Evaluation of the use of an "ask-the-expert" e-consultation service for support on health-related requests

E-consultation in health care can be used to respond to an increasing demand for care by offering support on health-related requests. In this study we evaluated the use of an Ask-the-expert e-consultation service in order to assess whether the service is efficient and useful. A content analysis of e-mail exchange between clients and online health professionals was performed to gain insight in the purposes of use of the service. Our findings show that the service was used for e-mails requests on not urgent, minor ailments. Clients asked for health information to increase knowledge on the cause of their injury or disease, its consequences, self-care solutions and treatment options. Decision support on assessing the necessity to visit a doctor for a certain health problem was another important reason to use the service. We believe that web-based triage systems could be used to more easily assess whether certain symptoms need to be investigated

Image-Based Classification of Double-Barred Beach States Using a Convolutional Neural Network and Transfer Learning

Nearshore sandbars characterize many sandy coasts, and unravelling their dynamics is crucial to understanding nearshore sediment pathways. Sandbar morphologies exhibit complex patterns that can be classified into distinct states. The tremendous progress in data-driven learning in image recognition has recently led to the first automated classification of single-barred beach states from Argus imagery using a Convolutional Neural Network (CNN). Herein, we extend this method for the classification of beach states in a double-barred system. We used transfer learning to fine-tune the pre-trained network of ResNet50. Our data consisted of labelled single-bar time-averaged images from the beaches of Narrabeen (Australia) and Duck (US), complemented by 9+ years of daily averaged low-tide images of the double-barred beach of the Gold Coast (Australia). We assessed seven different CNNs, of which each model was tested on the test data from the location where its training data came from, the self-tests, and on the test data of alternate, unseen locations, the transfer-tests. When the model trained on the single-barred data of both Duck and Narrabeen was tested on unseen data of the double-barred Gold Coast, we achieved relatively low performances as measured by F1 scores. In contrast, models trained with only the double-barred beach data showed comparable skill in the self-tests with that of the single-barred models. We incrementally added data with labels from the inner or outer bar of the Gold Coast to the training data from both single-barred beaches, and trained models with both single- and double-barred data. The tests with these models showed that which bar the labels used for training the model mattered. The training with the outer bar labels led to overall higher performances, except at the inner bar. Furthermore, only 10% of additional data with the outer bar labels was needed for reasonable transferability, compared to the 20% of additional data needed with the inner bar labels. Additionally, when trained with data from multiple locations, more data from a new location did not always positively affect the model’s performance on other locations. However, the larger diversity of images coming from more locations allowed the transferability of the model to the locations from where new training data were added

Huisarts loopt nog niet warm voor e-consult

Huisartsen verwachten door het gebruik van elektronische consultatie een toename van de werkdruk en slechtere zorg. Ook vinden zij dat e-consult onvoldoende wordt gehonoreer

CD47 Expression Defines Efficacy of Rituximab with CHOP in Non-Germinal Center B-cell (Non-GCB) Diffuse Large B-cell Lymphoma Patients (DLBCL), but Not in GCB DLBCL

Addition of rituximab (R) to "CHOP" (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy improved outcome for diffuse large B-cell lymphoma (DLBCL) patients. Approximately 40% of patients who receive R-CHOP still succumb to disease due to intrinsic resistance or relapse. A potential negative regulator of DLBCL treatment outcome is the CD47 "don't eat me" immune checkpoint. To delineate the impact of CD47, we used a clinically and molecularly well-annotated cohort of 939 DLBCL patients, comprising both germinal center B-cell (GCB) and non-GCB DLBCL subtypes, treated with either CHOP or R-CHOP. High (above median) CD47 mRNA expression correlated with a detrimental effect on overall survival (OS) when DLBCL patients received R-CHOP therapy (P = 0.001), but not CHOP therapy (P = 0.645). Accordingly, patients with low CD47 expression benefited most from the addition of rituximab to CHOP [HR, 0.32; confidence interval (CI), 0.21-0.50; P <0.001]. This negative impact of high CD47 expression on OS after R-CHOP treatment was only evident in cancers of non-GCB origin (HR, 2.09; CI, 1.26-3.47; P = 0.004) and not in the GCB subtype (HR, 1.16; CI, 0.68-1.99; P = 0.58). This differential impact of CD47 in non-GCB and GCB was confirmed in vitro, as macrophage-mediated phagocytosis stimulated by rituximab was augmented by CD47-blocking antibody only in non-GCB cell lines. Thus, high expression of CD47 mRNA limited the benefit of addition of rituximab to CHOP in non-GCB patients, and CD47-blockade only augmented rituximab-mediated phagocytosis in non-GCB cell lines. Patients with non-GCB DLBCL may benefit from CD47-targeted therapy in addition to rituximab

A thermoanalytical, X-ray diffraction and petrographic approach to the forensic assessment of fire affected concrete in the United Arab Emirates

For most fires, Forensic investigation takes place well after building materials have cooled and knowledge of the structural damage due to heat exposure can reveal the temperature reached during an incident. Recently, there have been significant changes in the characteristics of cementitious materials used in the United Arab Emirates. Few studies focus on the application of thermo-gravimetric and petrographic techniques on newly developed structures and this work aims to address this deficiency by utilising a series of parametric laboratory-based tests to assess the effects of heat on hardened concrete. Specimens were made with a design mix used for low-rise residential homes and storage facilities. The key constituents were: Portland cement (PC), crushed gabbro stone and dune sand with water/cement ratios of 0.4-0.5. Cement substitutes included slag (GGBS), and silica fume (SF) at replacement percentages of up to 50% and 4%, respectively. The concrete cubes were exposed to heat inside an electric furnace with pre-determined temperature regimes of 150°C, 300°C, 600°C and 900°C. Petrographic examination was utilised to compare the discolouration of the cooled concrete. Data derived from thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC) are reported in order to assess the usefulness of these techniques in fire scene investigation to differentiate between these temperature regimes.. The results from the TGA indicate that the majority of the percentage weight loss for all the mixtures occurred in the range 650-700°C, which corresponds to the decarbonation of calcium carbonate, mainly from the aggregates. The endothermic DSC peak at 70-120°C relates to the loss of evaporable water. Since both of these reactions are irreversible, this information can help fire investigators estimate the temperature history of concrete after exposure to fire. On the other hand, the portlandite in the cement matrix dehydroxylates at 450-550°C but then reforms as the concrete cools. The onset temperature for the dehydroxylation of the reformed mineral is always lower than in virgin samples and its enthalpy furthermore depends strongly on the thermal history of the portlandite. Thus, this feature can be used to establish the temperature to which the material was exposed to during a fire incident

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HLA dependent immune escape mechanisms in B-cell lymphomas:Implications for immune checkpoint inhibitor therapy?

Antigen presentation by tumor cells in the context of Human Leukocyte Antigen (HLA) is generally considered to be a prerequisite for effective immune checkpoint inhibitor therapy. We evaluated cell surface HLA class I, HLA class II and cytoplasmic HLA-DM staining by immunohistochemistry (IHC) in 389 classical Hodgkin lymphomas (cHL), 22 nodular lymphocyte predominant Hodgkin lymphomas (NLPHL), 137 diffuse large B-cell lymphomas (DLBCL), 39 primary central nervous system lymphomas (PCNSL) and 19 testicular lymphomas. We describe a novel mechanism of immune escape in which loss of HLA-DM expression results in aberrant membranous invariant chain peptide (CLIP) expression in HLA class II cell surface positive lymphoma cells, preventing presentation of antigenic peptides. In HLA class II positive cases, HLA-DM expression was lost in 49% of cHL, 0% of NLPHL, 14% of DLBCL, 3% of PCNSL and 0% of testicular lymphomas. Considering HLA class I, HLA class II and HLA-DM together, 88% of cHL, 10% of NLPHL, 62% of DLBCL, 77% of PCNSL and 87% of testicular lymphoma cases had abnormal HLA expression patterns. In conclusion, an HLA expression pattern incompatible with normal antigen presentation is common in cHL, DLBCL, PCNSL and testicular lymphoma. Retention of CLIP in HLA class II caused by loss of HLA-DM is a novel immune escape mechanism, especially prevalent in cHL. Aberrant HLA expression should be taken into account when evaluating efficacy of checkpoint inhibitors in B-cell lymphomas