A comparison of assays for the detection of Cryptosporidium parvum in the feces of scouring calves

Cryptosporidium parvum is a zoonotic, protozoan parasite that causes potentially life-threatening diarrhea in the host and can be transmitted via the fecal-oral route. C. parvum can infect cattle and may be detected in their feces using a variety of tests. We compared the level of agreement, ease of procedure, and cost among PCR, lateral flow immunoassay, fluorescent antibody, and Kinyoun acid-fast stain direct smear tests. Over the course of 9 mo, 74 calf fecal samples were submitted and tested for C. parvum using all 4 tests. A Fleiss kappa value of 0.813 was obtained, indicating an excellent level of agreement among tests. Overall, the best test based on cost and ease of procedure was the Kinyoun acid-fast stain direct smear.

Dense Tissue Pattern Characterization Using Deep Neural Network

Breast tumors are from the common infections among women around the world. Classifying the various types of breast tumors contribute to treating breast tumors more efficiently. However, this classification task is often hindered by dense tissue patterns captured in mammograms. The present study has been proposed a dense tissue pattern characterization framework using deep neural network. A total of 322 mammograms belonging to the mini-MIAS dataset and 4880 mammograms from DDSM dataset have been taken, and an ROI of fixed size 224 × 224 pixels from each mammogram has been extracted. In this work, tedious experimentation has been executed using different combinations of training and testing sets using different activation function with AlexNet, ResNet-18 model. Data augmentation has been used to create a similar type of virtual image for proper training of the DL model. After that, the testing set is applied on the trained model to validate the proposed model. During experiments, four different activation functions ‘sigmoid’, ‘tanh’, ‘ReLu’, and ‘leakyReLu’ are used, and the outcome for each function has been reported. It has been found that activation function ‘ReLu’ perform always outstanding with respect to others. For each experiment, classification accuracy and kappa coefficient have been computed. The obtained accuracy and kappa value for MIAS dataset using ResNet-18 model is 91.3% and 0.803, respectively. For DDSM dataset, the accuracy of 92.3% and kappa coefficient value of 0.846 are achieved. After the combination of both dataset images, the achieved accuracy is 91.9%, and kappa coefficient value is 0.839 using ResNet-18 model. Finally, it has been concluded that the ResNet-18 model and ReLu activation function yield outstanding performance for the task.

The Application Value of ceMDCT in the Diagnosis of Gastric Cancer Extramural Vascular Invasion and Its Influencing Factors

Objective. To investigate the value of enhanced multislice spiral CT (ceMDCT) in the diagnosis of extramural vascular invasion of gastric cancer and the influencing factors of extramural vascular invasion. There are different methods used in this paper. Method. 131 patients with primary gastric cancer treated in our hospital from January 2017 to May 2019 were selected. All patients underwent surgical resection and ceMDCT examination before operation. Result. There were 40 cases with extramural vascular invasion of gastric cancer by surgical pathological diagnosis. The kappa value of ceMDCT in diagnosing extramural vascular invasion of gastric cancer was 0.947, and the consistency was excellent. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were 100.00%, 96.70%, 93.02%, and 100.00%, respectively. The proportions of T3-T4, tumour diameter ≥5.0 cm, and growth pattern of proximal nodular + diffuse type in patients with gastric cancer extramural vascular invasion were 92.50%, 85.00%, and 65.00%, respectively, which were significantly higher than those in patients without extramural vascular invasion ( P < 0.05 ). The logistic regression analysis results showed that T3-T4, tumour diameter ≥5.0 cm, proximal nodular + diffuse growth pattern were the risk factors for extrahepatic vascular invasion in gastric cancer (OR = 3.751, 2.901, and 3.367, P < 0.05 ). Conclusion. ceMDCT has good application value in diagnosing gastric cancer extramural vascular invasion. The occurrence of gastric cancer extramural vascular invasion is affected by T staging, tumour diameter, and tumour growth pattern.

The Value of Lung Ultrasound Score Predicts the Ventilator use in Preterm with Dyspnea within 24h after Hospitalization

This study aims to explore the predictive value of LUSsc(Lung Ultrasound Score) in the selection of respiratory support mode for premature infants with dyspnea.We prospectively included 857 preterm infants and performed LU in the first 2 hours of admission and scored LUSsc by two specialist sonographers. They were divided into two stratification according to gestational age (<32 +0 weeks and 32 +0 -36+6 weeks), and had two main outcomes: invasive and non-invasive respiratory support. In the training set, analysis the clinical factors finding the best cut-off value of lung ultrasound score then verified the consistency in the verification set. The choice of invasive respiratory support is based on neonatal mechanical ventilation rules. Preterm infants with invasive respiratory support had higher LUS scores and lower OI 、birth weight、than those with non-invasive support. For preterm <32 +0 weeks the cut-off point of LUSsc was 6.5 that the area under curve was 0.749 (95% CI: 0.689-0.809), which was statistically significant (P<0.05), and the sensitivity and specificity were 74.0% and 68.3%, for preterm 32 +0 -36 +6 weeks, cut-off point was 6.5 and the area under curve was 0.863 (95% CI: 0.811-0.911), sensitivity and specificity were 75.3% and 0.836%.In the validation set, use actual clinical respiratory support selection results to verify, for preterm <32 +0 weeks (Kappa value 0.660, P<0.05, McNemar test P ＞0.05),for preterm 32 +0 -36 +6 weeks (Kappa value 0.779, P<0.05, McNemar test P ＞0.05). Conclusion: The LUS score shows good reliability to predict respiratory support mode for preterm infants with dyspnea

Forecasting Supply Chain Demand Approach Using Knowledge Management Processes and Supervised Learning Techniques

In today’s context (competition and knowledge economy), ML and KM on the supply chain level have received increased attention aiming to determine long and short-term success of many companies. However, demand forecasting with maximum accuracy is absolutely critical to invest in various fields, which places the knowledge extract process in high demand. In this paper, we propose a hybrid approach of prediction into a demand forecasting process in supply chain based on the one hand, on the processes analysis for best professional knowledge for required competencies. And on the other hand, the use of different data sources by supervised learning to improve the process of acquiring explicit knowledge, maximizing the efficiency of the demand forecasting, and comparing the obtained efficiency results. Therefore, the results reveal that the practices of KM should be considered as the most important factors affecting the demand forecasting process in supply chain. The classifier performance is examined by using a confusion matrix based on their Accuracy and Kappa value.

Development of Critical Thinking Transfer Practice Construct and Sub-Constructs: A 9-steps Approach

The study aimed to develop critical thinking transfer practice (CTTP) construct and sub-constructs relevant to medical undergraduates. The study used a 9-step qualitative case study approach. The prior relationship of construct and sub-constructs were conceptualised to produce the initial thematic framework (Step 1 to 3). Then, a qualitative study confirmed the sub-constructs that were relevant for the undergraduates, as the new data were fitted into the initial framework to become an evolving framework (Step 4 to 5). Next, the construct and sub-constructs were defined operationally (Step 6) and evaluated (Step 7). After that, the evolving framework was revised (Step 8) and developed to become the final construct and sub-constructs (Step 9). Based on the literature, the study conceptualised an initial framework that described the theoretical relationship of the prior construct and six sub-constructs. From the qualitative findings, 37 codes were fitted into the initial framework. The fitting resulted in an evolving framework that contained a theme (the medical undergraduates’ CTTP), 6 categories and 26 sub-categories. A 100% of participants agreed that the data were generated from them. Then, the team members and the expert panels accepted the theme (Cohen Kappa value > 0.80). The maintained and revised theme, categories and sub-categories were used to develop the CTTP construct and 6 sub-constructs. The study discussed in detail the included subconstructs for CTTP. The study also addressed the similarities and differences of the construct and sub-constructs for medical education and general studies. The study concluded that the construct and sub-constructs were theoretically proven to represent the medical undergraduates’ CTTP.

Comparative evaluation of cost effective extraction free molecular technique for detection of SARS-CoV-2 with reference to standard VTM based RT-qPCR method

Background and Objectives: The entire globe is undergoing an unprecedented challenge of COVID-19. Considering the need of rapid and accurate diagnostic tests for SARS-CoV-2, this study was planned to evaluate the cost effective extraction free RT-PCR technique in comparison to the standard VTM based RT-qPCR method. Materials and Methods: Paired swabs from nasopharynx and oropharynx were collected for SARS-CoV-2 testing, from 211 adult patients (≥18 years) in VTM and plain sterile tubes (dry swabs). These samples were processed and RT-qPCR was carried out as per standard protocols. Results: 54.5% of the patients were females and 45.5% were males with sex ratio 1:1.19 (M: F). 38.86% were symptomatic, of which fever (86.59%), cough (79.23%) and breathlessness (46.34%) were the most common symptoms. The positivity by VTM based method and index method was 31.27% and 13.27% respectively. Of the 27 inconclusive results from index method, 37.04% were positive, 48.15% were negative by VTM based method. However, in 40 inconclusive results by VTM based method, 90% were negative and rest remained inconclusive by index method. The sensitivity and specificity of the index method were 39.39% and 85.71% respectively. The overall agreement between VTM based method and index method was 49.59% with estimated Kappa value of 0.19. Conclusion: VTM based method showed higher sensitivity compared to the index method. The higher positivity by VTM based method, suggests that VTM based method could plausibly be a better detection method of SARS-CoV-2. Still, the index method might add value in a resource limited setups for detection of SARS-CoV-2.

Evaluation of a laboratory-developed multiplex real-time PCR assay for diagnosis of syphilis, herpes and chancroid genital ulcers in four public health laboratories in the USA

ObjectiveTo evaluate the field performance of a multiplex PCR (M-PCR) assay for detection of herpes simplex virus (HSV)-1 and HSV-2, Treponema pallidum (T. pallidum) and Haemophilus ducreyi (H. ducreyi) in genital ulcer disease (GUD) specimens.MethodsGUD M-PCR was performed on 186 remnant specimens, previously collected for HSV testing, by four public health laboratories (PHLs) and the Laboratory Reference and Research Branch (LRRB) at the Centers for Disease Control and Prevention. The results from the PHLs were compared with those of LRRB, which served as the reference testing method, and percentage agreement was calculated.ResultsHSV was detected in 31 of 52 (59.6%), 20 of 40 (50%), 43 of 44 (97.7%) and 19 of 50 (38.0%) specimens from PHL1, PHL2, PHL3 and PHL4, respectively. There were seven discrepant results for HSV, and the overall percent agreement between the PHLs and the LRRB was 94%–100%, with a kappa value of 0.922, which demonstrates high agreement. T. pallidum was identified in 7 of 51 (13.7%) specimens from PHL1 with 94.1% agreement and in 2 of 40 (5.0%) specimens from PHL2 with 100% agreement. The LRRB identified three additional T. pallidum-positive specimens from PHL1. The kappa value (0.849) for T. pallidum testing suggests good agreement. Consistent with the LRRB results, no T. pallidum was detected in specimens from PHL3 and PHL4, and H. ducreyi was not detected at any of the study sites.ConclusionsThe GUD M-PCR assay performed well in four independent PHLs and 12 suspected syphilis cases were identified in this study. The M-PCR assay could provide improved diagnostic options for GUD infections in state and local PHLs.

Comparison of China Reference with Different National and International References: The Prevalence of High Blood Pressure in 695,302 Children and Adolescents in a Metropolis of Yangtze River Delta, China

Objectives. This study aimed to compare performances of China reference and different national references on high blood pressure (HBP). Methods. A cross-sectional study including 695,302 children and adolescents aged 7 to 17 years in Suzhou, China, was conducted to determine the prevalence of HBP based on U.S., international, Europe, and China references in 2016. Results. Different percentiles of height and blood pressure were found among four references. Referring to U.S. reference, the prevalence of HBP was the highest with 26.0%, followed by International reference with 20.0%, Europe reference with 19.5%, and China reference with 19.2%. McNemar tests indicated statistically significant differences between HBP prevalence comparing China reference with the other 3 references ( P < 0.001 ). The area under the curve was 0.947, 0.851, and 0.949 for U.S., international, and Europe reference, respectively. U.S. reference showed the highest sensitivity (98.2%), but the lowest specificity (91.2%), and Europe reference showed the highest kappa value (0.893). Conclusions. The prevalence of HBP varied among these four references, and the appropriate choice of reference would be important to recognize high-risk children and judge the trends of HBP prevalence in the targeted population.

Effect of deep learning-based assistive technology use on chest radiograph interpretation by emergency department physicians: a prospective interventional simulation-based study

Background Interpretation of chest radiographs (CRs) by emergency department (ED) physicians is inferior to that by radiologists. Recent studies have investigated the effect of deep learning-based assistive technology on CR interpretation (DLCR), although its relevance to ED physicians remains unclear. This study aimed to investigate whether DLCR supports CR interpretation and the clinical decision-making of ED physicians. Methods We conducted a prospective interventional study using a web-based performance assessment system. Study participants were recruited through the official notice targeting board for certified emergency physicians and residents working at the present ED. Of the eight ED physicians who volunteered to participate in the study, seven ED physicians were included, while one participant declared withdrawal during performance assessment. Seven physicians’ CR interpretations and clinical decision-making were assessed based on the clinical data from 388 patients, including detecting the target lesion with DLCR. Participant performance was evaluated by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy analyses; decision-making consistency was measured by kappa statistics. ED physicians with < 24 months of experience were defined as ‘inexperienced’. Results Among the 388 simulated cases, 259 (66.8%) had CR abnormality. Their median value of abnormality score measured by DLCR was 59.3 (31.77, 76.25) compared to a score of 3.35 (1.57, 8.89) for cases of normal CR. There was a difference in performance between ED physicians working with and without DLCR (AUROC: 0.801, P < 0.001). The diagnostic sensitivity and accuracy of CR were higher for all ED physicians working with DLCR than for those working without it. The overall kappa value for decision-making consistency was 0.902 (95% confidence interval [CI] 0.884–0.920); concurrently, the kappa value for the experienced group was 0.956 (95% CI 0.934–0.979), and that for the inexperienced group was 0.862 (95% CI 0.835–0.889). Conclusions This study presents preliminary evidence that ED physicians using DLCR in a clinical setting perform better at CR interpretation than their counterparts who do not use this technology. DLCR use influenced the clinical decision-making of inexperienced physicians more strongly than that of experienced physicians. These findings require prospective validation before DLCR can be recommended for use in routine clinical practice.