Comparison of Mammography AI Algorithms with a Clinical Risk Model for 5-year Breast Cancer Risk Prediction: An Observational Study.

Background Although several clinical breast cancer risk models are used to guide screening and prevention, they have only moderate discrimination. Purpose To compare selected existing mammography artificial intelligence (AI) algorithms and the Breast Cancer Surveillance Consortium (BCSC) risk model for prediction of 5-year risk. Materials and Methods This retrospective case-cohort study included data in women with a negative screening mammographic examination (no visible evidence of cancer) in 2016, who were followed until 2021 at Kaiser Permanente Northern California. Women with prior breast cancer or a highly penetrant gene mutation were excluded. Of the 324 009 eligible women, a random subcohort was selected, regardless of cancer status, to which all additional patients with breast cancer were added. The index screening mammographic examination was used as input for five AI algorithms to generate continuous scores that were compared with the BCSC clinical risk score. Risk estimates for incident breast cancer 0 to 5 years after the initial mammographic examination were calculated using a time-dependent area under the receiver operating characteristic curve (AUC). Results The subcohort included 13 628 patients, of whom 193 had incident cancer. Incident cancers in eligible patients (additional 4391 of 324 009) were also included. For incident cancers at 0 to 5 years, the time-dependent AUC for BCSC was 0.61 (95% CI: 0.60, 0.62). AI algorithms had higher time-dependent AUCs than did BCSC, ranging from 0.63 to 0.67 (Bonferroni-adjusted P < .0016). Time-dependent AUCs for combined BCSC and AI models were slightly higher than AI alone (AI with BCSC time-dependent AUC range, 0.66-0.68; Bonferroni-adjusted P < .0016). Conclusion When using a negative screening examination, AI algorithms performed better than the BCSC risk model for predicting breast cancer risk at 0 to 5 years. Combined AI and BCSC models further improved prediction. © RSNA, 2023 Supplemental material is available for this article.

The formation and use of hierarchical cognitive maps in the brain: A neural network model.

Many researchers have tried to model how environmental knowledge is learned by the brain and used in the form of cognitive maps. However, previous work was limited in various important ways: there was little consensus on how these cognitive maps were formed and represented, the planning mechanism was inherently limited to performing relatively simple tasks, and there was little consideration of how these mechanisms would scale up. This paper makes several significant advances. Firstly, the planning mechanism used by the majority of previous work propagates a decaying signal through the network to create a gradient that points towards the goal. However, this decaying signal limited the scale and complexity of tasks that can be solved in this manner. Here we propose several ways in which a network can can self-organize a novel planning mechanism that does not require decaying activity. We also extend this model with a hierarchical planning mechanism: a layer of cells that identify frequently-used sequences of actions and reuse them to significantly increase the efficiency of planning. We speculate that our results may explain the apparent ability of humans and animals to perform model-based planning on both small and large scales without a noticeable loss of efficiency.

Colonisation of the male reproductive tract in asymptomatic infertile men: Effects on semen quality.

The objective was to explore presence/detection of microorganisms in the male reproductive tract (PMMRT) in asymptomatic patients undergoing infertility treatment and their effects on semen quality in our region. This study enrolled 205 men (mean age, 35.9 years) in a single-centre, tertiary university hospital from December 2015 to December 2016. We used the modified Meares-Stamey test, real-time polymerase chain reaction (rt-PCR) and the National Institutes of Health Chronic Prostatitis Sympton Index (NHI-CPSI) questionnaire to address this issue. No patient met the prostatitis criteria by the modified Meares-Stamey 4-sample test, 33 (16.1%) were positive for rt-PCR in the first-voided urine for any of the Mycoplasma (Ureaplasma urealyticum/parvum, Mycoplasma hominis/genitalium) and C. trachomatis was detected in two cases (1%), and three for rt-PCR in semen for HPV high-risk genotypes non-16/18 (1.5%). Significant statistical differences were reported among patients with and without PMMRT in terms of lower rate of progressive spermatozoa (PR) (p < .034), total motile sperm count (p < .028), normal morphologic forms, especially in the sperm head (p < .001) and highest viscosity (p < .012). It was concluded that PMMRT, specially Mycoplasmas, in asymptomatic infertility men, affects semen quality. The NIH-CPSI questionnaire was not a valid initial screening to subsequently evaluate the presence of prostatitis/PMMRT.

Not every credible interval is credible: Evaluating robustness in the presence of contamination in Bayesian data analysis.

As Bayesian methods become more popular among behavioral scientists, they will inevitably be applied in situations that violate the assumptions underpinning typical models used to guide statistical inference. With this in mind, it is important to know something about how robust Bayesian methods are to the violation of those assumptions. In this paper, we focus on the problem of contaminated data (such as data with outliers or conflicts present), with specific application to the problem of estimating a credible interval for the population mean. We evaluate five Bayesian methods for constructing a credible interval, using toy examples to illustrate the qualitative behavior of different approaches in the presence of contaminants, and an extensive simulation study to quantify the robustness of each method. We find that the "default" normal model used in most Bayesian data analyses is not robust, and that approaches based on the Bayesian bootstrap are only robust in limited circumstances. A simple parametric model based on Tukey's "contaminated normal model" and a model based on the t-distribution were markedly more robust. However, the contaminated normal model had the added benefit of estimating which data points were discounted as outliers and which were not.

On the likelihood of "encapsulating all uncertainty".

The assignment of personal probabilities to form a forensic practitioner's likelihood ratio is a mental operation subject to all the frailties of human memory, perception and judgment. While we agree that beliefs expressed as coherent probabilities are neither 'right' nor 'wrong' we argue that debate over this fact obscures both the requirement for and consideration of the 'helpfulness' of practitioner's opinions. We also question the extent to which a likelihood ratio based on personal probabilities can realistically be expected to 'encapsulate all uncertainty'. Courts cannot rigorously assess a forensic practitioner's bare assertions of belief regarding evidential strength. At a minimum, information regarding the uncertainty both within and between the opinions of practitioners is required.

Learning and choosing in an uncertain world: An investigation of the explore-exploit dilemma in static and dynamic environments.

How do people solve the explore-exploit trade-off in a changing environment? In this paper we present experimental evidence from an "observe or bet" task, in which people have to determine when to engage in information-seeking behavior and when to switch to reward-taking actions. In particular we focus on the comparison between people's behavior in a changing environment and their behavior in an unchanging one. Our experimental work is motivated by rational analysis of the problem that makes strong predictions about information search and reward seeking in static and changeable environments. Our results show a striking agreement between human behavior and the optimal policy, but also highlight a number of systematic differences. In particular, we find that while people often employ suboptimal strategies the first time they encounter the learning problem, most people are able to approximate the correct strategy after minimal experience. In order to describe both the manner in which people's choices are similar to but slightly different from an optimal standard, we introduce four process models for the observe or bet task and evaluate them as potential theories of human behavior.

How do people learn from negative evidence? Non-monotonic generalizations and sampling assumptions in inductive reasoning.

A robust finding in category-based induction tasks is for positive observations to raise the willingness to generalize to other categories while negative observations lower the willingness to generalize. This pattern is referred to as monotonic generalization. Across three experiments we find systematic non-monotonicity effects, in which negative observations raise the willingness to generalize. Experiments 1 and 2 show that this effect emerges in hierarchically structured domains when a negative observation from a different category is added to a positive observation. They also demonstrate that this is related to a specific kind of shift in the reasoner's hypothesis space. Experiment 3 shows that the effect depends on the assumptions that the reasoner makes about how inductive arguments are constructed. Non-monotonic reasoning occurs when people believe the facts were put together by a helpful communicator, but monotonicity is restored when they believe the observations were sampled randomly from the environment.

Rickettsia amblyommii infecting Amblyomma sculptum in endemic spotted fever area from southeastern Brazil.

The Rickettsia bacteria include the aetiological agents for the human spotted fever (SF) disease. In the present study, a SF group Rickettsia amblyommii related bacterium was detected in a field collected Amblyomma sculptum (Amblyomma cajennense species complex) tick from a Brazilian SF endemic site in southeastern Brazil, in the municipality of Juiz de Fora, state of Minas Gerais. Genetic analysis based on genes ompA,ompB and htrA showed that the detected strain, named R. amblyommii str. JF, is related to the species R. amblyommii.

Erroneous gambling-related beliefs as illusions of primary and secondary control: a confirmatory factor analysis.

Different classification systems for erroneous beliefs about gambling have been proposed, consistently alluding to 'illusion of control' and 'gambler's fallacy' categories. None of these classification systems have, however, considered the how the illusion of control and the gambler's fallacy might be interrelated. In this paper, we report the findings of a confirmatory factor analysis that examines the proposal that most erroneous gambling-related beliefs can be defined in terms of Rothbaum et al.'s (J Pers Soc Psychol, doi: 10.1037/0022-3514.42.1.5 , 1982) distinction between 'primary' and 'secondary' illusory control, with the former being driven to a large extent by the well-known gambler's fallacy and the latter being driven by a complex of beliefs about supernatural forces such as God and luck. A survey consisting of 100 items derived from existing instruments was administered to 329 participants. The analysis confirmed the existence of two latent structures (beliefs in primary and secondary control), while also offering support to the idea that gambler's fallacy-style reasoning may underlie both perceived primary control and beliefs about the cyclical nature of luck, a form of perceived secondary control. The results suggest the need for a greater focus on the role of underlying processes or belief structures as factors that foster susceptibility to specific beliefs in gambling situations. Addressing and recognising the importance of these underlying factors may also have implications for cognitive therapy treatments for problem gambling.

Learning time-varying categories.

Many kinds of objects and events in our world have a strongly time-dependent quality. However, most theories about concepts and categories either are insensitive to variation over time or treat it as a nuisance factor that produces irrational order effects during learning. In this article, we present two category learning experiments in which we explored peoples' ability to learn categories whose structure is strongly time-dependent. We suggest that order effects in categorization may in part reflect a sensitivity to changing environments, and that understanding dynamically changing concepts is an important part of developing a full account of human categorization.

What are the mechanics of quantum cognition?

Pothos & Busemeyer (P&B) argue that quantum probability (QP) provides a descriptive model of behavior and can also provide a rational analysis of a task. We discuss QP models using Marr's levels of analysis, arguing that they make most sense as algorithmic level theories. We also highlight the importance of having clear interpretations for basic mechanisms such as interference.

Better explanations of lexical and semantic cognition using networks derived from continued rather than single-word associations.

In this article, we describe the most extensive set of word associations collected to date. The database contains over 12,000 cue words for which more than 70,000 participants generated three responses in a multiple-response free association task. The goal of this study was (1) to create a semantic network that covers a large part of the human lexicon, (2) to investigate the implications of a multiple-response procedure by deriving a weighted directed network, and (3) to show how measures of centrality and relatedness derived from this network predict both lexical access in a lexical decision task and semantic relatedness in similarity judgment tasks. First, our results show that the multiple-response procedure results in a more heterogeneous set of responses, which lead to better predictions of lexical access and semantic relatedness than do single-response procedures. Second, the directed nature of the network leads to a decomposition of centrality that primarily depends on the number of incoming links or in-degree of each node, rather than its set size or number of outgoing links. Both studies indicate that adequate representation formats and sufficiently rich data derived from word associations represent a valuable type of information in both lexical and semantic processing.

Necrotizing scleritis due to Hormographiella aspergillata.

PURPOSE: To report the management and outcome of a case of necrotizing scleritis due to Hormographiella aspergillata. METHODS: Case report. RESULTS: A 79-year-old woman developed scleral inflammation following accidental trauma with a gorse plant in her left eye. An abscess formed at the site of the injury, which was surgically drained. Filamentous fungi were identified from the abscess contents, and oral voriconazole and topical voriconazole and natamycin drops were prescribed. Phenotypic analysis confirmed the presence of Hormographiella aspergillata, with low minimum inhibitory concentrations (MIC) for voriconazole and amphotericin B. Two weeks later the patient presented with an area of necrotizing scleritis which required surgical debridement and scleral grafting. Three months later, the scleral inflammation had resolved leaving an area of scleromalacia. CONCLUSIONS: Hormographiella aspergillata is a common environmental fungus that has recently emerged as a human pathogen and a rare cause of scleritis. To the best of our knowledge, this is the first report of scleritis in which a pure culture of H. aspergillata was obtained. Successful management poses a challenge as there are limited reports on antifungal susceptibility and a combination of medical and surgical treatment is often required.

Amniotic Membrane Transplantation in the Management of Corneal Ulceration Following Infectious Keratitis.

PURPOSE: To report on the outcomes of amniotic membrane transplantation (AMT) for corneal ulceration following infectious keratitis. METHOD: In this retrospective cohort study of 654 patients with culture-proven infectious keratitis from 8 hospitals in Galicia (Spain), a total of 43 eyes of 43 patients (6.6%) underwent AMT for postinfectious corneal ulceration. The indications for AMT were sterile persistent epithelial defects, severe corneal thinning or perforation. RESULTS: AMT was successful in 62.8% of cases, with 37.2% requiring an additional surgery. Median time to healing was 40.0 days (IQR 24.2-101.7 days) and final BCVA was lower than baseline (p = 0.001). Ulcers were large (>3 mm) in 55.8% of cases. Previous herpetic keratitis and topical steroid use were more common in patients who received AMT (p < 0.001). 49 microorganisms (43 bacteria and 6 fungi) were isolated. CONCLUSIONS: AMT is a therapeutic option for complications following infectious keratitis, which present with a sterile persistent epithelial defect, significant corneal thinning or perforation.

Copernicus for urban resilience in Europe.

The urban community faces a significant obstacle in effectively utilising Earth Observation (EO) intelligence, particularly the Copernicus EO program of the European Union, to address the multifaceted aspects of urban sustainability and bolster urban resilience in the face of climate change challenges. In this context, here we present the efforts of the CURE project, which received funding under the European Union's Horizon 2020 Research and Innovation Framework Programme, to leverage the Copernicus Core Services (CCS) in supporting urban resilience. CURE provides spatially disaggregated environmental intelligence at a local scale, demonstrating that CCS can facilitate urban planning and management strategies to improve the resilience of cities. With a strong emphasis on stakeholder engagement, CURE has identified eleven cross-cutting applications between CCS that correspond to the major dimensions of urban sustainability and align with user needs. These applications have been integrated into a cloud-based platform known as DIAS (Data and Information Access Services), which is capable of delivering reliable, usable and relevant intelligence to support the development of downstream services towards enhancing resilience planning of cities throughout Europe.

Epistemic trust: modeling children's reasoning about others' knowledge and intent.

A core assumption of many theories of development is that children can learn indirectly from other people. However, indirect experience (or testimony) is not constrained to provide veridical information. As a result, if children are to capitalize on this source of knowledge, they must be able to infer who is trustworthy and who is not. How might a learner make such inferences while at the same time learning about the world? What biases, if any, might children bring to this problem? We address these questions with a computational model of epistemic trust in which learners reason about the helpfulness and knowledgeability of an informant. We show that the model captures the competencies shown by young children in four areas: (1) using informants' accuracy to infer how much to trust them; (2) using informants' recent accuracy to overcome effects of familiarity; (3) inferring trust based on consensus among informants; and (4) using information about mal-intent to decide not to trust. The model also explains developmental changes in performance between 3 and 4 years of age as a result of changing default assumptions about the helpfulness of other people.

Synergy in tumor suppression by direct interaction of neutral endopeptidase with PTEN.

We show in this study that endogenous NEP and PTEN associate in cells directly through electrostatic interactions between a highly basic residue stretch in the intracellular domain of NEP and the major phosphorylation site in PTEN's tail. NEP binds and engages in higher order complexes both phosphorylated and unphosphorylated PTEN. NEP recruits PTEN to the plasma membrane and enhances its stability and phosphatase activity. As a result, an enzymatically inactive NEP mutant preserves the ability to bind PTEN, inactivates the Akt/PKB kinase, and partially suppresses the growth of PC cells. This study demonstrates a molecular cooperation between NEP and PTEN tumor suppressors in which NEP constitutively recruits and activates PTEN to inhibit the PI3K/Akt oncogenic pathway.

Osteonecrosis and Osteomyelitis of the Proximal Third of Tibia as a Late Sequela of COVID-19: A Case Report.

Coronavirus disease was first described as an identified syndrome in December 2019 (COVID-19). Since then, a global pandemic has taken place and the disease has repeatedly been associated with thromboembolic complications, most of which are venous, but may also occur at the arterial level, even in patients receiving thromboprophylaxis. To date, only medium- and large-caliber vessels have been affected by arterial thrombosis secondary to COVID-19. This article describes the case of a 60-year-old woman with a prior severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection who developed multiple bone infarcts, complicated by secondary osteomyelitis. The patient underwent multiple surgical debridements and received a variety of antibiotics before the correct diagnosis was made and a multidisciplinary surgery was planned that provided coverage with a medial gastrocnemius flap. At 5-months follow-up, the patient had recovered well without any clinical evidence of infection or other complications. To the best of our knowledge, this is the first known case of a bone infarct complicated with a secondary osteomyelitis occurring in a patient having suffered a previous SARS-CoV-2 infection. We postulate as our main hypothesis that the prothrombogenic state secondary to SARS-CoV-2 infection may have contributed to thrombosis of small-caliber vessels, in our patient the arteria nutricia tibialis, triggering bone infarcts and a secondary infection with Staphylococcus aureus .

Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study.

BACKGROUND: Accurate self-reported symptomatic toxicity documentation via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is essential throughout cancer treatment to ensure safety and understand therapeutic efficacy. However, the capture of accurate toxicities from patients undergoing radiation therapy is challenging because this is generally provided only at the time of scheduled visits. OBJECTIVE: This study seeks to establish the usability and feasibility of a mobile PRO-CTCAE Administration System (mPROS) to capture toxicities related to radiation therapy. METHODS: English-speaking adult patients who were undergoing radiation therapy for cancer were enrolled and given a brief demonstration of the Say All Your Symptoms (SAYS) and Symptom Tracking Entry Program (STEP) interfaces of the mPROS app, followed by a patient-use phase where patient actions were observed as they navigated mPROS to enter toxicities. Patient feedback was captured via a semistructured interview and brief questionnaire. RESULTS: We enrolled 25 patients (age: mean 60.7 years; females: n=13, 52%; White patients: n=13; 52%; non-Hispanic patients: n=19, 76%; college graduates: n=17, 68%). Patients almost equally preferred the SAYS (n=14, 56%) or STEP (n=11, 44%) interfaces, with 21 patients (84%) agreeing that they would use mPROS to report their symptoms to their health care team and 19 patients (76%) agreeing that they would recommend mPROS to others. CONCLUSIONS: The mPROS app is usable and feasible for facilitating the patient reporting of radiation therapy-related symptomatic toxicities. A revised version of mPROS that incorporates patient input and includes electronic health record integration is being developed and validated as part of a multicenter trial.

Generalized implementation of reflex testing of hepatitis C in Galicia: Results for reflection.

INTRODUCTION: The implementation of reflex testing of active hepatitis C virus (HCV) infection, together with the incorporation of informative alerts in the reports, has shown that it significantly reduces the number of patients who were not referred for therapeutic evaluation. METHODS: Since the implementation in 2018 of the DUSP in the Microbiology Services of the Galician Health Service hospitals (SERGAS), new diagnoses of active HCV infection have been retrospectively identified and characterized. RESULTS: In 2018, a total of 258 patients with unknown active HCV infection (70,2% men, middle age 52 years) were identified through by reflex testing from consultations of primary and specialized care units in 54.8% and 39.8% respectively, as well as from other locations by 5.4%. Of the 258 patients, 81.0% were referred for therapeutic evaluation, with a median of 54 days from their diagnosis. In 58.3% of the cases the reflex testing was determined by viral load, the predominant genotype was 1a (30,7%) and 52,1% were treated, observing sustained viral response (SVR) in 93.7 % of these. CONCLUSION: The generalized implementation of the HCV reflex testing together with informative alerts in Galicia has allowed us to obtain referral rates for treatment similar to those obtained in other studies. However, there is a wide variability between the different centers that require the incorporation of improvements, such as training or the use of rescue measures for optimization.