The performance of 11 fingertip pulse oximeters during hypoxemia in healthy human participants with varied, quantified skin pigment.

BACKGROUND: Fingertip pulse oximeters are widely available, inexpensive, and commonly used to make clinical decisions in many settings. Device performance is largely unregulated and poorly characterised, especially in people with dark skin pigmentation. METHODS: Eleven popular fingertip pulse oximeters were evaluated using the US Food and Drug Administration (FDA) Guidance (2013) and International Organization for Standardization Standards (ISO, 2017) in 34 healthy humans with diverse skin pigmentation utilising a controlled desaturation study with arterial oxygen saturation (SaO 2) plateaus between 70% and 100%. Skin pigmentation was assessed subjectively using a perceived Fitzpatrick Scale (pFP) and objectively using the individual typology angle (ITA) via spectrophotometry at nine anatomical sites. FINDINGS: Five of 11 devices had a root mean square error (ARMS) > 3%, falling outside the acceptable FDA performance range. Nine devices demonstrated worse performance in participants in the darkest skin pigmentation category compared with those in the lightest category. A commonly used subjective skin colour scale frequently miscategorised participants as being darkly pigmented when compared to objective quantification of skin pigment by ITA. INTERPRETATION: Fingertip pulse oximeters have variable performance, frequently not meeting regulatory requirements for clinical use, and occasionally contradicting claims made by manufacturers. Most devices showed a trend toward worse performance in participants with darker skin pigment. Regulatory standards do not adequately account for the impact of skin pigmentation on device performance. We recommend that the pFP and other non-standardised subjective skin colour scales should no longer be used for defining diversity of skin pigmentation. Reliable methods for characterising skin pigmentation to improve diversity and equitable performance of pulse oximeters are needed. FUNDING: This study was conducted as part of the Open Oximetry Project funded by the Gordon and Betty Moore Foundation, Patrick J McGovern Foundation, and Robert Wood Johnson Foundation. The UCSF Hypoxia Research Laboratory receives funding from multiple industry sponsors to test the sponsors' devices for the purposes of product development and regulatory performance testing. Data in this paper do not include sponsor's study devices. All data were collected from devices procured by the Hypoxia Research Laboratory for the purposes of independent research. No company provided any direct funding for this study, participated in study design or analysis, or was involved in analysing data or writing the manuscript. None of the authors own stock or equity interests in any pulse oximeter companies. Dr Ellis Monk's time utilised for data analysis, reviewing and editing was funded by grant number: DP2MH132941.

Should I Stay, or Should I Go? Early Phase Instrument Development of Workforce Movement-A Pilot Study with Breast Radiologists.

OBJECTIVE: The goal of this study was to develop a psychometrically valid survey on workplace satisfaction and examine predictors of workforce movement among breast radiologists. METHODS: Actively practicing members of the Society of Breast Imaging were invited to complete a survey on workplace satisfaction. Radiologists also indicated whether they had recently left their practice or were thinking of leaving their practice. RESULTS: In total, 228 breast radiologists provided valid responses (8.7% response rate); 45% were thinking of leaving or had left their practice. Factor analysis yielded five factors, and discriminant function analysis found six main aspects associated with workforce movement in breast radiologists: (1) not enough work-life balance; (2) salary too low; (3) not feeling valued; (4) wanting a different challenge and/or more growth opportunity; (5) safety concerns; and (6) not feeling respected by physician leadership. CONCLUSIONS: Pending further validation in larger and different cohorts, the survey created here can be administered by radiology practices to predict when breast radiologists are vulnerable to quitting. Atlhough this measure was designed for breast radiologists specifically, it could be adapted for other subspecialties.

Accelerated Partial Breast Irradiation for HER2-Positive Early-Stage Breast Cancer.

PURPOSE: HER2-positive (HER2+) breast cancer historically exhibited the most adverse local outcomes and, consequently, has had limited representation among trials of partial breast irradiation (PBI). We hypothesized that with contemporary HER2-targeted agents, patients may now exhibit excellent disease control outcomes after adjuvant PBI. METHODS AND MATERIALS: Using a prospectively maintained institutional database, we identified patients with HER2+ breast cancer treated with breast conserving surgery (BCS) and PBI from 2000 to 2022. Salient clinicopathologic and treatment parameters were collected. All patients received external beam PBI to 40 Gy in 10 daily fractions. Cumulative incidence functions were calculated to estimate the incidence of local recurrence (LR) with the competing risk of death. RESULTS: We identified 1248 patients who underwent PBI at our institution, of whom the study cohort comprised 52 (4%) with HER2+ breast cancer (median age, 64 years; range, 44-87). Nearly all had T1 tumors (98%; median size, 12 mm [range, 1-21 mm]). Most had estrogen receptor positive disease (88%), and all patients had negative surgical margins. Nearly all underwent sentinel node biopsy (94%), with the remainder undergoing no surgical axillary evaluation. Forty-two (81%) received chemotherapy; 40 (77%), hormone therapy; and 42 (81%), HER2-directed therapy, most commonly trastuzumab. At 143.8 person-years of follow-up (range, 7-226 months for each patient), we observed 2 LR events at 14 and 26 months, respectively, yielding a 2-year LR rate of 3.8%. No regional or distant recurrences were observed, nor were any breast-specific mortality events. Two deaths were observed, both without evidence of disease. CONCLUSIONS: Among a cohort of patients with HER2+ early-stage breast cancer managed with BCS and PBI, we observed a 2-year LR rate of 3.8%, with no regional or distant recurrences and excellent overall survival. These findings require confirmation with longer follow-up among larger cohorts but appear consistent with the excellent results of contemporary randomized trials of PBI unselected for HER2 status.

Governing beyond the project: Refocusing innovation governance in emerging science and technology funding.

This article analyses how a recent idiom of innovation governance, 'responsible innovation', is enacted in practice, how this shapes innovation processes, and what aspects of innovation are left untouched. Within this idiom, funders typically focus on one point in an innovation system: researchers in projects. However, the more transformational aspirations of responsible innovation are circumscribed by this context. Adopting a mode of critique that assembles, this article considers some alternative approaches to governing the shared trajectories of science, technology, and society. Using the idea of institutional invention to focus innovation governance on four inflection points-agendas, calls, spaces, evaluation-would allow funding organizations and researchers to look 'beyond the project', developing new methods to unpack and reflect on assumed purposes of science, technology, and innovation, and to potentially reconfigure the institutions that condition scientific practice.

Race-based biases in psychological distress and treatment judgments.

Racism creates and sustains mental health disparities between Black and White Americans and the COVID-19 pandemic and ongoing harassment directed at Black Americans has exacerbated these inequities. Yet, as the mental health needs of Black Americans rise, there is reason to believe the public paradoxically believes that psychopathology hurts Black individuals less than White individuals and these biased distress judgments affect beliefs about treatment needs. Four studies (two pre-registered) with participants from the American public and the field of mental health support this hypothesis. When presented with identical mental illnesses (e.g., depression, anxiety, schizophrenia), both laypeople and clinicians believed that psychopathology would be less distressing to Black relative to White individuals. These distress biases mediate downstream treatment judgments. Across numerous contexts, racially-biased judgments of psychological distress may negatively affect mental healthcare and social support for Black Americans.

Can incorrect artificial intelligence (AI) results impact radiologists, and if so, what can we do about it? A multi-reader pilot study of lung cancer detection with chest radiography.

OBJECTIVE: To examine whether incorrect AI results impact radiologist performance, and if so, whether human factors can be optimized to reduce error. METHODS: Multi-reader design, 6 radiologists interpreted 90 identical chest radiographs (follow-up CT needed: yes/no) on four occasions (09/20-01/22). No AI result was provided for session 1. Sham AI results were provided for sessions 2-4, and AI for 12 cases were manipulated to be incorrect (8 false positives (FP), 4 false negatives (FN)) (0.87 ROC-AUC). In the Delete AI (No Box) condition, radiologists were told AI results would not be saved for the evaluation. In Keep AI (No Box) and Keep AI (Box), radiologists were told results would be saved. In Keep AI (Box), the ostensible AI program visually outlined the region of suspicion. AI results were constant between conditions. RESULTS: Relative to the No AI condition (FN = 2.7%, FP = 51.4%), FN and FPs were higher in the Keep AI (No Box) (FN = 33.0%, FP = 86.0%), Delete AI (No Box) (FN = 26.7%, FP = 80.5%), and Keep AI (Box) (FN = to 20.7%, FP = 80.5%) conditions (all ps < 0.05). FNs were higher in the Keep AI (No Box) condition (33.0%) than in the Keep AI (Box) condition (20.7%) (p = 0.04). FPs were higher in the Keep AI (No Box) (86.0%) condition than in the Delete AI (No Box) condition (80.5%) (p = 0.03). CONCLUSION: Incorrect AI causes radiologists to make incorrect follow-up decisions when they were correct without AI. This effect is mitigated when radiologists believe AI will be deleted from the patient's file or a box is provided around the region of interest. CLINICAL RELEVANCE STATEMENT: When AI is wrong, radiologists make more errors than they would have without AI. Based on human factors psychology, our manuscript provides evidence for two AI implementation strategies that reduce the deleterious effects of incorrect AI. KEY POINTS: • When AI provided incorrect results, false negative and false positive rates among the radiologists increased. • False positives decreased when AI results were deleted, versus kept, in the patient's record. • False negatives and false positives decreased when AI visually outlined the region of suspicion.

A Pilot Study of Accelerometer-Based Biometric Data Collection among Patients Undergoing Locoregional Therapies.

This study evaluated the feasibility of measuring patient recovery after locoregional therapies (LRTs) using a wearable activity tracker (WAT). Twenty adult patients with cancer were provided with a WAT device to wear for a minimum of 7 days prior to their procedure (baseline) and for up to 30 days after their procedure (recovery). Daily step counts were continuously recorded. Patient responses to the Short Form 36-Item Health Survey (SF-36) were also collected before and after LRT. Analysis of WAT data demonstrated a mean of 4,850 daily steps taken at baseline, which decreased to 2,000 immediately after LRT and then rapidly increased to approximately 4,300 daily steps over an average of 10 days (P < .001). No significant changes were observed in SF-36 responses between baseline and follow-up assessments (P > .10). These results suggest that WAT devices capture dynamic periprocedural data not reflected in survey-based assessments and may be used to monitor patient recovery after interventional oncologic procedures.

COVID-19 non-pharmaceutical interventions: data annotation for rapidly changing local policy information.

Understanding the scope, prevalence, and impact of the COVID-19 pandemic response will be a rich ground for research for many years. Key to the response to COVID-19 was the non-pharmaceutical intervention (NPI) measures, such as mask mandates or stay-in-place orders. For future pandemic preparedness, it is critical to understand the impact and scope of these interventions. Given the ongoing nature of the pandemic, existing NPI studies covering only the initial portion provide only a narrow view of the impact of NPI measures. This paper describes a dataset of NPI measures taken by counties in the U.S. state of Virginia that include measures taken over the first two years of the pandemic beginning in March 2020. This data enables analyses of NPI measures over a long time period that can produce impact analyses on both the individual NPI effectiveness in slowing the pandemic spread, and the impact of various NPI measures on the behavior and conditions of the different counties and state.

Metaplastic carcinoma of the breast: matched cohort analysis of recurrence and survival.

PURPOSE: Metaplastic breast carcinoma (MBC) is a rare subtype of breast cancer, defined as mammary carcinoma with squamous or mesenchymal differentiation, that may include spindle cell, chondroid, osseous, or rhabdomyoid differentiation patterns. The implications of MBC recurrence and survival outcomes remains unclear. METHODS: Cases were ascertained from a prospectively maintained institutional database of patients treated from 1998 to 2015. Patients with MBC were matched 1:1 to non-MBC cases. Cox proportional-hazards models and Kaplan-Meier estimates were used to evaluate outcome differences between cohorts. RESULTS: 111 patients with MBC were matched 1:1 with non-MBC patients from an initial set of 2400 patients. Median follow-up time was 8 years. Most patients with MBC received chemotherapy (88%) and radiotherapy (71%). On univariate competing risk regression, MBC was not associated with locoregional recurrence (HR = 1.08; p = 0.8), distant recurrence (HR = 1.65; p = 0.092); disease-free survival (HR = 1.52; p = 0.065), or overall survival (HR = 1.56; p = 0.1). Absolute differences were noted in 8-year disease-free survival (49.6% MBC vs 66.4% non-MBC) and overall survival (61.3% MBC vs 74.4% non-MBC), though neither of these reached statistical significance (p = 0.07 and 0.11, respectively). CONCLUSION: Appropriately-treated MBC may exhibit recurrence and survival outcomes that are difficult to distinguish from those of non-MBC. While prior studies suggest that MBC has a worse natural history than non-MBC triple-negative breast cancer, prudent use of chemotherapy and radiotherapy may narrow these differences, although studies with more power will be required to inform clinical management. Longer follow-up among larger populations may further elucidate the clinical and therapeutic implications of MBC.

Computerization of the Work of General Practitioners: Mixed Methods Survey of Final-Year Medical Students in Ireland.

BACKGROUND: The potential for digital health technologies, including machine learning (ML)-enabled tools, to disrupt the medical profession is the subject of ongoing debate within biomedical informatics. OBJECTIVE: We aimed to describe the opinions of final-year medical students in Ireland regarding the potential of future technology to replace or work alongside general practitioners (GPs) in performing key tasks. METHODS: Between March 2019 and April 2020, using a convenience sample, we conducted a mixed methods paper-based survey of final-year medical students. The survey was administered at 4 out of 7 medical schools in Ireland across each of the 4 provinces in the country. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses. RESULTS: In total, 43.1% (252/585) of the final-year students at 3 medical schools responded, and data collection at 1 medical school was terminated due to disruptions associated with the COVID-19 pandemic. With regard to forecasting the potential impact of artificial intelligence (AI)/ML on primary care 25 years from now, around half (127/246, 51.6%) of all surveyed students believed the work of GPs will change minimally or not at all. Notably, students who did not intend to enter primary care predicted that AI/ML will have a great impact on the work of GPs. CONCLUSIONS: We caution that without a firm curricular foundation on advances in AI/ML, students may rely on extreme perspectives involving self-preserving optimism biases that demote the impact of advances in technology on primary care on the one hand and technohype on the other. Ultimately, these biases may lead to negative consequences in health care. Improvements in medical education could help prepare tomorrow's doctors to optimize and lead the ethical and evidence-based implementation of AI/ML-enabled tools in medicine for enhancing the care of tomorrow's patients.

Black individuals' suspicion of Whites' motives negatively predicts expected efficacy with White social partners.

OBJECTIVES: Interracial efficacy is critical to intergroup interactions. However, the antecedents of interracial efficacy are unclear and rarely studied from the perspectives of Black individuals. The current work addresses these empirical gaps by testing whether individual differences in suspicion of Whites' motives negatively relate to expected efficacy in interracial interactions. Suspicion was operationalized as beliefs that Whites' positivity toward people of color (POC) is primarily motivated by concerns with appearing prejudiced. METHOD: Four studies employing correlational and experimental vignette designs with Black adult participants (Ntotal = 2,295; ∼60% female) tested suspicion's hypothesized negative relation with three conceptions of interracial efficacy (general efficacy, liking-based efficacy, and respect-based efficacy). RESULTS: Four studies provided consistent evidence that suspicion of Whites' motives negatively related to expected efficacy in interactions with White social partners. Moreover, this relationship was unique to contexts with White partners and did not extend to imagined interactions with Black partners or members of other outgroup members (e.g., Latine partners). CONCLUSIONS: Results further suggest suspicion increases expected threat (i.e., anticipated uncertainty/anxiety), which undermines Black individuals' confidence in interactions with White partners. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The European Commission's Green Deal is an opportunity to rethink harmful practices of research and innovation policy.

The European Union's Green Deal and associated policies, aspiring to long-term environmental sustainability, now require economic activities to 'do no significant harm' to EU environmental objectives. The way the European Commission is enacting the do no significant harm principle relies on quantitative tools that try to identify harm and adjudicate its significance. A reliance on established technical approaches to assessing such questions ignores the high levels of imprecision, ambiguity, and uncertainty-levels often in flux-characterizing the social contexts in which harms emerge. Indeed, harm, and its significance, are relational, not absolute. A better approach would thus be to acknowledge the relational nature of harm and develop broad capabilities to engage and 'stay with' the harm. We use the case of European research and innovation activities to expose the relational nature of harm, and explore an alternative and potentially more productive approach that departs from attempts to unilaterally or uniformly claim to know or adjudicate what is or is not significantly harmful. In closing, we outline three ways research and innovation policy-makers might experiment with reconfiguring scientific and technological systems and practices to better address the significant harms borne by people, other-than-human beings, and ecosystems.

Electronic Cigarettes for Smoking Cessation: The Gap Between Behavior in Smokers and Medical Education.

INTRODUCTION: E-cigarettes have engendered a great deal of controversy within the public health and medical communities.  Methods: Two cross-sectional surveys were administered. First, patients at an annual lung cancer screening appointment who self-identified as former smokers were asked about strategies for achieving and maintaining smoking cessation with open-ended questions. Second, medical students at a single university reported their opinion and knowledge of combustible cigarettes and e-cigarettes. RESULTS: Among the n=102 in the patient survey indicating that they used e-cigarettes or over-the-counter (OTC) nicotine replacement products for smoking cessation, 34.3% (35/102) vaped e-cigarettes, making it the second most common next to patches (47.1% {48/102}). By comparison, n=48 reported using medication. Medical student participants (n=168) were mixed regarding whether a patient should switch from traditional to electronic cigarettes (56.0% yes; 44.0% no) and reported receiving education about traditional cigarettes (92.3%) at a much higher rate than for e-cigarettes (46.4%), p<.001. CONCLUSION: Many former heavy smokers undergoing a lung cancer screen used e-cigarettes to achieve smoking cessation. However, nearly half of medical students surveyed do not think patients should switch from traditional to e-cigarettes.

Socially situated artificial intelligence enables learning from human interaction.

Regardless of how much data artificial intelligence agents have available, agents will inevitably encounter previously unseen situations in real-world deployments. Reacting to novel situations by acquiring new information from other people-socially situated learning-is a core faculty of human development. Unfortunately, socially situated learning remains an open challenge for artificial intelligence agents because they must learn how to interact with people to seek out the information that they lack. In this article, we formalize the task of socially situated artificial intelligence-agents that seek out new information through social interactions with people-as a reinforcement learning problem where the agent learns to identify meaningful and informative questions via rewards observed through social interaction. We manifest our framework as an interactive agent that learns how to ask natural language questions about photos as it broadens its visual intelligence on a large photo-sharing social network. Unlike active-learning methods, which implicitly assume that humans are oracles willing to answer any question, our agent adapts its behavior based on observed norms of which questions people are or are not interested to answer. Through an 8-mo deployment where our agent interacted with 236,000 social media users, our agent improved its performance at recognizing new visual information by 112%. A controlled field experiment confirmed that our agent outperformed an active-learning baseline by 25.6%. This work advances opportunities for continuously improving artificial intelligence (AI) agents that better respect norms in open social environments.

How do US orthopaedic surgeons view placebo-controlled surgical trials? A pilot online survey study.

Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as 'completely' or 'mostly' unethical. Participants were also asked to rank-order the value of five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7 .% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects.