Services Task Research Articles

Census Tract Rurality, Predominant Race and Ethnicity, and Distance to Lung Cancer Screening Facilities : An Ecological Study.

The U.S. Preventive Services Task Force recommends annual lung cancer screening (LCS) for adults who meet specific age and smoking history criteria. To evaluate race-, ethnicity-, and rurality-based differences in distance to the nearest LCS facility. Cross-sectional ecological study. U.S. census tracts. 71 691 census tracts. The outcome variable was road network distance in miles between a census tract and the nearest LCS facility. Distance was log-transformed, and geometric means are reported. Census tracts were classified as majority (>50%) American Indian/Alaska Native (AI/AN), Asian, Black, non-Hispanic White (NHW), no single race, or Hispanic. Rurality was defined using the rural-urban commuting area codes. Ordinary least-squares regression examined the associations between distance and census tract race, ethnicity, and rurality. Geometric mean distance to the nearest LCS facility was 6.5 miles. Compared with NHW-majority census tracts, distance to the nearest LCS facility was 5.26 times (426%) longer in AI/AN-majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts. Adjustment for rurality reduced the mean distance in AI/AN-majority census tracts, but the mean distance was still 3.16 times the distance in NHW-majority census tracts. Adjustment for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of associations in Hispanic-majority census tracts. Analyses did not account for travel time or cost. Differences exist in distance to LCS facilities by race and ethnicity that can only be partially explained by rurality. Lung Ambition Alliance and the Center for Lung Research in Honor of Wayne Gittinger.

Screening for Osteoporosis to Prevent Fractures.

This JAMA Patient Page describes osteoporosis and the US Preventive Services Task Force recommendations for screening for osteoporosis.

Screening for Osteoporosis to Prevent Fractures: A Systematic Evidence Review for the US Preventive Services Task Force.

Fragility fractures result in significant morbidity. To review evidence on osteoporosis screening to inform the US Preventive Services Task Force. PubMed, Embase, Cochrane Library, and trial registries through January 9, 2024; references, experts, and literature surveillance through July 31, 2024. Randomized clinical trials (RCTs) and systematic reviews of screening; pharmacotherapy studies for primary osteoporosis; predictive and diagnostic accuracy studies. Two reviewers assessed titles/abstracts, full-text articles, study quality, and extracted data; when at least 2 similar studies were available, meta-analyses were conducted. Hip, clinical vertebral, major osteoporotic, and total fractures; mortality; harms; accuracy. Three RCTs and 3 systematic reviews reported benefits of screening in older, higher-risk women. Two RCTs used 2-stage screening: Fracture Risk Assessment Tool estimate with bone mineral density (BMD) testing if risk threshold exceeded. One RCT used BMD plus additional tests. Screening was associated with reduced hip (pooled relative risk [RR], 0.83 [95% CI, 0.73-0.93]; 3 RCTs; 42 009 participants) and major osteoporotic fracture (pooled RR, 0.94 [95% CI, 0.88-0.99]; 3 RCTs; 42 009 participants) compared with usual care. Corresponding absolute risk differences were 5 to 6 fewer fractures per 1000 participants screened. The discriminative accuracy of risk assessment instruments to predict fracture or identify osteoporosis varied by instrument and fracture type; most had an area under the curve between 0.60 and 0.80 to predict major osteoporotic fracture, hip fracture, or both. Calibration outcomes were limited. Compared with placebo, bisphosphonates (pooled RR, 0.67 [95% CI, 0.45-1.00]; 6 RCTs; 12 055 participants) and denosumab (RR, 0.60 [95% CI, 0.37-0.97] from the largest RCT [7808 participants]) were associated with reduced hip fractures. Compared with placebo, no statistically significant associations were observed for adverse events. Screening in higher-risk women 65 years or older was associated with a small absolute risk reduction in hip and major fractures compared with usual care. No evidence evaluated screening with BMD alone or screening in men or younger women. Risk assessment instruments, BMD alone, or both have poor to modest discrimination for predicting fracture. Osteoporosis treatment with bisphosphonates or denosumab over several years was associated with fracture reductions and no meaningful increase in adverse events.

Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement.

Osteoporotic fractures are associated with psychological distress, subsequent fractures, loss of independence, reduced ability to perform activities of daily living, and death. The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the evidence on the benefits and harms of screening for osteoporosis to prevent fractures in adults 40 years or older with no known diagnosis of osteoporosis or history of fragility fracture. Adults 40 years or older without known osteoporosis or history of fragility fractures. The USPSTF concludes with moderate certainty that screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older has moderate net benefit. The USPSTF concludes with moderate certainty that screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years at increased risk has moderate net benefit. The USPSTF concludes that the evidence is insufficient and the balance of benefits and harms for screening for osteoporosis to prevent osteoporotic fractures in men cannot be determined. The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older. (B recommendation) The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. (I statement).

Evaluation of an AI-Based Voice Biomarker Tool to Detect Signals Consistent With Moderate to Severe Depression.

Mental health screening is recommended by the US Preventive Services Task Force for all patients in areas where treatment options are available. Still, it is estimated that only 4% of primary care patients are screened for depression. The goal of this study was to evaluate the efficacy of machine learning technology (Kintsugi Voice, v1, Kintsugi Mindful Wellness, Inc) to detect and analyze voice biomarkers consistent with moderate to severe depression, potentially allowing for greater compliance with this critical primary care public health need. We performed a cross-sectional study from February 1, 2021 to July 31, 2022 to examine ≥25 seconds of free-form speech content from English-speaking samples captured from 14,898 unique adults in the United States and Canada. Participants were recruited via social media, provided informed consent, and their voice biomarker results were compared with a self-reported Patient Health Questionnaire-9 (PHQ-9) at a cut-off score of 10 (moderate to severe depression). From as few as 25 seconds of free-form speech, machine learning technology was able to detect vocal characteristics consistent with an increased PHQ-9 ≥10, with a sensitivity of 71.3 (95% CI, 69.0-73.5) and a specificity of 73.5 (95% CI, 71.5-75.5). Machine learning has potential utility in helping clinicians screen patients for moderate to severe depression. Further research is needed to measure the effectiveness of machine learning vocal detection and analysis technology in clinical deployment.

Small Area Estimation of PSA Testing in US States and Counties.

In 2012, the US Preventive Services Task Force recommended against prostate cancer screening using the PSA test for all age groups. In 2018, the US Preventive Services Task Force's recommendation shifted from a "D" (not recommended) to a "C" (selectively offering PSA-based screening based on professional judgment and patient preferences) in men ages 55 to 69. Limited reliable county-level prostate cancer screening data are available for cancer surveillance purposes. Utilizing data from the National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS) collected in 2012 to 2019, state- and county-level small area models were developed for estimating PSA testing. Model diagnosis, internal validation, and external validation examining associations of PSA testing and prostate cancer incidence were conducted. Model-based estimates of PSA testing rates were produced for all US states and 3,142 counties for two data periods: 2012 to 2016 and 2018 to 2019. Geographic variations across counties were demonstrated through maps. Moderate positive correlations between PSA-based screening and prostate cancer incidence were observed, e.g., the state-level weighted Pearson's correlation coefficients were 0.5025 (P value = 0.0002) and 0.3691 (P value = 0.0077) for 2012 to 2016 and 2018 to 2019, respectively. These modeled estimates showed improved precision and adjusted for the differences between the BRFSS and NHIS. The approach of combining the NHIS and BRFSS utilized strengths of the larger sample size of the BRFSS and generally higher response rates and better household coverage from the NHIS. The resulting small area estimates offer a valuable resource for the cancer surveillance community, aiding in targeted interventions, decision making, and further research endeavors.

Lung Cancer Screening Uptake under the Revised United States Preventive Services Task Force Guideline: Assessing Disparities.

Scanning with low-dose computed tomography reduces lung cancer mortality by 20% among high-risk individuals. Despite its efficacy, the uptake of lung cancer screening (LCS) remains low. Our study aimed to estimate state-level and nationwide LCS rates among eligible individuals and to assess disparities in LCS uptake. Data for this study were obtained from the 2022 Behavioral Risk Factor Surveillance System. Multivariable logistic regression models were used to model the associations between predictors and outcome variables and to examine LCS variability across states. Of the 28,071 participants eligible for LCS, 17.24% underwent LCS. Participants ages 65 to 79 years were [OR, 1.75; 95% confidence interval (CI), 1.54-1.99] more likely to undergo LCS than their younger counterparts. Those who were female (OR, 0.83; 95% CI, 0.73-0.94); divorced, separated, or widowed (OR, 0.85; 95% CI, 0.74-0.98); without health insurance (OR, 0.34; 95% CI, 0.22-0.53); without a primary care provider (OR, 0.29; 95% CI, 0.19-0.44); and without chronic obstructive pulmonary disease or those who did not disclose their chronic obstructive pulmonary disease status (OR, 0.35; 95% CI, 0.31-0.40 and OR, 0.37; 95% CI, 0.19-0.73, respectively) were less likely to undergo LCS than their respective counterparts. LCS uptake also varied significantly across U.S. states. We observed a low uptake of LCS overall and significant variability in LCS uptake by sociodemographic and health-related factors, as well as by state of residence. The findings from this study have important implications for community health workers and healthcare clinicians and indicate the need to design effective interventions to increase LCS uptake, targeting specific subgroups of populations and particular U.S. states. See related In the Spotlight, p. 9.

Examining Lung Cancer Screening Uptake in the United States: Recent Research and Limitations of Public-Use Data.

Eligibility criteria for lung cancer screening (LCS) were updated by the Centers for Medicare & Medicaid Services in 2022 following an updated recommendation from the United States Preventive Services Task Force. Recently, research has examined LCS use in the United States following this change, which centered on lowering the age to begin screening from 55 to 50 years and the smoking history threshold from 30 to 20 pack-years. These studies, including the accompanying article from Gudina and colleagues, have used the 2022 Behavioral Risk Factors Surveillance System data, which are publicly available and nationally representative. Although increases in LCS use have been reported in all studies, screening remains low compared with other population-level cancer screening programs, highlighting the need for interventions to improve LCS uptake and adherence. Data limitations from population-based surveys may affect the ability to accuracy track LCS rates. Additional, high-quality data are needed to further assess the uptake of-and adherence to-LCS following the updated eligibility criteria. See related article by Gudina et al., p. 35.

Toward a Computable Phenotype for Determining Eligibility of Lung Cancer Screening Using Electronic Health Records

PURPOSE Lung cancer screening (LCS) has the potential to reduce mortality and detect lung cancer at its early stages, but the high false-positive rate associated with low-dose computed tomography (LDCT) for LCS acts as a barrier to its widespread adoption. This study aims to develop computable phenotype (CP) algorithms on the basis of electronic health records (EHRs) to identify individual's eligibility for LCS, thereby enhancing LCS utilization in real-world settings. MATERIALS AND METHODS The study cohort included 5,778 individuals who underwent LDCT for LCS from 2012 to 2022, as recorded in the University of Florida Health Integrated Data Repository. CP rules derived from LCS guidelines were used to identify potential candidates, incorporating both structured EHR and clinical notes analyzed via natural language processing. We then conducted manual reviews of 453 randomly selected charts to refine and validate these rules, assessing CP performance using metrics, for example, F1 score, specificity, and sensitivity. RESULTS We developed an optimal CP rule that integrates both structured and unstructured data, adhering to the US Preventive Services Task Force 2013 and 2020 guidelines. This rule focuses on age (55-80 years for 2013 and 50-80 years for 2020), smoking status (current, former, and others), and pack-years (≥30 for 2013 and ≥20 for 2020), achieving F1 scores of 0.75 and 0.84 for the respective guidelines. Including unstructured data improved the F1 score performance by up to 9.2% for 2013 and 12.9% for 2020, compared with using structured data alone. CONCLUSION Our findings underscore the critical need for improved documentation of smoking information in EHRs, demonstrate the value of artificial intelligence techniques in enhancing CP performance, and confirm the effectiveness of EHR-based CP in identifying LCS-eligible individuals. This supports its potential to aid clinical decision making and optimize patient care.

Prostate-specific antigen testing in the United States during 2008–2022 in relation to the US preventive services task force recommendations

The prevalence of prostate-specific antigen (PSA) testing has consistently fallen for several years. This study explored how the decreasing trend differs by selected variables and reasons for taking the PSA test. Analyses involved men, aged 40 years or older, who completed the Behavior Risk Factor Surveillance System (BRFSS) survey in even number years from 2008 through 2022. Trends in PSA testing rates within the past year declined by 46% from 2008 to 2020 and then increased 21% from 2020 to 2022. The greatest changes corresponded with the years of new USPSTF guidelines. Declining PSA testing rates occurred across the levels of all variables considered but were more pronounced in younger men and men never married, less educated, and without health care coverage. After adjusting for these variables, declining PSA testing rates did not significantly differ between racial/ethnic groups or between income groups. The level of several variables influenced the decline, as a function of perceived risk, accessibility, and desire for the test. Inconsistencies with the USPSTF’s guidelines were seen in higher PSA testing in older and more educated men. The distribution of main reasons for taking the test (part of a routine exam [72%], prostate problem/cancer [12%], family history [6%], and other [10%]) remained constant. PSA testing as part of a routine exam (vs. no PSA test) increased with age and was higher in non-Hispanic Blacks, married (or cohabitating), and in men with higher education, higher income, and health care coverage. PSA testing because of a prostate problem/cancer or family history of prostate cancer according to these variables are also described in this study.

Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Systematic Review for the U.S. Preventive Services Task Force [Internet

Background: A healthy diet is characterized by a balanced and varied selection of meals and drinks that aids a person in attaining and sustaining a healthy weight. Aim: To carefully assess the proof regarding the harm and benefits of behavior therapy for the 1ry avoidance of cardiovascular illness in adults lacking recognized cardiovascular risk factors to educate the United States Preventive Services Task Force. Materials and methods: This systematic review and meta-analysis encompassed nine research studies, submitting to the Cochrane Collaboration principles and conforming to the PRISMA declaration (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Main findings: Behavioral interventions enhanced levels of nutritional consumption and physical activity, with consistent benefits for healthful diets versus controls at 6+ months. Small, although significant variations have been detected in systolic blood pressure (−1.26 millimeters mercury [ninety-five percent confidence interval, −1.77 to −0.75]), total cholesterol (−2.85 milligrams per deciliter [ninety-five percent confidence interval, −4.95 to −0.75]), in addition to body mass index (−0.41 [ninety-five percent confidence interval, −0.62 to −0.19]) at the six- to twelve-month interval. Modest correlations with activity and dietary behaviors were observed, with no increased adverse events in intervention participants. Conclusion: Behavioral interventions significantly improve levels of dietary intake and physical activity, with healthy diets and programs showing significant benefits over 6+ months. Small improvements in blood pressure, cholesterol, and BMI were noted, with tailored approaches being particularly effective without increased adverse events

Socio-Economic Determinants of Cancer Screening Adherence Among Cancer Survivors: Analysis from 2020 Behavioral Risk Factor Surveillance System.

Factors associated with cancer survivors' preventive health behaviors are understudied. We hypothesized that socioeconomic and healthcare access factors may be associated with adherence to recommended cancer screenings. We conducted a cross-sectional analysis using the 2020 Behavioral Risk Factor Surveillance System. Cancer survivors eligible for United States Preventive Services Task Force-recommended breast, cervical, prostate, and colorectal screenings were included. Multivariable logistic regression models were used to identify socioeconomic factors significantly associated with screening adherence. Overall, 64,958 (Weighted National Estimate 29,066,143) cancer survivors were included. Adherence rates varied across cancer types: 80.9% for breast, 88.9% for cervical, 54.1% for prostate, and 84.7% for colorectal cancer. Key predictors of low adherence included lower income (breast: aOR 0.56; 95%CI 0.43 to 0.74, cervical: aOR 0.38; 95%CI 0.24 to 0.59, prostate: aOR 0.36; 95%CI 0.24 to 0.52, colorectal: aOR 0.74; 95%CI 0.57 to 0.96), lack of healthcare coverage for colorectal cancer (aOR 0.51; 95%CI 0.36 to 0.73), time since last checkup between one and two years prior for breast (aOR 0.58; 95%CI 0.45 to 0.75), prostate (aOR 0.66; 95%CI 0.47 to 0.91), and colorectal (aOR 0.69; 95%CI 0.56 to 0.86) cancer, and no healthcare provider for breast (aOR 0.68; 95%CI 0.47 to 0.98), prostate (aOR 0.45; 95%CI 0.31 to 0.65), and colorectal (aOR 0.51; 95%CI 0.40 to 0.66) cancer. Cancer survivors' adherence to screening is associated with factors including lack of healthcare coverage, lower income, time since the last exam, and having a personal provider. Targeted interventions accounting for such factors may help mitigate these disparities.

Using the GRADE‐ADOLOPMENT framework in developing the Philippine national screening guideline recommendations

AbstractBackgroundPreventive health screening is an important strategy in improving health outcomes of the general population and sustaining universal healthcare initiatives. Due to the large resource requirement, we used the GRADE ADOLOPMENT framework to synthesize the evidence and develop recommendations for preventive health screening.ObjectiveOur objectives were to describe the development and feasibility of a national preventive screening practice guideline using the GRADE‐adolopment process and to discuss the methodological process, contextual differences from the source guidelines, and the resulting changes to the final recommendations.MethodsA multidisciplinary team was convened. We used the GRADE‐ADOLOPMENT and Evidence‐to‐Decision (EtD) framework in synthesizing the evidence and developing the recommendations. Evidence from the World Health Organization, United States Preventive Services Task Force, and Canadian Task Force on Preventive Healthcare were used. Values and preferences of the guideline developers were incorporated through the EtD framework.ResultIn 6 months, we developed 16 evidence summaries and developed 23 recommendations for 16 prioritized conditions. Thirteen recommendations were adopted. Four recommendations were modified to address contextual differences. Six recommendations were developed de novo due to either lack of evidence or differences in values and preferences.ConclusionThe GRADE‐adolopment framework was a feasible and efficient framework in adopting guidelines on preventive screening. The EtD framework improved the transparency and highlighted areas to consider in making recommendations for the Philippine context. Challenges encountered were insufficiency of local evidence, and the lack of experience and skills in interpreting and analyzing the evidence especially on screening strategies.

Cervical Cancer Screening: Patient Perspectives on Transitioning to Primary High-Risk Human Papillomavirus Testing Alone.

In 2018, the US Preventive Services Task Force updated cervical cancer screening recommendations to allow for screening every 5 years with primary human papillomavirus (HPV) testing in combination with cytology (cotesting) or every 5 years with primary HPV screening alone. Despite these changes, the uptake of primary HPV screening has been lower than expected. The purpose of this study was to evaluate the patient perspective of an integrated health system transition from cotesting to primary HPV testing among a 30- to 65-year-old cohort. Semistructured phone interviews were conducted from July to December 2023 at Kaiser Permanente Colorado with 16 members aged 30-65 years. Interviews asked about reactions to the forthcoming change in cervical cancer screening, personal concern about cervical cancer risk, feedback on patient-facing education materials, and preference on communication timing and modality. Participants reported concerns about cervical cancer screening intervals, primarily the reduction in frequency leading to underdiagnosis of sexually transmitted infections (STIs). Participants recommended defining the rationale for the change to primary HPV testing in the patient education materials. Participants preferred communication about the change in-clinic between practitioner and patient. The interviews identified key themes, including the differentiation between cervical cancer and STI screening methodologies, potential underdiagnosis of STI and cervical cancer, and the rationale supporting primary HPV testing and associated screening intervals. These qualitative findings can inform health systems of potential patient concerns to address when considering the transition from cotesting every 3 years to primary HPV testing every 5 years for cervical cancer screening.

Rationale for osteoporosis screening in men.

The US Preventive Services Task Force (USPSTF) has found insufficient evidence for recommending for or against osteoporosis screening in men. Department of Veterans Affairs osteoporosis experts reviewed the literature on osteoporosis screening and treatment in men. Although not done systematically, the literature was reviewed by a panel of 20 Department of Veterans Affairs clinicians with extensive experience with osteoporosis in men. Virtual meetings and multiple email communications resulted in a consensus. Screening, particularly targeted screening in men, has been found to identify men at risk for fracture. Prior studies have shown osteoporosis drugs have similar effects in men and women. A recent large observational trial demonstrated that hip fracture risk is similarly reduced for both sexes by current medications. The consensus of the panel was that targeted screening of men for osteoporosis would lead to greater use of osteoporosis medication, lowering fracture risk.

The 2021 US Preventive Services Task Force lung cancer screening eligibility criteria disproportionately exclude younger Black patients with lung cancer.

The 2021 US Preventive Services Task Force (USPSTF) lung cancer screening guideline may continue to exclude many younger Black individuals who have not yet accumulated enough smoking pack-years to be eligible for screening. The objective of this study was to evaluate the proportions of Black and White patients with lung cancer, stratified by age at diagnosis, who would have been eligible for lung cancer screening. Incident lung cancer cases among Black and White individuals aged 50-80 years with a smoking history in the Southern Community Cohort Study (SCCS) were identified for analysis. The proportions of Black and White individuals, stratified by age at diagnosis, who would have qualified for screening under the 2013 and 2021 USPSTF guidelines were calculated. A total of 1856 individuals met inclusion criteria. Compared to the 2013 USPSTF guideline, the 2021 USPSTF guideline significantly increased the proportions of Black and White patients with lung cancer who would have qualified for screening in all age groups evaluated. However, under the 2021 USPSTF guideline, there remained a notable racial disparity in lung cancer screening eligibility, particularly among younger patients with lung cancer. Only 47.4% and 61.9% of Black patients aged 50-54 and 50-59 years, respectively, would have qualified for screening under the 2021 USPSTF guideline compared to 80.3% and 88.8% of White patients aged 50-54 and 50-59 years, respectively. With increasing age, the racial disparity in lung cancer screening eligibility between Black and White patients with lung cancer was reduced, and there were no longer any statistically significant differences in screening eligibility between Black and White patients with lung cancer aged 70-74 and 75-80 years. Of Black individuals aged 50-54 and 55-59 years who were ineligible for screening, 100% and 97.5% were ineligible because they had smoked fewer than 20 pack-years, respectively. This analysis of SCCS participants with lung cancer found that the 2021 USPSTF eligibility criteria disproportionately exclude many younger Black individuals with lung cancer, primarily because they have too few smoking pack-years.

How does anthropomorphism promote consumer responses to social chatbots: mind perception perspective

PurposeBenefiting from the development and innovation of artificial intelligence and affective computing technology, social chatbots that integrate cognitive analysis and affective social services have flooded into the consumer market. For cognition and emotion-oriented tasks, social chatbots do not always receive positive consumer responses. In addition, consumers have a contradictory attitude toward the anthropomorphism of chatbots. Therefore, from the perspective of mind perception and the two dimensions of social judgment, this research explores the mechanism of consumer responses to anthropomorphic interaction styles when social chatbots complete different service tasks.Design/methodology/approachThis paper utilizes three behavior experimental designs and survey methods to collect data and the ANOVA, t-test and bootstrap analysis methods to verify the assumed hypotheses.FindingsThe results indicate that when the service task type of a social chatbot is cognition-oriented, compared to a warm anthropomorphic interaction style, a competent anthropomorphic interaction style can improve consumer responses more effectively. During this process, agent-mind perception plays a mediating role. When the service task type of a social chatbot is emotion-oriented, compared with a competent anthropomorphic conversation style, a warm anthropomorphic conversation style can improve consumer responses. Experience-mind perception mediates this influencing relationship.Originality/valueThe research results theoretically enrich the relevant research on the anthropomorphism of social chatbots and expand the application of the theory of mind perception in the fields of artificial intelligence and interactive marketing. Our findings provide theoretical guidance for the anthropomorphic development and design of social chatbots and the practical management of service task scenarios.

Early Detection of Basal Cell Carcinoma of Skin From Medical History.

Basal cell carcinoma (BCC) is the most common form of skin cancer, originating from basal cells in the skin's outer layer. It frequently arises from prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds. Although BCC rarely metastasizes, it can cause significant local tissue damage if left untreated. Early detection is essential to prevent extensive damage and potential disfigurement. The United States Preventive Services Task Force (USPSTF) currently remains uncertain about the benefits and potential harms of routine skin cancer screenings in asymptomatic individuals. This paper evaluates the accuracy of predicting BCC using patients' medical histories to address this uncertainty and support early detection efforts. We analyzed the medical histories of 405,608 patients, including 7733 with BCC. We categorized 25,154 diagnoses into 16 body systems based on the hierarchy in the Systematized Nomenclature of Medicine (SNOMED) ontology. For each body system, we identified the most severe condition present. Logistic Least Absolute Shrinkage and Selection Operator (LASSO) regression was then employed to predict BCC, using demographic information, body systems, and pairwise and triple combinations of body systems, as well as missing value indicators. The dataset was split into 90% for training and 10% for validation. Model performance was evaluated using McFadden's R2, Percentage Deviance Explained (PDE), and cross-validated with the area under the receiver operating characteristic curve (AUC). Diagnoses related to the Integument system showed an 8-fold higher likelihood of being associated with BCC compared to diagnoses related to other systems. Older (age from 60 to 69) white individuals were more likely to receive a BCC diagnosis. After training the model, it achieved a McFadden's R2 of 0.286, an AUC of 0.912, and a PDE of 28.390%, reflecting a high level of explained variance and prediction accuracy. This study underscores the potential of LASSO Regression models to enhance early identification of BCC. Extant medical history of patients, available in electronic health records, can accurately predict the risk of BCC. Integrating such predictive models into clinical practice could significantly improve early detection and intervention.

Dicle University Hospital's hospital disaster plan and emergency service management: Kahramanmaraş earthquake experience.

Hospitals, being establishments with varying functions and capacities, must have disaster plans that reduce vulnerability, ensure the continuity, and possibly increase the capacity of healthcare services; these measures are crucial for reducing mortality and facilitating the normalization of life after a disaster. In this study, the aim was to analyze the operational process of the disaster management plan at Dicle University Faculty of Medicine Hospital following the earthquake in Kahramanmaraş on 6 February 2023. This is a retrospective observational study. The study focused on determining the role of the hospital's disaster plan in crisis situations, specifically examining the emergency service task distribution and management. The study included patients aged 1 to 85years (median 34, mean 36.9 ± 19.0), with 52.5% being female. The median injury severity score was 17 (mean 20.1 ± 19.2). Hospital admission was 65.7%, with nephrology and orthopedics being the most common departments. Higher injury severity scores were significantly associated with mortality (P < .05), and dialysis and surgery rates were significantly higher in deceased patients (P < .05). No significant differences were found in age, gender, or comorbidities between groups. The earthquake highlighted the importance of disaster preparedness in hospitals for effective patient care, collaboration among disciplines, and resource management. Detailed data on the hospital's disaster plan and its operational process during the earthquake were provided to underscore its critical role in managing the crisis. Lessons learned will shape future disaster response protocols, stressing continual evaluation and improvement in healthcare disaster readiness.

Building Professional Competence of Prison Staff: Psychological, Pedagogical, and Legal Aspects

Considering the war in Ukraine, the study of the main aspects of building the professional competence of the prison staff is a current priority task of the State Penitentiary Service of Ukraine. The objective of the study is to determine the components of professional competence of the prison staff in Ukraine. Methods. The Social Readjustment Rating Scale, the Bass Personality Orientation Test, and the Coping Strategy Indicator (CSI). Statistical analysis involves the use of descriptive statistics and correlation analysis. Results. Graduates of the penitentiary system have formed general and special professional competencies, including partial stress resistance, coping with problem solving, and motivational focus on the task. It has been proven that general professional competencies are directly related to professionally important qualities (р≤0.01). Conclusions. The results can be used by higher education institutions (HEIs) to adjust professional training programs for prison staff. Heads of penal institutions can consider the obtained results when selecting staff for positions. The results are useful for the professional self-development of specialists, as they indicate the qualities and competencies that they need to develop. Prospects. Further study may focus on determining how the professional competencies of the prison staff are built at different stages of their professional activities.