Assessment of the Effectiveness of an Innovative Screening Colonoscopy Protocol in Producing High Quality Performance and Outcomes by Trained Primary Care Physicians

Colorectal cancer (CRC) is the 3rd most prevalent cancer and 2nd leading cause of cancer death in the U.S. Colonoscopies have been recommended as the preferred screening method to prevent cancer by removing polyps before they transform into cancer. Although colonoscopy every 10 years is considered to be the preferred screening method, it is not perfect mainly owing to the variable quality of screening colonoscopy under community-based practice conditions. Although the effectiveness of colonoscopy in preventing CRC is documented, screening colonoscopy coverage in the US population remains low. This is partly due to low colonoscopy capacity due to a shortage of gastroenterologists (GIs), the major physician type performing screening colonoscopies. When the supply of GIs is limited, trained primary care physicians (PCPs) could be a solution to address the gap, especially for underserved populations and regions (including rural areas). Another reason for low uptake of colonoscopy could be perceptions of colonoscopy as an invasive and potentially painful procedure, particularly concerns about partially or unsedated colonoscopy, limiting its protective potential. In this study, our setting is a community-based facility, which has followed a uniform protocol for almost all but not all physicians for 12 years. In order to evaluate the protocol elements, we explore the association between the 2-person technique pioneered by this center, and sedation type and the quality of colonoscopy outcomes. The aim of this study was to evaluate the quality of colonoscopies. We hypothesized that colonoscopy quality may be enhanced by applying the 2-person technique protocol relative to solo technique performance, and with deep sedation by propofol relative to the conventional Midazolam-meperdine combination. Our findings suggest that an innovation of a hands-on 2-person technique is highly associated with superior colonoscopy performance and lesion detection outcomes, and that by every discriminating measure, the results with the 2-person technique are superior, and consistent across measures. Propofol sedation might have improved the colonoscopy quality though not significantly when modified by the bowel preparation status. What we found is the bowel preparation actually plays an essential role in the colonoscopy performance and outcome quality indicators

Reducing Colorectal Cancer Incidence and Disparities: Performance and Outcomes of a Screening Colonoscopy Program in South Carolina

This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50–64 years (45–64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45–49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites

Colonoscopy Screening Among US Adults Aged 40 or Older With a Family History of Colorectal Cancer

IntroductionColonoscopy screening reduces colorectal cancer (CRC) incidence and mortality. CRC screening is recommended at age 50 for average-risk people. Screening of first-degree relatives of CRC patients is recommended to begin at age 40 or 10 years before the age at diagnosis of the youngest relative diagnosed with CRC. CRC incidence has increased recently among younger Americans while it has declined among older Americans. The objective of this study was to determine whether first-degree relatives of CRC patients are being screened according to recommended guidelines. MethodsWe studied colonoscopy screening rates among the US population reporting a CRC family history using 2005 and 2010 National Health Interview Survey data. ResultsOf 26,064 study-eligible respondents, 2,470 reported a CRC family history; of those with a family history, 45.6% had a colonoscopy (25.2% in 2005 and 65.8% 2010). The colonoscopy rate among first-degree relatives aged 40 to 49 in 2010 (38.3%) was about half that of first-degree relatives aged 50 or older (69.7%). First-degree relatives were nearly twice as likely as nonfirst-degree relatives to have a colonoscopy (adjusted odds ratio [AOR], 1.7; 95% confidence interval, 1.5–1.9), but those aged 40 to 49 were less likely to have a colonoscopy than those in older age groups (AOR, 2.6 for age 50–64; AOR, 3.6 for age ≥65). Interactions with age, insurance, and race/ethnicity were not significant. Having health insurance tripled the likelihood of screening. ConclusionDespite a 5-fold increase in colonoscopy screening rates since 2005, rates among first-degree relatives younger than the conventional screening age have lagged. Screening promotion targeted to this group may halt the recent rising trend of CRC among younger Americans

Benchmarking of eight recurrent neural network variants for breath phase and adventitious sound detection on a self-developed open-access lung sound database-HF_Lung_V1

A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios-such as in monitoring disease progression of coronavirus disease 2019-to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchi labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests for long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms of F1 scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.Comment: 48 pages, 8 figures. To be submitte

Researches in joint e-book reading on the literacy of young children

[[abstract]]The purpose of this research is to explore the joint e-book reading on the literacy of young children, adopting the case study. The researching object is the researcher’s daughter who is three and half years old. The joint book reading has been applied 7 times within 7 weeks, and the illustrated e-book is based upon the garden pictures produced by Children Culture Hall of the Ministry of Culture. We used the Peabody Picture Vocabulary Test-Revised to conduct the pretest and posttest, the research finding of which showed the point higher than that of those who didn’t join the joint e-book readings. We have further discovered that the illustrated e-book used in the joint reading is not only causing young children’s motive but also cultivating their concentration on the story content while the child is accompanied and instructed by adult in the process of rereading. According to the research findings, the researcher further propose this conclusion to serve as the references for oncoming study and teaching purpose

Factors Affecting Civil Servants’ Willingness to Promote Open Government Data

過去取得政府資料的方式較為有限，但隨著網際網路興起，政府資料開放(open government data)概念於焉誕生。個人或團體，能透過網路直接取用所需的政府資料，並進行資料再利用。本研究以我國財政部公務人員為研究對象，旨在探討影響公務人員參與推動政府資料開放時的因素。研究方法分為量化資料分析與訪談，量化部分使用次級資料分析，樣本數220份，並以結構方程模式(Structural Equation Modeling, SEM)驗證模型，模型構面包含：提升行政效能、高層支持、個人技術、組織特質、資料開放態度、資料開放行為意願。訪談對象從財政資訊中心選取，中心為財政部推動政府資料開放的主要機關，採用立意抽樣方式取得兩名受訪者。 量化分析結論認為，提升行政效能和組織特質，對於人員資料開放態度有正向影響；另外，人員對資料開放所持的態度越正面，越能增加參與資料開放意願。從訪談結果可以整理出原先不在量化模型的影響因素，包括法令限制、風險、第三方中介角色、資訊單位話語權、激勵措施。建議方面，嘗試加強宣導政府資料開放的正面印象與認知，以及持續塑造具創新與開放特質的組織文化。關於後續研究方向，本研究個案之財政部機關，設有獨特的資料開放三級推動體制，建議後續研究可深入探索三級體制的發展狀況。Access to government data has been limited over the past decades. However, as the Internet grows up, the idea of open government data emerges. Individual or organizations now can obtain government data from the Internet, and re-use these data. The focus of this study was on the civil sevants of Ministry of Finance in Taiwan, and aimed to explore the factors affecting government employees’ willingness to promote open government data. The research method employed in this study included survey-based secondary data analysis and interview. This study first developed a model consisting of enhancement of efficiency, top-level support, personal skills, organization characters, attitude towards open data, and intention to engage in open data. Structural equation modeling analysis was performed, with a sample of size 220 selected from the secondary data. On the other hand, the interview respondents were collected by purposive sampling from Fiscal Information Agency, Ministry of Finance, which was a leading sector in promoting open government data of the Ministry of Finance. The result of quantitative analysis indicated that enhancement of efficiency and organization characters had a positive impact on attitude towards open data. Furthermore, active attitude towards open data increased the intention to engage in open data. And the interview showed some factors that were not included in the quatitative model, such as legal restrictions, risk, role of third parties, discourse power of the IT sector, and incentive measures. Based on the empirical analyses, this study suggests that create better understanding of open data, as well as innovative and open-minded organizational culture, would make civil servants engage in open government data initiatives. For the future research, Ministry of Finance has set up a three-level system to implement open government data policies. Exploring this system might be a promising research material