Using meta-learning to recommend an appropriate time-series forecasting model.

BACKGROUND: There are various forecasting algorithms available for univariate time series, ranging from simple to sophisticated and computational. In practice, selecting the most appropriate algorithm can be difficult, because there are too many algorithms. Although expert knowledge is required to make an informed decision, sometimes it is not feasible due to the lack of such resources as time, money, and manpower. METHODS: In this study, we used coronavirus disease 2019 (COVID-19) data, including the absolute numbers of confirmed, death and recovered cases per day in 187 countries from February 20, 2020, to May 25, 2021. Two popular forecasting models, including Auto-Regressive Integrated Moving Average (ARIMA) and exponential smoothing state-space model with Trigonometric seasonality, Box-Cox transformation, ARMA errors, Trend, and Seasonal components (TBATS) were used to forecast the data. Moreover, the data were evaluated by the root mean squared error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE), and symmetric mean absolute percentage error (SMAPE) criteria to label time series. The various characteristics of each time series based on the univariate time series structure were extracted as meta-features. After that, three machine-learning classification algorithms, including support vector machine (SVM), decision tree (DT), random forest (RF), and artificial neural network (ANN) were used as meta-learners to recommend an appropriate forecasting model. RESULTS: The finding of the study showed that the DT model had a better performance in the classification of time series. The accuracy of DT in the training and testing phases was 87.50% and 82.50%, respectively. The sensitivity of the DT algorithm in the training phase was 86.58% and its specificity was 88.46%. Moreover, the sensitivity and specificity of the DT algorithm in the testing phase were 73.33% and 88%, respectively. CONCLUSION: In general, the meta-learning approach was able to predict the appropriate forecasting model (ARIMA and TBATS) based on some time series features. Considering some characteristics of the desired COVID-19 time series, the ARIMA or TBATS forecasting model might be recommended to forecast the death, confirmed, and recovered trend cases of COVID-19 by the DT model.

Epidemiological features, antimicrobial resistance profile and clinical outcomes of healthcare-associated infections in Islamic Republic of Iran.

Background: Healthcare-associated infections are a major cause of mortality worldwide, especially in intensive care units where severely ill patients have limited physical space. Aims: To investigate the incidence, microbial aetiology, antimicrobial resistance profile, and mortality rate of healthcare-associated infections in intensive care units in the Islamic Republic of Iran. Methods: This observational study retrospectively reviewed the medical records of 1722 intensive care units patients with confirmed healthcare-associated infections at hospitals affiliated with Mashhad University of Medical Sciences in 2017-2019. Data was analysed using SPSS for Windows version 11. Categorical variables were described using frequency and percentage, whereas continuous variables were defined using mean (standard deviation) with 95% confidence interval (CI) for precision. Logistic regression analysis was used to estimate crude odds ratio (OR) and adjusted OR (AOR) with 95% CI, and to identify univariate and multivariate predictors of healthcare-associated infection mortality. Results: In total, 4077 pathogens were isolated, yielding a healthcare-associated infection incidence rate of 22.1%. The most common microorganisms were Acinetobacter spp. (25.0%), Klebsiella spp. (15.1%), Staphylococcus spp. (14.0%), and Candida spp. (12.3%). Ventilator-associated events (39.5%), urinary tract infections (22.7%), and bloodstream infections (14.8%) were the main types of infection. Comorbidities, skin and soft tissue infections, and infections with Acinetobacter spp., Klebsiella spp., Pseudomonas spp., and Candida spp. were significantly associated with higher mortality among intensive care unit patients. Gram-positive bacteria were most resistant to ciprofloxacin (49.2%), clindamycin (38.0%), and erythromycin (37.1%). Gram-negative bacteria were most resistant to ceftazidime (71.0%), ciprofloxacin (65.2%), and cefotaxime (60.5%). The overall mortality rate was 45.2%. Conclusion: Healthcare-associated infections in nearly half of intensive care unit patients were fatal, especially when caused by Acinetobacter spp., Klebsiella spp., Pseudomonas spp., or Candida spp. Therefore, effective strategies must be implemented to combat antibiotic-resistant bacteria, along with stricter adherence to infection control programmes.

Prediction of serum anti-HSP27 antibody titers changes using a light gradient boosting machine (LightGBM) technique.

Previous studies have proposed that heat shock proteins 27 (HSP27) and its anti-HSP27 antibody titers may play a crucial role in several diseases including cardiovascular disease. However, available studies has been used simple analytical methods. This study aimed to determine the factors that associate serum anti-HSP27 antibody titers using ensemble machine learning methods and to demonstrate the magnitude and direction of the predictors using PFI and SHAP methods. The study employed Python 3 to apply various machine learning models, including LightGBM, CatBoost, XGBoost, AdaBoost, SVR, MLP, and MLR. The best models were selected using model evaluation metrics during the K-Fold cross-validation strategy. The LightGBM model (with RMSE: 0.1900 ± 0.0124; MAE: 0.1471 ± 0.0044; MAPE: 0.8027 ± 0.064 as the mean ± sd) and the SHAP method revealed that several factors, including pro-oxidant-antioxidant balance (PAB), physical activity level (PAL), platelet distribution width, mid-upper arm circumference, systolic blood pressure, age, red cell distribution width, waist-to-hip ratio, neutrophils to lymphocytes ratio, platelet count, serum glucose, serum cholesterol, red blood cells were associated with anti-HSP27, respectively. The study found that PAB and PAL were strongly associated with serum anti-HSP27 antibody titers, indicating a direct and indirect relationship, respectively. These findings can help improve our understanding of the factors that determine anti-HSP27 antibody titers and their potential role in disease development.

Laparoscopic splenectomy in patients with idiopathic thrombocytopenic purpura and very low platelet count.

Background: Chronic idiopathic thrombocytopenic purpura (ITP), is an autoimmune disease associated with a reduction in circulating blood platelets under 150±109g/L which persists longer than 6 months without any specific cause. With the current study, we aimed to evaluate the efficacy and safety of laparoscopic splenectomy in ITP patients with a very low platelet count and normal coagulation status. Methods: From April 2007 to January 2012, laparoscopic splenectomy was performed on 60 patients with chronic ITP who could not achieve a sustained recovery after steroid therapy. Results: Patients consisted of male/female ratio of 24 (40%):36 (60%) with the mean age of 53±15.1 years. All patients had normal coagulation state even with very low platelet count (below 5×103) before laparoscopic splenectomy. The mean operative time was 140.00±15.00 minutes. Blood transfusion was required in 10 (16.7%) and 8 (13.3%) patients before and after the operation, respectively. Preoperative transfusion of PRBC was not statistically significant between groups (P=0.265). Bleeding complications during within or after surgery was rare (5.0%). Convalescence was rapid and the mean hospital stay was 3.58±0.68 days (1-14 days) which shows that there was no significant difference in operative time and after operative hospitalization time among the three groups (P=0.070). The patients made a good uneventful recovery and were followed for at least one week who exhibited no postoperative problems. Conclusion: Laparoscopic splenectomy should be considered initially in the management of ITP. Also, very low platelet count should not be contraindicated for laparoscopic splenectomy in ITP patients and sometimes perioperative platelet transfusion may be unnecessary.

Transhiatal versus transthoracic esophagectomy for esophageal SCC: outcomes and complications.

BACKGROUND: Transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) are both accepted procedures for esophageal cancer but still the most effective surgical approach continues to be controversial. This study aimed to determine post-operative complications and outcomes of TTE compared with THE. METHODS: A retrospective analysis was performed on data of 243 adult patients with resectable esophageal cancer who underwent THE or TTE between December 2016 and October 2018. Demographic data, consisting of preoperative co-morbidities, disease stage, and perioperative morbidity and mortality were collected. RESULTS: Among the patients, 99 individuals (40.7%) had a transhiatal resection and 144 (59.3%) had a transthoracic resection. Most patients (83.1%) were above 50 years old with no significant difference between groups (p = 0.297). The frequency distribution of comorbidities was similar in both groups. The most common site of the tumor in TTE group was middle esophagus and in THE group was lower esophagus. The most common complication was recurrence of dysphagia which was more common in THE group without significant difference. The other complications including pulmonary and cardiac events, tracheal and recurrent laryngeal nerve injury, chylothorax and anastomosis stricture did not differ between the groups. The operative mortality within 30 days after the operation was 2.8% with significant difference favored the THE group (THE 0%, TTE 5.2%, p = 0.033). CONCLUSION: Because of the controversies, the decision on the type of surgical technique in esophageal cancer treatment hinges on patient's co-morbidities, cancer stage, tumor location and surgeon's experience.

Performing Soccer-Specific Training With Blood Flow Restriction Enhances Physical Capacities in Youth Soccer Players.

ABSTRACT: Hosseini Kakhak, SA, Kianigul, M, Haghighi, AH, Nooghabi, MJ, and Scott, BR. Performing soccer-specific training with blood flow restriction enhances physical capacities in youth soccer players. J Strength Cond Res 36(7): 1972-1977, 2022-This study investigated the effect of soccer training with blood flow restriction (BFR) on physical performance in youth athletes. Nineteen semiprofessional soccer players were randomly assigned to either normal soccer training (ST; n = 9) or soccer training with BFR (STBFR; n = 10). Both groups performed identical activities during a 6-week preseason training phase, either with or without lower limb BFR. Training included soccer-specific drills, small-sided games, plyometrics, and continuous running. Before and after the intervention, players were assessed for leg extension strength and endurance, countermovement jump performance, 40-yd sprint time, change-of-direction (COD) ability, aerobic endurance, and soccer-specific endurance (while dribbling a ball). Significantly larger improvements were observed in the STBFR compared with the ST group for tests of muscular endurance (74.8 ± 34.1% vs. 4.0 ± 14.6%), COD (8.1 ± 3.7% vs. 2.8 ± 4.7%), and aerobic (54.1 ± 19.6% vs. 24.7 ± 27.2%) and soccer-specific endurance (58.4 ± 19.6% vs. 22.7 ± 10.2%). Main effects for time were observed for maximal strength, jumping, and sprinting performance (p < 0.001) but with no group and time interaction. These findings demonstrate that team sport training with BFR can enhance physical qualities that are related to performance in youth soccer players. This application of BFR may improve the adaptive responses of muscles, without having to dedicate additional training time to muscular qualities.

Expression and Prognostic Significance of Cancer/Testis Antigens, MAGE-E1, GAGE, and SOX-6, in Glioblastoma: An Immunohistochemistry Evaluation.

BACKGROUND & OBJECTIVE: Glioblastoma is the most common primary malignancy of the brain, the prognosis of which is poor. Immunotherapy with cancer/testis (CT) antigens is a novel therapeutic approach for glioblastoma. This study aimed to investigate the expression rate of MAGE-E1, GAGE, and SOX-6 in glioblastoma tumors using the method of immunohistochemistry (IHC). METHODS: Expression of MAGE-E1, GAGE, and SOX-6 were determined by IHC in 50 paraffin blocks of glioblastoma. The results were compared between variables including age, gender, tumor location, and Karnofsky performance status (Kps) score. Survival analysis was also performed. RESULTS: The expression levels of SOX-6, MAGE-E1, and GAGE were 82%, 78%, and 76%, respectively. The relationship between CT antigens and age, gender, and tumor location was not significant, while the association between MAGE-E1 expression and age was statistically significant (P=0.002). High expression levels of SOX-6 and MAGE-E1 were associated with low Kps scores (P=0.034 and P<0.001, respectively). Survival analysis showed that age >40 and Kps score <80 were associated with significant relationship with shorter survival rate. (P=0.005 and P=0.018, respectively). Expression of MAGE-E1 and GAGE was negatively associated with overall 2-year survival rate (P=0.001 and P=0.021, respectively). CONCLUSION: The expression of all the three CT antigens, especially MAGE-E1 and SOX-6, was high in patients with glioblastoma. It can be concluded that these markers could be ideal targets for immunotherapy in such patients. MAGE-E1 and SOX-6 can be considered as important markers in determining the prognosis of glioblastoma.

Comparison of the Effect of Tea Tree Oil Shampoo With Regular Eyelid Shampoo in Meibomian Gland Dysfunction Treatment.

PURPOSE: This study is aimed at comparing the effects of tea tree oil (TTO) shampoo with regular eyelid shampoo on the treatment of meibomian gland dysfunction (MGD) signs and symptoms. DESIGN: Double-masked randomized clinical trial METHODOLOGY: Forty patients with MGD were treated by daily eyelid scrubbing with TTO shampoo in one eye and regular eyelid shampoo in the other one. Before treatment and then after 1 and 3 months, the effect on ocular surface symptoms, tear production and stability, and conjunctival and eyelid signs of the 2 eyes were compared. RESULTS: Plugging and capping of meibomian gland orifices, foamy tear, glands expressibility, 5-Item Dry Eye Questionnaire score (DEQ5), and tear breakup time were improved more significantly in TTO shampoo-treated eyes (capping P = .050, plugging and glands expressibility P = .001, others P < .001). In spite of improvement in both eyes, scores of meibum quality, conjunctival hyperemia, corneal and conjunctival staining, and Schirmer1 test value showed no statistically significant difference between the eyes (P = .06, .187, .192, .19, respectively). Moreover, eyelid margin telangiectasia resolved only in TTO shampoo-treated eyes (P < .001). Trichiasis and distichiasis changed in neither group (P > .99). Furthermore, ocular surface irritation during scrubbing was more common with TTO shampoo (P = .002). CONCLUSION: TTO shampoo was found to be more efficient than regular eyelid shampoo in controlling MGD signs and symptoms although ocular surface irritation during its application was more frequent.

Modeling and forecasting number of confirmed and death caused COVID-19 in IRAN: A comparison of time series forecasting methods.

BACKGROUND: The COVID-19 pandemic conditions are still prevalent in Iran and other countries and the monitoring system is gradually discovering new cases every day. Therefore, it is a cause for concern around the world, and forecasting the number of future patients and death cases, although not entirely accurate, helps the governments and health-policy makers to make the necessary decisions and impose restrictions to reduce prevalence. METHODS: In this study, we aimed to find the best model for forecasting the number of confirmed and death cases in Iran. For this purpose, we applied nine models including NNETAR, ARIMA, Hybrid, Holt-Winter, BSTS, TBATS, Prophet, MLP, and ELM network models. The quality of forecasting models is evaluated by three performance metrics, RMSE, MAE, and MAPE. The best model is selected by the lowest value of performance metrics. Then, the number of confirmed and the death cases forecasted for the 30 next days. The used data in this study is the absolute number of confirmed, death cases from February 20 to August 15, 2020. RESULTS: Our findings suggested that based on existing data in Iran, the suitable model with the lowest performance metrics for confirmed cases data obtained MLP network and the Holt-Winter model is the suitable model for forecasting death cases in the future. These models forecasted on September 14, 2020, we will have 2484 new confirmed and 114 new death cases of COVID-19. CONCLUSION: According to the results of this study and the existing data, we concluded that the MLP and Holt-Winter models had the lowest error in forecasting in comparison to other methods. Some models had fitted poorly in the test phase and this is because many other factors that are either not available or have been ignored in this study and can affect the accuracy of forecast results. Based on the trend of data and forecast results, the number of confirmed cases and death cases are almost constant and decreasing, respectively. However, due to disease progression and ignoring the recommendations and protocols of the Ministry of health, there is a possibility of re-emerging this disease more seriously in Iran and this requires more preventive care.

Sentinel lymph node mapping in colorectal cancers with radioactive tracer; is it an efficient method?

CONTEXT: The sentinel lymph nodes (SLNs), as most other regions, are prone to tumoral invasion. In colorectal cancers, they can help the higher levels of pathological examination techniques. AIMS: We attempted to investigate the efficiency of the use of radioactive tracer in identifying SLNs in colorectal cancers using the same pathological technique. SETTINGS AND DESIGN: This cross-sectional, single-center study was carried out from 2014 to august 2016 at Mashhad University of Medical Sciences. SUBJECTS AND METHODS: The study population included 100 patients with colorectal cancers. We used a radioactive tracer to detect SLNs and to compare the number and involvement of SLNs and non-SLNs generally and in terms of the tumor site. For pathological study, we used the same conventional method in both the groups. STATISTICAL ANALYSIS USED: Statistical analysis was performed using SPSS 22.0 software (IBM Corp., Armonk, NY, USA) with Chi-square and Fisher's exact test, Student's t-test, ANOVA test, Mann-Whitney U-test, and Kruskal-Wallis test. RESULTS: SLNs were detected in 89 of 100 patients. All the remaining 11 patients had T4 lower rectal cancer and the injection was performed ex vivo. We noted ten cases of upstaging due to SLN mapping and nine cases of false negative. Thus, the sensitivity was found to be 43.75%at and the accuracy was 78.65%. CONCLUSIONS: We used the same traditional method in both the groups, and our sensitivity, accuracy and upstaging rate were fewer than similar studies. Our recommendation for further studies is to use intensive SLN biopsy method in both groups of SLNs and non-SLNs.

Hepatic Function and Fibrosis Assessment Via 2D-Shear Wave Elastography and Related Biochemical Markers Pre- and Post-Gastric Bypass Surgery.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) exhibits a worldwide distribution and encompasses a wider range of hepatic abnormalities that can culminate in serious clinical outcomes. The growing incidence of NAFLD necessitates more efficient management strategies particularly in clinically severe obese patients. Weight reduction is the cornerstone of NAFLD treatment; therefore, bariatric surgery could be a therapeutic approach in selected obese patients afflicted with NAFLD and other cardiometabolic comorbidities. OBJECTIVE: The present study focused on the potential role of bariatric surgery on hepatic function and NAFLD-related histopathological features measured through a noninvasive method. METHOD: Ninety patients entered to this study and underwent initial preoperative assessments including demographic profile, anthropometric measurements, standard laboratory tests, and hepatic biopsy. Liver stiffness was also evaluated via two-dimensional shear wave elastography (2D-SWE). All assessments were repeated over the subsequent 6 months following surgery except for liver biopsy. RESULTS: Postoperative hepatic elasticity was lessened after 6 months (p = 0/002).The levels of alanine aminotransferase, gamma-glutamyl transferase, total protein, lipid indices, glucose, and platelet count were also improved following surgery (p < 0/001). Further progression of fibrosis was observed in 25% of patients after surgery. CONCLUSION: Bariatric surgery was associated with a favorable impact on anthropometric and hepatic elasticity indices as well as metabolic parameters. The ideal target population for bariatric surgery should be thoroughly addressed, and the underlying risk factors for fibrosis progression need to be controlled before surgery. However, expanded research designed as comprehensive randomized controlled trials are recommended to confirm these findings.

Is visuomotor training an effective intervention for children with autism spectrum disorders?

PURPOSE: Investigation of autism spectrum disorder (ASD) is somewhat dependent on addressing main core features of ASD. But it is not clear which kind of investigation can effect on more difficulties features. So, this study examines the effect of the visuomotor, motor, and computer-based training programs on social behavior, motor skills, and repetitive behaviors of children with ASD. PATIENTS AND METHODS: Sixty children with ASD aged 6-12 years were recruited and assigned to one of the three experimental groups and the control group (each group n=15). Training was provided in 30 sessions, scheduled 3 times a week. Social behavior and repetitive behaviors were determined objectively using the observation method, and motor skills were evaluated by the Test of Gross Motor Development-2. RESULTS: Our results suggested that children in the visuomotor group showed a significant reduction in the repetitive behaviors and an increase in gross motor skill scores in the post-test and follow-up. Also, the results exhibited that motor training group significantly improved in social behavior either in the post-test or follow-up. Although the post-test illustrated a considerable improvement of gross motor skills, this difference was not significant in follow-up. Similarly, no significant change was observed in visual training and control groups in relation to study variables. CONCLUSION: Given the improvement of repetitive behaviors and gross motor skills in post-test and follow-up, it seems that this investigation had a positive effect with a good retention effect on two core features of children with ASD. But according to group-based training protocol in motor training group and improvement in social communication, and mutual effect on gross motor skills, it seems that group-based practice can also be used to achieve the benefits of social communication in the investigations.

Measurement of Liver Stiffness with 2D-Shear Wave Elastography (2D-SWE) in Bariatric Surgery Candidates Reveals Acceptable Diagnostic Yield Compared to Liver Biopsy.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is common among severely obese patients. Two-dimensional shear wave elastography (2D-SWE) has been validated as a noninvasive diagnostic tool for liver stiffness measurement. However, the technical feasibility and accuracy of this method in severely obese patients are still under debate. OBJECTIVE: We aimed to assess the diagnostic accuracy of 2D-SWE in bariatric surgery candidates in comparison with the gold standard liver biopsy. METHODS: Ninety severely obese candidates for bariatric surgery were included. Liver stiffness was measured using 2D-SWE 14 days before liver biopsy. Liver biopsy was taken on the day of surgery. The area under the receiver operating curve (AUROC) was calculated for the staging of liver fibrosis. RESULTS: 2D-SWE was performed in 97.3% of patients successfully. Histologic stages of fibrosis (F0-F4) were detected in 34.2%, 36%, 6.3%, 3.6%, and 0.9% of patients, respectively. The AUROC for 2D-SWE was 0.77 for F1, 0.72 for F2, 0.77 for F3, and 0.70 for F4. In univariate analysis, 2D-SWE values were correlated with BMI, waist circumference, NAFLD activity score (NAS), and steatosis, whereas these components did not affect liver stiffness in multivariate analysis. CONCLUSION: Two-dimensional shear wave elastography of the liver can be feasible and has good accuracy in severely obese candidates for bariatric surgery. Therefore, 2D-SWE may be a good option for assessing liver fibrosis, especially in the early stages of fibrosis to lessen complications of surgery in this population. However, this method should be applied on a larger scale for late stage of fibrosis.

Effects of a Motor Intervention Program on Motor Skills and Executive Functions in Children With Learning Disabilities.

This study examined the effect of a motor intervention based on the attention, balance, and coordination (ABC) learning approach on motor proficiency and executive functions in children with learning disabilities (LD). Forty-five male elementary school students with LD aged 7-9 years were recruited and randomly assigned into one of three groups: two experimental groups and one control group. Experimental Group A received only the motor intervention. Experimental Group B simultaneously received both motor intervention and regular educational services. The control group received only regular educational services. The motor intervention involved sequential station exercises based on ABC; this training took place in 24 sessions, scheduled three times a week for eight weeks. We obtained children's scores on the Bruininks-Oseretsky Tests of Motor Proficiency, N-Back Test, Tower of London, and Continuous Performance Tests at pretest, posttest, and follow-up testing. Our results showed that both experimental groups significantly improved their motor skills and most measures of executive functions, relative to no significant improvement for the control group. The improvements on some measures of executive functions in Experimental Group B were just slightly better than in Experimental Group A. This study supported Blythe's ABC learning approach emphasizing ABC, and it extended earlier findings of benefits of this approach to populations of children with LD.

Using quantile regression for fitting lactation curve in dairy cows.

The main objective of this study was to compare the performance of different 'nonlinear quantile regression' models evaluated at the τth quantile (0·25, 0·50, and 0·75) of milk production traits and somatic cell score (SCS) in Iranian Holstein dairy cows. Data were collected by the Animal Breeding Center of Iran from 1991 to 2011, comprising 101 051 monthly milk production traits and SCS records of 13 977 cows in 183 herds. Incomplete gamma (Wood), exponential (Wilmink), Dijkstra and polynomial (Ali & Schaeffer) functions were implemented in the quantile regression. Residual mean square, Akaike information criterion and log-likelihood from different models and quantiles indicated that in the same quantile, the best models were Wilmink for milk yield, Dijkstra for fat percentage and Ali & Schaeffer for protein percentage. Over all models the best model fit occurred at quantile 0·50 for milk yield, fat and protein percentage, whereas, for SCS the 0·25th quantile was best. The best model to describe SCS was Dijkstra at quantiles 0·25 and 0·50, and Ali & Schaeffer at quantile 0·75. Wood function had the worst performance amongst all traits. Quantile regression is specifically appropriate for SCS which has a mixed multimodal distribution.

Diagnostic Errors in Tuberculous Patients: A Multicenter Study from a Developing Country.

Although there is still much to learn about the types of errors committed in health care and why they occur, enough is known today to recognize that a serious concern exists for patients. Tuberculosis (TB) is an infectious disease that is frequently subject to diagnostic errors. Missed or delayed diagnosis of TB can affect patients and community adversely. Our aim in the present study was at evaluating the type of diagnostic errors in TB patients from symptom onset to diagnosis. This was a multicenter cross-sectional study conducted in three university hospitals in Mashhad, Iran. We showed a long delay in diagnosing TB that is mostly related to the time from first medical visit to diagnosis. Errors in the diagnostic process were identified in 97.5% of patients. The most common type of error in diagnosing TB was failure in hypothesis generation (72%), followed by history taking and physical examination. In conclusion, it seems likely that efforts to improve public awareness of and health literacy for TB, to coordinate the referral and follow-up systems of patients, and to improve physicians' skills in history taking and physical examination and clinical reasoning will result in reduced delay in diagnosis of TB and, perhaps, improved patient safety and community health.

Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study.

OBJECTIVES: To assess the frequency of different types of diagnostic errors in patients with central nervous system (CNS) infection from the onset of symptoms to admission to the hospital, where the correct diagnosis was made. METHODS: A cross-sectional observational design was used, and the information was collected by interviewing patients and/or their knowledgeable relatives as well as reviewing the accompanying medical record documents and hospital records. RESULTS: Of 169 adult patients with CNS infection, 129 (76.33%) were subject to diagnostic errors. Failure in ordering tests and hypothesis generation were the most common types of diagnostic errors that accounted for more than 70% of errors. Several contributing factors that were associated with incorrect diagnostic hypotheses included failure in taking a patient's comprehensive history such as detecting relevant epidemiological clues, conducting a full clinical examination, and interpreting diagnostic evidence. The relationship between poor clinical outcome and longer delay from the onset of illness to diagnosis, inappropriate empirical antibiotic therapy, and lower level of consciousness on admission were found to be statistically significant. CONCLUSIONS: Although diagnosis and management of CNS infection in some patients are straightforward, clinical decision making in facing patients with complex scenarios often requires clinical reasoning instead of relying only on intuitive diagnosis. Justification in requesting diagnostic measures and interpretation of their results based on clinical findings and patient information could be a critical factor in preventing a substantial number of diagnostic errors in patients with CNS infection.

Validation of the influencing factors associated with traffic violations and crashes on freeways of developing countries: A case study of Iran.

Among the rural roads, freeways have the maximum allowable speed limit. This subject increases the tendency of drivers to use these kinds of roads, and despite its positive effects, it has caused numerous problems. One of them is the increase in the rate of traffic violations and crashes. The amount of crashes per kilometer in Iran's freeways is almost twice the other rural roads. Hence, finding a solution to this problem is of particular importance. This research intends to validate some of the influencing factors which cause traffic violations and crashes in freeways and determine their amount of influence through statistical models. For this purpose, the authors considered violations and crashes for 36 road segments as dependent variables and other factors as independent ones. Since dependent variables were count, discrete, and non-zero, the proposed models were Poisson and Zero-truncated Poisson. The processing of the models indicated that the amounts of Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) indices for the Zero-truncated Poisson model are less than those of the Poisson model and the result of the Pseudo-R2 test for this model is within the acceptable range. Moreover, the result of Chi-square test which shows the proximity of expected and observed amounts was better for Zero-truncated Poisson model. Thus, this model has a considerable advantage against Poisson model. Final models indicated that the average speed has a positive correlation with the number of violations and crashes and as it increases, they increase too. Besides, peripheral landscapes, number of interchanges, number of passing lanes, and exemption from paying toll have an opposite relationship with violations and crashes.

The Etiological Spectrum of Febrile Encephalopathy in Adult Patients: A Cross-Sectional Study from a Developing Country.

The profile of febrile encephalopathy varies based on different demographic and geographical characteristics of the study population. This retrospective, cross-sectional study was conducted to evaluate the etiological spectrum of febrile encephalopathy in hospitalized adult patients. A total of 293 patients with the mean age of 49.7 ± 23 were evaluated of whom 77.1% presented with encephalopathy syndrome. The most common diagnosis in patients with clinical syndromes suggestive of central nervous system (CNS) infection was sepsis associated encephalopathy (SAE) (22.9%), followed by bacterial meningitis (14%) and neurotuberculosis (9.9%). The comparison between the elderly and young adults showed that, in the young adults, bacterial meningitis and neurotuberculosis, and in the elderly SAE, are among the most common causes of clinical syndromes suggestive of CNS infection including febrile encephalopathy in our region. Moreover, we illustrated an upward trend for the proportion of diagnosing CNS infections among those who underwent diagnostic LP, from 40.4% in 2011 to 70% in 2015, that could be indicative of an increasing threshold for performing LP at least in our center in recent years. Whether these changes have been associated with increasing the rate of diagnostic errors or not needs to be evaluated in future studies.