BOLD: Blood-gas and Oximetry Linked Dataset - Open Source Research.

Pulse oximeters measure peripheral arterial oxygen saturation (SpO 2 ) noninvasively, while the gold standard (SaO 2 ) involves arterial blood gas measurement. There are known racial and ethnic disparities in their performance. BOLD is a new comprehensive dataset that aims to underscore the importance of addressing biases in pulse oximetry accuracy, which disproportionately affect darker-skinned patients. The dataset was created by harmonizing three Electronic Health Record databases (MIMIC-III, MIMIC-IV, eICU-CRD) comprising Intensive Care Unit stays of US patients. Paired SpO 2 and SaO 2 measurements were time-aligned and combined with various other sociodemographic and parameters to provide a detailed representation of each patient. BOLD includes 49,099 paired measurements, within a 5-minute window and with oxygen saturation levels between 70-100%. Minority racial and ethnic groups account for ∼25% of the data - a proportion seldom achieved in previous studies. The codebase is publicly available. Given the prevalent use of pulse oximeters in the hospital and at home, we hope that BOLD will be leveraged to develop debiasing algorithms that can result in more equitable healthcare solutions.

Patient acceptance of transvaginal sonographic endometrial thickness assessment compared with hysteroscopy and biopsy for exclusion of endometrial cancer in cases of postmenopausal bleeding.

INTRODUCTION: Available examinations for women with postmenopausal bleeding include transvaginal sonography to measure endometrial thickness (TVS-ET), and invasive endometrial assessment using hysteroscopy/endometrial biopsy. However, selection of the examination method seldom involves consideration of patient preferences. The aim of this study was to examine patient preferences for the method used to investigate postmenopausal bleeding. METHODS: Women were asked to complete an interviewer-administered structured survey before they underwent clinical investigations at a university gynaecology unit from June 2016 to June 2017. Using the standard gamble approach, women were asked to choose between invasive assessment by hysteroscopy/endometrial biopsy (gold standard) or TVS-ET with a risk of missing endometrial cancer. The risk of missing endometrial cancer during TVS-ET was varied until each woman was indifferent to either option. RESULTS: The median detection rate for endometrial cancer required using TVS-ET was 95% (interquartile range=80%-99.9%). In total, 200 women completed the survey, and 77 (38.5%) women required TVS-ET to have a 99.9% detection rate for endometrial cancer. Prior hysteroscopy experience was the only factor that influenced the women's decisions: a significantly higher detection rate was required by this patient group than by patients without previous hysteroscopy experience (P=0.047). CONCLUSION: A substantial proportion of women would accept TVS-ET alone for the investigation of postmenopausal bleeding. In the era of patientcentred care, clinicians should incorporate patient preferences and enable women to make informed choices concerning the management of postmenopausal bleeding.

Multiscale Assessment of Agricultural Consumptive Water Use in California's Central Valley.

Spatial estimates of crop evapotranspiration with high accuracy from the field to watershed scale have become increasingly important for water management, particularly over irrigated agriculture in semiarid regions. Here, we provide a comprehensive assessment on patterns of annual agricultural water use over California's Central Valley, using 30-m daily evapotranspiration estimates based on Landsat satellite data. A semiempirical Priestley-Taylor approach was locally optimized and cross-validated with available field measurements for major crops including alfalfa, almond, citrus, corn, pasture, and rice. The evapotranspiration estimates explained >70% variance in daily measurements from independent sites with an RMSE of 0.88 mm day-1. When aggregated over the Valley, we estimated an average evapotranspiration of 820 ± 290 mm yr-1 in 2014. Agricultural water use varied significantly across and within crop types, with a coefficient of variation ranging from 8% for Rice (1,110 ± 85 mm yr-1) to 59% for Pistachio (592 ± 352 mm yr-1). Total water uses in 2016 increased by 9.6%, as compared to 2014, mostly because of land-use conversion from fallow/idle land to cropland. Analysis across 134 Groundwater Sustainability Agencies (GSAs) further showed a large variation of agricultural evapotranspiration among and within GSAs, especially for tree crops, e.g., almond evapotranspiration ranging from 339 ± 80 mm yr-1 in Tracy to 1,240 ± 136 mm yr-1 in Tri-County Water Authority. Continuous monitoring and assessment of the dynamics and spatial heterogeneity of agricultural evapotranspiration provide data-driven guidance for more effective land use and water planning across scales.

Towards computer-aided severity assessment via deep neural networks for geographic and opacity extent scoring of SARS-CoV-2 chest X-rays.

A critical step in effective care and treatment planning for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause for the coronavirus disease 2019 (COVID-19) pandemic, is the assessment of the severity of disease progression. Chest x-rays (CXRs) are often used to assess SARS-CoV-2 severity, with two important assessment metrics being extent of lung involvement and degree of opacity. In this proof-of-concept study, we assess the feasibility of computer-aided scoring of CXRs of SARS-CoV-2 lung disease severity using a deep learning system. Data consisted of 396 CXRs from SARS-CoV-2 positive patient cases. Geographic extent and opacity extent were scored by two board-certified expert chest radiologists (with 20+ years of experience) and a 2nd-year radiology resident. The deep neural networks used in this study, which we name COVID-Net S, are based on a COVID-Net network architecture. 100 versions of the network were independently learned (50 to perform geographic extent scoring and 50 to perform opacity extent scoring) using random subsets of CXRs from the study, and we evaluated the networks using stratified Monte Carlo cross-validation experiments. The COVID-Net S deep neural networks yielded R[Formula: see text] of [Formula: see text] and [Formula: see text] between predicted scores and radiologist scores for geographic extent and opacity extent, respectively, in stratified Monte Carlo cross-validation experiments. The best performing COVID-Net S networks achieved R[Formula: see text] of 0.739 and 0.741 between predicted scores and radiologist scores for geographic extent and opacity extent, respectively. The results are promising and suggest that the use of deep neural networks on CXRs could be an effective tool for computer-aided assessment of SARS-CoV-2 lung disease severity, although additional studies are needed before adoption for routine clinical use.

A narrative review of healthcare financing and reimbursement of nutritional support for patients in Singapore.

AIMS: Nutritional support is used frequently in Singapore's healthcare settings, but limited research has been published on how it is financed. This paper aims to provide a narrative review on the financing of nutritional support in Singapore for acute care, step-down care, intermediate and long-term care (ILTC), community and home settings. METHODS: A structured search strategy was applied to available electronic databases using selected search terms, with additional reports and grey literature identified using iterative searches. RESULTS: A limited number of publications were found via electronic databases. The majority of publications were from governmental reports/ press releases, and healthcare organizations' websites. While funds are available via MediSave, MediShield Life, MediFund, and various other schemes, they may not be sufficient for individuals on long-term nutritional support. CONCLUSIONS: More funding sources for nutritional support are urgently required for patients in ILTC. Means-testing mechanism and targeting may need to improve to ensure access to financial assistance for nutritional support and prevent poorer outcomes and higher medical costs. Medical providers, dietitians, pharmacists and social workers play a role in determining need, prescribing and accessing nutritional support for optimal care of individuals in hospitals and ILTC. Future policies will need to address the issues of access to nutritional support in the elderly and low-income populations.

A systematic review of the cost and economic outcomes of home enteral nutrition.

OBJECTIVES: Studies are lacking in the health economic implications of home enteral nutrition (HEN) in home-residing and long-term care/institutionalized patients. The aims of this review were to determine the total costs, the cost-effectiveness and other economic outcomes for HEN. DESIGN: A systematic search of randomized trials and observational studies available from January 2000 to April 2016 was performed using standard literature and electronic databases. Inclusion criteria were adults receiving HEN with economic outcomes in the long-term care or home settings. There was no restriction to the control groups used in the studies. RESULTS: A total of 10 studies met the inclusion criteria. The majority of the studies were not specifically designed for economic evaluation. Cost per QALY was lower in residents residing in home compared to long-term care facilities, and HEN appeared to be cost-effective for those with pressure ulcers. Higher costs were incurred for patients with dementia on HEN. Lower hospitalization costs and infection rates were reported for patients who switched to commercial feeds from blenderized food. The availability of nutritional support teams may decrease overall costs but these studies were of poor study quality. CONCLUSIONS: The lack of good quality economic evaluation studies affected the ability to conclude the overall cost-effectiveness of HEN. There is a trend for cost-saving and improved clinical outcomes in some populations. HEN is unlikely beneficial for patients with dementia. The availability of a nutrition support team may lead to cost savings and improved clinical outcomes for HEN.

Prevalence of infections among residents of Residential Care Homes for the Elderly in Hong Kong.

INTRODUCTION: A point prevalence study was conducted to study the epidemiology of common infections among residents in Residential Care Homes for the Elderly in Hong Kong and their associated factors. METHODS: Residential Care Homes for the Elderly in Hong Kong were selected by stratified single-stage cluster random sampling. All residents aged 65 years or above from the recruited homes were surveyed. Infections were identified using standardised definitions. Demographic and health information-including medical history, immunisation record, antibiotic use, and activities of daily living (as measured by Barthel Index)-was collected by a survey team to determine any associated factors. RESULTS: Data were collected from 3857 residents in 46 Residential Care Homes for the Elderly from February to May 2014. A total of 105 residents had at least one type of infection based on the survey definition. The overall prevalence of all infections was 2.7% (95% confidence interval, 2.2%-3.4%). The three most common infections were of the respiratory tract (1.3%; 95% confidence interval, 0.9%-1.9%), skin and soft tissue (0.7%; 95% confidence interval, 0.5%-1.0%), and urinary tract (0.5%; 95% confidence interval, 0.3%-0.9%). Total dependence in activities of daily living, as indicated by low Barthel Index score of 0 to 20 (odds ratio=3.0; 95% confidence interval, 1.4-6.2), and presence of a wound or stoma (odds ratio=2.7; 95% confidence interval, 1.4-4.9) were significantly associated with presence of infection. CONCLUSIONS: This survey provides information about infections among residents in Residential Care Homes for the Elderly in the territory. Local data enable us to understand the burden of infections and formulate targeted measures for prevention.

Rapid assessment of postural instability in Parkinson's disease (RAPID): a pilot study.

BACKGROUND: The Fahn's pull (or retropulsion) test is an item in the motor section of the Unified Parkinson's Disease Rating Scale, which is used almost exclusively to classify postural instability in Parkinson's disease (PD). However, the test is hard to standardize and is often performed incorrectly, making it hard to interpret. Moreover, it may not be safe to administer in patients who experience pain in the shoulders, neck, trunk and/or lower extremities. Identifying and grading postural instability in PD without requiring a physical challenge would not only be useful for the clinician but would assist patients and caregivers in its recognition. We propose the use of the rapid assessment of postural instability in Parkinson's disease (RAPID) questionnaire as a non-physical assessment tool. METHODS: We determined the associations between the pull test and items on a risk-assessment questionnaire that consisted of three parts: activities of daily living, fear of falling, and frequency of falling. RESULTS: Significant correlations were found between the pull test and the predictor variables, which ranged between 0.51 and 0.56 whilst the correlations amongst the predictor variables ranged between 0.58 and 0.70. The three parts of the questionnaire, when used in combination, produced a 96% sensitivity in the classification of postural instability. CONCLUSIONS: The RAPID questionnaire can be used as an adjunct to the pull test or solely if the pull test is contraindicated. It may also be possible to administer the questionnaire via the telephone or Internet. It is hoped that the rapid identification of postural instability would lead to fewer falls.

Quantitative assessment of lens opacities with anterior segment optical coherence tomography.

AIM: To evaluate the reliability of lens density measurement with anterior segment optical coherence tomography (OCT) and its association with the Lens Opacity Classification System Version III (LOCS III) grading. METHODS: Fifty-five eyes from 55 age-related cataract patients were included. One eye from each subject was selected at random for lens evaluation. After dilation, lens photographs were taken with a slit lamp and graded against the LOCS III standardised condition. Anterior segment OCT imaging was performed on the same eyes with a high-resolution scan. The association between the anterior segment OCT nucleus density measurement and LOCS III nuclear opalescence (NO) and nuclear colour (NC) scores was evaluated with the Spearman correlation coefficient. Anterior segment OCT measurement precision, coefficient of variation (CVw), and intraclass correlation coefficient (ICC) were calculated. RESULTS: The mean NO and NC scores were 3.39 (SD 1.10) and 3.37 (SD 1.27), respectively. Significant correlations were found between anterior segment OCT nuclear density measurements and the LOCS III NO and NC scores (r = 0.77 and 0.60, respectively, both with p<0.001). The precision, CVw and ICC of anterior segment OCT measurement were 2.05 units, 4.55% and 0.98, respectively. CONCLUSION: Anterior segment OCT nucleus density measurement is reliable and correlates with the LOCS III NO and NC scores.

Evaluation of strategies to improve nutrition in people with dementia in an assessment unit.

OBJECTIVES: To evaluate strategies designed to improve nutrition in elderly hospitalised patients with dementia. DESIGN: Observation phase followed by sequential interventions. SETTING: A Short stay assessment unit. PARTICIPANTS: Hospital Inpatients with a variety of conditions causing dementia. INTERVENTIONS: Phase 1: Observation. Phase 2: Encouraging dietary, 'Grazing'. Phase 3: Using volunteers to feed patients. Phase 4: Improving dining room ambience by playing soothing music. MEASUREMENTS: Body Mass Index (BMI), mid arm circumference, mini nutrition index and caloric intake by plate waste measurement. RESULTS: BMI fell in the Observation phase 0.6 +/- 0.68 kg/m2 (p < 0.001), but increased in each of the Intervention phases. Phase2 0.3 +/- 0.86 kg/m2 (p < 0.04), Phase 3 0.37 +/- 0.4 kg/m2 (p < 0.04), Phase 4 0.39 +/- 0.7 kg/m2 (p < 0.007). Caloric intake increased in the intervention phases. CONCLUSIONS: Simple, inexpensive and easy to implement strategies can improve nutrition in hospital inpatients with dementia.

Direct assessment of international consistency of standards for ground-level ozone: strategy and implementation toward metrological traceability network in Asia.

An international exercise to directly assess consistency of standards for ground-level ozone in East Asia was conducted as part of the East Asian Regional Experiment 2005 (EAREX 2005) in the framework of the Atmospheric Brown Clouds (ABC) project. Ten organizations collaboratively participated in the intercomparison. Four groups representing Japan, Korea, Hong Kong, and Taiwan made comparisons at the Gosan super observatory, Jeju Island, Korea, in March 2005, with ozone instruments calibrated to their national standards, and four Japanese groups made off-site comparisons with laboratory-level standards. All comparisons generally indicated good agreement with the standard reference photometer (SRP) 35, built by the National Institute of Standards and Technology (USA) and maintained by the National Institute for Environmental Studies (Japan). The assessment was expanded to measurement networks contributing to the World Meteorological Organization's Global Atmospheric Watch (WMO/GAW) program as part of off-site comparisons, and excellent agreement was achieved. These efforts contribute to propagating traceability of the national metrology standards among the atmospheric science community, to ensuring comparability of the existing ozone measurements, and to establishing an integrated network of air quality monitoring in Asia.

Assessment of American College of Rheumatology quality criteria for rheumatoid arthritis in a pre-quality criteria patient cohort.

OBJECTIVE: To evaluate the American College of Rheumatology (ACR) starter set of quality measures for rheumatoid arthritis (RA) in an actual patient cohort that preceded publication of the quality measures. METHODS: We retrospectively applied the 2006 ACR quality criteria to a prospectively studied cohort of 568 patients with RA treated by 1,932 unique physicians including 255 different rheumatologists between the years 1999 and 2003. Data on performance were obtained from self-report surveys and medical record review within 12 months. RESULTS: At least 1 joint examination was performed in 98% of patients. Patient and physician global assessments were reported for 79% and 74% of patients, respectively. A total of 85% of patients received disease-modifying antirheumatic drugs (DMARDs). DMARD adjustments were made for 50% of patients in whom increasing disease activity was noted at least once and for 64% of patients in whom increasing disease activity was noted during 2 (of 4) 3-month periods within the year. Compared with self-report surveys, medical records substantially underreported performance on quality measures. CONCLUSION: The ACR-endorsed quality measures for RA can be assessed using available data sources. When both self-report and medical record data are used, adherence rates, designed to serve as minimum standards of care, were moderate or high for most measures. Prior to using indicators to compare quality across groups, specific strategies for operationalizing measures and for using accurate data sources to assess adherence to the measures should be defined.

Sustainability appraisal in infrastructure projects (SUSAIP): Part 1. Development of indicators and computational methods.

The process of translating strategic sustainability objectives into concrete action at project-specific levels is a difficult task. The multi-dimensional perspectives of sustainability such as economy, society, environment, combined with a lack of structured methodology and information at various hierarchical levels, further exacerbate the problem. This paper (Part 1 of a two-part series) proposes an analytical decision model and a structured methodology for sustainability appraisal in infrastructure projects. The paper uses the 'weighted sum model' technique in multi-criteria decision analysis (MCDA) and the 'additive utility model' in analytical hierarchical process (AHP) for multi-criteria decision making, to develop the model from first principles. It discusses the development of key performance indicators encapsulated within the analytical model. It concludes by discussing other potential applications of the proposed model and methodology for process automation as part of integrated sustainability appraisal in infrastructure design and construction. Part 2 uses a case study to demonstrate the model application in infrastructure sustainability appraisal at design stages. The paper also discusses the challenges for sustainability research, and gives recommendations.

Likelihood-based confidence intervals for a log-normal mean.

To construct a confidence interval for the mean of a log-normal distribution in small samples, we propose likelihood-based approaches - the signed log-likelihood ratio and modified signed log-likelihood ratio methods. Extensive Monte Carlo simulation results show the advantages of the modified signed log-likelihood ratio method over the signed log-likelihood ratio method and other methods. In particular, the modified signed log-likelihood ratio method produces a confidence interval with a nearly exact coverage probability and highly accurate and symmetric error probabilities even for extremely small sample sizes. We then apply the methods to two sets of real-life data.

Likelihood analysis for the ratio of means of two independent log-normal distributions.

Existing methods for comparing the means of two independent skewed log-normal distributions do not perform well in a range of small-sample settings such as a small-sample bioavailability study. In this article, we propose two likelihood-based approaches-the signed log-likelihood ratio statistic and modified signed log-likelihood ratio statistic-for inference about the ratio of means of two independent log-normal distributions. More specifically, we focus on obtaining p-values for testing the equality of means and also constructing confidence intervals for the ratio of means. The performance of the proposed methods is assessed through simulation studies that show that the modified signed log-likelihood ratio statistic is nearly an exact approach even for very small samples. The methods are also applied to two real-life examples.

Motor control assessment for rhizotomy in cerebral palsy.

OBJECTIVE: To apply motor control assessment for selection of appropriate spastic cerebral palsy children to receive selective posterior rhizotomy (SPR). DESIGN: Forty children with spastic cerebral palsy (3-16 yr) were divided into three groups: "independent ambulator," "dependent ambulator," and "nonambulator." Another 18 healthy children were selected as the control group. Both motor control (tested by using polyelectromyography (PEMG)) and clinical ambulatory capability were assessed within 1 mo before SPR and 12 mo after. PEMG patterns were classified into seven patterns according to electromyographic activities during hip/knee flexion and extension. Gait patterns, which were analyzed by computer DynoGraphy, were classified into four patterns for children with ambulatory capability. RESULTS: PEMG and gait patterns were correlated with ambulatory ability. PEMG patterns 2-3 could predict independent ambulatory ability, whereas patterns 6-7 will interfere with ambulatory ability. PEMG patterns showed significant improvement after SPR in the ambulatory groups (P < 0.05), whereas they did not improve in the nonambulator group. Children with cerebral palsy with co-contraction of proximal/distal muscles had better results after SPR, whereas those with diffuse co-contraction or reduced electromyography activities had poor results. CONCLUSIONS: PEMG patterns may allow the physician to select the appropriate children with spastic cerebral palsy to receive SPR with good results.

Consumerism in the financial services industry: lessons for managed care.

Managed care today is being shaped by the emergence of a savvier, better informed health care consumer. Facing a strikingly similar consumer movement over the past two decades, the banking industry experienced a market transformation that holds important lessons for managed care. Nontraditional entrants in the financial services industry, offering focused "monoline" products and services closely analogous to "carve-out" providers in health care, targeted rising consumer demands and stronger preferences. Banks in time answered these formidable new competitive forces with innovative consolidation and globalization strategies. The most successful initiatives in healthcare, as in banking, will focus on satisfying the consumer's hunger for information, improved levels of service, and enhanced outcomes. Managed care plans may play a lead role in accelerating the impact of consumerism by bridging the disconnect between patients and their purchasing decisions.

Effects of load carriage on heart rate, blood pressure and energy expenditure in children.

Fifteen male primary school children, aged 10 years, were selected to carry school bags of 10, 15 and 20% of their own body weights, where 0% body weight was used as a control. Maximum oxygen uptake (VO2max) tests were conducted on a motorized treadmill using a continuous incremental protocol. During the load carrying test, subjects walked on a treadmill at 1.1 m s(-1) for 20 min at each load condition. Blood pressures were measured before, immediately following, and at 3 and 5 min after every trial. Heart rate and expired VO2 were recorded before, during and 5 min after walking using a cardiopulmonary function system. The results showed a significant difference in oxygen uptake, energy expenditure and the recovery of blood pressure rise for between 10 and 20% body weight load conditions. The carrying weight of a school bag for children could be recommended as 10% of body weight because it was not significantly different from 0% load in the metabolic cost.

Falloposcopy--a prerequisite to the proper assessment of tubal infertility.

OBJECTIVE: To review the technique and results of falloposcopy, and the classification and management of fallopian tube disease. DATA SOURCES: Medline and non-Medline search of the relevant English literature, and personal experience. STUDY SELECTION: Studies involving the use of falloposcopy to assess tubal status were selected for review. DATA EXTRACTION: The procedure of falloposcopy and its possible problems and complications were studied. Results from falloposcopy were compared with those from conventional investigations of tubal status, and their correlation with pregnancy was evaluated. DATA SYNTHESIS: Falloposcopy gives a better assessment of tubal status than conventional methods and can also predict the subsequent pregnancy rate. By falloposcopy, the decision of the mode of therapy for subfertility can be changed in more than 60% of patients. CONCLUSION: Examination of the fallopian tube using falloposcopy allows an accurate assessment of the tubal status to be made and is a prerequisite to deciding the most appropriate mode of assisted reproductive therapy.