A Peer-to-Peer Approach to Increasing Staff Competency and Engagement in Wound and Ostomy Care: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement (QI) project was to provide an innovative, participatory approach to the education of staff nurses and nursing support personnel to improve skills and competencies in wound and ostomy care while enhancing staff engagement and empowerment. PARTICIPANTS AND SETTING: Project planning occurred between January and October 2020 and implementation began in November 2020. The project was implemented in 1 intensive care unit and 6 adult medical-surgical units of a 288-bed community hospital in the northeastern United States (Bronxville, New York). Participants included RNs and nursing support staff working in intensive care and medical-surgical units. A postimplementation survey was conducted in May 2021. APPROACH: The Plan-Do-Study-Act (PDSA) model was used as a framework for this QI intervention. A peer-to-peer approach to staff education addressing different learning styles was used to improve knowledge and competencies of staff nurses pertaining to wound and ostomy care. OUTCOMES: There were 72 participants; 68% (n = 49) exhibited knowledge retention 5 months after initial participation; 85% (n = 61) reported a high level of engagement; and 97.5% (n = 70) reported a high level of satisfaction 5 months after project implementation. IMPLICATIONS FOR PRACTICE: An emerging need exists for educational innovation regarding wound and ostomy care to improve quality of care, nursing care outcomes, and staff engagement. Through a peer-to-peer approach to wound and ostomy care education, enhanced clinical knowledge and competencies can result in improved patient safety and increase care outcomes.

Molecular mechanisms of Eda-mediated adaptation to freshwater in threespine stickleback.

A main goal of evolutionary biology is to understand the genetic basis of adaptive evolution. Although the genes that underlie some adaptive phenotypes are now known, the molecular pathways and regulatory mechanisms mediating the phenotypic effects of those genes often remain a black box. Unveiling this black box is necessary to fully understand the genetic basis of adaptive phenotypes, and to understand why particular genes might be used during phenotypic evolution. Here, we investigated which genes and regulatory mechanisms are mediating the phenotypic effects of the Eda haplotype, a locus responsible for the loss of lateral plates and changes in the sensory lateral line of freshwater threespine stickleback (Gasterosteus aculeatus) populations. Using a combination of RNAseq and a cross design that isolated the Eda haplotype on a fixed genomic background, we found that the Eda haplotype affects both gene expression and alternative splicing of genes related to bone development, neuronal development and immunity. These include genes in conserved pathways, like the BMP, netrin and bradykinin signalling pathways, known to play a role in these biological processes. Furthermore, we found that differentially expressed and differentially spliced genes had different levels of connectivity and expression, suggesting that these factors might influence which regulatory mechanisms are used during phenotypic evolution. Taken together, these results provide a better understanding of the mechanisms mediating the effects of an important adaptive locus in stickleback and suggest that alternative splicing could be an important regulatory mechanism mediating adaptive phenotypes.

Distinguishing Asthma and COPD in Primary Care: A Case-based Approach.

Asthma and chronic obstructive pulmonary disease (COPD) affect more than 40 million Americans, cost more than $100 billion annually, and together constitute the fourth-leading cause of death in the United States. Distinguishing between asthma and COPD can be difficult; accurate diagnosis requires spirometry that demonstrates a characteristic pattern. Asthma is diagnosed if airway obstruction on spirometry is reversible (greater than 12% and greater than 200 mL improvement in forced expiratory volume in one second [FEV1]) with administration of bronchodilators or through the observation of bronchoconstriction (reduction in FEV1 of 20% or greater) with a methacholine challenge. COPD is diagnosed if airway obstruction (FEV1/forced vital capacity [FEV1/FVC] ratio less than 70%) on spirometry is not reversible with bronchodilators. Although not considered a separate diagnosis, asthma-COPD overlap can be a useful clinical descriptor for patients displaying diagnostic features of both diseases. In these cases, spirometry will show reversibility after administration of bronchodilators, which is consistent with asthma, and the persistent baseline airflow limitation that is more characteristic of COPD. Treatment should follow Global Initiative for Asthma guidelines and Global Initiative for Chronic Obstructive Lung Disease guidelines. In patients with asthma-COPD overlap, pharmacotherapy should primarily follow asthma guidelines, but pharmacologic and nonpharmacologic approaches specific to COPD may also be needed.

Feasibility of nasal bridge pressure injury prevention using a protective dressing and the Halyard Fluidshield® N95 mask in a COVID-positive environment.

The purpose of this study was to prevent nasal bridge pressure injury among fit-tested employees, secondary to long-term wear of the N95 mask during working hours. A prospective, single-blinded, experimental cohort design. Participants were enrolled using the convenience sampling methods and randomisation was utilised for group assignment. Eligibility was determined by a COVID Anxiety Scale score and non-COVID clinical assignment. Participants with a history of previous skin injury or related condition were excluded. The experimental group was assigned Mepilex Lite® and the control group used Band- Aid®. Formal skin evaluations were done by Nurse Specialists who are certified in wound and ostomy care by the Wound, Ostomy, Continence, Nursing Certification Board (WOCNCB®). Fit test logs were provided to participants to measure subjective user feedback regarding mask fit and level of comfort. The results of this feasibility trial are promising in supporting the use of a thin polyurethane foam dressing as a safe and effective dressing to apply beneath the N95 mask. Additional research is needed to validate results due to limited data on efficacy and safety of the various barrier dressings as a potential intervention to prevent skin breakdown to the nasal bridge.

The Effect of Integrating Primary Care and Mental Health Services on Diabetes and Depression: A Multi-site Impact Evaluation on the US-Mexico Border.

BACKGROUND: Health care delivery systems are increasingly integrating physical and mental health services to address patients' complex needs, contain costs, and improve satisfaction. Therefore, it is critical to understand whether adoption of integrated care models is effective in diverse settings. OBJECTIVE: This study examined the effect of integrated care on physical and mental health outcomes among low-income Latino participants on the US-Mexico border. RESEARCH DESIGN: In this quasi-experimental multisite study, individual-level data were pooled from 8 studies of locally adapted integrated care models. SUBJECTS: Participants were 18 years or older and had 1 or more chronic conditions: diabetes, depression, hypertension, or obesity. The study enrolled 4226 participants with 2254 participants in the intervention group and 1972 in the comparison group. MEASURES: Primary outcomes were depressive symptoms as measured by the Patient Health Questionnaire-9 score and blood glucose measured by hemoglobin A1c (HbA1c). Blood pressure, body mass index, and quality of life were secondary outcomes. RESULTS: Multivariable linear regression analyses indicated intervention participants had significantly lower Patient Health Questionnaire-9 scores (ß=-0.39, P=0.03) and HbA1c (ß=-0.14, P=0.02) at 12 months compared with comparison group participants. Stratified analyses showed improvements in HbA1c were even greater among intervention participants who had diabetes, depression, severe and persistent mental illness, were older or female compared with their counterparts in the comparison group. CONCLUSIONS: Health care is constantly transforming, making it critical to study these changes across populations and settings. Findings from this study indicate that integrated care can significantly improve mental and physical health in an underserved Latino population.

What You Need to Know Before Reading Multiparametric MRI for Prostate Cancer.

OBJECTIVE. Multiparametric MRI (mpMRI) has become the main imaging modality for the detection, localization, and local staging of prostate cancer over the past decade. For radiologists to achieve consistent and reproducible reporting of prostate mpMRI, a comprehensive evaluation of the gland including detailed knowledge of anatomy, pathology, and clinical data is required. This article familiarizes radiologists with common pitfalls and conditions that affect mpMRI performance during readouts. CONCLUSION. Consistent, accurate, and reproducible reporting of prostate mpMRI is vital. Additionally, radiologists should be aware of common diagnostic pitfalls that can hinder mpMRI performance.

Prospective Evaluation of PI-RADS Version 2.1 for Prostate Cancer Detection.

OBJECTIVE. The purpose of this study was to prospectively evaluate Prostate Imaging Reporting and Data and System version 2.1 (PI-RADSv2.1), which was released in March 2019 to update version 2.0, for prostate cancer detection with transrectal ultrasound-MRI fusion biopsy and 12-core systematic biopsy. SUBJECTS AND METHODS. This prospective study included 110 consecutively registered patients who underwent multiparametric MRI evaluated with PI-RADSv2.1 criteria followed by fusion biopsy and systematic biopsy between April and September 2019. Lesion-based cancer detection rates (CDRs) were calculated for prostate cancer (Gleason grade group, > 0) and clinically significant prostate cancer (Gleason grade group, > 1). RESULTS. A total of 171 lesions (median size, 1.1 cm) in 110 patients were detected and evaluated with PI-RADSv2.1. In 16 patients no lesion was detected, and only systematic biopsy was performed. Lesions were categorized as follows: PI-RADS category 1, 1 lesion; PI-RADS category 2, 34 lesions; PI-RADS category 3, 54 lesions; PI-RADS category 4, 52 lesions; and PI-RADS category 5, 30 lesions. Histopathologic analysis revealed prostate cancer in 74 of 171 (43.3%) lesions and clinically significant prostate cancer in 57 of 171 (33.3%) lesions. The CDRs of prostate cancer for PI-RADS 2, 3, 4, and 5 lesions were 20.0%, 24.1%, 51.9%, and 90.0%. The CDRs of clinically significant prostate cancer for PI-RADS 1, 2, 3, 4, and 5 lesions were 0%, 5.7%, 14.8%, 44.2%, and 80.0%. In 16 patients with normal multiparametric MRI findings (PI-RADS 1), the CDRs were 50.0% for PCa and 18.8% for clinically significant prostate cancer. CONCLUSION. This investigation yielded CDRs assessed with prospectively assigned PI-RADSv2.1 scores. CDRs increased with higher PI-RADSv2.1 scores. These results can be compared with previously published outcomes derived with PI-RADS version 2.0.

Role of mpMRI in Benign Prostatic Hyperplasia Assessment and Treatment.

PURPOSE OF REVIEW: To summarize the role of prostate MRI in the assessment and treatment of benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS). RECENT FINDINGS: BPH/LUTS is a very common source of morbidity in aging men. mpMRI has become an increasingly popular modality for prostate imaging due to its ability to provide exceptional anatomic detail. This has allowed for MRI classification of BPH and detailed assessment of response to various BPH treatment modalities, including simple prostatectomy and transurethral resection of the prostate as well as newer methods like UroLift and prostatic artery embolization. MRI will continue to be a useful tool in the diagnosis and management of BPH/LUTS and provides useful information about the efficacy of a variety of available treatment options. Further studies are needed to fully characterize the effects of newer BPH interventions on mpMRI.

Estimates of the Absolute and Relative Strengths of Diverse Alcoholic Drinks by Young People.

BACKGROUND: Evidence suggests that college students are often unclear about how much alcohol is present in different drinks. OBJECTIVES: To evaluate the abilities of students to estimate the alcohol contents of drinks, both in relative and absolute terms, and to examine how alcohol strength informs behavior. METHODS: For 10 popular drinks that varied by alcohol content, beverage and volume, 209 UK university students rank-ordered the drinks according to total alcohol content and then estimated, for each drink, the number of UK "units" of alcohol contained and its percentage alcohol-by-volume (% ABV). Participants also reported the importance of drink strength as a factor in drink choice, and its influence in different scenarios. RESULTS: There was low but significant concordance between participants' rank-orderings of drinks by strength, and the correlation of mean ranks with correct ranks was also significant. However, their explicit estimates of the numbers of "units" in the drinks, and their % ABV values, often diverged dramatically from actual values. Participants tended to overestimate the unit contents of spirit-based drinks but underestimated the unit contents of beers and wine; women were consistently less accurate than men, typically making greater underestimates for commonly-consumed drinks. Over one-third of the sample reported that strength influenced drink choice, but its importance ranked below flavor and cost; drink strength might contribute to drink choice depending on the drinking situation. Conclusion/Importance: Young drinkers (women especially) have a poor awareness of the alcohol contents of different drinks, particularly wines and beers, but they make better judgments of relative strength.

WORK PATTERN DIFFERENCES BETWEEN MALE AND FEMALE ORTHODONTISTS IN CANADA.

OBJECTIVE: To examine sex-specific differences in the demographics and work patterns of Canadian orthodontists. METHODS: Questionnaires were mailed and emailed to a random sample of 384 orthodontists: 289 men and 95 women. Questions regarding work patterns and personal demographics were created and results were compared by sex. RESULTS: The response rate was 53.9%. The demographics and work patterns for male and female orthodontists were similar for most variables. Women were found to be 6 years younger; have 6 fewer years of work experience; expect to retire earlier; be more often married to a professional in full-time employment; and be more likely to take a leave of absence during their career than their male colleagues. Age significantly affected the number of hours worked per week and number of phase II starts per year; both variables increased with increasing age until approximately 50 years, after which they decreased with age. Having children did not significantly affect any of the analyzed variables. CONCLUSIONS: As the practice of female orthodontists was not found to be substantially different from that of men, it is not possible to speculate whether the increasing number of women specializing in orthodontics will provoke a significant change in the profession. As this is the first survey of its kind in Canada, these results may be used as a reference for future comparisons to determine work patterns and trends in the orthodontic workforce.

Identification of dfrA14 in two distinct plasmids conferring trimethoprim resistance in Actinobacillus pleuropneumoniae.

OBJECTIVES: The objective of this study was to determine the distribution and genetic basis of trimethoprim resistance in Actinobacillus pleuropneumoniae isolates from pigs in England. METHODS: Clinical isolates collected between 1998 and 2011 were tested for resistance to trimethoprim and sulphonamide. The genetic basis of trimethoprim resistance was determined by shotgun WGS analysis and the subsequent isolation and sequencing of plasmids. RESULTS: A total of 16 (out of 106) A. pleuropneumoniae isolates were resistant to both trimethoprim (MIC >32 mg/L) and sulfisoxazole (MIC ≥256 mg/L), and a further 32 were resistant only to sulfisoxazole (MIC ≥256 mg/L). Genome sequence data for the trimethoprim-resistant isolates revealed the presence of the dfrA14 dihydrofolate reductase gene. The distribution of plasmid sequences in multiple contigs suggested the presence of two distinct dfrA14-containing plasmids in different isolates, which was confirmed by plasmid isolation and sequencing. Both plasmids encoded mobilization genes, the sulphonamide resistance gene sul2, as well as dfrA14 inserted into strA, a streptomycin-resistance-associated gene, although the gene order differed between the two plasmids. One of the plasmids further encoded the strB streptomycin-resistance-associated gene. CONCLUSIONS: This is the first description of mobilizable plasmids conferring trimethoprim resistance in A. pleuropneumoniae and, to our knowledge, the first report of dfrA14 in any member of the Pasteurellaceae. The identification of dfrA14 conferring trimethoprim resistance in A. pleuropneumoniae isolates will facilitate PCR screens for resistance to this important antimicrobial.

Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments.

OBJECTIVE: To evaluate associations between neonatal intensive care unit (NICU) room type (open ward and private room) and medical outcomes; neurobehavior, electrophysiology, and brain structure at hospital discharge; and developmental outcomes at 2 years of age. STUDY DESIGN: In this prospective longitudinal cohort study, we enrolled 136 preterm infants born <30 weeks gestation from an urban, 75-bed level III NICU from 2007-2010. Upon admission, each participant was assigned to a bedspace in an open ward or private room within the same hospital, based on space and staffing availability, where they remained for the duration of hospitalization. The primary outcome was developmental performance at 2 years of age (n = 86 infants returned for testing, which was 83% of survivors) measured using the Bayley Scales of Infant and Toddler Development, 3rd Edition. Secondary outcomes were: (1) medical factors throughout the hospitalization; (2) neurobehavior; and (3) cerebral injury and maturation (determined by magnetic resonance imaging and electroencephalography). RESULTS: At term equivalent age, infants in private rooms were characterized by a diminution of normal hemispheric asymmetry and a trend toward having lower amplitude integrated electroencephalography cerebral maturation scores (P = .02; ß = -0.52 [CI -0.95, -0.10]). At age 2 years, infants from private rooms had lower language scores (P = .006; ß = -8.3 [CI -14.2, -2.4]) and a trend toward lower motor scores (P = .02; ß = -6.3 [CI -11.7, -0.99]), which persisted after adjustment for potential confounders. CONCLUSION: These findings raise concerns that highlight the need for further research into the potential adverse effects of different amounts of sensory exposure in the NICU environment.

Radiographic comparison of the extent of orthodontically induced external apical root resorption in vital and root-filled teeth: a systematic review.

OBJECTIVE: to critically analyse the available scientific literature radiographically comparing the incidence of orthodontically induced external apical root resorption (OIEARR) in human root-filled and vital teeth. METHODS: Several electronic databases (MEDLINE, PubMed, EMBASE, Scopus, Web of Science, CINAHL, and the Cochrane Database of Systematic Reviews and Google Scholar) were searched without limits, with the assistance of a senior librarian specialized in Health Sciences database searches. Human, in vivo studies that radiographically compared root resorption following fixed orthodontic treatment in root-filled and vital teeth were selected for full article review. Additionally, the bibliographies of the finally selected articles were hand searched to identify any relevant publications that were not identified by electronic searches. The lowest levels of evidence accepted for inclusion were case controls or cohort studies. Two authors independently reviewed and extracted data from selected studies. RESULTS: A total of 165 original articles were identified from electronic database searches and 2 from hand searches. Once selection criteria were applied, only four articles met all inclusion criteria, and individual analysis of the selected articles was undertaken. CONCLUSIONS: Based on available evidence, root-filled teeth do not appear to be more susceptible to OIEARR than their analogous vital teeth.

Genetics of destemming in pepper: A step towards mechanical harvesting.

Introduction: The majority of peppers in the US for fresh market and processing are handpicked, and harvesting can account for 20-50% of production costs. Innovation in mechanical harvesting would increase availability; lower the costs of local, healthy vegetable products; and perhaps improve food safety and expand markets. Most processed peppers require removal of pedicels (stem and calyx) from the fruit, but lack of an efficient mechanical process for this operation has hindered adoption of mechanical harvest. In this paper, we present characterization and advancements in breeding green chile peppers for mechanical harvesting. Specifically, we describe inheritance and expression of an easy-destemming trait derived from the landrace UCD-14 that facilitates machine harvest of green chiles. Methods: A torque gauge was used for measuring bending forces similar to those of a harvester and applied to two biparental populations segregating for destemming force and rate. Genotyping by sequencing was used to generate genetic maps for quantitative trait locus (QTL) analyses. Results: A major destemming QTL was found on chromosome 10 across populations and environments. Eight additional population and/or environment-specific QTL were also identified. Chromosome 10 QTL markers were used to help introgress the destemming trait into jalapeño-type peppers. Low destemming force lines combined with improvements in transplant production enabled mechanical harvest of destemmed fruit at a rate of 41% versus 2% with a commercial jalapeno hybrid. Staining for the presence of lignin at the pedicel/fruit boundary indicated the presence of an abscission zone and homologs of genes known to affect organ abscission were found under several QTL, suggesting that the easy-destemming trait may be due to the presence and activation of a pedicel/fruit abscission zone. Conclusion: Presented here are tools to measure the easy-destemming trait, its physiological basis, possible molecular pathways, and expression of the trait in various genetic backgrounds. Mechanical harvest of destemmed mature green chile fruits was achieved by combining easy-destemming with transplant management.

3D Printed Motor-Sensory Module Prototype for Facial Rehabilitation.

This work demonstrates the first 3D printed wearable motor-sensory module prototype designed for facial rehabilitation, focusing on facial paralysis. The novelty of the work lies in the fast fabrication of the first fully soft working prototype, including feedback control, with a focus on the methodology for individual customization. Facial paralysis results from a variety of conditions, and more wearable and modular technologies are needed to address the complexity of facial movement rehabilitation. Smiling muscles are especially important for both expression and eating, and so this work focuses on this motion as an example of how the module can be applied to mimic and support needed muscle movement. A generalized actuator-sensor pair with a feedback control system is created to translate signals from smiling on the healthy side of the face (notably temporal and zygomatic branch) to actuation on the paralyzed side of the face for augmented physiotherapy. Fabric and a sensor fluid are integrated during the silicone printing process to create a multicomponent wearable that is ready to use with minimal postprocessing. The actuators' force and vertical contraction results under a 0.98 and 1.96 N load meet the 1-7 N requirements needed for smiling. It is a challenge to measure soft surface-based force and contraction ratio consistently; therefore, a novel modular surface is designed to simulate the interaction of skin and bone using 3D printed hard plastic (bone) and a silicone sheet (skin). The actuator is tested on top of four different repeatable and standardized surface morphologies, and results reveal that the actuator force application will vary based on topography and hardness of the facial surface. Demonstration of the complete system on the face while collecting sensor and pressure data serves as a proof-of-concept and motivates potential applications in rapid customization of highly specialized soft wearable orthotics, prosthetics, and rehabilitation devices. This unique actuator-sensor combination can have additional applications for wearables due to the (1) customizability, (2) closed-loop control, and (3) unique "grounding" test platform.

Chile Pepper (Capsicum) Breeding and Improvement in the "Multi-Omics" Era.

Chile pepper (Capsicum spp.) is a major culinary, medicinal, and economic crop in most areas of the world. For more than hundreds of years, chile peppers have "defined" the state of New Mexico, USA. The official state question, "Red or Green?" refers to the preference for either red or the green stage of chile pepper, respectively, reflects the value of these important commodities. The presence of major diseases, low yields, decreased acreages, and costs associated with manual labor limit production in all growing regions of the world. The New Mexico State University (NMSU) Chile Pepper Breeding Program continues to serve as a key player in the development of improved chile pepper varieties for growers and in discoveries that assist plant breeders worldwide. Among the traits of interest for genetic improvement include yield, disease resistance, flavor, and mechanical harvestability. While progress has been made, the use of conventional breeding approaches has yet to fully address producer and consumer demand for these traits in available cultivars. Recent developments in "multi-omics," that is, the simultaneous application of multiple omics approaches to study biological systems, have allowed the genetic dissection of important phenotypes. Given the current needs and production constraints, and the availability of multi-omics tools, it would be relevant to examine the application of these approaches in chile pepper breeding and improvement. In this review, we summarize the major developments in chile pepper breeding and present novel tools that can be implemented to facilitate genetic improvement. In the future, chile pepper improvement is anticipated to be more data and multi-omics driven as more advanced genetics, breeding, and phenotyping tools are developed.

PI-RADSv2.1: Current status.

Multiparametric magnetic resonance imaging (mpMRI) has played an increasing role in the detection and local staging of prostate cancer over the last 15 years. Prostate mpMRI, due to various factors, is prone to high inter-reader variability necessitating standardized reporting guidelines that provide accurate and actionable information to the ordering clinician. The Prostate Imaging-Reporting and Data System version 2.1 (PI-RADSv2.1) was released in March 2019 as an update to PI-RADSv2.0 with the hope of further standardizing the reporting process of prostate mpMRI, improving the detection of clinically significant cancer, reducing the biopsy rate of indolent tumors, and decreasing inter-reader variability. Early data show an improved performance of PI-RADSv2.1 over PI-RADSv2.0. Updates included in PI-RADSv2.1 and its current experience in clinic will be reviewed in this review.

Quick guide on radiology image pre-processing for deep learning applications in prostate cancer research.

Purpose: Deep learning has achieved major breakthroughs during the past decade in almost every field. There are plenty of publicly available algorithms, each designed to address a different task of computer vision in general. However, most of these algorithms cannot be directly applied to images in the medical domain. Herein, we are focused on the required preprocessing steps that should be applied to medical images prior to deep neural networks. Approach: To be able to employ the publicly available algorithms for clinical purposes, we must make a meaningful pixel/voxel representation from medical images which facilitates the learning process. Based on the ultimate goal expected from an algorithm (classification, detection, or segmentation), one may infer the required pre-processing steps that can ideally improve the performance of that algorithm. Required pre-processing steps for computed tomography (CT) and magnetic resonance (MR) images in their correct order are discussed in detail. We further supported our discussion by relevant experiments to investigate the efficiency of the listed preprocessing steps. Results: Our experiments confirmed how using appropriate image pre-processing in the right order can improve the performance of deep neural networks in terms of better classification and segmentation. Conclusions: This work investigates the appropriate pre-processing steps for CT and MR images of prostate cancer patients, supported by several experiments that can be useful for educating those new to the field (https://github.com/NIH-MIP/Radiology_Image_Preprocessing_for_Deep_Learning).

Determination of disease severity in COVID-19 patients using deep learning in chest X-ray images.

PURPOSE: Chest X-ray plays a key role in diagnosis and management of COVID-19 patients and imaging features associated with clinical elements may assist with the development or validation of automated image analysis tools. We aimed to identify associations between clinical and radiographic features as well as to assess the feasibility of deep learning applied to chest X-rays in the setting of an acute COVID-19 outbreak. METHODS: A retrospective study of X-rays, clinical, and laboratory data was performed from 48 SARS-CoV-2 RT-PCR positive patients (age 60±17 years, 15 women) between February 22 and March 6, 2020 from a tertiary care hospital in Milan, Italy. Sixty-five chest X-rays were reviewed by two radiologists for alveolar and interstitial opacities and classified by severity on a scale from 0 to 3. Clinical factors (age, symptoms, comorbidities) were investigated for association with opacity severity and also with placement of central line or endotracheal tube. Deep learning models were then trained for two tasks: lung segmentation and opacity detection. Imaging characteristics were compared to clinical datapoints using the unpaired student's t-test or Mann-Whitney U test. Cohen's kappa analysis was used to evaluate the concordance of deep learning to conventional radiologist interpretation. RESULTS: Fifty-six percent of patients presented with alveolar opacities, 73% had interstitial opacities, and 23% had normal X-rays. The presence of alveolar or interstitial opacities was statistically correlated with age (P = 0.008) and comorbidities (P = 0.005). The extent of alveolar or interstitial opacities on baseline X-ray was significantly associated with the presence of endotracheal tube (P = 0.0008 and P = 0.049) or central line (P = 0.003 and P = 0.007). In comparison to human interpretation, the deep learning model achieved a kappa concordance of 0.51 for alveolar opacities and 0.71 for interstitial opacities. CONCLUSION: Chest X-ray analysis in an acute COVID-19 outbreak showed that the severity of opacities was associated with advanced age, comorbidities, as well as acuity of care. Artificial intelligence tools based upon deep learning of COVID-19 chest X-rays are feasible in the acute outbreak setting.