Criteria For Causality Research Articles

Self-administration of medications for chronic diseases and drug-related hospital admissions in elderly patients at a Thai hospital.

Background Studies of self-administered medications associated with hospital admissions are limited. Objective This study aimed to identify drug-related hospital admissions among elderly patients with diabetes, hypertension and chronic obstructive pulmonary disease and its association with self-administered medications. Method This was a prospective study of 335 patients admitted to a district hospital in Thailand from October 2018 to April 2019. The patients were divided into two groups: one with self-administered medication and the other with caregiver-administered medication. Pharmaceutical Care Network Europe V8.02-defined drug-related problems were identified. Those that conformed to the Hallas contribution and causality criteria were deemed drug-related hospital admissions and causes of the problems were examined. Main outcome measure An association between self-administration of medications and hospital admission was determined using a multivariable logistic regression analysis. Results The prevalence of drug-related hospital admissions was 20.6% (95% confidence interval, CI 16.4-25.3%) as an overall and was significantly higher in the self-administration group (25.4%) than in the caregiver administration group (12.7%). Among the drug-related hospital admissions in the self-administration and caregiver administration groups respectively, 71.7 and 62.5% were preventable, 63.2 and 37.7% were caused by patient themselves, and 26.3 and 37.5% were from adverse drug reactions. Medical conditions frequently caused by the patients included the exacerbation of chronic obstructive pulmonary disease due to using inhalers less than prescribed or administering drugs in the wrong manner in the self-administration group and hypoglycemia due to a long interval between insulin injection and meal consumption in the caregiver administration group. Compared to caregiver-administered medications, self-administration of medications increased the odds of hospital admission by approximately two-fold (adjusted odds ratio, OR 2.24, 95% CI 1.13-4.43). Other independent risk factors included the use of five or more medications a day (OR 2.65, 95% CI 1.16-6.07), the presence of underlying chronic obstructive pulmonary disease (OR 2.11, 95% CI 1.05-4.23) and self-medication (OR 2.59, 95% CI 1.12-5.99). Conclusion Self-administered medication was associated with hospital admissions in elderly patients with chronic diseases. To prevent problems, priority should be given to interventions to ensure the appropriate administration of inhaled medications for chronic obstructive pulmonary disease and antihyperglycemic agents.

Vitamin D and Clinical Cancer Outcomes: A Review of Meta-Analyses.

ABSTRACTThe relationship between vitamin D status or supplementation and cancer outcomes has been examined in several meta‐analyses. To address remaining knowledge gaps, we conducted a systematic overview and critical appraisal of pertinent meta‐analyses. For meta‐analyses of trials, we assessed their quality using AMSTAR‐2 (A Measurement Tool to Assess Systematic Reviews), strength of associations using umbrella review methodology and credibility of evidence using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) criteria. Meta‐analyses of observational studies reported inverse associations of 25OHD with risk of cancer incidence and cancer mortality and, particularly for colorectal cancer, fulfilled some of Bradford‐Hill's causation criteria. In meta‐analyses of trials, vitamin D supplementation did not affect cancer incidence. However, we found credible evidence that vitamin D supplementation reduced total cancer mortality risk, with five out of six meta‐analyses reporting a relative risk (RR) reduction of up to 16%: RR, 0.84 (95% CI, 0.74–0.95). The strength of the association, however, was classified as weak. This was true among meta‐analyses of high, moderate, and lower quality (AMSTAR‐2–rated). Trials did not include large numbers of vitamin D‐deficient participants; many tested relatively low doses and lacked sufficiently powered data on site‐specific cancers. In conclusion, meta‐analyses show that, although observational evidence indicates that low vitamin D status is associated with a higher risk of cancer outcomes, randomized trials show that vitamin D supplementation reduces total cancer mortality, but not cancer incidence. However, trials with larger proportions of vitamin D‐insufficient participants and longer durations of follow‐up, plus adequately powered data on site‐specific common cancers, would provide further insight into the evidence base. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

The prevalence of familial form of atrioventricular nodal reentry tachycardia in south-eastern regions of Poland

Abstract Introduction Atrioventricular nodal reentry tachycardia (AVNRT) is one of the most common regular supraventricular arrhythmia referred for catheter ablation (CA). Although, several families with familial form of AVNRT (FAVNRT) in Subcarpathia province (SP, Poland), the comparison or prevalence of FAVNRT and comparison of their incidence in other provinces in Poland were not prospectively validated. Methods Data was derived from prospective multicenter registry of CA (ELEKTRO- ELMedica Network). Between year 2010 to 2018, the clinical data of 1544 patients with invasively documented AVNRT were verify for family history of FAVNRT. From December 2016 to March 2019 each patient with AVNRT were consulted with detailed family history and family residence origin with up to three-generation pedigree. Families with substantiate form of FAVNRT (at least two persons from the family after invasive validation of AVNRT and CA) divided into three groups according to their origin. Results From 1544 recruited patients 932 had origin in south-eastern provinces (SEP) of Poland [n=379, from SP; n=34, from Lubelskie; n=214, from Lesser Poland; and n=305 from Holy Cross]. The rest of the group (n=612) consisted of patients from other, not SEP parts of the country – other part of Poland (RPP). Finally, 45 (2,91%) patients from 24 families had diagnosed FAVNRT. The incidence of FAVNRT was significantly higher in SEP than RPP (4.02% vs 1.17%). Moreover, patients from SP has the highest prevalence of FAVNRT (6.33%) as compared to other provinces of SEP (2.47%). In SP and in bordering SEP provinces as well as the RPP appropriate risk (according to previous region) of FAVNRT was respectively 2.67 (95% CI: 1.36–5.23; P<0.004), 2.14 (95% CI: 0.86–5.34; P<0.10) according to reference RPP were observed. Conclusion Based on Hill's Criteria for Causality observed biological monotonic risk gradient of FAVNRT is proving geographical cause of increased prevalence of FAVNT. The closer they are the higher they is to the most endangered provinces in Poland- SP that also adjoined to Ucraine and Slovakia. Further, international, trans-border cooperation and genetic testing are required to validate genetic impact of FAVNRT in past Galicia region of Central Europe. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Study is funding by the research grant DI2015 021945 from budget resources in 2015 to 2017, as a research project in “Diamentowy Grant” program from “Narodowe Centrum Badan i Rozwoju (PL)”.

Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity.

Vitamin D deficiency co-exists in patients with COVID-19. At this time, dark skin color, increased age, the presence of pre-existing illnesses and vitamin D deficiency are features of severe COVID disease. Of these, only vitamin D deficiency is modifiable. Through its interactions with a multitude of cells, vitamin D may have several ways to reduce the risk of acute respiratory tract infections and COVID-19: reducing the survival and replication of viruses, reducing risk of inflammatory cytokine production, increasing angiotensin-converting enzyme 2 concentrations, and maintaining endothelial integrity. Fourteen observational studies offer evidence that serum 25-hydroxyvitamin D concentrations are inversely correlated with the incidence or severity of COVID-19. The evidence to date generally satisfies Hill’s criteria for causality in a biological system, namely, strength of association, consistency, temporality, biological gradient, plausibility (e.g., mechanisms), and coherence, although experimental verification is lacking. Thus, the evidence seems strong enough that people and physicians can use or recommend vitamin D supplements to prevent or treat COVID-19 in light of their safety and wide therapeutic window. In view of public health policy, however, results of large-scale vitamin D randomized controlled trials are required and are currently in progress.

Does mouse mammary tumor-like virus cause human breast cancer? Applying Bradford Hill criteria postulates

BackgroundThe role of mouse mammary tumor-like virus (MMTV-like virus) in human breast cancer (BC) has already been widely investigated worldwide with conflicting results. Although the researchers tried to establish the link between MMTV-like virus and BC through the statistical meta-analysis of the previous studies associating MMTV-like virus with BC, they failed to establish a more reliable link due to the shortcomings of the statistical meta-analysis. In the present study, we identified population-wide studies relating MMTV-like virus with BC through the PubMed search engine. Then, we examined the available data of MMTV-like virus prevalence in BC, normal/benign samples, and applied the postulates of Bradford Hill criteria on the available evidence to investigate the association between MMTV-like virus and BC. In addition, to further enhance the reliability of our outcomes, we have also evaluated the methodologies of the previous studies to address the possibility of false-negative and false-positive results.ResultsAfter a careful evaluation of the extracted data against the postulates of Bradford Hill criteria, it was observed that none of the studies fulfill all the major postulates of Bradford Hill criteria for causation including temporality, consistency, biological gradient, experiment, coherence, specificity, and analogy. Hence, no causal relationship has been suggested between MMTV-like virus and BC patients of the any included population.ConclusionThe results failed to prove the causal relationship between MMTV-like virus and BC rather suggested it as a co-participant in the pathogenesis of BC.

Adherence to the Mediterranean diet in Cyprus and its relationship to multi-morbidity: an epidemiological study.

To examine the adherence to the Mediterranean diet in the adult general population of Cyprus and assess its relationship with multi-morbidity. A representative sample of the adult population of Cyprus was selected in 2018-2019 using stratified sampling. Demographics, Mediterranean diet, smoking and physical activity, as well as the presence of chronic, clinical and mental conditions, were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision. The five government-controlled municipalities of the Republic of Cyprus. A total of 1140 Cypriot men and women over 18 years. The average Mediterranean diet score was 15·5 ± 4·0 with males and residents of rural regions being more adherent to the Mediterranean diet compared with females and residents of urban regions (P < 0·05). Being in the higher tertile of adherence to the Mediterranean diet was associated with lower odds of multi-morbidity compared with the lower tertile, and this result was statistically significant even after adjusting for age, gender, smoking habits and physical activity (OR = 0·68, 95 % CI 0·46, 0·99). The study provides evidence of the adherence to the Mediterranean diet in Cypriot population and its association with multi-morbidity. Adherence to the Mediterranean diet was associated with lower risk of multi-morbidity. Future research would attempt to replicate such results that could add solid pieces of evidence towards meeting some criteria of causality and severity tests; hence, prevention programmes and practice guidelines in Cyprus and elsewhere should take into account those beneficial effects.

Serum potassium and heart failure: association, causation, and clinical implications

Dyskalemia (hypo- and hyperkalemia) is a common clinical encounter in patients with heart failure (HF), linked to underlying pathophysiologic alterations, pharmacological treatments, and concomitant comorbidities. Both hypo- and hyperkalemia have been associated with a poor outcome in HF. However, it is not known if this association is causal. In order to investigate this relation, we implemented the Bradford Hill criteria for causation examining the available literature. Of note, hypokalemia and low-normal potassium levels (serum potassium <4.0mmol/L) appear to be associated with adverse clinical outcomes in HF in a cause-and-effect manner. Conversely, a cause-and-effect relationship between hyperkalemia (serum potassium >5.0mmol/L) and adverse clinical outcomes in HF appears unlikely. We also examined the benefits of renin-angiotensin-aldosterone system inhibitors (RAASi) therapy uptitration in patients with HF and reduced ejection fraction. In fact, hyperkalemia often limits RAASi use, thereby negating or mitigating their clinical benefits. Finally, serum potassium levels in HF should be maintained within the range of 4.0-5.0mmol/L, and although the correction of hyperkalemia does not appear to improve clinical outcomes per se, it may enable the optimal titration of RAASi, offering indirect clinical benefit.

Does human papillomavirus cause human colorectal cancer? Applying Bradford Hill criteria postulates.

The role of human papillomavirus (HPV) in human colorectal cancer (CRC) has already been widely investigated worldwide with conflicting results. Although researchers have tried to establish the link between HPV and CRC through a statistical meta-analysis of the previous studies associating HPV with CRC, they failed to establish a more reliable link due to the shortcomings of the statistical meta-analysis. In the present study, we identified population-wide studies relating HPV with CRC through the PubMed search engine. Then, we examined the available data of HPV prevalence in CRC and normal/benign samples and applied the postulates of Bradford Hill criteria on the available evidence to investigate the association between HPV and CRC. The Bradford Hill criteria are very old, reliable and widely accepted for establishing a link between the cause and disease. In addition, to further enhance the reliability of the outcomes, we have also evaluated the methodologies of the previous studies to address the possibility of false-negative and false-positive results. After a careful evaluation of the extracted data against the postulates of Bradford Hill criteria, it was observed that none of the studies fulfil all the major postulates of Bradford Hill criteria for causation including temporality, consistency, biological gradient, experiment, coherence, specificity and analogy. Hence, no causal relationship has been suggested between HPV and CRC patients of the any included population. The results failed to prove the causal relationship between HPV and CRC and suggested HPV as a coparticipant in the pathogenesis of CRC.

A Systemwide Approach for Navigating the Dilemma of Oral Factor Xa Inhibitor Interference With Unfractionated Heparin Anti-Factor Xa Concentrations.

Oral factor Xa inhibitors are known to significantly increase heparin anti-Xa concentrations, which leads to inaccuracies when monitoring intravenous unfractionated heparin (IV UFH). Guidance for managing this laboratory interference is lacking, creating substantial uncertainty in clinical practice. To describe a strategy used by a large academic institution for managing the controversy of laboratory interference in the setting of oral factor Xa inhibitor use and provide effectiveness and safety data for this approach. In December 2016, a new Heparin IV Direct Oral Anticoagulant (DOAC) Interference PowerPlan (a comprehensive order set) was made available in the electronic health record (Cerner, North Kansas City, MO) throughout the health system. We retrospectively examined 169 patients with events reported in the error reporting system, RISKMASTER, and evaluated reports with and without the use of the PowerPlan. Effectiveness was determined through evaluation of thrombosis. The Naranjo criteria for causality were applied to assess thrombotic events. Of 56 events that were reported with apixaban when the PowerPlan was not ordered, 4 (7%) thrombotic events occurred within 7 days of UFH initiation. One out of the 4 events (25%) that occurred when the PowerPlan was not appropriately initiated was considered probable using the Naranjo Scale. Three additional events (75%) were possible using the Naranjo Scale. The Heparin IV DOAC Interference PowerPlan appears to be conducive to positive patient outcomes when evaluating voluntary reported events and may assist clinicians with managing the therapeutic dilemma of this laboratory interference.

Demystifying the role of causal-predictive modeling using partial least squares structural equation modeling in information systems research

PurposePartial least squares structural equation modeling (PLS-SEM) has become popular in the information systems (IS) field for modeling structural relationships between latent variables as measured by manifest variables. However, while researchers using PLS-SEM routinely stress the causal-predictive nature of their analyses, the model evaluation assessment relies exclusively on criteria designed to assess the path model's explanatory power. To take full advantage of the purpose of causal prediction in PLS-SEM, it is imperative for researchers to comprehend the efficacy of various quality criteria, such as traditional PLS-SEM criteria, model fit, PLSpredict, cross-validated predictive ability test (CVPAT) and model selection criteria.Design/methodology/approachA systematic review was conducted to understand empirical studies employing the use of the causal prediction criteria available for PLS-SEM in the database of Industrial Management and Data Systems (IMDS) and Management Information Systems Quarterly (MISQ). Furthermore, this study discusses the details of each of the procedures for the causal prediction criteria available for PLS-SEM, as well as how these criteria should be interpreted. While the focus of the paper is on demystifying the role of causal prediction modeling in PLS-SEM, the overarching aim is to compare the performance of different quality criteria and to select the appropriate causal-predictive model from a cohort of competing models in the IS field.FindingsThe study found that the traditional PLS-SEM criteria (goodness of fit (GoF) by Tenenhaus, R2 and Q2) and model fit have difficulty determining the appropriate causal-predictive model. In contrast, PLSpredict, CVPAT and model selection criteria (i.e. Bayesian information criterion (BIC), BIC weight, Geweke–Meese criterion (GM), GM weight, HQ and HQC) were found to outperform the traditional criteria in determining the appropriate causal-predictive model, because these criteria provided both in-sample and out-of-sample predictions in PLS-SEM.Originality/valueThis research substantiates the use of the PLSpredict, CVPAT and the model selection criteria (i.e. BIC, BIC weight, GM, GM weight, HQ and HQC). It provides IS researchers and practitioners with the knowledge they need to properly assess, report on and interpret PLS-SEM results when the goal is only causal prediction, thereby contributing to safeguarding the goal of using PLS-SEM in IS studies.

Causality and stability conditions of a conformal charged fluid

In this paper, I study the conditions imposed on a normal charged fluid so that the causality and stability criteria hold for this fluid. I adopt the newly developed General Frame (GF) notion in the relativistic hydrodynamics framework which states that hydrodynamic frames have to be fixed after applying the stability and causality conditions. To do this, I take a charged conformal matter in the flat and 3 + 1 dimension to analyze better these conditions. The causality condition is applied by looking to the asymptotic velocity of sound hydro modes at the large wave number limit and stability conditions are imposed by looking to the imaginary parts of hydro modes as well as the Routh-Hurwitz criteria. By fixing some of the transports, the suitable spaces for other ones are derived. I observe that in a dense medium having a finite U(1) charge with chemical potential μ0, negative values for transports appear and the second law of thermodynamics has not ruled out the existence of such values. Sign of scalar transports are not limited by any constraints and just a combination of vector transports is limited by the second law of thermodynamic. Also numerically it is proved that the most favorable region for transports {tilde{upgamma}}_{1,2}, coefficients of the dissipative terms of the current, is of negative values.

Development of a definition and rules for causal attribution of post-colonoscopy bleeding.

Post-colonoscopy bleeding (PCB) is an important colonoscopy quality indicator that is recommended to be routinely collected by colorectal cancer screening programs and endoscopy quality improvement programs. We created a standardized and reliable definition of PCB and set of rules for attributing the relatedness of PCB to a colonoscopy. PCB events were identified from colonoscopies performed at the Forzani & MacPhail Colon Cancer Screening Centre. Existing definitions and relatedness rules for PCB were reviewed by the authors and a draft definition and set of rules was created. The definition and rules were revised after initial testing was performed using a set of 15 bleeding events. Information available for each event included the original endoscopy report and data abstracted from the emergency or inpatient record by a trained research assistant. A validation set of 32 bleeding events were then reviewed to assess their interrater reliability by having three endoscopists and one research assistant complete independent reviews and three endoscopists complete a consensus review. The Kappa statistic was used to measure interrater reliability. The panel classified 28 of 32 events as meeting the definition of PCB and rated 7, 8 and 6 events as definitely, probably and possibly related to the colonoscopy, respectively. The Kappa for the definition of PCB for the three independent reviews was 0.82 (substantial agreement). The Kappa for the attribution of the PCB to the colonoscopy by the three endosocopists was 0.74 (substantial agreement). The research assistant had a high agreement with the panel for both the definition (100% agreement) and application of the causal criteria (kappa 0.95). A standardized definition of PCB and attribution rules achieved high interrater reliability by endoscopists and a non-endoscopist and provides a template of required data for event adjudication by screening and quality improvement programs.

Adverse effects to food supplements containing botanical ingredients

The use of Plant Food Supplements (PFS) has increased significantly in the last decades. The wide diffusion of these products has raised concerns about their safety and to solve at least some critical points the EU Project PlantLIBRA was financed. The project included among its goals the collection of adverse effects due to PFS; using different sources: 1) the scientific literature; 2) European Poison Centers; 3) the PlantLIBRA consumer survey. New data from the Pavia Poison Centre, ANSES and FDA were elaborated after the end of EU Project. Adverse effects were analysed according to the WHO causal relationship criteria. Valeriana officinalis and Camellia sinensis were the plants most frequently involved in adverse effects in European countries. Although mild/moderate symptomatology were generally described, some severe outcomes occurred, including fatal cases. Nervous and gastrointestinal systems were the main targets; the intestinal disorders were associated with fibres and polyphenols present in some plants.

A Second Population-Based Cohort Study in Cameroon Confirms the Temporal Relationship Between Onchocerciasis and Epilepsy.

To confirm our earlier evidence of a temporal and dose–response relationship between onchocerciasis and epilepsy, we conducted another cohort study in a different setting in Cameroon. Individuals whose Onchocerca volvulus microfilarial density (Ov-MFD) was measured in 1992–1994 when they were children were revisited in 2019 to determine if they acquired epilepsy. With reference to individuals with no microfilariae in 1992–1994, the relative risks of acquiring epilepsy were 0.96, 2.76, 3.67, and 11.87 in subjects with initial Ov-MFD of 1–7, 8–70, 71–200, and > 200 microfilariae per skin snip, respectively. This study further demonstrates reproducibility using the Bradford Hill’s criteria for causality.

Red Meat Intake and Cardiometabolic Disease Risk: An Assessment of Causality Using The Bradford Hill Criteria

Abstract Objectives Higher red meat intake is associated with increased risk of cardiometabolic diseases, but causation of this relationships is unclear. This umbrella systematic review qualitatively assessed causality between red meat intake and cardiometabolic diseases. Methods Two researchers independently screened and crosschecked 524 articles from MEDLINE, Scopus, Cochrane Library, and CINAHL up to November 25,2019. Articles included were systematic reviews and meta-analyses of observational or experimental studies using healthy subjects aged 19+ years; included red meat (RM) intake [total (TRM), unprocessed (URM), or processed (PRM)] as an a priori independent variable; and reported outcomes or risk factors of cardiovascular diseases (CVD) or type 2 diabetes mellitus (T2D). Causality was assessed using Bradford Hill's Causation Criteria: 1) strength (relative risk, RR ≥1.2), 2) consistency (≥67% of assessments), 3) specificity, 4) temporality, 5) biological dose-response gradient 6) plausibility, 7) coherence, 8) experimental evidence and 9) analogy. Results In total, 22 articles (16 with CVD data; 11 with T2D data) were included. While TRM and URM were statistically positively associated with CVD incidence and mortality, these associations were consistently weak (RR &amp;lt; 1.2). The strength of positive associations between TRM and T2D incidence were inconsistent while the positive associations between URM and T2D incidence were consistently weak. Results from short-term randomized controlled trials assessing effects of TRM and URM on CVD and T2D risk factors were predominately null. These experimental findings indicate a lack of coherence and need for more research to determine causality of the positive associations described above. For both CVD and T2D, temporality was established with the inclusion of prospective study designs. Researchers have proposed plausible biological mechanisms and analogies but specificity is lacking. Insufficient data precluded assessing causality between PRM and CVD or T2D; research is needed. Conclusions Weakness of associations between total and unprocessed red meat intake and cardiometabolic diseases and lack of coherence with short-term experimental evidence on cardiometabolic disease risk factors reduces confidence that associations are causal. Funding Sources The Beef Checkoff.

Culprit or correlate? An application of the Bradford Hill criteria to Vitamin E acetate

Vitamin E acetate (VEA) has come under significant scrutiny due to its association with e-cigarette, or vaping, product use-associated lung injury (EVALI). In 1965, Sir Austin Bradford Hill proposed a set of criteria used to critically assess an association for causality. In this article, we apply the Bradford Hill causation criteria to VEA and the EVALI outbreak to clarify what further areas of study are needed to strengthen the causal argument. Additionally, we highlight the need for systematized approaches to rapidly identify the cause of mass poisoning events of unknown etiology.

An Integrated Delphi-DEMATEL-ELECTRE Method on Gray Numbers to Rank Technology Providers

Misunderstanding of technology transfer and lack of a scientific viewpoint in this area are among the fundamental problems of some industries. A novel Delphi-decision-making trial and evaluation laboratory (DEMATEL)-elimination and choice expressing reality (ELECTRE) decision-making method, which benefited from both qualitative and quantitative methods, is introduced on gray numbers to solve the selection problem of technology providers systematically. The technology provider evaluation criteria are developed according to a literature review and experts’ opinions. Next, the Delphi method is used to evaluate the criteria. Gray DEMATEL is used to investigate the cause and effect relationship between the selected criteria, based on which the criteria were ranked. Finally, using the gray ELECTRE method, the priority of companies is determined. Based on the results of the illustrative case study, the two most robust causal criteria are management/executive capability and cost. Moreover, cost and support through organization policies played a leading role in the system. Also, out of nine technology providers, company 4 is superior to other companies, whereas most companies were of greater advantage to company 5. According to the comparison of weights by Spearman's correlation coefficients, the proposed method is as efficient as the available methods. This novel method can be used in uncertain conditions to select the most reliable company.

Reviewing the oral carcinogenic potential of E-cigarettes using the Bradford Hill criteria of causation

The past decade has seen a surge in the use of e-cigarettes, which has prompted the medical community to assess any associated potential health hazards. A major concern was the risk of cancer. Chemical analysis of e-cigarettes has shown the presence of volatile organic compounds with the potential for carcinogenicity. Comparative toxicology analysis has shown e-cigarette to have relatively lower dosages of toxins than conventional combustible cigarettes. Based on comparative analysis, e-cigarettes have been increasingly advocated as a safe alternative to conventional cigarettes. It is vital to recognize that presence of relatively lower toxin level does not preclude carcinogenic potential. The nicotine present in the e-cigarette was presumed to be the major cytotoxic agents, thus nicotine-free e-cigarette was considered as inert. On the contrary, experimental studies on oral cell lines have shown DNA strand breaks on exposure to e-cigarette vapors with or without nicotine. In addition, dysregulations of genes associated with carcinogenic pathways have also been demonstrated in oral tissues exposed to e-cigarette vapors. Despite alarming molecular data, the oral carcinogenic potential of e-cigarette remains unclear, which can be attributed to the lack of long-term prospective and large-scale case-control studies. As e-cigarette users often have other well-established risk factors (conventional cigarette smoking, alcohol, etc.) as associated habits, it is difficult to assess e-cigarette as an independent risk factor for oral cancer. Thus, the present manuscript aims to review the published literature using the Brad Ford Hill criteria of causation to determine the oral carcinogenic potential of e-cigarettes.

A conflict‐free replicated data type for collaborative annotation systems

SummaryWith the advent of Web 2.0, numerous collaborative annotation systems have been developed in an effort to enable distant users to annotate the same multimedia resources such as texts, audio, images, and videos. However, the existing systems do not support the semantic aspect of the data available on the Web and ignore the convergence aspect when executing concurrent annotations. Based on the technologies of Semantic Web, this article presents a new conflict‐free replicated data type called OAC‐Set, which extends Open Annotation Collaboration data model to enable concurrent annotations while guaranteeing convergence, causality, and intention preservation criteria. The experimental results show that our approach is efficient and effective.

A HYBRID GREY MCDM APPROACH FOR ASSET ALLOCATION: EVIDENCE FROM CHINA’S SHANGHAI STOCK EXCHANGE

Asset allocation is a critical concern for any investor in the financial market. This paper aims to prioritize five randomly selected firms from the top ten stocks by market capitalization of the Shanghai Stock Exchange (SSE) by opting for adequate financial procedures and practical criteria under uncertain conditions. Decision makers want not only the ranking order of stocks but also capital proportions to be allocated. Therefore, this study uses a hybrid multi-criteria decision-making (MCDM) approach comprising of an integrated analytic network process (ANP) and decision making trial and evaluation laboratory (DEMATEL) in a grey environment for optimal portfolio selection to provide both ranking and weighting information for decision makers. Results indicate that return, financial ratios, dividends, and risk are causal criteria group, which are the most influential determinants for obtaining high benefits with regards to stock portfolio selection in SSE. The free float of stocks is the least influencing criterion among all identified criteria of stock portfolio selection of SSE. The Industrial and Commercial Bank of China Ltd. stocks have the highest allocated proportion with the highest priority shown by investors and can be described as a suitable alternative. The practical implications of this research are that the approach, when applied, highlights how the grey system theory minimizes the uncertainties in all stages of decision-making of portfolio selection.