bluuebunny/crossref_metadata_2025 huggingface dataset:
A real-world data analysis-based study of Chinese medicine treatment patterns after breast cancer surgery
Authors: Hu Lvhui , Yang Yi , Wang Zhiwen , Wen Chuanbiao , Cheng Xiaoen
Published: December 2023

Based on the real clinical data of Hospital Information System to explore the common clinical syndromes of traditional Chinese medicine after breast cancer surgery, analysis of traditional Chinese medicine in the treatment of breast cancer after the compatibility law. The real medical records of breast cancer patients after surgery in a tertiary hospital in Sichuan Province were collected and screened to build a medical record database. Python language was used for data preprocessing to remove outliers and fill in missing values. Using International Business Machines Corporation (IBM) Statistical Product and Service Solutions (SPSS) Modeler software, Apriori association rules algorithm for data analysis, mining Chinese medicine treatment of breast cancer after common syndromes and the corresponding medication rules. A total of 472 cases of clinical real medical record data were included. Data analysis showed that there were 42 TCM syndromes after breast cancer surgery, of which the highest frequency was liver depression and spleen deficiency, qi deficiency and blood stasis, qi stagnation and blood stasis, qi and blood deficiency, qi and yin deficiency, phlegm and blood stasis. A total of 416 kinds of traditional Chinese medicine were involved. High-frequency drugs included angelica sinensis, coix seed, bupleurum, ginger magnolia bark, keel, oyster, astragalus, platycodon grandiflorum, antler frost, vinegar tortoise shell, poria cocos, lily, Jianqu, Ophiopogon japonicus (Maidong), Shancigu, etc. A total of 18 pairs of commonly used drug combinations were excavated, such as Fushen-Gancao-Chaihu-Angelica, Huangqi-Baishao-Jianghoupu, Chaihu-Huanhua-Maidong-Lily, Baizhu-Huangqi-Maidong, Fuling-Baishao, etc. The clinical syndrome type of traditional Chinese medicine after breast cancer surgery is mainly liver depression and spleen deficiency syndrome. The clinical treatment is mainly soothing liver and relieving depression, and harmonizing liver and spleen. Analyze the syndrome type and the corresponding drug compatibility law, and provide decision support for the clinical dialectical prescription of traditional Chinese medicine after breast cancer surgery.
Comparative effectiveness of intra-articular therapies in knee osteoarthritis: a meta-analysis comparing platelet-rich plasma (PRP) with other treatment modalities
Authors: Khalid Saad , Ali Abraish , Deepak FNU , Zulfiqar Muhammad Sibtain , Malik Laiba Urooj , Fouzan Zubaida , Nasr Rabiya Ali , Qamar Maryam , Bhattarai Pratik
Published: December 2023

Introduction:

Knee osteoarthritis (KOA) is a progressive joint disease commonly treated with intra-articular injections, including platelet-rich plasma (PRP), hyaluronic acid (HA), or corticosteroids (CS). This updated meta-analysis aims to enhance the statistical power of the results and provide comprehensive clinical evidence that reflects the most current research. By doing so, the authors aim to suggest a reliable estimate for the development of guidelines, addressing the pressing need for effective and minimally invasive treatment options.

Methods:

PubMed, Scopus, clinicaltrials.gov, Cochrane Central were searched until March 2023, for randomized controlled trials (RCTs) comparing the effectiveness of intra-articular injectable therapies, including PRP, HA, CS, and placebo, in KOA. Data extraction involved baseline characteristics and outcome measures [Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain scores, KOOS, and IKDC scores] at 1, 3, 6 and 12 months. Statistical analysis, including subgroup analysis, assessment of heterogeneity, and publication bias, was conducted using Review Manager.

Results:

Our meta-analysis of 42 studies involving 3696 patients demonstrated that PRP treatment resulted in significant pain relief compared to HA injections, as evidenced by improved WOMAC pain (MD: −0.74; 95% CI: −1.02 to −0.46; P≤0.00001; I
2=94%) and VAS pain (MD: −0.65; 95% CI: −1.24 to −0.06; P=0.03; I2=97%) outcomes. Similarly, PRP showed greater efficacy in reducing WOMAC pain (MD: −8.06; 95% CI: −13.62 to −2.51: P=0.004; I
2=96%) and VAS pain (MD: −1.11; 95% CI: −1.64 to −0.59; P≤0.0001; I
2=68%) compared to CS injections, with the most significant improvement observed at 6 months.

Conclusions:

PRP is an effective treatment for KOA. It provides symptomatic relief, has the potential to reduce disease progression, and has sustained effects up to 12 months. PRP offers superior pain relief and functional enhancement compared to CS and HA injections.
Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
Authors: Teede Helena J. , Tay Chau Thien , Laven Joop , Dokras Anuja , Moran Lisa J. , Piltonen Terhi T. , Costello Michael F. , Boivin Jacky , Redman Leanne M. , Boyle Jacqueline A. , Norman Robert J. , Mousa Aya , Joham Anju E. ,   on behalf of the International PCOS Network
Published: December 2023

(Abstracted from Hum Reprod 2023;38(9):1655–1679)

Polycystic ovary syndrome (PCOS) has a prevalence of 10% to 13%, making it the most common endocrinopathy affecting reproductive-aged women. The etiology of PCOS is complex, and its presentation is heterogeneous with reproductive, metabolic, and psychological features.
Clinical presentations and treatment outcomes of Mycoplasma genitalium infections at a large New York City healthcare system
Authors: Mullis Caroline E. , Marlow Kerry A. , Maity Aloke , Fazzari Melissa , Zingman Barry S. , Keller Marla J. , Meyerowitz Eric A.
Published: December 2023

Background

Mycoplasma genitalium (MG) is an emerging sexually transmitted infection. Treatment of MG is complicated by increasing resistance to primary treatment regimens, including macrolides and fluoroquinolones. Understanding the various clinical presentations and relative effectiveness of treatments for MG is crucial to optimizing care.

Methods

Patients with a positive MG Nucleic Acid Amplification Test (NAAT) between July 1, 2019 and June 30, 2021 at a large health system in New York City were included in a retrospective cohort. Demographics, clinical presentations, coinfections, treatment, and follow-up microbiologic tests were obtained from the electronic medical record. Associations with microbiologic cure were evaluated in bivariate and multivariable logistic regression models.

Results

Five-hundred and two unique patients had a positive MG NAAT during the study period. Males presented predominantly with urethritis (117/187, 63%) and females with vaginal symptoms (142/315, 45%). Among patients with follow-up testing who received a single antibiotic at the time of treatment, 43% (90/210) had persistent infection and 57% (120/210) had microbiologic cure. Eighty-two percent of patients treated with moxifloxacin had microbiologic cure compared to 41% of patients receiving azithromycin regimens (p < 0.001). In multivariable analysis, treatment with moxifloxacin was associated with four times the odds of microbiologic cure relative to low-dose azithromycin (aOR 4.18, 95% CI 1.73-10.13, p < 0.01).

Conclusions

Clinical presentations of MG vary, with urethritis or vaginal symptoms in most cases. Among patients who received a single antibiotic, only treatment with moxifloxacin was significantly associated with microbiologic cure relative to low-dose azithromycin.
Association of Medicaid Expansion with Reduction in Racial Disparities in the Timely Delivery of up-front Surgical Care for Patients with Early-Stage Breast Cancer
Authors: Tamirisa Nina , Lei Xiudong , Malinowski Catalina , Li Meng , Bedrosian Isabelle , Chavez-MacGregor Mariana
Published: December 2023

Objective:

We evaluated the association between Medicaid expansion and time to surgery among patients with early-stage breast cancer (BC)

Summary Background Data:

Delays in surgery are associated to adverse outcomes. It is known that underrepresented minorities are more likely to experience treatment delays. Understanding the impact of Medicaid expansion on reducing racial and ethnic disparities in healthcare delivery is critical.

Methods:

This was a population-based study including women ages 40-64 with stage I-II BC who underwent upfront surgery identified in the National Cancer Database (2010-2017) residing in states that expanded Medicaid on January 1, 2014. Difference-in-difference (DID) analysis compared rates of delayed surgery (>90 d from pathological diagnosis) according to time period (pre-expansion [2010-2013] and post-expansion [2014-2017]) and race/ethnicity (White vs. racial and ethnic minority), stratified by insurance type (private vs. Medicaid/uninsured). Secondary analyses included logistic and Cox proportional hazards regression. All analyses were conducted among a cohort of patients in the non-expansion states as a falsification analysis. Finally, a triple-differences approach compared pre-expansion with the post-expansion trend between expansion and non-expansion states.

Results:

Among Medicaid expansion states, 104,569 patients were included (50,048 pre- and 54,521 post-expansion). In the Medicaid/uninsured subgroup, Medicaid expansion was associated with a −1.8% point (95% CI -3.5% to −0.1,P=0.04) reduction of racial disparity in delayed surgery. Cox regression models demonstrated similar findings (adjusted DID hazard ratio 1.12 [95% CI 1.05-1.21]). The falsification analysis showed significant racial disparity reduction among expansion states but not among non-expansion states, resulting in a triple-difference estimate of −2.5% points (95% CI −4.9% to -0.1%,P=0.04) in this subgroup.

Conclusions:

As continued efforts are being made to increase access to healthcare, our study demonstrates a positive association between Medicaid expansion and a reduction in the delivery of upfront surgical care, reducing racial disparities among patients with early-stage BC.
FK-means: automatic atrial fibrosis segmentation using fractal-guided K-means clustering with Voronoi-clipping feature extraction of anatomical structures
Authors: Firouznia Marjan , Henningsson Markus , Carlhäll Carl-Johan
Published: December 2023

Assessment of left atrial (LA) fibrosis from late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) adds to the management of patients with atrial fibrillation. However, accurate assessment of fibrosis in the LA wall remains challenging. Excluding anatomical structures in the LA proximity using clipping techniques can reduce misclassification of LA fibrosis. A novel FK-means approach for combined automatic clipping and automatic fibrosis segmentation was developed. This approach combines a feature-based Voronoi diagram with a hierarchical 3D K-means fractal-based method. The proposed automatic Voronoi clipping method was applied on LGE-MRI data and achieved a Dice score of 0.75, similar to the score obtained by a deep learning method (3D UNet) for clipping (0.74). The automatic fibrosis segmentation method, which uses the Voronoi clipping method, achieved a Dice score of 0.76. This outperformed a 3D UNet method for clipping and fibrosis classification, which had a Dice score of 0.69. Moreover, the proposed automatic fibrosis segmentation method achieved a Dice score of 0.90, using manual clipping of anatomical structures. The findings suggest that the automatic FK-means analysis approach enables reliable LA fibrosis segmentation and that clipping of anatomical structures in the atrial proximity can add to the assessment of atrial fibrosis.
Patchy fibrosis promotes trigger–substrate interactions that both generate and maintain atrial fibrillation
Authors: Colman Michael A. , Sharma Roshan , Aslanidi Oleg V. , Zhao Jichao
Published: December 2023

Fibrosis has been mechanistically linked to arrhythmogenesis in multiple cardiovascular conditions, including atrial fibrillation (AF). Previous studies have demonstrated that fibrosis can create functional barriers to conduction which may promote excitation wavebreak and the generation of re-entry, while also acting to pin re-entrant excitation in stable rotors during AF. However, few studies have investigated the role of fibrosis in the generation of AF triggers in detail. We apply our in-house computational framework to study the impact of fibrosis on the generation of AF triggers and trigger–substrate interactions in two- and three-dimensional atrial tissue models. Our models include a reduced and efficient description of stochastic, spontaneous cellular triggers as well as a simple model of heterogeneous inter-cellular coupling. Our results demonstrate that fibrosis promotes the emergence of focal excitations, primarily through reducing the electrotonic load on individual fibre strands. This enables excitation to robustly initiate within these single strands before spreading to neighbouring strands and inducing a full tissue focal excitation. Enhanced conduction block can allow trigger–substrate interactions that result in the emergence of complex, re-entrant excitation patterns. This study provides new insight into the mechanisms by which fibrosis promotes the triggers and substrate necessary to induce and sustain arrhythmia.
Electrifying insights into cardiac arrhythmias: from molecular mechanisms to therapeutic translations
Authors: Trew Mark L. , Zhao Jichao
Published: December 2023

Disruptions to normal bioelectric rate and rhythm profiles in the heart are cardiac arrhythmias. Their impacts range from minor discomforting symptoms to acute or chronic life-threatening events, with atrial fibrillation increasing the risk of stroke and heart failure, and ventricular arrhythmia associated with sudden cardiac death. To improve mechanistic understandings and advance potential approaches to treatment of arrhythmias, this Interface Focus themed issue on cardiac electrophysiology is a collection of recent studies. They investigate some of the molecular and cellular mechanisms or tissue substrates instigating and maintaining arrhythmia, and discover relevant imaging and signalling biomarkers that assess arrhythmic risks. The studies use imaging, computer simulations, machine learning and both human and animal models in their investigations exploring basic science and strategies for early recognition and improved treatment strategies.
Optimisation of a DNA extraction protocol for improving the bacterial and fungal classification based on Nanopore sequencing
Authors: Thu May Soe , Sawaswong Vorthorn , Chanchaem Prangwalai , Klomkliew Pavit , Campbell Barry J. , Hirankarn Nattiya , Fothergill Joanne L , Payungporn Sunchai
Published: December 2023

Ribosomal RNA gene amplicon sequencing is commonly used to evaluate microbiome profiles in health and disease and document the impact of interventional treatments. Nanopore sequencing is attractive since it can provide greater classification at the species level. However, optimised protocols to target marker genes for bacterial and fungal profiling are needed. To achieve an increased taxonomic resolution, we developed extraction and full-length amplicon PCR-based approaches using Nanopore sequencing. Three lysis conditions were applied to a mock microbial community, including known bacterial and fungal species; the ZymoBIOMICSTM lysis buffer (ML) alone, incorporating bead-beating (MLB), or bead-beating plus MetaPolyzyme enzymatic treatment (MLBE). Profiling of bacterial comparison to reference data, MLB had more statistically different bacterial phyla and genera than the others. Fungal profiling, MLB had a significant increase of Ascomycota and a decline of Basidiomycota, subsequently failing to detect Malassezia and Cryptococcus. Also, the principal coordinates analysis (PCoA) plot by the Bray-Curtis index showed a significant difference among groups for bacterial (p = 0.033) and fungal (p = 0.012) profiles, highlighting the importance of understanding the biases present in pretreatment. Overall, the microbial profiling and diversity analysis revealed that ML and MLBE have more similarity than MLB for both bacteria and fungi; therefore, using this specific pipeline, bead-beating is not recommended for whole gene amplicon sequencing. However, ML alone was suggested as an optimal approach considering DNA yield, classification, reagent cost and hands-on time. This could be an initial proof-of-concept study for simultaneous human microbiome and mycobiome studies.
Protect or prevent? A practicable framework for the dilemmas of COVID-19 vaccine prioritization
Authors: Arghal Raghu , Rubin Harvey , Bidokhti Shirin Saeedi , Sarkar Saswati
Published: December 2023

1

Determining COVID-19 vaccination strategies presents many challenges in light of limited vaccination capacity and the heterogeneity of affected communities. Who should be prioritized for early vaccination when different groups manifest different levels of risks and contact rates? Answering such questions often becomes computationally intractable given that network size can exceed millions. We obtain a framework to compute the optimal vaccination strategy within seconds to minutes from among all strategies, including highly dynamic ones that adjust vaccine allocation as often as required, and even with modest computation resources. We then determine the optimal strategy for a large range of parameter values representative of various US states, countries, and case studies including retirement homes and prisons. The optimal is almost always one of a few candidate strategies, and, even when not, the suboptimality of the best among these candidates is minimal. Further, we find that many commonly deployed vaccination strategies, such as vaccinating the high risk group first, or administering second doses without delay, can often incur higher death rates, hospitalizations, and symptomatic counts. Our framework can be easily adapted to future variants or pandemics through appropriate choice of the compartments of the disease and parameters.
A Clinical Audit on Longer-Term Stroke Management as A Specific Service in A Primary Care Setting: Assessing Adherence of Service and Clinical Parameters
Authors: Mostapha Gadaffi , Aziz Noor Azah Abd , Ali Mohd Fairuz
Published: December 2023

Background

Primary-care long-term stroke care service offers comprehensive management at the community level. A clinical audit was carried out to assess the services of this clinic as compared to the established standardized criteria for longer-term stroke care.

Methods

A retrospective audit was performed to evaluate the adherence to service parameters based on eleven criteria adapted from the Canadian Post-Stroke Checklist. The following clinical parameters were audited using the Malaysian CPG on Cardiovascular Disease 2017 and Malaysian CPG on Ischemic Stroke 2020: systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), HbA1c, and weight, and smoking status. 113 registered patients from the 2022 clinic census were audited using paired Student’st-test and McNemar’s test.

Results

Overall, only 2 out of 11 criteria for service parameters did not meet the standard: inquiring about patient fatigue (43.4%) and access to community resources (26.5%). The attainment of the target for BP and HbA1c meets the standards set for this audit. Patients experienced reduced SBP, DBP, LDL-C, and HbA1c levels, and a statistically significant reduction was observed in DBP (4.15 mmHg, p<0.05) and LDL-C (0.30 mmol/L, p<0.05). A notable reduction in the percentage of smokers (p<0.05) was also seen.

Conclusions

Post-stroke patients at a specific-service clinic within the primary care setting benefited from clinicians’ high adherence to clinical guidelines, observed from improved clinical parameters. These may serve as an impetus for clinicians to include long-term stroke service as a specialized service within primary care specialties.
Augmentation of ChatGPT with Clinician-Informed Tools Improves Performance on Medical Calculation Tasks
Authors: Goodell Alex J , Chu Simon N , Rouholiman Dara , Chu Larry F
Published: December 2023

Abstract

Prior work has shown that large language models (LLMs) have the ability to answer expert-level multiple choice questions in medicine, but are limited by both their tendency to hallucinate knowledge and their inherent inadequacy in performing basic mathematical operations. Unsurprisingly, early evidence suggests that LLMs perform poorly when asked to execute common clinical calculations. Recently, it has been demonstrated that LLMs have the capability of interacting with external programs and tools, presenting a possible remedy for this limitation. In this study, we explore the ability of ChatGPT (GPT-4, November 2023) to perform medical calculations, evaluating its performance across 48 diverse clinical calculation tasks. Our findings indicate that ChatGPT is an unreliable clinical calculator, delivering inaccurate responses in one-third of trials (n=212). To address this, we developed an open-source clinical calculation API (openmedcalc.org), which we then integrated with ChatGPT. We subsequently evaluated the performance of this augmented model by comparing it against standard ChatGPT using 75 clinical vignettes in three common clinical calculation tasks: Caprini VTE Risk, Wells DVT Criteria, and MELD-Na. The augmented model demonstrated a marked improvement in accuracy over unimproved ChatGPT. Our findings suggest that integration of machine-usable, clinician-informed tools can help alleviate the reliability limitations observed in medical LLMs.
Compliance to food safety standards - Determining the barriers within the hotel industry
Authors: Segbedzi Cynthia Esinam , Ansah Edward Wilson , Apaak Daniel
Published: December 2023

The safety of food served to customers is obligatory for all food service establishments for public health effects. However, workplace barriers have led to noncompliance with safety standards resulting in food contamination and outbreak of foodborne diseases. This study assessed the compliance of restaurant facilities to standards by the Food and Drugs Authority’s (FDA) code of standards, awareness and training on the code and the workplace barriers to compliance. The study involved 233 respondents, 205 food handlers, 10 managers, and 18 officers from the regulatory authorities, who were at work after the COVID-19 restrictions. Questionnaire was used to obtain data from the food handlers and face-to-face interview for managers/chefs and officers from the regulatory authorities. Data was analysed using frequencies and percentages, and thematic content analysis. Results revealed that majority of the hotels did not comply with the FDA’s code of standards on the provision of facilities. However, in segregating the items individually, 70% of the hotels had high compliance with the provision of proper storage facilities for raw and cooked food, 81.5% of the food handlers had in-service training, but this was not routine. Most of the food handlers were aware of the FDA’s code on hygiene for food service establishments, but only a few were trained on it. The food handlers reported unconducive working environment, poor monitoring and supervision, inadequate supply of equipment, time pressure and workplace policy as barriers to compliance with food safety standards. We recommend that hotel owners/managers should be adequately trained to provide the required training and supervision for food handlers, provide the needed tools/equipment to enhance work flow and safe food to consumers. Also, regulatory authorities are encouraged to conduct regular and effective monitoring/supervision to ensure adherence to standards, to improve the safety of food served to the public.
Uptake and safety of pneumococcal vaccination in adults with immune mediated inflammatory diseases: a nationwide observational study using data from the Clinical Practice Research Datalink (Gold) in the UK
Authors: Nakafero Georgina , Grainge Matthew J. , Card Tim , Christian D. Mallen , Nguyen Van-Tam Jonathan S. , Abhishek Abhishek
Published: December 2023

Introduction

The uptake and safety of pneumococcal vaccination in people with immune mediated inflammatory diseases (IMIDs) is poorly understood. We investigated the UK wide pneumococcal vaccine uptake in adults with IMIDs and explored the association between vaccination and IMID flare.

Methods

Adults with IMIDs diagnosed on or before 01/09/2018, prescribed steroid-sparing drugs within the last 12 months and contributing data to the Clinical Practice Research Datalink Gold were included. Vaccine uptake was assessed using a cross-sectional study design. Self-controlled case series (SCCS) analysis investigated the association between pneumococcal vaccination and IMID flare. The SCCS observation period was up-to six-month before and after pneumococcal vaccination. This was partitioned into 14-day pre-vaccination, 90-days post-vaccination exposed, and the remaining unexposed period.

Results

We included 32,277 patients, 14,151 with RA, 13,631 with IBD, 3,804 with axial spondyloarthritis and 691 with SLE. Overall, 50% of patients were vaccinated against pneumococcus. Vaccine uptake was lower in those younger than 45 years (30%), with IBD (38%), and without additional indication(s) for vaccination (43%). In the vaccine-safety study, data for 1001, 854, 424 vaccinated patients with primary-care consultations for joint pain, AIRD flare and IBD flare respectively were included. Vaccination against pneumococcal pneumonia was not associated with primary-care consultations for joint pain, AIRD flare and IBD flare in the exposed period with incidence rate ratios (95% Confidence Interval) 0.95 (0.83-1.10), 1.07 (0.93-1.22), and 0.82 (0.64-1.06) respectively.

Conclusion

Uptake of pneumococcal vaccination in UK patients with IMIDs was suboptimal. Vaccination against pneumococcal disease was not associated with disease flare.
Equitable Artificial Intelligence for Glaucoma Screening with Fair Identity Normalization
Authors: Shi Min , Luo Yan , Tian Yu , Shen Lucy , Elze Tobias , Zebardast Nazlee , Eslami Mohammad , Kazeminasab Saber , Boland Michael V. , Friedman David S. , Pasquale Louis R. , Wang Mengyu
Published: December 2023

Objective

To develop an equitable artificial intelligence model for glaucoma screening.

Design

Cross-sectional study.

Participants

7,418 optical coherence tomography (OCT) paired with reliable visual field (VF) measurements of 7,418 patients from the Massachusetts Eye and Ear Glaucoma Service between 2021 and 2023.

Methods

We developed fair identify normalization (FIN) module to equalize the feature importance across different identity groups to improve model performance equity. EfficientNet served as the backbone model to demonstrate the effect of FIN on model equity. The OCT-derived retinal nerve fiber layer thickness (RNFLT) maps and corresponding three-dimensional (3D) OCT B-scans were used as model inputs, and a reliable VF tested within 30 days of an OCT scan was used to categorize patients into glaucoma (VF mean deviation < -3 dB, abnormal glaucoma hemifield test (GHT) and pattern standard deviation (PSD) < 5%) or non-glaucoma (VF mean deviation ≥ -1 dB and normal GHT and PSD results). The area under the receiver operating characteristic curve (AUC) was used to measure the model performance. To account for the tradeoff between overall AUC and group disparity, we proposed a new metric called equity-scaled AUC (ES-AUC) to compare model performance equity. We used 70% and 30% of the data for training and testing, respectively.

Main Outcome Measures

The glaucoma screening AUC in different identity groups and corresponding ES-AUC.

Results

Using RNFLT maps with FIN for racial groups, the overall AUC and ES-AUC increased from 0.82 to 0.85 and 0.76 to 0.81, respectively, with the AUC for Blacks increasing from 0.77 to 0.81. With FIN for ethnic groups, the overall AUC and ES-AUC increased from 0.82 to 0.84 and 0.77 to 0.80, respectively, with the AUC for Hispanics increasing from 0.75 to 0.79. With FIN for gender groups, the overall AUC and ES-AUC increased from 0.82 to 0.84 and 0.80 to 0.82, respectively, with an AUC improvement of 0.02 for both females and males. Similar improvements in equity were seen using 3D OCT B scans. All differences regarding overall-and ES-AUCs were statistically significant (p < 0.05).

Conclusions

Our deep learning enhances screening accuracy for underrepresented groups and promotes identity equity.
Detection of Noroviruses GII in wastewater samples of Bhopal, India, using Droplet Digital PCR
Authors: Nema R K , Nagar J , Singh A K , Tandekar A , Singh S , Rahman A , Sharma O P , Tiwari R R , Sarma D K , Mishra P K
Published: December 2023

Noroviruses are a significant cause of global gastroenteritis outbreaks, underscoring the importance of effective surveillance. Wastewater-based epidemiology helps identify viral pathogens in communities. Recent advancements in wastewater-based molecular surveillance have shown that viruses can be detected in feces and urine early, making sewage monitoring an essential tool for tracking viral presence. We aimed to create and validate a new method for detecting and monitoring Noroviruses GII in Bhopal’s wastewater using Automated Droplet Digital PCR (ddPCR) technology. In this study, a ddPCR assay targeting the ORF1-2 region of Norovirus GII was developed, allowing viral nucleic acid quantification without a standard curve. A total of 27 samples from five Sewage Treatment Plants located in Bhopal city were collected during the summer season (April and May 2023) at fortnightly intervals and analyzed for the presence of Norovirus using the novel ddPCR assay. Among the samples tested, 33% tested positive for Norovirus, with the highest detection rate observed as 72.72%, followed by 25%. The concentrations of Noroviruses GII in positive samples ranged from 0.06 to 6.60 copies/µl. These findings indicate a potentially higher patient population within Bansal Hospital’s catchment area than the other STPs in the Bhopal region. The study underscores Norovirus’s varying prevalence and distribution in wastewater across different STPs in Bhopal. Moreover, it demonstrates the utility of wastewater surveillance and digital PCR in accurately and specifically detecting Norovirus in wastewater. The practical application of this wastewater surveillance strategy could serve as an early warning system for communities, enabling timely preparedness for impending viral outbreaks, implementation of effective administrative containment measures, and intensified vaccination campaigns.
Pain, inconvenience, and blame - Defining work-related injuries in the veterinary workplace
Authors: Furtado Tamzin , Whiting Martin , Schofield Imogen , Jackson Rebecca , Tulloch John S.P.
Published: December 2023

Objectives

The veterinary workplace carries a high risk of staff accidents and injuries, yet there is scant research exploring it in comparison with other comparable fields, such as human medicine. The aim of this study was to understand how veterinary professionals define injuries and to understand what injuries they do, or do not, deem reportable.

Methods

A cross-sectional survey comprising demographic questions and open-text questions was shared with veterinary practice staff across the United Kingdom. Data were analysed descriptively and using an inductive content analysis.

Results

There were 740 respondents, who were broadly representative of the veterinary profession. There were differences in how injuries were defined; for example, small animal veterinarians expected injuries to involve blood, while equine and production animal veterinarians were more likely to expect injuries to reduce their ability to perform work and result in time off work. Many suggested that “all” workplace injuries should be reported, however “minor” injuries were often overlooked, for example needlestick injuries did not always meet the criteria of being an “injury”. Injuries caused by staff themselves (e.g. trips) were less likely to be reported than injuries that could be blamed on an external factor (e.g. dog bite).

Conclusions

Collectively, the data suggest a wide-ranging perception of risk of injury in practice, with some harms seen as “everyday norms”. Veterinary practices should interpret their injury statistics with a high degree of caution. They should explore the microcultures within their practices relating to worker perception of risk, injury and barriers to reporting.

What is already known on this topic

The veterinary industry has one of the highest case rates of non-fatal occupation injuries and illnesses per full time worker. In the USA, no other industry is higher; it is almost five times higher than the national average. Yet, little research has explored how injuries are perceived nor their context.

What this study adds

This study shows clear divisions within different veterinary sectors, and job roles, in how injuries are perceived. In particular, that equine and production animal veterinarians have a high threshold before acknowledging that an incident is a work-related injury.

How this study might affect research, practice or policy

To contextualise any epidemiological research into veterinary workplace injuries, one needs to understand how injuries are perceived. The discordance in definition needs to be accounted for when interpreting company or national injury reporting figures.
Multiscale predictability of Cutaneous Leishmaniasis in Morocco and Tunisia through the AMO-NAO coupling and its modulation of regional rainfall
Authors: San-José Adrià , Aoun Karim , Lemrani Meryem , Idis Mhaidi , Bouratbine Aida , Paul Richard , Rodó Xavier
Published: December 2023

The development of effective Early Warning Systems (EWS) for climate-driven zoonotic diseases has been hindered by a lack of predictors with adequate lead time for effective interventions. Atmosphere-Ocean coupled phenomena present predictability beyond the atmospheric deterministic limits and therefore are potentially useful climate drivers to be integrated in mathematical models. While the El Niño-Southern Oscillation (ENSO) has been used to forecast disease dynamics in equatorial and tropical regions, there is a lack of similar applications for temperate areas, likely because of the perceived unpredictability of atmospheric systems such as the North Atlantic Oscillation (NAO). This study challenges this notion by establishing a connection between the NAO and its oceanic counterpart, the Atlantic Multidecadal Oscillation (AMO), revealing common low-frequency components that strongly modulate Cutaneous Leishmaniasis (CL) in Northern Africa. We demonstrate not only short-term couplings, such as the known NAO’s impact on seasonal rainfall, which subsequently affects CL incidence, but we also uncover a significant lagged effect of approximately three years on rainfall and four years on CL incidence. Our findings reveal a unified, multiscale mechanism that influences CL epidemiology across different time scales, underscoring the predictive skill for short and long term time frames, which should be integrated in CL forecasting models.
Diagnostic Accuracy of the Abbot BinaxNOW COVID-19 Antigen Card Test, Puerto Rico
Authors: Madewell Zachary J. , Major Chelsea G. , Graff Nathan , Adams Cameron , Rodriguez Dania M. , Morales Tatiana , Medina Lopes Nicole A. , Tosado Rafael , Sánchez-González Liliana , Perez-Padilla Janice , Volkman Hannah R. , Bertran Jorge , Sainz Diego , Munoz-Jordan Jorge , Santiago Gilberto A. , Lorenzi Olga , Rivera-Amill Vanessa , Rolfes Melissa A. , Paz-Bailey Gabriela , Adams Laura E. , Wong Joshua M. ,   PRESCA Study Team
Published: December 2023

Background

The COVID-19 pandemic underscored the need for rapid and accurate diagnostic tools. In August 2020, the Abbot BinaxNOW COVID-19 Antigen Card test became available as a timely and affordable alternative for SARS-CoV-2 molecular testing, but its performance may vary due to factors including timing and symptomatology. This study evaluates BinaxNOW diagnostic performance in diverse epidemiological contexts.

Methods

Using RT-PCR as reference, we assessed performance of the BinaxNOW COVID-19 test for SARS-CoV-2 detection in anterior nasal swabs from participants of two studies in Puerto Rico from December 2020 to May 2023. Test performance was assessed by days post symptom onset, collection strategy, vaccination status, symptomatology, repeated testing, and RT-PCR cycle threshold (Ct) values.

Results

BinaxNOW demonstrated an overall sensitivity of 84.1% and specificity of 98.8%. Sensitivity peaked within 1–6 days after symptom onset (93.2%) and was higher for symptomatic (86.3%) than asymptomatic (67.3%) participants. Sensitivity declined over the course of infection, dropping from 96.3% in the initial test to 48.4% in testing performed 7–14 days later. BinaxNOW showed 99.5% sensitivity in participants with low Ct values (≤25) but lower sensitivity (18.2%) for participants with higher Cts (36–40).

Conclusions

BinaxNOW demonstrated high sensitivity and specificity, particularly in early-stage infections and symptomatic participants. In situations where test sensitivity is crucial for clinical decision- making, nucleic acid amplification tests are preferred. These findings highlight the importance of considering clinical and epidemiological context when interpreting test results and emphasize the need for ongoing research to adapt testing strategies to emerging SARS-CoV-2 variants.
GPT for RCTs?: Using AI to determine adherence to reporting guidelines
Authors: Wrightson J.G. , Blazey P. , Moher D. , Khan K.M. , Ardern C.L.
Published: December 2023

Background

Adherence to established reporting guidelines can improve clinical trial reporting standards, but attempts to improve adherence have produced mixed results. This exploratory study aimed to determine how accurate a Large Language Model generative AI system (AI-LLM) was for determining reporting guideline compliance in a sample of sports medicine clinical trial reports.

Design and Methods

This study was an exploratory retrospective data analysis. The OpenAI GPT-4 and Meta LLama2 AI-LLMa were evaluated for their ability to determine reporting guideline adherence in a sample of 113 published sports medicine and exercise science clinical trial reports. For each paper, the GPT-4-Turbo and Llama 2 70B models were prompted to answer a series of nine reporting guideline questions about the text of the article. The GPT-4-Vision model was prompted to answer two additional reporting guideline questions about the participant flow diagram in a subset of articles. The dataset was randomly split (80/20) into a TRAIN and TEST dataset. Hyperparameter and fine-tuning were performed using the TRAIN dataset. The Llama2 model was fine-tuned using the data from the GPT-4-Turbo analysis of the TRAIN dataset. Primary outcome measure: Model performance (F1-score, classification accuracy) was assessed using the TEST dataset.

Results

Across all questions about the article text, the GPT-4-Turbo AI-LLM demonstrated acceptable performance (F1-score = 0.89, accuracy[95% CI] = 90%[85-94%]). Accuracy for all reporting guidelines was > 80%. The Llama2 model accuracy was initially poor (F1-score = 0.63, accuracy[95%CI] = 64%[57-71%]), and improved with fine-tuning (F1-score = 0.84, accuracy[95%CI] = 83%[77-88%]). The GPT-4-Vision model accurately identified all participant flow diagrams (accuracy[95% CI] = 100%[89-100%]) but was less accurate at identifying when details were missing from the flow diagram (accuracy[95% CI] = 57%[39-73%]).

Conclusions

Both the GPT-4 and fine-tuned Llama2 AI-LLMs showed promise as tools for assessing reporting guideline compliance. Next steps should include developing an efficent, open-source AI-LLM and exploring methods to improve model accuracy.
Online cognitive behavioural therapy as an initial treatment for psychological distress in patients waiting for therapy: Study protocol
Authors: Guiney Hayley , Mahoney Alison , Morgan Andie , Elders Anna , David Charlie , Howell Zahra , Codyre David , Rapsey Charlene , Poulton Richie
Published: December 2023

Background

Wait times for mental health treatment are long. This protocol describes a trial to test whether engaging in a self-directed online cognitive behavioural therapy tool (called ‘Just a Thought’) while waiting for psychological therapy is an acceptable and effective intervention for help-seeking patients. The trial will be conducted within the context of a large psychological service in Auckland, New Zealand.

Methods

In this parallel group, pragmatic randomised controlled trial, consenting patients with at least five weeks to wait for their first therapy appointment will be randomly assigned to receive Just a Thought (intervention) or waitlist-as-usual conditions plus generic wellbeing information (control) while they wait. Mental health, general health and wellbeing, and treatment satisfaction will be measured across the first ten weeks of the trial, and at 8 months.

Outcomes

The primary outcomes are the acceptability and effectiveness of Just a Thought as an initial treatment. Acceptability will be assessed as participants’ satisfaction, and effectiveness as change in psychological distress over time (relative to control). We hypothesise that participants will be more satisfied with Just a Thought than generic wellbeing information and that those who engage in Just a Thought will show greater reductions in psychological distress than those in the waiting-as-usual group.

Conclusions

Online cognitive behavioural therapy is efficacious and has the potential to provide people experiencing psychological distress with fast access to evidence-based psychological treatment. This study will provide insight into its potential as an acceptable and effective pre-treatment for people seeking psychological help.
Portable Cerebral Blood Flow Monitor to Detect Large Vessel Occlusion in Suspected Stroke Patients
Authors: Favilla Christopher G. , Baird Grayson L. , Grama Kedar , Konecky Soren , Carter Sarah , Smith Wendy , Gitlevich Rebecca , Lebron-Cruz Alexa , Yodh Arjun G. , McTaggert Ryan A.
Published: December 2023

Background

Early detection of large vessel occlusion (LVO) facilitates triage to a comprehensive or thrombectomy-capable stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales, however, are not sufficiently sensitive, so here we investigate the ability of the portable Openwater optical blood flow monitor to detect LVO in patients undergoing acute stroke evaluation.

Methods

Patients were prospectively enrolled at two comprehensive stroke centers during acute stroke evaluation within 24 hours of symptom onset with NIHSS ≥2. Each patient underwent a 60-second bedside optical blood flow evaluation with the Openwater instrument. The Openwater instrument generates cerebral blood flow waveforms based on relative changes in speckle contrast. Anterior circulation LVO was deteremined based on CT angiographic imaging and defined as occlusion of the ICA, or first/second segment of the MCA. A deep learning model, based on a transformer architecture trained on all patient data using fivefold cross-validation and learned discriminative representations from the raw speckle contrast waveform data. ROC analysis compared the Openwater diagnostic performance (i.e., LVO detection) with performance of prehospital stroke scales.

Results

Amongst 135 patients, the median NIHSS was 8 (IQR: 4-14), and 52 (39%) had an anterior circulation LVO based on CT angiogram. The Openwater instrument had 79% sensitivity and 84% specificity for the detection of LVO. The RACE scale had 60% sensitivity and 81% specificity. LAMS had 50% sensitivity and 81% specificity. In the ROC analysis, the binary Openwater classification (high-likelihood vs low-likelihood) had an AUC of 0.82 (95%CI: 0.75-0.88), which outperformed RACE (AUC: 0.70; 95%CI: 0.62-0.78; p=0.04) and LAMS (AUC: 0.65; 95% CI: 0.57-0.73; p=0.002).

Conclusions

The Openwater optical blood flow monitor outperformed prehospital stroke scales for the detection of LVO in patients who presented to the Emergency Department for acute stroke evaluation. These encouraging findings need to be validated in the prehospital environment.
Airway epithelial cells as a novel intracellular host reservoir forCryptococcusspores
Authors: Ortiz Sébastien C. , Fortune-Grant Rachael , Davies Joshua , May Robin C. , Drummond Rebecca A. , Bertuzzi Margherita
Published: December 2023

Human fungal pathogens cause an estimated 1.5 million annual deaths andCryptococcus neoformans, an inhaled facultative intracellular pathogen, is at the top of the WHO’s priority list of fungal pathogens.Cryptococcuscauses disease when it disseminates out of the lung and into the brain which can occur years after initial exposure. However, the mechanisms of bothCryptococcusdissemination and latency are still unclear. One potential reason that these mechanisms remain unknown is that the morphotype used for the vast majority of studies is the yeast form and not the dormant and stress resistant spore morphotype. The inhalation ofCryptococcusspores initiates infections and recent evidencein vivohas shown that spores display unique host-pathogen interactions and are able to escape the lung and disseminate to the brain more readily than yeast. Due to the difficulties associated working with these spores, little is known about how they interact with host cells.AirwayEpithelialCells (AECs), which cover the entire alveolar surface and comprise 24% of all cells in the human lung parenchyma, likely have instant and extensive contact with inhaled spores. In this study, we demonstrated thatCryptococcusspores can invade AECs bothin vitroandin vivo. Once inside spores can germinate and subsequently replicate, persist and/or escape. This ability to enter AECs correlates with a preferential ability of spore to cross AEC barriers. Together our work indicates AECs may serve as a previously ignored intracellular host reservoir and challenges the current paradigms of bothCryptococcusdissemination and latency.
Path analysis reveals combined winter climate and pollution effects on the survival of a marine top predator
Authors: Layton-Matthews Kate , Erikstad Kjell E. , Sandvik Hanno , Ballesteros Manuel , Hodges Kevin , Mesquita Michael d.S. , Reiertsen Tone K. , Yoccoz Nigel G. , Bustnes Jan Ove
Published: December 2023

Marine ecosystems are experiencing growing pressure from multiple threats caused by human activities, with far-reaching consequences for marine food webs. Determining the effects of multiple stressors is complex, in part, as they can affect different levels of biological organisation (behaviour, individual traits, demographic rates). Knowledge of the cumulative effects of stressors is key to predict the consequences for threatened populations’ viability under global change. Due to their position in the food chain, top predators such as seabirds are considered more sensitive to environmental changes. Climate change is affecting the prey resources available for seabirds, through bottom-up effects, while organic pollutants can bioaccumulate in food chains with the greatest impacts on top predators. However, knowledge of their combined effects on seabird population dynamics is lacking. Using a path analysis, we quantify the effects of both climate change and pollution, via an effect on body mass, on the survival of adult great black-backed gulls. Warmer ocean temperatures in gulls’ winter foraging areas in the North Sea were correlated with higher survival, potentially explained by shifts in prey availability associated with global climate change. We also found support for indirect negative effects of organochlorines, highly toxic pollutants to seabirds, on survival acting through a negative effect on body mass. The results from this path analysis highlight how, even for such long-lived species where variance in survival tends to be limited, two stressors still have had a marked influence on adult survival and illustrate the potential of such models to improve predictions of population variability under multiple stressors.