bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized controlled trial to optimize patient’s selection for endovascular treatment in acute ischemic stroke (SELECT2): Study protocol
Authors: Sarraj Amrou , Hassan Ameer E , Abraham Michael , Ribo Marc , Blackburn Spiros , Chen Michael , Hussain Muhammad Shazam , Pereira Vitor Mendes , Ortega-Gutierrez Santiago , Sitton Clark , Lavori Phillip W , Cai Chunyan , Rahbar Mohammed , Pujara Deep , Shaker Faris , Lansberg Maarten G , Campbell Bruce , Grotta James C , Albers Gregory W ,   on behalf of the SELECT2 Investigators
Published: July 2021

Rationale

Randomized evidence for endovascular thrombectomy safety and efficacy in patients with large core strokes is lacking.

Aims

To demonstrate endovascular thrombectomy efficacy and safety in patients with large core on non-contrast CT or perfusion imaging (CT/MR) and determine if there is heterogeneity of treatment effect in large cores based on the imaging modality.

Design

SELECT2 is a prospective, randomized, multi-center, assessor-blinded controlled trial with adaptive enrichment design, enrolling up to 560 patients.

Procedure

Patients who meet the clinical criteria and have anterior circulation large vessel occlusions with large core on either NCCT (ASPECTS 3–5) or perfusion imaging (CTP [rCBF < 30%] and/or MRI [ADC < 620] ≥ 50 cc) will be randomized in a 1:1 ratio to undergo endovascular thrombectomy or medical management (MM) only up to 24 h of last known well.

Study outcomes

The distribution of 90-day mRS scores is the primary outcome. Functional independence (mRS = 0–2) rate is a secondary outcome. Other secondary outcomes include safety (symptomatic ICH, neurological worsening, mortality) and imaging outcomes.

Analysis

A normal approximation of the Wilcoxon-Mann-Whitney test (the generalized likelihood ratio test) to assess the primary outcome. Functional independence rates, safety and imaging outcomes will also be compared.

Discussion

The SELECT2 trial will evaluate endovascular thrombectomy safety and efficacy in large cores on either CT or perfusion imaging and may provide randomized evidence to extend endovascular thrombectomy eligibility to larger population. Registration: ClinicalTrials.gov–NCT03876457
Health status identification of catenary based on VMD and FA-ELM
Authors: Yi Lingzhi , Guo You , Liu Nian , Zhao Jian , Li Wang , Sun Junyong
Published: July 2021

Catenary works as a key part in the electric railway traction power supply system, which is exposed outdoors for a long time and the failure rate is very high. Once a failure occurs, it will directly affect the driving safety. Based on the above, a model of identifying the health status for the catenary based on firefly algorithm optimized extreme learning machine combined with variational mode decomposition is proposed in this paper. Variational mode decomposition is used to decompose the original detection curve of catenary into a series of intrinsic mode function components, and the intrinsic mode function components filtered by the correlation coefficient method after decomposing each detection curve are input into the firefly algorithm optimized extreme learning machine model to realize health status identification. Compared with some other models, the results show that the proposed model has better health status identification effect.
A New Analysis Tool for Continuous Glucose Monitor Data
Authors: Olawsky Evan , Zhang Yuan , Eberly Lynn E , Helgeson Erika S , Chow Lisa S
Published: July 2021

Background:

With the development of continuous glucose monitoring systems (CGMS), detailed glycemic data are now available for analysis. Yet analysis of this data-rich information can be formidable. The power of CGMS-derived data lies in its characterization of glycemic variability. In contrast, many standard glycemic measures like hemoglobin A1c (HbA1c) and self-monitored blood glucose inadequately describe glycemic variability and run the risk of bias toward overreporting hyperglycemia. Methods that adjust for this bias are often overlooked in clinical research due to difficulty of computation and lack of accessible analysis tools.

Methods:

In response, we have developed a new R package rGV, which calculates a suite of 16 glycemic variability metrics when provided a single individual’s CGM data. rGV is versatile and robust; it is capable of handling data of many formats from many sensor types. We also created a companion R Shiny web app that provides these glycemic variability analysis tools without prior knowledge of R coding. We analyzed the statistical reliability of all the glycemic variability metrics included in rGV and illustrate the clinical utility of rGV by analyzing CGM data from three studies.

Results:

In subjects without diabetes, greater glycemic variability was associated with higher HbA1c values. In patients with type 2 diabetes mellitus (T2DM), we found that high glucose is the primary driver of glycemic variability. In patients with type 1 diabetes (T1DM), we found that naltrexone use may potentially reduce glycemic variability.

Conclusions:

We present a new R package and accompanying web app to facilitate quick and easy computation of a suite of glycemic variability metrics.
On the obligation to make reasonable accommodation for an employee with a disability
Authors: Karjalainen Katja , Ylhäinen Marjo
Published: July 2021

The UN Convention on the Rights of Persons with Disabilities (UNCRPD) features interesting labour law related aspects. The goals of this article are to reconcile horizontal human rights and contract law in the context of reasonable accommodation in working life and to establish guidelines by which to assess the obligation to make accommodation, for example in relation to the EU Employment Equality Directive. This article utilises the framework of just social practice, which makes reference to welfarism in Nordic contract law. Just social practice creates a theoretical framework in which to investigate the rights and obligations attached to reasonable accommodation in working life, because it may be argued that its basic premises correspond to the ultimate justification of the accommodation rights provided for by the UNCRPD: the idea of social inclusion. The first part of the article seeks to identify common features between the UNCRPD and contract law. It sketches the theoretical framework of just social practice, in which contract law and human rights coincide within the context of employment. The second part of the article elaborates what the process of reasonable accommodation within the framework of just social practice constitutes and introduces specific steps that are followed when the right to accommodation is in question. The article also identifies the factors that have an influence on reasonableness evaluations as being either internal or external to the contractual relationship and exemplifies how contract law principles are to be applied when assessing reasonableness. The article argues that reconciliation of the goals of private law and human rights within the framework of just social practice makes it possible to argue that contract law principles can function as a tool for social inclusion.
Effectiveness of 2-year treatment with aripiprazole long-acting injectable and comparison with paliperidone palmitate
Authors: Mason Katy , Barnett Joshua , Pappa Sofia
Published: July 2021

Background:

The pragmatic management of psychotic disorders is more complex than that delivered in a controlled trial environment. Therefore, this study aims to evaluate the real-world effectiveness of aripiprazole long-acting injectable (ALAI) and compare it with another commonly used long-acting anti-psychotic, once-monthly paliperidone palmitate (PP1M).

Methods:

This naturalistic, independent 4-year mirror image study compared the mean number and length of hospital admissions 2 years before and 2 years after treatment initiation with ALAI. Retention rates, discontinuation reasons and level of adherence were also recorded. Furthermore, indirect comparisons were made between treatment outcomes on ALAI and PP1M.

Results:

A total of 109 eligible patients with a severe mental illness (65% with schizophrenia and 35% with other diagnosis) commenced on ALAI and 173 patients (69% with schizophrenia and 31% with other diagnoses) initiated on PP1M were included. Of these, 37% on ALAI and 34% on PP1M stopped treatment at 2 years; retention rates were most favourable for the schizophrenia group on PP1M. Patients were more likely to discontinue due to lack of effectiveness on ALAI and due to tolerability issues on PP1M. Those who continued for 2 years on ALAI ( n = 69), demonstrated an overall decrease of 84% in the mean number and 88% in the mean length of hospital admissions compared with the 2 years before initiation. Although patients on ALAI appeared to have a significantly higher bed occupancy the 2-year period before initiation than patients on PP1M, the reductions in hospitalizations were comparable across both cohorts after 2 years of treatment.

Conclusions:

The introduction of ALAI had a substantial impact on long-term clinical outcomes in this naturalistic cohort; more than half of patients continued treatment and had no admission during 2 years of follow up. There were no significant differences in hospitalisation rates between patients on ALAI and PP1M at 2 years.
Buprenorphine for the management of kratom dependency during covid-19: A case report
Authors: Gittins Rosalind , Cole Samantha
Published: July 2021

We describe a case report where buprenorphine was successfully used for the management of kratom ( Mitragyna speciosa) dependency during the Covid-19 pandemic in a specialist community substance misuse treatment service. The individual had a notable iatrogenic dependency on oral over the counter and prescribed opioid medication. She resorted to using kratom as a ‘tea’ to self-detoxify before getting into difficulty. Upon presentation, she disclosed using kratom up to 70 g/day with hourly dosing, in addition to co-codamol (8 mg codeine/500 mg paracetamol tablets) three times a week. Initiation of oral buprenorphine sublingual tablets was complicated due to Covid-19: dispensing arrangements were liberalised from the outset and the dose was incrementally increased, eventually to 24 mg/day. Comorbidities included mental health conditions and chronic pain which improved with buprenorphine treatment and psychotherapy. Further research is required to determine optimal regimens for the management of kratom dependency. This case study adds to the current paucity of published data regarding how to manage such cases in the community setting, which is important since kratom is thought to be increasingly used in the western world.
Low-Carbon Awareness and Behaviors: Effects of Exposure to Climate Change Impact Photographs
Authors: Liu Yong , Liu Jin , Su Yunpeng
Published: July 2021

Exposure to images on the impact of climate change has been shown to trigger low-carbon awareness and behaviors in individuals. In this study, pre-exposure to photographs of climate change impact, low-carbon awareness, and behaviors of a control group and an experimental group were not significantly different. However, following exposure, the two groups showed significant differences in terms of low-carbon awareness and behavior. Moreover, the experimental group was found to have better low-carbon awareness and behavior than the control group without exposure. Therefore, exposure to climate change impact photographs may play an important role in promoting low-carbon awareness and behavior. The findings have significant implications for climate change and low-carbon policy-making.
Technological- and Non-Technological Innovation During the Growth Phase of Industry Life Cycle: An Evidence From Vietnamese Manufacturing Enterprises
Authors: Vo-Thai Huy-Cuong , Hong-Hue Trinh-Hoang , Tran My-Linh
Published: July 2021

In the context of Industrial 4.0, Vietnam has emerged to play a critical role in the global supply chain while facing intense competition and fast changes. However, what drives manufacturing enterprises in Vietnam to innovate themselves and how well they perform in coping with business obstacle remains one of the central questions in the extent of studies. Therefore, this research primarily attempts to establish how innovation investment and obstacles affect technological and non-technological innovations, especially in the growth phase of the industry life cycle (ILC), with an analysis of available data obtained from the General Statistics Office of Vietnam and World Bank Enterprise Survey data with the use of descriptive statistics and regression analysis. The outcome of this article highlights that researchers and practitioners should consider the importance of the industry life cycle in the choice of technological or non-technological innovation through third significant contributions. First, the innovation investment is driven by R&D, and formal training enables both technological- and non-technological innovation. Second, the innovation obstacle related to finance, policy, competition, and regulation directly impacts the choice of innovation activities. Third, this study demonstrates that the firm’s engagement in technological- and non-technological innovation in line with innovation investment can help maintain successful post-innovation performance.
Childhood Blindness: Beyond VISION 2020 and the COVID-19 Pandemic
Authors: Tan Roland Joseph D. , Sharma Indra Prasad , Lucero-Prisno Don Eliseo
Published: July 2021

The World report on vision in 2019 found it difficult to evaluate VISION 2020’s impact on childhood blindness and VI since data on prevalence and causes were scarce. Considering the high chance of the global initiative missing its desired goal in children, we recommend that a sustainable version of it be launched soon. Central to this new initiative shall be better data collection on prevalence and causes of childhood blindness and VI, eye care provision and an updated and uniform system of reporting. Complete and updated data can better reflect the burden and monitor the impact of interventions. However, data collection will continue to be difficult due to the COVID-19 pandemic so the initial phase shall be tailored to the current situation.
Concordance and Patient-Centered Care in Medicaid Enrollees’ Care Experience With Providers
Authors: Ghabowen Iwimbong Kum , Bhandari Neeraj
Published: July 2021

Patient-centered care is at the nexus of several overlapping institutional reforms to improve health care system performance. However, we know little regarding Medicaid patients’ experience with their doctors along several key dimensions of patient-centered care, and how their experience compares with Medicare and privately insured patients. We studied 4 outcomes using the 2017 National Health Interview Survey: patient–provider concordance on racial/sexual/cultural identity, respectful provider attitude, solicitation of patient opinion/beliefs during the care encounter, and patient-centered communication (PCC). The primary independent variable was Medicaid enrollee status. We dichotomized responses and ran multivariate logistic regressions for each type of care experience outcome, controlling for sociodemographic factors, health care access, and health care utilization of respondents. Compared to Medicare and privately insured enrollees, Medicaid enrollees reported much lower odds of seeing providers who treated them with respect (OR = 1.91, P < .001; OR = 1.62, P < .01) and who offered PCC (OR = 1.35, P < .05; OR = 1.35, P < .01), but similar odds of seeing concordant providers (OR = 0.78, P = .96; OR = 0.96, P = .72). Importantly, Medicaid enrollees reported higher odds of seeing providers who solicited their opinion/beliefs/preferences than their Medicare or privately insured counterparts (OR = 0.82, P < .05; OR = 0.87 P < .10). Medicaid enrollees report less patient-centered experiences in some important facets of their provider interaction than their Medicare or privately insured counterparts. Federal, state, and local policies and practices directed at improving these facets of patient–provider interaction are needed and should be aimed squarely at Medicaid providers, especially those working in geographic areas and settings with a disproportionate number of racial, gender, cultural, and linguistic minorities.
Changes in Care Provision During COVID-19 Impact Patient Well-Being
Authors: Wang Judy J , Levi Jessica R , Edwards Heather A
Published: July 2021

The fast onset and extensive impact of COVID-19 necessitated strict public health measures and temporary diversion of personnel and resources from other types of medical care. This study examined the prevalence of such disruptions and their impacts on patient-perceived well-being using an untargeted survey. The majority of surveyed patients experienced changes in their routine medical care. Of those whose appointments were postponed or canceled, most patients indicated an overall negative impact on their emotional and physical well-being. We highlighted the impact of disruptions in nonurgent medical care during a large-scale public health emergency.
Free Tissue Transfer for Repair of Chronic Esophageal Perforations
Authors: Helton Matthew , Gardner James Reed , Dunlap Quinn , Pait T. Glenn , Sunde Jumin , Vural Emre , Moreno Mauricio Alejandro
Published: July 2021

Objective

Anterior cervical discectomy and fusion have become a common intervention for cervical spine stabilization. However, complications can cause life‐threatening morbidity. Among them, esophageal perforation is associated with severe morbidity, including dysphagia, malnutrition, and infection with the potential development of mediastinitis. Presentation is variable but often results in chronic morbidity. Herein we examine our experiences in the management of esophageal perforation with microvascular free tissue transfer.

Study Design

Retrospective review from January 2013 to September 2020.

Setting

Single academic tertiary care center.

Methods

This study comprised all patients (age, 41‐73 years) undergoing free tissue transfer for the repair of chronic esophageal perforation secondary to anterior cervical discectomy and fusion at an academic tertiary care center. Four patients underwent repair via vastus lateralis myofascial onlay grafting for defects ≤2 cm in greatest dimension, while 1 patient underwent a fasciocutaneous radial forearm free flap repair of an 11 × 5–cm defect.

Results

Defect location ranged from hypopharynx to cervical esophagus. Mean operative time was 6.2 hours; the average length of stay for all patients was 6.6 days. Of 5 patients, 1 required additional hardware placement for spine stabilization. All patients underwent gastrostomy tube placement to bypass the surgical site during healing, and all eventually resumed an oral diet postoperatively. Recurrent fistula occurred in 1 of 5 patients. No flap failures were encountered in the study population.

Conclusion

Vastus lateralis myofascial onlay grafting and fasciocutaneous radial forearm free flap are robust, relatively low‐morbidity interventions with a high success rate for definitive repair of chronic esophageal perforation. Repair should be undertaken in concert with a spine surgeon for management of the cervical spine.
Analysis of the Peak Systolic Velocity in the Transplant Renal Artery Anastomosis to Determine Normal Values in Patients Without Graft Dysfunction
Authors: Luna Cibele , Hassan Farooq , Scortegagna Eduardo , Castillo Rosa Patricia
Published: July 2021

Objective:

The primary purpose is to define the mean renal artery anastomosis peak systolic velocity (RAA PSV) and the renal artery anastomosis to external iliac artery ratio (RAA-to-EIA) of renal transplant recipients without graft dysfunction. Moreover, to determine associations with type of vascular anastomosis and type of graft.

Materials and Methods:

This is a single-center retrospective analysis of kidney transplant recipients. Recorded variables included recipient age, type of vascular anastomosis, type of graft, RAA PSV, and external iliac artery PSV (EIA PSV). Such variables were evaluated on different postoperative follow-up periods.

Results:

There was a high degree of reliability between the RAA PSV and EIA PSV ( P < .001). The mean RAA PSV was 174 cm/s ± 72.9 cm/s with 95% confidence interval (CI) (162.2 cm/s-185.5 cm/s].

Conclusion:

This study highlights the importance of determining the normal range of RAA PSV and showed that a high PSV does not necessarily indicate dysfunction.
Pre-capture multiplexing provides additional power to detect copy number variation in exome sequencing
Authors: Filer Dayne L. , Kuo Fengshen , Brandt Alicia T. , Tilley Christian R. , Mieczkowski Piotr A. , Berg Jonathan S. , Robasky Kimberly , Li Yun , Bizon Chris , Tilson Jeffery L. , Powell Bradford C. , Bost Darius M. , Jeffries Clark D. , Wilhelmsen Kirk C.
Published: July 2021

Background

As exome sequencing (ES) integrates into clinical practice, we should make every effort to utilize all information generated. Copy-number variation can lead to Mendelian disorders, but small copy-number variants (CNVs) often get overlooked or obscured by under-powered data collection. Many groups have developed methodology for detecting CNVs from ES, but existing methods often perform poorly for small CNVs and rely on large numbers of samples not always available to clinical laboratories. Furthermore, methods often rely on Bayesian approaches requiring user-defined priors in the setting of insufficient prior knowledge. This report first demonstrates the benefit of multiplexed exome capture (pooling samples prior to capture), then presents a novel detection algorithm, mcCNV (“multiplexed capture CNV”), built around multiplexed capture.

Results

We demonstrate: (1) multiplexed capture reduces inter-sample variance; (2) our mcCNV method, a novel depth-based algorithm for detecting CNVs from multiplexed capture ES data, improves the detection of small CNVs. We contrast our novel approach, agnostic to prior information, with the the commonly-used ExomeDepth. In a simulation study mcCNV demonstrated a favorable false discovery rate (FDR). When compared to calls made from matched genome sequencing, we find the mcCNV algorithm performs comparably to ExomeDepth.

Conclusion

Implementing multiplexed capture increases power to detect single-exon CNVs. The novel mcCNV algorithm may provide a more favorable FDR than ExomeDepth. The greatest benefits of our approach derive from (1) not requiring a database of reference samples and (2) not requiring prior information about the prevalance or size of variants.
Factors affecting in-hospital mortality of non-tuberculous mycobacterial pulmonary disease
Authors: Tanaka Goh , Jo Taisuke , Tamiya Hiroyuki , Sakamoto Yukiyo , Hasegawa Wakae , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo , Nagase Takahide
Published: July 2021

Background

The incidence and prevalence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) are reportedly increasing in many parts of the world. However, there are few published data on NTM-PD-related death. Using data from a national inpatient database in Japan, we aimed in this study to identify the characteristics of patients with NTM-PD and clinical deterioration and to identify risk factors for in-hospital mortality.

Methods

We examined data from the Diagnosis Procedure Combination (DPC) database in Japan from July 2010 to March 2014. We extracted data for HIV-negative NTM-PD patients who required unscheduled hospitalization. We evaluated these patients’ characteristics and performed multivariable logistic regression analysis to identify risk factors for all-cause in-hospital mortality.

Results

A total of 16,192 patients (median age: 78 years; women: 61.2%) were identified. The median body mass index (BMI) was 17.5 kg/m2 (IQR 15.4–20.0). All cause In-hospital death occurred in 3166 patients (19.6%). The median BMI of the patients who had died was 16.0 kg/m2 (IQR 14.2–18.4). Multivariable analysis revealed that increased mortality was associated with male sex, lower BMI, lower activities of daily living scores on the Barthel index, hemoptysis, and comorbidities, including pulmonary infection other than NTM, interstitial lung disease, pneumothorax, and malignant disease.

Conclusions

We found associations between being underweight and having several comorbidities and increased in-hospital mortality in patients with NTM-PD. Preventing weight loss and management of comorbidities may have a crucial role in improving this disease’s prognosis.
Ferroptosis-related gene signature predicts the prognosis in Oral squamous cell carcinoma patients
Authors: Li Hongyu , Zhang Xiliu , Yi Chen , He Yi , Chen Xun , Zhao Wei , Yu Dongsheng
Published: July 2021

Background

The prognosis of oral squamous cell carcinoma (OSCC) patients is difficult to predict or describe due to its high-level heterogeneity and complex aetiologic factors. Ferroptosis is a novel form of iron-dependent cell death that is closely related to tumour growth and progression. This study aims to clarify the predictive value of ferroptosis-related genes (FRGs) on the overall survival(OS) of OSCC patients.

Methods

The mRNA expression profile of FRGs and clinical information of patients with OSCC were collected from the TCGA database. Candidate differentially expressed ferroptosis-related genes (DE-FRGs) were identified by analysing differences between OSCC and adjacent normal tissues. A gene signature of prognosis-related DE-FRGs was established by univariate Cox analysis and LASSO analysis in the training set. Patients were then divided into high- and low-risk groups according to the cut-off value of risk scores, A nomogram was constructed to quantify the contributions of gene signature and clinical parameters to OS. Then several bioinformatics analyses were used to verify the reliability and accuracy of the model in the validation set. Finally, single-sample gene set enrichment analysis (ssGSEA) was also performed to reveal the underlying differences in immune status between different risk groups.

Results

A prognostic model was constructed based on 10 ferroptosis-related genes. Patients in high-risk group had a significantly worse OS (p < 0.001). The gene signature was verified as an independent predictor for the OS of OSCC patients (HR > 1, p < 0.001). The receiver operating characteristic curve displayed the favour predictive performance of the risk model. The prediction nomogram successfully quantified each indicator’s contribution to survival and the concordance index and calibration plots showed its superior predictive capacity. Finally, ssGSEA preliminarily indicated that the poor prognosis in the high-risk group might result from the dysregulation of immune status.

Conclusion

This study established a 10-ferroptosis-releated gene signature and nomogram that can be used to predict the prognosis of OSCC patients, which provides new insight for future anticancer therapies based on potential FRG targets.
Ultrasound-guided implantation of radioactive 125I seed in radioiodine refractory differentiated thyroid carcinoma
Authors: Chen Wei , Luo Yu kun , Zhang Ying , Song Qing , Tang Jie
Published: July 2021

Background

Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The purpose of this study was to assess the efficacy and safety of ultrasound-guided implantation of radioactive 125I-seed in radioiodine refractory differentiated thyroid carcinoma.

Methods

Thirty-six cervical metastatic lymph nodes (CMLNs) diagnosed with RR-DTC from 18 patients were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before implantation. Follow-up comprised US, CEUS, thyroglobulin (Tg) level and routine hematology at 1–3, 6, 9 and 12 months and every 6 months thereafter. The volumes of the nodules were compared before implantation and at each follow-up point. The volume reduction rate (VRR) of nodules was also recorded.

Results

The median volume of the nodules was 523 mm3 (148, 2010mm3) initially, which decreased significantly to 53mm3 (0, 286mm3) (P < 0.01) at the follow-up point of 24 months with a median VRR as 95% (86,100%). During the follow-up period (the range was 24–50 months), 25 (69%) nodules had VRR greater than 90%, of which 12 (33%) nodules had VVR ≈ 100% with unclear structures and only 125I seed images were visible in the US. At the last follow-up visit, the serum Tg level decreased from 57.0 (8.6, 114.8) ng/ml to 4.9 (0.7, 50.3) ng/ml, (P < 0.01).

Conclusion

US-guided 125I seed implantation is safety and efficacy in treating RR- DTC. It could be an effective supplement for the comprehensive treatment of thyroid cancer.
Cortical thickness distinguishes between major depression and schizophrenia in adolescents
Authors: Zhou Zheyi , Wang Kangcheng , Tang Jinxiang , Wei Dongtao , Song Li , Peng Yadong , Fu Yixiao , Qiu Jiang
Published: July 2021

Background

Early diagnosis of adolescent psychiatric disorder is crucial for early intervention. However, there is extensive comorbidity between affective and psychotic disorders, which increases the difficulty of precise diagnoses among adolescents.

Methods

We obtained structural magnetic resonance imaging scans from 150 adolescents, including 67 and 47 patients with major depressive disorder (MDD) and schizophrenia (SCZ), as well as 34 healthy controls (HC) to explore whether psychiatric disorders could be identified using a machine learning technique. Specifically, we used the support vector machine and the leave-one-out cross-validation method to distinguish among adolescents with MDD and SCZ and healthy controls.

Results

We found that cortical thickness was a classification feature of a) MDD and HC with 79.21% accuracy where the temporal pole had the highest weight; b) SCZ and HC with 69.88% accuracy where the left superior temporal sulcus had the highest weight. Notably, adolescents with MDD and SCZ could be classified with 62.93% accuracy where the right pars triangularis had the highest weight.

Conclusions

Our findings suggest that cortical thickness may be a critical biological feature in the diagnosis of adolescent psychiatric disorders. These findings might be helpful to establish an early prediction model for adolescents to better diagnose psychiatric disorders.
Application of failure mode and effects analysis (FMEA) to improve medication safety in the dispensing process – a study at a teaching hospital, Sri Lanka
Authors: Anjalee J. A. L. , Rutter V. , Samaranayake N. R.
Published: July 2021

Background

Failure mode and effects analysis (FMEA) is a prospective, team based, structured process used to identify system failures of high risk processes before they occur. Medication dispensing is a risky process that should be analysed for its inherent risks using FMEA. The objective of this study was to identify possible failure modes, their effects, and causes in the dispensing process of a selected tertiary care hospital using FMEA.

Methods

Two independent teams (Team A and Team B) of pharmacists conducted the FMEA for two months in the Department of Pharmacy of a selected teaching hospital, Colombo, Sri Lanka. Each team had five meetings of two hours each, where the dispensing process and sub processes were mapped, and possible failure modes, their effects, and causes, were identified. A score for potential severity (S), frequency (F) and detectability (D) was assigned for each failure mode. Risk Priority Numbers (RPNs) were calculated (RPN=SxFxD), and identified failure modes were prioritised.

Results

Team A identified 48 failure modes while Team B identified 42. Among all 90 failure modes, 69 were common to both teams. Team A prioritised 36 failure modes, while Team B prioritised 30 failure modes for corrective action using the scores. Both teams identified overcrowded dispensing counters as a cause for 57 failure modes. Redesigning of dispensing tables, dispensing labels, the dispensing and medication re-packing processes, and establishing a patient counseling unit, were the major suggestions for correction.

Conclusion

FMEA was successfully used to identify and prioritise possible failure modes of the dispensing process through the active involvement of pharmacists.
Tooth brushing performance in adolescents as compared to the best-practice demonstrated in group prophylaxis programs: an observational study
Authors: Eidenhardt Zdenka , Ritsert Alexander , Shankar-Subramanian Sadhvi , Ebel Stefanie , Margraf-Stiksrud Jutta , Deinzer Renate
Published: July 2021

Background

Research indicates that adolescents may have difficulties to adopt the tooth brushing recommendations delivered in prophylaxis programs. However, it is not clear whether these difficulties are seen amongst the entire age range of adolescence (10–19 years) or only occur at certain developmental stages of the adolescence. The present study analyzes the tooth brushing performance of adolescents and compares it to the best-practice of tooth brushing demonstrated during prophylaxis programs.

Methods

A random sample of N = 66 adolescents, comprising 10-year-olds (n = 42) and 15-year-olds (n = 24), were asked to perform oral hygiene to the best of their abilities in front of a tablet camera. Videos were analyzed for tooth brushing duration, location, and brushing movements, and the difference between the actual and expected behaviour was tested for consistency using repeated measures ANOVAs and Student’s t-tests. For the direct comparison across different age groups, already available data from 12- and 18-year-olds were reanalysed.

Results

The average brushing time (mean ± SD) of the 10-year-olds and 15-year-olds was 195.8 s (74.6 s) and 196.1 s (75.8 s), respectively. Regardless of age, the adolescents distributed their brushing time unevenly across the inner, outer and occlusal surfaces. The inner surfaces in particular were neglected to a considerable extent, as no age group spent more than 15.8% of the total brushing time on them. Furthermore, all age groups showed a high proportion of horizontal movements on the inner and outer surfaces, regardless of the movements instructed for the respective surfaces.

Conclusion

Even if adolescents brush to the best of their abilities, they neglect or skip one or many of the tooth surfaces. The reasons for the lack of compliance to tooth brushing instructions are discussed in light of the methods used in prophylaxis programs and the influence of parents.
CBCT evaluation of root canal morphology and anatomical relationship of root of maxillary second premolar to maxillary sinus in a western Chinese population
Authors: Yan Yujia , Li JingLin , Zhu Hualing , Liu Jun , Ren Jiayin , Zou Ling
Published: July 2021

Background

To evaluate the root anatomy, root canal morphology and the anatomical relationship between the roots and maxillary sinus of maxillary second premolars by CBCT in a western Chinese population.

Methods

A total of 1118 CBCT scans of the maxillary second premolars were collected from West China Hospital of Stomatology, Sichuan University. Information below were measured on axial, coronal and sagittal sections, recorded and evaluated properly: the number of roots and canals, the morphology of canal system classified by Vertucci standard, the inter-orifice distance of canal orifices, the curvature of each canal and the distance from root tip to maxillary sinus floor.

Results

Among the 1118 teeth, 94.2% (1053) are single-rooted and 55.1% (616) have one canal. Type I (55.1%) is the commonest root canal morphology followed by Type II (31.9%). The mean inter-orifice distance (IOD) for multi-canal teeth ranging from 2.72 ± 0.32 to 3.41 ± 0.11 mm. Of 1622 canals, 38.8% (630) curvature are mesiodistal and 30.9% (501) are straight canals. The distance from root tip to maxillary sinus floor increased with age and the mean distance of single-rooted ones is 2.47 ± 3.45 mm.

Conclusions

All kinds of canal morphology category can be detected in maxillary second premolars. The IOD might be a predictable factor for root canal morphology. Roots of maxillary second premolars are related to maxillary sinus which should be treated carefully.
The use of text mining to detect key shifts in Japanese first-year medical student professional identity formation through early exposure to non-healthcare hospital staff
Authors: Shikama Yayoi , Chiba Yasuko , Yasuda Megumi , Stanyon Maham , Otani Koji
Published: July 2021

Background

Professional identity formation is nurtured through socialization, driven by interaction with role models, and supported through early clinical exposure (ECE) programmes. Non-healthcare professionals form part of the hospital community but are external to the culture of medicine, with their potential as role models unexplored. We employed text mining of student reflective assignments to explore the impact of socialization with non-healthcare professionals during ECE.

Methods

Assignments from 259 first-year medical students at Fukushima Medical University, Japan, underwent hierarchical cluster analysis. Interrelationships between the most-frequently-occurring words were analysed to create coding rules, which were applied to elucidate underlying themes.

Results

A shift in terms describing professional characteristics was detected, from “knowledge/skill” towards “pride [in one’s work]” and “responsibility”. Seven themes emerged: contribution of non-healthcare professionals, diversity of occupation, pride, responsibility, teamwork, patient care and gratitude. Students mentioning ‘contribution of non-healthcare professionals’ spoke of altruistic dedication and strong sense of purpose. These students expressed gratitude towards non-healthcare professionals for supporting clinical work, from a doctor’s perspective.

Conclusion

Socialization with non-healthcare professionals provides important insights into the hospital working environment and cultural working norms. Through role modelling altruism and responsibility, non-healthcare professionals positively influenced student professional identity formation, promoting self-conceptualisation as a doctor.
Exploring perceptions of healthcare technologies enabled by artificial intelligence: an online, scenario-based survey
Authors: Antes Alison L. , Burrous Sara , Sisk Bryan A. , Schuelke Matthew J. , Keune Jason D. , DuBois James M.
Published: July 2021

Background

Healthcare is expected to increasingly integrate technologies enabled by artificial intelligence (AI) into patient care. Understanding perceptions of these tools is essential to successful development and adoption. This exploratory study gauged participants’ level of openness, concern, and perceived benefit associated with AI-driven healthcare technologies. We also explored socio-demographic, health-related, and psychosocial correlates of these perceptions.

Methods

We developed a measure depicting six AI-driven technologies that either diagnose, predict, or suggest treatment. We administered the measure via an online survey to adults (N = 936) in the United States using MTurk, a crowdsourcing platform. Participants indicated their level of openness to using the AI technology in the healthcare scenario. Items reflecting potential concerns and benefits associated with each technology accompanied the scenarios. Participants rated the extent that the statements of concerns and benefits influenced their perception of favorability toward the technology. Participants completed measures of socio-demographics, health variables, and psychosocial variables such as trust in the healthcare system and trust in technology. Exploratory and confirmatory factor analyses of the concern and benefit items identified two factors representing overall level of concern and perceived benefit. Descriptive analyses examined levels of openness, concern, and perceived benefit. Correlational analyses explored associations of socio-demographic, health, and psychosocial variables with openness, concern, and benefit scores while multivariable regression models examined these relationships concurrently.

Results

Participants were moderately open to AI-driven healthcare technologies (M = 3.1/5.0 ± 0.9), but there was variation depending on the type of application, and the statements of concerns and benefits swayed views. Trust in the healthcare system and trust in technology were the strongest, most consistent correlates of openness, concern, and perceived benefit. Most other socio-demographic, health-related, and psychosocial variables were less strongly, or not, associated, but multivariable models indicated some personality characteristics (e.g., conscientiousness and agreeableness) and socio-demographics (e.g., full-time employment, age, sex, and race) were modestly related to perceptions.

Conclusions

Participants’ openness appears tenuous, suggesting early promotion strategies and experiences with novel AI technologies may strongly influence views, especially if implementation of AI technologies increases or undermines trust. The exploratory nature of these findings warrants additional research.
Development of a theory-based intervention to increase cognitively able frail elders’ engagement with advance care planning using the behaviour change wheel
Authors: Combes S. , Forbes G. , Gillett K. , Norton C. , Nicholson C. J.
Published: July 2021

Background

Advance care planning (ACP) conversations support people to think about, discuss and document their beliefs, values and preferences regarding future care. This process means that should the person loose capacity in the future, care can be provided, consistent with their personal values and beliefs. The ACP process is particularly relevant for older people living with frailty (frail elders) as they are vulnerable to sudden deterioration. However, ACP is rarely undertaken by frail elders. The aim of this study was to develop an intervention to increase multidisciplinary health and social care professionals’ (H&SCPs) engagement of cognitively able, domestic-dwelling frail elders with ACP.

Methods

Intervention development was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel. Multiple methods were used to understand ACP barriers and enablers: a systematic integrative review, a survey (n = 73 H&SCPs), and semi-structured interviews (n = 10 frail elders, n = 8 family members). A conceptual model, developed from the integrative review, underpinned data collection for the survey and interviews. Synthesis of this data, including patient and public involvement, was then used to identify H&SCPs behaviours that needed to change for ACP to be implemented and decide content and implementation for the intervention.

Results

Following the Behaviour Change Wheel system, and based on the findings of the review, survey and interviews, the prototype intervention, Conversations on Living and Dying (CLaD), was developed. The CLaD prototype consisted of one 3.5-hour educational skills session for H&SCPs supported by a toolkit. Content focussed on the relevance of ACP for frail elders, experience of ACP by frail elders, and strategies H&SCPs could adopt to encourage frail elders’ engagement with ACP. Strategies include recognising the importance of relationships and living well now, preparing frail elders for ACP conversations and starting ACP early. Participants who took part in initial prototype refinement reported that the intervention helped them think differently about ACP and encouraged them to engage with frail elders.

Conclusions

The use of behavioural theory enabled the development of CLaD, an evidence-based, theory-driven, person-centred intervention to support ACP engagement with frail elders. While feasibility testing is required, initial prototype refinement demonstrated that H&SCPs found the intervention to be acceptable, engaging, and clinically valuable in their practice with frail elders and their families.
Continuous quality improvement (CQI) Institutionalization to reach 95:95:95 HIV targets: a multicountry experience from the Global South
Authors: Memiah Peter , Tlale Josephine , Shimabale Mope , Nzyoka Sarah , Komba Patience , Sebeza Jackson , Tina Adesina , Makokha Violet
Published: July 2021

Background

Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south.

Methods

The HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or ‘change packages’, (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous ‘plan-do-study-act’ (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation.

Results

Our selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %.

Conclusions

Adopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts.
Identification of novel antioxidant gene signature to predict the prognosis of patients with gastric cancer
Authors: Wu Jianhua , Wang Xuan , Wang Nan , Ma Li , Xie Xin , Zhang Hao , Kang Huafeng , Zhou Zhangjian
Published: July 2021

Background

Gastric cancer (GC) commonly relates to dismal prognosis and lacks efficient biomarkers. This study aimed to establish an antioxidant-related gene signature and a comprehensive nomogram to explore novel biomarkers and predict GC prognosis.

Methods

Clinical and expression data of GC patients were extracted from The Cancer Genome Atlas database. Univariate and multivariate Cox analyses were utilized to construct a score-based gene signature and survival analyses were conducted between high- and low-risk groups. Furthermore, we established a prognostic nomogram integrating clinical variables and antioxidant-related gene signature. Its predictive ability was validated by Harrell' concordance index and calibration curves and an independent internal cohort verified the consistency of the antioxidant gene signature-based nomogram.

Results

Four antioxidant-related genes (CHAC1, GGT5, GPX8, and PXDN) were significantly associated with overall survival of GC patients but only two genes, CHAC1 (HR = 0.803, P < 0.05) and GPX8 (HR = 1.358, P < 0.05), were confirmed as independent factors. A score-based signature was constructed and could act as an independent prognosis predictor (P < 0.05). Patients with lower scores showed significantly better prognosis (P < 0.05). Comprehensive nomogram combining the antioxidant-related gene signature and clinical parameters (age, gender, grade, and stage) was established and effectively predicted overall survival of GC patients [3-year survival AUC = 0.680, C index = 0.665 (95% CI 0.614–0.716)]. The independent internal validation cohort verified the reliability and good consistency of the model [3-year survival AUC = 0.703, C index = 0.706 (95% CI 0.612–0.800)].

Conclusions

Innovative antioxidant-related gene signature and nomogram performed well in assessing GC prognoses. This study enlightened further investigation of antioxidant system and provided novel tools for GC patient management.