Subsequent Review Research Articles

What about validity? Thoughts on the state of research on written corrective feedback

Validity is the most important factor in good research, and it cannot be taken for granted. As the term is used here, validity is determined by (a) whether the research actually addresses the question that it is intended to address; and (b) whether the inferences drawn from it, by its authors and by subsequent reviewers, are legitimate. Validity thus depends on the goals of the research. While a variety of meaningful goals can be identified, the primary goal of WCF research is to determine if WCF is an effective way to improve learners’ ability to write accurately and should therefore be used in language instruction. Judging validity in terms of this goal, it is argued here that problems are pervasive. Goals are confused, a variety of fundamental issues in design and analysis make a study unable to address the primary question, and far too much emphasis is placed on one very narrow feature, commonly studied in ways which themselves lack validity. These problems are reflected in the meta-analyses done on this topic; as a result, this work is not presenting us with a valid picture of the effects of WCF. Altogether, this research area has major validity problems; dealing with these problems should be the top priority for researchers.

Challenges with phenotyping dementia in a low resource setting; Frontotemporal dementias (FTDs) as a case study in Nigeria

AbstractBackgroundPhenotyping dementia is a major problem in low resource settings like Nigeria and it has implication for research and management of people with dementia. Challenges associated with phenotyping dementia are embedded in poor health financing and lack of health personnel. This study aimed at scoping studies on dementia in Nigeria to identify those related to frontotemporal dementia (FTD) and describe the pattern of its presentation in a memory clinic as a means of highlighting challenges of phenotyping.MethodA literature search of studies on dementia that reported FTDs as a phenotype and or described profile or pattern of FTDs in Nigeria was conducted. In addition, a review of hospital records of all persons clinically diagnosed with dementia (PWD) using the ICD 10 criteria was conducted. Those with FTD phenotypes were identified. The cohort comes from a memory clinic in University College Hospital, Ibadan, Nigeria. Records of these individuals with FTDs were reviewed and data (including sociodemographic details, clinical profile and pattern of presentation) extracted for case series report.ResultsLiterature search yielded 2 studies; a retrospective study that reported dementia phenotypes including FTD and a case report. From a total of 216 PWD, we identified and included 14 persons with FTDs (6.5%) in this case series. Initially, 32 records of tentative diagnosis of FTD were identified, however, 18 persons with incomplete evaluation after the initial assessment were excluded. The mean age (±S.D) of those included (n = 14) is 67.7(±8.4). The main presenting complaints were behavioral with 57.1% presenting to the hospital at least a year after onset of symptoms. The most common behavioral problem identified was personality change accompanied with disinhibition in 9 persons (64.3%). Symptoms started before age 60 years in only one person. Two of the 14 persons had an initial diagnosis of schizophrenia until subsequent review with neuroimaging. Delay in carrying out neuroimaging due to financial constraint was a major challenge in making a diagnosis.ConclusionThere is paucity of data on FTDs in Nigeria. Out‐of‐pocket payment for assessment is a major setback in phenotyping dementia and it has implication on both clinical practice and research.

Moving on from a Diesel Mindset—Understanding Enablers and Challenges for Electrifying Road Freight Using Stakeholder Engagement

Achieving net zero by 2050 requires the decarbonisation of road transport. Electrification is recognised as a market-ready solution for certain transport segments, but it still poses a considerable challenge when applied to road freight. Any consensus on the technology choice for road freight electrification has still not been established. Embedding stakeholder input in the approach to address the technology adoption challenge has proven useful in uncovering various perspectives, which can provide useful insights into managing such transitions. This review paper hence took a three-step approach where the findings from the initial step of the literature search were taken up for the second step of stakeholder validation and feedback. The third step involved an analysis of the input gathered and the subsequent literature review to arrive at the conclusions. The outcome from the stakeholder engagement suggests that any specific technology can only support the transition to electrified road freight if enabled by system changes around policy, infrastructure, user behaviour, and the societal setup A follow-up literature review validated the need for a sociotechnical approach to such transitions where system changes are involved. The review also found gaps in the literature when it comes to embedding such sociotechnical approaches to technology adoption for road freight transport.

P111: Responses of deferment of appointments during Circuit Breaker (CB) amongst psychogeriatric elderly patients

Introduction:The coronavirus disease 2019 (COVID-19) outbreak was declared a public health emergency by the World Health Organization (WHO) on 30 January 2020. COVID-19 circuit breaker (CB) was implemented in our country from April 2020 to June 2020 to curb the outbreak. Healthcare Institutions were tasked to reduce ‘non-essential’ outpatient appointments. This research aimed to capture the responses of elderly patients and caregivers to the deferment of appointments. It also attempted to identify psychiatric symptoms which might be exacerbated during the pandemic.Methods:This retrospective review captured patients’ mental state and caregivers’ responses and preferences for subsequent reviews; reasons for their decisions; as well as mental state findings post CB.Results:Records of 323 patients with a mean age of 79.24 ± 8.02 were analyzed. 50% were diagnosed with dementia (18% severe, 38% moderate, 44% mild); 23% depression; 11% anxiety and 16% psychosis. 64% documented stable mental state before CB. There was no statistical difference in the diagnoses and stability of mental state or decisions to defer. 77% agreed to defer whereas 7% preferred to retain appointments. Those who brought forward appointments (1%) reported insomnia with increased mood and anxiety symptoms. Post-CB mental state showed 57% of patients remained stable; 15% had increased mood symptoms and 11% reported worsening cognition.Discussions:Patients with stable mental state before CB were more agreeable to defer appointments regardless of psychiatric diagnoses. Amongst those with dementia, caregivers reported distress with patients’ inability to comprehend need for safe-distancing measures and closure of day care programs. Some caregivers were concerned about increased food intake, lack of physical and social activity. 11% showed increase forgetfulness and 15% suffered increase in mood and anxiety symptoms post-CB.Conclusions:Despite the cohort’s advanced age, 57% remained stable during CB. The anticipation of challenges in abiding by the safe-distancing measures with supporting documents of patients with mental illness allowed us to improve our psychoeducation efforts of our community. Cognition, mood and anxiety symptoms were exacerbated as a result of the safe distancing and movement restrictions during the pandemic.

Myeloid/Lymphoid Neoplasms With Fibroblast Growth Factor Receptor 1 Rearrangement: A US Real-World Chart Review

Abstract Introduction/Objective Myeloid/lymphoid neoplasms (MLN) with fibroblast growth factor receptor 1 gene (FGFR1) rearrangement (MLNFGFR1) is a rare and aggressive hematologic malignancy characterized by molecular disruption of FGFR1 at the 8p11 locus. This real-world study describes demographic and clinical characteristics, diagnostic testing, and clinical outcomes in patients with MLNFGFR1 in the US. Methods/Case Report Probable MLNFGFR1 cases (n=51) were identified from a retrospective, physician-abstracted (5/29/2020-6/23/2020) chart review of patients within the US Cardinal Health Oncology Provider Extended Network (feasibility survey). In a subsequent full chart review (12/29/2020-3/4/2021), 33 of these probable MLNFGFR1 cases were considered to be confirmed based on additional 8p11/FGFR1 testing result data collected. Descriptive analyses of demographic/clinical characteristics, diagnostic testing, and clinical outcomes of patients with confirmed MLN FGFR1 were performed. Results (if a Case Study enter NA) The mean age at initial MLNFGFR1 diagnosis was 65.9 (SD 13.5) years, 60.6% patients were male, and 63.6% were white. Patients were managed by 12 physicians,10 in community practices. FGFR1 translocations were identified by karyotyping in 72.7% of patients. Rearrangements in FGFR1 were detected by fluorescence in situ hybridization, next generation sequencing, and/or real-time polymerase chain reaction in 66.7%, 21.2% and 6.1% of patients, respectively. FGFR1 rearrangement was detected in bone marrow aspirate and peripheral blood in 90.9% and 9.1% of patients, respectively. Fusion partners ZMYM2 and CPSF6 were reported in 46.2% and 15.4% of patients, respectively, and BCR, CUX1, RANBP2, TPR, and MYO18A were reported in 7.7% of patients each. Conclusion Although rare, patients with MLNFGFR1 do present in US community practice settings. Conventional cytogenetics can identify FGFR1 translocations which can be confirmed by FISH with FGFR1 break-apart probes. NGS can be used to identify cryptic rearrangements when clinical suspicion is high but no rearrangement is present on FISH. In addition to diagnosis, RT-PCR is also useful to assess molecular response.

Time to diagnosis in rapid exome/genome sequencing in the clinical inpatient setting.

Exome and genome sequencing are clinically available, with many laboratories offering expedited testing (e.g., "rapid" and "ultra-rapid"). With the increase in uptake of expedited testing, there is a need for the development of inpatient protocols for best practices based on real-life data. A retrospective 2-year review (October 2019-November 2021) of the utilization of rapid exome and genome sequencing for inpatient cases at a tertiary care center using a utilization management tracking database with subsequent chart review was performed. Thirty-three expedited "rapid/priority" exome/genome tests were performed clinically. The average total turnaround time (TAT) was 17.88 days (5-43 days) with an average TAT of 13.97 days (3-41 days) for the performing laboratory. There were 5 positive diagnostic results (15.2%), 3 likely positive diagnostic results (9%), 2 noncontributory results (6%), and 26 nondiagnostic results (69.7%). Real-life data suggest that there is an approximately 3.91-day lag in getting samples to the performing laboratory. Although laboratories may advertise their expected TAT, a number of factors can potentially impact the actual time from test order placement to communication of the results for clinical use. Understanding the points of delay will enable the development of internal protocols and policies to improve time to diagnosis.

Critical Care Ultrasound Competency of Fellows and Faculty in Pulmonary and Critical Care Medicine: A Nationwide Survey

Purpose: Competency assessment standards for Critical Care Ultrasonography (CCUS) for Graduate Medical Education (GME) trainees in pulmonary/critical care medicine (PCCM) fellowship programs are lacking. We sought to answer the following research questions: How are PCCM fellows and teaching faculty assessed for CCUS competency? Which CCUS teaching methods are perceived as most effective by program directors (PDs) and fellows. Methods: Cross-sectional, nationwide, electronic survey of PCCM PDs and fellows in accredited GME training programs. Results: PDs and fellows both reported the highest rates of fellow competence to use CCUS for invasive procedural guidance, but lower rates for assessment of deep vein thrombosis and abdominal organs. 54% and 90% of PDs reported never assessing fellows or teaching faculty for CCUS competency, respectively. PDs and fellows perceived hands-on workshops and directly supervised CCUS exams as more effective learning methods than unsupervised CCUS archival with subsequent review and self-directed learning. Conclusions: There is substantial variation in CCUS competency assessment among PCCM fellows and teaching faculty nationwide. The majority of training programs do not formally assess fellows or teaching faculty for CCUS competence. Guidelines are needed to formulate standardized competency assessment tools for PCCM fellowship programs.

Anaphylaxis in Clinical Trials of Sublingual Immunotherapy Tablets

There is no consensus method to identify anaphylaxis in sublingual immunotherapy (SLIT) trials. Standardized Medical Dictionary for Regulatory Activities (MedDRA) queries (SMQs) are standardized groupings of MedDRA terms used in drug safety monitoring. To develop a method to identify potential anaphylaxis in SLIT-tablet trials using SMQ searches and case definitions of anaphylaxis adopted from the National Institute of Allergy and Infectious Disease. The SMQ search tool contained 2 criteria including treatment-emergent adverse events (AEs): (1) narrow MedDRA terms related to anaphylaxis and (2) all AEs with broad MedDRA terms from at least 2 of 3 categories (respiratory/skin/cardiovascular) occurring on the same day. Criteria were applied to a pooled data set of all subjects from 48 timothy grass, ragweed, house dust mite, and tree SLIT-tablet trials (SLIT-tablet, N= 8200; placebo, N= 7033). Additional search strategies were any treatment-emergent AE with MedDRA preferred term "hypersensitivity" and epinephrine administrations. Identified potential cases underwent blinded independent medical expert review. Nonanaphylaxis cases were designated local AEs or mild to moderate systemic reactions. Using the SMQ search tool and after subsequent medical review, 8 anaphylaxis cases were identified; 3 were considered treatment-related, resulting in a proportion of anaphylaxis cases/subject of 0.02% (2 of 8200) with SLIT-tablet and 0.01% (1 of 7033) with placebo. One additional anaphylaxis case related to SLIT-tablet was identified by the preferred term "hypersensitivity." The 3 anaphylaxis cases associated with SLIT-tablet treatment were not life-threatening. The epinephrine administration rate was 17 of 8200 (0.2%) with SLIT-tablet treatment and 2 of 7033 (0.03%) with placebo. SMQ search criteria for identifying potential anaphylaxis related to SLIT were developed. Anaphylaxis was rare for SLIT-tablets.

A proactive care pathway that improves medical therapy for patients with heart failure with reduced ejection fraction and implantable cardiac devices

Abstract Background The UK model for follow-up of most patients with implantable cardiac devices is in a device clinic led by cardiac physiologists. This may be their only contact with cardiac services for several years. Many of these patients have heart failure with reduced ejection fraction (HFrEF) but do not have ongoing review in a heart failure clinic if they are clinically stable. ESC guidelines recommend four drug classes for all patients with HFrEF; implementing pathways that increase the prescription of these drugs is a priority as it improves quality of life, reduces hospitalisation and increases lifespan. A new clinical pathway was therefore created to achieve this in patients with cardiac devices at a tertiary cardiac centre in the UK, by combining device and heart failure follow-up in a single clinic. Purpose To evaluate the effectiveness of a new clinical pathway to improve the delivery of medical heart failure therapy to patients with cardiac devices and HFrEF. Methods Education on HFrEF diagnosis was delivered to the cardiac physiology team. This team then screened patients attending device follow-up clinics to identify those with HFrEF, through review of medical records and cardiac imaging. All patients with HFrEF identified by screening, who were not already under the active care of a heart failure team, were referred by the physiology team to a new combined heart failure device clinic. Results From Aug 2022 to Jan 2023, 107 patients were referred to the new heart failure device clinic. 102/107 (95%) patients attended. 72/102 (71%) had HFrEF, 19/102 (19%) had HFmrEF and 16/102 (16%) had HFpEF. Of the 72 patients with HFrEF, mean age was 70 years (range 29 – 90) and 79% were male. At baseline, 4/72 (6%) were in NYHA class I, 41/72 (57%) class II, 27/72 (38%) class III and 0/72 in class IV. At baseline, only 15/72 (21%) patients with HFrEF were prescribed all four drug classes. Following heart failure device clinic review, after an average of 1.9 appointments, 44/72 (61%) patients were prescribed these four drug classes (see Figure 1). Doses of drug classes prescribed at baseline were increased in 18/72 (25%) patients and 6/37 (16%) patients who were taking ACE-I or ARB at baseline were switched to ARNI. Iron status was assessed in 52 patients. 20/52 (38%) were iron deficient and managed with IV iron. Conclusions Many patients with HFrEF and cardiac devices are neither treated with the four key drug classes nor under active follow up by a heart failure team. Proactive screening of patients attending the device clinic by the cardiac physiology team identified patients with HFrEF who were not optimally treated. Subsequent review in a combined heart failure device clinic led to an increase from 21% to 61% of patients taking all four guideline-recommended drugs. Proactive multi-disciplinary working is an effective strategy to improve medical therapy and therefore prognosis for patients with HFrEF and cardiac devices.

Abstract 13069: Submitting ACC-NCDR CathPCI Data Are Not Enough

Introduction: The majority of facilities performing PCI in the US report data to the ACC-NCDR CathPCI Registry. The large number of records included in this dataset provide benchmark comparisons for facilities to consider however it is of concern that this may not result in the development of meaningful actions for improvement. The current analysis was undertaken to understand changes in Registry findings over time in facilities undergoing accreditation reviews. Methods: A component of site visits for accreditation, executive summaries or dashboards for each facility are reviewed and findings are categorized as being ≤ 50 th percentile or ≤ 10 th percentile when compared to the registry benchmark data at the time they are reported. Results: Twenty-one facilities underwent 32 reviews. (Figure 1). Although there is a trend in decreasing percentage of variables ≤ 50 th percentile with subsequent reviews, these differences were not statistically significant. No such trend was observed for variables ≤ 10 th percentile. In general, facilities deferred have higher rates of both findings, but these differences also are not statistically significant overall or at each review point.(Figure 2) Conclusions: Facilities undergoing accreditation reviews, irrespective of the accreditation decision have high rates of NCDR registry variables that are ≤50th and ≤10th percentile. These do not change significantly over time and suggest that insufficient attention is paid to these variables, corrective action is not identified or is not effectively implemented. Ongoing support is necessary to achieve these changes.

Scoping review of African health histories: a protocol

IntroductionThe history of African health is closely entwined with the history of the continent itself—from precolonial times to the present day. A study of African health histories is critical to...

Patient and nursing staff perspectives on automated scalp cooling (ASC) for chemotherapy-induced alopecia in breast cancer.

365 Background: Automated scalp cooling (ASC) is utilized in breast cancer patients to reduce chemotherapy-induced alopecia. Nursing staff and patient perspectives on ASC are limited regarding impact on care delivery and outcomes. Methods: A survey-based study of patient and chemotherapy nurse perspectives of ASC was conducted at three multi-regional Mayo Clinic sites. One-time surveys were sent to breast cancer patients and nurses for self-reporting of the ASC experience. Patients were identified via ICD-10 codes for breast cancer with subsequent chart review to confirm relevant chemotherapy regimen and ASC use. Chemotherapy nurses were identified by their respective chemotherapy unit nurse managers. Patient survey responses were compared between groups that did or did not use ASC by use of Pearson chi-square test for frequency data and the Kruskal-Wallis rank sum test for continuous measures. P values <0.05 were considered statistically significant. Results: Surveys were sent to 181 nurses with 61 (33.7%) completing them. Nurses reported ASC administration to 10-50 patients (n=43, 63.9%) or ≥50 patients (n=18, 29.5%). Most felt they had little or no technical support available (67.2%), witnessed scheduling difficulties (52.5%), were distressed by workload intensity (52.5%), and did not receive adequate training (67.2%). Most felt that ASC demanded greater nursing time compared to other duties (57.4%). Most would not recommend ASC to a friend or family member (88.6%). Surveys were sent to chemotherapy patients with 93 of 465 (20.0%) ASC patients and 56 of 341 (16.4%) without ASC (control) completing them. Controls were significantly more likely to experience hair loss, shave their head, and wear a wig (all p<0.001). There was no significant difference between groups for the EORTC QLQC30, EORTC BR23, and Body Image Scale results or frequency of headaches. Patients who used ASC for less than half of their chemotherapy sessions reported significantly more cold discomfort ( p=0.040) and dizziness ( p=0.003). Time investment (33.3%) and side effects (31.2%) were the most frequent burdens cited. Conclusions: Most nurses indicated that ASC increased nursing workload compared with other duties, and they lacked adequate training and technical support. Increasing formal nurse education and access to technical support documents and live technical support may be options for improving nursing satisfaction with ASC. Patient responses suggest qualitative effectiveness of ASC in reducing hair loss. While those with ASC were less likely to shave or use a wig, this did not translate to significant differences in quality of life or psychosocial body image compared to controls. Cold discomfort and dizziness were the most frequent side effects among those with lower utilization of ASC.

Working well: Mitigating the impact of menopause in the workplace - A narrative evidence review.

In recent years there has been a much greater recognition by some employers of the need to support female employees experiencing the menopause. However, despite an increased awareness of the need to reduce the impact of menopause on the workforce, employers rarely have the opportunity to implement evidence-based interventions. This evidence review aims to provide an insight into the effectiveness of workplace programmes supporting women experiencing menopause symptoms, and to identify knowledge gaps as drivers for future research. A search for papers published in English between 2012 and 2023 was carried out on the PsycINFO, Medline, and Embase databases. Abstract review was used to screen initial returns before a subsequent full-text review determined the final studies included. Twelve studies were selected for in-depth review: four conducted in the UK, seven in continental Europe and one in South America. The findings of the papers fell into five categories: work ability, improved symptom management, mental wellbeing and empowerment, increased openness about menopause in the workplace, and the impact of management/leadership. None of the included interventions were reported to give a significant improvement in measures of work ability. However, there were improvements in women's wellbeing, and their ability to manage symptoms. Interventions to improve workplace openness and managers' skills were well received by participants. The evidence for effective workplace interventions for women experiencing menopause symptoms is currently lacking. There is considerable need for further high-quality evaluations of interventions designed to support women in the workplace.

Clinician burnout (CBO) research trends from 2013-2022: Results from the State of Cancer Care in America (SOCCA) ASCO Annual Meeting abstract analysis.

41 Background: Interest in CBO and wellness has increased due to concern about the impact of workforce wellness on the quality of care. Oncology CBO accelerated during the COVID-19 pandemic and affected the entire health care system and workforce. We analyzed whether increased interest in CBO is reflected in research on the oncology workforce by reviewing abstracts submitted to the ASCO Annual Meeting between 2013-2022. Methods: We reviewed abstracts from the 2013-2022 ASCO Annual Meetings available from the ASCO Data Library. We limited our analysis to abstracts accepted to the Care Delivery and Regulatory Policy, Health Services Research, and the Professional Development & Education Advances tracks. Abstract titles and body text were searched for keywords related to CBO, and a manual review was conducted to ensure match validity. A Poisson regression was used to estimate the annual rate of change. Results: Of the 48,761 abstracts submitted to the ASCO Annual Meeting between 2013-2022, 4,843 abstracts were submitted to the tracks of interest. The keyword search and subsequent manual review identified 53 abstracts related to CBO (1.1% of relevant track submissions, and 0.1% of all abstract submissions). 4 (8%) abstracts flagged for CBO terms were submitted in the first 5 years of the time-period (2013-2017), while 49 (92%) abstracts were submitted in the last 5 years of the time-period (2018-2022). From 2013-2022 there was a 34.1% annual increase (95% confidence interval: 18.1%, 54.1%) in CBO related abstracts submitted to the tracks of interest. Of those submitted between 2021-2022, 30% (n=8) were related to the impact of COVID-19 on CBO. Between 2013-2022, 53% of all abstracts and 72% of health service track abstracts submitted to the ASCO Annual Meeting were submitted by US-based authors. Of the 53 CBO abstracts identified between 2013-2022, 72% (n=38) were written by US-based authors. Conclusions: CBO-related research submitted to the ASCO Annual Meeting increased between 2013-2022 with a predominant share originating from US-based researchers. This reflects the growing concern in the U.S. health care system around workforce wellness and the potential negative impact of CBO on the quality of patient care. Importantly, the factors contributing to CBO existed prior to the COVID-19 pandemic, including institutional and system-level burdens. The COVID-19 pandemic likely accelerated this existing trend as demonstrated by the increase in abstract submissions on CBO in recent years. [Table: see text]

Mejoramiento del suministro de agua rural en Paraguay en tiempos de COVID-19

Water supply and access has gained widespread attention especially with the ongoing coronavirus pandemic. Summations from the documents show that the pandemic has led to investors holding out on channeling funds into water systems in Paraguay, thus leaving people in rural areas being unable to gain basic protection against the virus. The challenges faced are explored in the subsequent systematic review. Results show that Paraguay has a more than functional water system, which can, however, be improved through collaboration between private and government entities. Recommendations drawn call on the involvement of all stakeholders in decision making to find an iron-clad solution to the issue.

Case report: a missed case of chronic Q fever infective endocarditis demonstrating the ongoing diagnostic challenges

Diagnosis of chronic Q fever is often difficult for clinicians, particularly in the presence of a second pathology. In addition to the chronic constitutional symptoms, the most common manifestations of chronic Q fever include infective endocarditis and endovascular infection. We describe a case of prosthetic valve infective endocarditis caused by both Streptococcus sanguinis and Coxiella burnetti on a background of a previous aortic graft and bioprosthetic aortic valve replacement 2 years earlier. The diagnosis of chronic Q fever infective endocarditis was delayed because the significance of the abnormal valve histology from the patient’s previous surgery was initially overlooked. It was only after the patient had relapsed on appropriate therapy for the S. sanguinis prosthetic valve endocarditis that a subsequent review of the operative valve histology, along with the patient’s epidemiological risk factors, led to consideration of an additional culture-negative cause for infective endocarditis. Histological examination of the valve tissue had shown exophytic fibrin vegetations and acute inflammation. Further clinical assessment revealed previous exposure to Q fever and C. burnetti DNA was detected via polymerase chain reaction on the valve tissue. Q fever infective endocarditis must be considered if valves are inflamed or have vegetations with a subsequent negative culture. It should also still be considered in the presence of an alternative bacteraemia if the patient has risk factors for exposure.

Detection of dental restorations using no-code artificial intelligence

ObjectivesThe purpose of this study was to utilize a no-code computer vision platform to develop, train, and evaluate a model specifically designed for segmenting dental restorations on panoramic radiographs. MethodsOne hundred anonymized panoramic radiographs were selected for this study. Accurate labeling of dental restorations was performed by calibrated dental faculty and students, with subsequent final review by an oral radiologist. The radiographs were automatically split within the platform into training (70 %), development (20 %), and testing (10 %) subgroups. The model was trained for 40 epochs using a medium model size. Data augmentation techniques available within the platform, namely horizontal and vertical flip, were utilized on the training set to improve the model's predictions. Post-training, the model was tested for independent predictions. The model's diagnostic validity was assessed through the calculation of sensitivity, specificity, accuracy, precision, F1-score by pixel and by tooth, and by ROC-AUC. ResultsA total of 1,108 restorations were labeled on 960 teeth. At a confidence threshold of 0.95, the model achieved 86.64 % sensitivity, 99.78 % specificity, 99.63 % accuracy, 82.4 % precision and an F1-score of 0.844 by pixel. The model achieved 98.34 % sensitivity, 98.13 % specificity, 98.21 % accuracy, 98.85 % precision and an F1-score of 0.98 by tooth. ROC curve showed high performance with an AUC of 0.978. ConclusionsThe no-code computer vision platform used in this study accurately detected dental restorations on panoramic radiographs. However, further research and validation are required to evaluate the performance of no-code platforms on larger and more diverse datasets, as well as for other detection and segmentation tasks. Clinical significanceThe advent of no-code computer vision holds significant promise in dentistry and dental research by eliminating the requirement for coding skills, democratizing access to artificial intelligence tools, and potentially revolutionizing dental diagnostics.

The relative significance of behavioural finance factors in the investment decisions of Australasian REITs

PurposeReferring to “behavioural finance” and “normative model” theories, this study explores the relative significance of behavioural heuristic biases in the investment decisions of real estate investment trusts (REITs) when compared with the conventional normative decision factors, with an ultimate aim to identify the significant behavioural factors that should be avoided to ensure rational asset acquisitions and market efficiency.Design/methodology/approachA triangulation approach was adopted. Qualitative multiple case studies were conducted, with four cases selected from Australian and New Zealand REITs across the industry, to identify what normative and behavioural finance factors are involved in investment decisions. This formed the basis for the subsequent expert review survey to explore how significant the behavioural factors were manifested in the judgement when compared with the normative factors.FindingsThree out of four theoretical behavioural factors manifested themselves in the investment decisions: investor sentiment, anchoring factors and overconfidence. The overall impact of these three behavioural factors was that they were as significant as normative factors in investment decisions. The heuristic availability of information was found to have no significant effect on experienced REIT fund managers.Research limitations/implicationsThe findings were based on four multiple cases and an expert review survey of six frontline fund managers, which form a baseline upon which further research can be conducted to widen the scope of research to cover all REITs in Australasia so that the results can become more robust to benefit the entire market in the region.Practical implicationsAs behavioural factors are significant in the decision-making process, REIT fund managers should raise awareness to avoid the significant behavioural factors identified, in particular investor sentiment, which was found to be the most significant one.Originality/valueThis study confirms the relative significance of behavioural factors in property investment decisions within the context of Australasian REITs and alerts fund managers to the ways they should follow to ensure rational investments and market efficiency. It also extends the scale of existing studies to cover not only Australia but also New Zealand for the benefit of the entire Australasian market.

Associations of Fish and Fish Oil Consumption With Incident Inflammatory Bowel Disease: A Population-Based Prospective Cohort Study.

We examined the associations of fish and fish oil consumption with inflammatory bowel disease (IBD) incidence. We conducted a longitudinal analysis based on the UK Biobank, a population-based prospective cohort. Dietary consumption of fish and fish oil was collected by questionnaire. IBD incident cases were identified through links to National Health Services datasets. Cox proportional hazards regression models were used to assess the associations between oily fish, nonoily fish, and fish oil intake and IBD incidence with adjustment for various confounding factors. A total of 265 839 participants free of IBD at baseline were included, and 1554 incident IBD cases were identified during an average follow-up of 11.8 years. In fully adjusted models, we found that compared with participants who never ate oily fish, those having <1 serving/wk, 1 serving/wk, and >1 serving/wk had 9% (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.77-1.08), 19% (HR, 0.81; 95% CI, 0.69-0.96), and 12% (HR, 0.88; 95% CI, 0.73-1.06) lower risks of IBD, respectively, albeit not all statistically significant. A significant association was found between fish oil intake and a reduced risk of IBD (HR, 0.84; 95% CI, 0.75-0.93). We found no significant associations for nonoily fish. In a subsample (n = 105 714) of participants with multiple subsequent dietary reviews, we also found a negative association between the frequency of fish oil intake over time and incident IBD (P trend < .05). Our findings indicate that oily fish and fish oil supplements might be protective factors against IBD.

Impacts of user-generated images in online reviews on customer engagement: A panel data analysis

Visual content has become an integral component of customers’ experience sharing, with customers increasingly searching for visual content in online reviews prior to making purchases. This study examines the effects of customer-generated images in online reviews on subsequent customer engagement using a multimethod design combining computer vision technique and panel data analysis. Based on online review data for 300 restaurants, findings revealed the following: 1) the ratio of pictorial reviews positively influenced subsequent review volume and average review length, whereas the effect on subsequent review valence was not significant; 2) review text–photo sentiment disparity had a complex impact on customer engagement (i.e., an inverse U-shaped relationship with subsequent review volume and a positive and negative linear relationship with subsequent average review length and review valence, respectively); and 3) business price level could mitigate the above effects. This study contributes to the literature on electronic word of mouth and customer engagement.