bluuebunny/crossref_metadata_2025_split huggingface dataset:
Automated classification of multiple ophthalmic diseases using ultrasound images by deep learning
Authors: Wang Yijie , Xu Zihao , Dan Ruilong , Yao Chunlei , Shao Ji , Sun Yiming , Wang Yaqi , Ye Juan 
Published: October 2023

Background
Ultrasound imaging is suitable for detecting and diagnosing ophthalmic abnormalities. However, a shortage of experienced sonographers and ophthalmologists remains a problem. This study aims to develop a multibranch transformer network (MBT-Net) for the automated classification of multiple ophthalmic diseases using B-mode ultrasound images.

Methods
Ultrasound images with six clinically confirmed categories, including normal, retinal detachment, vitreous haemorrhage, intraocular tumour, posterior scleral staphyloma and other abnormalities, were used to develop and evaluate the MBT-Net. Images were derived from five different ultrasonic devices operated by different sonographers and divided into training set, validation set, internal testing set and temporal external testing set. Two senior ophthalmologists and two junior ophthalmologists were recruited to compare the model’s performance.

Results
A total of 10 184 ultrasound images were collected. The MBT-Net got an accuracy of 87.80% (95% CI 86.26% to 89.18%) in the internal testing set, which was significantly higher than junior ophthalmologists (95% CI 67.37% to 79.16%; both p<0.05) and lower than senior ophthalmologists (95% CI 89.45% to 92.61%; both p<0.05). The micro-average area under the curve of the six-category classification was 0.98. With reference to comprehensive clinical diagnosis, the measurements of agreement were almost perfect in the MBT-Net (kappa=0.85, p<0.05). There was no significant difference in the accuracy of the MBT-Net across five ultrasonic devices (p=0.27). The MBT-Net got an accuracy of 82.21% (95% CI 78.45% to 85.44%) in the temporal external testing set.

Conclusions
The MBT-Net showed high accuracy for screening and diagnosing multiple ophthalmic diseases using only ultrasound images across mutioperators and mutidevices.
Evaluating the outcome of screening for glaucoma using colour fundus photography-based referral criteria in a teleophthalmology screening programme for diabetic retinopathy
Authors: Tan Rose , Teo Kelvin Yi Chong , Husain Rahat , Tan Ngiap Chuan , Lee Qian Xin , Hamzah Haslina , Wong Tina , Aung Tin , Cheng Ching Yu , Lamoureux Ecosse Luc , Tan Colin S , Wong Hon-Tym , Wong Tien Y , Tan Gavin Siew Wei 
Published: October 2023

Aims
To evaluate the effectiveness of glaucoma screening using glaucoma suspect (GS) referral criteria assessed on colour fundus photographs in Singapore’s Integrated Diabetic Retinopathy Programme (SiDRP).

Methods
A case–control study. This study included diabetic subjects who were referred from SiDRP with and without GS between January 2017 and December 2018 and reviewed at Singapore National Eye Centre. The GS referral criteria were based on the presence of a vertical cup-to-disc ratio (VCDR) of ≥0.65 and other GS features. The final glaucoma diagnosis confirmed from electronic medical records was retrospectively matched with GS status. The sensitivity, specificity and positive predictive value (PPV) of the test were evaluated.

Results
Of 5023 patients (2625 with GS and 2398 without GS) reviewed for glaucoma, 451 (9.0%, 95% CI 8.2% to 9.8%) were confirmed as glaucoma. The average follow-up time was 21.5±10.2 months. Using our current GS referral criteria, the sensitivity, specificity and PPV were 81.6% (95% CI 77.7% to 85.1%), 50.6% (95% CI 49.2% to 52.1%) and 14.0% (95% CI 13.4% to 14.7%), respectively, resulting in 2257 false positive cases. Increasing the VCDR cut-off for referral to ≥0.80, the specificity increased to 93.9% (95% CI 93.1% to 94.5%) but the sensitivity decreased to 11.3% (95% CI 8.5% to 14.6%), with a PPV of 15.4% (95% CI 12.0% to 19.4%).

Conclusions
Opportunistic screening for glaucoma in a lower VCDR group could result in a high number of unnecessary referrals. If healthcare infrastructures are limited, targeting case findings on a larger VCDR group with high specificity will still be beneficial.
Performance of polygenic risk scores in screening, prediction, and risk stratification: secondary analysis of data in the Polygenic Score Catalog
Authors: Hingorani Aroon D , Gratton Jasmine , Finan Chris , Schmidt A Floriaan , Patel Riyaz , Sofat Reecha , Kuan Valerie , Langenberg Claudia , Hemingway Harry , Morris Joan K , Wald Nicholas J 
Published: October 2023

ObjectiveTo clarify the performance of polygenic risk scores in population screening, individual risk prediction, and population risk stratification.DesignSecondary analysis of data in the Polygenic Score Catalog.SettingPolygenic Score Catalog, April 2022. Secondary analysis of 3915 performance metric estimates for 926 polygenic risk scores for 310 diseases to generate estimates of performance in population screening, individual risk, and population risk stratification.ParticipantsIndividuals contributing to the published studies in the Polygenic Score Catalog.Main outcome measuresDetection rate for a 5% false positive rate (DR5) and the population odds of becoming affected given a positive result; individual odds of becoming affected for a person with a particular polygenic score; and odds of becoming affected for groups of individuals in different portions of a polygenic risk score distribution. Coronary artery disease and breast cancer were used as illustrative examples.ResultsFor performance in population screening, median DR5for all polygenic risk scores and all diseases studied was 11% (interquartile range 8-18%). Median DR5was 12% (9-19%) for polygenic risk scores for coronary artery disease and 10% (9-12%) for breast cancer. The population odds of becoming affected given a positive results were 1:8 for coronary artery disease and 1:21 for breast cancer, with background 10 year odds of 1:19 and 1:41, respectively, which are typical for these diseases at age 50. For individual risk prediction, the corresponding 10 year odds of becoming affected for individuals aged 50 with a polygenic risk score at the 2.5th, 25th, 75th, and 97.5th centiles were 1:54, 1:29, 1:15, and 1:8 for coronary artery disease and 1:91, 1:56, 1:34, and 1:21 for breast cancer. In terms of population risk stratification, at age 50, the risk of coronary artery disease was divided into five groups, with 10 year odds of 1:41 and 1:11 for the lowest and highest quintile groups, respectively. The 10 year odds was 1:7 for the upper 2.5% of the polygenic risk score distribution for coronary artery disease, a group that contributed 7% of cases. The corresponding estimates for breast cancer were 1:72 and 1:26 for the lowest and highest quintile groups, and 1:19 for the upper 2.5% of the distribution, which contributed 6% of cases.ConclusionPolygenic risk scores performed poorly in population screening, individual risk prediction, and population risk stratification. Strong claims about the effect of polygenic risk scores on healthcare seem to be disproportionate to their performance.
Subthreshold micropulse laser versus standard laser for the treatment of central-involving diabetic macular oedema with central retinal thickness of <400µ: a cost-effectiveness analysis from the DIAMONDS trial
Authors: Mistry Hema , Maredza Mandy , Campbell Christina , Lois Noemi 
Published: October 2023

ObjectivesTo estimate the economic costs, health-related quality-of-life outcomes and cost-effectiveness of subthreshold micropulse laser (SML) versus standard laser (SL) for the treatment of diabetic macular oedema (DMO) with central retinal thickness (CRT) of <400µ.DesignAn economic evaluation was conducted within a pragmatic, multicentre, randomised clinical trial, DIAbetic Macular Oedema aNd Diode Subthreshold.Setting18 UK Hospital Eye Services.ParticipantsAdults with diabetes and centre involving DMO with CRT<400µ.InterventionsParticipants (n=266) were randomised 1:1 to receive SML or SL.MethodsThe base-case used an intention-to-treat approach conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective. Costs (2019–2020 prices) were collected prospectively over the 2-year follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit of SML in comparison to SL. Sensitivity analyses explored uncertainty and heterogeneity in cost-effectiveness estimates.ResultsOne participant in the SL arm withdrew consent for data to be used; data from the remaining 265 participants were included in analyses. Mean (SE) NHS and PSS costs over 24 months were £735.09 (£111.85) in the SML arm vs £1099.70 (£195.40) in the SL arm (p=0.107). Mean (SE) QALY estimates were 1.493 (0.024) vs 1.485 (0.020), respectively (p=0.780), giving an insignificant difference of 0.008 QALYs. The probability SML is cost-effective at a threshold of £20 000 per QALY was 76%.ConclusionsThere were no statistically significant differences in EQ-5D-5L scores or costs between SML and SL. Given these findings and the fact that SML does not burn the retina, unlike SL and has equivalent efficacy to SL, it may be preferred for the treatment of people with DMO with CRT<400µ.Trial registration numbersISRCTN17742985;NCT03690050.
Diagnostic utility of haematological parameters in predicting the severity of HIV infection in southwestern Ethiopia: a comparative cross-sectional study
Authors: Haile Kassahun , Timerga Abebe , Alemayehu Mihret , Mose Ayenew 
Published: October 2023

ObjectivesThis study aimed to evaluate the diagnostic utility of haematological parameters as a predictive marker of the severity of HIV infection in southwestern Ethiopia.DesignComparative cross-sectional study.SettingThis study was conducted in southwestern Ethiopia.ParticipantsVenous blood samples were collected from 344 participants (172 HIV, 172 healthy controls (HC)) and haematological parameters were determined using the automated haematology analyser. The diagnostic utility of haematological parameters was determined by a receiver operating curve analysis. Data were analysed using SPSS V.21 and the p value was set at less than 0.05 for the statistical significance.ResultsIn this study, red cell count (RCC) distinguishes HIV-infected patients from HC at a threshold value of 4.05×109/L with sensitivity, specificity and an area under the curves (AUC) of 73.8%, 78.5% and 0.87, respectively. At a cut-off value of 4.25×109/L, RCC significantly distinguishes non-severe HIV-infected patients from HC with a sensitivity of 72.7%, specificity of 81.7% and an AUC of 0.86. Haemoglobin (Hgb) significantly differentiates severe HIV-infected patients from HC with sensitivity, specificity and an AUC of 95.9%, 86.7% and 0.96, respectively. Platelet count (PLT) significantly discriminates HC from non-severe and severe HIV-infected patients with an AUC of 0.74 and 0.963, respectively.ConclusionRCC, PLT and Hgb demonstrated better diagnostic performance in predicting the severity of HIV infection and have been identified as the best haematological markers in predicting the presence and severity of HIV infection. Thus, the haematological profiles (RCC, PLT and Hgb) should be used as an alternative marker to predict the severity of HIV infection and may provide supportive information for evidence-based interventions and early diagnosis of infections.
Evaluation of the quality and reliability of anal cancer and its precancerous lesions-related content on YouTube: a cross-sectional study
Authors: Chen Zeyang , Pan Shaorong , Zhou Meng , Wang Xin 
Published: October 2023

ObjectivesThis research aims at evaluating the quality of anal cancer and its precancerous lesions-related videos on YouTube.DesignCross-sectional survey design.SettingUSA.ParticipantsThe top 150 videos on YouTube were selected for analysis based on three search terms. The duplicate, irrelevant, commercial, operation-related and audio-free videos were excluded. Finally, 105 relevant videos were included.MethodsWe assessed the completeness of video content from six dimensions and marked the men having sex with men (MSM)-related videos. To measure the video quality, DISCERN,Journal of the American Medical Association(JAMA) Benchmark Criteria, Patient Education Materials Assessment Tool (PEMAT) and Global Quality Scale (GQS) were used. The correlation between DISCERN classification and duration,JAMA, PEMAT and GQS scores were recorded.ResultsThe video content was mainly about the management of the disease (mean score 1.086). Overall, the quality of videos uploaded by the non-profit organisation was relatively high. A correlation existed between each other of theJAMA, DISCERN and GQS scores (p<0.001). Moreover, they were positively correlated with video duration and PEMAT scores (p<0.001).ConclusionsAlthough the overall quality of information about anal cancer and its precancerous lesions videos on YouTube is acceptable, it might not fully meet the health information needs of patients. Therefore, they should exercise caution when using YouTube as a source of anal cancer-related information, especially the MSM population.
UK robotic arthroplasty clinical and cost effectiveness randomised controlled trial for hips (RACER-Hip): a study protocol
Authors: Griffin James , Davis Edward T , Parsons Helen , Stevens Siobhan , Bradley Helen , Bruce Julie , Ellard David R , Haddad Fares , Hutchinson Charles E , Mason James , Nwankwo Henry , Metcalfe Andrew , Smith Toby , Smith Jennifer , Warwick Jane , Skinner John A , Rees Sophie , Underwood Martin , Khatri Chetan , Wall Peter David Henry 
Published: October 2023

IntroductionThe number of robotic-assisted hip replacement procedures has expanded globally with the intended aim of improving outcomes. Intraoperative robotic-arm systems add additional costs to total hip replacement (THR) surgery but may improve surgical precision and could contribute to diminished pain and improved function. Additionally, these systems may reduce the need for expensive revision surgery. Surgery with conventional instruments may be just as successful, quick and affordable. There is timely demand for a robust evaluation of this technology.Methods and analysisThe Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial for Hips (RACER-Hip) is a multicentre (minimum of six UK sites), participant–assessor blinded, randomised controlled trial. 378 participants with hip osteoarthritis requiring THR will be randomised (1:1) to receive robotic-assisted THR, or THR using conventional surgical instruments. The primary outcome is the Forgotten Joint Score at 12 months post-randomisation; a patient-reported outcome measure assessing participants’ awareness of their joint when undertaking daily activities. Secondary outcomes will be collected post-operatively (pain, blood loss and opioid usage) and at 3, 6, 12, 24 months, then 5 and 10 years postrandomisation (including function, pain, health-related quality of life, reoperations and satisfaction). Allocation concealment will be accomplished using a computer-based randomisation procedure on the day of surgery. Blinding methods include the use of sham incisions for marker clusters and blinded operation notes. The primary analysis will adhere to the intention-to-treat principle. Results will adhere to Consolidated Standards of Reporting Trials statements.Ethics and disseminationThe trial was approved by an ethics committee (Solihull Research Ethics Committee, 30 June 2021, IRAS: 295831). Participants will provide informed consent before agreeing to participate. Results will be disseminated using peer-reviewed journal publications, presentations at international conferences and through the use of social media. We will develop plans to disseminate to patients and public with our patient partners.Trial registration numberISRCTN13374625.
Acceptability and feasibility of the BEMPU TempWatch for hypothermia monitoring in neonatal care in Ghana: a qualitative study of clinicians’ perspectives
Authors: Sheehama Justice E K , Dey Nutifafa Eugene Yaw , Adade Abigail Esinam , Owusu Prince Gyebi , Basher Irfanul , Dail Robin B , Sacks Emma , Kanyangarara Mufaro , Sakyi Kwame Sarfo 
Published: October 2023

ObjectiveTo identify factors influencing the acceptability and feasibility of using the BEMPU TempWatch bracelet in a neonatal intensive care unit (NICU).Methods and analysisWe conducted in-depth interviews with 21 clinicians at Korle Bu Teaching Hospital in Accra, Ghana, after the bracelet had been introduced in a pilot programme. A purposive sampling technique was used to select participants for in-depth interviews. SPSS Statistical Software was used for the descriptive analysis of the participants’ demographic information. Dedoose V.9.0.54 was used to analyse interview data using a thematic analysis approach. We used the domains and constructs of the Conceptual Framework for Implementation Research framework to inform themes for the key implementation outcomes (acceptability and feasibility).ResultsMost participants found the bracelet’s use in neonatal care acceptable in theory. However, most participants found the bracelet not feasible in the NICU in its current state and suggested modifications to the bracelet’s alarm system, fit, cost and additional features to improve its utility. Participants’ acceptance hinged on attitudes towards the bracelet’s utility in the NICU and its relative advantages to the current standards of practice. The identified determinants of feasibility centred primarily around the complexities or challenges of incorporating the bracelet into routine care, affordability and its compatibility with the workload in the NICU.ConclusionModifications to the bracelet are required, and further research is needed to explore implementation strategies to effectively integrate an updated BEMPU TempWatch into routine care in the NICU and other settings.
Comparing migration experiences of Venezuelan women and girls: a mixed-method, cross-sectional analysis of refugees/migrants in Ecuador, Peru and Brazil
Authors: Bartels Susan A , Vahedi Luissa , Friesen Sofia , Noriega Monica , Rodriquez Belen , Marisol Garcia Maria , Deutscher Julianna M , Luna-Siachoque M Sofia , Johnson Sydney , Mcconnell Maegan , Stoner Bradley P , Purkey Eva 
Published: October 2023

ObjectiveOver the past decade, geopolitical turmoil in Venezuela has resulted in the displacement of 7.1 million people, resulting in a migration and refugee crisis.Methods and analysisThis current cross-sectional, mixed-method research, which is focused on women and girls, examines differences in Venezuelan refugee/migrant demographics, migration characteristics, experiences and perceptions across nine locations in Ecuador, Peru and Brazil.ResultsA total of 9116 Venezuelan refugees/migrants shared 9339 migration experiences. Respondents in Brazil had been displaced for less time, reported more extreme poverty, perceived that they had received more support from the host community, and had more positive migration experiences. In contrast, respondents in Peru had been displaced for longer, were more likely to share experiences of insecurity/violence, perceived that they had not received adequate support and were more likely to report that the migration experience was negative. Respondents in Ecuador tended to provide more moderate responses somewhere between those from Brazil and Peru with one exception being around the impact of COVID-19, which they perceived more negatively.ConclusionIt is critical to recognise that Venezuelan refugee/migrant populations are not homogenous and that their experiences, needs and priorities vary by location of settlement and migration route. From these findings, we recommend more open regularisation policies for Venezuelan nationals in Ecuador and Peru in addition to improved socioeconomic integration in accordance with the Quito Process. Sharing of successful models from other contexts may prove helpful.
Cost of acute respiratory illness episode and its determinants among community-dwelling older adults: a four-site cohort study from India
Authors: Krishnan Anand , Shekhawat Kusum , Ortega-Sanchez Ismael R , Kanungo Suman , Rajkumar Prabu , Bhardwaj Sumit Dutt , Kumar Rakesh , Prabhakaran Aslesh Ottapura , Gopal Giridara , Chakrabarti Alok Kumar , Kumar Chethrapilly Purushothaman Girish , Potdar Varsha , Manna Byomkesh , Gharpure Radhika , Amarchand Ritvik , Choudekar Avinash , Lafond Kathryn E , Dar Lalit , Bhattacharjee Uttaran , Azziz-Baumgartner Eduardo , Saha Siddhartha 
Published: October 2023

IntroductionAdvocacy for the provision of public health resources, including vaccine for the prevention of acute respiratory illnesses (ARIs) among older adults in India, needs evidence on costs and benefits. Using a cohort of community-dwelling adults aged 60 years and older in India, we estimated the cost of ARI episode and its determinants.MethodsWe enrolled 6016 participants in Ballabgarh, Chennai, Kolkata and Pune from July 2018 to March 2020. They were followed up weekly to identify ARI and classified them as acute upper respiratory illness (AURI) or pneumonia based on clinical features based on British Thoracic Society guidelines. All pneumonia and 20% of AURI cases were asked about the cost incurred on medical consultation, investigation, medications, transportation, food and lodging. The cost of services at public facilities was supplemented by WHO-Choosing Interventions that are Cost-Effective(CHOICE) estimates for 2019. Indirect costs incurred by the affected participant and their caregivers were estimated using human capital approach. We used generalised linear model with log link and gamma family to identify the average marginal effect of key determinants of the total cost of ARI.ResultsWe included 2648 AURI and 1081 pneumonia episodes. Only 47% (range 36%–60%) of the participants with pneumonia sought care. The mean cost of AURI episode was US$13.9, while that of pneumonia episode was US$25.6, with indirect costs comprising three-fourths of the total. The cost was higher among older men by US$3.4 (95% CI: 1.4 to 5.3), those with comorbidities by US$4.3 (95% CI: 2.8 to 5.7) and those who sought care by US$17.2 (95% CI: 15.1 to 19.2) but not by influenza status. The mean per capita annual cost of respiratory illness was US$29.5.ConclusionGiven the high community disease and cost burden of ARI, intensifying public health interventions to prevent and mitigate ARI among this fast-growing older adult population in India is warranted.