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Abstract Introduction Early prediction and timely treatment are essential for minimizing the risk of visual loss or blindness of retinopathy of prematurity, emphasizing the importance of ROP screening in clinical routine. Objective To establish predictive models for ROP occurrence based on the risk factors using artificial neural network. Methods A cohort of 591 infants was recruited in this retrospective study. The association between ROP and perinatal factors was analyzed by univariate analysis and multivariable logistic regression. We developed predictive models for ROP screening using back propagation neural network, which was further optimized by applying genetic algorithm method. To assess the predictive performance of the models, the areas under the curve, sensitivity, specificity, negative predictive value, positive predictive value and accuracy were used to show the performances of the prediction models. Results ROP of any stage was found in 193 (32.7%) infants. Twelve risk factors of ROP were selected. Based on these factors, predictive models were built using BP neural network and genetic algorithm-back propagation (GA-BP) neural network. The areas under the curve for prediction models were 0.857, and 0.908 in test, respectively. Conclusions We developed predictive models for ROP using artificial neural network. GA-BP neural network exhibited superior predictive ability for ROP when dealing with its non-linear clinical data.

Upper extremity injuries in baseball pitchers cause significant time loss from competing and decreased quality of life. Although shoulder range of motion (ROM) is reported as a key factor to prevent potential injury, it remains unclear how limited glenohumeral ROM affects pitching biomechanics which may contribute to upper extremity injuries. To investigate how pitchers with decreased total arc glenohumeral ROM of the throwing arm differed in upper extremity pitching kinematics and kinetics as well as ball velocity compared with pitchers with greater levels of glenohumeral ROM. Cross-sectional study. Laboratory. Fifty-seven baseball pitchers (ages 18–24) were divided into either control (≥160° total arc) or lower ROM (<160° total arc) groups. The mean glenohumeral ROM deficits, pitching kinematic and kinetic outcomes, and ball velocity were compared between groups. The control group demonstrated significantly less deficit in total arc ROM between arms than the lower ROM (control: −1.5° ± 10.0°; lower ROM: −12.4° ± 13.9°; P <.001). While the lower ROM group displayed less maximal shoulder external rotation (ER) while pitching, the control group had significantly less difference in ROM between maximal shoulder ER while pitching and clinically measured ER (lower ROM: 64.4° ± 12.1°; control: 55.8° ± 16.6°; P =.025). The control group had significantly faster ball velocity than the lower ROM group (control: 85.0 ± 4.3 mph; lower ROM: 82.4 ± 4.8 mph; P =.024). Pitchers with decreased total arc glenohumeral ROM (<160° total arc) may undergo overstretching toward ER in the shoulder during the late cocking phase. Pitchers with higher total arc ROM can pitch the same or faster ball without increasing loading in the upper extremity. Total arc glenohumeral ROM measurement can be a clinical screening tool to monitor shoulder condition over the time, and pitchers with limited total arc ROM might be at higher risk of shoulder injury. [ABSTRACT FROM AUTHOR]

Introduction: Early prediction and timely treatment are essential for minimizing the risk of visual loss or blindness of retinopathy of prematurity, emphasizing the importance of ROP screening in clinical routine. Objective: To establish predictive models for ROP occurrence based on the risk factors using artificial neural network. Methods: A cohort of 591 infants was recruited in this retrospective study. The association between ROP and perinatal factors was analyzed by univariate analysis and multivariable logistic regression. We developed predictive models for ROP screening using back propagation neural network, which was further optimized by applying genetic algorithm method. To assess the predictive performance of the models, the areas under the curve, sensitivity, specificity, negative predictive value, positive predictive value and accuracy were used to show the performances of the prediction models. Results: ROP of any stage was found in 193 (32.7%) infants. Twelve risk factors of ROP were selected. Based on these factors, predictive models were built using BP neural network and genetic algorithm-back propagation (GA-BP) neural network. The areas under the curve for prediction models were 0.857, and 0.908 in test, respectively. Conclusions: We developed predictive models for ROP using artificial neural network. GA-BP neural network exhibited superior predictive ability for ROP when dealing with its non-linear clinical data. [ABSTRACT FROM AUTHOR]

ABSTRACT Gastric cancer (GC) prevalence is very high in the Asian population. Oncogenic viruses play a crucial role in the progression of different types of cancers. Through reanalysis of clinical RNA-seq data sets derived from Asian GC patients, this study identified the presence of human cytomegalovirus (HCMV) in Asian GC tumors, next to the well-studied association of EBV. Clinical recruitment of the Indian GC cohort and screening for HCMV presence identified a 14.28% occurrence, similar to that observed in the bioinformatics analysis. A combinatorial approach of rank-based meta-analysis and ranking of groups based on an expectation-maximization algorithm identified that the upregulated LINC02864 and MAGEA10 correlated with poor survival of GC patients and downregulated tumor suppressor genes enriching for gastric acid secretion pathway to be associated with HCMV-positive GC patients, revealing the progressive role of HCMV infection in GC. Genes that discriminate between different stages of GC were identified through feature selection implemented in a machine-learning approach. LTF and KLK10 expressions were found to be specifically dysregulated by HCMV and can also indicate the GC stages. The results of this study will guide future studies to identify the functional role of these genes in the HCMV-associated GC.IMPORTANCENearly 75% of gastric cancer (GC) cases reported globally are from the Asian population. Most existing public databases, such as TCGA, comprise only a fractional portion of data derived from Asian ancestry. This study identified EBV and human cytomegalovirus (HCMV)'s higher detection in GC patients. The presence and role of EBV associated with GC are well-known, and the observation of HCMV prompted us to validate the findings in a small cohort of 40 Indian GC patients. We observed a 14.28% occurrence of HCMV in the Indian cohort, similar to that observed from next-generation sequencing. A combinatorial approach of rank-based meta-analysis and ranking of groups based on an expectation-maximization algorithm identified that the upregulated LINC02864 and MAGEA10 correlated with poor survival of GC patients and downregulated tumor suppressor genes enriching for gastric acid secretion pathway to be associated with HCMV-positive GC patients, revealing the progressive role of HCMV infection in GC.

Background: The use of pre- and perinatal risk factors as predictive factors may lower the age limit for reliable autism prediction. The objective of this study was to develop a clinical model based on these risk factors to predict autism. Methods: A stepwise logistic regression analysis was conducted to explore the relationships between 28 candidate risk factors and autism risk among 615 Han Chinese children with autism and 615 unrelated typically developing children. The significant factors were subsequently used to create a clinical risk score model. A chi-square automatic interaction detector (CHAID) decision tree was used to validate the selected predictors included in the model. The predictive performance of the model was evaluated by an independent cohort. Results: Five factors (pregnancy influenza-like illness, pregnancy stressors, maternal allergic/autoimmune disease, cesarean section, and hypoxia) were found to be significantly associated with autism risk. A receiver operating characteristic (ROC) curve indicated that the risk score model had good discrimination ability for autism, with an area under the curve (AUC) of 0.711 (95% CI=0.679-0.744); in the external validation cohort, the model showed slightly worse but overall similar predictive performance. Further subgroup analysis indicated that a higher risk score was associated with more behavioral problems. The risk score also exhibited robustness in a subgroup analysis of patients with mild autism. Conclusion: This risk score model could lower the age limit for autism prediction with good discrimination performance, and it has unique advantages in clinical application. [ABSTRACT FROM AUTHOR]

IntroductionTuberculosis (TB) stands as a paramount global health concern, contributing significantly to worldwide mortality rates. Effective containment of TB requires deployment of cost-efficient screening method with limited resources. To enhance the precision of resource allocation in the global fight against TB, this research proposed chest X-ray radiography (CXR) based machine learning screening algorithms with optimization, benchmarking and tuning for the best TB subclassification tasks for clinical application.MethodsThis investigation delves into the development and evaluation of a robust ensemble deep learning framework, comprising 43 distinct models, tailored for the identification of active TB cases and the categorization of their clinical subtypes. The proposed framework is essentially an ensemble model with multiple feature extractors and one of three fusion strategies-voting, attention-based, or concatenation methods-in the fusion stage before a final classification. The comprised de-identified dataset contains records of 915 active TB patients alongside 1,276 healthy controls with subtype-specific information. Thus, the realizations of our framework are capable for diagnosis with subclass identification. The subclass tags include: secondary tuberculosis/tuberculous pleurisy; non-cavity/cavity; secondary tuberculosis only/secondary tuberculosis and tuberculous pleurisy; tuberculous pleurisy only/secondary tuberculosis and tuberculous pleurisy.ResultsBased on the dataset and model selection and tuning, ensemble models show their capability with self-correction capability of subclass identification with rendering robust clinical predictions. The best double-CNN-extractor model with concatenation/attention fusion strategies may potentially be the successful model for subclass tasks in real application. With visualization techniques, in-depth analysis of the ensemble model's performance across different fusion strategies are verified.DiscussionThe findings underscore the potential of such ensemble approaches in augmenting TB diagnostics with subclassification. Even with limited dataset, the self-correction within the ensemble models still guarantees the accuracies to some level for potential clinical decision-making processes in TB management. Ultimately, this study shows a direction for better TB screening in the future TB response strategy.

Primary hyperparathyroidism (PHPT) includes sporadic PHPT and hereditary PHPT. However, until now, there have been no exact data on the proportion and composition of hereditary PHPT in the Chinese PHPT population. This study aimed to clarify the proportion and composition of hereditary PHPT in patients at a large academic center in Beijing, China, and to analyze genotype–phenotype characteristics. A total of 394 newly diagnosed Han PHPT patients who consented to genetic screening were enrolled. Targeted next‐generation sequencing (T‐NGS) (including for MEN1, RET, CDKN1B, CaSR, HRPT2/CDC73, GNA11, AP2S1, GCM2), combined with MEN1‐multiplex ligation‐dependent probe amplification (MLPA) and CDC73‐MLPA, was used for genetic screening. Diagnosis of hereditary PHPT was based on clinical manifestations, family history, and genetic screening. Thirty‐seven pathogenic (P)/likely pathogenic (LP) variants were detected in 41 patients via T‐NGS, and three patients carried long‐range deletions of MEN1 or CDC73 detected by MLPA, with a variant detection rate of 11.2% (44/394). In total, 30 patients were clinically diagnosed with MEN1. Combined with genetic and clinical screening, the rate of hereditary PHPT in this study was 18.8% (74/394). For purposes of comparison, the rate of unequivocal nonhereditary PHPT was 66.5% (262/394); 14.7% (58/394) did not exhibit the clinical features of hereditary PHPT but carried variants of uncertain clinical significance and so could not be clearly categorized. Both the age at hospital visit (43.6 ± 14.0 versus 53.7 ± 14.9 years) and age at onset (35.4 ± 13.8 versus 50.6 ± 14.8 years) in the hereditary group (n = 74) were significantly lower than those in the nonhereditary group (n = 262). Higher levels of ionized calcium and serum β‐CTX were observed in the hereditary group; proportions of parathyroid hyperplasia and multigland involvement were also higher. In addition to multigland disease and positive family history, it is recommended that patients with an age of onset less than 38 should be screened for hereditary forms. © 2023 American Society for Bone and Mineral Research (ASBMR). [ABSTRACT FROM AUTHOR]

OBJECTIVE: The American Academy of Pediatrics recommends routine sleep problem screenings during child well-visits. However, studies suggest a discrepancy between caregiver- and clinician-reported child sleep problems. The present study examines whether caregiver-reported child sleep problems (ie, habitual snoring, insomnia symptoms, poor sleep health) and clinician-documented child sleep problems and management are congruent. METHODS: The sample included 170 caregiver-child dyads (child Mage = 3.3 years, range = 2-5 years; 56.5% girls; 64.1% Black, 20.0% non-Latinx White, and 4.1% Latinx; 86.5% maternal caregiver reporter). Caregivers' questionnaire-based reports of habitual snoring, insomnia symptoms, and sleep health behaviors (nighttime electronics, caffeine intake, insufficient sleep) were compared with clinician documentation in the electronic health record. RESULTS: About 92.3% of children had at least 1 caregiver-reported sleep problem (66% insomnia symptoms, 64% electronics, 38% insufficient sleep, 21% caffeine, 17% snoring). In contrast, a substantially lower percent of children had a clinician documented sleep problem (20% overall; 10% insomnia symptoms, 7% electronics, 0% insufficient sleep, 3% caffeine, 4% snoring), sleep-related referral (1% overall; 0.6% Otolaryngology, 0.6% polysomnogram, 0% sleep clinic), or recommendation (12% overall; 8% insomnia symptoms, 4% electronics, 0% insufficient sleep, 1% caffeine). CONCLUSIONS: There is a vast discrepancy between caregiver-reported child sleep problems and clinician-documented sleep problems and management, with a higher proportion of caregiver reports. To benefit overall child health and well-being, future research and quality improvement initiatives should focus on enhancing screening tools and educational opportunities to improve clinician documentation and enhance family conversations about early childhood sleep problems. [ABSTRACT FROM AUTHOR]

Abstract Background Pathogenic germline variants (PGVs) in certain genes are linked to higher lifetime risk of developing breast cancer and can influence preventive surgery decisions and therapy choices. Public health programs offer genetic screening based on criteria designed to assess personal risk and identify individuals more likely to carry PGVs, dividing patients into screened and non-screened groups. How tumor biology and clinicopathological characteristics differ between these groups is understudied and could guide refinement of screening criteria. Methods Six thousand six hundred sixty breast cancer patients diagnosed in South Sweden during 2010–2018 were included with available clinicopathological and RNA sequencing data, 900 (13.5%) of which had genes screened for PGVs through routine clinical screening programs. We compared characteristics of screened patients and tumors to non-screened patients, as well as between screened patients with (n = 124) and without (n = 776) PGVs. Results Broadly, breast tumors in screened patients showed features of a more aggressive disease. However, few differences related to tumor biology or patient outcome remained significant after stratification by clinical subgroups or PAM50 subtypes. Triple-negative breast cancer (TNBC), the subgroup most enriched for PGVs, showed the most differences between screening subpopulations (e.g., higher tumor proliferation in screened cases). Significant differences in PGV prevalence were found between clinical subgroups/molecular subtypes, e.g., TNBC cases were enriched for BRCA1 PGVs. In general, clinicopathological differences between screened and non-screened patients mimicked those between patients with and without PGVs, e.g., younger age at diagnosis for positive cases. However, differences in tumor biology/microenvironment such as immune cell composition were additionally seen within PGV carriers/non-carriers in ER + /HER2 − cases, but not between screening subpopulations in this subgroup. Conclusions Characterization of molecular tumor features in patients clinically screened and not screened for PGVs represents a relevant read-out of guideline criteria. The general lack of molecular differences between screened/non-screened patients after stratification by relevant breast cancer subsets questions the ability to improve the identification of screening candidates based on currently used patient and tumor characteristics, pointing us towards universal screening. Nevertheless, while that is not attained, molecular differences identified between PGV carriers/non-carriers suggest the possibility of further refining patient selection within certain patient subsets using RNA-seq through, e.g., gene signatures. Trial registration The Sweden Cancerome Analysis Network – Breast (SCAN-B) was prospectively registered at ClinicalTrials.gov under the identifier NCT02306096.

Background: Pathogenic germline variants (PGVs) in certain genes are linked to higher lifetime risk of developing breast cancer and can influence preventive surgery decisions and therapy choices. Public health programs offer genetic screening based on criteria designed to assess personal risk and identify individuals more likely to carry PGVs, dividing patients into screened and non-screened groups. How tumor biology and clinicopathological characteristics differ between these groups is understudied and could guide refinement of screening criteria. Methods: Six thousand six hundred sixty breast cancer patients diagnosed in South Sweden during 2010–2018 were included with available clinicopathological and RNA sequencing data, 900 (13.5%) of which had genes screened for PGVs through routine clinical screening programs. We compared characteristics of screened patients and tumors to non-screened patients, as well as between screened patients with (n = 124) and without (n = 776) PGVs. Results: Broadly, breast tumors in screened patients showed features of a more aggressive disease. However, few differences related to tumor biology or patient outcome remained significant after stratification by clinical subgroups or PAM50 subtypes. Triple-negative breast cancer (TNBC), the subgroup most enriched for PGVs, showed the most differences between screening subpopulations (e.g., higher tumor proliferation in screened cases). Significant differences in PGV prevalence were found between clinical subgroups/molecular subtypes, e.g., TNBC cases were enriched for BRCA1 PGVs. In general, clinicopathological differences between screened and non-screened patients mimicked those between patients with and without PGVs, e.g., younger age at diagnosis for positive cases. However, differences in tumor biology/microenvironment such as immune cell composition were additionally seen within PGV carriers/non-carriers in ER + /HER2 − cases, but not between screening subpopulations in this subgroup. Conclusions: Characterization of molecular tumor features in patients clinically screened and not screened for PGVs represents a relevant read-out of guideline criteria. The general lack of molecular differences between screened/non-screened patients after stratification by relevant breast cancer subsets questions the ability to improve the identification of screening candidates based on currently used patient and tumor characteristics, pointing us towards universal screening. Nevertheless, while that is not attained, molecular differences identified between PGV carriers/non-carriers suggest the possibility of further refining patient selection within certain patient subsets using RNA-seq through, e.g., gene signatures. Trial registration: The Sweden Cancerome Analysis Network – Breast (SCAN-B) was prospectively registered at ClinicalTrials.gov under the identifier NCT02306096. [ABSTRACT FROM AUTHOR]

As the key enzyme mediating ribonucleotide excision repair, RNase H2 is essential for the removal of single ribonucleotides from DNA in order to prevent genome damage. Loss of RNase H2 activity directly contributes to the pathogenesis of autoinflammatory and autoimmune diseases and might further play a role in ageing and neurodegeneration. Moreover, RNase H2 activity is a potential diagnostic and prognostic marker in several types of cancer. Until today, no method for quantification of RNase H2 activity has been validated for the clinical setting. Herein, validation and benchmarks of a FRET-based whole-cell lysate RNase H2 activity assay are presented, including standard conditions and procedures to calculate standardized RNase H2 activity. Spanning a wide working range, the assay is applicable to various human cell or tissue samples with overall methodological assay variability from 8.6% to 16%. Using our assay, we found RNase H2 activity was reduced in lymphocytes of two patients with systemic lupus erythematosus and one with systemic sclerosis carrying heterozygous mutations in one of the RNASEH2 genes. Implementation of larger control groups will help to assess the diagnostic and prognostic value of clinical screening for RNase H2 activity in the future. [ABSTRACT FROM AUTHOR]

Background: Motoric cognitive risk syndrome (MCR) is a pre-dementia stage. The existence of stable and transient MCR, their related clinical characteristics and their association with incident dementia is a matter of debate. Objective: This study aims to examine the clinical characteristics and the time course associated with new onset, transient and stable MCR, and their association with incidence of probable dementia in community-dwelling older adults living in the province of Quebec (Canada). Design: Quebec elderly population-based observational cohort study with 3 years of follow-up. Setting: Community dwellers. Subjects: A subset of participants (n = 1,113) from the "Quebec Longitudinal Study on Nutrition and Successful Aging" (NuAge) cohort. Methods: Participants with MCR were identified at baseline and after 1 year of followup. Socio-demographic characteristics, 30-item Geriatric depression scale (GDS) score, cardiovascular risk factors and diseases were recorded at baseline. Incidence of probable dementia was measured at annual follow-up visits over a 3-year period. Results: Over the period of the first year of follow-up, the prevalence of MCR was 8.5% with 4.3% having new onset MCR, 2.8% transient MCR and 1.4% stable MCR. A higher 30-item GDS score was reported with new onset and transient MCR, and the highest prevalence of cerebrovascular diseases was shown with stable MCR compared to non-MCR participants (p < 0.05). MCR was associated with overall incidence of probable dementia, regardless of its status (Hazard Ratio ≥ 1.86, p ≤ 0.034). Conclusion: Greater prevalence of depressive symptoms and cerebrovascular diseases were reported, respectively, with new onset and transient MCR, and stable MCR. The association of MCR with incidence of probable dementia remains significant, regardless of MCR subtypes. [ABSTRACT FROM AUTHOR]

[Display omitted] • A microcolumn IEF array chip developed for thalassemia and hemoglobinopathy screening. • Ultrahigh resolution separation of Hb variants of the chip in contrast to LC, CZE and cIEF. • Simultaneous assays of up to 24 blood samples by the chip higher than LC, CZE and cIEF. • 100% sensitivity and 89.1% specificity achieved for screening of adult beta-thalassemia. Traditional capillary isoelectric focusing (cIEF), liquid chromatography (LC) and capillary zone electrophoresis (CZE) still suffered from low resolution for hemoglobinopathy screening. Herein, a 30-mm pH 5.2–7.8 microcolumn IEF (mIEF) array chip was developed for hemoglobinopathy screening. As a proof of concept, adult beta-thalassemia was chosen as a model disease. In the method, blood samples were hemolyzed via hemolysin solution and loaded into the microcolumn. The experiments showed that (i) the species of Hb A, F, A 2 and variants were clearly separated in the chip, and the resolution was greatly higher than the ones of LC/CZE/cIEF; (ii) up to 24 samples could be simultaneously analyzed in 12-min run; (iii) the intraday and interday RSDs were respectively 3.32–4.91 % and 4.07–5.33 %. The assays of mIEF to total 634 samples were compared with the ones of LC (n = 327) and PCR (n = 307). The cutoff of 3.5 % HbA 2 led to the sensitivity of 100 % and specificity of 89.1 % for the mIEF-based screening; and there was 96.7 % coincidence between the methods of mIEF and PCR if refer Hb A 2 and F. The method had the merits of facility, efficiency, specificity and sensitivity in contrast to the currently-used methods, implying its potential to screening of beta-thalassemia and hemoglobinopathies. [ABSTRACT FROM AUTHOR]

Background: Changes in loneliness are associated with corresponding changes in depression, anxiety, and general health in population surveys, but few studies have assessed these associations through repeated screening in clinical settings. Methods: Retrospective cohort study among individuals ≥age 65 in an integrated health care system who completed loneliness screening before two annual wellness visits, separated by a mean of 12.9 (SD 2.0) months, between 2013 and 2018. Their responses identified four subgroups: individuals who were persistently lonely; not lonely; experienced an increase (recently lonely); or decrease (previously lonely) in loneliness. Loneliness was assessed with a single item. Depression was assessed with the Patient Health Questionnaire‐2. Anxiety was assessed with the Generalized Anxiety Disorder‐2. Fair/poor general health was assessed by a single item. Linear mixed effects models assessed changes in outcomes after covariate adjustment. Results: The cohort comprised 24,666 individuals (19.2% of older adults in the system). Mean age was 73.7 years (SD 6.4); 54.6% were female, and 11.6% were members of racial and ethnic minority groups. Of these individuals, 1936 (7.8%) were persistently lonely, 1687 (6.8%) were recently lonely, 1551 (6.3%) were previously lonely, and 19,492 (79.0%) were not lonely at either time point. After adjustment for sociodemographic, clinical and social variables, recent loneliness was associated with increases in depression (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.41–2.19) and anxiety (aOR 1.67, 95% CI 1.32–2.10). Previous loneliness was associated with decreases in depression (aOR, 0.46, 95% CI 0.36–0.58) and anxiety (aOR 0.69, 95% CI 0.54–0.90). Changes in loneliness were not associated with changes in general health. Conclusions: Changes in loneliness identified through screening were associated with corresponding changes in depression and anxiety. These findings support the potential value of identifying social risk factors in clinical settings among older adults. [ABSTRACT FROM AUTHOR]

BackgroundMotoric cognitive risk syndrome (MCR) is a pre-dementia stage. The existence of stable and transient MCR, their related clinical characteristics and their association with incident dementia is a matter of debate.ObjectiveThis study aims to examine the clinical characteristics and the time course associated with new onset, transient and stable MCR, and their association with incidence of probable dementia in community-dwelling older adults living in the province of Quebec (Canada).DesignQuebec elderly population-based observational cohort study with 3 years of follow-up.SettingCommunity dwellers.SubjectsA subset of participants (n = 1,113) from the “Quebec Longitudinal Study on Nutrition and Successful Aging” (NuAge) cohort.MethodsParticipants with MCR were identified at baseline and after 1 year of follow-up. Socio-demographic characteristics, 30-item Geriatric depression scale (GDS) score, cardiovascular risk factors and diseases were recorded at baseline. Incidence of probable dementia was measured at annual follow-up visits over a 3-year period.ResultsOver the period of the first year of follow-up, the prevalence of MCR was 8.5% with 4.3% having new onset MCR, 2.8% transient MCR and 1.4% stable MCR. A higher 30-item GDS score was reported with new onset and transient MCR, and the highest prevalence of cerebrovascular diseases was shown with stable MCR compared to non-MCR participants (p

IntroductionSociodemographic and behavioral factors are usually associated with the unsuitability to donate blood. Understanding the reasons behind the exclusion of blood bags is crucial for reducing donor deferral rates. This study aimed to characterize the profile of unsuitable donors in the Blood Center of the northern Brazilian state of Amazonas.MethodsThis is a retrospective study, based on documentary analysis of electronic medical records obtained in the Hematology and Hemotherapy Foundation of the state of Amazonas. This study included all individuals with complete medical records (n = 87,463) who tried to donate blood between 2017 and 2019.ResultsThe overall rate of donor unsuitability was 19.12% (n = 16,627) and the main reason was poor nutritional status (15.17%), followed by chronic health problems (11.40%), risky sexual behavior (9.5%) and exposure to risk (8.83%). High blood pressure figured as the leading cause of unsuitability among chronic health conditions (85.19%), while having sex with multiple partners (92.63%) was the main sexual risk behavior. The risk of exposure to malaria was responsible for 99.45% of unsuitability among those who were unsuitable due to exposure to risk factors. Deferral rates were associated with increasing age and replacement donation, which was the predominant type of donation. Women had the highest rates of unsuitability, mainly during the first donation (37.04%).DiscussionThis study provides the first known profile of blood donor unsuitability in the Brazilian Amazon and raises awareness of the region-specific needs that must be met to reduce blood donor unsuitability.

Soccer is a very popular sport with a high incidence of injuries. Clinical screening tools are an important component of injury prevention. The aim of this study was to investigate the relationship between two screening tools, the Functional Movement Screen (FMS) and Star Excursion Balance Test (SEBT), and whether there are differences regarding SEBT scores, injuries, and painful symptoms in participants below and above the FMS cutoff score of ≤14. The research was performed as a secondary analysis of a longitudinal cohort study and included 42 non-professional soccer players from Eastern Croatia (age 25.5±6 years, training experience 15.8±6.6 years). Participants were surveyed regarding their sociodemographic data, soccer playing, and FMS and SEBT tests were performed. They were followed for 3.5 months when an additional set of data regarding injuries and painful symptoms was obtained. Moderate to good correlation was found between FMS total score and posterolateral reach of dominant and non-dominant legs (r=0.503, p=0.001; r=0.525, p<0.001). Significant correlations were found between FMS total score and SEBT composite scores for dominant and non-dominant legs (r=0.486, p=0.001; r=0.453, p=0.003). Numerous significant correlations were found between individual items of FMS and SEBT. Participants with FMS score ≤14 had a higher occurrence of injuries and painful symptoms (p=0.018; p=0.034) and lower results of SEBT composite scores for dominant and non-dominant legs (p=0.010; p=0.001). There is a significant relationship between FMS and SEBT scores. Players with FMS scores ≤14 are more prone to injuries and painful symptoms and they have lower SEBT scores. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDH) contribute to nearly 50% of health outcomes; however, SDH data collection is inconsistent in clinical practice. This study used mixed methods to evaluate health care professionals' perceptions of universal SDH screening at an academic medical center by surveying physicians, advanced practice providers, nurses, social workers, case managers, pharmacists, and administrators. An electronic survey assessed SDH screening practices, prioritization of SDH domains, disciplines to perform screening, and attitudes and barriers to universal screening. Likert-scale responses were dichotomized and compared disciplines with proportions tests. Qualitative interviews identified themes and elaborated survey findings. Participant discipline was the primary predictor variable. Of 193 survey participants (62.5% response rate), most were physicians (31%) or social workers (22%). Participants overwhelmingly reported using SDH information in patient care (93%), and social workers as the most appropriate role for screening (95%). Most respondents (75%) believed health literacy is important, but 40% reported routine assessment. Housing status (73% vs. 53%) and financial strain (62% vs. 48%) followed similar patterns. SDH screening barriers included lacking resources to address identified needs (51%), time to ask (45%), support staff to ask (33%), and training in responding to identified needs (28%). Social workers cited barriers less often than non-social workers (P < 0.001). Qualitative interviews (n = 16) supported survey findings and described barriers including lack of time, resources, standardized approaches, and professional burnout. Health care professionals support universal SDH screening while highlighting the need to address implementation barriers. Strategies should leverage social work expertise and optimize SDH data accessibility for all providers. [ABSTRACT FROM AUTHOR]

Introduction: Artificial intelligence (AI) systems leveraging speech and language changes could support timely detection of Alzheimer's disease (AD). Methods: The AMYPRED study (NCT04828122) recruited 133 subjects with an established amyloid beta (Aβ) biomarker (66 Aβ+, 67 Aβ–) and clinical status (71 cognitively unimpaired [CU], 62 mild cognitive impairment [MCI] or mild AD). Daily story recall tasks were administered via smartphones and analyzed with an AI system to predict MCI/mild AD and Aβ positivity. Results: Eighty‐six percent of participants (115/133) completed remote assessments. The AI system predicted MCI/mild AD (area under the curve [AUC] = 0.85, ±0.07) but not Aβ (AUC = 0.62 ±0.11) in the full sample, and predicted Aβ in clinical subsamples (MCI/mild AD: AUC = 0.78 ±0.14; CU: AUC = 0.74 ±0.13) on short story variants (immediate recall). Long stories and delayed retellings delivered broadly similar results. Discussion: Speech‐based testing offers simple and accessible screening for early‐stage AD. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of hip (DDH) is a common disorder of childhood and has a good prognosis when treated at an early age. In spite of being a significant concern, many children with DDH are not picked early and present late at walking age. In our country, it is presumed to be due to absence of a national policy for screening of DDH. Screening programmes including the combination of clinical and radiological methods in different ways have been suggested. However, the exact method of screening is controversial. Purpose: To analyze effectiveness and cost-effectiveness of various screening methods for DDH. Study Design: Systematic review. Methods: This review was conducted in accordance with PRISMA guidelines. Medline database was explored for original case series and randomized clinical trials. Inclusion criteria were English language, screening for DDH in neonates, sample size more than 500, and studies with minimum duration of one year. Results: Thirty-four studies were selected to write the manuscript. This included 23 studies looking for effectiveness of a screening programme and 11 studies comparing various outcomes of different screening strategies. A trend favoring universal ultrasound screening was observed Conclusion: The literature supports universal ultrasound screening and has proved its cost-effectiveness. However, considering the logistic and financial challenges in our country, immediate implementation of universal ultrasound screening seems impractical. In the absence of any current guidelines for screening for DDH in India, we suggest professional organizations involved in the care of children and public health policy-makers to come together to develop national screening guidelines for DDH. [ABSTRACT FROM AUTHOR]

Orientation: South Africa carries a high burden of mental ill-health. Screening to identify individuals for further referral is emerging as one pathway to promote access to mental health interventions. Existing occupational health surveillance infrastructure may be a useful mechanism for clinical mental health screening. Research purpose: This study explored the clinical validity of a range of brief mental health measures in the context of occupational health surveillance. Motivation for the study: To meaningfully screen for mental health as part of occupational health surveillance, tools are required that are empirically validated, clinically useful, locally available and practical to administer. Research approach/design and method: Workers (n = 1816), recruited through workplace occupational health surveillance programmes, completed the Patient Health Questionnaire-9, Brief Symptom Inventory 18-somatisation subscale, Generalised Anxiety Disorder scale-7, Primary Care Post-Traumatic Stress Disorder Screen, Intense (panic-like) anxiety scale and CAGE scale and partook in a diagnostic interview with a clinical psychologist. Main findings: Basic psychometric characteristics were reported, including confirmatory factor analyses, measurement invariance, internal consistencies and socio-demographic effects. Clinical utility was explored through receiver operating/operator characteristics curve analyses, and calculations of positive and negative predictive values, as well as sensitivity and specificity. These indicators provided evidence of clinical validity in the study context. Practical/managerial implications: The findings support the use of psychological screening as a brief, practicable and easily accessible mode of occupational mental health support. Contribution/value-add: This article presented evidence of structural and criterion validity for these scales and described their clinical application for practical use in occupational mental health surveillance.

With an increase in aging populations worldwide, age-related diseases such as Alzheimer’s disease (AD) have become a global concern. At present, a cure for neurodegenerative disease is lacking. There is an urgent need for a biomarker that can facilitate the diagnosis, classification, prognosis, and treatment response of AD. The recent emergence of highly sensitive mass-spectrometry platforms and high-throughput technology can be employed to discover and catalog vast datasets of small metabolites, which respond to changed status in the body. Metabolomics analysis provides hope for a better understanding of AD as well as the subsequent identification and analysis of metabolites. Here, we review the state-of-the-art emerging candidate biomarkers for AD.

With an increase in aging populations worldwide, age-related diseases such as Alzheimer's disease (AD) have become a global concern. At present, a cure for neurodegenerative disease is lacking. There is an urgent need for a biomarker that can facilitate the diagnosis, classification, prognosis, and treatment response of AD. The recent emergence of highly sensitive mass-spectrometry platforms and high-throughput technology can be employed to discover and catalog vast datasets of small metabolites, which respond to changed status in the body. Metabolomics analysis provides hope for a better understanding of AD as well as the subsequent identification and analysis of metabolites. Here, we review the state-of-the-art emerging candidate biomarkers for AD. [ABSTRACT FROM AUTHOR]

Social robots are coming to our homes and have already been used to help humans in a number of ways in geriatric care. This article aims to develop a framework that enables social robots to conduct regular clinical screening interviews in geriatric care, such as cognitive evaluation, falls’ risk evaluation, and pain rating. We develop a social robot with essential features to enable clinical screening interviews, including a conversational interface, face tracking, an interaction handler, attention management, robot skills, and cloud service management. Besides, a general clinical screening interview management (GCSIM) model is proposed and implemented. The GCSIM enables social robots to handle various types of clinical questions and answers, evaluate and score responses, engage interviewees during conversations, and generate reports on their well-being. These reports can be used to evaluate the progression of cognitive impairment, risk of falls, pain level, and so on by caregivers or physicians. Such a clinical screening capability allows for early detection and treatment planning in geriatric care. The framework was developed and implemented on our 3-D-printed social robot. It was tested on 30 older adults with different ages, achieved satisfying results, and received their high confidence and trust in the use of this robot for human well-being assessment. Note to Practitioners—This article is motivated by the goal of using a social robot to perform geriatric well-being assessment through clinical screening interviews. In order to conduct clinical screening interviews, the social robot needs the following essential features: having a verbal conversational interface, adapting to different types of clinical screening interviews, scoring and evaluating answers, having nondirective listening responses, and enabling directive listening responses. The proposed general clinical screening interview management (GCSIM) model demonstrates these capabilities on the social robot. The robot can give structured clinical screening interviews with different question–answer sheets. This will help advance assistive technologies for use by geriatric physicians, nurses, and social service professionals to keep older adults healthy, safe, and independent at home. Robots will become more and more essential in working alongside geriatric practitioners to help monitor older adults at home and to provide early detection and warning of cognitive/mental health problems, falls’ risk, and so on. This early detection property can improve quality-of-care and help older adults remain living at home. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to evaluate the prevalence of perceived bleeding symptoms in Nigerian women and the usefulness of a simple clinical screening tool for bleeding symptoms. Materials and Methods: A population-based cross-sectional survey of 1524 women of 16–50 years in Southeast Nigeria using a structured, prevalidated, pretested questionnaire was conducted. Results: A total of 1524 (85%) women responded with the mean age of 26 (10.6) years. Prevalence of bleeding symptoms was 24.6% and 11% of the women reported a positive family history of bleeding symptoms. There was a significant association between having a positive family history of bleeding disorder and experiencing bleeding symptoms (adjusted odds ratio: 0.12, 95% confidence interval: 0.06–0.22 P < 0.0001). Two hundred and six women experienced at least one bleeding symptom, 125 (8.2%) experienced at least two, whereas 43 (2.8%) experienced >3 bleeding symptoms. The most common perceived bleeding symptom was heavy menstrual bleeding (HMB) present in 83 women (22.2%), 141 (9.3%) reported a past history of HMB, 202 (13.3%) had heavy bleeds during most of their monthly cycle, and 351 (23%) requiring resuscitation with blood support. Conclusion: The prevalence of perceived bleeding symptoms among women is high, and HMB is the most common bleeding symptom. This clinical screening tool is easy and cost-effective in routinely identifying women with bleeding symptoms needing further hemostatic and obstetrics evaluation. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the expression of microRNA (miR)-495 and miR-326 in the peripheral blood of patients with rheumatoid arthritis (RA). A total of 107 RA patients, admitted to the Yidu Central Hospital of Weifang (Weifang, China) from February 2016 to February 2019, and 112 healthy subjects, who underwent physical examination during the same period, were selected as the research subjects for prospective analysis. The RA patients served as the study group and the healthy subjects as the control group. The expression levels of miR-495 and miR-326 in the peripheral blood of the two groups of subjects were compared. The association between miR-495 and miR-326 with RA clinical pathology and the diagnostic value of miR-495 and miR-326 for RA were analyzed. In the study group, miR-495 expression was significantly higher than that in the control group, and miR-326 expression was significantly lower than that in the control group (P<0.001). miR-495 and miR-326 combined diagnosis showed good predictive value for the occurrence of RA (P<0.001) and was closely related to RA clinical pathology (P<0.001). After treatment, miR-495 expression was significantly decreased in the study group, whereas miR-326 expression was significantly increased (P<0.001). Pearson's correlation coefficient analysis showed that rheumatoid factor (RF) was positively correlated with miR-495 expression and negatively correlated with miR-326 expression (P<0.001). In conclusion, miR-495 was highly expressed in patients with RA, whereas miR-326 was poorly expressed in RA patients, and the combined detection of miR-495 and miR-326 has good diagnostic value for RA. [ABSTRACT FROM AUTHOR]

As food insecurity interventions are incorporated into hospitals' population health initiatives, addressing the needs of hospitals' patients and communities through the same interventions may be ineffective if the groups vary and have different needs. This study examined whether food insecurity predictors were different in the general population compared to individuals with hospital discharges, and also whether food-insecure hospital patients differed from food-insecure community members. National data were extracted from the 2016 Medical Expenditures Panel Survey. Summary statistics were compared to test for differences between food security status groups. Logistic regressions were estimated for the general population and for individuals with hospital discharges to identify associations between food insecurity and demographic, socioeconomic, and health characteristics. Food-insecure individuals with and without hospital discharges differed statistically across multiple variables, including 15 of 16 health-related variables. However, compared to food-secure individuals with hospital discharges, food-insecure individuals with hospital discharges differed on only half of the health variables. Food insecurity predictors also differed among the general population and hospital discharge samples; for instance, age and race were only associated with higher likelihoods of food insecurity in the population sample. Furthermore, 9 health-related variables were associated with food insecurity in the population sample relative to only 2 in the hospital discharge sample. Food insecurity predictors differed between the general population and individuals with hospital discharges; food-insecure individuals with and without hospital discharges also differed statistically. Therefore, hospitals should carefully consider their target populations when constructing population health initiatives. [ABSTRACT FROM AUTHOR]

Drug use disorders caused by illicit drug use are significant contributors to the global burden of disease, and it is vital to conduct early detection of people with drug use disorders (PDUD). However, the primary care clinics and emergency departments lack simple and effective tools for screening PDUD. This study proposes a novel method to detect PDUD using facial images. Various experiments are designed to obtain the convolutional neural network (CNN) model by transfer learning based on a large-scale dataset (9870 images from PDUD and 19,567 images from GP (the general population)). Our results show that the model achieved 84.68%, 87.93%, and 83.01% in accuracy, sensitivity, and specificity in the dataset, respectively. To verify its effectiveness, the model is evaluated on external datasets based on real scenarios, and we found it still achieved high performance (accuracy > 83.69%, specificity > 90.10%, sensitivity > 80.00%). Our results also show differences between PDUD and GP in different facial areas. Compared with GP, the facial features of PDUD were mainly concentrated in the left cheek, right cheek, and nose areas (p < 0.001), which also reveals the potential relationship between mechanisms of drugs action and changes in facial tissues. This is the first study to apply the CNN model to screen PDUD in clinical practice and is also the first attempt to quantitatively analyze the facial features of PDUD. This model could be quickly integrated into the existing clinical workflow and medical care to provide capabilities.

Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy – Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy – Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy – Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy – Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy – Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke. [ABSTRACT FROM AUTHOR]

Despite the widespread use of the drug court model, standardized performance measures for drug courts are not uniformly utilized, and rarely include process measures. To ensure that drug courts are being implemented in the most effective manner, the use of performance measurement tools should be considered for wide scale adoption. Drug court effectiveness is moderated by participant characteristics, and is most effective for individuals with the highest substance use needs. Therefore, having quality clinical screening processes is crucial to ensuring that drug courts are serving the population for which they are effective. This paper examines clinical screening in drug courts, to answer the following 1) what is the current state of screening, 2) what works, and 3) why measurement matters. It also proposes a clinical screening performance measure to improve fidelity and ensure appropriate participant enrollment. The creation of a performance measure would create opportunities to improve drug court outcomes, and leverage pay-for-performance models. [ABSTRACT FROM AUTHOR]

Objective: To evaluate associations between the Functional Movement Screen (FMS), Star Excursion Balance Test (SEBT), and Balance Error Scoring System (BESS) scores. Design: Correlational. Setting: College athletic training facilities. Participants: Fifty-two intercollegiate athletes (men = 36 and women = 16) representing 8 sports and cleared for unrestricted sport participation. Interventions: Participants completed the FMS, SEBT, and BESS, in random order, during 1 testing session. Testing order was randomized to control for fatigue and learning effects. Main Outcome Measures: Composite and item scores for the FMS, SEBT, and BESS. Results: A fair, negative correlation was found between FMS asymmetry and SEBT composite (r = -0.31, P = 0.03) scores. Fair, positive correlations were reported for FMS rotary stability task and SEBT anterior (r = 0.37-0.41, P ≤ 0.007) and posteromedial (r = 0.31, P = 0.03) reaches. Fair, negative correlations were reported for FMS deep squat and BESS single-leg firm (r = -0.33, P = 0.02), double-leg foam (r = -0.34, P = 0.02) and tandem foam (r = -0.40, P = 0.003), FMS inline lunge and BESS single-leg firm (r = -0.39, P = 0.004), FMS trunk stability pushup and tandem foam (r = -0.31, P = 0.025), and FMS composite and BESS single-leg firm (r = -0.37, P = 0.007). Little-to-no correlations were reported for remaining comparisons. Conclusions: Results indicate that each instrument provides distinct information about function, with only small areas of overlap. Associations between the FMS asymmetry score and SEBT composite score may indicate a relationship between movement asymmetry and postural stability. Associations between the FMS deep squat and BESS foam tasks may be related to underlying neuromuscular control factors. [ABSTRACT FROM AUTHOR]

Background: Retinopathy of prematurity (ROP) is a disorder of the preterm newborn characterized by neurovascular disruption in the immature retina that may cause visual impairment and blindness. Objective: To develop a clinical screening tool for early postnatal prediction of ROP in preterm newborns based on risk information available within the first 48 h of postnatal life. Methods: Using data submitted to the Vermont Oxford Network (VON) between 1995 and 2015, we created logistic regression models based on infants born <28 completed weeks gestational age. We developed a model with 60% of the data and identified birth weight, gestational age, respiratory distress syndrome, non-Hispanic ethnicity, and multiple gestation as predictors of ROP. We tested the model in the remaining 40%, performed tenfold cross-validation, and tested the score in ELGAN study data. Results: Of the 1,052 newborns in the VON database, 627 recorded an ROP status. Forty percent had no ROP, 40% had mild ROP (stages 1 and 2), and 20% had severe ROP (stages 3-5). We created a weighted score to predict any ROP based on the multivariable regression model. A cutoff score of 5 had the best sensitivity (95%, 95% CI 93-97), while maintaining a strong positive predictive value (63%, 95% CI 57-68). When applied to the ELGAN data, sensitivity was lower (72%, 95% CI 69-75), but PPV was higher (80%, 95% CI 77-83). Conclusions: STEP-ROP is a promising screening tool. It is easy to calculate, does not rely on extensive postnatal data collection, and can be calculated early after birth. Early ROP screening may help physicians limit patient exposure to additional risk factors, and may be useful for risk stratification in clinical trials aimed at reducing ROP. [ABSTRACT FROM AUTHOR]

Background Indirect and direct trauma following vaginal birth can negatively impact on the pelvic floor function increasing the risk of anal incontinence. It is often difficult for women to openly disclose that they have anal incontinence and there are limited data collection tools available for the identification of these women in a clinical setting. Aim This study aims to describe the prevalence of undisclosed anal incontinence in antenatal and postnatal women with pelvic floor dysfunction. Methods Retrospective cohort study of 230 antenatal and postnatal women referred to a Continence Nursing Service in a large tertiary hospital in South Australia, Australia, with pelvic floor dysfunction. A criteria list was utilised to access the primary reason for referral, anal incontinence assessments and attendance to an appointment. Results Anal incontinence was identified in 26% of women ( n = 59). Anal incontinence was the primary reason for referral amongst 8 women, with the remaining 51 women identified as having anal incontinence following clinical screening via phone consultation. Eighty six percent of women stated they had not previously disclosed anal incontinence to health professionals. Overall, 71% of symptomatic women ( n = 28 antenatal and n = 14 postnatal women) attended appointments to a service specialising in pelvic floor dysfunction. Conclusion Women presenting with urinary incontinence or other markers of pelvic floor dysfunction should be actively screened for anal incontinence as the prevalence of this condition is high amongst childbearing women. [ABSTRACT FROM AUTHOR]