Search

We show that the reflection interference fringe (RIF) is formed on a screen far away from the microdroplets placed on a prism-based substrate, which have low contact angles and thin droplet heights, caused by the dual convex–concave profile of the droplet, not a pure convex profile. The geometric formulation shows that the interference fringes are caused by the optical path difference when the reflected rays from the upper convex profile at the droplet–air interface interfere with reflection from the lower concave profile at oblique angles lower than the critical angle. Analytic solutions are obtained for the droplet height and the contact angle out of the fringe number and the fringe radius in RIF from the geometric formulation. Furthermore, the ray tracing simulation is conducted using the custom-designed code. The geometric formulation and the ray tracing show excellent agreement with the experimental observation in the relation between the droplet height and the fringe number and the relation between the contact angle and the fringe radius. This study is remarkable as the droplet's dual profile cannot be easily observed with the existing techniques. However, the RIF technique can effectively verify the existence of a dual profile of the microdroplets in a simple setup. In this work, the RIF technique is successfully developed as a new optical diagnostic technique to determine the microdroplet features, such as the dual profile, the height, the contact angle, the inflection point, and the precursor film thickness, by simply measuring the RIF patterns on the far-field screen. [ABSTRACT FROM AUTHOR]

Through 'Aneuploidy' I poeticise bioethicist Chris Kaposy's lived experience of prenatal screening as expressed in a personal essay that recounts how he reacted to the positive result of Down Syndrome testing for his unborn son. The poem aims to capture the shock of the unexpected diagnosis through the morbidities that are evoked and associated with the condition. It also offers a poeticised exposé of 'neoliberal perfectionism' a term Kaposy uses to critique the technologisation of reproduction that can encourage a norm of ableist perfectionism. A prominent motive, he argues, for seeking to terminate foetuses with Down Syndrome is the belief that children born with the condition are limited market actors with diminished economic opportunities. Similarly, the poet asks readers to reconsider the neoliberal, societal dictates that lead to the stigmatisation of people with disabilities and the empathic potential of poetry and its ability to delineate complex, reprogenetic consumption scenarios. [ABSTRACT FROM AUTHOR]

3D printing techniques allow for the precise placement of living cells, biological substances, and biochemical components, establishing themselves as a promising approach in bioengineering. Recently, 3D printing has been applied to develop human-relevant in vitro cancer models with highly controlled complexity and as a potential method for drug screening and disease modeling. Compared to 2D culture, 3D-printed in vitro cancer models more closely replicate the in vivo microenvironment. Additionally, they offer a reduction in the complexity and ethical issues associated with using in vivo animal models. This focused review discusses the relevance of 3D printing technologies and the applied cells and materials used in cutting-edge in vitro cancer models and microfluidic device systems. Future prospective solutions were discussed to establish 3D-printed in vitro models as reliable tools for drug screening and understanding cancer disease mechanisms. [ABSTRACT FROM AUTHOR]

Context: A healthy, 22-year-old, male NCAA Division I baseball shortstop was experiencing confusion, chest pain, and tightness during an off-season intersquad scrimmage. The patient did not have any significant medical history or mechanism of head injury. After initial evaluation from the athletic trainer, the patient's cognitive status began to quickly decline. The emergency action plan was put in place rapidly and referred the patient to the local emergency clinic. Case Presentation: Upon arrival at the emergency department, an electrocardiogram was performed to rule out myocardial infarction or stroke. The first electrocardiogram results returned negative for any cardiac pathology, but a stroke alert was called. The patient was then transported to a level II trauma center due to continual cognitive decline. The patient was diagnosed with transient ischemic attack (TIA) secondary to an undiagnosed patent foramen ovale (PFO) that would later be diagnosed with further evaluation 2 months after the initial TIA incident. After multiple diagnostic and laboratory tests, the PFO went undetected until a 2D echocardiogram was performed and evaluated by a cardiologist. Management and Outcomes: After the confirmation of the congenital defect, surgical intervention was performed to correct the PFO using catheterization. Despite multiple preparticipation examinations, electrocardiograms, and examination of past family history, the PFO went undetected until the patient experienced symptoms of TIA. The discovery of PFO in this 22-year-old athletic individual is unusual because traditional screening techniques (electrocardiogram and preparticipation examinations) failed to detect the congenital defect. Conclusions: Due to the emergent and timely actions of the athletic trainer, the patient has made a full recovery and is able to compete fully in athletic events. This case study amplifies the need for athletic trainers at all sporting events, updated and reviewed emergency action plans, rapid recognition of TIA in athletic individuals, and return-to-play protocol for an athletic individual after TIA. [ABSTRACT FROM AUTHOR]

This randomized controlled trial (NCT03475316) examined the relative efficacy of 6 months of social ballroom dancing and treadmill walking on a composite executive function score, generated from digit symbol substitution test, flanker interference, and walking while talking tasks. Brain activation during functional magnetic resonance imaging (fMRI) versions of these executive function tasks were secondary outcomes. Twenty-five dementia-at-risk older adults (memory impairment screen score of ≥3 to ≤6 and/or an Alzheimer's disease-8 Dementia Screening Interview of ≥1) were randomized in June 2019 to March 2020—16 completed the intervention before study termination due to the COVID-19 (eight in each group). Composite executive function scores improved post-intervention in both groups, but there was no evidence for between-group differences. Social dancing, however, generated greater improvements on digit symbol substitution test than treadmill walking. No intervention-related differences were observed in brain activation—although less hippocampal atrophy (tertiary) was observed following social dancing than treadmill walking. These preliminary findings are promising but need to be confirmed in future large-scale and sufficiently powered randomized controlled trials. [ABSTRACT FROM AUTHOR]

One of the most severe cancers worldwide is Colorectal Cancer (CRC), which has the third-highest incidence of cancer cases and the second-highest rate of cancer mortality. Early diagnosis and treatment are receiving much attention globally due to the increasing incidence and death rates. Colonoscopy is acknowledged as the gold standard for screening CRC. Despite early screening, doctors miss approximately 25% of polyps during a colonoscopy examination because the diagnosis varies from expert to expert. After a few years, this missing polyp may develop into cancer. This study is focused on addressing such diagnostic challenges, aiming to minimize the risk of misdiagnosis and enhance the overall accuracy of diagnostic procedures. Thus, we propose an efficient deep learning method, DeepCPD, combining transformer architecture and Linear Multihead Self-Attention (LMSA) mechanism with data augmentation to classify colonoscopy images into two categories: polyp versus non-polyp and hyperplastic versus adenoma based on the dataset. The experiments are conducted on four benchmark datasets: PolypsSet, CP-CHILD-A, CP-CHILD-B, and Kvasir V2. The proposed model demonstrated superior performance compared to the existing state-of-the-art methods with an accuracy above 98.05%, precision above 97.71%, and recall above 98.10%. Notably, the model exhibited a training time improvement of over 1.2x across all datasets. The strong performance of the recall metric shows the ability of DeepCPD to detect polyps by minimizing the false negative rate. These results indicate that this model can be used effectively to create a diagnostic tool with computer assistance that can be highly helpful to clinicians during the diagnosing process. [ABSTRACT FROM AUTHOR]

The primary goal of the present research work is to build machine learning based classification model for classifying an individual with different degrees of autism that can yield better performance than traditional autism assessment scale used in India. The study aimed to find how significant are the selected additional 6 attributes for better identification and understanding of Autism spectrum disorder (ASD). This work focuses on a unique screening tool developed for the Indian population –Indian Scale for assessment of Autism(ISAA) to build the classification model. For better performance few additional significant features are also considered following proper procedure. Selective machine learning models are built and finally performance evaluation is done on all classifier results. As an alternative approach, a binary classifier multi-layer perceptron (MLP) model has also been trained on both the data sets to distinguish between people with autism who need less attention and those who need more attention for assessment and further intervention. Overall performance of 3 best classifiers (KNN, Random Forest, SVM) suggests that after considering additional 6 attributes SVM produced better efficacy in identification of degree of autism over conventional ISAA parameters with higher weighted F1 score of 85.7% and accuracy of 90% respectively. It is also reconfirmed with the results of the MLP model. The basic model converges after 71 epochs with training accuracy 97.78% wherein the extended model converges after 61 epochs with training accuracy 98.89%. The best model functions better than conventional scale of assessment which also made the screening task unbiased, accurate and time efficient. [ABSTRACT FROM AUTHOR]

Spirometry is one of the important non-invasive, sensitive, easy-to-perform, reproducible, and objective biomedical screening and diagnostic procedures in healthcare for the assessment of lung function. To date, there is no unified system, equation, or framework for the prediction of spirometry parameters for the Indian population. In this research article, a machine-learning-based system has been proposed and evaluated, and a web application developed for the prediction of Spirometry Parameters of the Adult Indian Population. The four most commonly used supervised machine-learning algorithms (Linear Regression, Gradient Boosting Regression, Deep Neural Multi-Layer Perceptron (MLP) Regression, and Support Vector Regression) for regression tasks have been evaluated for this purpose. Based on Mean absolute error, root mean squared error and adjusted R2 value, it has emerged that Gradient Boosting and Deep Neural MLP are the best-fit models to predict Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1) respectively for the Indian population. A web application has been designed using the Flask web framework to predict the FVC, FEV1, and corresponding Lower Limit Normality. This research work paves the foundation for ML-assisted spirometry for lung function assessment of the Indian population to extend the benefits of state-of-the-art technology in healthcare. [ABSTRACT FROM AUTHOR]

Biomarkers screening is a benefit approach for early diagnosis of major diseases. In this study, magnetic nanoparticles (MNPs) have been utilized as labels to establish a multi-line immunochromatography (MNP-MLIC) for simultaneous detection of carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA 19–9), and alpha-fetoprotein (AFP) in a single serum sample. Under the optimal parameters, the three biomarkers can be rapidly and simultaneously qualitative screening within 15 min by naked eye. As for quantitative detection, the MNP-MLIC test strips were precisely positioned and captured by a smartphone, and signals on the test and control lines were extracted by ImageJ software. The signal ratio of test and control lines has been calculated and used to plot quantitative standard curves with the logarithmic concentration, of which the correlation coefficients are more than 0.99, and the limit of detection for CEA, CA 19–9, and AFP were 0.60 ng/mL, 1.21 U/mL, and 0.93 ng/mL, respectively. The recoveries of blank serum were 75.0 ~ 112.5% with the relative standard deviation ranging from 2.5 to 15.3%, and the specificity investigation demonstrated that the MNP-MLIC is highly specific to the three biomarkers. In conclusion, the developed MNP-MLIC offers a rapid, simple, accurate, and highly specific method for simultaneously detecting multiple biomarkers in serum samples, which provides an efficient and accurate approach for the early diagnosis of diseases. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) screening is underused, particularly among low‐income and minoritized populations, for whom the coronavirus disease 2019 (COVID‐19) pandemic has challenged progress in achieving equity. Methods: A hub‐and‐spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster‐randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient‐level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text‐based reminders. Year 1 intervention impact, which took place during the COVID‐19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant. Results: Among 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1–16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2–18.0 ppts] for females; 8.8 ppts [95% CI, 4.7–13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0–20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6–22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8–16.8 ppts] for non‐Hispanic White individuals; 6.1 ppts [95% CI, 0.8–10.4 ppts] for Black individuals). Conclusions: A regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low‐income populations. The results of this pragmatic randomized controlled trial conducted in three community health center systems show that among 26,736 randomized patients, a regional mailed fecal immunochemical test intervention conducted during the coronavirus disease 2019 pandemic was effective for increasing colorectal cancer screening. Effectiveness was shown across multiple demographic groups, including Hispanic/Latino and Asian populations, as well as Spanish‐speaking individuals. [ABSTRACT FROM AUTHOR]

Perinatal depression is a global public health problem that seriously affects the health of perinatal women. This study evaluated the pooled uptake rate of interventions among women who screened positive for perinatal depression to provide a basis for clinical intervention. We systematically searched four databases (PubMed, Embase, Cochrane Library and Web of Science) from the establishment of the database to May 1, 2023. All included studies were used to derive the pooled uptake rate. We also performed meta-regression and subgroup analysis to explore the potential sources of heterogeneity using STATA 17.0. Of 15024 retrieved articles, only 41 met the inclusion criteria. The overall uptake rate was 55 % (95 % CI 43–67 %). Meta-regression and subgroup analyses both showed that the uptake rate in high-income countries 57 % (95 % CI 50–65 %) was higher than that in low and middle-income countries 37 % (95 % CI 18–56 %). First, only English publications were included. Therefore, articles in other languages were likely missed. Second, of the 41 studies included, there were only six randomized controlled trials, with limited quality of evidence. Third, we could not adequately explain the source of heterogeneity because there were too many mediating variables, although further subgroup and sensitivity analysis were performed. About a half of women did not receive interventions after screening positive, and the uptake rate of interventions in high-income countries was higher than that in low and middle-income countries. • About a half of women did not receive interventions after screening positive. • The uptake rate of interventions in high-income countries was higher. • The longer the intervention frequency and cycle, the higher the sample size dropout rate. • The uptake rate of online interventions was higher. [ABSTRACT FROM AUTHOR]

Objective To perform a systematic review of screening tools and interventions focused on reducing adverse health outcomes associated with intimate partner violence (IPV) at abortion-related visits. Study Design Studies were eligible if they included individuals seeking pregnancy options health care services in the United States, screening for or implementation of an intervention for IPV, and were published in English after the year 2000. The primary outcomes were to summarize screening tools, interventions studied, and if interventions led to individuals being connected to IPV-related resources. Secondary outcomes included patient responses to the IPV-related interventions and any other outcomes reported by the studies (PROSPERO #42021252199). Results Among 4,205 abstracts identified, nine studies met inclusion criteria. The majority (n = 6) employed the ARCHES (Addressing Reproductive Coercion in Health Settings) tool for identification of IPV. Interventions included provider-facilitated discussions of IPV, a safety card with information about IPV and community-based resources, and referral pathways to directly connect patients with support services. For the primary outcome, IPV-related interventions were shown to better inform patients of available IPV-related resources as compared to no intervention at all. For the secondary outcomes, screening and intervening on IPV were associated with improvements in patient perception of provider empathy (i.e., caring about safety) and safer responses by patients to unhealthy relationships. Conclusion Screening for and intervening on IPV at abortion-related visits are associated with positive outcomes for patient safety and the patient–provider relationship. However, data on effective tools for identifying and supporting these patients are extremely limited. This review emphasizes the unmet need for implementation and evaluation of IPV-specific interventions during abortion-related clinical encounters. Key Points The abortion visit offers a crucial setting to address IPV among a highly affected population. This study reviews others that analyzed interventions and associated outcomes for IPV at abortion-related visits. Appropriate interventions for IPV can improve patient-provider relationships and connect patients to essential resources. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To explore the effectiveness of HPV 16/18 E7 oncoprotein in detecting high‐grade cervical intraepithelial neoplasia (CIN) and predicting disease outcomes in HPV 16/18‐positive patients.The present study was a cross‐sectional study with a 2‐year follow up. We collected 915 cervical exfoliated cell samples from patients who tested positive for HPV 16/18 in gynecologic clinics of three tertiary hospitals in Beijing from March 2021 to October 2022 for HPV 16/18 E7 oncoprotein testing. Subsequently, 2‐year follow up of 408 patients with baseline histologic CIN1 or below were used to investigate the predictive role of HPV 16/18 E7 oncoprotein in determining HPV persistent infection and disease progression.The positivity rate of the HPV 16/18 E7 oncoprotein assay was 42.06% (249/592) in the inflammation/CIN 1 group and 85.45% (277/324) in the CIN2+ group. For CIN2+ detection, using the HPV 16/18 E7 oncoprotein assay combined with HPV 16/18 testing, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.45%, 57.94%, 52.57%, and 87.95%, respectively. During the 2‐year follow up, the sensitivity, specificity, PPV, and NPV for predicting persistent HPV infection were 48.44%, 58.21%, 34.64%, and 71.18% in the baseline inflammation and CIN1 group.As a triage method for high‐grade CIN screening in HPV 16/18‐positive patients, HPV 16/18 E7 oncoprotein demonstrated a relatively high NPV, making it suitable for clinical use in triaging HPV 16/18‐positive cases and potentially reducing the colposcopic referral rate. HPV 16/18 E7 oncoprotein exhibited a preferably predictive value in determining HPV infection outcomes and disease progression. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the second most commonly diagnosed cancer worldwide, with a high mortality rate in developing countries, including sub-Saharan Africa. Screening is one way to ensure early detection and management of breast cancer, and it is influenced by several factors. Education and socio-economic status may also affect the utilization of breast cancer screening services as these impact decision-making. This study aimed to investigate women's empowerment and its influence on the uptake of breast cancer screening among women in Tanzania. Methods: This study utilized the 2022 Tanzania Demographic and Health Survey data, and included 4216 women aged 20 to 49 years. Women empowerment variables used include social independence, decision-making, ownership of assets, and attitude towards violence. Statistical Package for Social Sciences version 26 was used for data cleaning and analysis. Descriptive statistics and bivariate analysis were done, including a multivariate logistic regression to assess the level of association between independent variables with breast cancer screening. Results: Findings indicate that the prevalence of breast cancer screening is 5.2%. Age, education level, literacy, ownership of assets, attitude towards violence, and decision making are associated with ever going for breast cancer screening. Women aged 45 to 49 years (AOR = 6.28, 95% CI = 6.27–6.28), those with secondary or higher education (AOR 1.1, 95% CI = 1.05–1.06), literate women (AOR = 1.13, 95% CI = 1.13–1.13), those who own a house (AOR = 3.08, 95% CI = 3.08–3.09), who jointly decide on their healthcare with partners on healthcare (AOR = 1.18, 95% CI = 1.18–1.19) had significantly higher odds of going for breast cancer screening. Conclusion: Women's empowerment is significantly associated with the likelihood of engaging in breast cancer screening. Empowered women are more likely to undergo screening. Focus should be on empowering women through education, businesses, and community involvement. Country-specific interventions and breast cancer screening awareness campaigns should include empowerment initiatives to promote screening uptake. [ABSTRACT FROM AUTHOR]

Background: Risk-stratified approaches to breast screening show promise for increasing benefits and reducing harms. But the successful implementation of such an approach will rely on public acceptability. To date, research suggests that while increased screening for women at high risk will be acceptable, any de-intensification of screening for low-risk groups may be met with less enthusiasm. We report findings from a population-based survey of women in England, approaching the age of eligibility for breast screening, to compare the acceptability of current age-based screening with two hypothetical risk-adapted approaches for women at low risk of breast cancer. Methods: An online survey of 1,579 women aged 40–49 with no personal experience of breast cancer or mammography. Participants were recruited via a market research panel, using target quotas for educational attainment and ethnic group, and were randomised to view information about (1) standard NHS age-based screening; (2) a later screening start age for low-risk women; or (3) a longer screening interval for low-risk women. Primary outcomes were cognitive, emotional, and global acceptability. ANOVAs and multiple regression were used to compare acceptability between groups and explore demographic and psychosocial factors associated with acceptability. Results: All three screening approaches were judged to be acceptable on the single-item measure of global acceptability (mean score > 3 on a 5-point scale). Scores for all three measures of acceptability were significantly lower for the risk-adapted scenarios than for age-based screening. There were no differences between the two risk-adapted scenarios. In multivariable analysis, higher breast cancer knowledge was positively associated with cognitive and emotional acceptability of screening approach. Willingness to undergo personal risk assessment was not associated with experimental group. Conclusion: We found no difference in the acceptability of later start age vs. longer screening intervals for women at low risk of breast cancer in a large sample of women who were screening naïve. Although acceptability of both risk-adapted scenarios was lower than for standard age-based screening, overall acceptability was reasonable. The positive associations between knowledge and both cognitive and emotional acceptability suggests clear and reassuring communication about the rationale for de-intensified screening may enhance acceptability. [ABSTRACT FROM AUTHOR]

COPD is the second leading cause of death in India. The guidelines for early detection of COPD were released by the Government of India in 2019. However, due to the COVID-19 pandemic, its implementation could not be optimal. Diagnosis of COPD is based on the presence of respiratory symptoms, the presence of exposure to risk factors, and the presence of poorly reversible airflow obstruction as assessed using a spirometer. Spirometers are currently available only at a few district hospitals. The existing guidelines expect the patient to visit the Rural hospital/ Community Health Centre, which does not have a spirometer or a pulmonary medicine specialist. Also, it is not feasible or accessible for patients to visit the district hospital to get diagnosed. The current study will be implemented to determine the prevalence, annual incidence of COPD and asthma, quality of life, and nutritional status of COPD and asthma patients. The novelty of this implementation research, which will be conducted in collaboration with Zilla Parishad (i.e., Government), Pune district, is the empowerment of an Accredited Social Health Activist (ASHA), a peripheral health worker to screen all individuals using a peak flow meter and confirmation of the diagnosis at health and wellness center (HWC). An accredited Social Health Activist (ASHA) will take relevant history to suspect COPD and asthma in 30+-year-old adults, and she will refer the suspected cases to the Community Health Officer (CHO) at the Health and Wellness Center. The CHO/ Medical officer of PHC will initiate the appropriate treatment after confirming the diagnosis using a portable spirometer. The difficult-to-diagnose patients with comorbidity and acute exacerbations will be referred to the nearest higher center, i.e., Primary Health Centre (PHC) or Community Health Centre (CHC), where a primary care physician is available. The ASHA workers will provide two follow-ups to these patients in a year, depending on the severity, to ensure compliance with the treatment. Thus, early diagnosis and appropriate treatment of COPD and asthma at the community level may help to reduce the episodes of acute exacerbations. [ABSTRACT FROM AUTHOR]

Background: Lynch syndrome represents the most common hereditary cause of both colorectal and endometrial cancer. It is caused by defects in mismatch repair genes, as well as EPCAM. Universal screening of colon tumors for Lynch syndrome via microsatellite instability (MSI) and/or immunohistochemistry (IHC) can identify patients and families at risk to develop further cancers and potentially impact surveillance and treatment options. The approach to implementation of universal screening, taking ethical considerations into account, is critical to its effectiveness, with patient perspectives providing valuable insight. Methods: Patients whose colon tumors underwent universal screening at Penn State Hershey Medical Center over a period of 2.5 years were mailed a survey on universal screening in 2017. Along with the survey, they received a recruitment letter and a summary explanation of research. The survey included both multiple choice and free-response questions that covered topics including respondent knowledge of Lynch syndrome, attitudes toward universal screening and experiences with the screening protocol as implemented. Results: Sixty-six of 297 possible patients (22.2%) responded to the survey, including 13 whose screening results raised concern for Lynch syndrome. 75.8% of respondents supported universal tumor screening without informed consent. 92.4% preferred receiving screening results regardless of outcome. Respondents described benefits to screening for themselves and their families. Conclusions: While broadly supporting universal tumor screening without informed consent, respondents also wanted more information shared about the screening policy, as well as their results. These patient preferences should be one of many factors considered when implementing universal screening and can also inform practices regarding both tumor profiling and universal genetic testing, which is becoming more prevalent. [ABSTRACT FROM AUTHOR]

Background: Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are "intenders"; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. Methods: Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit ("completers") were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. Results: Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. Conclusions: These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening. [ABSTRACT FROM AUTHOR]

The development of new statistical models for the meta‐analysis of diagnostic test accuracy studies is still an ongoing field of research, especially with respect to summary receiver operating characteristic (ROC) curves. In the recently published updated version of the “Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy”, the authors point to the challenges of this kind of meta‐analysis and propose two approaches. However, both of them come with some disadvantages, such as the nonstraightforward choice of priors in Bayesian models or the requirement of a two‐step approach where parameters are estimated for the individual studies, followed by summarizing the results. As an alternative, we propose a novel model by applying methods from time‐to‐event analysis. To this task we use the discrete proportional hazard approach to treat the different diagnostic thresholds, that provide means to estimate sensitivity and specificity and are reported by the single studies, as categorical variables in a generalized linear mixed model, using both the logit‐ and the asymmetric cloglog‐link. This leads to a model specification with threshold‐specific discrete hazards, avoiding a linear dependency between thresholds, discrete hazard, and sensitivity/specificity and thus increasing model flexibility. We compare the resulting models to approaches from the literature in a simulation study. While the estimated area under the summary ROC curve is estimated comparably well in most approaches, the results depict substantial differences in the estimated sensitivities and specificities. We also show the practical applicability of the models to data from a meta‐analysis for the screening of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a globally prevalent cardiac arrhythmia with significant genetic underpinnings, as highlighted by recent large-scale genetic studies. A prominent clinical and genetic overlap exists between AF, heritable ventricular cardiomyopathies, and arrhythmia syndromes, underlining the potential of AF as an early indicator of severe ventricular disease in younger individuals. Indeed, several recent studies have demonstrated meaningful yields of rare pathogenic variants among early-onset AF patients (∼4%–11%), most notably for cardiomyopathy genes in which rare variants are considered clinically actionable. Genetic testing thus presents a promising opportunity to identify monogenetic defects linked to AF and inherited cardiac conditions, such as cardiomyopathy, and may contribute to prognosis and management in early-onset AF patients. A first step towards recognizing this monogenic contribution was taken with the Class IIb recommendation for genetic testing in AF patients aged 45 years or younger by the 2023 American College of Cardiology/American Heart Association guidelines for AF. By identifying pathogenic genetic variants known to underlie inherited cardiomyopathies and arrhythmia syndromes, a personalized care pathway can be developed, encompassing more tailored screening, cascade testing, and potentially genotype-informed prognosis and preventive measures. However, this can only be ensured by frameworks that are developed and supported by all stakeholders. Ambiguity in test results such as variants of uncertain significance remain a major challenge and as many as ∼60% of people with early-onset AF might carry such variants. Patient education (including pretest counselling), training of genetic teams, selection of high-confidence genes, and careful reporting are strategies to mitigate this. Further challenges to implementation include financial barriers, insurability issues, workforce limitations, and the need for standardized definitions in a fast-moving field. Moreover, the prevailing genetic evidence largely rests on European descent populations, underscoring the need for diverse research cohorts and international collaboration. Embracing these challenges and the potential of genetic testing may improve AF care. However, further research—mechanistic, translational, and clinical—is urgently needed. [ABSTRACT FROM AUTHOR]

Introduction: Beyond our population growing older and living longer, there is an increased risk of developing a cognitive disorder. Standardized screening during a routine visit in primary care may be ideal for early detection of mild cognitive impairment (MCI) and follow-up for cognitive changes. Aim: This quality improvement (QI) project aimed to determine the impact of implementing the Mini-Cog© quick screening for early dementia detection to identify and follow up on the cognitive impairment of older adults in a primary care clinic setting. Methods: Implementation started in February 2024 in a primary care clinic in Southern California. Data was collected for this project over a total of 16 weeks. This QI project implemented a routine cognitive screening using the Mini-Cog©. Cognitive impairment was identified, and if indicated by the Mini-Cog© scores, follow-up for a cognitive assessment and care plan services were initiated. Data were obtained from the project site's electronic medical record on a total sample size of 471 participants (n = 382 in the pre-implementation group and n = 89 in the post-implementation group). Results: Pearson's chi-square test indicated a statistically significant improvement in the identification rate of cognitive impairment, increasing from 11.8% (n = 45 out of 382) at pre-implementation to 34.8% (n = 31 out of 89) at post-implementation, and specifically, mild cognitive impairment increased from zero identified in pre-implementation to 12.4% (n = 11 out of 89) post-implementation. Lastly, follow-up rates improved from 91.1% (n = 41 out of 45) to 100% (n = 31 out of 31) in post-implementation, and clinical significance was evident based on the phi-coefficient (φ = 0.196), indicating a small effect size and a 100% follow-up rate. Conclusions: The findings of this project suggest older adults should receive cognitive screenings to help identify early cognitive impairment and increase follow-up for further evaluation, treatment, and advanced care planning. [ABSTRACT FROM AUTHOR]

Objective: Fatal overdoses are the third leading cause of death in the pediatric population. Substance use disorders (SUD) screening is not routinely done in primary care practices. Early screening and intervention for adolescent SUD could mitigate future harm. Methods: We conducted a 3-month pilot adapting universal screening using the CRAFFT tool in patients aged 12 to 17 presenting to an urban and a rural primary care practice during well-child and acute/sick-child visits. We collaborated with our pediatric addiction service to ensure access availability for further assessment and treatment for all positively screened patients; this was broadly communicated to primary care providers. Results: There was a higher CRAFFT completion rate in the urban site (90%, vs 52.6% in our rural site). The majority of CRAFFT questionnaires were completed during acute/sick-child visits in both study sites. Moreover, we found a higher positive screen rate in our rural practice (14.6%, vs 2.4% in our urban practice). Only 27% of positively screened patients had substance use addressed by their providers. No pediatric addiction referrals were made. Conclusions: Findings suggest provider-level barriers exist despite having adequate specialty referral sources and institutional encouragement. Future work is needed to explore these barriers. [ABSTRACT FROM AUTHOR]

Background: More efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff. Methods: We screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O'clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women's experiences after screening, and the experience of the nurses who operated the SCME. Results: Between November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME's usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME. Conclusion: Our findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images. [ABSTRACT FROM AUTHOR]

Background: Pediatric palliative care (PPC) patients are at an elevated risk of malnutrition. Nutritional inadequacy can also cause micronutrient deficiencies. These factors can lead to weight loss, stunted growth, and poor quality of life. Despite the prevalence of these issues, limited research exists in the micronutrient status of PPC patients. The purpose of this study was to determine the vitamin B12 and D, iron, ferritin, folate, calcium, phosphorus, and magnesium levels of PPC patients to contribute to a better understanding of their micronutrient needs as well as the appropriate management of diet and treatment approaches. Methods: This was a single-center observational cross-sectional retrospective study. This study evaluated the levels of vitamin B12, 25-hydroxyvitamin D, iron, ferritin, folate, calcium, phosphorus, and magnesium in PPC patients. The patients were classified according to the Chronic Complex Conditions (CCC) v2 and then compared. Results: A total of 3,144 micronutrient data points were collected from 822 hospitalizations of 364 patients. At least one micronutrient deficiency was identified in 96.9% of the patients. The most prevalent deficiencies were observed for iron, calcium, and phosphate. In addition, 25-hydroxyvitamin D deficiency was observed in one-third of patients. Calcium, magnesium, phosphorus, folate, and 25-hydroxyvitamin D were negatively correlated with age. Conclusion: The results of this study indicate that micronutrient deficiencies are highly prevalent in PPC patients. These findings have the potential to contribute to improvements in the nutritional and therapeutic management of patients. [ABSTRACT FROM AUTHOR]

Background: Most Chinese blood centers have implemented mini pool (MP) HBV nucleic acid testing (NAT) together with HBsAg ELISA in routine blood donor screening for HBV infection since 2015, and a few centers upgraded MP to individual donation (ID) NAT screening recently, raising urgent need for cost-benefit analysis of different screening strategies. In an effort to prevent transfusion-transmitted infections (TTIs) for HBV, cost-benefit analyses of three different screening strategies: HBsAg alone, HBsAg plus MP NAT and HBsAg plus ID NAT were performed in blood donors from southern China where HBV infection was endemic. Methods: MP-6 HBV NAT and ID NAT were adopted in parallel to screen blood donors for further comparative analysis. On the basis of screening data and the documented parameters, the number of window period (WP) infection, HBV acute infection, chronic hepatitis B infection (CHB) and occult hepatitis B infection (OBI) was evaluated, and the potential prevented HBV TTIs and benefits of these three strategies were predicted based on cost-benefit analysis by an estimation model. Results: Of 132,323 donations, the yield rate for HBsAg-/DNA + screened by ID NAT (0.12%) was significantly higher than that by MP NAT (0.058%, P < 0.05). Furthermore, the predicted transfusion-transmitted HBV cases prevented was 1.25 times more by ID NAT compared to MP-6 NAT. The cost-benefit ratio of the universal HBsAg screening, HBsAg plus ID NAT and HBsAg plus MP NAT were 1:58, 1:27 and 1:22, respectively. Conclusions: Universal HBsAg ELISA screening in combination with HBV ID NAT or MP-6 NAT strategies was highly cost effective in China. To further improve blood safety, HBsAg plus HBV DNA ID NAT screening should be considered in HBV endemic regions/countries. [ABSTRACT FROM AUTHOR]

Background: Severe trauma is the leading cause of disability and mortality in the patients under 35 years of age. Surgical site infections (SSI) represent a significant complication in this patient population. However, they are often inadequately investigated, potentially impacting the quality of patient outcomes. The aim of this study was to investigate the epidemiology of SSI and risk factors in severe trauma patients. Methods: We conducted a multicenter retrospective cohort study screening the severe trauma patients (STP) admitted to two intensive care units of an academic institution in Marseille between years2018 and 2019. Those who underwent orthopedic or spinal surgery within 5 days after admission were included and classified into two groups according to the occurrence of SSI (defined by the Centers for Disease Control (CDC) international diagnostic criteria) or not. Our secondary goal was to evaluate STP survival at 48 months, risk factors for SSI and microbiological features of SSI. Results: Forty-seven (23%) out of 207 STP developed an SSI. Mortality at 48-months did not differ between SSI and non-SSI patients (12.7% vs. 10.0%; p = 0.59). The fractures of 22 (47%) severe trauma patients with SSI were classified as Cauchoix 3 grade and 18 (38%) SSI were associated with the need for external fixators. Thirty (64%) severe trauma patients with SSI had polymicrobial infection, including 34 (72%) due to Gram-positive cocci. Empirical antibiotic therapy was effective in 31 (66%) cases. Multivariate analysis revealed that risk factors such as low hemoglobin, arterial oxygenation levels, hyperlactatemia, high serum creatinine and glycemia, and Cauchoix 3 grade on the day of surgery were associated with SSI in severe trauma patients. The generated predictive model showed a good prognosis performance with an AUC of 0.80 [0.73–0.88] and a high NPV of 95.9 [88.6–98.5] %. Conclusions: Our study found a high rate of SSI in severe trauma patients, although SSI was not associated with 48-month mortality. Several modifiable risk factors for SSI may be effectively managed through enhanced perioperative monitoring and the implementation of a patient blood management strategy. [ABSTRACT FROM AUTHOR]

Objective: There are very few reports on the prevalence of diabetic retinopathy (DR) in children and youth with type-1 diabetes (T1D). Studies have also found very low rates of referral for DR screening in children and youth with T1D. We conducted this study to determine the prevalence of DR, to study the reliability of ISPAD screening recommendations and to identify predictors of DR, its progression and regression in Indian children and youth with T1D. Methods: This study included 882 children and youth with T1D. Demographic data, anthropometry, blood pressure, sexual maturity rating, ophthalmological examination (slit lamp for cataract) and biochemical measurements were performed using standard protocols. Fundus images were captured using the Forus Health 3netra classic digital non-mydriatic fundus camera by the same experienced operator. De-identified images were assessed by a senior grader and ophthalmologist (Belfast Ophthalmic Reading Center). Severity of DR was graded as per the UK National Health Service (NHS) DR classification scale. Result: We report 6.4% and 0.2% prevalence of DR and cataract in Indian children and youth with T1D, respectively. All the subjects with DR had early non-proliferative DR. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Presence of hypertension and older age were significant predictors of DR (P <.05). Subjects with DR had significantly higher triglyceride concentrations (P <.05), of these, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR (P <.05). None of the participants included in the study progressed to develop sight-threatening DR. Conclusion: DR is not uncommon in Indian children and youth with T1D, thus screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D. Plain Language Summary: Diabetic retinopathy in Indian children with Type 1 Diabetes We found that 6.4% and 0.2% Indian children and youth with type-1 diabetes had diabetic retinopathy and cataract respectively. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Thus, International Society for Paediatric and Adolescent Diabetes (ISPAD) screening criteria must be implemented by all centres to avoid missing cases. Presence of high blood pressure, high triglyceride levels and older age were significant predictors of DR. Of the subjects with DR, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR. None of the participants included in the study progressed to develop sight-threatening DR. DR is not uncommon in Indian children and youth with T1D, hence, screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D. [ABSTRACT FROM AUTHOR]

Background: Mother's milk provides optimal nutrition for infants. Donor human milk (DHM) is recommended for low birthweight infants when mother's milk is unavailable. Little is known about human milk (HM) donation practices in New Zealand (NZ), where few HM banks are available. This study aimed to investigate parents' and health professionals' (HP) experiences with formal and informal HM donation in NZ. Methods: Two electronic surveys were disseminated in 2022 to parents and HPs involved with HM donation in NZ. The surveys covered respondents' views and experiences with HM donation. HPs were also asked about HM donation practices in their workplace. Chi-squared and Fisher-Freeman-Halton exact tests were used for quantitative analysis and qualitative data were thematically analysed using inductive approach. Results: A total of 232 HP and 496 parents completed the surveys. Most parents either donated (52%) or sought DHM (26%) for their infant and most donations were informal, arranged between individuals (52%) or through hospital staff (22%). HP reported DHM was used in 86% of facilities, with only 20% of donations facilitated by HM banks. Almost half (48%) of HP stated they would like to use DHM in their workplace but access was limited. The most common screening processes undertaken by parents and HP before informal HM donation were lifestyle including smoking status, medication, drug and alcohol intake (44% and 36%, respectively) and serological screening such as CMV, HIV, Hepatitis C or B (30% and 39%, respectively). Pasteurisation of DHM obtained informally was not common. Most donors were satisfied with their HM donation experiences (informal and/or formal, 91%) and most respondents supported use of DHM in hospitals and community. Participants reported HM donation could be improved (e.g., better access) and identified potential benefits (e.g., species-specific nutrition) and risks (e.g., pathogens) for the infant. Potential benefits for the donor were also identified (e.g., altruism), but respondents acknowledged potential negative impacts (e.g., cost). Conclusion: Informal HM donation in NZ is common. Most parents and HP support the use of DHM; however, improvements to current practices are needed to ensure safer and more equitable access to DHM. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Lung cancer screening with low‐dose computed tomography (CT) scans (LDCT) has reduced mortality for patients with high‐risk smoking histories, but it has significant limitations: LDCT screening implementation remains low, high rates of false‐positive scans, and current guidelines exclude those without smoking histories. We sought to explore the utility of liquid biopsy (LBx) in early cancer screening and diagnosis of lung cancer.Using the high‐definition single‐cell assay workflow, we analyzed 99 peripheral blood samples from three cohorts: normal donors (NDs) with no known pathology (n = 50), screening CT patients (n = 25) with Lung‐RADS score of 1–2, and biopsy (BX) patients (n = 24) with abnormal CT scans requiring tissue biopsy.For CT and BX patients, demographic information was roughly equivalent; however, average pack‐years smoked differed. A total of 14 (58%) BX patients were diagnosed with primary lung cancer (BX+). The comparison of the rare event enumerations among the cohorts revealed a greater incidence of total events, rare cells, and oncosomes, as well as specific cellular phenotypes in the CT and BX cohorts compared with the ND cohort. LBx analytes were also significantly elevated in the BX compared with the CT samples, but there was no difference between BX+ and BX− samples.The data support the utility of the LBx in distinguishing patients with an alveolar lesion from those without, providing a potential avenue for prescreening before LDCT. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate users' perceptions and preferences on the design features of the COVID-19 prevention promotion icon from the perspective of users' aesthetic and perceptual needs. In this study, 120 officially published icons from 24 countries and regions were collected from online platforms for ranking tests, and then the top-ranked icons were subjectively rated by the semantic differential method. By evaluating the quality of users' perceptions of multiple semantic dimensions of icons, we extracted the perceptual semantic words that users valued as the main icon design features. Spearmen correlations were applied to derive possible correlations between user rankings and semantic scales, and a Friedman test was also conducted to determine the true differences in user perceptions and preferences for different styles of icons. Factor analysis was conducted to extract six perceptual words that influence the design features of the COVID-19 prevention promotion icon. The methodology adopted in this study facilitated the screening of design features related to icon effectiveness, and the findings show that "Interesting," "Simple," "Familiar, "Recognizable," "Concrete," and "Close(semantic distance)" are the key features that influence users' perception and preference of COVID-19 icon design. The results of this study can be used as the basis for designing and improving publicity icons for preventive measures in COVID-19, and the methods adopted in this study can be applied to evaluate other types of icon design. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Solid organ transplantation (SOT) has expanded significantly in Asia over past few decades. Donor‐derived infections (DDIs) remain a significant concern as they may adversely impact transplant outcomes. We aim to review the existing regulatory frameworks, screening protocols, and management practices for DDIs in Asia.We reached out to transplant infectious diseases experts in Asia to provide standardized data on annual SOT numbers, incidence of DDIs, regulatory frameworks, donor and recipient screening protocols, and DDI surveillance measures. We present the data from Singapore, Japan, and Thailand.Donor screening for HIV, hepatitis B, hepatitis C, and syphilis is mandatory in all countries. Additionally, Japan screens for HTLV‐1 antibody due to its endemicity. We also reviewed the protocols for screening and prevention of endemic infections in Asia. Singapore is the only country implementing universal screening for all donors for dengue, Zika, and chikungunya via blood and urine RT‐PCR. Strongyloidiasis screening is not routinely done, although some transplant centers empirically give ivermectin prophylaxis to organ recipients. Tuberculosis screening with a donor questionnaire and chest radiograph is common for deceased donors, and some centers do Interferon Gamma Release Assay test for living donors. We also found a significant gap in the surveillance and reporting of potential DDIs in Asia and the overall incidence of DDIs in Asia is unknown and likely underreported.The experiences of Singapore, Japan, and Thailand offer valuable insights into current practices and the unmet needs regarding a DDI registry and call for coordinated efforts to address this critical issue in the region. [ABSTRACT FROM AUTHOR]

Introduction Mass screening for SARS-CoV-2 using nasopharyngeal swabs (NPS) is costly, uncomfortable for patients, and increases the chance of virus exposure to health care workers. Therefore, this study focused on determining if self-collected unpreserved saliva can be an effective alternative to NPS collection in COVID-19 surveillance. Materials and Methods In this study, patients being tested for SARS-CoV-2 using NPS were asked to provide a saliva sample to compare their results. NPS samples were evaluated for SARS-CoV-2 using BioFire® FilmArray® Torch® or Cepheid® GeneXpert® systems while saliva samples were evaluated using an in-house developed reverse transcriptase polymerase chain reaction (RT-PCR) which targeted the Envelope (E) and Nucleocapsid (N) genes. Results Detection of SARS-CoV-2 using self-collected saliva was found to be only slightly less accurate (<5%) than testing using NPS. In addition, initial saliva RT-PCR identified 27 positive subjects, 18 of which provided amplicons sufficient for confirmatory sequencing. The sequencing data showed a genetic shift in the virus within our population sometime between 22 June and July 8, 2021 from Alpha to Delta variant. Conclusions The saliva sample collection method identifies the E gene in SARS COVID-2 samples which provides an alternative specimen source to the NPS. This identifies the S gene and ORF1ab. Saliva collection is more convenient to the patient, yields comparable results to NPS collection, and potentially increases Covid-19 surveillance. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Method Result and Discussion Conclusion Few psychosis screening instruments have been tested for use in Africa, yet appropriate tools can increase the detection of self‐reported psychotic symptoms, improve the detection of psychosis and impact its prognosis.The construct validity and factor structure of Psychosis Screening Questionnaire (PSQ) were tested with confirmatory factor analysis (CFA) and item response theory (IRT) in a sample of 1928 Ethiopian adults without any history of psychosis. We tested a unidimensional model with and without an item on mania. For IRT, unidimensional latent structure one‐parameter logistic (1PL) and two‐parameter (2PL) logistic models were tested and compared for relative fit using a likelihood‐ratio test.The prevalence of lifetime positive screens was 2.8% in an Ethiopian sample of adults from a general medical setting. A unidimensional model demonstrated good fit for the PSQ, (CFI = 0.993, TLI = 0.986 and RMSEA = 0.025). For IRT, a 2PL model was the best fitting one. IRT tests of item difficulty and discrimination parameters showed that paranoia had the highest discrimination α=4.59$$ \left(\alpha =4.59\right) $$ and lowest difficulty (β=2.53$$ \beta =2.53 $$), likely to be endorsed at low levels of psychotic features. Thought insertion had the highest item difficulty (β=2.98$$ \beta =2.98 $$). Overall, the measure captures the psychosis construct at higher levels of the latent trait and may be suited for detecting moderate to severe levels of psychosis.The PSQ is found to have good construct validity in screening for psychosis among Ethiopian adults. Future studies may focus on the diagnostic validity of the PSQ comparing it with a structured clinical interview. [ABSTRACT FROM AUTHOR]

Background: Post-COVID-19 conditions (PCCs), also known as long COVID, is persistently debilitating disorders that need investigation on their incidence, morbidity, and case-fatality rate. Purpose: The objectives of this cohort study were to determine the incidence, characteristics, case-fatality, morbidity, and recovery of post-COVID-19 symptoms throughout a two-year period of observation. Methods: This was a population-based cohort study of post-COVID-19 cases among 12,925 SARS-CoV-2 positive individuals in eight administrative districts of Bangladesh between July and December 2021–2023. PCC was diagnosed according to WHO clinical diagnostic criteria, and the screening procedure was completed through a household screening process. Results: The incidence of PCC was 3.6%, the case-fatality rate was 1.92%, and the recovery rate was 9.0%. The significant predictors of PCC morbidity were geographical distribution, vaccination, comorbidities, and a longer duration of symptoms or multiple symptoms (p < 0.05). Conclusion: Nearly 465 out of 522 people suffering from PCC are persistent and have a significant disability. However, the rate of recovery was 9.0%. It is necessary to investigate approaches to improve the recovery of PCC in Bangladesh. [ABSTRACT FROM AUTHOR]

Purpose: Emerging research evidence suggests positive relationships between higher screen time and eating disorders. However, few studies have examined the prospective associations between screen use and eating disorder symptoms in early adolescents and how problematic screen use may contribute to symptom development. Methods: We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,246, 2016–2020, ages 9–14). Logistic regression analyses were used to estimate the longitudinal associations between baseline self-reported screen time and eating disorder symptoms in year two. Logistic regression analyses were also used to estimate cross-sectional associations between problematic screen use in year two (either problematic social media or mobile phone use) and eating disorder symptoms in year two. Eating disorder symptoms based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) included fear of weight gain, self-worth tied to weight, engaging in compensatory behaviors, binge eating, and distress with binge eating. Results: Each additional hour of total screen time and social media use was associated with higher odds of fear of weight gain, self-worth tied to weight, compensatory behaviors to prevent weight gain, binge eating, and distress with binge eating two years later (odds ratio [OR] 1.05–1.55). Both problematic social media and mobile phone use were associated with higher odds of all eating disorder symptoms (OR 1.26–1.82). Conclusions: Findings suggest greater total screen time, social media use, and problematic screen use are associated with more eating disorder symptoms in early adolescence. Clinicians should consider assessing for problem screen use and, when high, screen for disordered eating. Level of evidence: Level III: Evidence obtained from well-designed cohort or case–control analytic studies. [ABSTRACT FROM AUTHOR]

Objective: The research aims to develop an advanced and precise lung cancer screening model based on Convolutional Neural Networks (CNN). Methods: Based on the health medical big data platform of Shandong University, we developed a VGG16-Based CNN lung cancer screening model. This model was trained using the Computed Tomography scans data of patients from Pingyi Traditional Chinese Medicine Hospital in Shandong Province, from January to February 2023. Data augmentation techniques, including random resizing, cropping, horizontal flipping, color jitter, random rotation and normalization, were applied to improve model generalization. We used five-fold cross-validation to robustly assess performance. The model was fine-tuned with an SGD optimizer (learning rate 0.001, momentum 0.9, and L2 regularization) and a learning rate scheduler. Dropout layers were added to prevent themodel from relying too heavily on specific neurons, enhancing its ability to generalize. Early stopping was implemented when validation loss did not decrease over 10 epochs. In addition, we evaluated the model's performance with Area Under the Curve (AUC), Classification accuracy, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), Sensitivity, Specificity and F1 score. External validation used an independent dataset from the same hospital, covering January to February 2022. Results: The training and validation loss and accuracy over iterations show that both accuracy metrics peak at over 0.9 by iteration 15, prompting early stopping to prevent overfitting. Based on five-fold cross-validation, the ROC curves for the VGG16-Based CNN model, demonstrate an AUC of 0.963 ± 0.004, highlighting its excellent diagnostic capability. Confusion matrices provide average metrics with a classification accuracy of 0.917 ± 0.004, PPV of 0.868 ± 0.015, NPV of 0.931 ± 0.003, Sensitivity of 0.776 ± 0.01, Specificity of 0.962 ± 0.005 and F1 score of 0.819 ± 0.008, respectively. External validation confirmed the model's robustness across different patient populations and imaging conditions. Conclusion: The VGG16-Based CNN lung screening model constructed in this study can effectively identify lung tumors, demonstrating reliability and effectiveness in real-world medical settings, and providing strong theoretical and empirical support for its use in lung cancer screening. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) readers of mammograms compare favourably to individual radiologists in detecting breast cancer. However, AI readers cannot perform at the level of multi-reader systems used by screening programs in countries such as Australia, Sweden, and the UK. Therefore, implementation demands human-AI collaboration. Here, we use a large, high-quality retrospective mammography dataset from Victoria, Australia to conduct detailed simulations of five potential AI-integrated screening pathways, and examine human-AI interaction effects to explore automation bias. Operating an AI reader as a second reader or as a high confidence filter improves current screening outcomes by 1.9–2.5% in sensitivity and up to 0.6% in specificity, achieving 4.6–10.9% reduction in assessments and 48–80.7% reduction in human reads. Automation bias degrades performance in multi-reader settings but improves it for single-readers. This study provides insight into feasible approaches for AI-integrated screening pathways and prospective studies necessary prior to clinical adoption. Successful human-AI collaboration could greatly contribute to breast cancer mammographic screening. Here, the authors use a large-scale retrospective mammography dataset to simulate and compare five plausible AI-integrated screening pathways, finding optimal ways in which human-AI collaboration could be implemented in real-world settings. [ABSTRACT FROM AUTHOR]

Several barriers exist in Alberta, Canada to providing accurate and accessible diagnoses for patients presenting with acute knee injuries and chronic knee problems. In efforts to improve quality of care for these patients, an evidence-informed clinical decision-making tool was developed. Forty-five expert panelists were purposively chosen to represent stakeholder groups, various expertise, and each of Alberta Health Services' 5 geographical health regions. A systematic rapid review and modified Delphi approach were executed with the intention of developing standardized clinical decision-making processes for acute knee injuries, atraumatic/overuse conditions, knee arthritis, and degenerative meniscus. Standardized criteria for screening, history-taking, physical examination, diagnostic imaging, timelines, and treatment were developed. This tool standardizes and optimizes assessment and diagnosis of acute knee injuries and chronic knee problems in Alberta. This project was a highly collaborative, province-wide effort led by Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). [ABSTRACT FROM AUTHOR]

Background: Our research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered and Equity Data-Driven Implementation (PEDDI) to promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology to evaluate the usability of PEDDI and generate redesign solutions to address usability issues in the context of a cancer screening intervention. Methods: We applied the Cognitive Walkthrough for Implementation Strategies (CWIS), a pragmatic assessment method with steps that include group testing with end users to identify and prioritize usability problems. We conducted three facilitated 60-min CWIS sessions with end users (N = 7) from four CHCs that included scenarios and related tasks for implementing a colorectal cancer (CRC) screening intervention. Participants rated the likelihood of completing each task and identified usability issues and generated ideas for redesign solutions during audio-recorded CWIS sessions. Participants completed a pre-post survey of PEDDI usability. Our research team used consensus coding to synthesize usability problems and redesign solutions from transcribed CWIS sessions. Results: Usability ratings (scale 0–100: higher scores indicating higher usability) of PEDDI averaged 66.3 (SD = 12.4) prior to the CWIS sessions. Scores averaged 77.8 (SD = 9.1) following the three CWIS sessions improving usability ratings from "marginal acceptability" to "acceptable". Ten usability problems were identified across four PEDDI tasks, comprised of 2–3 types of usability problems per task. CWIS participants suggested redesign solutions that included making data fields for social determinants of health and key background variables for identifying health equity targets mandatory in the electronic health record and using asynchronous communication tools to elicit ideas from staff for adaptations. Conclusions: Usability ratings indicated PEDDI was in the acceptable range following CWIS sessions. Staff identified usability problems and redesign solutions that provide direction for future improvements in PEDDI. In addition, this study highlights opportunities to use the CWIS methodology to address inequities in the implementation of cancer screening and other clinical innovations in resource-constrained healthcare settings. [ABSTRACT FROM AUTHOR]

Objectives: The pathophysiology of multiple sclerosis (MS) involves inflammatory neurodegeneration in the brainstem, cerebellum, and retina. The clinical relevance of oculomotor involvement in MS, however, remains uncertain. Methods: In this cross-sectional study, we evaluated heterophoria as a (sub) clinical tool in 54 MS patients and 55 age-matched healthy controls (HCs). We quantified heterophoria in prism diopters for distance and near range with orthoptic examination. Our primary outcome was high degrees of horizontal heterophoria (HDHH) defined as measurements beyond ±2 standard deviations from the mean prism diopter of heterophoria of our HCs. Results: More than one-third (37%, n=20/54) of MS patients but only 11% (n=6/ 55) of HCs were classified as HDHH [distance, MS=9% (n=5/54) versus HC=6% (n=3/55); near, MS=19% (n=10/54) versus HC=5% (n=3/55)]. Our MS patients presented more combined vertical and horizontal deviations at near range [MS 19% (n=10/54) versus for HC 7% (n=4/55)]. We observed the combination of HDHH both at distance and at near testing in 9% (n=5/54) of MS patients but not at all in HCs (n=0/55). Discussion: Despite the high prevalence of heterophoria, HDHH may be an additional (sub)clinical tool of subclinical involvement in MS. Thus, orthoptic examination may be an additional tool to improve MS diagnostic procedures. [ABSTRACT FROM AUTHOR]

Background: Malnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly. Methods: Based on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years. Results: Surveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients. Conclusion: We recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention. [ABSTRACT FROM AUTHOR]

Objective Cystic Fibrosis Foundation guidelines recommend annual diabetes screening by oral glucose tolerance test (OGTT) in pediatric patients with cystic fibrosis (CF) starting at the age of 10 years. Adherence to these guidelines proves to be challenging, and the nationwide screening rates are still considered suboptimal. The aim of this study was to assess and improve the screening rates at our large pediatric center. Methods A 4-year retrospective audit of OGTT completion among pediatric patients with CF of age ≥10 years who are not yet diagnosed with diabetes was conducted. A collaborative working group was formed to identify the barriers to screening and formulate a quality improvement plan, which was monitored and evaluated for a 9-month period. Results Diabetes screening rates determined by OGTT completion at our center showed a gradual decline during the COVID-19 pandemic from 2019 to 2022. Following the implementation of the quality improvement plan during the summer of 2023, there was a marked increase in OGTT ordering compliance by providers as well as test completion by patients. Notably, the fractional OGTT completion rate rose from 45% during the preintervention phase (January-April 2023) to 70% during the postintervention phase (May-September 2023). Conclusion Diabetes screening in pediatric patients with CF can be effectively improved by refining practices related to patient experience, care coordination, and laboratory testing strategies. [ABSTRACT FROM AUTHOR]

Pulmonary nodules are common incidental findings requiring surveillance. Follow‐up recommendations vary depending on risk factors, size and solid or subsolid characteristics. This review aimed to evaluate the prevalence of clinically significant nodules detected on noncancer‐dedicated imaging and the prevalence of part‐solid and ground‐glass nodules. We conducted a systematic search of literature and screened texts for eligibility. Clinically significant nodules were noncalcified nodules >4–6 mm. Prevalence estimates were calculated for all studies and risk of bias was assessed by one reviewer. Twenty‐four studies were included, with a total of 30 887 participants, and 21 studies were cross‐sectional in design. Twenty‐two studies used computed tomography (CT) imaging with cardiac‐related CT being the most frequent. Prevalence of significant nodules was highest in studies with large field of view of the chest and low size thresholds for reporting nodules. The prevalence of part‐solid and ground‐glass nodules was only described in two cardiac‐related CT studies. The overall risk of bias was low in seven studies and moderate in 17 studies. While current literature frequently reports incidental nodules on cardiovascular‐related CT, there is minimal reporting of subsolid characteristics. Unclear quantification of smoking history and heterogeneity of imaging protocol also limits reliable evaluation of nodule prevalence in nonscreening cohorts. [ABSTRACT FROM AUTHOR]

The Australian Scleroderma Interest Group (ASIG) algorithm for screening pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) requires only respiratory function tests and serum N‐terminal pro‐brain natriuretic peptide as first‐tier tests, and is recommended in international guidelines. In this communication, we present the findings of the application of the ASIG screening algorithm to a Singaporean cohort undergoing prospective annual screening for PAH, which shows a high negative predictive value. The ASIG algorithm may offer an alternative to more complex and costly SSc‐PAH screening algorithms. [ABSTRACT FROM AUTHOR]

Purpose: Spontaneous closure of idiopathic full-thickness macular holes (iFTMH) has been reported regularly. However, little is known about its probability and timeline. Methods: In this retrospective study all consecutive patients who presented between August 2008 and August 2019 were screened for the presence of a macular hole and only iFTMHs were included. The primary outcome measure was the spontaneous closure of the iFTMH. Results: Of 1256 eyes with macular holes, 338 fulfilled the inclusion criteria. Spontaneous closure of the iFTMH was detected in 31 eyes (9.2%) with a median time of 44 days after diagnosis. Eyes exhibiting spontaneous closure demonstrated a higher baseline best-corrected visual-acuity (BCVA) and smaller iFTMH diameter (p < 0.0001 and p < 0.0001, respectively). The mean BCVA improved from 0.4 logMAR (SD ± 0.21) to 0.29 logMAR (SD ± 0.20) after spontaneous closure (p = 0.031). The iFTMH diameter was positively correlated with the time to spontaneous closure (Pearson-r = 0.37, p = 0.0377). Spontaneously closed iFTMHs reopened in 16% (n = 5) of cases, with a median of 136 days after closure. A logistic regression model showed the hole diameter was associated with spontaneous closure (odds-Ratio 0.97, 95%CI [0.96, 0.98]). The Kaplan–Meier-Curve revealed that approximately 25% of small-iFTMH (n = 124) and 55% of iFTMH with a diameter < 150µm (n = 48) closed spontaneously within two months. Conclusion: The established gold-standard for the treatment of iFTMHs is macular surgery. However, the potential for spontaneous closure of small iFTMHs must be acknowledged. Therefore, if surgical treatment is delayed in individual cases, close observation is recommended. [ABSTRACT FROM AUTHOR]

Aim: Code-free deep learning (CFDL) allows clinicians without coding expertise to build high-quality artificial intelligence (AI) models without writing code. In this review, we comprehensively review the advantages that CFDL offers over bespoke expert-designed deep learning (DL). As exemplars, we use the following tasks: (1) diabetic retinopathy screening, (2) retinal multi-disease classification, (3) surgical video classification, (4) oculomics and (5) resource management. Methods: We performed a search for studies reporting CFDL applications in ophthalmology in MEDLINE (through PubMed) from inception to June 25, 2023, using the keywords 'autoML' AND 'ophthalmology'. After identifying 5 CFDL studies looking at our target tasks, we performed a subsequent search to find corresponding bespoke DL studies focused on the same tasks. Only English-written articles with full text available were included. Reviews, editorials, protocols and case reports or case series were excluded. We identified ten relevant studies for this review. Results: Overall, studies were optimistic towards CFDL's advantages over bespoke DL in the five ophthalmological tasks. However, much of such discussions were identified to be mono-dimensional and had wide applicability gaps. High-quality assessment of better CFDL applicability over bespoke DL warrants a context-specific, weighted assessment of clinician intent, patient acceptance and cost-effectiveness. We conclude that CFDL and bespoke DL are unique in their own assets and are irreplaceable with each other. Their benefits are differentially valued on a case-to-case basis. Future studies are warranted to perform a multidimensional analysis of both techniques and to improve limitations of suboptimal dataset quality, poor applicability implications and non-regulated study designs. Conclusion: For clinicians without DL expertise and easy access to AI experts, CFDL allows the prototyping of novel clinical AI systems. CFDL models concert with bespoke models, depending on the task at hand. A multidimensional, weighted evaluation of the factors involved in the implementation of those models for a designated task is warranted. [ABSTRACT FROM AUTHOR]

Objective This study aimed to establish a screening model for differentiating anti-synthetase syndrome (ASS) from other ANA-associated rheumatic diseases (AARDs) using a combination of cytoplasmic and non-cytoplasmic ANA (ncANA) patterns. Methods : This retrospective observational study included patients with AARDs such as SLE, SSc, SS, MCTD and PM/DM who underwent ANA screening between April 2012 and December 2021. Variables included age, sex, ANA patterns (Cytoplasmic and ncANA) and titres. Logistic regression analysis of Cytoplasmic and ncANA patterns was performed to differentiate ASS from other AARDs. Result : The 981 diagnosed cases of AARDs consisted of SS (n  = 451), SSc (n  = 264), SLE (n  = 201), PM/DM (n  = 104), MCTD (n  = 52) and ASS, including PM/DM (n  = 64). Of these, 155 patients had ≥2 overlapping diseases; however, there was no overlap between AARDs and ASS. ASS is more likely to occur when the cytoplasmic titre is positive and the ncANA <320. Receiver operating characteristic analysis of the Cytoplasmic and ncANA range revealed an area under the receiver operating characteristic curve of 0.885 (95% CI: 0.844–0.927). Conclusion : It is important to detect cytoplasmic patterns as an ANA screening test for ASS diagnosis, even if the titre is low. Additionally, combining the cytoplasmic and ncANA patterns yields more accurate ASS screening results. [ABSTRACT FROM AUTHOR]

Background Early identification, diagnosis and symptom control of psoriatic arthritis (PsA) in patients with psoriasis remain unmet medical needs. Objectives To compare the impact of disease and other characteristics between patients with psoriasis who screened positive for PsA using the Psoriasis Epidemiology Screening Tool (PEST) (screen-positive group) and patients who (i) have PsA (PsA group) or (ii) screened negative for PsA (screen-negative group). Also, to determine the proportion of patients at a patient-acceptable symptom state (PASS) in the screen-positive and PsA groups. Methods This was a cross-sectional analysis of the CorEvitas Psoriasis Registry. We included a convenience sample of patients with psoriasis from the screen-positive and PsA groups who completed the Psoriatic Arthritis Impact of Disease-12 (PsAID12), and a comparator screen-negative group who did not complete the PsAID12. We report descriptive summaries of demographics, comorbidities, psoriasis characteristics, patient-reported outcome measures and the proportion of patients at PASS (i.e. PsAID12 ≤ 4). Results The screen-positive, PsA and screen-negative groups included 369, 70 and 4724 patients, respectively. The screen-positive and PsA groups had a similar impact of disease, demographics, comorbidities and psoriasis characteristics (d < 0.337). Mean PsAID12 scores were 3.1 (SD 2.3) and 3.7 (SD 2.6) in the screen-positive and PsA groups, respectively. Compared with patients who screened negative for PsA, patients who screened positive exhibited higher rates of selected known predictors of PsA such as older age, longer psoriasis duration, nail disease and inverse psoriasis. The proportion of patients at PASS was 56% and 67% for the PsA and screen-positive groups, respectively. Conclusions The similar profiles between screen-positive and PsA groups, in comparison with the screen-negative group, support observations of possible underdiagnosis of PsA and the increased impact of disease, especially musculoskeletal disease, among patients who screen positive for PsA. The high percentage of patients not at an acceptable symptom state in the PsA and screen-positive groups highlights the need to optimize care in PsA. [ABSTRACT FROM AUTHOR]