The Specialist Treatment of Inpatients: Caring for Diabetes in Surgery (STOIC-D Surgery) Trial: A Randomized Controlled Trial of Early Intervention With an Electronic Specialist-Led Model of Diabetes Care

OBJECTIVE

To investigate the effect of early intervention with an electronic specialist-led "proactive" model of care on glycemic and clinical outcomes.

RESEARCH DESIGN AND METHODS

The Specialist Treatment of Inpatients: Caring for Diabetes in Surgery (STOIC-D Surgery) randomized controlled trial was performed at the Royal Melbourne Hospital. Eligible participants were adults admitted to a surgical ward during the study with either known diabetes or newly detected hyperglycemia (at least one random blood glucose result ≥11.1 mmol/L). Participants were randomized 1:1 to standard diabetes care or the intervention consisting of an early consult by a specialist inpatient diabetes team using electronic tools for patient identification, communication of recommendations, and therapy intensification. The primary outcome was median patient-day mean glucose (PDMG). The key secondary outcome was incidence of health care-associated infection (HAI).

RESULTS

Between 12 February 2021 and 17 December 2021, 1,371 admissions met inclusion criteria, with 680 assigned to early intervention and 691 to standard diabetes care. Baseline characteristics were similar between groups. The early intervention group achieved a lower median PDMG of 8.2 mmol/L (interquartile range [IQR] 6.9-10.0 mmol/L) compared with 8.6 mmol/L (IQR 7.2-10.3 mmol/L) in the control group for an estimated difference of -0.3 mmol/L (95% CI -0.4 to -0.2 mmol/L, P < 0.0001). The incidence of HAI was lower in the intervention group (77 [11%] vs. 110 [16%]), for an absolute risk difference of -4.6% (95% CI -8.2 to -1.0, P = 0.016).

CONCLUSIONS

In surgical inpatients, early diabetes management intervention with an electronic specialist-led diabetes model of care reduces glucose and HAI.

Variability in cell division among anatomical sites shapes Escherichia coli antibiotic survival in a urinary tract infection mouse model

Urinary tract infection (UTI), mainly caused by Escherichia coli, are frequent and have a recurrent nature even after antibiotic treatment. Potential bacterial escape mechanisms include growth defects, but probing bacterial division in vivo and establishing its relation to the antibiotic response remain challenging. Using a synthetic reporter of cell division, we follow the temporal dynamics of cell division for different E. coli clinical strains in a UTI mouse model with and without antibiotics. We show that more bacteria are actively dividing in the kidneys and urine compared with the bladder. Bacteria that survive antibiotic treatment are consistently non-dividing in three sites of infection. Additionally, we demonstrate how both the strain in vitro persistence profile and the microenvironment impact infection and treatment dynamics. Understanding the relative contribution of the host environment, growth heterogeneity, non-dividing bacteria, and antibiotic persistence is crucial to improve therapies for recurrent infections.

Clinical Outcome of Three Different Types of Posterior All-Ceramic Crowns. A 3-Year Follow-up of a Multicenter, Randomized, Controlled Clinical Trial

PURPOSE

To assess and compare the clinical outcomes of three different types of all-ceramic posterior monolithic tooth-supported crowns.

MATERIALS AND METHODS

A total of 71 patients received 90 all-ceramic crowns randomized to be either high-translucency zirconia (ZC), high-translucency zirconia with a partial buccal veneer (ZC-V), or lithium disilicate glass-ceramic (LDS). All treatments were performed by four general dentists who were blinded to the material used. Baseline and subsequent annual evaluations were based on modified California Dental Association (CDA) criteria. A questionnaire was used to include patient-reported outcomes and to compare them to the crown quality rating performed by dentists.

RESULTS

A total of 66 patients with 84 crowns were examined after 3 years. The survival rate was 98.8%. No crowns fractured during the observation period. One ZC-V crown failed due to loss of retention, and three complications were noted: loss of retention occurred in one ZC crown, and two ZC crowns needed to be endodontically treated. There was no significant difference between the different crowns regarding marginal integrity, surface, or anatomical form. Both patients and examining dentists rated the crowns favorably regarding esthetics, patients more than dentists.

CONCLUSIONS

All crown types used show excellent and promising clinical outcomes from a short-term perspective. Patients and dentists rate the restorations favorably concerning esthetics and function. Int J Prosthodont 2023;36:546-553.

Research on the Impact of Data Density on Memristor Crossbar Architectures in Neuromorphic Pattern Recognition

Binary memristor crossbars have great potential for use in brain-inspired neuromorphic computing. The complementary crossbar array has been proposed to perform the Exclusive-NOR function for neuromorphic pattern recognition. The single crossbar obtained by shortening the Exclusive-NOR function has more advantages in terms of power consumption, area occupancy, and fault tolerance. In this paper, we present the impact of data density on the single memristor crossbar architecture for neuromorphic image recognition. The impact of data density on the single memristor architecture is mathematically derived from the reduced formula of the Exclusive-NOR function, and then verified via circuit simulation. The complementary and single crossbar architectures are tested by using ten 32 × 32 images with different data densities of 0.25, 0.5, and 0.75. The simulation results showed that the data density of images has a negative effect on the single memristor crossbar architecture while not affecting the complementary memristor crossbar architecture. The maximum output column current produced by the single memristor crossbar array decreases as data density decreases while the complementary memristor crossbar array architecture provides stable maximum output column currents. When recognizing images with data density as low as 0.25, the maximum output column currents of the single memristor crossbar architecture is reduced four-fold compared with the maximum currents from the complementary memristor crossbar architecture. This reduction causes the Winner-take-all circuit to work incorrectly and will reduce the recognition rate of the single memristor crossbar architecture. These simulation results show that the single memristor crossbar architecture has more advantages compared with the complementary crossbar architecture when the images do have not many different densities, and none of the images have very low densities. This work also indicates that the single crossbar architecture must be improved by adding a constant term to deal with images that have low data densities. These are valuable case studies for archiving the advantages of single memristor crossbar architecture in neuromorphic computing applications.

Evaluating machine learning architectures for sound event detection for signals with variable signal-to-noise-ratios in the Beaufort Sea

This paper explores the challenging polyphonic sound event detection problem using machine learning architectures applied to data recorded in the Beaufort Sea during the Canada Basin Acoustic Propagation Experiment. Four candidate architectures were investigated and evaluated on nine classes of signals broadcast from moored sources that were recorded on a vertical line array of hydrophones over the course of the yearlong experiment. These signals represent a high degree of variability with respect to time-frequency characteristics, changes in signal-to-noise ratio (SNR) associated with varying signal levels as well as fluctuating ambient sound levels, and variable distributions, which resulted in class imbalances. Within this context, binary relevance, which decomposes the multi-label learning task into a number of independent binary learning tasks, was examined as an alternative to the conventional multi-label classification (MLC) approach. Binary relevance has several advantages, including flexible, lightweight model configurations that support faster model inference. In the experiments presented, binary relevance outperformed conventional MLC approach on classes with the most imbalance and lowest SNR. A deeper investigation of model performance as a function of SNR showed that binary relevance significantly improved recall within the low SNR range for all classes studied.

Genomic analyses reveal three phylogenetic species and their evolutionary histories in the big-headed turtle

The critically endangered big-headed turtle (Platysternon megacephalum) is currently classified into three subspecies. However, the classification is still controversial and their evolutionary histories are still unclear. Here, multiple genetic analyses consistently revealed three phylogenetic groups with substantial genetic divergences and distinct demographic histories, suggesting three phylogenetic species (P. megacephalum, P. peguense, and Baise clade). Phylogeographical analyses revealed that the Red River plains and Guangxi basins are largely coincident with the boundaries between the three phylogenetic species, highlighting the key role of lowland areas in driving speciation in the big-headed turtle. The Baise clade is characterized by high-linkage disequilibrium but the lowest effective population size, indicating that the cryptic phylogenetic species is more vulnerable to human activities and environmental disturbance, and urgently needs more protection. Our findings provide fundamental insights into the taxonomy and scientific conservation of the family Platysternidae.

Movement disorders in Indochina: Resource challenges and future solutions

Movement disorders are a major cause of disability worldwide and their increasing prevalence predicts a substantial future burden of care. Impactful patient care requires availability of, and accessibility to, effective medications, knowledge, and disease awareness among both medical professionals and patients, driven by skilled personnel to harness and manage resources. The highest burden of movement disorders is in low-to-middle income countries where resources are often limited and infrastructure is insufficient to meet growing demands. This article focuses on the specific challenges faced in the management and delivery of care for movement disorders in Indochina, the mainland region of Southeast Asia comprising the neighboring countries of Cambodia, Laos, Malaysia, Myanmar, Thailand, and Vietnam. The first Indochina Movement Disorders Conference was held in August 2022 in Ho Chi Minh City, Vietnam, to provide a platform to better understand the situation in the region. Future management of movement disorders in Indochina will require progressive adaptation of existing practices to reflect modern approaches to care delivery. Digital technologies offer an opportunity to strengthen these processes and address the challenges identified in the region. Ultimately, a long-term collaborative approach by regional healthcare providers is key.

Fight for vaccine diplomacy in the global world of IPR and trademarks

The article aims to shed to light on the topic of vaccine diplomacy and the role of IPR and trademarks in vaccine crisis. The research design is explanatory. The data collection methods and the data analysis methods have been discussed. The quantitative analysis has shown that the “regression model” was insignificant as the higher prices of the vaccines allowed the countries to enjoy the profit as the imposition of IPRs forces the poor countries to buy from the “developed countries”. The qualitative analysis tends to show the imposition of IPRs creates barriers for the less developed countries to have vaccines.

Examining participant perceptions of the UCSF school of pharmacy master preceptor program

INTRODUCTION

The University of California San Francisco School of Pharmacy faculty created the Master Preceptor Program (MPP) to instill best practices in clinical precepting, leadership and professional development, and interprofessional education (IPE). Graduates of the program are encouraged to mentor colleagues at affiliated sites. This study aimed to explore MPP participants' perceptions about the program and to collect general feedback.

METHODS

A descriptive qualitative study of MPP participants who completed the program between 2017 and 2019 was conducted. Semi-structured interviews and focus groups were used to collect general programmatic feedback and examples of skill implementation. All encounters were conducted and recorded online via Zoom. Three investigators independently analyzed transcripts for codes related to key programmatic areas using conventional content analysis.

RESULTS

Ten of 14 past MPP participants participated. Themes included confidence and skills gained in clinical teaching, self-reflection and network opportunities supporting professional and leadership development, and a need for structured expectations and deliverables. Participants noted several benefits of the MPP on clinical teaching, such as improving confidence and adopting teaching techniques, structural and organizational skills, and a learner-centered approach. Participants also mentioned programmatic offerings that improved leadership and professional development, such as networking opportunities in the MPP and at conferences. Participants did not mention IPE in their responses.

CONCLUSIONS

All participants recognized the MPP as an effective training program to enhance clinical precepting skills, leadership, and professional development. Program structure and intentional incorporation of IPE skills are areas of improvement for future cohorts.

When AI meets store layout design: a review

An efficient store layout presents merchandise to attract customer attention and encourages customers to walk down more aisles which exposes them to more merchandise, which has been shown to be positively correlated with the sales. It is one of the most effective in-store marketing tactics which can directly influence customer decisions to boost store sales and profitability. The recent development of Artificial Intelligence techniques, especially with its sub-fields in Computer Vision and Deep Learning, has enabled retail stores to take advantage of existing CCTV infrastructure to extract in-store customer and business insights. This research aims to conduct a comprehensive review on existing approaches in store layout design and modern AI techniques that can be utilized in the layout design task. Based on this review, we propose an AI-powered store layout design framework. This framework applies advanced AI and data analysis techniques on top of existing CCTV video surveillance infrastructure to understand, predict and suggest a better store layout.

Calibration methods for VSCs measured on AS-TD-GC-SCD

Volatile sulfur compounds (VSCs) are key odorous compounds from emissions of various odour sources because they are odorous and generally have very low odour threshold values. Identification and quantification of them through air server-thermal desorber-gas chromatography-sulfur chemiluminescence detector (AS-TD-GC-SCD) become more and more popular, although VSCs can be determined by other detectors. To find a valid, practical and quick calibration method is also an important step in their analytical processes. This study compared three different sample preparation and unity sampling methods using both gas standards (with 10 VSCs balanced in pure nitrogen gas) and liquid standards of 7 VSCs. For liquid standard sample preparation, two solvents (methanol and n-pentane) were tested and their calibration results were compared. The study revealed that the three calibration methods with both manual and dynamic dilution of VSC standard gases can achieve satisfactory calibration results with nice linear regression and correlation coefficient (r²). The dynamic dilution and loop sampling method is recommended because of its better reliability and time-saving processing. For calibration of VSCs with liquid standards, preparing the samples using dissolved VSCs in n-pentane and analysing them using the loop sampling method achieved best calibration results. For dimethyl trisulfide (DMTS), its calibration cannot obtain as good results as other sulfur compounds even using the best performance calibration method.

Slow flow or prolonged arterial phase in coronary arteries is the cause of ischemia or sudden death in patients with dilated cardiomyopathy

Background

In patients with dilated cardiomyopathy (DCM), the patients could be symptomatic or presented with recurrent fluid overload, syncope or sudden cardiac death (SCD) while the coronary arteries were patent. The aim of our study was to use the coronary flow abnormalities to stratify the high risk symptomatic versus the low risk asymptomatic patient with DCM.

Methods

Consecutive patients with DCM were enrolled. Twenty patients with normal ejection fraction (EF) without coronary artery disease served as control. The study patients were checked for symptoms (fluid overload, syncope, SCD) and re-admission. All patients underwent a new coronary angiographic technique with injection of contrast until all the coronary arteries were completely filled. As the injection of contrast stopped, the blood in white color moved in and the blood movement could be clearly observed. The angiogram was recorded from the entry of blood flow until all the contrast was cleared. During the review, the investigators downloaded, selected the angiogram from the electronic medical record, tapped on the Key Image and used the Up and Down arrow to move the images, frame-by-frame. Each frame represented a 0.06-second recording. The duration of the arterial phase was calculated starting the time when the blood entered the ostium of the index artery until all the contrast disappeared from the distal vasculature. At the same time, an AI program was trained to measure the length of the arterial phase by Machine learning, supervised and unsupervised Deep Learning and Convoluted Neural Networks. (Figure 1) The AI programs compared the time when the arteries were full with contrast until there was no contrast left in the distal vasculature. (Figure 2)

Results

One hundred patients with DCM were consecutively enrolled. Twenty patients served as control. In the control group with normal flow and EF, the duration of the arterial phase was 24–30 frames (1.44 to 2 seconds). In the study group, seventy patients had extremely prolonged arterial phase (average of 120 frames or &gt;8 seconds (p&lt;0.05). These patients were very symptomatic and had recurrent hospitalizations. Thirty patients had normal arterial phase of &lt;2 seconds. These patients had shorter length of stay (&lt;3 days), became asymptomatic after only 2 days of treatment and had rare readmission. (p&lt;0.05) The AI programs confirmed the results of the arterial phases calculated manually by junior investigators.

Conclusions

In patients with DCM, the extreme prolonged arterial phase caused ischemia in the myocardium even there was no coronary artery disease. This ischemic burden triggered recurrent ventricular dysfunction, arrhythmia, syncope and SCD. The patients with normal arterial phase became asymptomatic after optimal medical treatment. With these results, more effective prevention and management could be achieved for high risk symptomatic patients with high mortality and readmissions.

Funding Acknowledgement

Type of funding sources: None. U Net architectureArterial Phase

Clinical and echocardiographic risk score predicts need for hospitalization among patients with COVID-19

Background

Age and medical co-morbidities are known predictors of disease severity in coronavirus disease-2019 (COVID-19). Whether baseline transthoracic echocardiographic (TTE) abnormalities could refine risk-stratification in this context remains unknown.

Purpose

To analyze performance of a risk score combining clinical and pre-morbid TTE features in predicting risk of hospitalization among patients with COVID-19.

Methods

Adult patients testing positive for COVID-19 between March 1st and October 31st, 2020 with pre-infection TTE (within 15–180 days) were selected. Those with severe valvular disease, acute cardiac events between TTE and COVID-19, or asymptomatic carriers of virus (on employment screening/nursing home placement) were excluded. Baseline demographic, clinical co-morbidities, and TTE findings were extracted from electronic health records and compared between groups stratified by hospital admission. Total sample was randomly split into training (≈70%) and validation (≈30%) sets. Age was transformed into ordered categories based on cubic spline regression. Regression model was developed on the training set. Variables found significant (at p&lt;0.10) on univariate analysis were selected for multivariate analysis with hospital admission as outcome. β-coefficients were obtained from 5000 bootstrapped samples after forced entry of significant variables, and scores assigned using Schneeweiss's scoring system. Final risk score performance was compared between training/validation cohorts using receiver-operating curve (ROC) and calibration curve analyses.

Results

192 patients were included, 83 (43.2%) were admitted. Clinical/TTE characteristics stratified by hospitalization are in Table 1. Moderate or worse pulmonary hypertension and left atrial enlargement were only TTE parameters with coefficients deserving a score (Table 1). The risk score had excellent discrimination in training and validation sets (figure 1 left panel; AUC 0.785 versus 0.836, p=0.452). Calibration curves showed strong linear correlation between predicted and observed probabilities of hospitalization in both training and validation sets (Figure 1, middle and right panels, respectively). ROC analysis revealed a score ≥7 as having best overall quality with sensitivity and specificity of 70–75% in both training and validation sets. A score ≥12 had 98% and 97% specificity and ≥14 had 100% specificity.

Conclusion

A combined clinical and echocardiographic risk score shows promise in predicting risk of hospitalization among patients with COVID-19, and hence help anticipate resource utilization. External validation and comparison against clinical risk score alone is worth further investigation.

Funding Acknowledgement

Type of funding sources: None.

Psychosocial adjustment mediates impacts of playmate positive support on body mass index and overweight risk in adolescents

OBJECTIVES

We examined the mediation effects of psychosocial adjustment on the impact of playmate positive support throughout childhood and early adolescence (from age 54 months to 11 years) on later body mass index (BMI) and overweight risk in middle adolescence (age 15 years).

STUDY DESIGN

This was a prospective cohort study.

METHODS

Among 844 children and their families, positive support between child-playmate dyads was repeatedly assessed from child's age 54 months to Grade 5. Long-term positive support between child-playmate dyads throughout childhood and early adolescence was prospectively linked to child's BMI and overweight/obesity status at age 15 years. The average scores of repeated assessments of internalizing and externalizing behavior problems from Grades 3 to 6 were used as mediators.

RESULTS

Significant mediations of internalizing and externalizing behavior problems were observed on pathways from positive support between child-playmate dyads to later BMI and overweight/obesity status at age 15 years. The observed mediations were mainly sustained with pronounced magnitudes in girls, but not in boys.

CONCLUSIONS

Our findings demonstrated a significant mediating role of psychosocial adjustment. Future research efforts are highly encouraged to replicate our findings and further explore this underlying mediation mechanism.

Noise and Memristance Variation Tolerance of Single Crossbar Architectures for Neuromorphic Image Recognition

We performed a comparative study on the Gaussian noise and memristance variation tolerance of three crossbar architectures, namely the complementary crossbar architecture, the twin crossbar architecture, and the single crossbar architecture, for neuromorphic image recognition and conducted an experiment to determine the performance of the single crossbar architecture for simple pattern recognition. Ten grayscale images with the size of 32 × 32 pixels were used for testing and comparing the recognition rates of the three architectures. The recognition rates of the three memristor crossbar architectures were compared to each other when the noise level of images was varied from -10 to 4 dB and the percentage of memristance variation was varied from 0% to 40%. The simulation results showed that the single crossbar architecture had the best Gaussian noise input and memristance variation tolerance in terms of recognition rate. At the signal-to-noise ratio of -10 dB, the single crossbar architecture produced a recognition rate of 91%, which was 2% and 87% higher than those of the twin crossbar architecture and the complementary crossbar architecture, respectively. When the memristance variation percentage reached 40%, the single crossbar architecture had a recognition rate as high as 67.8%, which was 1.8% and 9.8% higher than the recognition rates of the twin crossbar architecture and the complementary crossbar architecture, respectively. Finally, we carried out an experiment to determine the performance of the single crossbar architecture with a fabricated 3 × 3 memristor crossbar based on carbon fiber and aluminum film. The experiment proved successful implementation of pattern recognition with the single crossbar architecture.

Novel (R)-6,6a,7,8,9,10-hexahydro-5H-pyrazino[1,2-a][1,n]naphthyridines as potent and selective agonists of the 5-HT2C receptor

A series of novel (R)-6,6a,7,8,9,10-hexahydro-5H-pyrazino[1,2-a][1,n]naphthyridines were identified as potent and selective agonists of the 5-HT_2C receptor. Optimizations performed on a previously reported series of racemic tetrahydroquinoline-based tricyclic amines, delivered an advanced drug lead, (R)-4-(3,3,3-trifluoropropyl)-6,6a,7,8,9,10-hexahydro-5H-pyrazino[1,2-a][1,8]naphthyridine, which displayed excellent in vitro and in vivo pharmacological profiles.

School-based, two-arm, parallel, controlled trial of a culturally adapted resilience intervention to improve adolescent mental health in Vietnam: study protocol

INTRODUCTION

The Resourceful Adolescent Program (RAP) is an evidence-based resilience intervention for adolescents. Operating in a strength-focused paradigm, the programme uses an integration of cognitive behavioural therapy and interpersonal psychotherapy to improve coping skills and build resilience. This study aims to establish whether a culturally and linguistically adapted intervention informed by RAP principles is effective in increasing resilience, enhancing coping skills and preventing symptoms of depression and anxiety.

METHODS AND ANALYSIS

We will translate, back-translate and culturally adapt the RAP for adolescents and training materials for facilitators, and the adapted intervention will be called Happy House. A two-arm parallel controlled trial will be conducted in eight high schools in the north of Vietnam. In each of the selected schools, all students from four randomly selected grade 10 classes (an estimation of about 1204 students) will be invited to participate. The control group will receive the usual curriculum. The intervention group will receive six weekly 90 min school-based group sessions of Happy House in addition to the usual curriculum. The primary outcome, depressive symptoms, will be measured using a locally validated version of the Centre for Epidemiologic Studies Depression Scale Revised. Secondary outcomes are mental well-being, coping self-efficacy, school connectedness, anger management and health risk behaviours. Data will be collected at recruitment, and at two weeks and six months post intervention. Mixed-effect logistic regression for the main outcome and mixed-effect linear and logistic regression models for the secondary outcomes will be conducted to estimate the effects of the intervention on the outcomes.

ETHICS AND DISSEMINATION

This trial has been approved by Monash University Human Research Ethics Committee (No. 21455) and the Institutional Review Board of the Hanoi School of Public Health (488/2019/YTCC-HD3). Dissemination of findings will include peer-reviewed publications, international and national conferences, seminar and media presentations, national policy briefings in Vietnam, local language reports and lay language summaries for participants.

TRIAL REGISTRATION NUMBERS

Registered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12620000088943 (3/2/2020).WHO Universal Trial Number: U1111-1246-4079.

Disability outcomes of early cerebellar and brainstem symptoms in multiple sclerosis

BACKGROUND

Cerebellar and brainstem symptoms are common in early stages of multiple sclerosis (MS) yet their prognostic values remain unclear.

OBJECTIVE

The aim of this study was to investigate long-term disability outcomes in patients with early cerebellar and brainstem symptoms.

METHODS

This study used data from MSBase registry. Patients with early cerebellar/brainstem presentations were identified as those with cerebellar/brainstem relapse(s) or functional system score ⩾ 2 in the initial 2 years. Early pyramidal presentation was chosen as a comparator. Andersen-Gill models were used to compare cumulative hazards of (1) disability progression events and (2) relapses between patients with and without early cerebellar/brainstem symptoms. Mixed effect models were used to estimate the associations between early cerebellar/brainstem presentations and expanded disability status scale (EDSS) scores.

RESULTS

The study cohort consisted of 10,513 eligible patients, including 2723 and 3915 patients with early cerebellar and brainstem symptoms, respectively. Early cerebellar presentation was associated with greater hazard of progression events (HR = 1.37, p < 0.001) and EDSS (β = 0.16, p < 0.001). Patients with early brainstem symptoms had lower hazard of progression events (HR = 0.89, p = 0.01) and EDSS (β = -0.06, p < 0.001). Neither presentation was associated with changes in relapse risk.

CONCLUSION

Early cerebellar presentation is associated with unfavourable outcomes, while early brainstem presentation is associated with favourable prognosis. These presentations may be used as MS prognostic markers and guide therapeutic approach.

Investigating epidemiologic trends and the geographic distribution of patients with anal squamous cell carcinoma throughout Canada

Background

Anal cancer is a rare disease, constituting 0.5% of new cancer cases in the United States. The most common subtype is squamous cell carcinoma (scc). Studies in several developed nations have reported on an increasing incidence of anal cancer in recent decades, and various risk factors pertaining to the pathogenesis of the disease have been identified, including infection with the human papillomavirus, tobacco use, and immunosuppression. The epidemiology and distribution of anal scc throughout Canada remain poorly understood, however.

Methods

Using 3 population-based cancer registries, a retrospective analysis of demographic data across Canada for 1992-2010 was performed. The incidence and mortality for anal scc was examined at the levels of provinces, cities, and the forward sortation area (FSA) component (first 3 characters) of postal codes.

Results

During 1992-2010, 3720 individuals were diagnosed with anal scc in Canada; 64% were women. The overall national incidence rate was 6.3 cases per million population per year, with an average age at diagnosis of 60.4 years. The incidence increased over time, with significantly higher incidence rates documented in British Columbia and Nova Scotia (9.3 cases per million population each). Closer examination revealed clustering of cases in various urban centres and self-identified lgbtq communities in Toronto, Montreal, and Vancouver.

Discussion

This study provides, for the first time, a comprehensive analysis of the burden of anal scc in Canada, identifying susceptible populations and shedding light onto novel avenues of research to lower the incidence of anal cancer throughout the country.

Scalable probabilistic PCA for large-scale genetic variation data

Principal component analysis (PCA) is a key tool for understanding population structure and controlling for population stratification in genome-wide association studies (GWAS). With the advent of large-scale datasets of genetic variation, there is a need for methods that can compute principal components (PCs) with scalable computational and memory requirements. We present ProPCA, a highly scalable method based on a probabilistic generative model, which computes the top PCs on genetic variation data efficiently. We applied ProPCA to compute the top five PCs on genotype data from the UK Biobank, consisting of 488,363 individuals and 146,671 SNPs, in about thirty minutes. To illustrate the utility of computing PCs in large samples, we leveraged the population structure inferred by ProPCA within White British individuals in the UK Biobank to identify several novel genome-wide signals of recent putative selection including missense mutations in RPGRIP1L and TLR4.

Principal component analysis is a commonly used technique for understanding population structure and genetic variation. With the advent of large-scale datasets that contain the genetic information of hundreds of thousands of individuals, there is a need for methods that can compute principal components (PCs) with scalable computational and memory requirements. In this study, we present ProPCA, a highly scalable statistical method to compute genetic PCs efficiently. We systematically evaluate the accuracy and scalability of our method on large-scale simulated data and apply it to the UK Biobank. Leveraging the population structure inferred by ProPCA within the White British individuals in the UK Biobank, we identify several novel signals of putative recent selection.

Epidemiology of adult and pediatric Burkitt lymphoma in Canada: sequelae of the HIV epidemic

Background

Although the pathogenesis and epidemiology of endemic Burkitt lymphoma (bl) have been extensively studied, the epidemiologic landscape of sporadic and immunodeficiency-associated bl in North America remains poorly understood.

Methods

We used 3 distinct population-based cancer registries to retrospectively study bl incidence and mortality in Canada. Data for patient sex; age at the time of diagnosis; and reporting province, city, and forward sortation area (fsa, the first three characters of a postal code) were analyzed.

Results

During 1992-2010, 1420 patients with bl in Canada were identified (incidence rate: 2.40 cases per million patient-years), of which 71.1% were male patients. Mean age at diagnosis was 55.5 ± 20.8 years. A bimodal incidence by age distribution was seen in both sexes, with pediatric- and adult-onset peaks. An analysis based on fsas identified select communities with statistically higher rates of adult bl. Several of those fsas were located within the 3 major metropolitan areas (Montreal, Vancouver, Toronto) and within self-identified lgbtq communities. The fsas with a higher socioeconomic status score were associated with lower rates of bl.

Conclusions

Current results highlight the geographic and historic pattern of bl in Canada. The human immunodeficiency virus remains an important risk factor for adult bl.

Validating the Vietnamese version of wearing - Off 19 questionnaire for patients with Parkinson's disease

BACKGROUND

One of the most common complication of the progression of Parkinson's disease (PD) is the wearing off phenomenon. A validated Vietnamese version of Wearing off 19 (WO19) questionnaire is necessary to optimize the Vietnamese PD treatment.

OBJECTIVES

This study was undertaken to determine the quality attribute of the questionnaire as a tool for early detection of wearing off (WO) in Vietnamese population with PD. We also sought the relationship between the WO phenomenon and factors concerning the clinical condition and course of the disease.

SUBJECTS AND METHODS

This is an observational, cross-sectional study. Patients diagnosed with PD under dopaminergic treatment came to University Medical Center Ho Chi Minh city for a regular appointment were sequentially asked to complete the Vietnamese WO19 questionnaire. A neurologist specialized in movement disorders assessed the patient and determined whether he had experienced wearing off or not. The questionnaire results were then compared to the clinical opinion of the expert which is considered the gold standard for diagnosing wearing off. The reliability of the questionnaire is evaluated by Cronbach'α and Cohen's kappa coefficient. The validity is measured by the sensitivity and the specificity of the instrument compared to the gold standard. The multivariate logistic regression analysis is used to learn the relations of associated factors and wearing off phenomenon.

RESULTS

98 patients with the mean age 59.12 ± 10.99 have joined our study; 58.2% are male; and the mean disease duration is 6.32 years. The Vietnamese version of the WO19 questionnaire has a good reliability (Cronbach'α = 0.778) and the agreement with the expert assessment (the diagnostic accuracy) is at a substantial level (Kappa value = 0.618). The sensitivity and specificity of the questionnaire resulted 89.28% and 71.43% respectively. The multivariate logistic regression analysis revealed a long disease duration (≥6 years) (OR: 16.96; 95% CI: 2.17-132.57; p = 0.007), a high daily levodopa dosage (≥400 mg/day) (OR: 6.31; 95% CI: 1.36-29.23; p = 0.019) and high score of MDS-UPDRS part IV (≥4) (OR: 15.36; 95% CI: 2.13-110.58; p = 0.007) were independent predictive factors for wearing off in Vietnamese PD patients.

CONCLUSIONS

Vietnamese - WO19 is a reliable and effective tool which should be used in clinical practice for early detecting PD patients with wearing off.

Incidence and mortality trends and geographic patterns of follicular lymphoma in Canada

Background

Follicular lymphoma (fl) is the most common indolent lymphoma and the 2nd most common non-Hodgkin lymphoma, accounting for 10%-20% of all lymphomas in the Western world. Epidemiologic and geographic trends of fl in Canada have not been investigated. Our study's objective was to analyze incidence and mortality rates and the geographic distribution of fl patients in Canada for 1992-2010.

Methods

Demographic and geographic patient data for fl cases were obtained using the Canadian Cancer Registry, the Registre québécois du cancer, and the Canadian Vital Statistics database. Incidence and mortality rates and 95% confidence intervals were calculated per year and per geographic area. Rates were plotted using linear regression models to assess trends over time. Overall data were mapped using Microsoft Excel mapping software (Redmond, WA, U.S.A.) to identify case clusters across Canada.

Results

Approximately 22,625 patients were diagnosed with fl during 1992-2010. The age-standardized incidence rate of this malignancy in Canada was 38.3 cases per million individuals per year. Geographic analysis demonstrated that a number of Maritime provinces and Manitoba had the highest incidence rates, and that the provinces of Nova Scotia and Quebec had the highest mortality rates in the nation. Regional data demonstrated clustering of fl within cities or regions with high herbicide use, primary mining, and a strong manufacturing presence.

Conclusions

Our study provides a comprehensive overview of the fl burden and its geographic distribution in Canada. Regional clustering of this disease in concentrated industrial zones strongly suggests that multiple environmental factors might play a crucial role in the development of this lymphoma.

Cervical dystonia: Injecting botulinum neurotoxin into semispinalis capitis improves goose-neck posture

We describe a patient with goose-neck posture as the presenting form of cervical dystonia. In our case, the bilateral semispinalis capitis muscles were hypertrophic, thick, and overactive while both splenius capitis and sternocleidomastoid muscles were normal. In this single case experience, we demonstrated that the semispinalis capitis muscle may play a primary role in causing a goose-neck posture and the observed forward sagittal shift may be a compensatory or overflow activity of neck flexor muscles. Therefore, botulinum toxin injection to the semispinalis capitis muscles can be considered in the management of patients with goose-neck posture.

FLAIR2 improves LesionTOADS automatic segmentation of multiple sclerosis lesions in non-homogenized, multi-center, 2D clinical magnetic resonance images

Background

Accurate segmentation of MS lesions on MRI is difficult and, if performed manually, time consuming. Automatic segmentations rely strongly on the image contrast and signal-to-noise ratio. Literature examining segmentation tool performances in real-world multi-site data acquisition settings is scarce.

Objective

FLAIR², a combination of T₂-weighted and fluid attenuated inversion recovery (FLAIR) images, improves tissue contrast while suppressing CSF. We compared the use of FLAIR and FLAIR² in LesionTOADS, OASIS and the lesion segmentation toolbox (LST) when applied to non-homogenized, multi-center 2D-imaging data.

Methods

Lesions were segmented on 47 MS patient data sets obtained from 34 sites using LesionTOADS, OASIS and LST, and compared to a semi-automatically generated reference. The performance of FLAIR and FLAIR² was assessed using the relative lesion volume difference (LVD), Dice coefficient (DSC), sensitivity (SEN) and symmetric surface distance (SSD). Performance improvements related to lesion volumes (LVs) were evaluated for all tools. For comparison, LesionTOADS was also used to segment lesions from 3 T single-center MR data of 40 clinically isolated syndrome (CIS) patients.

Results

Compared to FLAIR, the use of FLAIR² in LesionTOADS led to improvements of 31.6% (LVD), 14.0% (DSC), 25.1% (SEN), and 47.0% (SSD) in the multi-center study. DSC and SSD significantly improved for larger LVs, while LVD and SEN were enhanced independent of LV. OASIS showed little difference between FLAIR and FLAIR², likely due to its inherent use of T₂w and FLAIR. LST replicated the benefits of FLAIR² only in part, indicating that further optimization, particularly at low LVs is needed. In the CIS study, LesionTOADS did not benefit from the use of FLAIR² as the segmentation performance for both FLAIR and FLAIR² was heterogeneous.

Conclusions

In this real-world, multi-center experiment, FLAIR² outperformed FLAIR in its ability to segment MS lesions with LesionTOADS. The computation of FLAIR² enhanced lesion detection, at minimally increased computational time or cost, even retrospectively. Further work is needed to determine how LesionTOADS and other tools, such as LST, can optimally benefit from the improved FLAIR² contrast.

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FLAIR² improves automatic MS lesion segmentation with LesionTOADS compared to FLAIR.

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Segmentation similarity improves for higher lesion volumes, particularly for FLAIR².

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FLAIR² provides greater sensitivity independent of lesion volume than FLAIR alone.

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Other segmentation tools need further optimization to fully benefit from FLAIR².

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FLAIR² provides immediate benefits at 1.5 T and visually improves segmentation at 3 T.

Enabling multi-hop remote method invocation in device-to-device networks

To avoid shrinking down the performance and preserve energy, low-end mobile devices can collaborate with the nearby ones by offloading computation intensive code. However, despite the long research history, code offloading is dilatory and unfit for applications that require rapidly consecutive requests per short period. Even though Remote Procedure Call (RPC) is apparently one possible approach that can address this problem, the RPC-based or message queue-based techniques are obsolete or unwieldy for mobile platforms. Moreover, the need of accessibility beyond the limit reach of the device-to-device (D2D) networks originates another problem. This article introduces a new software framework to overcome these shortcomings by enabling routing RPC architecture on multiple group device-to-device networks. Our framework provides annotations for declaring distribution decision and out-of-box components that enable peer-to-peer offloading, even when a client app and the service provider do not have a direct network link or Internet connectivity. This article also discusses the two typical mobile applications that built on top of the framework for chatting and remote browsing services, as well as the empirical experiments with actual test-bed devices to unveil the low overhead conduct and similar performance as RPC in reality.

Prevalence of human T cell lymphotropic virus 1 infection in Canada

Human T cell lymphotropic virus 1 (htlv-1) is a bloodborne retrovirus that infects at least 5–20 million people around the world [...]

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.