Experimental nest cooling reveals dramatic effects of heatwaves on reproduction in a Mediterranean bird of prey.

Future climatic scenarios forecast increases in average temperatures as well as in the frequency, duration, and intensity of extreme events, such as heatwaves. Whereas behavioral adjustments can buffer direct physiological and fitness costs of exposure to excessive temperature in wild animals, these may prove more difficult during specific life stages when vagility is reduced (e.g., early developmental stages). By means of a nest cooling experiment, we tested the effects of extreme temperatures on different stages of reproduction in a cavity-nesting Mediterranean bird of prey, the lesser kestrel (Falco naumanni), facing a recent increase in the frequency of heatwaves during its breeding season. Nest temperature in a group of nest boxes placed on roof terraces was reduced by shading them from direct sunlight in 2 consecutive years (2021 and 2022). We then compared hatching failure, mortality, and nestling morphology between shaded and non-shaded (control) nest boxes. Nest temperature in control nest boxes was on average 3.9°C higher than in shaded ones during heatwaves, that is, spells of extreme air temperature (>37°C for ≥2 consecutive days) which hit the study area during the nestling-rearing phase in both years. Hatching failure markedly increased with increasing nest temperature, rising above 50% when maximum nest temperatures exceeded 44°C. Nestlings from control nest boxes showed higher mortality during heatwaves (55% vs. 10% in shaded nest boxes) and those that survived further showed impaired morphological growth (body mass and skeletal size). Hence, heatwaves occurring during the breeding period can have both strong lethal and sublethal impacts on different components of avian reproduction, from egg hatching to nestling growth. More broadly, these findings suggest that the projected future increases of summer temperatures and heatwave frequency in the Mediterranean basin and elsewhere in temperate areas may threaten the local persistence of even relatively warm-adapted species.

Multipitch estimation based on the iterative detection and separation of note events from single-channel polyphonic recordings.

Multiple fundamental frequency estimation has been extensively used in applications such as melody extraction, music transcription, instrument identification, and source separation. This paper presents an approach based on the iterative detection and extraction of note events, which are considered to be harmonic sounds characterised by a continuous pitch trajectory. Note events are assumed to be associated with musical notes being played by a single instrument, and their pitch trajectories are iteratively estimated. In every iteration, the pitch contour of the predominant note event is selected from a set of pitch estimates and used to separate its spectral energy from the input mixture in order to obtain a residual signal, which is then used as input in the next iteration. This iterative process stops when the energy of the residual is below a significance threshold. The pitch trajectories of all detected note events are then revised and reassembled to form the final set of pitch estimates for the original audio input. Evaluation of performance is conducted in different scenarios to show the potential of the proposed system, both in terms of its accuracy, and also as an initial stage in other complex tasks, such as note tracking and multipitch streaming.

[The Bayes factor in the analysis of mechanical power in patients with severe respiratory failure due to SARS-CoV-2]. / El método del factor de Bayes en el análisis de la energía mecánica en pacientes con insuficiencia respiratoria grave por SARS-CoV-2.

Objective: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17 J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design: Cohort study, longitudinal, analytical. Setting: Intensive care unit of a third level hospital in Spain. Patients: Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. Interventions: Bayesian analysis with the beta binomial model. Main variables of interest: Bayes factor, mechanical power. Results: A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83 × 106), peak pressure value (BF10: 3.72 × 1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP < 17 J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP ≥ 17 J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. Conclusions: A MP ≥ 17 J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease.

Evolution and conservation genetics of an insular hemiparasitic plant lineage at the limit of survival: the case of Thesium sect. Kunkeliella in the Canary Islands.

PREMISE: The diversification of island flora has been widely studied. However, the role of environmental niches in insular radiation processes has been less investigated. We combined population genetic analyses with species distribution modelling to clarify the genetic relationships, diversification patterns, species niche requirements, and conservation of Thesium sect. Kunkeliella, a clade of rare hemiparasitic plants endemic to the Canaries. METHODS: We studied the three extant Thesium species and a new taxon from La Palma Island. We developed 12 microsatellites and performed population genetic analysis and studied the demographic history of the group. To evaluate the role of niche conservatism in the diversification of the group, we performed species distribution modelling (ESM) with four algorithms. RESULTS: All species presented moderate genetic diversity values for rare endemics. Thesium canariense (Gran Canaria) showed high differentiation, whereas T. subsucculentum, T. retamoides (Tenerife), and La Palma populations are closely related. The lineage may have undergone a recent diversification with colonization proceeding east to west, with T. canariense as sister to the others. We detected a climatic niche shift, as taxa showed different distributions across the temperature gradient. There is enough evidence to describe La Palma populations as a new species. CONCLUSIONS: We characterized the evolutionary history of Thesium sect. Kunkeliella by integrating genetic and ecological assessments. Our results indicate that this clade has undergone a recent radiation process with niche differentiation among species. The results increase our knowledge about insular radiations and will inform the conservation management of the study species.

Influence of androgen deprivation therapy on the severity of COVID-19 in prostate cancer patients.

BACKGROUND: The TMPRSS2 protein has been involved in severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). The production is regulated by the androgen receptor (AR). It is speculated that androgen deprivation therapy (ADT) may protect patients affected by prostate cancer (PC) from SARS-CoV-2 infection. METHODS: This is a retrospective study of patients treated for COVID-19 in our institution who had a previous diagnosis of PC. We analyzed the influence of exposure of ADT on the presence of severe course of COVID-19. RESULTS: A total of 2280 patients were treated in our center for COVID-19 with a worse course of disease in males (higher rates of hospitalization, intense care unit [ICU] admission, and death). Out of 1349 subjects registered in our PC database, 156 were on ADT and 1193 were not. Out of those, 61 (4.52%) PC patients suffered from COVID-19, 11 (18.0%) belonged to the ADT group, and 50 (82.0%) to the non-ADT group. Regarding the influence of ADT on the course of the disease, statistically significant differences were found neither in the death rate (27.3% vs. 34%; p = 0.481), nor in the presence of severe COVID-19: need for intubation or ICU admission (0% vs. 6.3%; p = 0.561) and need for corticoid treatment, interferon beta, or tocilizumab (60% vs. 34.7%; p = 0.128). Multivariate analysis adjusted for clinically relevant comorbidities did not find that ADT was a protective factor for worse clinical evolution (risk ratio [RR] 1.08; 95% confidence interval [CI], 0.64-1.83; p = 0.77) or death (RR, 0.67; 95% CI, 0.26-1.74; p = 0.41). CONCLUSIONS: Our study confirms that COVID-19 is more severe in men. However, the use of ADT in patients with PC was not shown to prevent the risk of severe COVID-19.

Problem-solving in a cooperative task in peach-fronted conures (Eupsittula aurea).

Cooperation is a complex behaviour found in many kinds of organisms and occurs between individuals of the same and different species. Several studies have examined the intentionality of this behaviour by testing the animals' understanding of the need for a partner when working in pairs. The mammalian species tested express such understanding, whereas most tested birds fail, especially when the test involves a delayed access to the setup by one of the co-operators. In the present study, the cooperative problem-solving capability of four peach-fronted conures (Eupsittula aurea) was investigated with the loose string test. All four parrots solved the paradigm by simultaneously pulling the ends of the same string to bring a platform with a food reward within reach. They were also capable of solving the task when one of the co-operators was delayed, even when visually isolated from each other. To further test their comprehension and to exclude the birds relying on task-associated cues, we video-recorded the trials and quantified possible cues and strategies for timing the pulling behaviour (e.g., sound of the partner's door when opening, sound of steps of partner approaching). The preferred cue to start pulling was to wait for their partner's arrival to the string. The number of vocalisations was significantly higher during visually isolated conditions and for successful trials compared to failed trials, suggesting possible information exchange. Our findings show that peach-fronted conures can solve a cooperative task, and that cooperation success is not determined by external cues or by partner identity or affinity.

New 2,6,9-trisubstituted purine derivatives as Bcr-Abl and Btk inhibitors and as promising agents against leukemia.

Bcr-Abl and Btk kinases are among the targets that have been considered for the treatment of leukemia. Therefore, several strategies have focused on the use of inhibitors as chemotherapeutic tools to treat these types of leukemia, such as imatinib (for Bcr-Abl) or ibrutinib (for Btk). However, the efficacy of these drugs has been reduced due to resistance mechanisms, which have motivated the development of new and more effective compounds. In this study, we designed, synthesized and evaluated 2,6,9-trisubstituted purine derivatives as novel Bcr-Abl and Btk inhibitors. We identified 5c and 5d as potent inhibitors of both kinases (IC50 values of 40 nM and 0.58/0.66 µM for Abl and Btk, respectively). From docking and QSAR analyses, we concluded that fluorination of the arylpiperazine system is detrimental to the activity against two kinases, and we also validated our hypothesis that the substitution on the 6-phenylamino ring is important for the inhibition of both kinases. In addition, our studies indicated that most compounds could suppress the proliferation of leukemia and lymphoma cells (HL60, MV4-11, CEM, K562 and Ramos cells) at low micromolar concentrations in vitro. Finally, we preliminarily demonstrated that 5c inhibited the downstream signaling of both kinases in the respective cell models. Therefore, 5c or 5d possessed potency to be further optimized as anti-leukemia drugs by simultaneously inhibiting the Bcr-Abl and Btk kinases.

Alpine species in dynamic insular ecosystems through time: conservation genetics and niche shift estimates of the endemic and vulnerable Viola cheiranthifolia.

BACKGROUND AND AIMS: Alpine oceanic ecosystems are considered amongst the most ephemeral and restricted habitats, with a biota highly vulnerable to climate changes and disturbances. As an example of an alpine insular endemic, the past and future population genetic structure and diversity, and the future distribution of Viola cheiranthifolia (Violaceae), endemic to Tenerife (Canary Islands), were estimated. The main goals were to predict distribution changes of this alpine oceanic plant under climate change, and to assist in actions for its conservation. METHODS: To perform population genetic analysis, 14 specific microsatellite markers and algorithms which considered the polyploid condition of V. cheiranthifolia were employed. The niche modelling approach incorporated temperature gradients, topography and snow cover maps. Models were projected into climate change scenarios to assess the extent of the altitudinal shifts of environmental suitability. Finally, simulations were performed to predict whether the environmental suitability loss will affect the genetic diversity of populations. KEY RESULTS: Viola cheiranthifolia presents short dispersal capacity, moderate levels of genetic diversity and a clear population genetic structure divided into two main groups (Teide and Las Cañadas Wall), showing signs of recolonization dynamics after volcanic eruptions. Future estimates of the distribution of the study populations also showed that, despite being extremely vulnerable to climate change, the species will not lose all its potential area in the next decades. The simulations to estimate genetic diversity loss show that it is correlated to suitability loss, especially in Las Cañadas Wall. CONCLUSIONS: The low dispersal capacity of V. cheiranthifolia, coupled with herbivory pressure, mainly from rabbits, will make its adaptation to future climate conditions in this fragile alpine ecosystem difficult. Conservation actions should be focused on herbivore control, population reinforcement and surveillance of niche shifts, especially in Guajara, which represents the oldest isolated population and a genetic reservoir for the species.

Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial.

Importance: Daily spontaneous breathing trials (SBTs) are the best approach to determine whether patients are ready for disconnection from mechanical ventilation, but mode and duration of SBT remain controversial. Objective: To evaluate the effect of an SBT consisting of 30 minutes of pressure support ventilation (an approach that is less demanding for patients) vs an SBT consisting of 2 hours of T-piece ventilation (an approach that is more demanding for patients) on rates of successful extubation. Design, Setting, and Participants: Randomized clinical trial conducted from January 2016 to April 2017 among 1153 adults deemed ready for weaning after at least 24 hours of mechanical ventilation at 18 intensive care units in Spain. Follow-up ended in July 2017. Interventions: Patients were randomized to undergo a 2-hour T-piece SBT (n = 578) or a 30-minute SBT with 8-cm H2O pressure support ventilation (n = 557). Main Outcome and Measures: The primary outcome was successful extubation (remaining free of mechanical ventilation 72 hours after first SBT). Secondary outcomes were reintubation among patients extubated after SBT; intensive care unit and hospital lengths of stay; and hospital and 90-day mortality. Results: Among 1153 patients who were randomized (mean age, 62.2 [SD, 15.7] years; 428 [37.1%] women), 1018 (88.3%) completed the trial. Successful extubation occurred in 473 patients (82.3%) in the pressure support ventilation group and 428 patients (74.0%) in the T-piece group (difference, 8.2%; 95% CI, 3.4%-13.0%; P = .001). Among secondary outcomes, for the pressure support ventilation group vs the T-piece group, respectively, reintubation was 11.1% vs 11.9% (difference, -0.8%; 95% CI, -4.8% to 3.1%; P = .63), median intensive care unit length of stay was 9 days vs 10 days (mean difference, -0.3 days; 95% CI, -1.7 to 1.1 days; P = .69), median hospital length of stay was 24 days vs 24 days (mean difference, 1.3 days; 95% CI, -2.2 to 4.9 days; P = .45), hospital mortality was 10.4% vs 14.9% (difference, -4.4%; 95% CI, -8.3% to -0.6%; P = .02), and 90-day mortality was 13.2% vs 17.3% (difference, -4.1% [95% CI, -8.2% to 0.01%; P = .04]; hazard ratio, 0.74 [95% CI, 0.55-0.99]). Conclusions and Relevance: Among patients receiving mechanical ventilation, a spontaneous breathing trial consisting of 30 minutes of pressure support ventilation, compared with 2 hours of T-piece ventilation, led to significantly higher rates of successful extubation. These findings support the use of a shorter, less demanding ventilation strategy for spontaneous breathing trials. Trial Registration: ClinicalTrials.gov Identifier: NCT02620358.

Edible Insects Processing: Traditional and Innovative Technologies.

Insects are part of the human diet in many parts of the world. Their nutritional value is widely recognized. Currently, most edible insects are harvested from the wild, although semi-domestication and indoor farming have increased insect availability and the sustainability of production. In traditional cultures, insects are processed in a number of ways (steaming, roasting, smoking, frying, stewing, and curing, among others) to improve their sensory and nutritional qualities as well as their shelf-life. In order to increase consumer interest in the West, various technologies have been developed that are aimed primarily at using insects as ingredients in a non-recognizable form, such as powders or flour. These technologies include drying (sun-drying, freeze-drying, oven-drying, fluidized bed drying, and microwave-drying) and new processing methods (ultrasound-assisted extraction, cold atmospheric pressure plasma, and dry fractionation) designed mainly for protein, fat, and/or chitin extraction. Insect-based ingredients are sold for the production of cookies, chocolates, tortilla-style chips, and other snacks. This review focuses on edible insect production, processing technologies, and commercialization using strategies ranging from traditional to novel as a sustainable approach for improving food security worldwide.

Air Versus Ground Transportation in Isolated Severe Head Trauma: A National Trauma Data Bank Study.

BACKGROUND: The effect of prehospital helicopter emergency medical services (HEMS) on mortality has been analyzed previously in polytrauma patients with discordant results. OBJECTIVE: Our aim was to compare outcomes in patients with isolated severe blunt traumatic brain injuries (TBIs) transported by HEMS or ground emergency medical services (GEMS). METHODS: We conducted a National Trauma Data Bank study (2007-2014). All adult patients (≥16 years old) who sustained an isolated severe blunt TBI and were transported by HEMS or GEMS were included in the study. RESULTS: There were 145,559 patients who met the inclusion criteria. Overall, 116,391 (80%) patients were transported via GEMS and 29,168 (20%) via HEMS. Median transportation time was longer for HEMS patients (41 vs. 25 min; p < 0.001). HEMS patients were more likely to have hypotension (2.7% vs. 1.5%; p < 0.001), Glasgow Coma Scale (GCS) score < 9 (38.2% vs. 10.9%; p < 0.001), and head Abbreviation Injury Scale (AIS) score of 5 (20.1% vs. 9.7%; p < 0.001). Stepwise logistic regression analysis identified age ≥ 65 years old, male sex, hypotension, GCS score < 9, prehospital intubation, and head AIS scores 4 and 5 as independent predictors of mortality. Helicopter transportation was independently associated with improved survival (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.47-0.67; p < 0.001). Admission to a Level I trauma center was an independent predictor of survival (OR 0.64; 95% CI 0.53-0.82; p = 0.001). Regardless of head AIS, helicopter transport was an independent predictor of survival (AIS 3: OR 0.35; p < 0.001; AIS 4: OR 0.44; p < 0.001; AIS 5: OR 0.76; p < 0.001). A prolonged transport time was not an independent predictor of mortality. CONCLUSIONS: Helicopter transport, in adult patients with isolated severe TBI, is associated with improved survival.

Ornithophily for the nonspecialist: Differential pollination efficiency of the Macaronesian island paleoendemic Navaea phoenicea (Malvaceae) by generalist passerines.

PREMISE OF THE STUDY: A bird pollination syndrome exists in the Canary Islands archipelago across independent plant lineages despite the absence of specialist birds. The pollination efficiency of current floral visitors remains unknown for many plant species despite this being a fundamental factor in testing hypotheses about the origin of the syndrome. Here, we studied the components of pollination efficiency in the paleoendemic Navaea phoenicea, a species exhibiting conspicuous anatomical modifications associated with bird pollination. METHODS: We measured the components of the pollination efficiency (PE) of species foraging on flowers. The measured quantitative components were visitation frequency patterns to plants and individual flowers. The qualitative components were the contributions to the fitness of male and female functions (pollen removal and deposition and fruit set). KEY RESULTS: Pollination by warbler species was highly efficient, but visit frequency was low; conversely, Canarian chiffchaffs had high visit frequency and low efficiency. Overall PE was almost 0 for blue tits due to disruptive behavior. We also found insects acting as nectar robbers. CONCLUSIONS: Pollination efficiency of three of the four bird species visiting flowers of Navaea phoenicea may be high enough to maintain selective pressure on floral traits of a relict pollination syndrome. The behavior of these birds plays a crucial role in their pollination efficiency. Perching, by generalist passerines when visiting N. phoenicea flowers, is the most efficient habit. The frequency and PE of insect visits calls into question their role as legitimate visitors.

Pollinator shifts drive petal epidermal evolution on the Macaronesian Islands bird-flowered species.

Pollinator shifts are considered to drive floral trait evolution, yet little is still known about the modifications of petal epidermal surface at a biogeographic region scale. Here we investigated how independent shifts from insects to passerine birds in the Macaronesian Islands consistently modified this floral trait (i.e. absence of papillate cells). Using current phylogenies and extensive evidence from field observations, we selected a total of 81 plant species and subspecies for petal microscopy and comparative analysis, including 19 of the 23 insular species pollinated by opportunistic passerine birds (Macaronesian bird-flowered element). Species relying on passerine birds as the most effective pollinators (bird-pollinated) independently evolved at least five times and in all instances associated with a loss of papillate cells, whereas species with a mixed pollination system (birds plus insects and/or other vertebrates) evolved at least five times in Macaronesia and papillate cells were lost in only 25% of these transitions. Our findings suggest that petal micromorphology is a labile trait during pollinator shifts and that papillate cells tend to be absent on those species where pollinators have limited mechanical interaction with flowers, including opportunistic passerine birds that forage by hovering or from the ground.

Access to transportation for Chittenden County Vermont older adults.

BACKGROUND: Aging often leads to decreased independence and mobility, which can be detrimental to health and well-being. The growing population of older adults will create a greater need for reliable transportation. AIMS: Explore whether and how lack of transportation has compromised areas of daily lives in older adults. METHODS: 1221 surveys with 36 questions assessing transportation access, usage, and impact on activities were distributed to Chittenden County, Vermont older adults; 252 met criteria for analysis. RESULTS: Older adults reported overwhelming difficulty getting to activities considered important, with 69 % of participants delaying medical appointments due to transportation barriers. Although family and friends represent a primary method of transportation, older adults reported difficulty asking them for help. DISCUSSION: Lack of accessible transportation leads to missed healthcare appointments and social isolation, which may have detrimental effects on older adults' quality of life. CONCLUSION: Many older adults face significant transportation challenges that negatively affect their health and well-being.

Photovoltaic properties of multilayered quantum dot/quantum rod-sensitized TiO2 solar cells fabricated by SILAR and electrophoresis.

A multilayered semiconductor sensitizer structure composed of three differently sized CdSe quantum rods (QRs), labeled as Q530, Q575, Q590, were prepared and deposited on the surface of mesoporous TiO2 nanoparticles by electrophoretic deposition (EPD) for photovoltaic applications. By varying the arrangement of layers as well as the time of EPD, the photoconversion efficiency was improved from 2.0% with the single layer of CdSe QRs (TiO2/Q590/ZnS) to 2.9% for multilayers (TiO2/Q590Q575/ZnS). The optimal EPD time was shorter for the multilayered structures. The effect of CdS quantum dots (QDs) deposited by successive ionic layer adsorption and reaction (SILAR) was also investigated. The addition of CdS QDs resulted in the enhancement of efficiency to 4.1% for the configuration (TiO2/CdS/Q590Q575/ZnS), due to increased photocurrent and photovoltage. Based on detailed structural, optical, and photoelectrical studies, the increased photocurrent is attributed to broadened light absorption while the increased voltage is due to a shift in the relevant energy levels.

Radiology medical malpractice suits in gastrointestinal radiology: prevalence, causes, and outcomes.

The purpose of this study is to determine the prevalence, causes, and outcomes of GI malpractice suits in a survey of 8,401 radiologists. The malpractice histories of 8,401 radiologists from 47 states were evaluated from credentialing data of all radiologists participating in the network of One Call Medical Inc. Thirty-two percent of radiologists were defendants in at least one malpractice suit. Of the 4,073 total claims, 346 (8.49 %) were related to the gastrointestinal system. The most frequent primary allegations were failure to diagnose, 65.9 %, and procedural complications, 17.1 %. The commonest missed diagnoses were malignancy, 31.6 %; pneumoperitoneum, 19.3 %; and appendicitis, 14.5 %. Payment to the plaintiff occurred in 75.8 % of claims pertinent to cancer, 73.2 % for missed pneumoperitoneum, and 62.5 % related to appendicitis. Of cases in which a ruling was made in favor of the plaintiff, median payments for pneumoperitoneum was $215,000, for primary cancer $200,000, and for appendicitis $60,000. Among procedurally related errors resulting in judgment against a defending radiologist, 78.6 % of claims regarding retained foreign body, 75 % of barium enema cases, and 62.5 % of liver biopsy resulted in a payment to the plaintiff. Among all resolved cases, the median award was $30,000 for unrecognized foreign body retention, $100,000 for barium enema complications, and $400,000 for liver biopsy complication. Of all GI malpractice claims, failure to diagnose was the most prevalent. Among them, approximately three fourths of claims related to either the diagnosis of primary cancer or for detection of a pneumoperitoneum.

Concordance between automated oscillometric measurement of ankle-brachial index and traditional measurement by eco-Doppler in patients without peripheral artery disease.

AIM: To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a Spanish population without peripheral artery disease attended in primary care. METHODS: The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them. RESULTS: A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences - 0.03 ± 0.09; p < 0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70. CONCLUSIONS: The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care.

Non-spinal musculoskeletal malpractice suits against radiologists in the USA--rates, anatomic locations, and payments in a survey of 8,265 radiologists.

The objective of this study was to present the characteristics of non-spinal musculoskeletal malpractice suits with attention to rates, anatomic location, and payments in a survey of 8,265 radiologists. The malpractice histories of 8,265 radiologists from 36 states were evaluated from credentialing data required of all radiologists participating in the network of One Call Medical, Inc., a broker for imaging tests in workmen's compensation cases. Twenty six hundred of the 8,265 radiologists (31.5 %) had at least one suit. Of the 4,741 total claims, 627 (13.2 %) were related to the bones and soft tissues. Four hundred seventeen (66.1 %) of them involved the musculoskeletal system other than the spine. A cause was known for 400. Of these, 91.8 % (367/400) resulted from an alleged failure to diagnose. The foot was the most common site with a rate 6.00 cases/1,000 radiologist's person years (95 % confidence interval (CI), 4.68-7.68), and the hip was second with a rate of 5.30 cases/1,000 person years (95 % CI, 4.15-6.76). The highest median payment related to ankle injuries with a median settlement of $72,500 (interquartile range (IQR), $40,000-$161,250). The state in which the highest median settlement occurred was Maryland ($125,000; IQR, $95,000-$230,000)) whereas Utah had the highest rate of suits (5.24 cases per 1,000 person years; CI, 3.03-9.04). Claims regarding foot and hip injury were the most common, but ankle settlements incurred the highest awards.