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INTRODUCTION Ureteropelvic junction (UPJ) obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 1000-2000 newborns. Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of hydronephrosis. Before the advent of ultrasonography, congenital hydronephrosis presented throughout childhood and even adulthood with various symptoms such as abdominal or flank pain, recurrent urinary tract infections (UTIs), abdominal mass, renal stones, and hematuria. AIMS AND OBJECTIVES the safety and efficacy of lateral flank pycloplasty in comparison with the dorsal lumbotomypycloplasty in management of pelviureteric junction obstruction, good operative procedure in respect of post-operative complication. post-operative complications and its management. Know which procedure is suitable for which group of patient. MATERIALS AND METHODS It was a prospective randomized study performed to patients, presenting with pelviureteric junction obstruction. IPGME& R, SSKM HOSPITAL KOLKATA-700020. In the present study, 100 cases were included. Analysis was made on the basis of percentages, mean values, standard deviation, t-test and proportion/chisquare test of significance. The study comprises of 100 patients of pelviureteric junction obstruction admitted to indoors, OPD and casualty of IPGME& R, SSKM HOSPITAL, and KOLKATA. Preoperative History, investigations, operative data and postoperative course were recorded prospectively in a computerized database and in standardized data format. RESULT In our study showed that association between Post-op abdominal Distension in two groups was statistically significant. (P-value: 0.02699). Difference between Hospital Stay in two groups was statistically significant. (P-value: <0.0001). Association between Wound Infection in two groups was statistically significant. (P-value: 0.00268). Association between Seroma formation in two groups was statistically significant. (P-value: 0.0117). Association between Persistance of Abdominal lump in two groups was not statistically significant. (P-value: 0.09212). CONCLUSION Post-operative morbidity, wound infection and seroma formation all are low in dorsal lumbotomy approach. Overall, the complication rates were not significantly different for the 2 approaches .Further evaluation of cosmesis and pain control, and future studies with larger numbers of patients and longer follow up may show more divergent outcomes. [ABSTRACT FROM AUTHOR]

Background: Populations disproportionately impacted by the opioid epidemic are less likely to receive medications for opioid use disorder (MOUD; OUD). The COVID-19 pandemic exacerbated these disparities. We performed an ecological survey of subpopulations to compare differences in MOUD receipt among Veterans with OUD before versus during the pandemic., Methods: Using 2 cross-sections of 2 time periods of national Veterans Health Administration electronic health record data, we calculated proportions of Veterans with any MOUD receipt by demographics, Elixhauser comorbidity index, and natural language processing (NLP)-derived substance use and social determinants of health in each time period. We evaluated differences in MOUD receipt before and during the pandemic by patient characteristics using Chi-square and Cohen's h for effect size., Results: Among 62 195 patients with OUD before the pandemic, the proportion prescribed MOUD increased from 46.5% before to 47.5% ( P  = .0003) during the pandemic. Statistically significant increased receipt of MOUD was observed for patients who were ≥55 years, men, White, with Elixhauser comorbidity indices of 2 and ≥5, and with NLP-derived indicators of substance use. There was a decrease that did not achieve statistical significance in MOUD receipt from before to during the pandemic for patients who were women, Black, Latinx, and food insecure., Conclusions: The proportions of patients with OUD prescribed MOUD increased from before to during the pandemic. However, Veterans who were women, Black, Latinx, and food insecure did not experience these increases. These patients may benefit from interventions such as targeted outreach efforts to improve MOUD engagement to reduce OUD harms., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Automatic International Classification of Diseases (ICD) coding aims to assign multiple ICD codes to a medical note with average length of 3,000+ tokens. This task is challenging due to a high-dimensional space of multi-label assignment (tens of thousands of ICD codes) and the long-tail challenge: only a few codes (common diseases) are frequently assigned while most codes (rare diseases) are infrequently assigned. This study addresses the long-tail challenge by adapting a prompt-based fine-tuning technique with label semantics, which has been shown to be effective under few-shot setting. To further enhance the performance in medical domain, we propose a knowledge-enhanced longformer by injecting three domain-specific knowledge: hierarchy, synonym, and abbreviation with additional pretraining using contrastive learning. Experiments on MIMIC-III-full, a benchmark dataset of code assignment, show that our proposed method outperforms previous state-of-the-art method in 14.5% in marco F1 (from 10.3 to 11.8, P<0.001). To further test our model on few-shot setting, we created a new rare diseases coding dataset, MIMIC-III-rare50, on which our model improves marco F1 from 17.1 to 30.4 and micro F1 from 17.2 to 32.6 compared to previous method.

Social and Behavioral Determinants of Health (SBDHs) are environmental and behavioral factors that have a profound impact on health and related outcomes. Given their importance, physicians document SBDHs of their patients in Electronic Health Records (EHRs). However, SBDHs are mostly documented in unstructured EHR notes. Determining the status of the SBDHs requires manually reviewing the notes which can be a tedious process. Therefore, there is a need to automate identifying the patients' SBDH status in EHR notes. In this work, we created MIMIC-SBDH, the first publicly available dataset of EHR notes annotated for patients' SBDH status. Specifically, we annotated 7,025 discharge summary notes for the status of 7 SBDHs as well as marked SBDH-related keywords. Using this annotated data for training and evaluation, we evaluated the performance of three machine learning models (Random Forest, XGBoost, and Bio-ClinicalBERT) on the task of identifying SBDH status in EHR notes. The performance ranged from the lowest 0.69 F1 score for Drug Use to the highest 0.96 F1 score for Community-Present. In addition to standard evaluation metrics such as the F1 score, we evaluated four capabilities that a model must possess to perform well on the task using the CheckList tool (Ribeiro et al., 2020). The results revealed several shortcomings of the models. Our results highlighted the need to perform more capability-centric evaluations in addition to standard metric comparisons.

A bleeding event is a common adverse drug reaction amongst patients on anticoagulation and factors critically into a clinician's decision to prescribe or continue anticoagulation for atrial fibrillation. However, bleeding events are not uniformly captured in the administrative data of electronic health records (EHR). As manual review is prohibitively expensive, we investigate the effectiveness of various natural language processing (NLP) methods for automatic extraction of bleeding events. Using our expert-annotated 1,079 de-identified EHR notes, we evaluated state-of-the-art NLP models such as biLSTM-CRF with language modeling, and different BERT variants for six entity types. On our dataset, the biLSTM-CRF surpassed other models resulting in a macro F1-score of 0.75 whereas the performance difference is negligible for sentence and document-level predictions with the best macro F1-scores of 0.84 and 0.96, respectively. Our error analyses suggest that the models' incorrect predictions can be attributed to variability in entity spans, memorization, and missing negation signals., (©2020 AMIA - All rights reserved.)

DyCrO 3 and 10% Fe-doped DyCrO 3 nanoparticles have been synthesized using a sol-gel method to investigate their performance in photocatalytic hydrogen production from water. The synthesized nanoparticles have been characterized by performing X-ray diffraction, energy dispersive X-ray spectroscopy and UV-visible spectrophotometric measurements. In addition, field emission scanning electron microscopy has been performed to observe their size and shape. The Fe-doped DyCrO 3 nanoparticles show a significantly smaller band gap of 2.45 eV compared to the band gap of 2.82 eV shown by the DyCrO 3 nanoparticles. The Fe-doped DyCrO 3 nanoparticles show better photocatalytic activity in the degradation of rhodamine B (RhB) compared to the photocatalytic activity shown by both the DyCrO 3 and Degussa P25 titania nanoparticles. The recycling and reuse of Fe-doped DyCrO 3 four times for the photo-degradation of RhB shows that Fe-doped DyCrO 3 is a stable and reusable photocatalyst. To evaluate the extent of the photocatalytic hydrogen production ability of the synthesized nanoparticles, a theoretical model has been developed to determine their "absorptance", a measure of the ability to absorb photons. Finally, 10% Fe-doped DyCrO 3 proves itself to be an efficient photocatalyst as it demonstrated three times greater hydrogen production than Degussa P25., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)