Impact of Data Presentation on Physician Performance Utilizing Artificial Intelligence-Based Computer-Aided Diagnosis and Decision Support Systems.

Ultrasound (US) is a valuable imaging modality used to detect primary breast malignancy. However, radiologists have a limited ability to distinguish between benign and malignant lesions on US, leading to false-positive and false-negative results, which limit the positive predictive value of lesions sent for biopsy (PPV3) and specificity. A recent study demonstrated that incorporating an AI-based decision support (DS) system into US image analysis could help improve US diagnostic performance. While the DS system is promising, its efficacy in terms of its impact also needs to be measured when integrated into existing clinical workflows. The current study evaluates workflow schemas for DS integration and its impact on diagnostic accuracy. The impact on two different reading methodologies, sequential and independent, was assessed. This study demonstrates significant accuracy differences between the two workflow schemas as measured by area under the receiver operating curve (AUC), as well as inter-operator variability differences as measured by Kendall's tau-b. This evaluation has practical implications on the utilization of such technologies in diagnostic environments as compared to previous studies.

Use of Screening Tests for Colorectal Cancer Among Gynecologists in Puerto Rico.

OBJECTIVE: To determine the use of screening tests for colorectal cancer (CRC) among Gynecologists in Puerto Rico. This study evaluates the screening practices used by Gynecologists in PR to diagnose CRC and adherence to screening guidelines. METHODS: A self-administered anonymous questionnaire was mailed to 440 practicing gynecologists through the College of Physicians and Surgeons of PR. The questionnaire included general and specific questions. RESULTS: Response rate was 23.2% (102/440). Of this group of gynecologists, 77.5% referred screening patients, while 22.5% did not. The majority (28.4%) use Fecal Occult Blood Test (FOBT) as a first screening test, while 27.5% use Colonoscopy. Screening is started by 49% at age 50. Only 7% stop screening at 75 years and 31% never stop screening. CRC Screening performed by participants were: 35% screen annually, 6% screen 2-3 years, 10% screen every 5 years, 6% screen every 10 years and 6% screen 5-10 years. Data for CRC Screening reveals 7% gynecologists comply with all the guidelines; 49% comply with the recommendations regarding the start screening age and 7% stop screening as per guidelines. CONCLUSION: The recommendations are not followed by most of the gynecologists in PR that participated in the study, Further research should be directed towards the reasons for not complying and how to educatethemedical population to achieve adequate screening in the PR female population.

A pilot program to improve TB care with primary and specialty care coordination in TB public health clinic.

BACKGROUND: The Wetmore Tuberculosis (TB) Clinic in New Orleans serves patients who often lack primary care (PC) or specialty care (SC), which is complicated by comorbidities. An initiative to provide on-site PC and coordinate care aims to enhance TB patient management. METHODS: Data collection involved categorizing patients based on their PC status: Group I (regular PC), Group II (intermittent PC), and Group III (no PC), with on-site Nurse Practitioner-based Bridge Care (NPBC) provided as needed. RESULTS: Over 12 months, 209 out of 354 patients required NPBC and PC/SC coordination, with a 20% shift from Group III to Group I, reducing the need for NPBC. CONCLUSION: The program improved TB care at Wetmore TB Clinic, offering a potential model for other TB clinics to enhance patient adherence and TB and post-TB treatment follow-up.

CONTEXTE: La clinique de TB de Wetmore à la Nouvelle-Orléans, États Unis, dessert des patients qui manquent souvent de soins primaires (PC, pour l'anglais « primary care ¼) ou de soins spécialisés (SC, pour l'anglais « specialty care ¼), ce qui est compliqué par des comorbidités. Une initiative visant à fournir des ordinateurs sur place et à coordonner les soins vise à améliorer la prise en charge des patients atteints de TB. MÉTHODES: La collecte des données a consisté à catégoriser les patients en fonction de leur statut de PC : Groupe I (PC régulier), Groupe II (PC intermittent) et GROUPE III (pas de PC), avec des soins de transition basés sur l'infirmière praticienne (NPBC, pour l'anglais « Nurse Practitioner-based Bridge Care ¼) sur place fournis au besoin. RÉSULTATS: Sur une période de 12 mois, 209 patients sur 354 ont nécessité une coordination NPBC et PC/SC, avec un passage de 20% du groupe III au groupe I, réduisant ainsi le besoin de NPBC. CONCLUSION: Le programme a amélioré les soins contre la TB à la clinique de TB de Wetmore, proposant ainsi un modèle potentiel pour d'autres cliniques afin d'améliorer l'observance des patients et le suivi du traitement de la TB et de la période post-traitement.

The cross-sectional and longitudinal dependence of the resting metabolic rate on the fat-free mass.

The dependence of the resting metabolic rate (RMR) on the fat-free mass (FFM) of temporarily fasted well-fed subjects has been studied by many researchers over the years. The results of 10 such studies yield an average linear dependence with a slope of 75 +/- 15 kJ/kg per day. In the work of Keys et al (The biology of human starvation. Minneapolis, MN: University of Minnesota Press, 1950) on semistarved subjects, however, the slope of the RMR dependence on the FFM was found to be 280 +/- 50 kJ/kg per day. The argument presented in this article is that the result derived for the large group of well-fed subjects is cross-sectional information, whereas that for the semistarved subjects is longitudinal data. The linear regression of the longitudinal data yields a negative offset term that when combined with the RMR vs FFM slope divides the FFM into active and inactive components, active tissue being that which interacts directly with oxygen. The linearity of the RMR vs FFM curve suggests that the elements of the active tissue mass are energetically similar regardless of their distribution in the body's organ systems. The active-inactive model implies that the longitudinal data results from the decrease in active tissue alone, whereas cross-sectional data for different individuals correspond to an admixture of both active and inactive tissue. For different individuals having the average RMR vs FFM slope of the semistarved subjects, it is calculated that a change in the FFM consists of about 27% active and 73% inactive tissue. A histogram of the individual longitudinal RMR vs FFM slopes for the 32 semistarved subjects yields an unexpected non-Gaussian distribution with a minimal value of 158 kJ/kg per day and a maximal value of 405 kJ/kg per day.

A microlaparoscopic technique for Pomeroy tubal ligation.

OBJECTIVE: To evaluate the efficacy of performing Pomeroy tubal ligation using microlaparoscopic techniques. METHODS: Thirty-eight consecutive women desiring permanent sterilization underwent laparoscopic Pomeroy tubal ligation using small (2 or 5 mm) transumbilical laparoscopes and secondary midline sites (5 mm and 14 gauge). The procedures were performed under general anesthesia (n = 28) or local anesthesia with conscious sedation (n = 10). RESULTS: The mean operative time +/- standard deviation (SD) in minutes was 33.0 +/- 10.3. The mean recovery time +/- SD in minutes was 104.3 +/- 41.6. There were no operative complications, and no cases required conversion from the microlaparoscopic technique to a traditional method. CONCLUSION: The results of this study indicate that the Pomeroy tubal ligation may be performed using microlaparoscopic techniques. Furthermore, in selected cases, this technique can be performed under local anesthesia in an outpatient setting.

Cardiac tamponade resulting from pneumopericardium: case report and implications for the critical care nurse.

Pneumopericardium resulting in cardiac tamponade may be caused by a variety of phenomena. The onset of cardiac tamponade can indicate the presence of a rare underlying condition. As a rare complication of mechanical ventilation and PEEP, our patient experienced pneumopericardium that resulted in cardiac tamponade. Perhaps the most crucial therapy of all is astute critical care nursing assessment of patients at risk of developing the life-threatening complication of cardiac tamponade. All critical care nurses should know the signs and symptoms of cardiac tamponade. Through accurate data collection, frequent monitoring, and immediate referral to the critical care team for medical diagnosis and treatment, a patient's death can be prevented.

Treatment activity preferences of occupational therapists in adult physical dysfunction settings.

OBJECTIVES: Research has suggested that using an adaptive approach to provide direct training in occupational behaviors is more effective than using a remedial approach to retrain component skills. This survey was done to see whether occupational therapy practice in physical dysfunction reflects that research. METHOD: Surveys from a convenience sample of 269 (70.2% response rate) occupational therapy directors in adult physical rehabilitation facilities throughout the United States were analyzed to determine the relative rankings of remedial and adaptive activities by therapists in those settings. RESULTS: For all facilities combined, the four most frequently used types of activities, in order of frequency, were self-care, upper extremity exercise, functional mobility, and neuromuscular training. Facilities using multiple formal methods to assess client priorities used functional activities more frequently than other facilities. CONCLUSION: Occupational therapists in adult physical dysfunction settings are not routinely providing client training in the full spectrum of occupational behaviors.

Preoperative fluid restrictions: hospital policy and clinical practice.

This study examined the practice of preoperative fluid restrictions and the influence of the hospital 'nil by mouth' policy on clinical practice. Structured interviews were used to assess the knowledge of nurses and anaesthetists relating to current hospital policy, their attitudes to fluid fasting and the constituents of clear fluids. The interval between the last intake of fluid and the induction of anaesthesia was measured in 90 adult patients to determine actual periods of fasting. It was found that most patients on the same operating list commenced fasting simultaneously with little or no attempt made to individualize the timing which contributed to prolonged periods without fluids, ranging from 3 hours 30 minutes to 17 hours and 45 minutes. Only 30% of nurses were aware of the hospital policy compared with 75% of anaesthetists. The evidence from this study demonstrated that the hospital policy was not reflected in clinical practice which continued to be based on tradition.

Causes and treatment options for women with dyspareunia.

The incidence of dyspareunia, defined as difficult and painful intercourse, appears to be increasing. A symptom not a disease, dyspareunia is rarely reported by patients, even though it may be the actual reason why they seek health care. Often, patients will only discuss their concerns after questioning. Health care professionals who provide primary care to women must understand the various etiologies of dyspareunia. Possible causes of dyspareunia as well as current treatment modalities are identified. Sex education, counseling, vaginal dilatation and pelvic-relaxation exercises may be needed to restore the woman's confidence and decrease anxiety. Not until all organic causes of dyspareunia are ruled out, should the option of psychiatric intervention be suggested.

Diagnosis and treatment of ankle sprains.

Clinicians in ambulatory and primary care are almost guaranteed, at some point in their practice, to encounter a patient who has suffered an ankle injury. They must be prepared to diagnose, treat, and refer appropriately. By understanding the anatomy of the ankle, the health care provider will understand the mechanisms and common types of injury. By using techniques of inspection, palpation, and performing the anterior drawer and talar tilt tests, the clinician can grade a sprain accordingly, and refer for x-rays or orthopedic consultation appropriately. The principles of RICE (rest, ice, compression, elevation) are explained and different treatment methodologies for grades I to III of sprain are discussed.

Exposure to copper induces oxidative and stress responses and DNA damage in the coral Montastraea franksi.

Copper is a common chemical contaminant in coastal environments, including coral reefs. Ecotoxicological studies have demonstrated that exposure to copper can cause stress and detrimental effects in both host cnidarian and algal symbionts. The objective of this study was to investigate the sublethal effects of copper on the reef-building coral Montastraea franksi, by identifying genes with altered expression in corals exposed to dissolved copper, and by measuring the extent of damage to DNA in response to copper exposure. Corals exposed to 30 µg L(-1) copper for 48 h experienced significant DNA damage and displayed changes in expression patterns of genes that are known to play role cellular and oxidative stress responses. Corals also experienced changes in gene expression of genes that are not already known to play roles in oxidative stress in corals. Our data suggest that these genes may either play roles directly in mediating a stress response, or may be genes acting downstream of the stress response. These include an ETS domain-containing transcription factor related to the ETS1 family of transcription factors, known in mammals to mediate development, disease, and stress response, and two genes that are associated with biomineralization: galaxin, a protein from the organic matrix of the coral skeleton, and a coral-specific gene SCRIP2.

A limit on the energy transfer rate from the human fat store in hypophagia.

A limit on the maximum energy transfer rate from the human fat store in hypophagia is deduced from experimental data of underfed subjects maintaining moderate activity levels and is found to have a value of (290+/-25) kJ/kgd. A dietary restriction which exceeds the limited capability of the fat store to compensate for the energy deficiency results in an immediate decrease in the fat free mass (FFM). In cases of a less severe dietary deficiency, the FFM will not be depleted. The transition between these two dietary regions is developed and a criterion to distinguish the regions is defined. An exact mathematical solution for the decrease of the FFM is derived for the case where the fat mass (FM) is in its limited energy transfer mode. The solution shows a steady-state term which is in agreement with conventional ideas, a term indicating a slow decrease of much of the FFM moderated by the limited energy transferred from the fat store, and a final term showing an unprotected rapid decrease of the remaining part of the FFM. The average resting metabolic rate of subjects undergoing hypophagia is shown to decrease linearly as a function of the FFM with a slope of (249+/-25) kJ/kgd. This value disagrees with the results of other observers who have measured metabolic rates of diverse groups. The disagreement is explained in terms of individual metabolic properties as opposed to those of the larger population.

FMRFamide-like material in the earwig, Euborellia annulipes, and its functional significance.

The neurosecretory system of the earwig, Euborellia annulipes, contained material similar to that of FMRFamide, as shown by immunocytochemistry. Within the brain were two pairs of darkly staining perikarya in the medial protocerebrum, and up to four pairs of immunoreactive cells in the lateral protocerebrum. The corpora allata appeared immunoreactive in 10-day females, but not in 2-day-old adults. Additionally, immunoreactive material was detected in midgut endocrine cells of both 2- and 10-day-old females. FMRFamide at 1 to 100 nM did not inhibit juvenile hormone production by earwig corpora allata in vitro. This was true of glands of low activity from 2-day cat food-fed or starved virgin females, 10-day starved females, and those of relatively high activity from 10-day-old, cat food-fed females. In contrast, FMRFamide at 50 and 100 (but not at 1) nM stimulated gut motility in vitro in distended guts from 2-day fed females. Preparations from starved females and those from 10-day fed females (in which feeding behavior is on the decline) did not respond to exogenous FMRFamide with enhanced rates of contraction. Lastly, preparations from females starved for 7 days and subsequently fed for 3 days responded to 10 nM FMRFamide with increases in gut motility.

Interface skin pressures on four pressure-relieving devices.

Nurses employed in acute care hospitals frequently encounter patients who require a pressure-relieving device. It is often difficult for nurses to decide which support surface should be used to best meet a patient's need for a pressure-reducing device because of the multiplicity of products available. One of the variables studied was found not to statistically influence the effectiveness of the various pressure-relieving devices. Body build is not a consideration when determining which support surface is effective in a healthy population of subjects. The two air-flotation low air-loss beds would be defined as effective pressure-relieving devices. The interface pressure readings vary from individual to individual on various bony prominences. The population studied was that of healthy volunteers. Healthy subjects have an increased fat pad in their sacral area compared with the critically ill patient. The heel had the highest interface pressure of the five that were studied. This is a bony prominence that requires additional attention if skin integrity is to be maintained.

The disconnection syndrome. Basic findings reaffirmed.

Recent challenges to the traditional view of the disconnection syndrome have been based primarily on evidence of information shared between the hemispheres in commissurotomy patients L.B. and N.G. of the West Coast series. In order to evaluate the generality of these claims, patients J.W., V.P. and D.R. were tested using a series of experiments which replicated and extended some of the experiments carried out in the West Coast series. Using comparisons of numerical identity and value as the model tasks, we found no indication that the separated hemispheres of J.W. or D.R. could share information on any of the tasks they performed. V.P., who has spared callosal fibres and has shown highly specific transfer in previous investigations, performed above chance (60%) in one out of three between field conditions. Together the data fail to support the claims that split-brain patients show evidence of unified cognitive functioning particularly for more abstract, nonperceptual tasks. The data are consistent with the traditional view of the corpus callosum as the primary interhemispheric pathway by which sensory and high-level cognitive integration is achieved.

Comparison of descriptive variables for symptomatic volunteers and clinical patients with anxiety disorders.

Worry about the generalizability of findings derived from clinical trials is a nagging problem. Because most clinical trials use individuals recruited by advertisements rather than patients solicited from clinical practice, bias in subject recruitment is a major concern. This paper compares and contrasts the demographic characteristics, symptomatologies, functional disabilities, health beliefs, and health expectations of clinical outpatients to those of subjects recruited from the media (symptomatic volunteers) for pharmacologic trials. Clinical patients were slightly younger, better educated, wealthier, and were more likely to be married. They had more recent exposure to benzodiazepines and antidepressants and were more likely to view their current condition as amenable to psychotherapy. They were more likely to feel that their symptoms would get worse without some type of treatment and to believe that treatment would cure them. The symptomatic volunteers had more presenting symptoms than the clinical patients. The two groups had similar Sheehan Disability Scale scores. These results suggest that further study is warranted of the characteristics of clinical patients and symptomatic volunteers.

A comparison of descriptive variables for clinical patients and symptomatic volunteers with depressive disorders.

Uncertainty about the generalizability of results from clinical trials is a nagging issue plaguing psychiatric research. The possible bias introduced by the use of subjects recruited from advertisements is one source of concern. Investigators question whether these subjects are representative of the types of individuals who seek treatment in clinical practice. This article compares and contrasts demographic characteristics, functional disabilities, symptomatologies, and the health beliefs and expectations of a cohort seeking treatment at a university outpatient clinic with a cohort of symptomatic volunteers recruited by advertisements. These two groups were alike in most variables; however, the clinical subjects reported more recent exposure to psychotropic medications and were more likely to indicate that they wanted psychotherapy. The symptomatic volunteers were slightly older, endorsed more psychiatric symptoms, drank more alcohol, and believed that combined pharmacology and psychotherapy would most help them. These findings suggest that the two cohorts were remarkably similar on most variables.