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Objective We aimed to develop a distributed, immutable, and highly available cross-cloud blockchain system to facilitate federated data analysis activities among multiple institutions. Materials and Methods We preprocessed 9166 COVID-19 Structured Query Language (SQL) code, summary statistics, and user activity logs, from the GitHub repository of the Reliable Response Data Discovery for COVID-19 (R2D2) Consortium. The repository collected local summary statistics from participating institutions and aggregated the global result to a COVID-19-related clinical query, previously posted by clinicians on a website. We developed both on-chain and off-chain components to store/query these activity logs and their associated queries/results on a blockchain for immutability, transparency, and high availability of research communication. We measured run-time efficiency of contract deployment, network transactions, and confirmed the accuracy of recorded logs compared to a centralized baseline solution. Results The smart contract deployment took 4.5 s on an average. The time to record an activity log on blockchain was slightly over 2 s, versus 5–9 s for baseline. For querying, each query took on an average less than 0.4 s on blockchain, versus around 2.1 s for baseline. Discussion The low deployment, recording, and querying times confirm the feasibility of our cross-cloud, blockchain-based federated data analysis system. We have yet to evaluate the system on a larger network with multiple nodes per cloud, to consider how to accommodate a surge in activities, and to investigate methods to lower querying time as the blockchain grows. Conclusion Blockchain technology can be used to support federated data analysis among multiple institutions.

Prognostic factors for prostate cancer include tumor, node, metastases stage, pretreatment prostate-specific antigen, and pathology (via Gleason score [GS] or grade group). Of these, GS yields the largest effect on prostate cancer specific mortality. It was previously determined that those with cores with a mix of higher and lower GS at biopsy (which was termed a "ComboGS") had decreased risk for prostate cancer specific mortality after either surgical or radiation treatment. We validate the effect of ComboGS in an independent cohort of patients with prostate cancer treated with definitive dose-escalated radiation therapy (DE-RT) at 2 institutions.DE-RT was administered to 2539 men, of which 687 men had a ComboGS. To further ascertain the ComboGS effect we employed the modified Cancer of the Prostate Risk Assessment (mCAPRA) score. Rates of biochemical event-free survival and distant metastasis-free survival were compared across CAPRA scores, with and without modification, and the prognostic value of the CAPRA scores was compared using Harrel's concordance index.On univariate analysis in Gleason 7 to 10 patients the presence of ComboGS improved 10-year biochemical event-free survival from 76.6% to 82.4% (hazard ratio [HR], 0.75; confidence interval [CI], 0.59-0.96; P = .021), 10-year distant metastasis-free survival from 89.3% to 93.2% (HR, 0.57; CI, 0.39-0.85; P = .005), 10-year prostate cancer specific survival from 93.9% to 97.4% (HR, 0.39; CI, 0.21-0.7; P = .001), and 10-year overall survival from 65.7% to 75.6% (HR, 0.69; CI, 0.57-0.83; P.001). Multivariable analysis also supported that ComboGS is protective for biochemical failure (HR, 0.64; CI, 0.50-0.83; P.001), distant metastasis (HR, 0.42; CI, 0.28-0.63; P.001), death from prostate cancer (HR, 0.32; CI, 0.17-0.58; P.001), and overall mortality (HR, 0.65; CI, 0.54-0.79; P.001). Additionally, adjusting the mCAPRA score for ComboGS decreased the risk of biochemical failure by nearly 30% (HR, 0.70; 95% CI, 0.55-0.88; P = .003) and by 50% (HR, 0.54; 95% CI, 0.37-0.80; P = .002) for distant metastasis.ComboGS is a useful and readily available independent prognostic factor for all clinical endpoints evaluated. Moreover, the ComboGS can be used in conjunction with the extensively validated CAPRA scoring to better risk stratify patients being treated with definitive DE-RT for GS 7 to 10 disease.

The ability to efficiently combine information from different senses is an important perceptual process that underpins much of our daily activities. This process, known as multisensory integration, varies from individual to individual, and is affected by the ageing process, with impaired processing associated with age-related conditions, including balance difficulties, mild cognitive impairment and cognitive decline. Impaired multisensory perception has also been associated with a range of neurodevelopmental conditions, where novel intervention approaches are actively sought, for example dyslexia and autism. However, it remains unclear to what extent and how multisensory perception can be modified by training. This systematic review aims to evaluate the evidence that we can train multisensory perception in neurotypical adults. In all, 1521 studies were identified following a systematic search of the databases PubMed, Scopus, PsychInfo and Web of Science. Following screening for inclusion and exclusion criteria, 27 studies were chosen for inclusion. Study quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS) tool and the Cochrane Risk of Bias tool 2.0 for Randomised Control Trials. We found considerable evidence that in-task feedback training using psychophysics protocols led to improved task performance. The generalisability of this training to other tasks of multisensory integration was inconclusive, with few studies and mixed findings reported. Promising findings from exercise-based training indicate physical activity protocols warrant further investigation as potential training avenues for improving multisensory integration. Future research directions should include trialling training protocols with clinical populations and other groups who would benefit from targeted training to improve inefficient multisensory integration.

To evaluate the Canadian Syncope Risk Score (CSRS) in syncope patients presenting to the ED from an economic perspective, using very-low and low-risk patients (CSRS -3 to 0) as a threshold for avoiding hospital admissions.A decision-analytic model, specifically a decision-tree, was developed to evaluate application of the CSRS. A hypothetical cohort of 1000 patients was modelled based on characteristics and outcome of patients enrolled in a clinical validation study performed alongside this evaluation. Several analytic based approaches were used to handle model outputs and uncertainties.For a cohort of 1000 patients, applying the CSRS was associated with 169 less inpatient admissions from the ED, when compared to usual care. There was also a cost-saving of $8255 per admitted patient, when the CSRS was applied, compared to usual care. Adopting the CSRS was the optimal approach in all scenario analyses and was robust to changes in model parameters. More than three-quarters (78.6%) of all model simulations showed that applying the CSRS is a cost-saving approach to managing syncope. There was high confidence in all results, with the approach using the CSRS reducing the costs and number of syncope-related hospital admissions.Compared to usual care, applying the CSRS appeared as a cost-effective strategy. This new evidence will help decision-makers choose cost-effective approaches for the management of patients presenting to the ED with syncope, as they search for efficient ways to maximise health gain from a finite budget.

Objective: To investigate the effect of double reads by a second radiologist on cancer detection rate (CDR), positive predictive value of recommendation for tissue diagnosis (PPV2), and the positive predictive value of biopsy performed (PPV3) for biopsy recommendations in high-risk screening breast MRIs. Methods: The policy of second reads on biopsies recommended for MRIs was prospectively implemented in October 2019. This IRB approved retrospective analysis compared consecutive high-risk screening breast MRI scans performed in a single academic institution between 06/01/2018 to 06/01/2019 (pre-intervention) with screening breast MRI scans performed between 10/31/2019 to 10/31/2020 (post-intervention). Pathology results after biopsy were recorded. Testing of association was performed using the Chi-square test. Results/Discussion: A total of 1124 screening breast MRIs in the pre-intervention and 1672 screening breast MRIs were performed in the post-intervention periods. Biopsies were recommended in 8.6% (97/1124) of pre-intervention and 5.5% (92/1672) of post-intervention MRIs ( P = .0012). There was a non-significant increase in PPV2 from pre-intervention 10.3% (10/97) to post-intervention 18.4% (17/92) ( P = .109) and in PPV3 from 14% (10/71) to 22.9% (17/74), respectively ( P = .17). Similar cancer detection rates, 8.9/1000 (10/1124) and 10.2/1000 (17/1672) ( P = .736) were diagnosed in pre-intervention and post-intervention periods, respectively. Conclusion: Double reading of screening breast MRI scans significantly reduced the number of unnecessary biopsies without significant impact in the PPVs or cancer detection rate.

This study investigated the use of routine contrast-enhanced chest computed tomography (CT) to diagnose unsuspected pulmonary embolism (PE).All adult routine contrast-enhanced chest CTs performed at Montefiore in 2018 were included. Pulmonary artery enhancement was measured by placing regions of interest in the pulmonary vasculature. Adequate enhancement was defined as 200 Hounsfield units (HU) or greater. Presence or absence of PE was noted. Descriptive statistics and logistic regression analysis were performed.A total of 3164 CTs were evaluated (55.8% women; mean age, 63.2 years). Main pulmonary enhancement was highly correlated with peripheral enhancement. Of all cases, 28.7% (907 of 3164) reached the 200 HU threshold. Greater enhancement was associated with female sex, older age, outpatients, and contrast amount administered. Pulmonary embolism-positive cases comprised 1.8% (58 of 3164) of total cases. Furthermore, 39.7% (23 of 58) of PE-positive cases reached the 200 HU threshold.Over one quarter of routine contrast-enhanced chest CT scans met the 200 HU threshold indicative of adequate pulmonary artery enhancement, including nearly half of the 2% of examinations positive for PE.

ImportanceThe presence of diabetic macular ischemia (DMI) on optical coherence tomography angiography (OCTA) images predicts diabetic retinal disease progression and visual acuity (VA) deterioration, suggesting an OCTA-based DMI evaluation can further enhance diabetic retinopathy (DR) management.ObjectiveTo investigate whether an automated binary DMI algorithm using OCTA images provides prognostic value on DR progression, diabetic macular edema (DME) development, and VA deterioration in a cohort of patients with diabetes.Design, Setting, and ParticipantsIn this cohort study, DMI assessment of superficial capillary plexus and deep capillary plexus OCTA images was performed by a previously developed deep learning algorithm. The presence of DMI was defined as images exhibiting disruption of fovea avascular zone with or without additional areas of capillary loss, while absence of DMI was defined as images presented with intact fovea avascular zone outline and normal distribution of vasculature. Patients with diabetes were recruited starting in July 2015 and were followed up for at least 4 years. Cox proportional hazards models were used to evaluate the association of the presence of DMI with DR progression, DME development, and VA deterioration. Analysis took place between June and December 2022.Main Outcomes and MeasuresDR progression, DME development, and VA deterioration.ResultsA total of 321 eyes from 178 patients were included for analysis (85 [47.75%] female; mean [SD] age, 63.39 [11.04] years). Over a median (IQR) follow-up of 50.41 (48.16-56.48) months, 105 eyes (32.71%) had DR progression, 33 eyes (10.28%) developed DME, and 68 eyes (21.18%) had VA deterioration. Presence of superficial capillary plexus–DMI (hazard ratio [HR], 2.69; 95% CI, 1.64-4.43; P P P = .003) and VA deterioration (HR, 2.12; 95% CI, 1.01-5.22; P = .04) after adjusting for age, duration of diabetes, fasting glucose, glycated hemoglobin, mean arterial blood pressure, DR severity, ganglion cell–inner plexiform layer thickness, axial length, and smoking at baseline.Conclusions and RelevanceIn this study, the presence of DMI on OCTA images demonstrates prognostic value for DR progression, DME development, and VA deterioration.

The choice funding scheme is an important design dimension in crowdfunding for which platforms should not assume that they are restricted to the use of one funding scheme. In particular, we find that the addition of a donation scheme can increase the success rate of reward campaigns substantially, especially those with prosocial causes. In addition, the donation received is found to have a crowd-in effect on subsequent contributions. To get the most out of donation schemes, crowdfunding sites should provide features that help backers locate reward campaigns for prosocial causes, for example, by providing tags or search filters related to prosocial causes. Second, campaign owners should take steps to highlight the prosocial aspects of their crowdfunding campaign, for example, by revising campaign descriptions to include prosocial keywords/tags. Third, campaign owners should play a more active role in encouraging early donations to enjoy the crowd-in effect that could help their campaigns reach the targeted funding amount. Specifically, the owner’s direct social network is a potentially good source for soliciting these early donations. Relatedly, the campaign owners could benefit by spreading the word about the early donations they receive so as to generate a greater crowd-in effect at later phases of the crowdfunding process.

The continued emergence of large social network applications has introduced a scale of data and query volume that challenges the limits of existing data stores. However, few benchmarks accurately simulate these request patterns, leaving researchers in short supply of tools to evaluate and improve upon these systems. In this paper, we present a new benchmark, TAOBench, that captures the social graph workload at Meta. We open source workload configurations along with a benchmark that leverages these request features to both accurately model production workloads and generate emergent application behavior. We ensure the integrity of TAOBench's workloads by validating them against their production counterparts. We also describe several benchmark use cases at Meta and report results for five popular distributed database systems to demonstrate the benefits of using TAOBench to evaluate system tradeoffs as well as identify and address performance issues. Our benchmark fills a gap in the available tools and data that researchers and developers have to inform system design decisions.

BACKGROUND Counseling supporting HIV self-testing (HIVST) users is essential to ensure support and linkage to care among men who have sex with men (MSM). An HIVST service with online real-time instruction, pre-test and post-test counseling provided by trained administrators (HIVST-OIC) was developed by previous projects. Although the HIVST-OIC was highly effective in increasing HIVST uptake and the proportion of HIVST users receiving counseling along with testing, it required intensive resources to implement and sustain. The service capacity of HIVST-OIC cannot meet the increasing demands of HIVST. OBJECTIVE The primary objective of this randomized controlled trial (RCT) is to establish whether HIVST-Chatbot, an innovative HIVST service with online real-time instruction and counseling provided by a fully automated Chatbot, would produce effects that are similar to HIVST-OIC in increasing HIVST uptake and proportion of HIVST users receiving counseling alongside testing among MSM within a six-month follow-up period. METHODS A parallel-group non-inferiority RCT will be conducted. Participants are Chinese-speaking MSM aged 18 years or above with access to live-chat applications. A total of 528 participants will be recruited through multiple sources, including outreach in gay venues, online advertisement, and peer referral. After completing the baseline telephone survey, participants will be randomized evenly into the intervention or control groups. Participants in the intervention group will watch an online video promoting HIVST-Chatbot and receive a free HIVST kit. The Chatbot will contact the participant to implement HIVST and provide standard-of-care and real-time pre-test and post-test counseling, and instruction on how to use the HIVST kit through WhatsApp. Participants in the control group will watch an online video promoting HIVST-OIC and receive a free HIVST kit in the same manner. Upon appointment, a trained testing administrator will implement HIVST and provide standard-of-care and real-time pre-test and post-test counseling and instruction on how to use the HIVST kit through live-chat applications. All participants will complete a telephone follow-up survey six months after the baseline. The primary outcomes are HIVST uptake and the proportion of HIVST users receiving counseling support along with testing in the past six months measured at Month 6. Secondary outcomes include sexual risk behaviors and uptake of HIV testing other than HIVST during the follow-up period. Intention-to-treat analysis will be used. RESULTS Recruitment and enrollment of participants will start in April 2023. CONCLUSIONS This study will generate important research and policy implications regarding using Chatbot in HIVST services. If HIVST-Chatbot is proven non-inferior to HIVST-OIC, it can be easily integrated into existing HIVST services in Hong Kong. The coverage of HIV testing and the level of support to HIVST users will be increased. CLINICALTRIAL The study was registered at ClinicalTrial.gov (number NCT05796622).

Balkan endemic nephropathy (BEN) is a multifactorial environmental disease, with chronic exposure to aristolochic acids (AAs) through AA-contaminated food being one of the major etiological mechanisms. However, the bulk of previous research has only focused on investigating the possible roles of individual pollutants in disease development and the etiological mechanism of BEN remains controversial. In this study, we investigated the exposure concentration and duration dependence of coexposure to phthalate esters and lignite coal-derived phenol and polycyclic aromatic hydrocarbons (PAHs) on the metabolism and DNA adduct formation of aristolochic acid I (AAI). Results showed that both the metabolic activation and DNA adduct formation of AAI in cultured human kidney cells were affected by their coexposure to the above-mentioned environmental pollutants. Furthermore, our results suggest that chemicals leached from lignite coal likely played a role by triggering AA-activating enzymes to produce more of the promutagenic DNA adducts, thus further elevating the nephrotoxicity and carcinogenicity of AAs and increasing the risk of BEN. It is believed that the results of this study provide a better understanding of the etiological mechanism of BEN and offer insights into methods and policies to lower the risk of this devastating disease.

The most commonly cited issues with mobile apps are low user engagement and retention levels. In this paper, we use a randomized control trial to test the efficacy of crowdsourcing on enhancing user engagement and retention in the context of mobile gaming apps. We examine two specific crowdsourcing features: the ability to submit content and the ability to access crowdsourced content. We find that the content submission significantly increases engagement and retention by reducing users’ hazard of ending a session by approximately 11% relative to the baseline and reducing the hazard of abandoning the game app by 14%. In contrast, giving users the ability to access crowdsourced content has no significant effect on engagement but has a positive effect on retention by reducing the hazard of abandoning the game app by 13%. Surprisingly, we find that the interaction effect of these two crowdsourced features is negative on user engagement. Individually, the submission feature manifests itself via empowering users to control their product use experience, whereas the access feature’s positive effect on retention is mediated by diversity and novelty of content. However, the two effects are not complementary. It turns out when these two features are given together, the empowerment enabled by one’s own submission is crowded out by others’ submissions, and this dominates the diversity benefit. Crowdsourcing features have heterogeneous impact on different user segments, with heavy users and users of longer tenure being more affected by the crowdsourcing features. This paper was accepted by Anandhi Bharadwaj, information systems.

OBJECTIVE The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs). METHODS This is a multicentered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM, with volume stages separated by intervals of 3–6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. The authors evaluated permanent, transient, and total ARE events that were symptomatic. RESULTS Patients received 2–4 total volume stages. The median age was 33 years at the time of the first SRS volume stage, and the median follow-up was 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cm3 (range 7.7–94.4 cm3), with a median margin dose per stage of 17 Gy (range 12–20 Gy). A total of 64 patients (25%) experienced an ARE, of which 19 were permanent. Rather than volume, maximal linear dimension in the Z (craniocaudal) dimension was associated with toxicity; a threshold length of 3.28 cm was associated with an ARE, with a 72.5% sensitivity and a 58.3% specificity. In addition, parietal lobe involvement for superficial lesions and temporal lobe involvement for deep lesions were associated with an ARE. CONCLUSIONS Size remains the dominant predictor of toxicity following SRS, but overall rates of AREs were lower than anticipated based on baseline features, suggesting that dose and size were relatively dissociated through volume staging. Further techniques need to be assessed to optimize outcomes.