Rapid translation of clinical guidelines into executable knowledge : a case study of COVID-19 and online demonstration

Introduction: We report a pathfinder study of AI/knowledge engineering methods to rapidly formalise COVID‐19 guidelines into an executable model of decision making and care pathways. The knowledge source for the study was material published by BMJ Best Practice in March 2020. Methods: The PROforma guideline modelling language and OpenClinical.net authoring and publishing platform were used to create a data model for care of COVID‐19 patients together with executable models of rules, decisions and plans that interpret patient data and give personalised care advice. Results: PROforma and OpenClinical.net proved to be an effective combination for rapidly creating the COVID‐19 model; the Pathfinder 1 demonstrator is available for assessment at https://www.openclinical.net/index.php?id=746. Conclusions: This is believed to be the first use of AI/knowledge engineering methods for disseminating best‐practice in COVID‐19 care. It demonstrates a novel and promising approach to the rapid translation of clinical guidelines into point of care services, and a foundation for rapid learning systems in many areas of healthcare

Limitations of Prostate Biopsy in Detection of Cribriform and Intraductal Prostate Cancer

Funding Information: Acknowledgments: Rui M. Bernardino is supported by Fundacao para a Ciencia e a Tecnologia (2022.13386.BD). Publisher Copyright: © 2023 European Association of UrologyBackground: The presence of cribriform morphology and intraductal carcinoma (IDC) in prostate biopsies and radical prostatectomy specimens is an adverse prognostic feature that can be used to guide treatment decisions. Objective: To assess how accurately biopsies can detect cribriform morphology and IDC cancer by examining matched biopsy and prostatectomy samples. Design, setting, and participants: Patients who underwent radical prostatectomy at The Princess Margaret Cancer Centre between January 2015 and December 2022 and had cribriform morphology and/or IDC in the surgical specimen were included in the study. Outcome measurements and statistical analysis: We used detection sensitivity to evaluate the level of agreement between biopsy and prostatectomy samples regarding the presence of cribriform morphology and IDC. Results and limitations: Of the 287 men who underwent radical prostatectomy, 241 (84%) had cribriform morphology and 161 (56%) had IDC on final pathology. The sensitivity of prostate biopsy, using radical prostatectomy as the reference, was 42.4% (95% confidence interval [CI] 36–49%) for detection of cribriform morphology and 44.1% (95% CI 36–52%) for detection of IDC. The sensitivity of prostate biopsy for detection of either IDC or cribriform morphology was 52.5% (95% CI 47–58%). Among patients who underwent multiparametric magnetic resonance imaging–guided biopsies, the sensitivity was 54% (95% CI 39–68%) for detection of cribriform morphology and 37% (95% CI 19–58%) for detection of IDC. Conclusions: Biopsy has low sensitivity for detecting cribriform morphology and IDC. These limitations should be incorporated into clinical decision-making. Biomarkers for better detection of these histological patterns are needed. Patient summary: Prostate biopsy is not an accurate method for detecting two specific types of prostate cancer cells, called cribriform pattern and intraductal prostate cancer, which are associated with unfavorable prognosis.proofepub_ahead_of_prin

Association of pregnancy complications/risk factors with the development of future long-term health conditions in women : overarching protocol for umbrella reviews

Acknowledgments Patient representatives and MuM-PreDiCT team. Funding This work was funded by the Strategic Priority Fund 'Tackling multimorbidity at scale' programme (grant number-MR/W014432/1) delivered by the Medical Research Council and the National Institute for Health and Care Research in partnership with the Economic and Social Research Council and in collaboration with the Engineering and Physical Sciences Research Council.Peer reviewedPublisher PD

Symptoms and risk factors for long COVID in non-hospitalized adults

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with a range of persistent symptoms impacting everyday functioning, known as post-COVID-19 condition or long COVID. We undertook a retrospective matched cohort study using a UK-based primary care database, Clinical Practice Research Datalink Aurum, to determine symptoms that are associated with confirmed SARS-CoV-2 infection beyond 12 weeks in non-hospitalized adults and the risk factors associated with developing persistent symptoms. We selected 486,149 adults with confirmed SARS-CoV-2 infection and 1,944,580 propensity score-matched adults with no recorded evidence of SARS-CoV-2 infection. Outcomes included 115 individual symptoms, as well as long COVID, defined as a composite outcome of 33 symptoms by the World Health Organization clinical case definition. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for the outcomes. A total of 62 symptoms were significantly associated with SARS-CoV-2 infection after 12 weeks. The largest aHRs were for anosmia (aHR 6.49, 95% CI 5.02–8.39), hair loss (3.99, 3.63–4.39), sneezing (2.77, 1.40–5.50), ejaculation difficulty (2.63, 1.61–4.28) and reduced libido (2.36, 1.61–3.47). Among the cohort of patients infected with SARS-CoV-2, risk factors for long COVID included female sex, belonging to an ethnic minority, socioeconomic deprivation, smoking, obesity and a wide range of comorbidities. The risk of developing long COVID was also found to be increased along a gradient of decreasing age. SARS-CoV-2 infection is associated with a plethora of symptoms that are associated with a range of sociodemographic and clinical risk factors

The language of the mid-seventeenth-century organ mass: the 1688 "Livre d'Orgue" of Andre Raison

Bibliography: p. 219-23

Signs of change? A longitudinal study of Internet adoption in the UK retail sector

The Internet and the World Wide Web have changed quite significantly in a relatively short period of time. Some of the differences are readily quantifiable or at least easily visible; e.g., exponential growth rates in the number of users, rapid expansion in the number of personal and business web sites, an increase in transmission speeds and the advent of new markup scripts, such as DHTML. Whilst these quantifiable changes and technological improvements are a valuable benchmark when considering the practical ramifications of developing an on-line business, from a strategic perspective it is perhaps more important to consider the extent to which Internet technologies are likely to effect long-term changes to organisational behaviour and economic activity. For instance, in the book retailing business, Internet vendors, benefiting from comparatively low on-line set-up costs, have been able to use price as a major marketing tool. This action has resulted in reduced profit margins across the sector. Therefore, from a retailer's perspective perhaps the most important issue to resolve is not whether there are sufficient customers on-line but how e-commerce is likely to reshape their markets and business processes. However, little academic research exists which has recorded Internet adoption trends, over time, making assessment of such issues difficult. This paper seeks to redress the balance by presenting a comprehensive and rigorous longitudinal review of the adoption of e-commerce within the UK retail sector. More specifically, the paper provides an up to date assessment of the state of e-commerce within the UK retail sector, before reviewing trends in its adoption over a four-year period form 1997 to 2000. The key finding is that whilst clear evidence of growth has been found across all types of retailers, it is fastest amongst larger retailers, and those operating in sectors such as books, alcoholic beverages and mail order. The paper concludes by offering implications for retail practitioners and for research

Planning and wastewater management of a combined sewer system in San Francisco

CER73-74NSG57.Includes bibliographical references.June 1973.Supported by OWRR grant number 14-31-0001-3685, Title II, Project No. C-3105, from funds provided by the United States Department of Interior as authorized under the Water Resources Research Act of 1964, Public Law 88-379