Abstract Objective To assess the impact of a multicomponent nutrition education program on student knowledge, attitudes, and behaviors related to consumption of fruits and vegetables (FVs). Design ...Quasi-experimental pretest/posttest research design; 3 study conditions (Intervention+, Intervention, Comparison). Setting Six schools from the Los Angeles Unified School District (LAUSD). Participants Three hundred ninety-nine low-income third-, fourth-, and fifth-grade students. Intervention The Intervention+ condition included 4 components: traditional Network–LAUSD program, new standardized nutrition curriculum, teacher training workshops, and parent nutrition education workshops. The Intervention condition included 2 components: traditional Network–LAUSD program and teacher training workshops. Main Outcome Measures Fruit and vegetable consumption, knowledge of food groups, attitudes and beliefs toward FVs, and parent/teacher influence on students’ attitudes toward FVs. Analysis Linear mixed models. Results The Intervention+ resulted in a positive change in knowledge ( P < .05), attitudes and beliefs toward vegetables ( P < .01), and teacher influence on students’ FV attitudes ( P < .05). Conclusions and Implications Although this study influenced knowledge and attitudes regarding FVs, a significant increase in students’ FV consumption was not observed. Given the ultimate aim of the LAUSD nutrition efforts is to increase FV consumption, future studies should consider adopting new intervention strategies, such as focusing on changing the school food environment.
Prompt epinephrine autoinjector (EAI) use is the primary treatment for anaphylaxis. However, limited Canadian data exist on the impact of reaction location on EAI use for food-induced anaphylaxis ...(FIA).
We sought to investigate the setting, management, and severity of pediatric FIA.
We recruited children presenting with FIA from 11 Canadian emergency departments. Patient demographics and the setting, management, and symptoms of FIA were collected by standardized questionnaire. Factors associated with prehospital EAI use and reaction severity were determined by logistic regression.
We recruited 3,604 children; 60.2% were male and the median age was 5.0 years (interquartile range 1.8-11.0). Among cases with a known location of FIA (85.0%), home was the most common setting (68.1%), followed by school/daycare (12.8%), other locations (11.4%; eg, park, car), and restaurants (7.4%). In the prehospital setting, EAI was administered in 36.7% of reactions at home, 66.7% in school/daycare, 40.2% in other locations, and 44.5% in restaurants. Relative to reactions occurring at school/daycare, prehospital EAI use was less likely at home (adjusted odds ratio aOR 0.80; 95% CI 0.76-0.84), in restaurants (aOR 0.81; 95% CI 0.75-0.87), and in other settings (aOR 0.77; 95% CI 0.73-0.83), when data were adjusted for reaction severity, sex, age, comorbidities, and province. The FIA setting was not associated with reaction severity or hospitalization.
Prehospital EAI use was higher at school/daycare than in other settings, potentially owing to the presence of policies and training on FIA. Setting-specific interventions including educational programs and policies/laws mandating training and stocking an EAI may improve anaphylaxis recognition and treatment.
•Hepatitis C virus–related liver disease is a leading cause of death among Latinos.•Community health centers serve a high proportion of Latinos and are an important setting.•Latino English-preferred ...patients had lower hepatitis C virus screening rates than other groups.•Understanding how language preference impacts screening disparities is needed.
Hepatitis C virus is associated with high morbidity and mortality—chronic liver disease is a leading cause of death among Latinos in the U.S. Screening for hepatitis C virus in community health center settings, which serve a disproportionate percentage of Latinos, is essential to eradicating hepatitis C virus infection. We assessed hepatitis C virus screening disparities in adults served by community health centers by ethnicity and language preference.
This was an observational cohort study (spanning 2013–2017) of adults born in 1945–1965 in the Accelerating Data Value Across a National Community Health Center Network electronic health record data set. Our exposure of interest was race/ethnicity and language preference (non-Hispanic White, Latino English preferred, Latino Spanish preferred). Our primary outcome was the relative hazard of hepatitis C virus screening, estimated using multivariate Cox proportional hazards regression.
A total of 182,002 patients met the study criteria and included 60% non-Hispanic Whites, 29% Latino Spanish preferred, and 11% Latino English preferred. In total, 9% received hepatitis C virus screening, and 2.4% were diagnosed with hepatitis C virus. Latino English-preferred patients had lower rates of screening than both non-Hispanic Whites and Latino Spanish preferred (5.5% vs 9.4% vs 9.6%, respectively). Latino English preferred had lower hazards of hepatitis C virus screening than non-Hispanic Whites (adjusted hazard ratio=0.56, 95% CI=0.44, 0.72), and Latino Spanish preferred had similar hazards of hepatitis C virus screening (adjusted hazard ratio=1.11, 95% CI=0.88, 1.41).
We found that in a large community health center network, adult Latinos who preferred English had lower hazards of hepatitis C virus screening than non-Hispanic Whites, whereas Latinos who preferred Spanish had hazards of screening similar to those of non-Hispanic Whites. The overall prevalence of hepatitis C virus screening was low. Further work on the role of language preference in hepatitis C virus screening is needed to better equip primary care providers to provide this recommended preventive service in culturally relevant ways.
Oral food challenge is the main tool for diagnosing food allergy, but there is little data on the reaction profiles of young children undergoing challenges, nor how these reactions compare to ...reactions on accidental ingestion in the community.
To compare reaction profiles from food challenges and parent-reported reactions on accidental ingestion, and assess predictors of severe reactions.
HealthNuts is a longitudinal population-based cohort study of 5276 1-year-old infants. Infants underwent skin prick tests and those with identifiable wheals were offered food challenges. Food challenges were repeated at age 4 years in those with previous food allergy or reporting new food allergies. Community-reported reactions were ascertained from parent questionnaires.
Food challenges were undertaken in 916 children at age 1 year and 357 children at age 4 years (a total of 2047 peanut, egg, or sesame challenges). Urticaria was the most common sign in positive challenges at both ages (age 1 year, 88.7%, and age 4 years, 71.2%) although angioedema was significantly more common at age 4 years (40.1%) than at age 1 year (12.9%). Anaphylaxis was equally uncommon at both ages (2.1% and 2.8% of positive challenges at ages 1 and 4 years, respectively) but more common for peanut than for egg (4.5% and 1.2% of positive challenges at ages 1 and 4 years, respectively). The patterns of presenting signs reported during community reactions were similar to those observed in formal food challenges. Serum food-specific IgE levels of 15 kU/L or more were associated with moderate to severe reactions but skin prick test was not.
There was a shift from the most common presenting reaction of urticaria during food challenges toward more angioedema in older children. Serum food-specific IgE levels were associated with reaction severity.
To compare the efficacy and efficiency of training neural networks for medical image classification using comparison labels indicating relative disease severity versus diagnostic class labels from a ...retinopathy of prematurity (ROP) image dataset.
Evaluation of diagnostic test or technology.
Deep learning neural networks trained on expert-labeled wide-angle retinal images obtained from patients undergoing diagnostic ROP examinations obtained as part of the Imaging and Informatics in ROP (i-ROP) cohort study.
Neural networks were trained with either class or comparison labels indicating plus disease severity in ROP retinal fundus images from 2 datasets. After training and validation, all networks underwent evaluation using a separate test dataset in 1 of 2 binary classification tasks: normal versus abnormal or plus versus nonplus.
Area under the receiver operating characteristic curve (AUC) values were measured to assess network performance.
Given the same number of labels, neural networks learned more efficiently by comparison, generating significantly higher AUCs in both classification tasks across both datasets. Similarly, given the same number of images, comparison learning developed networks with significantly higher AUCs across both classification tasks in 1 of 2 datasets. The difference in efficiency and accuracy between models trained on either label type decreased as the size of the training set increased.
Comparison labels individually are more informative and more abundant per sample than class labels. These findings indicate a potential means of overcoming the common obstacle of data variability and scarcity when training neural networks for medical image classification tasks.
Abstract Background Context Common Data Elements (CDE) represent an important tool for understanding and classifying health outcomes across settings. While CDE's have been developed for a number of ...disorders, to date CDEs for Lumbar Spinal Stenosis (LSS) have not been fully developed. To facilitate the identification of CDEs and measures to assess them, this technical study leverages The International Classification of Functioning, Disability and Health (ICF), peer-reviewed research, and a panel of experts to identify CDEs specific to LSS. Purpose To define common data elements for disease characteristics and outcomes of lumbar spinal stenosis using the World Health Organization's International Classification of Functioning, Disability and Health taxonomy; to facilitate the selection of assessment instruments for research and clinical care. Design Scoping review using a modified Delphi approach with a technical expert panel composed of clinicians and scientists representing academia, policy and advocacy stakeholders, and professional associations with expertise in LSS. Methods Scoping review to identify measures that assess lumbar spinal stenosis symptoms. Thirty-one subject matter experts (SMEs) prioritized ICF codes and evaluated instruments measuring specific domains. We used a modified Delphi technique to evaluate item-level content and achieve consensus. Results SMEs prioritized 53 ICF codes; 3 received 100% endorsement, 27 received ≥ 90% endorsement, while the remaining 23 received ≥ 80% endorsement. Prioritized ICF codes represent diverse domains including pain, activities and participation, and emotional well-being. The review yielded 58 instruments; we retained 24 for content analysis. Conclusions The retained instruments adequately represent the ICF's Activities and Participation, and Body Function domains. Body Structure and Environmental Factors were assessed infrequently. Adoption of these common data elements may guide clinical decision-making and facilitate comparative effectiveness trials for interventions focused on lumbar spinal stenosis.
The effect of prosthesis-patient mismatch on long-term survival after aortic valve replacement has received considerable attention but there remains controversy. This study was performed to determine ...the predictors of mortality after aortic valve replacement and influence of prosthesis-patient mismatch on survival.
Contemporary mechanical prostheses and bioprostheses were implanted in 3,343 patients with aortic valve replacement between 1982 and 2003. The mean age was 68.06 +/- 11.20 years (median 70.06; range, 19 to 94), and the mean follow-up was 6.18 +/- 4.96 years, for a total of 20,666 years of follow-up. Prosthesis-patient mismatch was classified by effective orifice area index categories: normal (> 0.85 cm(2)/m(2)), 1,547 (46.3%); mild-to-moderate (> 0.65 cm(2)/m(2) to < or = 0.85 cm(2)/m(2)), 1,584 (47.4%); and severe (< 0.65 cm(2)/m(2)), 212 (6.3%).
The predictors of overall mortality were age, age categorization, New York Heart Association functional class III/IV, concomitant coronary artery bypass graft surgery, prosthesis type, preoperative congestive heart failure, diabetes mellitus, renal failure, and chronic obstructive pulmonary disease. All categories of effective orifice area indexes were not predictive of overall mortality, late mortality, or early mortality. The 15-year overall survival was differentiated by effective orifice area index categories: 38.1% +/- 2.1%, 37.0% +/- 2.2%, and 22.1% +/- 6.5%, respectively, for the three categories. Survival adjusted for the covariates (effective orifice area index, age, basal mass index, and ejection fraction) determined no effect except severe effective orifice area index when adjusted for ejection fraction more than 50% (p = 0.049).
Prosthesis-patient mismatch is not a predictor of overall standard unadjusted mortality to 15 years after aortic valve replacement, regardless of the category of effective orifice area index.
The aim was to develop a novel artificial intelligence (AI)–guided clinical decision support system, to predict radiation doses to subsites of the mandible using diagnostic computed tomography scans ...acquired before any planning of head and neck radiation therapy (RT).
A dose classifier was trained using RT plans from 86 patients with oropharyngeal cancer; the test set consisted of an additional 20 plans. The classifier was trained to predict whether mandible subsites would receive a mean dose >50 Gy. The AI predictions were prospectively evaluated and compared with those of a specialist head and neck radiation oncologist for 9 patients. Positive predictive value (PPV), negative predictive value (NPV), Pearson correlation coefficient, and Lin concordance correlation coefficient were calculated to compare the AI predictions to those of the physician.
In the test data set, the AI predictions had a PPV of 0.95 and NPV of 0.88. For 9 patients evaluated prospectively, there was a strong correlation between the predictions of the AI algorithm and physician (P = .72, P < .001). Comparing the AI algorithm versus the physician, the PPVs were 0.82 versus 0.25, and the NPVs were 0.94 versus 1.0, respectively. Concordance between physician estimates and final planned doses was 0.62; this was 0.71 between AI-based estimates and final planned doses.
AI-guided decision support increased precision and accuracy of pre-RT dental dose estimates.
Background
Gout is the most prevalent inflammatory arthritis in the Asia‐Pacific region and worldwide. This clinical practice guideline (CPG) aims to provide recommendations based on systematically ...obtained evidence and values and preferences tailored to the unique needs of patients with gout and hyperuricemia in Asia, Australasia, and the Middle East. The target users of these guidelines are general practitioners and specialists, including rheumatologists, in these regions.
Methods
Relevant clinical questions were formulated by the Steering Committee. Systematic reviews of evidence were done, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. A multi‐sectoral consensus panel formulated the final recommendations.
Results
The Asia‐Pacific League of Associations for Rheumatology Task Force developed this CPG for treatment of gout with 3 overarching principles and 22 recommendation statements that covered the treatment of asymptomatic hyperuricemia (2 statements), treatment of acute gout (4 statements), prophylaxis against gout flare when initiating urate‐lowering therapy (3 statements), urate‐lowering therapy (3 statements), treatment of chronic tophaceous gout (2 statements), treatment of complicated gout and non‐responders (2 statements), treatment of gout with moderate to severe renal impairment (1 statement), and non‐pharmacologic interventions (5 statements).
Conclusion
Recommendations for clinically relevant scenarios in the management of gout were formulated to guide physicians in administering individualized care.
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