pediatric GI Health Care Professionals’ Perceptions of and Engagement With Psychosocial Providers in Pediatric IBD Care
Authors: David Jennie G. , Sejkora Ellen , Michel Hilary K. , Mackner Laura ,   ImproveCareNow Learning Health System
Published: April 2023

Objectives:

Multidisciplinary care is recommended for optimal pediatric inflammatory bowel disease (IBD) care, including psychosocial providers (eg, psychologists). However, health care professionals’ (HCPs) perceptions of and engagement with psychosocial providers in pediatric IBD is lacking.

Methods:

Cross-sectional REDCap surveys were completed by HCPs (eg, gastroenterologists) across American ImproveCareNow (ICN) centers. Demographics and self-reported perceptions of and engagement with psychosocial providers were collected. Data were analyzed at participant and site levels through descriptives, frequencies, an independent t test, and exploratory analyses of variance.

Results:

A total of 101 participants from 52% of ICN sites participated. Participants were 88% gastrointestinal physicians, 49% identifying as female, 94% non-Hispanic, and 76% Caucasian. Of ICN sites, 75% and 94% of sites reported outpatient and inpatient psychosocial care, respectively. Participants referred for various clinical reasons to psychosocial providers (eg, illness adjustment). At the participant level, 92% of HCPs reported psychosocial care was very important and 64% reported their clinical thresholds shifted to engage psychosocial providers earlier in care. Barriers to psychosocial care included limited psychosocial providers (92%), psychosocial providers availability (87%), and IBD patients’ lack of openness to psychosocial care (85%). One-way analyses of variance by HCP length of experiences were not statistically significant on perceived understanding of psychosocial providers or perceived changes in clinical threshold over time.

Conclusion:

HCPs overall reported positive perceptions of and frequent engagement with psychosocial providers in pediatric IBD. Limited psychosocial providers and other notable barriers are discussed. Future work should continue interprofessional education of HCPs and trainees and efforts to improve access to psychosocial care in pediatric IBD.
A Case of Pediatric Alcohol-Associated Hepatitis Evaluated for Liver Transplant Listing
Authors: Schenker Rachel B. , Dybbro Eric , Kim Brian , Patel Shreena , Yanni George
Published: April 2023

Alcohol-associated hepatitis (AH) refers to liver injury from alcoholic intake that usually occurs after years of heavy alcohol abuse. Frequent, heavy alcohol consumption causes hepatic inflammation, fibrosis, and cirrhosis. Some patients develop severe AH, which carries high short-term mortality and is the second most common reason for adult liver transplants (LTs) worldwide. We present one of the first cases of a teenager diagnosed with severe AH that led to LT evaluation. Our patient was a 15-year-old male who presented with epistaxis and 1 month of jaundice after 3 years of heavy daily alcohol abuse. In collaboration with our adult transplant hepatologist colleagues, we initiated a management plan that consisted of treating acute alcohol withdrawal, steroid utilization, mental health support, and LT evaluation.
Population Segmentation for COVID-19 Vaccine Outreach: A Clustering Analysis and Implementation in Missouri
Authors: Chessen Eleanor G. , Ganser Madelyn E. , Paulish Colin A. , Malik Aamia , Wishner Allison G. , Turabelidze George , Glenn Jeffrey J.
Published: April 2023

Objectives:

The purpose of this work was to segment the Missouri population into unique groups related to COVID-19 vaccine acceptance using data science and behavioral science methods to develop tailored vaccine outreach strategies.

Methods:

Cluster analysis techniques were applied to a large data set that aggregated vaccination data with behavioral and demographic data from the American Community Survey and Deloitte's HealthPrism™ data set. Outreach recommendations were developed for each cluster, specific to each group's practical and motivational barriers to vaccination.

Results:

Following selection procedures, 10 clusters—or segments—of census tracts across Missouri were identified on the basis of k-means clustering analysis of 18 different variables. Each cluster exhibited unique geographic, demographic, socioeconomic, and behavioral patterns, and outreach strategies were developed on the basis of each cluster's practical and motivational barriers.

Discussion:

The segmentation analysis served as the foundation for “working groups” comprising the 115 local public health agencies (LPHAs) across the state. LPHAs with similar community segments in their service area were grouped together to discuss their communities' specific challenges, share lessons learned, and brainstorm new approaches. The working groups provided a novel way for public health to organize and collaborate across the state. Widening the aperture beyond Missouri, population segmentation via cluster analysis is a promising approach for public health practitioners interested in developing a richer understanding of the types of populations they serve. By pairing segmentation with behavioral science, practitioners can develop outreach programs and communications campaigns that are personalized to the specific behavioral barriers and needs of the population in focus. While our work focused on COVID-19, this approach has broad applicability to enhance the way public health practitioners understand the populations they serve to deliver more tailored services.
The Vibrio vulnificus stressosome is dispensable in nutrient-rich media
Authors: Cutugno Laura , Mc Cafferty Jennifer , Pané-Farré Jan , O'Byrne Conor , Boyd Aoife
Published: April 2023

The stressosome is a protein complex that senses environmental stresses and mediates the stress response in several Gram-positive bacteria, through the activation of the alternative sigma factor SigB. The stressosome locus is found in 44% of Gram-negative Vibrio vulnificus isolates. However, V. vulnificus does not possess SigB. Nonetheless, in nutrient-limited media, the stressosome modulates gene transcription and bacterial behaviour.
In this work, the expression of the stressosome genes was proven during stationary phase in nutrient-rich media and the co-transcription as one operonic unit of the stressosome locus and its putative downstream regulatory locus was demonstrated. The construction of a stressosome mutant lacking the genes encoding the four proteins constituting the stressosome complex (VvRsbR, VvRsbS, VvRsbT, VvRsbX) allowed us to examine the role of this complex in vivo. Extensive phenotypic characterisation of the ΔRSTX mutant in nutrient-rich media showed that the stressosome does not contribute to growth of V. vulnificus. Moreover, the stressosome did not modulate the tolerance or survival response of V. vulnificus to the range of stresses tested, which included ethanol, hyperosmolarity, hypoxic, high temperature, acidity and oxidative stress. Furthermore, the stressosome was dispensable for motility and exoenzyme production of V. vulnificus in nutrient-rich media-.
Therefore, in conclusion, although stressosome gene transcription occurs in nutrient-rich media, the stressosome neither has an essential role in stress responses of V. vulnificus, nor does it seem to modulate these activities in these conditions. We hypothesise that the stressosome is expressed in nutrient-rich conditions as a sensor complex, but that activation of the complex does not occur in this environment.
BactoBattle: A game-based learning companion for medical bacteriology
Authors: Imwattana Korakrit , Methawirune Areeya , Voralakkulchai Isara , Ngamskulrungroj Popchai
Published: April 2023

A card game called “BactoBattle” was developed to help medical students who have just started learning medical bacteriology improve their learning efficacy and learning satisfaction, especially on the topic of antimicrobial resistance. Copies of the game were placed in the students’ study room (approximately 1 set per 12 students) and made available to the students throughout the study period so that students could choose to play the game during their free time if desired. After the study period had ended, the students were asked to complete a questionnaire and a posttest. In total, 33 students completed the questionnaire, and were split into two groups: the player group, comprising 12 (36.4%) students who had played the game, and the non-player group. The player group perceived that they could memorize more knowledge compared to the non-player group and indeed recorded higher posttest scores than the non-player group (10.4 vs. 8.3, p = 0.031). However, there was no difference in the learning motivation (p = 0.441) nor enjoyment (p = 0.562) between the two groups. A majority of the players said they would continue playing the game after the study period and a majority of both the players and non-players would recommend the game to other students. In short, the BactoBattle game can be a useful tool to improve the learning efficacy of students, but its effect on learning satisfaction remains unclear.
Thyroid cancer polygenic risk score combined with deep learning analysis of ultrasound images improves the classification of thyroid nodules as benign or malignant
Authors: Pozdeyev Nikita , Dighe Manjiri , Barrio Martin , Raeburn Christopher , Smith Harry , Fisher Matthew , Chavan Sameer , Rafaels Nicholas , Shortt Jonathan A. , Lin Meng , Leu Michael G. , Clark Toshimasa , Marshall Carrie , Haugen Bryan R. , Subramanian Devika , Center Regeneron Genetics , Crooks Kristy , Gignoux Christopher , Cohen Trevor
Published: April 2023

Evaluating thyroid nodules to rule out malignancy is a very common clinical task. Image-based clinical and machine learning risk stratification schemas rely on the presence of thyroid nodule high-risk sonographic features. However, this approach is less suitable for diagnosing malignant thyroid nodules with a benign appearance on ultrasound. In this study, we developed thyroid cancer polygenic risk scoring (PRS) to complement deep learning analysis of ultrasound images. When the output of the deep learning model was combined with thyroid cancer PRS and genetic ancestry estimates, the area under the receiver operating characteristic curve (AUROC) of the benign vs. malignant thyroid nodule classifier increased from 0.83 to 0.89 (DeLong, p-value = 0.007). The combined deep learning and genetic classifier achieved a clinically relevant sensitivity of 0.95, 95 CI [0.88-0.99], specificity of 0.63 [0.55-0.70], and positive and negative predictive values of 0.47 [0.41-0.58] and 0.97 [0.92-0.99], respectively. An improved AUROC was consistent in ancestry-stratified analysis in Europeans (0.83 and 0.87 for deep-learning and deep learning combined with PRS classifiers, respectively). An elevated PRS was associated with a greater risk of thyroid cancer structural disease recurrence (ordinal logistic regression, p-value = 0.002). This study demonstrates that augmenting ultrasound image analysis with PRS improves diagnostic accuracy, paving the way for developing the next generation of clinical risk stratification algorithms incorporating inherited risk for developing thyroid malignancy.
Validation of automated hippocampus volume assessment using deep learning convolutional neural networks in patients with Alzheimer’s disease
Authors: Nabila Ibrahim Nur Shahidatul , Suppiah Subapriya , Ibrahim Buhari , Mohad Azmi Nur Hafizah , Seriramulu Vengkatha Priya , Mohamad Mazlyfarina , Hanafi Marsyita , Sallehuddin Hakimah Mohammad , Razali Rizah Mazzuin , Harrun Noor Harzana
Published: April 2023

Background

Dementia is a spectrum of diseases characterised by a progressive and irreversible decline in cognitive function. Appropriate tools and references are essential for evaluating individuals’ cognitive levels, especially hippocampal volume as it is the commonly used biomarker in detecting Alzheimer’s disease (AD). It is important to note that while there is no cure for dementia, early intervention and support can greatly improve the lives of those affected.

Method

Ongoing research is being conducted to develop new treatments and improve our understanding of the disease by using VBM to compare sensitivity and specificity with the HippoDeep toolbox.

Result

We were able to validate AD’s hippocampal volume compared to age-matched healthy controls (HC) based on HippoDeep Model by comparing it with VBM as the reference standard.

Conclusion

There are significant differences between hippocampal volume in AD and HC that have been detected using VBM and HippoDeep analysis.
Sex-specific developmental scales improve early childhood developmental surveillance
Authors: Sudry Tamar , Amit Guy , Zimmerman Deena R , Tsadok Meytal Avgil , Baruch Ravit , Yardeni Hadar , Akiva Pinchas , Moshe Dror Ben , Bachmat Eitan , Sadaka Yair
Published: April 2023

Introduction

Routine developmental surveillance is fundamental for timely identification of developmental delays. We explored sex-related differences in milestone attainment rate and evaluated the clinical need for sex-specific developmental scales.

Methods

This is a retrospective cross-sectional study, utilizing data from a national child surveillance program. The study included children from birth to six years of age, assessed between 2014-2021 (n=643,958 and n=309,181 for the main and validation cohorts, respectively).

We measured the differences between sexes in normative attainment age of 59 milestones from four developmental domains and calculated the projected error rates when conducting unified vs. sex-specific surveillance.

Results

Girls preceded boys in most milestones of all domains. Conducting developmental surveillance using unified rather than sex-specific scales resulted in potential missing of girls at risk of developmental delay (19.3% of failed assessments), and false alerts for boys (5.9%).

Conclusion

These findings suggest that using sex-specific scales may improve the accuracy of early childhood developmental surveillance.
Performance of ChatGPT on Clinical Medicine Entrance Examination for Chinese Postgraduate in Chinese
Authors: Liu Xiao , Fang Changchang , Yan Ziwei , Liu Xiaoling , Jiang Yuan , Cao Zhengyu , Wu Maoxiong , Chen Zhiteng , Ma Jianyong , Yu Peng , Zhu Wengen , Abudukeremu Ayiguli , Wang Yue , Chen Yangxin , Zhang Yuling , Wang Jingfeng
Published: April 2023

Background

The ChatGPT, a Large-scale language models-based Artificial intelligence (AI), has fueled interest in medical care. However, the ability of AI to understand and generate text is constrained by the quality and quantity of training data available for that language. This study aims to provide qualitative feedback on ChatGPT’s problem-solving capabilities in medical education and clinical decisionmaking in Chinese.

Methods

A dataset of Clinical Medicine Entrance Examination for Chinese Postgraduate was used to assess the effectiveness of ChatGPT3.5 in medical knowledge in Chinese language. The indictor of accuracy, concordance (explaining affirms the answer) and frequency of insights was used to assess performance of ChatGPT in original and encoding medical questions.

Result

According to our evaluation, ChatGPT received a score of 153.5/300 for original questions in Chinese, which is slightly above the passing threshold of 129/300. Additionally, ChatGPT showed low accuracy in answering open-ended medical questions, with total accuracy of 31.5%. While ChatGPT demonstrated a commendable level of concordance (achieving 90% concordance across all questions) and generated innovative insights for most problems (at least one significant insight for 80% of all questions).

Conclusion

ChatGPT’s performance was suboptimal for medical education and clinical decision-making in Chinese compared with in English. However, ChatGPT demonstrated high internal concordance and generated multiple insights in Chinese language. Further research should investigate language-based differences in ChatGPT’s healthcare performance.
Caught in the data quality trap: A case study from the evaluation of a new digital technology supporting routine health data collection in Southern Tanzania
Authors: Unkels Regine , Ahmad Aziz , Manzi Fatuma , Kasembe Asha , Kapologwe Ntuli A. , Nabiev Rustam , Berndtsson Maria , Hirose Atsumi , Hanson Claudia
Published: April 2023

Background

Health service data from Health Management Information Systems is important for decision-making at all health system levels. Data quality issues in low-and-middle-income countries hamper data use however.Smart Paper Technology, a novel digital-hybrid technology, was designed to overcome quality challenges through automated digitization. Here we assessed the impact of the novel system on data quality dimensions, metrics and indicators as proposed by the World Health Organization’sData Quality Review Toolkit.

Methods

This cross-sectional study was conducted between November 2019 and October 2020 in 13 health facilities sampled from 33 facilities of one district in rural Tanzania, where we implementedSmart Paper Technology. We assessed the technology’s data quality for maternal health care against the standardDistrict Health Information System-2applied in Tanzania.

Results

Smart Paper Technologyperformed slightly better than theDistrict Health Information System-2regardingconsistency between related indicatorsandoutliers. We found <10% difference between related indicators for 62% of the facilities for the new system versus 38% for the standard system in the reference year.

Smart Paper Technologywas inferior toDistrict Health Information System-2data in terms ofcompleteness. We observed that data on 1stantenatal care visitswere complete ⍰ 90% in only 76% of facilities for the new system against 92% for the standard system. For the indicatorinternal consistency over time73%, 59% and 45% of client numbers for antenatal, labour and postnatal care recorded in the standard system were documented in the new system.Smart Paper Technologyforms were submitted in 83% of the months for all service areas.

Conclusion

Our results suggest that not all client encounters were documented inSmart Paper Technology, affecting data completeness and partly consistency. The novel system was unable to leverage opportunities from automated processes because primary documentation was poor. Low buy-in of policymakers and lack of internal quality assurance may have affected data quality of the new system. We emphasize the importance of including policymakers in evaluation planning to co-design a data quality monitoring system and to agree on a realistic way to ensure reporting of routine health data to national level.
Relating mutational signature exposures to clinical data in cancers via signeR 2.0
Authors: Drummond Rodrigo , Defelicibus Alexandre , Meyenberg Mathilde , Valieris Renan , Dias-Neto Emmanuel , Rosales Rafael A. , da Silva Israel Tojal
Published: April 2023

Motivation

Cancer is a collection of diseases caused by the deregulation of cell processes, which is triggered by somatic mutations. The search for patterns in somatic mutations, known as mutational signatures, is a growing field of study that has already became a useful tool in oncology. Several algorithms have been proposed to perform one or both the following two tasks: 1)de novoestimation of signatures and their exposures, 2) estimation of the exposures of each one of a set of pre-defined signatures. Our group developed signeR, a Bayesian approach to both these tasks.

Results

Here we present a new version of the software, signeR 2.0, which extends the possibilities of previous analyses to explore the relation of signature exposures to other data of clinical relevance. signeR 2.0 includes an user-friendly interface developed using the R-Shiny framework and improvements in performance. This version allows the analysis of submitted data or public TCGA data, which is embedded on the package for easy access.

Availability

signer 2.0 is an open-source R package available through the Bioconductor project athttps://doi.org/doi:10.18129/B9.bioc.signeR

Contact

itojal@accamargo.org.brorrrosales@usp.br
Vitamin D, chronic pain, and depression: linear and non-linear Mendelian randomization analyses
Authors: Bassett Emily , Gjekmarkaj Eva , Mason Amy M. , Zhao Sizheng Steven , Burgess Stephen
Published: April 2023

Vitamin D deficiency has been linked to various chronic pain conditions. However, randomized trials of vitamin D supplementation have had mixed results. In contrast, systematic reviews of randomized trials indicate a protective effect of vitamin D supplementation on depression. We undertake a Mendelian randomization investigation in UK Biobank, a study of UK residents aged 40-65 at recruitment. We perform linear and non-linear Mendelian randomization analyses for four outcomes: fibromyalgia, clinical fatigue, chronic widespread pain, and probable lifetime major depression. We use genetic variants from four gene regions with known links to vitamin D biology as instruments. In linear analyses, genetically-predicted levels of 25-hydroxyvitamin D [25(OH)D], a clinical marker of vitamin D status, were not associated with fibromyalgia (odds ratio [OR] per 10 nmol/L higher 25(OH)D 1.02, 95% confidence interval [CI] 0.93, 1.12), clinical fatigue (OR 0.99, 95% CI 0.94, 1.05), chronic widespread pain (OR 0.95, 95% CI 0.89, 1.02), or probable lifetime major depression (OR 0.97, 95% CI 0.93, 1.01). In non-linear analyses, an association was observed between genetically-predicted 25(OH)D levels and depression in the quintile of the population with the lowest 25(OH)D levels (OR 0.78, 95% CI 0.64, 0.94); associations were null in other strata. Our findings suggest that population-wide vitamin D supplementation will not substantially reduce pain or depression; however, targeted supplementation of deficient individuals may reduce risk of depression.
Ambulatory Video EEG extended to 10 days: A retrospective review of a large database of ictal events
Authors: Wong Victoria , Hannon Timothy , Fernandes Kiran M. , Freestone Dean R. , Cook Mark J. , Nurse Ewan S.
Published: April 2023

Objective

This work aims to determine the AVEM duration and number of captured seizures required to resolve different clinical questions, using a retrospective review of ictal recordings.

Methods

Patients who underwent home-based AVEM had event data analyzed retrospectively. Studies were grouped by clinical indication: seizure differential diagnosis, classification, or treatment assessment. The proportion of studies where the conclusion was changed after the first seizure was determined, as was the AVEM duration needed for at least 99% of studies to reach a diagnostic conclusion.

Results

The referring clinical question was not answered entirely by the first event in 29.56% (n=227) of studies. Diagnostic and classification indications required a minimum of 7 days for at least 99% of studies to be answered, whilst treatment-assessment required at least 6 days.

Conclusions

At least 7 days of monitoring, and potentially multiple events, are required to adequately answer these clinical questions in at least 99% of patients. The widely applied 72 hours or single event recording cut-offs may be insufficient to correctly answer these three indications in a substantial proportion of patients.

Significance

Extended duration of monitoring and capturing multiple events should be considered when attempting to capture seizures on AVEM.
Automatic segmentation and quantification of nigrosome-1 neuromelanin and iron in MRI: a candidate biomarker for Parkinson’s disease
Authors: Ariz Mikel , Martínez Martín , Alvarez Ignacio , Fernández-Seara Maria A. ,   The Catalonian Neuroimaging Parkinson’s disease Consortium, Pastor Pau , Pastor Maria A. , de Solórzano Carlos Ortiz
Published: April 2023

The dopaminergic neuronal loss in the substantia nigra pars compacta (SNc) has been related to a reduction of neuromelanin (NM) and accumulation of iron in the nigrosome-1 (N1) in Parkinson’s disease (PD). This suggests that N1 degeneration could be a promising early biomarker of PD. To date, only qualitative visual scales have been used to assess its degeneration in iron-sensitive images. Here we present the first fully-automatic method for the quantification of NM and iron content in the N1. Our method uses a multi-image atlas populated with healthy N1 structures that implements a customised label fusion strategy to segment the N1. NM-MRI and susceptibility-weighted images (SWI) of 71 PD patients and 30 healthy controls (HCs) were used in the study. Our quantification showed that N1’s NM content was reduced and the iron content increased in PD patients compared with HCs. ROC analyses showed the high diagnostic potential of N1, and revealed that the N1 alone was more sensitive than the entire SNc to detect abnormal iron accumulations in PD patients. Multi-parametric binary logistic regression showed that computer-assisted diagnosis methods could benefit from the segmentation of the N1 to boost their performance. A significant correlation was also found between most N1 image parameters and both disease duration and the motor status scored with the Unified Parkinson’s disease rating scale part III (UDPRS-III), suggesting a NM reduction along with an iron accumulation in N1 as the disease progresses. In addition, voxel-wise analyses revealed that this association was stronger for the N1 than for the entire SNc, highlighting the benefits of an accurate segmentation of the N1 to monitor disease course.
Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: A design-weighted MAIHDA
Authors: McGuire F. Hunter , Beccia Ariel L. , Peoples JaNiene , Williams Matthew R. , Schuler Megan S. , Duncan Alexis E.
Published: April 2023

This study examined how race/ethnicity, sex/gender, and sexual orientation intersect to socially pattern depression among US adults. We used repeated, cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,772) to conduct design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) for two outcomes: past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated group-specific prevalence and excess/reduced prevalence attributable to intersectional effects (i.e., two-way or higher interactions between identity variables). Models revealed heterogeneity between intersectional groups, with prevalence estimates ranging from 3.4–31.4% (past-year) and 6.7–47.4% (lifetime). Model main effects indicated that people who were Multiracial, White, women, gay/lesbian, or bisexual had greater odds of MDE. Additive effects of race/ethnicity, sex/gender, and sexual orientation explained most between-group variance; however, approximately 3% (past-year) and 12% (lifetime) were attributable to intersectional effects, with some groups experiencing excess/reduced prevalence. For both outcomes, sexual orientation main effects (42.9–54.0%) explained a greater proportion of between-group variance relative to race/ethnicity (10.0–17.1%) and sex/gender (7.5–7.9%). Notably, we extend MAIHDA to calculate nationally representative estimates to open future opportunities to quantify intersectionality with complex sample survey data.
The spatial distribution of coupling between tau and neurodegeneration in amyloid-β positive mild cognitive impairment
Authors: Robinson Belfin , Bhamidi Shankar , Dayan Eran ,   the Alzheimer’s Disease Neuroimaging Initiative
Published: April 2023

Synergies between amyloid-β (Aβ), tau, and neurodegeneration persist along the Alzheimer’s disease (AD) continuum. This study aimed to evaluate the extent of spatial coupling between tau and neurodegeneration (atrophy) and its relation to Aβ positivity in mild cognitive impairment (MCI). Data from 409 subjects were included (95 cognitively normal controls, 158 Aβ positive (Aβ+) MCI, and 156 Aβ negative (Aβ-) MCI) Florbetapir PET, Flortaucipir PET, and structural MRI were used as biomarkers for Aβ, tau and atrophy, respectively. Individual correlation matrices for tau load and atrophy were used to layer a multilayer network, with separate layers for tau and atrophy. A measure of coupling between corresponding regions of interest/nodes in the tau and atrophy layers was computed, as a function of Aβ positivity. The extent to which tau-atrophy coupling mediated associations between Aβ burden and cognitive decline was also evaluated. Heightened coupling between tau and atrophy in Aβ+ MCI was found primarily in the entorhinal and hippocampal regions (i.e., in regions corresponding to Braak stages I/II), and to a lesser extent in limbic and neocortical regions (i.e., corresponding to later Braak stages). Coupling strengths in the right middle temporal and inferior temporal gyri mediated the association between Aβ burden and cognition in this sample. Higher coupling between tau and atrophy in Aβ+ MCI is primarily evident in regions corresponding to early Braak stages and relates to overall cognitive decline. Coupling in neocortical regions is more restricted in MCI.
Investigating the relationship between sleep disturbances and white matter hyperintensities in older adults on the Alzheimer’s disease spectrum
Authors: Kamal Farooq , Morrison Cassandra , Dadar Mahsa
Published: April 2023

Background

While studies report that sleep disturbance can have negative effects on brain vasculature, its impact on cerebrovascular disease such as white matter hyperintensities (WMHs) in beta-amyloid positive older adults remains unexplored.

Methods

Linear regressions, mixed effects models, and mediation analysis examined the cross-sectional and longitudinal associations between sleep disturbance, cognition, and WMH burden, and cognition in normal controls (NCs), mild cognitive impairment (MCI), and Alzheimer’s disease (AD) at baseline and longitudinally.

Results

People with AD reported more sleep disturbance than NC and MCI. AD with sleep disturbance had more WMHs than AD without sleep disturbances. Mediation analysis revealed an effect of regional WMH burden on the relationship between sleep disturbance and future cognition.

Conclusion

These results suggest that WMH burden and sleep disturbance increases from aging to AD. Sleep disturbance decreases cognition through increases in WMH burden. Improved sleep could mitigate the impact of WMH accumulation and cognitive decline.
Low-versus conventional-dose trimethoprim-sulfamethoxazole for non-HIV PCP
Authors: Nagai Tatsuya , Matsui Hiroki , Fujioka Haruka , Homma Yuya , Otsuki Ayumu , Ito Hiroyuki , Ohmura Shinichiro , Miyamoto Toshiaki , Shichi Daisuke , Tomohisa Watari , Otsuka Yoshihito , Nakashima Kei
Published: April 2023

Trimethoprim-sulfamethoxazole (TMP-SMX) is an effective treatment forPneumocystis jiroveciipneumonia (PCP); however, a high incidence of adverse events has been observed. Low-dose TMP-SMX is a potentially effective treatment with fewer adverse events; however, evidence is limited. We aimed to evaluate the efficacy and safety of low-dose TMP-SMX after adjusting for patient background characteristics.

In this multicentre retrospective cohort study, we included patients diagnosed with non-human immunodeficiency virus (HIV) PCP and treated with TMP-SMX between June 2006 and March 2021 at three institutions. The patients were classified into low-(TMP equivalent <12.5 mg/kg) and conventional-dose groups (TMP equivalent 12.5–20 mg/kg/day). The primary endpoint was 30-day mortality, and the secondary endpoints were 180-day mortality, adverse events of grade 3 or greater per the Common Terminology Criteria for Adverse Events Version 5.0, and initial treatment completion rates. The background characteristics were adjusted using the overlap weighting method with propensity scores.

Fifty-five patients in the low-dose and 81 in the conventional-dose groups were evaluated. There was no significant difference in 30-day mortality (7.6% vs. 14.9%,P= 0.215) or 180-day mortality (18.1% vs. 24.0%,P= 0.416) after adjusting for patient background characteristics. The incidence of adverse events, especially nausea and hyponatremia, was significantly lower in the low-dose group (27.3% vs. 58.6%,P= 0.001). The initial treatment completion rates were 43.8% and 27.7% in the low-dose and conventional-dose groups, respectively.

Low-dose TMP-SMX did not alter survival but reduced the incidence of adverse events in patients with non-HIV PCP, compared with conventional-dose TMP-SMX.
Acceptability of using mobile Health (mHealth) as an intervention tool for People with Drug Use Disorders in Tanga, Tanzania
Authors: Munishi Castory , Ndumwa Harrieth P , Massawe Josephine E , Njiro Belinda J , Ngowi Jackline , Suhartono Sanita , Busse Anja , Campello Giovanna , Garofalo Giovanna , Cipolla Pietro , Nyandindi Cassian , Ubuguyu Omary , Sunguya Bruno
Published: April 2023

Background

With the increasing numbers of people with drug use disorders (PWDUD) in Tanzania as in other parts of the world the need for innovative interventions specifically tailored for this population has increased. Tanga, a coastal region on the Northeast of Tanzania has the second highest number of PWDUD in Tanzania. Evidence on the additional benefit in treatment and recovery process among PWDUD using digital health interventions is lacking. This study aimed to describe the acceptability of using a digital intervention to increase information access for PWDUD in Tanga region, Tanzania.

Methods

A cross-sectional descriptive study using both quantitative and qualitative approaches was conducted in Tanga Municipality and Muheza District. The quantitative approach used face to face interviews with a pre-tested questionnaire with 465 participants, while the quantitative method was carried out through In-Depth Interviews with 12 participants by the saturation point. Analysis was done descriptively to generate frequencies, cross tabulations, and chi-square test used to examine associations between categorical variables. Thematic analysis using codes was used to analyze qualitative data.

Results

Majority of the PWDUD 67.6% do not own mobile phones. Out of the 156 participants with mobile phones, only 6.4% owned a smartphone. Most of the participants, 83.6%, reported to live with someone who owns a mobile phone. Importantly, a significant number of participants, 98.5% from both areas showed readiness to use mobile phones to access information about the harmful use of substance and substance use disorder treatment options. Participants described how mobile phones can be useful to them in accessing information related to treatment and access to treatment options. The reasons they gave for not owning mobile phones included the need of money to buy drugs and the lack of money to buy credit drives them to sell their phones. A digital app calledHuru appwas developed during study as part of an information sharing campaign on substance use.

Conclusion and recommendations

The findings of this study helped to inform the target audience for the developed Huru app that should not be only PWDUD but the community at large. Despite the participants having expressed high readiness to use mobile phones to access drug use disorder treatment information, only few of them were found to own mobile phones but reported to live with family members who own mobile phones. Thus, a mobile phone intervention should also target their family members who are key in supportive treatment.