bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opportunities and limitations of genomics for diagnosing bedaquiline-resistant tuberculosis: an individual isolate meta-analysis
Authors: Nimmo Camus , Bionghi Neda , Cummings Matthew J. , Perumal Rubeshan , Hopson Madeleine , Al Jubaer Shamim , Wolf Allison , Mathema Barun , Larsen Michelle H. , O’Donnell Max 
Published: May 2023

BackgroundClinical bedaquiline resistance predominantly involves mutations inmmpR5(Rv0678). However,mmpR5resistance-associated variants (RAVs) have a variable relationship with phenotypicM. tuberculosisresistance. We performed a systematic review to (1) assess the maximal sensitivity of sequencing bedaquiline resistance-associated genes and (2) evaluate the association between RAVs and phenotypic resistance, using traditional and machine-based learning techniques.MethodsWe screened public databases for articles published until October 2022. Eligible studies performed sequencing of at leastmmpR5andatpEon clinically-sourcedM. tuberculosisisolates and measured bedaquiline minimum inhibitory concentrations (MICs). We performed genetic analysis for identification of phenotypic resistance and determined the association of RAVs with resistance. Machine-based learning methods were employed to define test characteristics of optimised sets of RAVs, andmmpR5mutations were mapped to the protein structure to highlight mechanisms of resistance.ResultsEighteen eligible studies were identified, comprising 975M. tuberculosisisolates containing ≥1 potential RAV (mutation inmmpR5, atpE, atpBorpepQ), with 201 (20.6%) demonstrating phenotypic bedaquiline resistance. 84/285 (29.5%) resistant isolates had no candidate gene mutation. Sensitivity and positive predictive value of taking an ‘any mutation’ approach was 69% and 14% respectively. Thirteen mutations, all inmmpR5, had a significant association with a resistant MIC (adjusted p<0.05). Gradient-boosted machine classifier models for predicting intermediate/resistant and resistant phenotypes both had receiver operator characteristic c-statistics of 0.73. Frameshift mutations clustered in the alpha 1 helix DNA binding domain, and substitutions in the alpha 2 and 3 helix hinge region and in the alpha 4 helix binding domain.DiscussionSequencing candidate genes is insufficiently sensitive to diagnose clinical bedaquiline resistance, but where identified a limited number of mutations should be assumed to be associated with resistance. Genomic tools are most likely to be effective in combination with rapid phenotypic diagnostics.
GPT-4 outperforms ChatGPT in answering non-English questions related to cirrhosis
Authors: Yeo Yee Hui , Samaan Jamil S. , Ng Wee Han , Ma Xiaoyan , Ting Peng-Sheng , Kwak Min-Sun , Panduro Arturo , Lizaola-Mayo Blanca , Trivedi Hirsh , Vipani Aarshi , Ayoub Walid , Yang Ju Dong , Liran Omer , Spiegel Brennan , Kuo Alexander 
Published: May 2023

AbstractBackground and ObjectivesArtificial intelligence is increasingly being employed in healthcare, raising concerns about the exacerbation of disparities. This study evaluates ChatGPT and GPT-4’s ability to comprehend and respond to cirrhosis-related questions in English, Korean, Mandarin, and Spanish, addressing language barriers that may impact patient care.MethodsA set of 36 cirrhosis-related questions were translated into Korean, Mandarin, and Spanish and prompted to both ChatGPT and GPT-4 models. Non-English responses were graded by native-speaking hepatologists on accuracy and similarity to English responses. Chi-square tests were used to compare the proportions of grading between ChatGPT and GPT-4.ResultsGPT-4 showed a marked improvement in the proportion of comprehensive and correct answers compared to ChatGPT across all four languages (p<0.05). GPT-4 demonstrated enhanced accuracy and avoided erroneous responses evident in ChatGPT’s output. Significant improvement was observed in Mandarin and Korean subgroups, with a smaller quality gap between English and non-English responses in GPT-4 compared to ChatGPT.ConclusionsGPT-4 exhibited significantly higher accuracy in English and non-English cirrhosis-related questions, highlighting its potential for more accurate and reliable language model applications in diverse linguistic contexts. These advancements have important implications for patients with language discordance, contributing to equalizing health literacy on a global scale.
Evaluating GPT-4-based ChatGPT’s Clinical Potential on the NEJM Quiz
Authors: Ueda Daiju , Walston Shannon L , Matsumoto Toshimasa , Deguchi Ryo , Tatekawa Hiroyuki , Miki Yukio 
Published: May 2023

AbstractBackgroundGPT-4-based ChatGPT demonstrates significant potential in various industries; however, its potential clinical applications remain largely unexplored.MethodsWe employed the New England Journal of Medicine (NEJM) quiz “Image Challenge” from October 2021 to March 2023 to assess ChatGPT’s clinical capabilities. The quiz, designed for healthcare professionals, tests the ability to analyze clinical scenarios and make appropriate decisions. We evaluated ChatGPT’s performance on the NEJM quiz, analyzing its accuracy rate by questioning type and specialty after excluding quizzes which were impossible to answer without images. The NEJM quiz has five multiple-choice options, but ChatGPT was first asked to answer without choices, and then given the choices to answer afterwards, in order to evaluate the accuracy in both scenarios.ResultsChatGPT achieved an 87% accuracy without choices and a 97% accuracy with choices, after excluding 16 image-based quizzes. Upon analyzing performance by quiz type, ChatGPT excelled in the Diagnosis category, attaining 89% accuracy without choices and 98% with choices. Although other categories featured fewer cases, ChatGPT’s performance remained consistent. It demonstrated strong performance across the majority of medical specialties; however, Genetics had the lowest accuracy at 67%.ConclusionChatGPT demonstrates potential for clinical application, suggesting its usefulness in supporting healthcare professionals and enhancing AI-driven healthcare.
Excess Mortality Resulting from COVID-19 in Turkey during 2020-2021: Regional and Time-Based Analysis
Authors: Keskin Salih , Ergör Gül 
Published: May 2023

AbstractTurkey experienced substantial excess mortality in 2020 and 2021 related to the COVID-19 pandemic. Methods used to estimate excess mortality vary, making comparisons difficult. This study assessed the impact of the COVID-19 pandemic in Turkey, using the TURKSTAT data which became available on February 23, 2023. We applied a quasi-Poisson model to estimate excess mortality during 2020–2021, comparing excess mortality by time periods and socioeconomic factors. During 2020–2021, Turkey experienced 72,886 excess deaths in 2020 (P-score 16.8%) and 125,540 in 2021 (P-score 28.5%). An additional 80 excess deaths per 100,000 people were recorded in 2020 and 143 in 2021. Excess all-cause mortality varied across socioeconomic levels, with notable social disparities in pandemic deaths as the highest rates were observed in the lowest socioeconomic group. This study highlights the importance of a comprehensive approach to address the diverse impacts of the pandemic on health and well-being while considering socioeconomic disparities, and potential areas for improvement in data collection and reporting.
A blended learning approach for capacity strengthening to improve the quality of integrated HIV, TB, and Malaria services during antenatal and postnatal care in LMICs: A feasibility study
Authors: Ladur Alice Norah , Kumah Elizabeth Adjoa , Egere Uzochukwu , Mgawadere Florence , Murray Christopher , Ravit Marion , White Sarah Ann , Mohammed Hauwa , Mutai Rael , Nyaga Lucy , Shikuku Duncan , Bashir Issak , Ayinde Olubunmi Olufunmilola , Bakar Rukia , Katalambula Leonard , Federici Carlo , Torbica Aleksandra , Furtado Nicholas , Ameh Charles 
Published: May 2023

AbstractThe blended learning (BL) approach to training health care professionals is increasingly adopted in many countries because of high costs and disruption to service delivery in the light of severe human resource shortage in low resource settings. The Covid-19 pandemic increased the urgency to identify alternatives to traditional face-to-face (f2f) education approach. A four-day f2f antenatal care (ANC) and postnatal care (PNC) continuous professional development course (CPD) was repackaged into a 3-part BL course; 1) self-directed learning (16 hours) 2) facilitated virtual sessions (2.5 hours over 3 days) and 3) 2-day f2f sessions. This study assessed the feasibility, change in healthcare providers’ knowledge and costs of the BL package in Nigeria, Tanzania, and Kenya. A mixed methods design was used. A total of 89 healthcare professionals, were purposively selected. Quantitative data was collected through an online questionnaire and skills assessments, analyzed using STATA 12 software. Qualitative data was collected through key informant interviews and focus group discussions, analysed using thematic analysis.Majority of participants (86%) accessed the online sessions using a mobile phone from home and health facilities. The median (IQR) time of completing the self-directed component was 16 hours, IQR (8, 30). A multi-disciplinary team comprising of 42% nurse-midwives, 28% doctors, 20% clinical officers and 10% other healthcare professionals completed the BL course. Participants liked the BL approach due to its flexibility in learning, highly educative/relevant content, mixing of health worker cadres and CPD points. Aspects that were noted as challenging were related to personal log-in details and network connectivity issues during the self-directed learning and facilitated virtual sessions respectively. The blended learning approach to ANC-PNC in-service training was found to be feasible, cost saving compared to the face-to-face approach and acceptable to health care professionals in LMICs.
Understanding the social inclusion needs of people living in mental health supported accommodation
Authors: Eager Sharon , Killaspy Helen , Joanna C , Mezey Gillian , Downey Megan , Lloyd-Evans Brynmor 
Published: May 2023

AbstractObjectivesTo identify the social inclusion needs that were i) most commonly identified and ii) most and least commonly prioritised as support planning goals for mental health service users living in supported accommodation, using the online Social Inclusion Questionnaire User Experience (SInQUE). We qualitatively examined mental health supported accommodation staff and servicer users’ views on barriers to offering support with two less commonly prioritised areas: help finding a partner and feeling less lonely.MethodsAnonymous SInQUE data were collected during a completed study in which we developed and tested the online SInQUE. Four focus groups were conducted with mental health supported accommodation staff (N=2) and service users (N=2).ResultsThe most common social inclusion needs identified by service users (n=31) were leisure activities, finding transport options, and feeling less lonely. Of the needs identified, those that service users and staff least frequently prioritised as support planning goals were having company at mealtimes, getting one’s own furniture, feeling less lonely, help with finances, and help finding a partner. In the focus groups, staff and service users identified barriers to helping with loneliness and finding a partner which related to staff and service users themselves, supported accommodation services, and wider societal factors.
Using Random Forest feature importance results to predict zoonosis
Authors: Gonzalez Roger Geertz 
Published: May 2023

ABSTRACTThis study fills a gap in the literature regarding using machine learning techniques within the field of zoonoses. Instead of using linear and logistic inference modeling like in previous (Knowledge, Attitudes, and Practices (KAP) studies, this study incorporates Random Forest (RF) to identify important features that predict zoonotic diseases using survey and blood serology data. Using RF, we found that the most important features related to zoonoses were villages where households were 46 or larger and where participants owned many animals such as ducks, cats, and pigs. Compared to previous KAP studies in other countries where ethnicity, age, and education background were important features regarding knowledge, awareness, and practices relating to zoonoses, the KAP Cambodia case was different because these features were not found to be important.
Prevalence of cardiometabolic risk factors according to urbanization level, gender and age, in apparently healthy adults living in Gabon, Central Africa
Authors: Ada Mengome Mérédith Flore , Kono Héléna Néoline , Ayo Bivigou Elsa , M’Bondoukwe Noé Patrick , Ndong Ngomo Jacques-Mari , Moutombi Ditombi Bridy , Pongui Ngondza Bedrich , Bisseye Cyrille , Mawili-Mboumba Denise Patricia , Bouyou Akotet Marielle Karine 
Published: May 2023

AbstractThe prevalence of cardiometabolic risk factors (CMRFs) is increasing in sub-Saharan Africa and represents a serious health issue. Specific and accurate data are required to implement prevention programs and healthcare strategies. Thus, the aim of this study was to estimate the prevalence rates of CMRFs according to the level of urbanization, age and gender in Gabon.A cross-sectional study was conducted using the World Health Organization’s (WHO) stepwise approach for the surveillance of chronic disease risk factors. Participants over 18 years of age, without known underlying disease, from rural and urban areas of Gabon were included. Biological and behavioral data were collected using an adapted version of the standardized WHO survey questionnaire.The median age was 38[28–50] years. Tobacco consumption was more frequent in rural areas than in urban areas (26.1% vs 6.2%;p< 0.01). Men were more likely to be smokers than women, in both settings (aOR: 8.0[4.9-13.5],p< 0.01). Excessive alcohol consumption (19.4% vs 9.6%;p< 0.01) predominated in rural than in urban areas. Urban dwellers were less physically active than rural people (29.5% vs 16.3%;p< 0.01). In total, 79.9% of participants aged under 54 years had a high blood pressure (HBP) while 10.6% of the younger participants had pre-hypertension. Metabolic syndrome was higher in women (21.7% vs 10.0%;p< 0.01) than in men. Furthermore, 6.4% of men and 2.5% of women had a high risk of developing coronary heart diseases in the next 10 years (p= 0.03). Finally, 54.0% of the study population had three or four risk factors.The prevalence rates of CMRFs were high in the study population. Disparities were observed according to urban and rural areas, gender and age groups. National prevention and healthcare strategies for cardiometabolic diseases in Gabon should take into account these observed differences.
Using comprehensive disease modeling to assess the burden of substandard and falsified oxytocin in Kenya
Authors: Zaraa Sabra , Carlson Josh J , Vodicka Elisabeth , Stergachis Andy 
Published: May 2023

ABSTRACTBACKGROUNDSubstandard and falsified (SF) oxytocin threatens the health of pregnant patients, resulting in prolonged illness and severe avertable disease outcomes. Additionally, SF oxytocin leads to an economic burden on the healthcare system and society due to increased treatment costs and productivity losses from sickness and premature death. While oxytocin is widely accessible, there are concerns about its quality and the burden of SF oxytocin remains understudied.OBJECTIVETo develop an impact model to estimate the health and economic burden of SF oxytocin in Kenya. This paper presents the methodology and the findings of assessing SF oxytocin in Kenya.METHODSA decision tree model was developed to compare health outcomes and costs with and without SF oxytocin from a healthcare sector and societal perspective. This model incorporates healthcare seeking behavior, epidemiological parameters, medicine quality, health outcomes and costs. The main assumption of the model is that lower active pharmaceutical ingredient (API) percentage results in lower medicine efficacy. Sensitivity analyses were performed to evaluate parameter uncertainty.FINDINGSFor 1.1 million pregnant patients delivering in a healthcare facility in Kenya and a 7% prevalence of oxytocin with 75%-90% API, the model estimates that the presence of SF oxytocin in Kenya is associated with 1,484 additional cases of mild PPH, 583 additional cases of severe PPH, 15 hysterectomies, 32 deaths, 633 DALYs accrued, 560 QALYs lost, and 594 years of life lost yearly. The economic burden of SF oxytocin was $1,970,013 USD from a societal perspective, including $1,219,895 from the healthcare sector perspective. Productivity losses included $12,069 due to missed days of work and $725,979 due to premature death.CONCLUSIONSBy providing local estimates on the burden of SF medicines, the model can inform key policy makers on the magnitude of their impact and support initiatives that facilitate greater access to quality medicines.
COMMON ADOLESCENT MENTAL HEALTH DISORDERS SEEN IN FAMILY MEDICINE CLINICS IN GHANA AND NIGERIA
Authors: Kumbet JS , Oseni TIA , Mensah-Bonsu M , Damagum FM , Opare-Lokko EA , Namisango E , Olawumi AL , Ephraim OC , Aweh B 
Published: May 2023

ABSTRACTBackgroundMental health disorders among adolescents is on the rise globally. For fear of stigmatization, patients seldom present to mental health physicians. They are mostly picked during consultations with Family Physicians. This study seeks to evaluate the common mental health disorders seen by family Physicians in Family Medicine Clinics in Nigeria and Ghana.MethodologyA descriptive cross-sectional study involving 302 Physicians practicing in Family Medicine Clinics in Nigeria and Ghana who were randomly selected for the study. Data were collected using self-administered semi-structured questionnaire, and were entered into excel spreadsheet before analysing with IBM-SPSS version 22. Descriptive statistics using frequencies and percentages was used to describe variables. Ethical approval was obtained prior to commencement of the study.ResultsOf the 302 Physicians recruited for the study, only 233 completed the study, in which 168 (72.1%) practiced in Nigeria and 65 (27.9%) in Ghana. They were mostly in urban communities (77.3%) and tertiary health facilities (65.2%). Over 90% of Family Medicine practitioners attended to adolescents with mental health issues with over 70% of them seeing at least 2 adolescents with mental health issues every year. The burden of mental health disorder was 16% and the common mental health disorders seen were depression (59.2%), Bipolar Affective Disorder (55.8%), Epilepsy (51.9%) and Substance Abuse Disorder (44.2%).ConclusionFamily Physicians in Nigeria and Ghana attend to a good number of adolescents with mental health disorders in their Family Medicine clinics. There is the need for Family Physicians to have specialized training and retraining to be able to recognize and treat adolescent mental health disorders. This will help reduce stigmatization and improve the management of the disease thus reducing the burden.
Real-time heart rate variability according to ambulatory glucose profile in patients with diabetes mellitus
Authors: Im Sung Il , Bae Su Hyun , Kim Soo Jin , Kim Bong Joon , Heo Jung Ho , Kwon Su kyoung , Cho Sung Pil , Shim Hun , Park Jung Hwan , Kim Hyun Su , Oak Chul Ho 
Published: May 2023

AbstractBackgroundAutonomic neuropathy commonly occurs as a long-term complication of diabetes mellitus (DM) and can be diagnosed based on heart rate variability (HRV), calculated from electrocardiogram (ECG) recordings. There are limited data on HRV using real-time ECG and ambulatory glucose monitoring in patients with DM.Methods and ResultsA total of 43 patients (66.3±7.5 years) with DM underwent continuous real-time ECG monitoring (225.7±107.3 hours) for HRV and ambulatory glucose monitoring using a remote monitoring system. We compared the HRV according to the ambulatory glucose profile. Data were analyzed according to the target in glucose range (TIR). There were no significant differences in the baseline characteristics of the patients according to the TIR. During monitoring, we checked ECG and ambulatory glucose levels (a total of 15,090 times) simultaneously for all patients. Both time- and frequency-domain HRVs were lower when the patients had poorly controlled glucose levels (>200 mg/dL) and TIR<70% compared with normally controlled glucose levels (<200 mg/dL) and TIR>70%. In addition, heart and respiratory rates increased with real-time glucose levels (P<0.001).ConclusionsPoorly controlled glucose levels were independently associated with lower HRV in patients with DM. This was further substantiated by the independent continuous association between real-time measurements of hyperglycemia and lower HRV. These data strongly suggest that cardiac autonomic dysfunction is caused by elevated blood sugar levels.
Behavioral Paradigm for the Evaluation of Stimulation-Evoked Somatosensory Perception Thresholds in Rats
Authors: Smith Thomas J. , Wu Yupeng , Cheon Claire , Khan Arlin A. , Srinivasan Hari , Capadona Jeffrey R. , Cogan Stuart F. , Pancrazio Joseph J. , Engineer Crystal T. , Hernandez-Reynoso Ana G. 
Published: May 2023

AbstractIntracortical microstimulation (ICMS) of the somatosensory cortex via penetrating microelectrode arrays (MEAs) can evoke cutaneous and proprioceptive sensations for restoration of perception in individuals with spinal cord injuries. However, ICMS current amplitudes needed to evoke these sensory percepts tend to change over time following implantation. Animal models have been used to investigate the mechanisms by which these changes occur and aid in the development of new engineering strategies to mitigate such changes. Non-human primates are commonly the animal of choice for investigating ICMS, but ethical concerns exist regarding their use. Rodents are a preferred animal model due to their availability, affordability, and ease of handling, but there are limited choices of behavioral tasks for investigating ICMS. In this study, we investigated the application of an innovative behavioral go/no-go paradigm capable of estimating ICMS-evoked sensory perception thresholds in freely moving rats. We divided animals into two groups, one receiving ICMS and a control group receiving auditory tones. Then, we trained the animals to nose-poke – a well-established behavioral task for rats – following either a suprathreshold ICMS current-controlled pulse train or frequency-controlled auditory tone. Animals received a sugar pellet reward when nose-poking correctly. When nose-poking incorrectly, animals received a mild air puff. After animals became proficient in this task, as defined by accuracy, precision, and other performance metrics, they continued to the next phase for perception threshold detection, where we varied the ICMS amplitude using a modified staircase method. Finally, we used non-linear regression to estimate perception thresholds.Results indicated that our behavioral protocol could estimate ICMS perception thresholds based on ∼95% accuracy of rat nose-poke responses to the conditioned stimulus. This behavioral paradigm provides a robust methodology for evaluating stimulation-evoked somatosensory percepts in rats comparable to the evaluation of auditory percepts. In future studies, this validated methodology can be used to study the performance of novel MEA device technologies on ICMS-evoked perception threshold stability using freely moving rats or to investigate information processing principles in neural circuits related to sensory perception discrimination.