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Abstract This study investigates the effects of including patients’ clinical information on the performance of deep learning (DL) classifiers for disease location in chest X-ray images. Although current classifiers achieve high performance using chest X-ray images alone, consultations with practicing radiologists indicate that clinical data is highly informative and essential for interpreting medical images and making proper diagnoses. In this work, we propose a novel architecture consisting of two fusion methods that enable the model to simultaneously process patients’ clinical data (structured data) and chest X-rays (image data). Since these data modalities are in different dimensional spaces, we propose a spatial arrangement strategy, spatialization, to facilitate the multimodal learning process in a Mask R-CNN model. We performed an extensive experimental evaluation using MIMIC-Eye, a dataset comprising different modalities: MIMIC-CXR (chest X-ray images), MIMIC IV-ED (patients’ clinical data), and REFLACX (annotations of disease locations in chest X-rays). Results show that incorporating patients’ clinical data in a DL model together with the proposed fusion methods improves the disease localization in chest X-rays by 12% in terms of Average Precision compared to a standard Mask R-CNN using chest X-rays alone. Further ablation studies also emphasize the importance of multimodal DL architectures and the incorporation of patients’ clinical data in disease localization. In the interest of fostering scientific reproducibility, the architecture proposed within this investigation has been made publicly accessible( https://github.com/ChihchengHsieh/multimodal-abnormalities-detection ).

In his 2016 articles (Hyland, 2016a, 2016b), Ken Hyland makes a case for what he terms the 'myth of linguistic injustice', calling into question the assumption that 'non-native' users of English are at a linguistic disadvantage compared with their 'native' counterparts when writing for publication. In response, Flowerdew (2019) argues that Hyland is mistaken in categorically dismissing the extra challenges inherent in academic writing in an additional language, suggesting that while all academic writers may face a common set of challenges, 'EAL [English as additional language] writers have an additional set of linguistic challenges, which do not apply (to such an extent) to L1 writers' (p. 257). Here, we aim primarily to respond to Flowerdew yet, as his ideas are intrinsically intertwined with Hyland's initial claims, our article is unavoidably and necessarily a response to both writers and an attempt to contribute to the ongoing and wider discussion of native-speakerism and notions of speakerhood based on our own professional and personal experiences.

Background: The use of regional anesthesia in shoulder arthroscopy improves perioperative pain control, thereby reducing the need for opioids and their recognized side effects. Occasionally one type of block is not suitable for a patient’s anatomy or comorbidities or requires a specially trained anesthetist to safely perform. The primary aim of this study is to compare the efficacy of 3 different nerve blocks for pain management in patients undergoing shoulder arthroscopy. Methods: A 3-arm, blinded, randomized controlled trial in patients undergoing elective, unilateral shoulder arthroscopic procedures between August 2018 and November 2020 was conducted at a single center. One hundred and thirty participants were randomized into 1 of 3 regional anesthesia techniques. The first group received an ultrasound-guided interscalene block performed by an anesthetist (US + ISB). The second group received an ultrasound-guided suprascapular nerve block and an axillary nerve block by an anesthetist (US + SSANB). The final group received a suprascapular nerve block without ultrasound and an axillary nerve block under arthroscopic guidance by an orthopedic surgeon (A + SSANB). Intraoperative pain response, analgesia requirements, and side effects were recorded. Visual analogue pain scores and opioid doses were recorded in the Post Anaesthesia Care Unit (PACU) and daily for 8 days following the procedure. Results: Twelve patients withdrew from the study after randomization, leaving 39 participants in US + ISB, 40 in US + SSANB, and 39 in A + SSANB. The US + ISB group required significantly lower intraoperative opioid doses than US + SSANB and A + SSANB (P

Modern zoos and aquariums have evolved greatly since the end of the Second World War, to become centres of conservation excellence and scientific institutions for the study of animal behaviour, ecology, husbandry management. Whilst the impact of zoos and aquariums to biodiversity conservation, population management and advancement of species care is well documented, their positive impacts on society (including the communities that they are located within) is less well known. The four established aims of the modern zoo—Conservation, Education, Recreation (Engagement) and Research—provide a strong foundation for wider review and critique of the societal value of zoos and aquariums. This article synthesises what such value may be, and how it could be measured, from a systematic review of the literature pertaining to each of these four established aims. It also recommends areas of future scientific inquiry to further study the wider impact of zoos on their local communities and on human populations and behaviour more generally. Including Wellbeing as a fifth aim of the modern zoo would also cement their wider societal value. Further scrutiny of the societal value of the modern zoo enhances the value of the zoo’s living collection and the green spaces that it manages to provide accessibility to biodiversity and nature-centric education essential to long-term, planetary friendly human behaviour change.

This paper complements the data published thus far about species of the nymphalid family with data collected in Romania’s eight regions between 1887 and 1984 and elsewhere in Europe (Austria, Germany, Croația, the Republic of Moldova, Serbia and Switzerland), including the date and the site of original collection. For the first time, this research presents the collecting information of the species held in the entomological collection of the Museum of Natural History in Sibiu. It identifies the species of the nymphalid family in six of the museum’s lepidoptera collections. These collections are of extraordinary interest not least because they are associated with natural scientists of European renown, such as Daniel Czekelius, Eugen Worell, Viktor Weindel, Rolf Weirauch, Heinrich Hann von Hannenheim and Eckbert Schneider. The analysis, cataloguing, centralisation and updating of the nomenclature resulted in a number of 1,865 specimens from 49 species and fifteen genera (of the 90 referenced in Romania’s fauna): Aglais, Apatura, Araschnia, Argynnis, Brenthis, Boloria, Euphydryas, Inachis, Issoria, Libythea, Limenitis, Melitaea, Neptis, Nymphalis and Polygonia. Data published in a previous article add 101 specimens from the Vanessa genus.Most species originate regionally from the nine counties of Transylvania followed by Oltenia and Moldova (three counties each), Banat and Dobrogea (two counties each), Crișana, Satu Mare and Muntenia (one county each) and the capital of Romania, Bucharest. The species presented in this paper also include the extinct taxon Polygonia egea (Cramer, 1775), Eugen Worrell collection and three species that are endemic to Romania: Melitaea retyezatica Diöszeghy, 1930, Argynnis pandora dacica Hormuzaki, 1892, Daniel Czekelius collection and Boloria pales ([Denis & Schiffermüller], 1775) carpathomeridionalis Crosson et Popescu-Gorj, 1963, both in the Viktor Weindel collection.

Wastewater treatment is a necessary step to avoid environmental impacts of water consumption and usage. Traditional approaches are expensive and are limited to developed countries. Phytofiltration using fast-growing trees and shrubs like willows potentially offer an alternative. This paper aims to determine if wastewater treatment using phytofiltration can provide complementary environmental and economic benefits for rural communities in a Nordic climate such as the province of Québec, Canada. It looks at different perspectives of the wastewater treatment solution in a local and rural context. Based on life cycle analysis (LCA) and life cycle cost analysis (LCC), we found that, for an exemplar Québec municipality, the conventional wastewater treatment scenario impacted more on climate change, ecosystem quality and human health than the two phytofiltration of wastewater scenarios studied, where impact is highly dependant on the biomass valorization. The net present cost of the phytofiltration scenarios were lower than typical conventional treatment in Québec. For a biomass producer, conventional biomass production had the highest environmental impact on ecosystem quality, while biomass production from phytofiltration had the highest environmental impact on climate change, human health, and resources. We demonstrate that the phytofiltration is a viable and multifunctional technology that could provide good incentives for a local biomass value chain. it allows to both alleviate wastewater treatment burden and provide affordable biomass for bioenergy development for rural communities. Mobilizing local stakeholders will be key to make phytofiltration an alternative solution for both environmental burden alleviation and rural economic development.

BackgroundDespite the touted potential of artificial intelligence (AI) and machine learning (ML) to revolutionize health care, clinical decision support tools, herein referred to as medical modeling software (MMS), have yet to realize the anticipated benefits. One proposed obstacle is the acknowledged gaps in AI translation. These gaps stem partly from the fragmentation of processes and resources to support MMS transparent documentation. Consequently, the absence of transparent reporting hinders the provision of evidence to support the implementation of MMS in clinical practice, thereby serving as a substantial barrier to the successful translation of software from research settings to clinical practice. ObjectiveThis study aimed to scope the current landscape of AI- and ML-based MMS documentation practices and elucidate the function of documentation in facilitating the translation of ethical and explainable MMS into clinical workflows. MethodsA scoping review was conducted in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed was searched using Medical Subject Headings key concepts of AI, ML, ethical considerations, and explainability to identify publications detailing AI- and ML-based MMS documentation, in addition to snowball sampling of selected reference lists. To include the possibility of implicit documentation practices not explicitly labeled as such, we did not use documentation as a key concept but as an inclusion criterion. A 2-stage screening process (title and abstract screening and full-text review) was conducted by 1 author. A data extraction template was used to record publication-related information; barriers to developing ethical and explainable MMS; available standards, regulations, frameworks, or governance strategies related to documentation; and recommendations for documentation for papers that met the inclusion criteria. ResultsOf the 115 papers retrieved, 21 (18.3%) papers met the requirements for inclusion. Ethics and explainability were investigated in the context of AI- and ML-based MMS documentation and translation. Data detailing the current state and challenges and recommendations for future studies were synthesized. Notable themes defining the current state and challenges that required thorough review included bias, accountability, governance, and explainability. Recommendations identified in the literature to address present barriers call for a proactive evaluation of MMS, multidisciplinary collaboration, adherence to investigation and validation protocols, transparency and traceability requirements, and guiding standards and frameworks that enhance documentation efforts and support the translation of AI- and ML-based MMS. ConclusionsResolving barriers to translation is critical for MMS to deliver on expectations, including those barriers identified in this scoping review related to bias, accountability, governance, and explainability. Our findings suggest that transparent strategic documentation, aligning translational science and regulatory science, will support the translation of MMS by coordinating communication and reporting and reducing translational barriers, thereby furthering the adoption of MMS.

Rationale & Objective: The coronavirus disease 2019 (COVID-19) pandemic imposed several changes in the care of patients with kidney failure receiving dialysis. We explored patient care experiences during the pandemic. Study Design: The study team verbally administered surveys including Likert scale multiple-choice questions and open-ended questions and recorded responses. Setting & Participants: Surveys were administered to adults receiving dialysis through an academic nephrology practice after the first wave of the COVID-19 pandemic. Exposure: Outpatient dialysis treatment during the COVID-19 pandemic. Outcomes: Perceptions of care and changes in health. Analytical Approach: Multiple-choice responses were quantified using descriptive statistics. Thematic analysis was used to code open-ended responses and derive themes surrounding patient experiences. Results: A total of 172 patients receiving dialysis were surveyed. Most patients reported feeling “very connected” to the care teams. Seventeen percent of participants reported transportation issues, 6% reported difficulty obtaining medications, and 9% reported difficulty getting groceries. Four themes emerged as influencing patient experiences during the pandemic: 1) the COVID-19 pandemic did not significantly affect participants’ experience of dialysis care; 2) the COVID-19 pandemic significantly impacted other aspects of participants’ lives, which in turn were felt to affect mental and physical health; 3) regarding dialysis care experience more generally, participants valued consistency, dependability, and personal connection to staff; and 4) the COVID-19 pandemic highlighted the importance of external social support. Limitations: Surveys were administered early in the COVID-19 pandemic, and patient perspectives have not been reassessed. Further qualitative analysis using semi-structured interviews was not performed. Survey distribution in additional practice settings, using validated questionnaires, would increase generalizability of the study. The study was not powered for statistical analysis. Conclusions: Early in the COVID-19 pandemic, perceptions of dialysis care were unchanged for most patients. Other aspects of participants’ lives were impacted, which affected their health. Subpopulations of patients receiving dialysis may be more vulnerable during the pandemic: those with histories of mental health conditions, non-White patients, and patients treated by in-center hemodialysis. Plain-language summary: Patients with kidney failure continue to receive life-sustaining dialysis treatments during the coronavirus disease 2019 (COVID-19) pandemic. We sought to understand perceived changes in care and mental health during this challenging time. We administered surveys to patients receiving dialysis after the initial wave of COVID-19, asking questions on topics including access to care, ability to reach care teams, and depression. Most participants did not feel that their dialysis care experiences had changed, but some reported difficulties in other aspects of living such as nutrition and social interactions. Participants highlighted the importance of consistent dialysis care teams and the availability of external support. We found that patients who are treated with in-center hemodialysis, are non-White, or have mental health conditions may have been more vulnerable during the pandemic.