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Vitamin K antagonist (VKA) therapy is safer and more effective when patients have a high time within the therapeutic range and low international normalised ratio variability. The SAMe-TT2R2 score aims to identify those at risk for poor VKA control.To evaluate the predictive value and clinical usefulness of the SAMe-TT2R2 score to identify those at risk for poor VKA control.We performed a systematic review in MEDLINE and Embase for original research papers assessing the SAMe-TT2R2's relation to poor TTR. We performed a meta-analysis where scores ≥ 2 and ≥ 3 predicting TTR < 70%. When studies evaluated other cutoffs for TTR or SAMe-TT2R2, they were harmonised by multiple simulations with patient characteristics from the individual studies, if the data were available.16 studies were identified and used in the meta-analysis: 4 and 2 times directly, 8 and 8 times harmonised for scores ≥ 2 and ≥ 3, respectively (not all studies provided information about both cutoffs). The sensitivities and specificities were too heterogeneous to pool. The positive likelihood ratios were 1.25 (1.14-1.38) for a score ≥ 2, and 1.24 (1.09-1.40) for a score ≥ 3; the negative ones were 0.87 (0.82-0.93) and 0.96 (0.91-1.02), respectively. This shows that the post-test probabilities hardly differ from the prior probability (prevalence).The SAMe-TT2R2 score does predict low TTR, but the effect is small. Its effect on individual patients is too limited to be clinically useful.

Abstract Personal and family history of suicidal thoughts and behaviors (PSH and FSH, respectively) are significant risk factors associated with suicides. Research is limited in automatic identification of such data from clinical notes in Electronic Health Records. This study developed deep learning (DL) tools utilizing transformer models (Bio_ClinicalBERT and GatorTron) to detect PSH and FSH in clinical notes derived from three academic medical centers, and compared their performance with a rule-based natural language processing tool. For detecting PSH, the rule-based approach obtained an F1-score of 0.75 ± 0.07, while the Bio_ClinicalBERT and GatorTron DL tools scored 0.83 ± 0.09 and 0.84 ± 0.07, respectively. For detecting FSH, the rule-based approach achieved an F1-score of 0.69 ± 0.11, compared to 0.89 ± 0.10 for Bio_ClinicalBERT and 0.92 ± 0.07 for GatorTron. Across sites, the DL tools identified more than 80% of patients at elevated risk for suicide who remain undiagnosed and untreated.

BackgroundLow- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation. ObjectiveThis interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research. MethodsWe conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach. ResultsThis review included 13 studies that examined open-source EHRs’ adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes. ConclusionsWhile open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers’ experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.

Abstract INTRODUCTION Alzheimer's disease (AD) is often misclassified in electronic health records (EHRs) when relying solely on diagnosis codes. This study aimed to develop a more accurate, computable phenotype (CP) for identifying AD patients using structured and unstructured EHR data. METHODS We used EHRs from the University of Florida Health (UFHealth) system and created rule‐based CPs iteratively through manual chart reviews. The CPs were then validated using data from the University of Texas Health Science Center at Houston (UTHealth) and the University of Minnesota (UMN). RESULTS Our best‐performing CP was “patient has at least 2 AD diagnoses and AD‐related keywords in AD encounters,” with an F1‐score of 0.817 at UF, 0.961 at UTHealth, and 0.623 at UMN, respectively. DISCUSSION We developed and validated rule‐based CPs for AD identification with good performance, which will be crucial for studies that aim to use real‐world data like EHRs. Highlights Developed a computable phenotype (CP) to identify Alzheimer's disease (AD) patients using EHR data. Utilized both structured and unstructured EHR data to enhance CP accuracy. Achieved a high F1‐score of 0.817 at UFHealth, and 0.961 and 0.623 at UTHealth and UMN. Validated the CP across different demographics, ensuring robustness and fairness.

Abstract MVA-based monovalent eastern equine encephalitis virus (MVA-BN-EEEV) and multivalent western, eastern, and Venezuelan equine encephalitis virus (MVA-BN-WEV) vaccines were evaluated in the cynomolgus macaque aerosol model of EEEV infection. Macaques vaccinated with two doses of 5 × 108 infectious units of the MVA-BN-EEEV or MVA-BN-WEV vaccine by the intramuscular route rapidly developed robust levels of neutralizing antibodies to EEEV that persisted at high levels until challenge at day 84 via small particle aerosol delivery with a target inhaled dose of 107 PFU of EEEV FL93-939. Robust protection was observed, with 7/8 animals receiving MVA-BN-EEEV and 100% (8/8) animals receiving MVA-BN-WEV surviving while only 2/8 mock vaccinated controls survived lethal challenge. Complete protection from viremia was afforded by both vaccines, with near complete protection from vRNA loads in tissues and any pathologic evidence of central nervous system damage. Overall, the results indicate both vaccines are effective in eliciting an immune response that is consistent with protection from aerosolized EEEV-induced disease.

Protoclusters, the progenitors of galaxy clusters, trace large scale structures in the early Universe and are important to our understanding of structure formation and galaxy evolution. To date, only a handful of protoclusters have been identified in the Epoch of Reionization. As one of the rarest populations in the early Universe, distant quasars that host active supermassive black holes are thought to reside in the most massive dark matter halos at that cosmic epoch and could thus potentially pinpoint some of the earliest protoclusters. In this Letter, we report the discovery of a massive protocluster around a luminous quasar at z = 6.63. This protocluster is anchored by the quasar and includes three [C ii ] emitters at z ∼ 6.63, 12 spectroscopically confirmed Ly α emitters (LAEs) at 6.54 < z ≤ 6.64, and a large number of narrow-band-imaging selected LAE candidates at the same redshift. This structure has an overall overdensity of $\delta ={3.3}_{-0.9}^{+1.1}$ within ∼35 × 74 cMpc ^2 on the sky and an extreme overdensity of δ > 30 in its central region (i.e., R ≲ 2 cMpc). We estimate that this protocluster will collapse into a galaxy cluster with a mass of ${6.9}_{-1.4}^{+1.2}\times {10}^{15}\,{M}_{\odot }$ at the current epoch, more massive than the most massive clusters known in the local Universe such as Coma. In the quasar vicinity, we discover a double-peaked LAE, which implies that the quasar has a UV lifetime greater than 0.8 Myrs and has already ionized its surrounding intergalactic medium.

Previous observational studies of the diabetes drugs metformin vs. sulfonylureas have yielded mixed results about whether metformin reduces the risk of dementia, relative to the sulfonylureas. Here, the authors apply a novel competing risks approach to emulate dementia-related target trials in electronic health records of diabetic patients and a complementary systems pharmacology evaluation on human neural cells.

We present deep James Webb Space Telescope (JWST)/Mid-Infrared Instrument (MIRI) F560W observations of a flux-limited, Atacama Large Millimeter/submillimeter Array (ALMA)-selected sample of 28 galaxies at z = 0.5–3.7 in the Hubble Ultra Deep Field (HUDF). The data from the MIRI Deep Imaging Survey (MIDIS) reveal the stellar structure of the HUDF galaxies at rest-frame wavelengths of λ > 1 μ m for the first time. We revise the stellar mass estimates using new JWST photometry and find good agreement with pre-JWST analyses; the few discrepancies can be explained by blending issues in the earlier lower-resolution Spitzer data. At z ∼ 2.5, the resolved rest-frame near-infrared (1.6 μ m) structure of the galaxies is significantly more smooth and centrally concentrated than seen by the Hubble Space Telescope at rest-frame 450 nm (F160W), with effective radii of R _e (F560W) = 1–5 kpc and Sérsic indices mostly close to an exponential (disk-like) profile ( n ≈ 1), up to n ≈ 5 (excluding active galactic nuclei). We find an average size ratio of R _e (F560W)/ R _e (F160W) ≈ 0.7 that decreases with stellar mass. The stellar structure of the ALMA-selected galaxies is indistinguishable from a HUDF reference sample of all galaxies with a MIRI flux density greater than 1 μ Jy. We supplement our analysis with custom-made, position-dependent, empirical point-spread function models for the F560W observations. The results imply that a smoother stellar structure is in place in massive gas-rich, star-forming galaxies at “Cosmic Noon,” despite a more clumpy rest-frame optical appearance, placing additional constraints on galaxy formation simulations. As a next step, matched-resolution, resolved ALMA observations will be crucial to further link the mass- and light-weighted galaxy structures to the dusty interstellar medium.

We present the first results from the JWST program A SPectroscopic survey of biased halos In the Reionization Era (ASPIRE). This program represents an imaging and spectroscopic survey of 25 reionization-era quasars and their environments by utilizing the unprecedented capabilities of NIRCam Wide Field Slitless Spectroscopy (WFSS) mode. ASPIRE will deliver the largest ( $\sim 280\,{\mathrm{arcmin}}^{2}$ ) galaxy redshift survey at 3–4 μ m among JWST Cycle 1 programs and provide extensive legacy values for studying the formation of the earliest supermassive black holes, the assembly of galaxies, early metal enrichment, and cosmic reionization. In this first ASPIRE paper, we report the discovery of a filamentary structure traced by the luminous quasar J0305–3150 and 10 [O iii ] emitters at z = 6.6. This structure has a 3D galaxy overdensity of δ _gal = 12.6 over 637 cMpc ^3 , one of the most overdense structures known in the early universe, and could eventually evolve into a massive galaxy cluster. Together with existing VLT/MUSE and ALMA observations of this field, our JWST observations reveal that J0305–3150 traces a complex environment where both UV-bright and dusty galaxies are present and indicate that the early evolution of galaxies around the quasar is not simultaneous. In addition, we discovered 31 [O iii ] emitters in this field at other redshifts, 5.3 < z < 6.7, with half of them situated at z ∼ 5.4 and 6.2. This indicates that star-forming galaxies, such as [O iii ] emitters, are generally clustered at high redshifts. These discoveries demonstrate the unparalleled redshift survey capabilities of NIRCam WFSS and the potential of the full ASPIRE survey data set.

Studies of rest-frame optical emission in quasars at z > 6 have historically been limited by the wavelengths accessible by ground-based telescopes. The James Webb Space Telescope (JWST) now offers the opportunity to probe this emission deep into the reionization epoch. We report the observations of eight quasars at z > 6.5 using the JWST/NIRCam Wide Field Slitless Spectroscopy as a part of the “A SPectroscopic survey of biased halos In the Reionization Era (ASPIRE)” program. Our JWST spectra cover the quasars’ emission between rest frame ∼4100 and 5100 Å. The profiles of these quasars’ broad H β emission lines span a full width at half maximum from 3000 to 6000 km s ^−1 . The H β -based virial black hole (BH) masses, ranging from 0.6 to 2.1 billion solar masses, are generally consistent with their Mg ii -based BH masses. The new measurements based on the more reliable H β tracer thus confirm the existence of a billion solar-mass BHs in the reionization epoch. In the observed [O iii ] λ λ 4960,5008 doublets of these luminous quasars, broad components are more common than narrow core components (≤ 1200 km s ^−1 ), and only one quasar shows stronger narrow components than broad. Two quasars exhibit significantly broad and blueshifted [O iii ] emission, thought to trace galactic-scale outflows, with median velocities of −610 and −1430 km s ^−1 relative to the [C ii ] 158 μ m line. All eight quasars show strong optical Fe ii emission and follow the eigenvector 1 relations defined by low-redshift quasars. The entire ASPIRE program will eventually cover 25 quasars and provide a statistical sample for the studies of the BHs and quasar spectral properties.

This publication discusses a survey used to evaluate ranch management practices to determine benchmarks in cattle production and pasture management. Written by Laura Bennett, Jonael Bosques, Sarah Bostick, Lauren Butler, Sonja Crawford, Taylor Davis, Christa Kirby, Colleen Larson, Philipe Moriel, Chris Prevatt, Brent Sellers, Maria Silveira, Aaron Stam, Bridget Stice, Joao Vendramini, and Lindsey Wiggins, and published by the UF/IFAS Agronomy Department, July 2021.

Background During the past several decades, the American College of Surgeons has led efforts to standardize trauma care through their trauma center verification process and Trauma Quality Improvement Program. Despite these endeavors, great variability remains among trauma centers functioning at the same level. Little research has been conducted on the correlation between trauma center organizational structure and patient outcomes. We are attempting to close this knowledge gap with the Comparative Assessment Framework for Environments of Trauma Care (CAFE) project.Methods Our first action was to establish a shared terminology that we then used to build the Ontology of Organizational Structures of Trauma centers and Trauma systems (OOSTT). OOSTT underpins the web-based CAFE questionnaire that collects detailed information on the particular organizational attributes of trauma centers and trauma systems. This tool allows users to compare their organizations to an aggregate of other organizations of the same type, while collecting their data.Results In collaboration with the American College of Surgeons Committee on Trauma, we tested the system by entering data from three trauma centers and four trauma systems. We also tested retrieval of answers to competency questions.Discussion The data we gather will be made available to public health and implementation science researchers using visualizations. In the next phase of our project, we plan to link the gathered data about trauma center attributes to clinical outcomes.

Suchmaschinen sind für die Nutzer ein zentrales Werkzeug zur Erschließung des Internets. Als Intermediäre filtern sie die Informationsflut im Netz und identifizieren bedeutsame Inhalte, haben also eine ähnliche Funktion und eine vergleichbare gesellschaftliche Verantwortung wie der Journalismus. Damit stellt sich die Frage nach der Qualität ihrer Trefferlisten, die in der Kommunikationswissenschaft bislang kaum erforscht wurde. Die vorliegende Studie untersucht dem Ansatz der nutzerzentrierten Inhaltsanalyse folgend die Benutzerfreundlichkeit, Relevanz, Gattungsvielfalt und Aktualität der Trefferlisten von fünf Suchmaschinen zu sechs gesellschaftlich relevanten, kontroversen Themen. Auf diese Weise wird geprüft, ob die Suchmaschinen die Voraussetzungen dafür bieten, dass die Nutzer zwei Rollen erfüllen können: die des Konsumenten, für den der Nutzwert im Fokus steht, und die des Bürgers, der sich an gesellschaftlichen Wertvorstellungen orientiert. Die Ergebnisse zeigen, dass Google insgesamt qualitativ hochwertigere Trefferlisten bietet als die Mitbewerber Bing, Ixquick, Lycos und Ask, hinsichtlich der Gattungsvielfalt aber etwas hinter der Konkurrenz zurückbleibt.

Pre-clinical markers of Parkinson's Disease (PD) are needed, and to be relevant in pre-clinical disease, they should be quantifiably abnormal in early disease as well. Handwriting is impaired early in PD and can be evaluated using computerized analysis of drawn spirals, capturing kinematic, dynamic, and spatial abnormalities and calculating indices that quantify motor performance and disability. Digitized spiral drawing correlates with motor scores and may be more sensitive in detecting early changes than subjective ratings. However, whether changes in spiral drawing are abnormal compared with controls and whether changes are detected in early PD are unknown.138 PD subjects (50 with early PD) and 150 controls drew spirals on a digitizing tablet, generating x, y, z (pressure) data-coordinates and time. Derived indices corresponded to overall spiral execution (severity), shape and kinematic irregularity (second order smoothness, first order zero-crossing), tightness, mean speed and variability of spiral width. Linear mixed effect adjusted models comparing these indices and cross-validation were performed. Receiver operating characteristic analysis was applied to examine discriminative validity of combined indices.All indices were significantly different between PD cases and controls, except for zero-crossing. A model using all indices had high discriminative validity (sensitivity = 0.86, specificity = 0.81). Discriminative validity was maintained in patients with early PD.Spiral analysis accurately discriminates subjects with PD and early PD from controls supporting a role as a promising quantitative biomarker. Further assessment is needed to determine whether spiral changes are PD specific compared with other disorders and if present in pre-clinical PD.