Medical Research Articles

Combined LT3 and LT4 therapy for precision medicine: easier with TTCombo system.

Hypothyroidism is typically treated with levothyroxine monotherapy. However, despite normalized serum thyroid-stimulating hormone levels, 5-10% of patients continue to experience persistent symptoms, raising concerns about the adequacy of thyroxine monotherapy. Combination therapy with levothyroxine and liothyronine has been proposed as an alternative, but it presents practical challenges, including dosing complexity, the short half-life of triiodothyronine, increased monitoring requirements, and potential adverse effects. Moreover, there is no clear consensus within the medical community regarding the superiority of combination therapy over levothyroxine monotherapy, although some studies indicate potential benefits in specific patient populations. Genetic factors, such as polymorphisms in the DIO2 gene, may influence individual responses to therapy, further complicating treatment. To address the limitations of combination therapy, we propose a novel approach: TTCombo. This digital health technology delivers personalized doses of levothyroxine and liothyronine, improving treatment adherence and optimizing outcomes. By providing individualized, physiologically tailored hormone replacement, TTCombo has the potential to revolutionize hypothyroidism management and enhance patient quality of life.

Participant-reported personal utility of genetic testing for Parkinson’s disease and interest in clinical trial participation

Genetic testing for Parkinson’s disease (PD) is infrequently performed due to perceptions of low utility. We investigated the personal utility in PD GENEration and how results lead to enrollment in additional research studies. Participants (n = 972) underwent genetic testing, results disclosure, genetic counseling, and completed a survey examining the perceived personal utility of their results and interest in participating in additional studies. Most participants found their genetic test results useful, including satisfying curiosity (81%), feeling good about helping the medical community (80%), and having information to share with family (77%). There were no significant differences in responses based on result type. Forty-five percent of participants expressed interest in participating in research studies; whereas 16% of participants confirmed enrollment. Our results suggest that participants find personal utility in genetic testing regardless of results. Although participants may be interested in enrolling in additional research, they may need support and resources.

Functional outcome of treatment of fracture intertrochanteric femur by using proximal femoral nail antirotation II

Background: The elderly are most frequently affected by intertrochanteric fractures, which have a major effect on the medical community and society at large. In 2003, AO introduced the proximal femoral nail anti-rotation device, which was further improved and named proximal femoral nail antirotation II (PFNA II) in 2009. Methods: This study was conducted from December 2020 to August 2022. The 60 cases of proximal femoral nail anti-rotation II-managed intertrochanteric femur fractures were assessed. Results: In the present study, 24 patients (40%) had type IV (Evan’s) fractures. Right hip was involved in 30 patients (50%). Meantime for clinic-radiological union was 20 weeks. There was complication rate of 2.08% as helical blade protrusion and non-union, 2.08% as helical blade protrusion, 2.08% as blade backout, 4.17% as superficial infection and 4.17% as lateral wall fracture. Seven patients expired postoperatively within 3 months while 5 patients lost during follow Up. After a 6-month follow-up, the Harris hip grade was used to evaluate 48 instances. Of these, 8 cases (16.67%) had an excellent score, 29 cases (60.42%) had a good score, 7 cases (14.58%) had a fair score, and 4 cases (8.33%) had a poor score. Thirty-seven of the 48 cases had reached the one-year follow-up mark. Thus, of the 37 patients assessed, 11 cases (29.73%) had excellent Harris hip grades, 19 cases (51.35%) had good scores, 4 cases (10.81%) had fair scores, and 3 cases (8.11%) had poor scores at the end of a one-year follow-up. Conclusions: Even in rural populations, PFN A-II is a better, safer implant with a low rate of complications for treating stable and unstable intertrochanteric femur fractures.

Identifying Barriers to Implementing Complementary and Integrative Health Therapies in Rhode Island Health Care Systems: A Qualitative Approach.

Introduction: Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers and facilitators to CIH implementation in Rhode Island (RI). Methods: A qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR) was used to conduct interviews with key stakeholder groups: health care administrators, health insurance administrators, physicians, and CIH practitioners. Interviews were analyzed by directed content analysis of transcripts with CFIR as the a priori coding framework. Results: Eleven subconstructs within four major domains were most prominent in interviews across all stakeholder groups. Key barriers in the "innovation" domain include a perceived lack of evidence and credibility of CIH therapies, logistical and administrative complexity of implementation, high costs to patients, and little financial incentive for hospitals and insurance companies. The "outer setting" domain highlights the utility of market pressure in decision making to implement CIH and the role of health policy. The "inner setting" domain demonstrates the varied personal beliefs about CIH, credentialing challenges, and the dissonance between medical system priorities and patient needs. Positive facilitation of implementation is marked by personal exposure to CIH and provider satisfaction in the "implementation process" domain. Conclusion: CIH therapies offer the medical system low risk and effective interventions that meet patient needs not currently met by Western medicine. However, implementation is difficult due to poor perception of evidence and lack of financial gain for the medical system. Acupuncture and massage may be modalities better situated for implementation in the RI medical system. Further education, awareness, and advocacy for CIH therapies would help meet patients' needs for CIH availability.

Construction and Application of a Private 5G Standalone Medical Network in a Smart Health Environment: Exploratory Practice From China.

To date, the differentiated requirements for network performance in various health care service scenarios-within, outside, and between hospitals-remain a key challenge that restricts the development and implementation of digital medical services. This study aims to construct and implement a private 5G (the 5th generation mobile communication technology) standalone (SA) medical network in a smart health environment to meet the diverse needs of various medical services. Based on an analysis of network differentiation requirements in medical applications, the system architecture and functional positioning of the proposed private 5G SA medical network are designed and implemented. The system architecture includes the development of exclusive and preferential channels for medical use, as well as an ordinary user channel. A 3-layer network function architecture is designed, encompassing resource, control, and intelligent operation layers to facilitate management arrangements and provide network open services. Core technologies, including edge cloud collaboration; service awareness; and slicing of access, bearer, and core networks, are employed in the construction and application of the 5G SA network. The construction of the private 5G SA medical network primarily involves system architecture, standards, and security measures. The system, featuring exclusive, preferential, and common channels, supports a variety of medical applications. Relevant standards are adhered to in order to ensure the interaction and sharing of medical service information. Security is achieved through mechanisms such as authentication, abnormal behavior analysis, and dynamic access control. Three typical medical applications that rely on the 5G network in intrahospital, interhospital, and out-of-hospital scenarios-namely, mobile ward rounds, remote first aid, and remote ultrasound-were conducted. Testing of the 5G-enabled mobile ward rounds showed an average download rate of 790 Mbps and an average upload rate of 91 Mbps. Compared with 4G, the 5G network more effectively meets the diverse requirements of various business applications in prehospital emergency scenarios. For remote ultrasound, the average downlink rate of the 5G network is 4.82 Mbps, and the average uplink rate is 2 Mbps, with an average fluctuation of approximately 8 ms. The bandwidth, performance, and delay of the 5G SA network were also examined and confirmed to be effective. The proposed 5G SA medical network demonstrates strong performance in typical medical applications. Its construction and application could lead to the development of new medical service models and provide valuable references for the further advancement and implementation of 5G networks in other industries, both in China and globally.

High quality factor, monodisperse micron-sized random lasers based on porous PLGA spheres

Miniature random lasers with high quality factor are crucial for applications in barcoding, bioimaging, and on-chip technologies. However, achieving monodisperse and size-tunable biocompatible random lasers has been a significant challenge. In this study, we employed poly(lactic-co-glycolic) acid (PLGA), a biocompatible material approved for medical use, as the base material for random lasers. By integrating a dye-doped PLGA solution with a microfluidic system, we successfully fabricated monodisperse and miniature dye-doped PLGA spheres with tunable sizes ranging from 25 to 52 µm. Upon optical pulse excitation, these spheres exhibited strong random lasing emission at 610–640 nm with a threshold of approximately 22 µJ·mm−2. The lasing modes demonstrated a spectral linewidth of 0.2 nm, corresponding to a quality factor of 3100. Fourier transform analysis of the lasing emission revealed fundamental cavity lengths, providing insights into the properties of the random lasers.

Multi-layered factors contribute to irrational use of antibiotics among pediatric patients in Tanzania: ADDO dispensers perspective

BackgroundAntimicrobial resistance (AMR) is a major public health problem affecting both current and future generations. Development of resistance to the commonly available antibiotics has been directly linked to their irrational use. The World Health Organization (WHO) has clearly stated on the Global Strategy on AMR, judicious antibiotic use as well as adequate knowledge and awareness about AMR, as important tools in curbing the existing problem. Therefore, this study aimed to explore the level of knowledge among accredited drug dispensing outlet (ADDO) dispensers on factors contributing to irrational use of antibiotics among Tanzanian pediatric patients.MethodsA qualitative study employing focused group discussions was conducted among 6–10 ADDO dispensers with at least 6 months dispensing experience in 14 regions between July and August 2020. Thematic analysis was used to analyze the data.ResultsFindings from this study indicate that the ADDO dispensers have adequate knowledge on antimicrobial resistance. Participants were aware of the general meaning and the use of antimicrobials. They were aware that antimicrobials are used for treating infections caused by microbes such as bacteria, fungi, and viruses. Participants knew AMR increases health related costs and that the increasing burden of AMR is not an outcome of a specific group of people such as health care providers or patients, rather a contribution of many factors that bring change in microorganism behavior. Despite this knowledge, participants felt that most of the private health care facilities are profit-oriented; they practice polypharmacy to maximize profit rather than focusing on providing quality health services. Participants revealed that dose shortage after symptomatic relief strongly contributes to AMR. Lastly, the ADDO dispensers expressed that continuous medical education and community education to patients is necessary in the efforts to fight against AMR.ConclusionsTo mitigate the increasing AMR burden in our society, integrated interventions must include both communities, ADDOs as first point of contact and other healthcare providers. Periodic refresher training with an emphasis on proper practices is crucial to help the dispensers transform their knowledge into action. Responsible authorities should ensure that ADDOs and other private health care facilities adhere to regulations.

Enhancing Equity in Clinical Research: A Multifaceted Proposal for Spondyloarthritis.

Clinical research advances medical knowledge and improves healthcare outcomes. However, disparities in research participation hinder progress. The Unmet Research Needs in Spondyloarthritis Conference IV highlighted critical insights and strategies to enhance equity in clinical research. Talks focused on engaging underrepresented communities and addressing disparities in rheumatic diseases, particularly spondyloarthritis (SpA), to ensure research results are generalizable and inclusive. Disparities in SpA management, such as greater back pain severity among Black and Hispanic Americans and sex-based differences in pain management, emphasize the need for equitable research. Dr. Elizabeth Ferucci discussed the racial disparities in rheumatologic care, highlighting the importance of early access to rheumatologists and culturally informed primary care to improve outcomes. Dr. Hani El-Gabalawy's talk on engaging Indigenous communities stressed the importance of community consent and reciprocal benefits. Dr. Sarfaraz Hasni's presentation on mitigating disparities in research participation underscored the need for inclusive practices and strategies to promote diverse representation. Finally, Dr. Edith Williams emphasized institutional approaches to fostering equity, including diverse recruitment practices and institutional review board alignment with diversity priorities. Strategies to enhance equity in clinical research include community engagement, addressing logistical barriers to participation, and ensuring diverse research teams. These approaches can dismantle barriers for underrepresented communities, making research more accessible and reflective of the broader population. The SpA research community must commit to creating structures that foster inclusivity, ensuring medical advancements benefit all populations, especially historically underrepresented groups. The principles and strategies proposed serve as a roadmap for achieving equity in SpA research.

Accurate prediction of drug-target interactions in Chinese and western medicine by the CWI-DTI model

Accurate prediction of drug-target interactions (DTIs) is crucial for advancing drug discovery and repurposing. Computational methods have significantly improved the efficiency of experimental predictions for drug-target interactions in Western medicine. However, accurately predicting the complex relationships between Chinese medicine ingredients and targets remains a formidable challenge due to the vast number and high heterogeneity of these ingredients. In this study, we introduce the CWI-DTI method, which achieves high-accuracy prediction of DTIs using a large dataset of interactive relationships of drug ingredients or candidate targets. Moreover, we present a novel dataset to evaluate the prediction accuracy of both Chinese and Western medicine. Through meticulous collection and preprocessing of data on ingredients and targets, we employ an innovative autoencoder framework to fuse multiple drug (target) topological similarity matrices. Additionally, we employ denoising blocks, sparse blocks, and stacked blocks to extract crucial features from the similarity matrix, reducing noise and enhancing accuracy across diverse datasets. Our results indicate that the CWI-DTI model shows improved performance compared to several existing state-of-the-art methods on the datasets tested in both Western and Chinese medicine databases. The findings of this study hold immense promise for advancing DTI prediction in Chinese and Western medicine, thus fostering more efficient drug discovery and repurposing endeavors. Our model is available at https://github.com/WANG-BIN-LAB/CWIDTI.

Overcoming Challenges in Interdisciplinary Collaboration Between Human and Veterinary Medicine

Companion animals, such as dogs and cats, have gained considerable attention in translational medicine due to their potential as models for human diseases. The use of these animals in research has opened new avenues for developing treatments that can benefit both human and veterinary patients, aligning with the One Health approach. Unlike traditional laboratory models like mice, rats, and rabbits, companion animals naturally develop diseases that closely mirror those in humans, including but not limited to diabetes, aging, cancer, and neurological disorders, making them particularly valuable in translational research. Recent advances have highlighted the role of companion animals in enhancing the effectiveness of novel therapies during clinical trials, as they are exposed to diverse environmental and lifestyle factors similar to those experienced by humans. However, the integration of companion animals into translational medicine presents challenges, particularly in terms of collaboration between veterinary and human medicine, where terminology differences in anatomy, clinical terminology, and animal classification can lead to miscommunication. In conclusion, these findings underscore the need for better implementation of the One Health approach by uniting the fragmented collaboration between veterinarians and doctors through interdisciplinary training and fostering unified efforts across both fields, with experts from various disciplines contributing their specialized knowledge in clinical practice and research.

Preserving Stem Cells for Potential Use in Future Reparative Medicine

With its enormous potential for regenerative medicine and therapeutic applications, stem cell preservation represents a major breakthrough in biomedical science. Stem cells are gathered, processed, and stored under carefully monitored circumstances in order to preserve their viability for potential use in the future. Because they may differentiate into a variety of cell types, stem cells—especially those derived from sources like umbilical cord blood—are essential for both therapeutic and research uses. An essential function of cord blood banking is to offer a plentiful supply of immune system cells that may be stored for potential future therapeutic applications. Immunological deficits, osteoarthritis, Parkinson's disease, and heart failure are just a few of the conditions for which stem cell treatments have shown promise. Notwithstanding the promise, there remain obstacles such immunological rejection and the need for more research to fully comprehend the development and functionality of stem cells. It is essential for the general public to be informed about stem cell treatments and cord blood banking in order for expectant parents to make well-informed decisions. Future advancements in the subject depend heavily on resolving ethical issues and enhancing the effectiveness of stem cell-based therapies. To fully realise the promise of stem cell preservation in conventional medicine, more research, creativity, and international cooperation are required.

Cold Consolidation of Pharmaceutical Waste Glass Powders Through Alkali Activation and Binder Jet 3D Printing

The recent COVID-19 emergency has led to an impressive increase in the production of pharmaceutical vials. This has led to a parallel increase in the amounts of waste glass; manufacturers typically recover material from faulty containers by crushing, giving origin to an unrecyclable fraction. Coarse fragments are effectively reused as feedstock for glass melting; on the contrary, fine powders (<100 microns), contaminated by metal and ceramic particles due to the same crushing operations, are landfilled. Landfilling is also suggested for pharmaceutical containers after medical use. This study aims at proposing new opportunities for the recycling of fine glass particles, according to recent findings concerning alkali activation of pharmaceutical glass, combined with novel processing, i.e., binder jetting printing. It has already been shown that pharmaceutical glass, immersed in low-molarity alkaline solution (not exceeding 2.5 M NaOH), undergoes surface dissolution and hydration; cold consolidation is later achieved, upon drying at 40–60 °C, by a condensation reaction occurring at hydrated layers of adjacent particles. Binder jetting printing does not realize a full liquid immersion of the glass powders, as the attacking solution is selectively sprayed on a powder bed. Here, we discuss the tuning of key parameters, such as the molarity of the attacking solution (from 2.5 to 10 M) and the granulometry of the waste glass, to obtain stable printed blocks. In particular, the stability depends on the formation of bridges between adjacent particles consisting of strong T-O bonds (Si-O-Si, Al-O-Si, B-O-Si), while degradation products (concentrating Na ions) remain as a secondary phase, solubilized by immersion in boiling water. Such stability is achieved by operating at 5 M NaOH.

Development and validation of knowledge, attitude, and practice scale regarding antibiotic use for Chinese medical students.

This study aimed to develop and validate a knowledge, attitude, and practice scale of antibiotic use for Chinese medical students. A five-phased procedure was adopted: (a) A item pool was constructed after literature review; (b) Delphi method was used to refine the items; (c) A pilot study was conducted to clarify the item; (d) Item analysis and exploratory factor analysis were used to finalize the scale; (e) Content validity, construct validity and reliability of the scale were analysed. The scale of 32 items, respectively 15, 9, and 8 for knowledge, attitude, and practice, was finalized. The item-level content validity ranged from 0.80 to 1.00. The scale-level content validity of the scale was 0.90. Model fit indices of total scale and the three dimensions met the criteria. Cronbach's α and the split-half coefficient were respectively 0.81 and 0.65 for the total scale. For each dimension, Cronbach's α varied from 0.68 to 0.89 and the split-half coefficient varied from 0.64 to 0.83. The scale can be used as a whole or separately, serving as an effective tool to measure medical students' knowledge, attitude, or practice regarding antibiotic use.

Black Women in Medical Education Publishing: Bibliometric and Testimonio Accounts Using Intersectionality Methodology.

Black women in academic medicine experience racial and gender discrimination, all while being tasked with improving a flawed system. Representation of Black women in medicine remains low, yet they bear the burden of fostering diversity and mentoring trainees, exacerbating their minority tax and emotional labor, and negatively impacting career progression. To complement qualitative accounts of Black women authors in the medical education literature with a quantitative account of their representation. We used statistical modeling to estimate the representation of Black women authors in medical education publishing as compared to other groups. An intersectional methodology employing bibliometric analysis and testimonio reflection. US-based authors of journal articles published in medical education journals between 2000 and 2020. Author race was determined using a probability-based algorithm incorporating US Census data, and author gender was ascribed using Social Security Administration records. We conducted two negative binomial generalized linear models by first and last author publications. Metadata for each article was retrieved from Web of Science and PubMed to include author names, country of institutional affiliation, and Medical Subject Headings (MeSH). Results were contextualized via the "testimonio" account of a Black woman author. Of 21,945 unique authors, Black women (and other racially minoritized groups) published far fewer first and last author papers than white women and men. In addition, major MeSH terms used by Black women authors reveal little overlap with highly ranked medical education topics. The testimonio further narrated struggles with belonging and racial identity. This study revealed that Black women are underrepresented in medical education publishing. We believe that dismantling oppressive structures in the publishing ecosystem and the field is imperative for achieving equity. Additionally, further experiential accounts are needed to contextualize this quantitative account and understand underrepresentation in medical education publishing.

Medical large language models are susceptible to targeted misinformation attacks

Large language models (LLMs) have broad medical knowledge and can reason about medical information across many domains, holding promising potential for diverse medical applications in the near future. In this study, we demonstrate a concerning vulnerability of LLMs in medicine. Through targeted manipulation of just 1.1% of the weights of the LLM, we can deliberately inject incorrect biomedical facts. The erroneous information is then propagated in the model’s output while maintaining performance on other biomedical tasks. We validate our findings in a set of 1025 incorrect biomedical facts. This peculiar susceptibility raises serious security and trustworthiness concerns for the application of LLMs in healthcare settings. It accentuates the need for robust protective measures, thorough verification mechanisms, and stringent management of access to these models, ensuring their reliable and safe use in medical practice.

Knowledge-injected Prompt Learning for Chinese Biomedical Entity Normalization

The Biomedical Entity Normalization (BEN) task aims to align raw, unstructured medical entities to standard entities, thus promoting data coherence and facilitating better downstream medical applications. Recently, prompt learning methods have shown promising results in the natural language processing field. However, existing research falls short in tackling the more complex Chinese BEN task, especially in the few-shot scenario with limited medical data, and the vast potential of the external medical knowledge base has not yet been fully exploited. To address these challenges, this article proposes a novel Knowledge-injected Prompt Learning (PL-Knowledge) method. Specifically, the approach consists of five stages: candidate entity matching, knowledge extraction, knowledge encoding, knowledge injection, and prediction output. By effectively encoding the knowledge items contained in medical entities and incorporating them into tailor-made knowledge-injected templates, the additional knowledge enhances the model’s ability to capture latent relationships between medical entities, thus achieving a better match with the standard entities. Comprehensive experiments are conducted on a benchmark dataset in both few-shot and full-scale settings. This method outperforms existing baselines, with an average accuracy improvement of 12.96 percentage points in few-shot and 0.94 percentage points in full-data cases, showcasing its excellence in the BEN task.

Psychologists' Opportunities for Fostering Leadership Skills in Academic Medicine: The Rothenberger Leadership Academy.

Healthcare leaders must increasingly attend to the monumental challenges facing their organizations (Angood and Falcone, American Association for Physician Leadership, 2023). As such, leadership in healthcare settings demands new skills sets amongst healthcare professionals that transcend the technical skills of any given profession. Academic health center psychologists are well-positioned to contribute to the leadership of academic health centers due to knowledge, skills, and attitudes fostered in doctoral psychology education, practice, and research through the focus on Profession-Wide Competencies. This article calls for psychologists to pursue more leadership opportunities within academic health centers.The article starts by identifying parallels between psychology's Profession-Wide Competencies and needed leadership skills/concepts for healthcare leaders. An example of an academic health center psychologist's leadership in a cohort-based physician leadership program illustrates how Profession-Wide Competencies were used in three structural elements of the leadership program. The article identifies particular leadership opportunities for psychologists within academic health centers.

Low PD-L1 expression, MAP2K2 alterations, and enriched HPV gene signatures characterize brain metastases in head and neck squamous cell carcinoma

BackgroundBrain metastasis (BM) is a rare but severe complication of head and neck squamous cell carcinoma (HNSCC), with limited knowledge of molecular characteristics and immunogenicity.MethodsWe analyzed 61 cases of HNSCC-BM from three academic institutions (n = 24) and Foundation Medicine Inc (FMI, n = 37). A subset of cases underwent next-generation sequencing, multiple immunofluorescence, and proximity ligation sequencing. Gene enrichment analysis compared alterations in FMI BM samples (n = 37) with local samples (n = 4082).ResultsDemographics included: median age of 59 years, 75% male, 55% current/former smokers, 75% oropharyngeal primary, and 67% human papillomavirus (HPV) +. ATM (54%), KMT2A (54%), PTEN (46%), RB1 (46%), and TP53 (46%) were frequently altered in BM samples from academic centers (62% HPV/p16+). Structural rearrangements ranged from 9 to 90 variants by proximity ligation sequencing. BMs had low densities of CD8+, PD-1+, PD-L1+, and FOXP3 + cells, and 92% had PD-L1 combined positive scores < 1%. CDKN2A (40.5%), TP53 (37.8%), and PIK3CA (27.0%) alterations were common in the FMI BMs (51% HPV+). MAP2K2 alterations and HPV + signature were enriched in FMI BMs compared to local tumors (11.8% vs. 6.4%, P = 0.005 and 51.25% vs. 26.11%, P = 0.001 respectively), and pathogenic TSC1 inactivating mutations were enriched in local tumors (67.3% vs. 37.8%, P = 0.008). Median overall survival from BM diagnosis was 9 months (range 0–27).ConclusionsHNSCC patients with BM frequently have oropharyngeal primary sites and are HPV+. Common molecular alterations in BM samples, including targetable PIK3CA and ATM, were identified. MAP2K2 alterations were enriched and densities of immune cells were low, highlighting potential targets for further research and immunotherapy considerations.

Efficient labeling of french mammogram reports with MammoBERT

Recent advances in deep learning and natural language processing (NLP) have broadened opportunities for automatic text processing in the medical field. However, the development of models for low-resource languages like French is challenged by limited datasets, often due to legal restrictions. Large-scale training of medical imaging models often requires extracting labels from radiology text reports. Current methods for report labeling primarily rely on sophisticated feature engineering based on medical domain knowledge or manual annotations by radiologists. These methods can be labor-intensive. In this work, we introduce a BERT-based approach for the efficient labeling of French mammogram image reports. Our method leverages both the expansive scale of existing rule-based systems and the precision of radiologist annotations. Our experimental results showcase the superiority of the proposed approach. It was initially fine-tuned on a limited dataset of radiologist annotations. Then, it underwent training on annotations generated by a rule-based labeler. Our findings reveal that our final model, MammoBERT, significantly outperforms the rule-based labeler while simultaneously reducing the necessity for radiologist annotations during training. This research not only advances the state of the art in medical image report labeling but also offers an efficient and effective solution for large-scale medical imaging model development.

Medical imaging utilization in migrants compared with nonmigrants in a universal healthcare system: A population-based matched cohort study.

Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown. A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary. Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system.