Employing CNN ensemble models in classifying dental caries using oral photographs

Dental caries is arguably the most persistent dental condition that affects most people over their lives. Carious lesions are commonly diagnosed by dentists using clinical and visual examination along with oral radiographs. In many circumstances, dental caries is challenging to detect with photography and might be mistaken as shadows for various reasons, including poor photo quality. However, with the introduction of Artificial Intelligence and robotic systems in dentistry, photographs can be a helpful tool in oral epidemiological research for the assessment of dental caries prevalence among the population. It can be used particularly to create a new automated approach to calculate DMF (Decay, Missing, Filled) index score. In this paper, an autonomous diagnostic approach for detecting dental cavities in photos is developed using deep learning algorithms and ensemble methods. The proposed technique employs a set of pretrained models including Xception, VGG16, VGG19, and DenseNet121 to extract essential characteristics from photographs and to classify images as either normal or caries. Then, two ensemble learning methods, E- majority and E-sum, are employed based on majority voting and sum rule to boost the performances of the individual pretrained model. Experiments are conducted on 50 images with data augmentation for normal and caries images, the employed E-majority and E-sum achieved an accuracy score of 96% and 97%, respectively. The obtained results demonstrate the superiority of the proposed ensemble framework in the detection of caries. Furthermore, this framework is a step toward constructing a fully automated, efficient decision support system to be used in the dentistry area

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Deep Learning Based Abstractive Text Summarization: Approaches, Datasets, Evaluation Measures, and Challenges

In recent years, the volume of textual data has rapidly increased, which has generated a valuable resource for extracting and analysing information. To retrieve useful knowledge within a reasonable time period, this information must be summarised. This paper reviews recent approaches for abstractive text summarisation using deep learning models. In addition, existing datasets for training and validating these approaches are reviewed, and their features and limitations are presented. The Gigaword dataset is commonly employed for single-sentence summary approaches, while the Cable News Network (CNN)/Daily Mail dataset is commonly employed for multisentence summary approaches. Furthermore, the measures that are utilised to evaluate the quality of summarisation are investigated, and Recall-Oriented Understudy for Gisting Evaluation 1 (ROUGE1), ROUGE2, and ROUGE-L are determined to be the most commonly applied metrics. The challenges that are encountered during the summarisation process and the solutions proposed in each approach are analysed. The analysis of the several approaches shows that recurrent neural networks with an attention mechanism and long short-term memory (LSTM) are the most prevalent techniques for abstractive text summarisation. The experimental results show that text summarisation with a pretrained encoder model achieved the highest values for ROUGE1, ROUGE2, and ROUGE-L (43.85, 20.34, and 39.9, respectively). Furthermore, it was determined that most abstractive text summarisation models faced challenges such as the unavailability of a golden token at testing time, out-of-vocabulary (OOV) words, summary sentence repetition, inaccurate sentences, and fake facts

Zero-Cement Concrete Resistance to External Sulfate Attack: A Critical Review and Future Needs

The durability of zero-cement concrete or alkali-activated materials (AAMs) is a subject of controversy, especially when exposed to sulfate attacks. This can be due to the different elemental and microstructural compositions of the broad alkali-activated systems that exhibit different degradation mechanisms in sulfate-rich environments. Various parameters, such as properties of raw source materials (nature, fineness, and mineralogy), activators (type and concentration), mixture design, curing regime, types of sulfate salt and sulfate ion concentrations, and weathering conditions, are considered to have a significant impact on zero-cement concrete sulfate attack resistance. Furthermore, the adequacy of the standard sulfate immersion tests raises more concerns about the reported behavior. This paper presents a critical review of the current aging protocol associated with ordinary cement resistance and zero-cement concrete or AAMs to external sulfate attack

Zero-Cement Concrete Resistance to External Sulfate Attack: A Critical Review and Future Needs

The durability of zero-cement concrete or alkali-activated materials (AAMs) is a subject of controversy, especially when exposed to sulfate attacks. This can be due to the different elemental and microstructural compositions of the broad alkali-activated systems that exhibit different degradation mechanisms in sulfate-rich environments. Various parameters, such as properties of raw source materials (nature, fineness, and mineralogy), activators (type and concentration), mixture design, curing regime, types of sulfate salt and sulfate ion concentrations, and weathering conditions, are considered to have a significant impact on zero-cement concrete sulfate attack resistance. Furthermore, the adequacy of the standard sulfate immersion tests raises more concerns about the reported behavior. This paper presents a critical review of the current aging protocol associated with ordinary cement resistance and zero-cement concrete or AAMs to external sulfate attack

Enhanced Multilevel Fuzzy Inference System for Risk Adaptive Hybrid RFID Access Control System

Risk-based access control systems are part of identity management systems used to accommodate environments with needs for dynamic access control decisions. The risk value is subjected to overestimation or underestimation since it is measured qualitatively, thus; causing uncertainty problems, which was apparent in a previously proposed hybrid risk adaptive (HRA) access control system. Conversely, Fuzzy Inference Systems can deal with the uncertainty of measures and control the outcomes more precisely; therefore, a multilevel fuzzy inference system (HRA-MFIS) was proposed to replace the risk assessment model in HRA. This paper continues to improve the previous model by introducing an enhanced multilevel fuzzy inference system (EHRA-MFIS), which utilizes user behaviour and time analysis to detect anomalous access behaviour. Moreover, it improves the hybrid adaptive risk calculation module by adding authentication, classification and the degree of user anomalous behaviour to the risk calculation algorithm. The results show that the proposed model has smoothed out the transition between the different risk levels and enhanced the system's overall security by considering the failed authorization attempts and failed authentication attempts, asset classification, and user behaviour when calculating the risk level

The pass/fail grading system at Jordanian universities for online learning courses from students’ perspectives

This study aimed to investigate the perspectives of Jordanian university students toward the pass/fail grading system (PFGS) that was used during the COVID-19 pandemic. To achieve this goal, a questionnaire was prepared, consisting of 37 items in its final form; divided into four subscales: advantages, drawbacks of (PFGS), the reasons for its use by students, and their attitudes toward it. This questionnaire was applied to a sample of 6,404 male and female students from four Jordanian universities: Al al-Bayt University, Balqa Applied University, The Hashemite University, and The University of Jordan. Out of the 6,404 responses, we rejected 263 responses due to careless survey filling and/or incomplete answers. The results revealed that most students were satisfied with applying the PFGS to all courses, especially among the freshmen. They believed that the PFGS was the best choice for grading due to online exams and full distance learning lectures. The results showed significant differences at α = 0.05 in how students evaluated the PFGS; namely: its advantages, drawbacks, reasons, and their attitudes toward it, based on participants’ gender, school, and academic level. As for the relationship between GPA and students’ perspectives on the PFGS, it was clear that the correlation coefficients indicated weak but significant correlations