Development of mobile CAT for patient feedback on pediatric consultations based on Rasch analysis of online techniques.

The Rasch Rating Scale Model (RSM) is widely used in questionnaire analysis, providing insights into how individuals respond to item-level stimuli. Existing software for Rasch RSM parameter estimation, while powerful, often presents a steep learning curve. An accessible online tool can greatly benefit novice users, particularly students and clinicians, by simplifying the analytical process. This study introduces an online tool, an intuitive online RSM analysis tool designed to facilitate questionnaire data analysis for applied researchers, students, and clinicians. The online tool employs the joint maximum likelihood method for estimation, yielding estimates, standard errors (SE), and fit statistics iteratively. A unique feature of the tool is its ability to visualize estimates on Google Maps with an opacity setting of 0, enhancing data interpretation through a user-friendly interface. This study outlines the estimation process and key features, employing data from 200 proxy participants who answered 20 5-point questions regarding doctor-patient and doctor-family interactions in pediatric consultations. Mobile computerized adaptive testing (CAT) was employed. The online tool offers 5 essential visual displays often utilized in Rasch analyses, including the Wright Map, KIDMAP, category probability curve, performance plot, and differential item functioning (DIF) graph. DIF analysis revealed that 2 items, concerning the doctor attentiveness and empathy toward the child illness, exhibited differences in female proxy participants' responses, indicating lower satisfaction with pediatricians. The online tool emerges as a user-friendly and efficient RSM analysis tool with notable advantages for newcomers, improving data visualization and comprehension. Its capacity to pinpoint key areas of concern, such as gender-related satisfaction disparities among proxy participants, enhances its utility in questionnaire analysis. The online tool holds promise as a valuable resource for researchers, students, and clinicians seeking accessible Rasch analysis solutions.

Developing a novel algorithm for comparing cluster patterns in networks on journal articles during and after COVID-19: Bibliometric analysis.

BACKGROUND: Cluster analysis is vital in bibliometrics for deciphering large sets of academic data. However, no prior research has employed a cluster-pattern algorithm to assess the similarities and differences between 2 clusters in networks. The study goals are 2-fold: to create a cluster-pattern comparison algorithm tailored for bibliometric analysis and to apply this algorithm in presenting clusters of countries, institutes, departments, authors (CIDA), and keywords on journal articles during and after COVID-19. METHODS: We analyzed 9499 and 5943 articles from the Journal of Medicine (Baltimore) during and after COVID-19 in 2020 to 2021 and 2022 to 2023, sourced from the Web of Science (WoS) Core Collection. Follower-leading clustering algorithm (FLCA) was compared to other 8 counterparts in cluster validation and effectiveness and a cluster-pattern-comparison algorithm (CPCA) was developed using the similarity coefficient, collaborative maps, and thematic maps to evaluate CIDA cluster patterns. The similarity coefficients were categorized as identical, similar, dissimilar, or different for values above 0.7, between 0.5 and 0.7, between 0.3 and 0.5, and below 0.3, respectively. RESULTS: Both stages displayed similar trends in annual publications and average citations, although these trends are decreasing. The peak publication year was 2020. Similarity coefficients of cluster patterns in these 2 stages for CIDA entities and keywords were 0.73, 0.35, 0.80, 0.02, and 0.83, respectively, suggesting the existence of identical patterns (>0.70) in countries, departments, and keywords plus, but dissimilar (<0.5) and different patterns (<0.3) found in institutes and 1st and corresponding authors, during and after COVID-19. CONCLUSIONS: This research effectively created and utilized CPCA to analyze cluster patterns in bibliometrics. It underscores notable identical patterns in country-/department-/keyword based clusters, but dissimilar and different in institute-/author- based clusters, between these 2 stages during and after COVID-19, offering a framework for future bibliographic studies to compare cluster patterns beyond just the CIDA entities, as demonstrated in this study.

Evaluating the dependability of reference-driven citation forecasts amid the COVID-19 pandemic: A bibliometric analysis across diverse journals.

BACKGROUND: The journal impact factor significantly influences research publishing and funding decisions. With the surge in research due to COVID-19, this study investigates whether references remain reliable citation predictors during this period. METHODS: Four multidisciplinary journals (PLoS One, Medicine [Baltimore], J. Formos. Med. Assoc., and Eur. J. Med. Res.) were analyzed using the Web of Science database for 2020 to 2022 publications. The study employed descriptive, predictive, and diagnostic analytics, with tools such as 4-quadrant radar plots, univariate regressions, and country-based collaborative maps via the follower-leading cluster algorithm. RESULTS: Six countries dominated the top 20 affiliations: China, Japan, South Korea, Taiwan, Germany, and Brazil. References remained strong citation indicators during the COVID-19 period, except for Eur. J. Med. Res. due to its smaller sample size (n = 492) than other counterparts (i.e., 41,181, 12,793, and 1464). Three journals showed higher network density coefficients, suggesting a potential foundation for reference-based citation predictions. CONCLUSION: Despite variations among journals, references effectively predict article citations during the COVID-19 era, underlining the importance of network density. Future studies should delve deeper into the correlation between network density and citation prediction.

A comprehensive approach for clustering analysis using follower-leading clustering algorithm (FLCA): Bibliometric analysis.

BACKGROUND: There are 3 issues in bibliometrics that need to be addressed: The lack of a clear definition for author collaborations in cluster analysis that takes into account collaborations with and without self-connections; The need to develop a simple yet effective clustering algorithm for use in coword analysis, and; The inadequacy of general bibliometrics in regard to comparing research achievements and identifying articles that are worth reading and recommended for readers. The study aimed to put forth a clustering algorithm for cluster analysis (called following leader clustering [FLCA], a follower-leading clustering algorithm), examine the dissimilarities in cluster outcomes when considering collaborations with and without self-connections in cluster analysis, and demonstrate the application of the clustering algorithm in bibliometrics. METHODS: The study involved a search for articles and review articles published in JMIR Medical Informatics between 2016 and 2022, conducted using the Web of Science core collections. To identify author collaborations (ACs) and themes over the past 7 years, the study utilized the FLCA algorithm. With the 3 objectives of; Comparing the results obtained from scenarios with and without self-connections; Applying the FLCA algorithm in ACs and themes, and; Reporting the findings using traditional bibliometric approaches based on counts and citations, and all plots were created using R. RESULTS: The study found a significant difference in cluster outcomes between the 2 scenarios with and without self-connections, with a 53.8% overlap (14 out of the top 20 countries in ACs). The top clusters were led by Yonsei University in South Korea, Grang Luo from the US, and model in institutes, authors, and themes over the past 7 years. The top entities with the most publications in JMIR Medical Informatics were the United States, Yonsei University in South Korea, Medical School, and Grang Luo from the US. CONCLUSION: The FLCA algorithm proposed in this study offers researchers a comprehensive approach to exploring and comprehending the complex connections among authors or keywords. The study suggests that future research on ACs with cluster analysis should employ FLCA and R visualizations.

Emergence and dissemination of multidrug-resistant Escherichia coli ST8346 coharboring blaNDM-5 and blaOXA-181 in Southern Taiwan, 2017-2021.

BACKGROUND: Enterobacterales carrying blaNDM represent an emerging challenge in treating infectious diseases. In this study, we aimed to investigate the characteristics of blaNDM-producing Enterobacterales from three hospitals in southern Taiwan. METHODS: Enterobacterales strains that were nonsusceptible to more than one carbapenem (ertapenem, meropenem, imipenem, or doripenem) were collected from hospitalized patients. Molecular typing for New Delhi metallo-ß-lactamase (NDM) and antibiotic susceptibility tests were performed, followed by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and plasmid analysis by PCR-based replicon typing. RESULTS: A total of 1311 carbapenem-nonsusceptible Enterobacterales were isolated from 2017 to 2021. blaNDM-encoding genes were detected in 108 isolates, with 53 (49.1%) harboring blaNDM-1 and 55 (50.9%) harboring blaNDM-5. The rate of blaNDM-1 detection among isolates decreased to 2% in 2021. However, the rate of E. coli harboring blaNDM-5 increased from 1% to 12% of total isolates during the study period. Of 47 NDM-5-positive E. coli isolates, 44 (93.6%) were ST8346 with high genetic relatedness. E. coli ST8346 isolates showed high-level resistance to both carbapenems and aminoglycosides. Most (38 out of 47, 80.9%) blaNDM-5-harboring E. coli isolates co-harbored blaOXA-181. We analyzed the regions harboring blaNDM-5 in E. coli ST8346 via PCR amplification. blaNDM-5 and blaOXA-181 were located on two separate plasmids, IncF and IncX3, respectively. CONCLUSION: The dissemination of E. coli ST8346 caused an increase in blaNDM-5 and blaOXA-181 co-harboring Enterobacterales in southern Taiwan, which show high-level resistance to both carbapenems and aminoglycosides. We identified a distinct IncF plasmid encoding blaNDM-5 that has the potential for rapid spread and needs further surveillance.

Real-time artificial intelligence system for bacteremia prediction in adult febrile emergency department patients.

BACKGROUND: Artificial intelligence (AI) holds significant potential to be a valuable tool in healthcare. However, its application for predicting bacteremia among adult febrile patients in the emergency department (ED) remains unclear. Therefore, we conducted a study to provide clarity on this issue. METHODS: Adult febrile ED patients with blood cultures at Chi Mei Medical Center were divided into derivation (January 2017 to June 2019) and validation groups (July 2019 to December 2020). The derivation group was utilized to develop AI models using twenty-one feature variables and five algorithms to predict bacteremia. The performance of these models was compared with qSOFA score. The AI model with the highest area under the receiver operating characteristics curve (AUC) was chosen to implement the AI prediction system and tested on the validation group. RESULTS: The study included 5,647 febrile patients. In the derivation group, there were 3,369 patients with a mean age of 61.4 years, and 50.7% were female, including 508 (13.8%) with bacteremia. The model with the best AUC was built using the random forest algorithm (0.761), followed by logistic regression (0.755). All five models demonstrated better AUC than the qSOFA score (0.560). The random forest model was adopted to build a real-time AI prediction system integrated into the hospital information system, and the AUC achieved 0.709 in the validation group. CONCLUSION: The AI model shows promise to predict bacteremia in adult febrile ED patients; however, further external validation in different hospitals and populations is necessary to verify its effectiveness.

Analyzing author collaborations by developing a follower-leader clustering algorithm and identifying top co-authoring countries: Cluster analysis.

BACKGROUND: This study aimed to explore suitable clustering algorithms for author collaborations (ACs) in bibliometrics and investigate which countries frequently coauthored with others in recent years. To achieve this, the study developed a method called the Follower-Leading Clustering Algorithm (FLCA) and used it to analyze ACs and cowords in the Journal of Medicine (Baltimore) from 2020 to 2022. METHODS: This study extracted article metadata from the Web of Science and used the statistical software R to implement FLCA, enabling efficient and reproducible analysis of ACs and cowords in bibliometrics. To determine the countries that easily coauthored with other countries, the study observed the top 20 countries each year and visualized the results using network charts, heatmaps with dendrograms, and Venn diagrams. The study also used chord diagrams to demonstrate the use of FLCA on ACs and cowords in Medicine (Baltimore). RESULTS: The study observed 12,793 articles, including 5081, 4418, and 3294 in 2020, 2021, and 2022, respectively. The results showed that the FLCA algorithm can accurately identify clusters in bibliometrics, and the USA, China, South Korea, Japan, and Spain were the top 5 countries that commonly coauthored with others during 2020 and 2022. Furthermore, the study identified China, Sichuan University, and diagnosis as the leading entities in countries, institutes, and keywords based on ACs and cowords, respectively. The study highlights the advantages of using cluster analysis and visual displays to analyze ACs in Medicine (Baltimore) and their potential application to coword analysis. CONCLUSION: The proposed FLCA algorithm provides researchers with a comprehensive means to explore and understand the intricate connections between authors or keywords. Therefore, the study recommends the use of FLCA and visualizations with R for future research on ACs with cluster analysis.

The 10 top-cited authors who published papers in journal medicine since 2000 using the betweenness centrality to identify unique names: Bibliometric analysis.

BACKGROUND: Numerous studies have explored the most productive and influential authors in a specific field. However, 2 challenges arise when conducting such research. First, some authors may have identical names in the study data, and second, the contributions of coauthors may vary in the article by line, requiring consideration. Failure to address these issues may result in biased research findings. Our objective was to illustrate how the author-weighted scheme (AWS) and betweenness centrality (BC) can be employed to identify the 10 most frequently cited authors in a particular journal and analyze their research themes. METHODS: We collected 24,058 abstracts from the PubMed library between 2000 and 2020 using the keyword "Medicine [Journal]." Author names, countries/regions, and medical subject headings (MeSH terms) were collected. The AWS to identify the top 10 authors with a higher x-index was applied. To address the issue of authors with identical names affiliated with different research institutes, we utilized the BC method. Social network analysis (SNA) was conducted, and 10 major clusters were identified to highlight authors with a higher x-index within the corresponding clusters. We utilized SNA to analyze the MeSH terms from articles of the 10 top-cited authors to identify their research themes. RESULTS: Our findings revealed the following: within the top 10 cited authors, 2 authors from China shared identical names with Jing Li and Tao-Wang; JA Winkelstein from Maryland (US) had the highest x-index (15.58); Chia-Hung Kao from Taiwan was the most prolific author, having published 115 articles in Medicine since 2003; and the 3 primary research themes, namely, complications, etiology, and epidemiology, were identified using MeSH terms from the 10 most frequently cited authors. CONCLUSIONS: Using AWS and BC, we identified the top 10 most cited authors. The research methods we utilized in this study (BC and AWS) have the potential to be applied to other bibliometric analyses in the future.

Assessing ChatGPT's capacity for clinical decision support in pediatrics: A comparative study with pediatricians using KIDMAP of Rasch analysis.

BACKGROUND: The application of large language models in clinical decision support (CDS) is an area that warrants further investigation. ChatGPT, a prominent large language models developed by OpenAI, has shown promising performance across various domains. However, there is limited research evaluating its use specifically in pediatric clinical decision-making. This study aimed to assess ChatGPT's potential as a CDS tool in pediatrics by evCDSaluating its performance on 8 common clinical symptom prompts. Study objectives were to answer the 2 research questions: the ChatGPT's overall grade in a range from A (high) to E (low) compared to a normal sample and the difference in assessment of ChatGPT between 2 pediatricians. METHODS: We compared ChatGPT's responses to 8 items related to clinical symptoms commonly encountered by pediatricians. Two pediatricians independently assessed the answers provided by ChatGPT in an open-ended format. The scoring system ranged from 0 to 100, which was then transformed into 5 ordinal categories. We simulated 300 virtual students with a normal distribution to provide scores on items based on Rasch rating scale model and their difficulties in a range between -2 to 2.5 logits. Two visual presentations (Wright map and KIDMAP) were generated to answer the 2 research questions outlined in the objectives of the study. RESULTS: The 2 pediatricians' assessments indicated that ChatGPT's overall performance corresponded to a grade of C in a range from A to E, with average scores of -0.89 logits and 0.90 logits (=log odds), respectively. The assessments revealed a significant difference in performance between the 2 pediatricians (P < .05), with scores of -0.89 (SE = 0.37) and 0.90 (SE = 0.41) in log odds units (logits in Rasch analysis). CONCLUSION: This study demonstrates the feasibility of utilizing ChatGPT as a CDS tool for patients presenting with common pediatric symptoms. The findings suggest that ChatGPT has the potential to enhance clinical workflow and aid in responsible clinical decision-making. Further exploration and refinement of ChatGPT's capabilities in pediatric care can potentially contribute to improved healthcare outcomes and patient management.

A leading author of meta-analysis does not have a dominant contribution to research based on the CJAL score: Bibliometric analysis.

BACKGROUND: There have been nearly 200 thousand meta-analysis articles indexed by web of science (WoS) since 2013. To date, a bibliometric analysis of leading authors of meta-analyses that contribute to the field has not been conducted. Analyzing trend patterns in article citations and comparing individual research achievements (IRAs) are required following the extraction of meta-analysis articles. Using trend analysis, this study aims to verify the hypotheses that; The leading author has a dominant research achievement and; Recent articles that deserve worth reading can be identified. METHODS: In the WoS collection, we identified the top 20 authors with the most articles related to meta-analysis. Using coword analysis, 2882 articles were collected to cluster author collaborations and identify the top 3 authors with the highest weighted centrality degrees. Based on the CJAL (category, journal raking by impact factor, authorship, and L-index on article citation) score and absolute advantage coefficient (AAC), we compared the IRAs and identified the author who dominated the field significantly beyond the next 2 authors. In WoS collection, coword analysis was used to highlight the characteristics of research domains for the top authors contributing to meta-analyses. The selection of articles that deserve reading is based on a temporal heatmap. RESULTS: The top 2 authors were Young-Ho Lee (South Korea), Patompong Ungprasert (U.S.), and Brendon Stubbs (US) with CJAL scores of 240.71, 230.99, and 240.71, respectively. Based on the weak dominance coefficient (AAC = 0.49 < 0.50), it is evident that the leading meta-analysis author does not possess a significant dominant position over the next 2 leading authors in IRAs. Coword analysis was used to illustrate the characteristics of the 3 authors research domains. The 3 articles worth reading were selected based on a trend analysis of the last 4 years using the temporal heatmap. CONCLUSION: A coword analysis of meta-analysis studies identified 3 leading authors. There was no evidence that 1 author possessed a dominant position due to the lower AAC (=0.49 < 0.50) for the leading author. As we have demonstrated in this study, the CJAL score and the AAC can be applied to many bibliographical studies in the future.

The ascendancy of research in acronyms related to COVID-19 displayed on a growth-share matrix (GSM): Bibliometric analysis.

BACKGROUND: The acronym COVID, which stands for coronavirus disease, has become one of the most infamous acronyms in the world since 2020. An analysis of acronyms in health and medical journals has previously found that acronyms have become more common in titles and abstracts over time (e.g., DNA and human immunodeficiency virus are the most common acronyms). However, the trends in acronyms related to COVID remain unclear. It is necessary to verify whether the dramatic rise in COVID-related research can be observed by visualizations. The purpose of this study was to display the acronym trends in comparison through the use of temporal graphs and to verify that the COVID acronym has a significant edge over the other 2 in terms of research dominance. METHODS: An analysis of the 30 most frequently used acronyms related to COVID in PubMed since 1950 was carried out using 4 graphs to conduct this bibliometric analysis, including line charts, temporal bar graphs (TBGs), temporal heatmaps (THM), and growth-share matrices (GSM). The absolute advantage coefficient (AAC) was used to measure the dominance strength for COVID acronym since 2020. COVID's AAC trend was expected to decline over time. RESULTS: This study found that COVID, DNA, and human immunodeficiency virus have been the most frequently observed research acronyms since 2020, followed by computed tomography and World Health Organization; although there is no ideal method for displaying acronym trends over time, researchers can utilize the GSM to complement traditional line charts, TBGs, and THMs, as shown in this study; and COVID has a significant edge over the other 2 in terms of research dominance by ACC (≥0.67), but COVID's AAC trend has declined (e.g., AACs 0.83, 0.80, and 0.69) since 2020. CONCLUSIONS: It is recommended that the GSM complement traditional line charts, TBGs, and THMs in trend analysis, rather than being restricted to acronyms in future research. This research provides readers with the AAC to understand how research dominates its counterparts, which will be useful for future bibliometric analyses.

Detecting dengue fever in children using online Rasch analysis to develop algorithms for parents: An APP development and usability study.

BACKGROUND: Dengue fever (DF) is a significant public health concern in Asia. However, detecting the disease using traditional dichotomous criteria (i.e., absent vs present) can be extremely difficult. Convolutional neural networks (CNNs) and artificial neural networks (ANNs), due to their use of a large number of parameters for modeling, have shown the potential to improve prediction accuracy (ACC). To date, there has been no research conducted to understand item features and responses using online Rasch analysis. To verify the hypothesis that a combination of CNN, ANN, K-nearest-neighbor algorithm (KNN), and logistic regression (LR) can improve the ACC of DF prediction for children, further research is required. METHODS: We extracted 19 feature variables related to DF symptoms from 177 pediatric patients, of whom 69 were diagnosed with DF. Using the RaschOnline technique for Rasch analysis, we examined 11 variables for their statistical significance in predicting the risk of DF. Based on 2 sets of data, 1 for training (80%) and the other for testing (20%), we calculated the prediction ACC by comparing the areas under the receiver operating characteristic curve (AUCs) between DF + and DF- in both sets. In the training set, we compared 2 scenarios: the combined scheme and individual algorithms. RESULTS: Our findings indicate that visual displays of DF data are easily interpreted using Rasch analysis; the k-nearest neighbors algorithm has a lower AUC (<0.50); LR has a relatively higher AUC (0.70); all 3 algorithms have an almost equal AUC (=0.68), which is smaller than the individual algorithms of Naive Bayes, LR in raw data, and Naive Bayes in normalized data; and we developed an app to assist parents in detecting DF in children during the dengue season. CONCLUSION: The development of an LR-based APP for the detection of DF in children has been completed. To help patients, family members, and clinicians differentiate DF from other febrile illnesses at an early stage, an 11-item model is proposed for developing the APP.

The model of descriptive, diagnostic, predictive, and prescriptive analytics on 100 top-cited articles of nasopharyngeal carcinoma from 2013 to 2022: Bibliometric analysis.

BACKGROUND: Nasopharyngeal carcinomas (NPCs) are prevalent in southeast Asia. There is a need to systematically review the current trend and status of NPC research. However, most bibliometric analyses have tended to focus on descriptive and diagnostic analytics rather than predictive and prescriptive analyses. Thus, it is necessary to use the model of the 4 (called the descriptive, diagnostic, predictive, and prescriptive analytics [DDPP]) to derive insights from the data. This study aimed to apply the DDPP model to classify article themes and illustrate the characteristics of NPCs; compare NPC researcher achievements across countries, institutes, departments, and authors; determine whether the mean citations of keywords can be used to predict article citations; and highlight articles that are worthy of reading. METHODS: The Web of Science Core Collection was searched for 100 top-cited articles and reviews related to NPCs published between 2013 and 2022. As part of Microsoft Office Excel 2019, Visual Basic for Applications was used to illustrate the number of publications and scientific productivity of authors over time and to generate network/temporal heatmaps, chord/Sankey diagrams, radar/impact beam plots, and scatter/pyramid charts about collaborations among countries. The DDPP model identifies institutions, authors, and hotspots of NPC research. The category, journal, authorship, and L-index (CJAL) score was applied to evaluate individual research achievements. RESULTS: A total of 10,564 publications were extracted from Web of Science Core Collection and screened for 100 top-cited articles and reviews related to NPCs. Despite having the highest number of publications (36%), China lags slightly behind the US in CJAL scores. CJAL was higher at Sun Yat-Sen University, Radiat Oncol department, and author Jun Ma from China. The number of article citations was significantly correlated with the number of weighted keywords (F = 1791.17; P < .0001). Six articles with significantly increasing citations over the last 4 years were recommended. CONCLUSION: This bibliometric study utilizes the DDPP model to analyze the scientific progress of NPC over the past decade. The whole genome is a hot topic that may prove to be a promising research area in the future. A temporal heatmap may serve as a tool for providing readers with articles that are worth reading, which could lead to additional research in bibliometrics.

Using chord diagrams to explore article themes in 100 top-cited articles citing Hirsch's h-index since 2005: A bibliometric analysis.

BACKGROUND: The h-index is increasingly being used as a measure of individual research achievement (IRA). More than 4876 citing articles have been published and indexed in Web of Science. The articles citing the h-index that have made the greatest contribution to scientific academics are still unknown. It is also unclear which subject categories (SCs) can be classified based on their keywords. METHODS: These 4976 citing articles have been collected from the Web of Science since 2005. SCs were classified using chord diagrams to visualize their associations of SCs and documents in 100 top-cited articles (T100hciting). In addition to chord diagrams, 6 visualizations were used to illustrate study results: choropleth maps were used to depict the geographical distribution of publications across countries, network diagrams were created by using coword analysis, box plots were created to complement the network diagrams, Sankey diagrams highlighted the 5 most important elements in each article entity, the dot plot was used for displaying T100hciting, and a radar plot was used to present the top 10 high-IRA elements of countries, institutes, departments, and authors based on category, journal impact factor, authorship, and L-index scores. RESULTS: A coword cluster analysis indicates that the majority of articles come from the US (918, 18%) and China (603, 12%), the top 2 SCs are h-index and bibliometric analysis, and the top 5 countries account for 55% in T100hciting, such as the US (25%), Spain (10%), Netherlands (9%), China (6%), and Belgium (5%). In T100hciting, 4 SCs are included, namely, the h-index (72%), bibliometric analysis (24%), physics & multidisciplinary (3%), and infectious diseases (1%). CONCLUSION: A total of 7 visualizations were used to display the results in this study. Chord diagrams are suggested as a tool for future bibliographical studies to classify SCs Future bibliometrics with chord diagrams should not be limited to the topic of h-index-citing articles, as we did in this study.

Circulating pediatric respiratory pathogens in Taiwan during 2020: Dynamic change under low COVID-19 incidence.

BACKGROUND: In Taiwan, there were only 799 confirmed COVID-19 cases in 2020. The unique backdrop amidst a pandemic and promotion of nonpharmaceutical interventions generated some distinct changes in the epidemiology of common respiratory pathogens. In this study, we aimed to investigate the dynamic changes in respiratory pathogens in children during 2020. METHODS: We performed a retrospective cohort study at a tertiary hospital in southern Taiwan during 2020. Patients aged 0-18 years who visited the pediatric emergency department were enrolled. Children who presented with clinical symptoms (fever or respiratory illness) and received nasopharyngeal swabs for multiplex polymerase chain reaction (PCR) were included in our analysis. We also compared respiratory syncytial virus (RSV) trends from previous years by PCR and lateral flow immunochromatographic assays from 2017 to 2020. RESULTS: A total of 120 children were tested. The overall detection rate was 55%. With strengthened restrictions, the detection rate dropped from 70% to 30%. However, non-enveloped viruses (rhinovirus/enterovirus and adenovirus) were in constant circulation. Upon easing prevention measures, the detection rate remained above 60%, and an outbreak of an enveloped virus (RSV and parainfluenza virus) was noted. Compared with 2017-2019, the cyclical RSV epidemic was delayed, with a large surge in late 2020. CONCLUSIONS: We observed a constant circulation of non-enveloped viruses when strict nonpharmaceutical interventions were employed and a delayed surge of enveloped viruses during the easing of restrictions. Continuous surveillance and monitoring of the evolutionary dynamics of respiratory viruses is important, while easing restrictions requires balanced judgment.

Suggestions to the article: demonstrating the ascendancy of COVID-19 research using acronyms.

The article published on 16 May 2021 is interesting and impressive, particularly on the Figure displaying several acronyms in trend. Although the most popular eight acronyms in 2019 and 2020 are individually highlighted and labeled, how to determine the points in 2019 and 2020 is required for classifications. The analysis for the evolution of keywords is common and necessary in the bibliographic study. None of the studies addressed the determination of the bursting point for a given keyword over the years. We aim to illustrate the way to determine the inflection point on a given ogive curve and apply the temporal bar graph (TBG) to interpret the trend of a specific keyword (or acronym). The prediction model is based on item response theory, commonly used in educational and psychometric fields. The eight acronyms presented in the previous study were demonstrated using the TBG. We found that the TBG includes more valuable information than the traditional trend charts. The inflection point denoted the topic burst indicates the turning point suddenly from increasing to decreasing. The TBG combined with the inflection point to represent the trend of a given keyword can make the data in trend easier and clearer to understand than any graph used in ever before bibliometric analyses.

Anti-Tn Monoclonal Antibody Ameliorates Hyperoxia-Induced Kidney Injury by Suppressing Oxidative Stress and Inflammation in Neonatal Mice.

The Tn antigen, an N-acetylgalactosamine structure linked to serine or threonine, has been shown to induce high-specificity, high-affinity anti-Tn antibodies in mice. Maternal immunization with the Tn vaccine increases serum anti-Tn antibody titers and attenuates hyperoxia-induced kidney injury in neonatal rats. However, immunizing mothers to treat neonatal kidney disease is clinically impractical. This study is aimed at determining whether anti-Tn monoclonal antibody treatment ameliorates hyperoxia-induced kidney injury in neonatal mice. Newborn BALB/c mice were exposed to room air (RA) or normobaric hyperoxia (85% O2) for 1 week. On postnatal days 2, 4, and 6, the mice were injected intraperitoneally with PBS alone or with anti-Tn monoclonal antibodies at 25 µg/g body weight in 50 µL phosphate-buffered saline (PBS). The mice were divided into four study groups: RA + PBS, RA + anti-Tn monoclonal antibody, O2 + PBS, and O2 + anti-Tn monoclonal antibody. The kidneys were excised for histology, oxidative stress, cytokine, and Western blot analyses on postnatal day 7. The O2 + PBS mice exhibited significantly higher kidney injury scores, 8-hydroxy-2'-deoxyguanosine (8-OHdG) and nuclear factor-κB (NF-κB) expression, and cytokine levels than did the RA + PBS mice or RA + anti-Tn mice. Anti-Tn monoclonal antibody treatment reduced kidney injury and cytokine levels to normoxic levels. The attenuation of kidney injury was accompanied by a reduction of oxidative stress and NF-κB expression. Therefore, we propose that anti-Tn monoclonal antibody treatment ameliorates hyperoxia-induced kidney injury by suppressing oxidative stress and inflammation in neonatal mice.

Development of the Computerized Adaptive Test of Motor Development (MD-CAT) Adopting Multidimensional Rasch Analysis.

OBJECTIVE: This study aimed to develop the Computerized Adaptive Test of Motor Development (MD-CAT) in preschool children based on multidimensional Rasch analysis. DESIGN: A retrospective study with cross-sectional design. SETTING: A medical center. PARTICIPANTS: A total of 1738 children (N=1738). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: MD-CAT. RESULTS: Multidimensional Rasch analysis was used to develop the item bank of the MD-CAT. The item bank of the MD-CAT contained 74 items, with 44 and 30 items, respectively, for the subscales of gross and fine motor skills. High correlation existed between the 2 subscales (r=0.96). Three stopping rules were set for the MD-CAT: (1) the person reliability achieved 0.95 or the limited reliability increase by <0.01; (2) at least 3 items were assessed in each dimension; and (3) the number of items used for assessment reached 16. Based on the 3 stopping rules, the MD-CAT had high correlations with its total test length (r=0.87-0.98 for the 2 dimensions), indicating sufficient construct validity. The MD-CAT also had adequate diagnostic validity (area under the curve=0.72-0.93) and efficiency (an average of 3-6 items used for the assessment). CONCLUSIONS: The MD-CAT has high precision and efficiency, good construct validity, and high diagnostic validity. The results of our study indicate that the MD-CAT can be useful in clinical practice and in research as a diagnostic measure.

Longer length of post-acute care stay causes greater functional improvements in poststroke patients.

ABSTRACT: Post-acute care (PAC) is a type of transitional care for poststroke patients after the acute medical stage; it offers a relatively intensive rehabilitative program. Under Taiwan's National Health Insurance guidelines, the only patients who can transfer to PAC institutions are those who have had an acute stroke in the previous month, are in a relatively stable medical condition, and have the potential for improvement after aggressive rehabilitation. Poststroke patients receive physical, occupational, and speech therapy in PAC facility. However, few studies have evaluated the effects of PAC in poststroke patients since PAC's initiation in Taiwan. Thus, this study aims to investigate whether the length of stay in a PAC institution correlates with patients' improvements.This retrospective and single-center study in Taiwan enrolled 193 poststroke patients who had received acute care at Chi-Mei Medical Center, Taiwan, at any period between 2014 and 2017. Data on their length of stay in the PAC institution were collected. Poststroke patients' functional ability-such as activities of daily living (ADL) function and swallowing ability-as well as their corresponding scales were assessed on the first and last day of PAC stay. Statistical analysis was conducted by SPSS version 21.0 .The average duration of PAC stay was 35.01 ±â€Š16.373 days. Duration of PAC stay was significantly positively correlated with the Barthel index (P < .001), Berg balance test score (P < .001), gait speed (P = .002), and upper sensory function and upper motor function within the Fugl-Meyer Assessment (both P < .001).Poststroke patients with longer stay in a PAC institution had superior ADL function, balance and coordination, walking speed, and upper-limb dexterity and sensory function.

Streptococcus gallolyticus - A potentially neglected pathogen causing neonatal sepsis not covered by routine group B streptococcus screening.

We report 4 cases of neonatal sepsis caused by Streptococcus gallolyticus. The clinical course was quite similar to early-and late-onset group B streptococcus disease. None of the mothers had group B streptococcus (GBS) colonization on prenatal screening nor received intrapartum antibiotics. We proposed the sporadic distribution of S. gallolyticus sepsis among neonates was partly due to relatively low colonization rate in adults compared with GBS. Species determination of S. gallolyticus may not be available using conventional microbiological methods and may contribute to underestimation or misclassification. In our series, we highlighted the importance of S. gallolyticus as an important pathogen in neonatal sepsis deserving further surveillance.