Basic Research Research Articles

CMCN: Chinese medical concept normalization using continual learning and knowledge-enhanced

Medical Concept Normalization (MCN) is a crucial process for deep information extraction and natural language processing tasks, which plays a vital role in biomedical research. Although MCN in English has achieved significant research achievements, Chinese medical concept normalization (CMCN) remains insufficiently explored due to its complex syntactic structure and the paucity of Chinese medical semantic and ontology resources. In recent years, deep learning has been extensively applied across numerous natural language processing tasks, owing to its robust learning capabilities, adaptability, and transferability. It has proven to be well suited for intricate and specialized knowledge discovery research in the biomedical field. In this study, we conduct research on CMCN through the lens of deep learning. Specifically, our research introduces a model that leverages polymorphic semantic information and knowledge enhanced through multi-task learning and retain more important medical features through continual learning. As the cornerstone of CMCN, disease names are the main focus of this research. We evaluated various methodologies on Chinese disease dataset built by ourselves, finally achieving 76.12 % on Accuracy@1, 87.20 % on Accuracy@5 and 90.02 % on Accuracy@10 with our best-performing model GCBM-BSCL. This research not only advances the fields of knowledge mining and medical concept normalization but also enhances the integration and application of artificial intelligence in the medical and health field. We have published the source code and results on https://github.com/BearLiX/CMCN.

Delphi studies in social and health sciences-Recommendations for an interdisciplinary standardized reporting (DELPHISTAR). Results of a Delphi study.

While different proposals exist for a guideline on reporting Delphi studies, none of them has yet established itself in the health and social sciences and across the range of Delphi variants. This seems critical because empirical studies demonstrate a diversity of modifications in the conduction of Delphi studies and sometimes even errors in the reporting. The aim of the present study is to close this gap and formulate a general reporting guideline. In an international Delphi procedure, Delphi experts were surveyed online in three rounds to find consensus on a reporting guideline for Delphi studies in the health and social sciences. The respondents were selected via publications of Delphi studies. The preliminary reporting guideline, containing 65 items on five topics and presented for evaluation, had been developed based on a systematic review of the practice of Delphi studies and a systematic review of existing reporting guidelines for Delphi studies. Starting in the second Delphi round, the experts received feedback in the form of mean values, measures of dispersion, a summary of the open-ended responses and their own response in the previous round. The final draft of the reporting guideline contains the items on which at least 75% of the respondents agreed by assigning scale points 6 and 7 on a 7-point Likert scale. 1,072 experts were invited to participate. A total of 91 experts completed the first Delphi round, 69 experts the second round, and 56 experts the third round. Of the 65 items in the first draft of the reporting guideline, consensus was ultimately reached for 38 items addressing the five topics: Title and Abstract (n = 3), Context (n = 7), Method (n = 20), Results (n = 4) and Discussion (n = 4). Items focusing on theoretical research and on dissemination were either rejected or remained subjects of dissent. We assume a high level of acceptance and interdisciplinary suitability regarding the reporting guideline presented here and referred to as the "Delphi studies in social and health sciences-recommendations for an interdisciplinary standardized reporting" (DELPHISTAR). Use of this reporting guideline can substantially improve the ability to compare and evaluate Delphi studies.

Policy brief – cancer research in Belgium

Research is central to achieving Europe’s Beating Cancer Plan, and is the key focus of the European Commission’s Mission on Cancer. To successfully tackle the challenges we face in cancer research, a coordinated effort of the entire Belgian scientific community is needed. It is for this reason the Belgian Cancer Research Alliance was proposed. The aim of BeCRA is to bring together various Belgian research institutes and associated care institutions and position them optimally at the EU level, with respect to the many research initiatives launched in the EBCP within the EU4Health program, the Mission on Cancer, Digital Europe programs and other EU projects. Members of BeCRA collaboratively plan the participation in certain cancer research activities to ensure optimal use of investment and sustained excellence of Belgian cancer research. Belgium cancer research has an excellent track record in fundamental, translational research and phase I, II, III clinical trials. However, translating outcomes from research to patients in the Belgian healthcare system has been less successful. Gaps in the collaboration between actors in the research field, have led to fragmentation hampering the development of fundamental and translational research. Moreover, actors from multi-disciplinary background, such as behavioural or psycho-social fields, are not systematically included in cancer research. More efficient coordination between the aforementioned actors is necessary. Academic hospitals and universities should be incentivized to collaborate across regions, as well as to put sufficient focus on research activities with a virtuous spiral ("bed-to bench" and "bench to bed" process), while supporting researchers focusing on patient-driven research. There is an urgent need for Belgium to determine how best to ensure it remains an attractive market so that patients have access to innovative care. This could include streamlining regulatory complexity, while establishing lean and harmonized clinical trial designs, procedures and networks.

The chain mediating role of negative emotions at work and meaning in life between interpersonal conflict at work and depressive symptoms among nurses: a multicenter cross-sectional study

BackgroundDepressive symptoms among nurses have been a significant public health concern. Although many studies have demonstrated the potential relationship between interpersonal conflict at work and depressive symptoms, the mechanisms underlying this relationship among nurses remain unclear. Based on the theoretical and empirical research, this study aimed to investigate the multiple mediating effects of negative emotion at work and meaning in life on the relationship between interpersonal conflict at work and depressive symptoms among nurses.MethodsAn online multicenter cross-sectional study was conducted in 15 hospitals from different geographical areas of Hunan Province, China, from December 2021 to February 2022. A total of 1754 nurses completed validated self-reported questionnaires, including their sociodemographic information, interpersonal conflict at work, negative emotions at work, meaning in life, and depressive symptoms. Descriptive statistics analysis, Spearman’s correlation analysis, multiple linear regression analysis, and chain mediation analysis were performed using IBM SPSS software (version 29) and Mplus software (version 8).ResultsThere were significant correlations between interpersonal conflict at work, negative emotions at work, meaning in life, and depressive symptoms (r = -0.206 ~ 0.518, all p < 0.01). Interpersonal conflict at work had a statistically significantly direct effect on depressive symptoms (β = 0.061; 95% confidence interval, CI: 0.011 ~ 0.126, p = 0.039). Analysis of mediating effects revealed that interpersonal conflict at work also influenced depressive symptoms through two statistically significantly indirect pathways: (a) the mediating effect of negative emotions at work (β = 0.167; 95% CI: 0.138 ~ 0.195, p < 0.001) and (b) the chain mediating effect between negative emotions at work and meaning in life (β = 0.008; 95% CI: 0.003 ~ 0.013, p = 0.005).ConclusionInterpersonal conflict at work has a direct positive effect on depressive symptoms among nurses. Meanwhile, interpersonal conflict at work can influence depressive symptoms among nurses through the mediating effect of negative emotions at work and the chain mediating effect between negative emotions at work and meaning in life.

Modeling underground climate change across a city based on data about a building block

Subsurface heat islands induce an underground climate change in urban areas, which can threaten public comfort and health, subsurface ecosystems, transportation infrastructure, and civil infrastructure. Meanwhile subsurface heat islands harbor a marked energy recovery potential. Despite increasing investigations, the understanding of subsurface heat islands remains limited and suffers from the lack of expedient and accurate simulation approaches. Here we explore the use of machine learning to accurately and expediently simulate subsurface heat islands in terms of ground temperature and deformation anomalies. Using the Chicago Loop district as a case study, we identify a series of physical features to establish a relationship between central drivers and effects of subsurface heat islands. We incorporate these features into a random forest model to simulate underground climate change with variable training datasets. The results indicate that ground temperature and deformation anomalies across an entire city district can be predicted based on data extracted solely from a handful of buildings. The proposed approach achieves comparable accuracy to current simulation methods but boasts a calculation speed that can be over a hundred times faster, promising to advance fundamental science while effectively informing engineering and decision-making in the mitigation of underground climate change.

A new two-parameter Rayleigh distribution: Statistical properties, actuarial measures, regression analysis, and applications

This paper presents a novel two-parameter distribution derived from the Rayleigh distribution, thoroughly investigating its essential mathematical properties. We employ estimation techniques to determine the proposed distribution's estimated parameters. Through extensive simulation studies, we analyze and evaluate the asymptotic behavior of the model estimators. Furthermore, we calculate various actuarial measures to highlight the practical utility of the proposed distribution in actuarial science. To further substantiate the applicability of our distribution, we perform a comprehensive regression analysis. The practical relevance of the proposed distribution is demonstrated by modeling a lifetime dataset from the insurance field, where it exhibits a superior fit compared to existing distributions. The findings suggest that the new distribution significantly improves modeling capabilities, making it a valuable tool for theoretical research and practical applications in fields requiring accurate lifetime data modeling.

Flexoelectricity, Triboelectricity, and Free Interfacial Charges.

Triboelectricity has been a topic of some confusion for many years, probably because it is very diverse and some of the fundamental science has not been clear. This is now starting to change. A few years ago, the importance of flexoelectricity at asperities is pointed out. That paper exploited the established physics of compensation of bound surface or interfacial charges without going into detail. The purpose of this paper is to expand further on this, mapping from the established physics of electrostatics with contact potentials and Maxwell's displacement field to the underlying fundamentals of charge transfer in triboelectricity. Examples from the published literature are used to illustrate this. In the discussion, some of the open questions and challenges to the community are mentioned.

Adaptive and Priority-Based Data Aggregation and Scheduling Model for Wireless Sensor Network

Wireless Sensor Networks (WSN) use sensor nodes placed in potential places to collect sensitive information. These sensor nodes monitor necessary data and send it to the sink node. Sensor nodes have resource constraints, especially energy and power depletion. The majority of sensor and battery power is wasted on redundant data transmission. The redundant data transmission consumes a significant amount of the sensor and battery life, decreasing the total lifespan of the sensor nodes. Data aggregation is an approach that expands the useful lifetime of sensor nodes overall and removes unnecessary data and delays. There are many types of data aggregation techniques, such as centralized, tree-based, in-network, and cluster-based. The available tree-based data aggregation mechanism performs well, but the whole tree may be down due to single-node failure. Due to bottlenecks, node data aggregation suffers from an increased packet failure ratio. Another limitation is that every node aggregates data into slices, which consumes more energy. For this purpose, an adaptive and priority-based data aggregation and scheduling model (APB-DASM) for WSNs is proposed in this paper to address these issues. It is proposed that APB-DASM be used to improve quality of service (QoS) with regard to energy consumption and data transmission. The APB-DASM model aggregates sensor data into cluster heads and divides it into three formats: The first format categorizes the most important data that consists of four slices, and the second format categorizes the important data that consists of three slices. Format three data is represented in two slices, which is normal data. These three types of format data are aggregated on a priority basis, such that the highest priority is given to the first format, i.e., most important data; moderate priority is given to the second format, i.e., important data; and then low priority is given to the normal data. Due to an efficient priority-based data aggregation and scheduling algorithm, our proposed model sends the most important data first, and so on. Theoretical study and simulation research demonstrate that our proposed approach improves the existing tree-based models. By using APB-DASM, significant decreases in energy usage, packet delivery ratio, and overall QoS are achieved, and as a result, the WSNs' lifetime is thus increased. The proposed model is implemented in MATLAB, and the results are compared with existing tree-based models. Simulations comparing our model to the most recent models indicate that it worked effectively, reducing the packet failure ratio and energy usage by 36.8% and 30%, respectively, for CBF-ADA, D-SMART, and WDARS. This article emphasizes how the suggested methodology can be effectively used in the aggregation of coronavirus patient data. It demonstrates how adaptable and applicable our method is in the real world.

Thermally drawn multi-material fibers: from fundamental research to industrial applications

Thermally drawn fiber devices, with their complex micro- to nanoscale architectures, hold great promises not only for scientific research but also for scalable industrial applications in soft smart systems.

Integrated deep learning model for automatic detection and classification of stenosis in coronary angiography

Coronary artery disease poses a significant threat to human health. In clinical settings, coronary angiography remains the gold standard for diagnosing coronary heart disease. A crucial aspect of this diagnosis involves detecting arterial narrowings. Categorizing these narrowings can provide insight into whether patients should receive vascular revascularization treatment. The majority of current deep learning methods for analyzing coronary angiography are mostly confined to the theoretical research domain, with limited studies offering direct practical support to clinical practitioners. This paper proposes an integrated deep-learning model for the localization and classification of narrowings in coronary angiography images. The experimentation employed 1606 coronary angiography images obtained from 132 patients, resulting in an accuracy of 88.9 %, a recall rate of 85.4 %, an F1 score of 0.871, and a MAP value of 0.875 for vascular stenosis detection. Furthermore, we developed the "Hemadostenosis" web platform (http://bioinfor.imu.edu.cn/hemadostenosis) using Django, a highly mature HTTP framework. Users are able to submit coronary angiography image data for assessment via a visual interface. Subsequently, the system sends the images to a trained convolutional neural network model to localize and categorize the narrowings. Finally, the visualized outcomes are displayed to users and are downloadable. Our proposed approach pioneers the recognition and categorization of arterial narrowings in vascular angiography, offering practical support to clinical practitioners in their learning and diagnostic processes.

Theoretical study of tip-enhanced photoluminescence of single molecule in nanocavity formed by apex protrusion and substrate

Tip-enhanced photoluminescence techniques, characterized by ultra-high detection sensitivity and spatial resolution, have exhibited unprecedented capabilities in exploring optoelectronic phenomena and unraveling intrinsic physical mechanism at the single-molecule level. To suppress the quenching of molecular luminescence and achieve high-resolution optical imaging, a rational design of the tip-substrate configuration is required. In this paper, we systematically investigate the tip-enhanced photoluminescence characteristics of single molecules located within the plasmonic nanocavity formed by the tip protrusion and the substrate from a theoretical perspective. The impacts of electron tunneling and electron-hole pair creation on localized electric field and quantum yield are discussed using the quantum correction model and nonlocal dielectric theory, respectively. The crucial roles of atomic-scale protrusion at the tip apex and the decoupling layer on the substrate in enhancing vertical and horizontal electric fields as well as quantum yields have been emphasized. The results indicate that in smaller sub-nanometer cavities, electron tunneling and nonlocal dielectric effects greatly weaken the electric field intensity and fluorescence quantum yield. Meanwhile, due to the sharp lightning rod effect, the presence of atomic-level protrusion at the tip apex can provide a strong and highly localized plasmonic field. We find that the added NaCl layer not only blocks charge transfer between molecules and the substrate but also effectively prevents fluorescence quenching. The maximum fluorescence and Raman enhancement factors near the tip apex approach up to 5 and 12 orders of magnitude, respectively, achieving sub-nanometer spatial resolution. Finally, compared to vertical electric field and dipole, sharp protrusion can excite a stronger horizontal electric field and couple with horizontal dipoles to yield a higher quantum yield, resulting in a three orders of magnitude higher in the fluorescence enhancement of horizontal dipole compared to the tip without protrusion. Our theoretical research not only confirms the experimental results of spectral enhancement with the proximity of the tip to the molecule in tip-enhanced photoluminescence, but also provides effective guidance for a deeper understanding of the mechanism of tip-enhanced fluorescence and Raman spectroscopy, as well as optimizing the experimental system.

Organizational and pedagogical conditions for the formation of the readiness of future physical training and sports instructors for professional activity

Today, physical training and sports instructors play a key role in the training of military personnel of various categories and age groups, because in the process of professional activity they ensure the development and improvement of: physical qualities and military-applied skills; psychophysical readiness to act in extreme conditions, etc. The theoretical research was carried out in accordance with the plan of the initiative scientific project "SPT Instructor, 2022-2025" with the participation of leading specialists in physical training (physical education of various population groups) of representatives of specialized departments of higher military educational institutions (institutions of higher education) of Ukraine (in accordance with agreements on interdepartmental cooperation). According to the results of the analysis of the scientific and methodological literature by the members of the scientific research group, it was established that empirical studies that comprehensively reveal the peculiarities of the organization of the training process of instructors in physical training and sports in institutions of the security and defense sector of Ukraine are rare, which emphasizes the relevance of the chosen direction of scientific research. Research methods: axiomatic, experience of organizing the system of physical and special physical training of military personnel, idealization, instrumental, historical and logical, departure from the concrete, formalization. As a result of the research, we have developed organizational and pedagogical conditions for the formation of the readiness of future instructors in physical training and sports for professional activity (using the example of servicemen of the National Guard of Ukraine who study at the courses of instructors in physical training and sports).

Characterization of ferromagnetic semiconductors and valley polarization in janus VBXS2(X = N, P) monolayers

The manipulation of the valley degree of freedom has attracted increasing attention in both fundamental scientific research and emerging applications. Here, we employ first-principles calculations to investigate the structural stability and electronic properties of Janus monolayers of VBXS2 (X=N, P). These materials exhibit characteristics of ferromagnetic semiconductors, with their valence band maximum located at the K/K′ point. Due to the combined effects of inversion symmetry breaking and time reversal symmetry breaking, VBNS2 and VBPS2 exhibit exotic spontaneous valley polarization in their top valence bands, measured at magnitudes of 48.6 meV and 47.6 meV, respectively. Consequently, this phenomenon potentially enables the observation of the anomalous valley Hall effect (AVHE). The unique electronic and valleytronic properties exhibited by Janus VBXS2 suggest a feasible experimental avenue for exploring ferrovalley (FV) and valley-related Hall effects within a two dimensional lattice.

Therapists' defense use impacts their patients' defensive functioning: a systematic case study.

Research into defensive functioning in psychotherapy has thus far focused on patients' defense use. However, also the defensive functioning of therapists might be significant because of its potential in promoting changes in the patient's overall defensive functioning by sharing their higher-level understanding of a given situation and letting the patient have the opportunity to learn how to cope more successfully. This exploratory case study is the first to examine therapist's defense mechanisms and their relationship to changes in the patient's defensive functioning evaluated at different times throughout psychoanalytic treatment. We assessed the use of defense mechanisms with the Defense Mechanisms Rating Scales in 20 sessions collected at three phases (early, middle and late) of the psychoanalytic treatment. For each session, we identified therapist's and patient's defenses, defense levels and overall defensive functioning, with particular attention to the sequence of consecutively activated defenses within the therapeutic dyad. Results showed that the patient's defensive functioning tended to gradually improve over the course of the treatment, with a slight decrease at the end. Therapists' overall defensive functioning remained stable throughout the treatment with values in the range of high-neurotic and mature defenses. Assessment of the dyadic interaction between therapist and patient's use of defenses showed that within-session, the patient tended to use the same individual defenses that the therapist used, which was especially pronounced in the initial phases of the treatment. Towards the end of the treatment, once there was a stable shared knowledge, the patient started to explore using new, higher-level defenses on her own, independent from what defenses the therapist used. Our findings emphasized the analyst's role in encouraging the development of more effective ways of coping in the patient, confirming previous theoretical and empirical research regarding the improvement of patient's defensive functioning in psychotherapy. The alterations in these coping strategies, also called high-adaptive defenses, as part of the therapist-patient interaction demonstrate the importance of studying defenses as an excellent process-based outcome measure. The measurement of the degree to which the analyst models and illustrates these superior coping methods to the patient is a prime vehicle for supporting internalization of these skills by the patient.

Seismic performance of precast UHPC pipe pile with two pile-cap beam connection types: An experimental and numerical study

To develop an effective pile foundation scheme for earthquake-prone regions, this study introduces a novel pile structure that integrates ultra-high-performance concrete (UHPC) with traditional prestressed high-strength concrete (PHC) pipe piles. The research focuses on assessing the impact of various connection forms between the pile and cap beam on the seismic performance of bridge substructures. Two 1/3-scale specimens were meticulously designed and tested: one featuring a cast-in-place (CIP) connection and the other incorporating precast assembly (PA) connection between the pipe pile and cap beam. Cyclic loading tests were conducted to evaluate the failure mode, lateral capacity, ductility, energy dissipation ability, residual displacement, rebar strain, curvature distribution and rotation of UHPC pipe piles with the two connection forms. The results indicate that the specimen with a CIP connection exhibits a higher horizontal load capacity and stronger energy dissipation ability, while the specimen with the PA connection displays superior self-centering ability, increased ductility, and causes less damage to the cap beam. Finally, finite element models were developed to analyze the effects of design parameters on the seismic performance of the pile connected by the two methods. This research may provide valuable design guidance for incorporating UHPC in pile foundations. To facilitate its practical implementation in engineering projects, further theoretical and experimental research is recommended in this paper.

Criteria and levels of readiness of future physical training and sports instructors for professional activity

According to the results of the analysis of a number of scientific and methodological sources, it was established that the level of physical readiness of the representatives of the studied category directly affects the quality and efficiency of their performance of assigned tasks. This actualizes the need for all-round harmonious and physical development of the soldier's personality. Therefore, the high-quality and effective organization of the system of training future instructors in physical training and sports for the needs of institutions of the security and defense sector of Ukraine is relevant and timely. Taking into account the results of the monitoring of current scientific and methodological and special literature by the members of the scientific research group, it was established that studies that comprehensively reveal the peculiarities of the organization of the system of professional education of future instructors in physical training and sports are rare. In the process of theoretical research, the following methods were used: axiomatic, idealization, historical and logical, descent from the concrete, formalization, as well as the experience of organizing the system of professional education of military specialists in physical training and sports for the needs of institutions of the security and defense sector of Ukraine. As a result of the theoretical study, the members of the scientific research group determined the "criteria" (basic- motivational; substantive-content and analytical-evaluative), corresponding "indicators" and "levels" of the readiness of future physical training and sports instructors for professional activity. Prospects for further research in the chosen direction of scientific research provide for the development of organizational and pedagogical conditions for the formation of the readiness of future instructors in physical training and sports for professional activity.

Theoretical investigation of the nickel-catalyzed Mizoroki-Heck/Amination reaction towards the synthesis of biologically active Indolo[2,1-a] isoquinolines derivatives

Density functional theory (DFT) was employed to computationally investigate the nickel-catalyzed Mizoroki-Heck/amination cascade reaction of o-dihaloarenes with cyclic imines. The computational results reveal that this reaction proceeds via the generation of a sterically bulky N-heterocylcic carbene ligand-coordinated Ni(0) active catalyst, which triggers the Ni(0)-Ni(II)-Ni(0) catalytic cycle. Furthermore, during the cyclic imine insertion, the formation of hydrogen bond (NH…Cl) plays a pivotal role in facilitating the reaction. Additionally, theoretical analysis elucidates the origin of high regioselectivity and provides valuable insights for experiments and theoretical research in the future.

Test for the mean of high-dimensional functional time series

The one-sample test and two-sample test for the mean of high-dimensional functional time series are considered in this study. The proposed tests are built on the dimension-wise max-norm of the sum of squares of diverging projections. The null distribution of the test statistics is investigated using normal approximation, and the asymptotic behavior under the alternative is studied. The approach is robust to the cross-series dependence of unknown forms and magnitude. To approximate the critical values, a blockwise wild bootstrap method for functional time series is employed. Both fully and partially observed data are analyzed in theoretical research and numerical studies. Evidence from simulation studies and an IT stock data case study demonstrates the usefulness of the test in practice. The proposed methods have been implemented in a R package.

Why Survey-Based Subjective Expectations Are Meaningful and Important

For decades, households’ subjective expectations elicited via surveys have been considered meaningless because they often differ substantially from the forecasts of professionals and ex-post realizations. In sharp contrast, the literature we review shows that household characteristics and the ways in which households collect and process economic information help us understand previously considered puzzling facts about their subjective expectations. In turn, subjective expectations contribute to explain heterogeneous consumption, saving, investment, and debt choices as well as different reactions by similar households to the same monetary and fiscal policy measures. Matching microdata on households’ characteristics with the price signals the same households observe, their subjective expectations, and their real-world economic decisions is crucial to establishing these facts. Our growing understanding of households’ subjective expectations inspires several theoretical and empirical research directions and begets the design of innovative and more effective policy instruments.

Socioeconomic disparities in children's posture defects: a comparison between private and public educational institutions

The topic of risk factors for posture pathology in Polish children is relevant at present, as it is insufficiently studied and reflects the need to investigate the relationship between family socioeconomic status and the occurrence of posture defects, to develop relevant prevention and treatment strategies in the context of current socioeconomic conditions in Poland. The research aims to study posture defects in children depending on their socioeconomic status in the example of private and public schools. A comparison of the prevalence of deformities and posture disorders of participants in private and public educational institutions from 2017 to 2020 is presented. Theoretical research methods (literature analysis, generalisation); empirical methods (study of other researchers' experience), statistical analysis, and graphical presentation of data were used. More than 1300 Polish schoolchildren from private and public schools took part in this cross-sectional study. The most common problems were flat feet (54.73%), calf muscle contracture (44.30%), and valgus deformity (21.22%). The least common problems were funnel chest (0.37%), cavus foot (0.10%), and hammer toe deformity (0.04%). The general trend shows that problems with flat feet and calf muscle contracture were more common among participants in both types of educational institutions. There was a general trend of increasing the number of nosological forms per patient in both private and public institutions over a period of three years. Private institutions had significantly fewer cases of one patient having more than one nosological form as compared to public institutions.