Cardiac Surgical Bleeding, Transfusion and Quality Metrics: Joint Consensus Statement by the Enhanced Recovery After Surgery Cardiac Society and Society for the Advancement of Patient Blood Management.

BACKGROUND: Excessive perioperative bleeding is associated with major complications in cardiac surgery, resulting in increased morbidity, mortality and cost. METHODS: An international expert panel was convened to develop consensus statements on the control of bleeding and management of transfusion, and to suggest key quality metrics for cardiac surgical bleeding. The panel reviewed relevant literature from the previous 10 years and used a modified RAND Delphi methodology to achieve consensus. RESULTS: Thirty consensus statements in 8 categories were developed, including prioritizing control of bleeding, pre-chest closure checklists and the need for additional quality indicators beyond re-exploration rate, such as time to re-exploration. Consensus was also reached on the need for a universal definition of excessive bleeding, the use of antifibrinolytics, optimal cessation of antithrombotic agents, and preoperative risk scoring based on patient and procedural factors to identify those at greatest risk of excessive bleeding. Furthermore, there is a need for an objective bleeding scale based on the volume and rapidity of blood loss accompanied by viscoelastic management algorithms and standardized, patient-centered blood management strategies reflecting an interdisciplinary approach to quality improvement. CONCLUSIONS: Prioritizing the timely control and management of bleeding is essential to improving patient outcomes in cardiac surgery. To this end, a cardiac surgical bleeding quality metric that is more comprehensive than re-exploration rate alone is needed. Similarly, interdisciplinary quality initiatives that seek to implement enhanced quality indicators will likely lead to improved patient care and outcomes.

A meta-analysis of factors influencing the inactivation of Shiga toxin-producing Escherichia coli O157:H7 in leafy greens.

Recent advancements in modeling suggest that microbial inactivation in leafy greens follows a nonlinear pattern, rather than the simple first-order kinetics. In this study, we evaluated 17 inactivation models commonly used to describe microbial decline and established the conditions that govern microbial survival on leafy greens. Through a systematic review of 65 articles, we extracted 530 datasets to model the fate of Shiga toxin-producing Escherichia coli O157:H7 on leafy greens. Various factor analysis methods were employed to evaluate the impact of identified conditions on survival metrics. A two-parameter model (jm2) provided the best fit to most of both natural and antimicrobial-induced persistence datasets, whereas the one-parameter exponential model provided the best fit to less than 20% of the datasets. The jm2 model (adjusted R2 = .89) also outperformed the exponential model (adjusted R2 = .58) in fitting the pooled microbial survival data. In the context of survival metrics, the model averaging approach generated higher values than the exponential model for >4 log reduction times (LRTs), suggesting that the exponential model may be overpredicting inactivation at later time points. The random forest technique revealed that temperature and inoculum size were common factors determining inactivation in both natural and antimicrobial-induced die-offs.. The findings show the limitations of relying on the first-order survival metric of 1 LRT and considering nonlinear inactivation in produce safety decision-making.

Linking animal and human health burden: challenges and opportunities.

Quantifying the impact of poor animal health outcomes on human health represents a complex challenge. Using the disability-adjusted life year (DALY) metric as an endpoint, this article discusses how animal health outcomes can impact humans through three key processes: directly through zoonotic disease, indirectly via changes in yields and their impacts on nutrition and wealth, and finally, through indirect features associated with the agricultural industry, such as pharmaceuticals and climate change. For each process, the current state of the art and feasibility of global DALY-associated estimates are discussed. Existing frameworks for zoonoses already consider some key pathogens; ensuring completeness in the pathogens considered and consistency in methodological decisions is an important next step. For diet, risk factor frameworks enable a calculation of attributable DALYs; however, significant economic methodological developments are needed to ensure that local production changes are appropriately mapped to both local and global changes in dietary habits. Concerning wealth-related impacts, much work needs to be done on method development. Industry-related impacts require a focus on key research topics, such as attribution studies for animal antimicrobial resistance contributing to human outcomes. For climate change, a critical next step is identifying to what extent associated industry emissions are amenable to change should animal health outcomes improve. Allocation of finite funds to improve animal health must also consider the downstream impact on humans. Leveraging DALYs enables comparisons with other human health-related decisions and would represent a transformative way of approaching animal health decision-making should the obstacles in this article be addressed and new methods be developed.

La quantification de l'impact des problèmes de santé animale sur la santé humaine constitue un défi d'une grande complexité. En se servant de l'indicateur des années de vie ajustées sur l'incapacité (DALY) comme critère d'évaluation, les auteurs examinent trois processus essentiels illustrant l'impact que la situation zoosanitaire peut avoir sur la santé humaine : impact direct résultant des maladies zoonotiques, impact indirect résultant des mauvaises performances des animaux et de leurs conséquences sur la nutrition et la création de richesses, et enfin, effets indirects résultant de facteurs en lien avec le secteur agricole, par exemple l'utilisation de produits pharmaceutiques et le changement climatique. Pour chacun de ces processus, les auteurs font le point sur l'état actuel des connaissances et sur l'applicabilité des évaluations mondiales basées sur l'indicateur DALY. Les cadres existants relatifs aux zoonoses recouvrent déjà certains agents pathogènes majeurs ; la prochaine étape importante consistera à assurer une couverture complète des agents pathogènes et à veiller à la cohérence des décisions méthodologiques. S'agissant de l'alimentation, les cadres basés sur l'analyse des facteurs de risque permettent de calculer les DALY imputables à l'alimentation ; toutefois, d'importantes avancées méthodologiques sur les aspects économiques de cette corrélation seront nécessaires pour s'assurer que tout changement intervenant localement en matière de production animale est correctement mis en correspondance avec les modifications des habitudes alimentaires dans ce même contexte local mais aussi à l'échelle mondiale. S'agissant des impacts liés à la création de richesses, il reste beaucoup à faire dans le domaine méthodologique. La détermination des impacts liés aux filières d'élevage requiert des travaux axés sur des sujets précis, par exemple des études visant à déceler les sources de la résistance aux agents antimicrobiens qui contribuent à l'apparition d'antibiorésistances chez l'être humain. Enfin, pour ce qui concerne le changement climatique, une étape cruciale consistera à déterminer dans quelle mesure les émissions associées à l'élevage sont susceptibles de changer en cas d'amélioration de la situation zoosanitaire. Dans un contexte de ressources limitées, l'affectation de fonds à l'amélioration de la santé animale doit également prendre en compte l'impact en aval sur la santé humaine. L'utilisation de l'indicateur DALY permet des comparaisons avec d'autres décisions de santé publique et représenterait une approche transformative de la prise de décision en santé animale, dès lors que les obstacles mentionnés dans cet article sont surmontés et que de nouvelles méthodes sont mises au point.

Cuantificar el impacto de una mala sanidad animal en la salud humana es un desafío complejo. Utilizando el parámetro de años de vida ajustados en función de la discapacidad (AVAD o DALY) como criterio de valoración, en este artículo se examina cómo la sanidad animal puede repercutir en los seres humanos a través de tres procesos clave: directamente, a través de las zoonosis; indirectamente, a través de cambios en los rendimientos y sus repercusiones en la nutrición y la riqueza; y, por último, a través de factores indirectos asociados a la industria agropecuaria, como los fármacos y el cambio climático. Para cada uno de estos procesos, se examinan el estado actual y la viabilidad de estimar AVAD a escala mundial. Los marcos existentes para la zoonosis ya tienen en cuenta algunos patógenos claves; garantizar la exhaustividad de los patógenos considerados y la coherencia en las decisiones metodológicas es un próximo paso importante. En lo que respecta a la alimentación, aunque los marcos de factores de riesgo permiten calcular los AVAD atribuibles, se necesitan importantes avances metodológicos en el ámbito económico para asegurar que los cambios en la producción local se correspondan adecuadamente con los cambios locales y mundiales en los hábitos alimentarios. En cuanto a las repercusiones en la riqueza, queda mucho trabajo por hacer en el desarrollo de métodos. Para abordar las repercusiones relacionadas con la industria, es necesario centrarse en temas clave de investigación, como los estudios de atribución relativos al impacto en la salud humana de la resistencia a los antimicrobianos en los animales. En lo que se refiere al cambio climático, un próximo paso crucial es determinar en qué medida las emisiones de la industria podrían cambiar, en función de la mejora de los resultados en materia de sanidad animal. Al asignar fondos limitados para la mejora de la sanidad animal también se deben tener en cuenta las repercusiones correspondientes en los seres humanos. Utilizar los AVAD permite hacer comparaciones con otras decisiones importantes relacionadas con la salud humana y representaría una forma transformadora de enfocar la toma de decisiones en materia de sanidad animal, en caso de que se aborden los obstáculos presentados en ese artículo y se desarrollen nuevos métodos.

Pitch-Tracking Metrics as a Predictor of Future Shoulder and Elbow Injuries in Major League Baseball Pitchers: A Machine-Learning and Game-Theory Based Analysis.

Background: Understanding interactions between multiple risk factors for shoulder and elbow injuries in Major League Baseball (MLB) pitchers is important to identify potential avenues by which risk can be reduced while minimizing impact on player performance. Purpose: To apply a novel game theory-based approach to develop a machine-learning model predictive of next-season shoulder and elbow injuries in MLB pitchers and use this model to understand interdependencies and interaction effects between the most important risk factors. Study Design: Case-control study; Level of evidence, 3. Methods: Pitcher demographics, workload measures, pitch-tracking metrics, and injury data between 2017 and 2022 were used to construct a database of MLB pitcher-years, where each item in the database corresponded to a pitcher's information and metrics for that year. An extreme gradient boosting machine-learning model was trained to predict next-season shoulder and elbow injuries utilizing Shapley additive explanation values to quantify feature importance as well as interdependencies and interaction effects between predictive variables. Results: A total of 3808 pitcher-years were included in this analysis; 606 (15.9%) of these involved a shoulder or elbow injury resulting in placement on the MLB injured list. Of the >65 candidate features (including workload, demographic, and pitch-tracking metrics), the most important contributors to predicting shoulder/elbow injury were increased: pitch velocity (all pitch types), utilization of sliders (SLs), fastball (FB) spin rate, FB horizontal movement, and player age. The strongest game theory interaction effects were that higher FB velocity did not alter a younger pitcher's predicted risk of shoulder/elbow injury versus older pitchers, risk of shoulder/elbow injury increased with the number of high-velocity pitches thrown (regardless of pitch type and in an additive fashion), and FB velocity <95 mph (<152.9 kph) demonstrated strong negative interaction effects with higher SL percentage, suggesting that the overall predicted risk of injury for pitchers throwing a high number of SLs could be attenuated by lower FB velocity. Conclusion: Pitch-tracking metrics were substantially more predictive of future injury than player demographics and workload metrics. There were many significant game theory interdependencies of injury risk. Notably, the increased risk of injury that was conferred by throwing with a high velocity was even further magnified if the pitchers were also older, threw a high percentage of SLs, and/or threw a greater number of pitches.

A Volunteer Passion: A Qualitative Look at How We Measure and Reward the Work of Medical Educators.

Background  Medical educators face many challenges, including the absence of defined roles, lack of standard career paths, and limited support in systems that generally prioritize research and clinical productivity over educational activities. Providers also teach to widely varying degrees. This study was designed to specifically examine the professional rewards and obstacles experienced by physicians who have dedicated significant energy and career focus to medical education. Methodology A phenomenological approach was used in this qualitative study. Purposeful sampling was utilized to identify medical educators from different institutions and geographical areas. Participants were categorized by gender and career stage. Semi-structured interviews were conducted, and reflexive thematic analysis was used to develop themes across items and participants. Results Twenty-two medical educators were interviewed (11 males, 11 females), with an average age of 51 (range: 38-72) years. The average time from completion of training was 18 years (range: <1 to 41 years). Two main themes were constructed, which related to medical educators' career motivations and challenges: (1) Joy and purpose (subthemes: Interaction with learners, Impact, and Innovation) and (2) Everyone teaches (subthemes: Lack of recognition, Lack of reward, Malalignment of metrics) Conclusions The greatest source of motivation and satisfaction for medical educators is linked to the work itself; in addition to interactions with learners, educators derive pleasure from the innovation, collaboration, and systems thinking involved in their work. Importantly, participants also experience dissatisfaction, primarily due to a lack of recognition and reward, and metrics that do not consistently demonstrate their achievements. Participants provided examples of metrics that more accurately reflected the work of education; they identified clear benefits of academic promotion; and they highlighted significant challenges in the promotional system. The implementation of appropriate systems of measurement and reward is needed to better support the work of medical educators. Our aim should be not only to increase opportunities for satisfaction but also to reduce factors that cause frustration and limit advancement.

Identifications of Similarity Metrics for Patients With Cancer: Protocol for a Scoping Review.

BACKGROUND: Understanding the similarities of patients with cancer is essential to advancing personalized medicine, improving patient outcomes, and developing more effective and individualized treatments. It enables researchers to discover important patterns, biomarkers, and treatment strategies that can have a significant impact on cancer research and oncology. In addition, the identification of previously successfully treated patients supports oncologists in making treatment decisions for a new patient who is clinically or molecularly similar to the previous patient. OBJECTIVE: The planned review aims to systematically summarize, map, and describe existing evidence to understand how patient similarity is defined and used in cancer research and clinical care. METHODS: To systematically identify relevant studies and to ensure reproducibility and transparency of the review process, a comprehensive literature search will be conducted in several bibliographic databases, including Web of Science, PubMed, LIVIVIVO, and MEDLINE, covering the period from 1998 to February 2024. After the initial duplicate deletion phase, a study selection phase will be applied using Rayyan, which consists of 3 distinct steps: title and abstract screening, disagreement resolution, and full-text screening. To ensure the integrity and quality of the selection process, each of these steps is preceded by a pilot testing phase. This methodological process will culminate in the presentation of the final research results in a structured form according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flowchart. The protocol has been registered in the Journal of Medical Internet Research. RESULTS: This protocol outlines the methodologies used in conducting the scoping review. A search of the specified electronic databases and after removing duplicates resulted in 1183 unique records. As of March 2024, the review process has moved to the full-text evaluation phase. At this stage, data extraction will be conducted using a pretested chart template. CONCLUSIONS: The scoping review protocol, centered on these main concepts, aims to systematically map the available evidence on patient similarity among patients with cancer. By defining the types of data sources, approaches, and methods used in the field, and aligning these with the research questions, the review will provide a foundation for future research and clinical application in personalized cancer care. This protocol will guide the literature search, data extraction, and synthesis of findings to achieve the review's objectives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58705.

The impact of controlled breathing on autonomic nervous system modulation: analysis using phase-rectified signal averaging, entropy and heart rate variability.

Objective The present study investigated how breathing stimuli affect both non-linear and linear metrics of the autonomic nervous system (ANS). Approach The analyzed dataset consisted of 70 young, healthy volunteers, in whom arterial blood pressure (ABP) was measured noninvasively during 5-minute sessions of controlled breathing at three different frequencies: 6, 10, and 15 breaths/min. CO2 concentration and respiratory rate were continuously monitored throughout the controlled breathing sessions. The ANS was characterized using non-linear methods, including Phase-Rectified Signal Averaging (PRSA) for estimating heart acceleration and deceleration capacity (AC, DC), multiscale entropy (MSEn), approximate entropy (ApEn), sample entropy (SampEn), and fuzzy entropy (FuzzyEn), as well as time and frequency domains (low frequency, LF; high-frequency, HF; total power, TP) of heart rate variability (HRV). Main Results Higher breathing rates resulted in a significant decrease in end-tidal CO2 concentration (p < 0.001), accompanied by increases in both ABP (p<0.001) and heart rate (p<0.001). A strong, linear decline in AC and DC (p<0.001 for both) was observed with increasing respiratory rate. All entropy metrics increased with breathing frequency (p<0.001). In the time-domain, HRV metrics significantly decreased with breathing frequency (p<0.01 for all). In the frequency-domain, HRV LF and HRV HF decreased (p = 0.038 and p = 0.040, respectively), although these changes were modest. There was no significant change in HRV TP with breathing frequencies. Significance Alterations in CO2 levels, a potent chemoreceptor trigger, and changes in HR most likely modulate ANS metrics. Non-linear PRSA and entropy appear to be more sensitive to breathing stimuli compared to frequency-dependent HRV metrics. Further research involving a larger cohort of healthy subjects is needed to validate our observations. .

Exploring the dynamics of Women's field hockey performance: A comparative analysis of the impact of opponent quality between Olympic Games and Chinese National Games.

This is an observational retrospective study analyzed the performance of the Chinese women's national field hockey team during the 2020 Tokyo Olympics and 2021 National Games to assess the impact of opposition quality on performance. Game statistics were collected using notational analysis software for 76 Olympic and 40 National Games matches. Non-parametric Mann-Whitney U tests were used to compare tournaments. No significant differences existed for 35 out of 38 metrics, except Offense in 25-Yd Area (P = 0.013), Handball Style (P = 0.000) and Entry into Arc - Right Lane (P = 0.017). When exclusively considering Chinese national team's observations, superior National Games performance did emerge for Shot (P = 0.046), Goal from Short Corner (P = 0.044), Into the Arc (P = 0.046), Entry into Arc - Q3 (P = 0.009), Dribble into the Arc (P = 0.046), Handball Style into Arc (P = 0.041), Forehand Shot (P = 0.033), and Small Skill Shot (P = 0.014). The study underscores the influence of opposition quality on team performance, with a need for targeted improvements in arc penetration efficacy, conversion rates of shots to goals, and adaptation of tactical approaches against stronger defenses. The research points towards the need for strategic high-performance programs, improved domestic league quality, and a structured youth development system to elevate the overall standard of Chinese field hockey to achieve global competitiveness.

Identification of Circular Patterns in Capsule Endoscopy Bubble Frames.

Background: A significant number of frames captured by the wireless capsule endoscopy are involved with varying amounts of bubbles. Whereas different studies have considered bubbles as nonuseful agents due to the fact that they reduce the visualization quality of the small intestine mucosa, this research aims to develop a practical way of assessing the rheological capability of the circular bubbles as a suggestion for future clinical diagnostic purposes. Methods: From the Kvasir-capsule endoscopy dataset, frames with varying levels of bubble engagements were chosen in two categories based on bubble size. Border reflections are present on the edges of round-shaped bubbles in their boundaries, and in the frequency domain, high-frequency bands correspond to these edges in the spatial domain. The first step is about high-pass filtering of border reflections using wavelet transform (WT) and Differential of Gaussian, and the second step is related to applying the Fast Circlet Transform (FCT) and the Hough transform as circle detection tools on extracted borders and evaluating the distribution and abundance of all bubbles with the variety of radii. Results: Border's extraction using WT as a preprocessing approach makes it easier for circle detection tool for better concentration on high-frequency circular patterns. Consequently, applying FCT with predefined parameters can specify the variety and range of radius and the abundance for all bubbles in an image. The overall discrimination factor (ODF) of 15.01, and 7.1 showing distinct bubble distributions in the gastrointestinal (GI) tract. The discrimination in ODF from datasets 1-2 suggests a relationship between the rheological properties of bubbles and their coverage area plus their abundance, highlighting the WT and FCT performance in determining bubbles' distributions for diagnostic objectives. Conclusion: The implementation of an object-oriented attitude in gastrointestinal analysis makes it intelligible for gastroenterologists to approximate the constituent features of intra-intestinal fluids. this can't be evaluated until the bubbles are considered as non-useful agents. The obtained results from the datasets proved that the difference between the calculated ODF can be used as an indicator for the quality estimation of intraintestinal fluids' rheological features like viscosity, which helps gastroenterologists evaluate the quality of patient digestion.

Impact of health practice index and cardiovascular health metrics on incident cardiovascular disease according to glucose tolerance status.

Aims: To evaluate and compare the association of incident cardiovascular disease (CVD) with the Health Practice Index (HPI) reflecting only lifestyle habits and Ideal Cardiovascular Health Metrics (ICVHMs) consisting of lifestyle habits and factors targeted for control in the same population according to glucose status. Methods: This retrospective cohort study included 1,28,162 participants aged 18-72 years with no history of CVD followed for ≥ 3 years between 2008 and 2016. Participants were classified according to normal glucose tolerance (86,174), prediabetes (36,096), or diabetes (5892). HPI and ICVHMs scores were classified into three groups (high/medium/low). Multivariate Cox regression hazard analysis examined CVD risk. Results: During a mean follow-up of 5.2 years, 1057 CVD events occurred. In prediabetes, CVD risk was significantly higher in groups with both medium and low HPI scores and ICVHMs scores compared to high scores for normal glucose tolerance (hazard ratios [HRs] for high/medium/low HPI scores were 0.95 [0.78-1.17], 1.56 [1.29-1.89], and 2.41 [1.74-3.34] and for ICVHMs scores were 0.74 [0.50-1.11], 1.58 [1.26-1.98], and 2.63 [2.10-3.31], respectively). Regarding diabetes, compared with high HPI/ICVHMs scores in the normal glucose tolerance group, a significantly increased CVD risk was observed in the high-score HPI group, but not in the high-score ICVHMs group (HPI high/medium/low HR, 1.63 [1.22-2.18], 2.19 [1.69-2.83], and 2.26 [1.34 -3.83]; ICVHMs high/medium/low HR, 1.14 [0.47-2.81], 2.38 [1.75-3.23], and 3.31 [2.50-4.38], respectively). Conclusions: In diabetes, ideal lifestyle practices alone were insufficient for primary prevention of CVD but had a greater impact on primary prevention of CVD in prediabetes. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-024-00708-7.

Interventions to optimize dispatcher-assisted CPR instructions: A scoping review.

Aim: To review and summarize existing literature and knowledge gaps regarding interventions that have been tested to optimize dispatcher-assisted CPR (DA-CPR) instruction protocols for out-of-hospital cardiac arrest (OHCA). Methods: This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the ILCOR methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were published in peer-reviewed journals and evaluated interventions used to improve DA-CPR. The search was carried out in MEDLINE, EMBASE, Education Resources Information Center (ERIC), PsycINFO, the Cochrane Library, Evidence Based Medicine (EBM) Reviews, and the Campbell Library from 2000 to December 18, 2023. Results: After full text review, 31 studies were included in the final review. The interventions reviewed were use of video at the scene (n = 9), changes in terminology about compressions (n = 6), implementation of novel DA-CPR protocols (n = 4), advanced dispatcher training (n = 3), centralization of the dispatch center (n = 2), use of metronome or varied metronome rates (n = 2), change in CPR sequence and compression ratio (n = 1), animated audio-visual recording (n = 1), pre-recorded instructions vs. conversational live instructions (n = 1), inclusion of "undress patient" instructions (n = 1), and specific verbal encouragement (n = 1). Studies ranged in methodology from registry studies to randomized clinical trials with the majority being observational studies of simulated EMS calls for OHCA. Outcomes were highly variable but included rates of bystander CPR, confidence & willingness to perform CPR, time to initiation of bystander CPR, bystander CPR quality (including CPR metrics: chest compression depth and rate; chest compression fraction; full chest recoil, ventilation rate, overall CPR competency), rates of automated external defibrillator (AED) use, return of spontaneous circulation (ROSC) and survival. Overall, all interventions seem to be associated with potential improvement in bystander CPR and CPR metrics. Conclusion: There appears to be trends towards improvement on key outcomes however more research is needed. This scoping review highlights the lack of high-quality clinical research on any of the tested interventions to improve DA-CPR. There is insufficient evidence to explore the effectiveness of any of these interventions via systematic review.

The Effect of Annotation Quality on Wear Semantic Segmentation by CNN.

In this work, we investigate the impact of annotation quality and domain expertise on the performance of Convolutional Neural Networks (CNNs) for semantic segmentation of wear on titanium nitride (TiN) and titanium carbonitride (TiCN) coated end mills. Using an innovative measurement system and customized CNN architecture, we found that domain expertise significantly affects model performance. Annotator 1 achieved maximum mIoU scores of 0.8153 for abnormal wear and 0.7120 for normal wear on TiN datasets, whereas Annotator 3 with the lowest expertise achieved significantly lower scores. Sensitivity to annotation inconsistencies and model hyperparameters were examined, revealing that models for TiCN datasets showed a higher coefficient of variation (CV) of 16.32% compared to 8.6% for TiN due to the subtle wear characteristics, highlighting the need for optimized annotation policies and high-quality images to improve wear segmentation.

SIMpat: A Synthetic Benchmark for Similarity Metrics on Patient Representations.

Similarity and clustering tasks based on data extracted from electronic health records on the patient level suffer from the curse of dimensionality and the lack of inter-patient data comparability. Indeed, for many health institutions, there are many more variables, and ways of expressing those variables to represent patients than patients sharing the same set of data. To lower redundancy and increase interoperability one strategy is to map data to semantic-driven representations through medical knowledge graphs such as SNOMED-CT. However, patient similarity metrics based on this knowledge-graph information lack quantitative evaluation and comparisons with pure data-driven methods. The reasons are twofold, firstly, it is hard to conceptually assess and formalize a gold-standard similarity between patients resulting in poor inter-annotator agreement in qualitative evaluations. Secondly, the community has been lacking a clear benchmark to compare existing metrics developed by scientific communities coming from various fields such as ontology, data science, and medical informatics. This study proposes to leverage the known challenges of evaluating patient similarities by proposing SIMpat, a synthetic benchmark to quantitatively evaluate available metrics, based on controlled cohorts, which could later be used to assess their sensibility regarding aspects such as the sparsity of variables or specificities of patient disease patterns.

Synthetic Generation of Patient Service Utilization Data: A Scalability Study.

To address privacy and ethical issues in using health data for machine learning, we evaluate the scalability of advanced synthetic data generation methods like GANs, VAEs, copulaGAN, and transformer models specifically for patient service utilization data. Our study examines five models on data from a Canadian health authority, focusing on training and generation efficiency, data resemblance, and practical utility. Our findings indicate that statistical models excel in efficiency, while most models produce synthetic data that closely mirrors real data, and is also useful for real-world applications.

Matters We Metric Vs. Metrics that Matter.

Introduction: Geriatric fracture is a pressing global health issue, marked by elevated mortality and morbidity rates and escalating health care costs. The evolving health care system from fee-for-service to quality-based reimbursement has led to externally driven reward and reimbursement systems that may not account for the complexity of caring for older adults with fracture. Significance: The aim of this review is to highlight the need for a shift towards meaningful metrics that impact geriatric fracture care and to issue a call to action for all medical societies to advocate for national reimbursement and ranking systems that focus on metrics that truly matter. Results: Traditional metrics, while easier to capture, may not necessarily represent high quality care and may even have unintentional adverse consequences. For example, the focus on reducing length of stay may lead to older patients being discharged too early, without adequately addressing pain, constipation, or delirium. In addition, a focus on mortality may miss the opportunity to deliver compassionate end-of-life care. Existing geriatric fracture care metrics have expanded beyond traditional metrics to include assessment by geriatricians, fracture prevention, and delirium assessments. However, there is a need to further consider and develop patient-focused metrics. The Age-Friendly Health Initiative (4 Ms), which includes Mobility, Medication, Mentation, and what Matters is an evidence-based framework for assessing and acting on critical issues in the care of older adults. Additional metrics that should be considered include an assessment of nutrition and secondary fracture prevention. Conclusion: In the realm of geriatric fracture care, the metrics currently employed often revolve around adherence to established guidelines and are heavily influenced by financial considerations. It is crucial to shift the paradigm towards metrics that truly matter for geriatric fracture patients, recognizing the multifaceted nature of their care and the profound impact these fractures have on their lives.

Longitudinal bibliometric investigation of published orthodontic research 2013-23: are we investigating patient-reported outcomes?

BACKGROUND: The published literature represents the fundamental basis of any academic specialty, including orthodontics. Orthodontic research outputs provide useful insight into clinical and research priorities, which can help inform future research efforts and resource outputs. In recent years, the need for more patient-reported outcomes in orthodontic research has been highlighted. OBJECTIVES: To identify the most common reported research subjects in orthodontics between 2013-23; (2) identify the main outcomes and types of study design associated with this research, including study design related to patient-reported outcomes; and (3) identify trends in this research activity based upon these findings. MATERIAL AND METHODS: A literature search was performed in a single electronic database (Scopus) to return all indexed publications with relevance to orthodontics published from 2013 to 2023. The 50 most-cited publications per year were then identified. Publication characteristics were extracted using a data collection sheet. Descriptive statistics including frequency distributions were calculated. RESULTS: A total of 14 397 publications were identified. Publications on orthodontic bonding made up 7.02% of all output, followed by materials (5.88%) and tooth movement (5.42%). Subsequent analysis of the most-cited publications per year revealed the most frequently published subjects were aligners (12.5%), orthodontic tooth movement (9.45%), and digital workflow (9.09%), and the most common study designs were in vitro (19.09%) and retrospective observational studies (15.45%). The most common outcome type was morphological features of malocclusion (26.9%). Conversely, patient-focused measures were only reported in 12.7% of studies. CONCLUSIONS: Orthodontic research outputs are dynamic but do show consistent research interest in certain subjects. There is a predilection for the reporting of clinician-focused outcomes; whilst these have some value, more efforts should be focused on conducting rigorous and robust studies that include patient-reported outcomes.

A protocol for assessing bias and robustness of social network metrics using GPS based radio-telemetry data.

BACKGROUND: Social network analysis of animal societies allows scientists to test hypotheses about social evolution, behaviour, and dynamic processes. However, the accuracy of estimated metrics depends on data characteristics like sample proportion, sample size, and frequency. A protocol is needed to assess for bias and robustness of social network metrics estimated for the animal populations especially when a limited number of individuals are monitored. METHODS: We used GPS telemetry datasets of five ungulate species to combine known social network approaches with novel ones into a comprehensive five-step protocol. To quantify the bias and uncertainty in the network metrics obtained from a partial population, we presented novel statistical methods which are particularly suited for autocorrelated data, such as telemetry relocations. The protocol was validated using a sixth species, the fallow deer, with a known population size where ∼ 85 % of the individuals have been directly monitored. RESULTS: Through the protocol, we demonstrated how pre-network data permutations allow researchers to assess non-random aspects of interactions within a population. The protocol assesses bias in global network metrics, obtains confidence intervals, and quantifies uncertainty of global and node-level network metrics based on the number of nodes in the network. We found that global network metrics like density remained robust even with a lowered sample size, while local network metrics like eigenvector centrality were unreliable for four of the species. The fallow deer network showed low uncertainty and bias even at lower sampling proportions, indicating the importance of a thoroughly sampled population while demonstrating the accuracy of our evaluation methods for smaller samples. CONCLUSIONS: The protocol allows researchers to analyse GPS-based radio-telemetry or other data to determine the reliability of social network metrics. The estimates enable the statistical comparison of networks under different conditions, such as analysing daily and seasonal changes in the density of a network. The methods can also guide methodological decisions in animal social network research, such as sampling design and allow more accurate ecological inferences from the available data. The R package aniSNA enables researchers to implement this workflow on their dataset, generating reliable inferences and guiding methodological decisions.

Estimation of sex assigned at birth using dental crown and cervical measurements in a modern global sample.

Despite developing prior to the appearance of secondary sexual characteristics of the skeleton, the permanent dentition exhibits sexual dimorphism. Therefore, teeth can serve as a means to estimate sex assigned at birth even in young individuals. This project takes a large global sample of maximum dimensions of the crown as well as measurements of the crown at the cervix to explore sexual dimorphism. Dimorphism is noted in teeth throughout the dental arcade, particularly in the canines. We provide sectioning points as well as the probability of correct classification (ranging from 50.9% to 81.3%) for each measurement to aid the practitioner in sex estimation from the dentition. This research provides a method to estimate sex without arbitrary population specifications. We argue for a global approach that incorporates more population variation to remove the need to estimate "ancestry," (which in actuality is translated to a social race category) and therefore does not force sexual dimorphism-related variation into these mutable and ambiguous categories. Further, this paper demonstrates the utility of the dentition as an additional indicator to aid with the estimation of sex assigned at birth in forensic anthropology. The goal of this research is to better understand the expression of sexual dimorphism across the skeleton in a global context.

Development and consensus of a dashboard model to evaluate research activity in Spanish Hospital Pharmacy Services. / Desarrollo y consenso de un cuadro de mando para evaluar la actividad investigadora en los servicios de farmacia hospitalaria en España.

OBJECTIVE: To develop by consensus a dashboard model to standardize and promote the evaluation of research activity in Spanish Hospital Pharmacy Services. METHODS: The study was carried out in 5 phases following the modified Delphi methodology: constitution of the coordinating group, elaboration of a list of scenarios, selection of participating centers, evaluation of the list of scenarios, and analysis of the results. The coordinating group designed a questionnaire with 114 questions. General research questions and different scenarios (indicators) were included to form the dashboard. The Hospital Pharmacy Services with the highest number of publications were identified to participate in the Delphi consultation. Two rounds of consultations were conducted in which the "Need" and/or "Feasibility" of their measurement was evaluated for each of the scenarios, using a numerical scale from 1 (lowest score) to 9 (highest score). RESULTS: Sixteen Hospital Pharmacy Services, belonging to 8 different autonomous communities, participated in the Delphi consultation. A total of 100% of them responded to all the questions in the 2 rounds of consultations. It was considered that the Hospital Pharmacy Services should have a research dashboard (need = 100%) with a basic structure and a common minimum set of data for all them (need = 87.5%). The consensus was reached on distinguishing research projects led by the Hospital Pharmacy Services from those led by other groups in which the Hospital Pharmacy Services collaborate (need = 87.5%), and a definition was approved on the leadership of these projects according to whether they are single-center or multicenter. A consensus was reached on 40 indicators to form the dashboard, which evaluates publications (13 indicators), human resources (12 indicators), research projects (9 indicators), doctoral theses (4 indicators), and patents and intellectual property registrations (2 indicators). CONCLUSIONS: This is the first consensus dashboard developed to evaluate the research activity of the Hospital Pharmacy Services, which will help to analyze the productivity and impact of research systematically and continuously. In addition, it will allow comparison between them and will help to establish synergies and identify trends, patterns, and challenges.

[Translated article] Development and consensus of a dashboard model to evaluate research activity in Spanish Hospital Pharmacy Services.

OBJECTIVE: To develop by consensus a dashboard model to standardise and promote the evaluation of research activity in Spanish Hospital Pharmacy Services. METHODS: The study was carried out in 5 phases following the modified Delphi methodology: constitution of the coordinating group, elaboration of a list of scenarios, selection of participating centres, evaluation of the list of scenarios, and analysis of the results. The coordinating group designed a questionnaire with 114 questions. General research questions and different scenarios (indicators) were included to form the dashboard. The Hospital Pharmacy Services with the highest number of publications were identified to participate in the Delphi consultation. Two rounds of consultations were conducted in which the "Need" and/or "Feasibility" of their measurement was evaluated for each of the scenarios, using a numerical scale from 1 (lowest score) to 9 (highest score). RESULTS: Sixteen Hospital Pharmacy Services, belonging to 8 different Autonomous Communities, participated in the Delphi consultation. A total of 100% of them responded to all the questions in the 2 rounds of consultations. It was considered that the Hospital Pharmacy Services should have a research dashboard (Need=100%) with a basic structure and a common minimum set of data for all them (Need=87.5%). The consensus was reached on distinguishing research projects led by the Hospital Pharmacy Services from those led by other groups in which the Hospital Pharmacy Services collaborate (Need=87.5%), and a definition was approved on the leadership of these projects according to whether they are single-centre or multicentre. A consensus was reached on 40 indicators to form the dashboard, which evaluates publications (13 indicators), human resources (12 indicators), research projects (9 indicators), doctoral theses (4 indicators), and patents and intellectual property registrations (2 indicators). CONCLUSIONS: This is the first consensus dashboard developed to evaluate the research activity of the Hospital Pharmacy Services, which will help to analyse the productivity and impact of research systematically and continuously. In addition, it will allow comparison between them and will help to establish synergies and identify trends, patterns, and challenges.