In-silico study of the impact of system design parameters on microcalcification detection in wide-angle digital breast tomosynthesis.

Purpose: Accurate detection of microcalcifications ( µ Calcs ) is crucial for the early detection of breast cancer. Some clinical studies have indicated that digital breast tomosynthesis (DBT) systems with a wide angular range have inferior µ Calc detectability compared with those with a narrow angular range. This study aims to (1) provide guidance for optimizing wide-angle (WA) DBT for improving µ Calcs detectability and (2) prioritize key optimization factors. Approach: An in-silico DBT pipeline was constructed to evaluate µ Calc detectability of a WA DBT system under various imaging conditions: focal spot motion (FSM), angular dose distribution (ADS), detector pixel pitch, and detector electronic noise (EN). Images were simulated using a digital anthropomorphic breast phantom inserted with 120 µ m µ Calc clusters. Evaluation metrics included the signal-to-noise ratio (SNR) of the filtered channel observer and the area under the receiver operator curve (AUC) of multiple-reader multiple-case analysis. Results: Results showed that FSM degraded µ Calcs sharpness and decreased the SNR and AUC by 5.2% and 1.8%, respectively. Non-uniform ADS increased the SNR by 62.8% and the AUC by 10.2% for filtered backprojection reconstruction with a typical clinical filter setting. When EN decreased from 2000 to 200 electrons, the SNR and AUC increased by 21.6% and 5.0%, respectively. Decreasing the detector pixel pitch from 85 to 50 µ m improved the SNR and AUC by 55.6% and 7.5%, respectively. The combined improvement of a 50 µ m pixel pitch and EN200 was 89.2% in the SNR and 12.8% in the AUC. Conclusions: Based on the magnitude of impact, the priority for enhancing µ Calc detectability in WA DBT is as follows: (1) utilizing detectors with a small pixel pitch and low EN level, (2) allocating a higher dose to central projections, and (3) reducing FSM. The results from this study can potentially provide guidance for DBT system optimization in the future.

Estimation of the absorbed dose in simultaneous digital breast tomosynthesis and mechanical imaging.

Purpose: Use of mechanical imaging (MI) as complementary to digital mammography (DM), or in simultaneous digital breast tomosynthesis (DBT) and MI - DBTMI, has demonstrated the potential to increase the specificity of breast cancer screening and reduce unnecessary biopsies compared with DM. The aim of this study is to investigate the increase in the radiation dose due to the presence of an MI sensor during simultaneous image acquisition when automatic exposure control is used. Approach: A radiation dose study was conducted on clinically available breast imaging systems with and without an MI sensor present. Our estimations were based on three approaches. In the first approach, exposure values were compared in paired clinical DBT and DBTMI acquisitions in 97 women. In the second approach polymethyl methacrylate (PMMA) phantoms of various thicknesses were used, and the average glandular dose (AGD) values were compared. Finally, a rectangular PMMA phantom with a 45 mm thickness was used, and the AGD values were estimated based on air kerma measurements with an electronic dosemeter. Results: The relative increase in exposure estimated from digital imaging and communications in medicine headers when using an MI sensor in clinical DBTMI was 11.9 % ± 10.4 . For the phantom measurements of various thicknesses of PMMA, the relative increases in the AGD for DM and DBT measurements were, on average, 10.7 % ± 3.1 and 11.4 % ± 3.0 , respectively. The relative increase in the AGD using the electronic dosemeter was 11.2 % ± < 0.001 in DM and 12.2 % ± < 0.001 in DBT. The average difference in dose between the methods was 11.5 % ± 3.3 . Conclusions: Our measurements suggest that the use of simultaneous breast radiography and MI increases the AGD by an average of 11.5 % ± 3.3 . The increase in dose is within the acceptable values for mammography screening recommended by European guidelines.

Desarrollo de la comprensión emocional. ¿Qué tipo de tecnología para qué alumno con trastorno del espectro autista? Revisión sistemática / Development of emotional understanding. What type of technology for which student with autism spectrum disorder? Systematic review

La falta de información sobre el uso de la tecnología en niños con trastorno del espectro autista (TEA) de diferentes perfiles puede dificultar que docentes y alumnos se estén beneficiando del apoyo tecnológico más eficaz y ajustado a sus necesidades. El objetivo de esta revisión fue analizar y sintetizar la evidencia científica sobre la eficacia de los recursos tecnológicos en la mejora de la comprensión emocional de estudiantes con TEA con perfiles de alto y bajo funcionamiento. Para ello se realizó una revisión sistemática de las publicaciones científicas indexadas en algunas de las bases de datos de mayor relevancia siguiendo los criterios establecidos en la declaración PRISMA. En total se analizaron 38 artículos que cumplieron con los criterios de inclusión preestablecidos. Los resultados muestran la importancia de diseñar sistemas versátiles que puedan personalizarse y adaptarse en tiempo real y en contextos naturales con un enfoque claramente inclusivo. Pero también sugieren que la tecnología puede no ser una herramienta de intervención complementaria adecuada para todos los niños con TEA. Lo que subraya la necesidad de ensayos adicionales bien controlados sobre las características que permitan identificar qué estudiantes podrían o no beneficiarse de diferentes modalidades de tecnología. (AU)

The lack of information on the use of technology in children with autism spectrum disorder (ASD) of different profiles can make it difficult for teachers and students to benefit from the most effective technology support tailored to their needs. The aim of this review was to analyze and synthesize scientific evidence on the effectiveness of technological resources in improving the emotional understanding of students with high and low functioning ASD profiles. A systematic review of the scientific publications indexed in some of the most relevant databases was carried out following the criteria established in the PRISMA declaration. A total of 38 articles that met the pre-established inclusion criteria were analyzed. The results show the importance of designing versatile systems that can be customized and adapted in real time and in natural contexts with a clearly inclusive approach. But they also suggest that technology may not be an appropriate complementary intervention tool for all children with ASD. This underlines the need for additional well-controlled tests on the characteristics that would allow identifying which students might or might not benefit from different technology modalities. (AU)

Desarrollo de la comprensión emocional. ¿Qué tipo de tecnología para qué alumno con trastorno del espectro autista? Revisión sistemática / Development of emotional understanding. What type of technology for which student with autism spectrum disorder? Systematic review

La falta de información sobre el uso de la tecnología en niños con trastorno del espectro autista (TEA) de diferentes perfiles puede dificultar que docentes y alumnos se estén beneficiando del apoyo tecnológico más eficaz y ajustado a sus necesidades. El objetivo de esta revisión fue analizar y sintetizar la evidencia científica sobre la eficacia de los recursos tecnológicos en la mejora de la comprensión emocional de estudiantes con TEA con perfiles de alto y bajo funcionamiento. Para ello se realizó una revisión sistemática de las publicaciones científicas indexadas en algunas de las bases de datos de mayor relevancia siguiendo los criterios establecidos en la declaración PRISMA. En total se analizaron 38 artículos que cumplieron con los criterios de inclusión preestablecidos. Los resultados muestran la importancia de diseñar sistemas versátiles que puedan personalizarse y adaptarse en tiempo real y en contextos naturales con un enfoque claramente inclusivo. Pero también sugieren que la tecnología puede no ser una herramienta de intervención complementaria adecuada para todos los niños con TEA. Lo que subraya la necesidad de ensayos adicionales bien controlados sobre las características que permitan identificar qué estudiantes podrían o no beneficiarse de diferentes modalidades de tecnología. (AU)

The lack of information on the use of technology in children with autism spectrum disorder (ASD) of different profiles can make it difficult for teachers and students to benefit from the most effective technology support tailored to their needs. The aim of this review was to analyze and synthesize scientific evidence on the effectiveness of technological resources in improving the emotional understanding of students with high and low functioning ASD profiles. A systematic review of the scientific publications indexed in some of the most relevant databases was carried out following the criteria established in the PRISMA declaration. A total of 38 articles that met the pre-established inclusion criteria were analyzed. The results show the importance of designing versatile systems that can be customized and adapted in real time and in natural contexts with a clearly inclusive approach. But they also suggest that technology may not be an appropriate complementary intervention tool for all children with ASD. This underlines the need for additional well-controlled tests on the characteristics that would allow identifying which students might or might not benefit from different technology modalities. (AU)

Competencias digitales en los ingresantes a la carrera de Licenciatura en Enfermería

Objetivo: Determinar las habilidades y conocimientos sobre las tecnologías de la información y la comunicación (TIC) de los ingresantes a la carrera de Licenciatura en Enfermería de una institución superior pública de Bahía Blanca, Provincia de Buenos Aires, Argentina. Metodología: Estudio observacional, descriptivo, transversal y cuantitativo. Se implementó un instrumento conformado por 59 preguntas con opciones de respuesta cerrada orientado a valorar las competencias digitales en los ingresantes a la carrera. Resultados: Participaron 386 ingresantes, mayormente de género femenino (85.49 %), del primer ciclo (74.35 %) y con 20 años o menos de edad (47.15 %). El 98.19 % tenía acceso a internet, el 79.27 % tiene computadora y más del 80 % tiene un amplio uso de redes sociales (WhatsApp, Instagram) y correo electrónico. Los ingresantes se autoevaluaron competentes en el programa MS Word, mientras que en MS Excel se declararon menos competentes. Hay desconocimiento y bajo desarrollo de habilidades para generar contenido, y un amplio despliegue de habilidades para buscar y descargar información de la web. La edad, el género, el tiempo diario de uso de internet y el ciclo de ingreso mostraron relación con el dominio de las herramientas digitales aplicadas a la educación. Conclusiones: Se identificó un desarrollo intermedio de competencias digitales aplicadas a la educación, lo que podría ameritar el diseño de programas que nivelen estas habilidades durante el proceso de ingreso o durante la formación.

Objetivo: determinar habilidades e conhecimentos sobre as tecnologias da informação e comunicação (TIC) dos calouros no curso de bacharelado em enfermagem em uma instituição pública de ensino superior na cidade de Bahía Blanca, província de Buenos Aires, Argentina. Metodologia: estudo observacional, descritivo, transversal e quantitativo. Foi utilizado um instrumento composto por 59 perguntas com opções de resposta fechada para avaliar as competências digitais dos calouros do curso. Resultados: Participaram 386 estudantes, em sua maioria do gênero feminino (85,49 %), do primeiro ciclo estudantil (74,35 %) e com idade igual ou inferior a 20 anos (47,15 %). 98,19 % tinham acesso à internet, 79,27 % tinham computador e mais de 80 % usavam amplamente as redes sociais (WhatsApp, Instagram) e o e-mail. Os calouros se auto-avaliaram competentes no programa MS Word, enquanto no MS Excel se declararam menos competentes. Há desconhecimento e baixo desenvolvimento de habilidades para gerar conteúdo e uma ampla demonstração de habilidades para pesquisar e baixar informações da web. A idade, o gênero, o tempo diário de uso da Internet e o ciclo de ingresso estudantil mostraram relação com o domínio das ferramentas digitais aplicadas à educação. Conclusões: Foi identificado um desenvolvimento intermediário de competências digitais aplicadas à educação, o que poderia demandar a concepção de programas que nivelem essas competências durante o processo de admissão ou durante a formação.

Objective: To determine the skills and knowledge about information and communication technologies (ICT) of entrants to the Bachelor's Degree in Nursing at a public higher institution in Bahía Blanca, Province of Buenos Aires, Argentina. Methodology: Observational, descriptive, transversal and quantitative study. An instrument was implemented consisting of 59 questions with closed response options aimed at assessing digital competencies in those entering the career. Results: 386 entrants participated, mostly female (85.49 %), from the first cycle (74.35 %) and 20 years old or younger (47.15%). 98.19 % had access to the internet, 79.27 % have a computer and more than 80 % have extensive use of social networks (WhatsApp, Instagram) and email. The entrants evaluated themselves as competent in the MS Word program, while in MS Excel they declared themselves less competent. There is a lack of knowledge and low development of skills to generate content and a wide range of skills to search and download information from the web. Age, gender, daily time of Internet use and entry cycle showed a relationship with the mastery of digital tools applied to education. Conclusions: An intermediate development of digital competencies applied to education was identified, and a high one for the use of social networks. The variables age, gender, daily time of Internet use and entry cycle were related to the knowledge and skills for using ICT applied to education.

Assessing the role of visual dysfunctions in the association between visual symptomatology and the use of digital devices / Evaluación del papel de las disfunciones visuales en la asociación entre la sintomatología visual y el uso de dispositivos digitales

Purpose: To evaluate the association between visual symptoms and use of digital devices considering the presence of visual dysfunctions. Methods: An optometric examination was conducted in a clinical sample of 346 patients to diagnose any type of visual anomaly. Visual symptoms were collected using the validated SQVD questionnaire. A threshold of 6 hours per day was used to quantify the effects of digital device usage and patients were divided into two groups: under and above of 35 years old. A multivariate logistic regression was employed to investigate the association between digital device use and symptoms, with visual dysfunctions considered as a confounding variable. Crude and the adjusted odds ratio (OR) were calculated for each variable. Results: 57.02 % of the subjects reported visual symptoms, and 65.02% exhibited some form of visual dysfunction. For patients under 35 years old, an association was found between having visual symptoms and digital device use (OR = 2.10, p = 0.01). However, after adjusting for visual dysfunctions, this association disappeared (OR = 1.44, p = 0.27) and the association was instead between symptoms and refractive dysfunction (OR = 6.52, p < 0.001), accommodative (OR = 10.47, p < 0.001), binocular (OR = 6.68, p < 0.001) and accommodative plus binocular dysfunctions (OR = 46.84, p < 0.001). Among patients over 35 years old, no association was found between symptoms and the use of digital devices (OR = 1.27, p = 0.49) but there was an association between symptoms and refractive dysfunction (OR = 3.54, p = 0.001). Conclusions: Visual symptoms are not dependent on the duration of digital device use but rather on the presence of any type of visual dysfunction: refractive, accommodative and/or binocular one, which should be diagnosed.(AU)

The examination of the relationships among digital addiction, loneliness, shyness, and social anxiety in adolescents / El examen de las relaciones entre adicción digital, soledad, timidez y ansiedad social en adolescentes

La adicción digital, que se determina como un problema común entre los adolescentes en los últimos años, afecta negativamente la vida de los adolescentes en muchos aspectos. El objetivo del estudio es examinar las relaciones entre la adicción digital, la soledad, la timidez y la ansiedad social de los adolescentes. Gate se reunió con adolescentes que completaron la Escala de adicción digital, la versión corta de la Escala de soledad de UCLA, la Escala de timidez y la Escala de gravedad del trastorno de ansiedad social DSM-5 - Formulario infantil. Las hipótesis sugeridas se han probado utilizando los datos recopilados de 991 adolescentes y un análisis de regresión jerárquica. Los resultados de la investigación encontraron una relación positiva y significativa entre la adicción digital, la soledad, la timidez y la ansiedad social entre los adolescentes. Además, los hallazgos muestran que la adicción digital, la soledad y la timidez predicen la ansiedad social. Los resultados obtenidos demuestran que la adicción digital, la soledad y la timidez tienen efecto sobre la ansiedad social. Según los hallazgos, se sugiere aplicar diversas intervenciones educativas por parte de profesionales de la salud mental a adolescentes que presenten signos de adicción digital, soledad, timidez y ansiedad social.(AU)

Digital addiction, which is determined as a common problem among adolescents in the last years, affects the lives of adolescents nega-tively in terms of many aspects. The aim of the study is to examine the re-lationships between adolescents' digital addiction, loneliness, shyness and social anxiety. Gate gathered from adolescents who completed Digital Ad-diction Scale, Short Form of UCLA Loneliness Scale, Shyness Scale, and DSM-5 Social Anxiety Disorder Severity Scale -Child Form. The suggest-ed hypotheses have been tested using the data gathered from 991 adoles-cents and hierarchical regression analysis. The research findings found a positive and significant relationship between digital addiction, loneliness, shyness and social anxiety among adolescents. Furthermore, the findings show that digital addiction, loneliness, and shyness predict social anxiety. The results obtained prove that digital addiction, loneliness and shyness have an effect on social anxiety. According to the findings, it is suggested to applyvarious educational interventions by mental health professionals to adolescents who show signs of digital addiction, loneliness, shyness, and social anxiety.(AU)

Digital health in perinatal care: Exploring usage, attitudes, and needs among Swiss women in urban and rural settings.

Background: Switzerland's healthcare system is known for its quality but faces challenges such as slow digitalization and fragmentation, especially in perinatal care. This study investigates Swiss women's use, needs, and attitudes in respect of digital health tools during pregnancy and postpartum, focusing on any differences between rural and urban populations. Methods: A web-based cross-sectional survey targeted pregnant women and those who had given birth in the last 12 months. Participants were recruited through social media, and the data were analyzed using principal component analysis and multivariable regressions to explore factors affecting the use of digital tools and attitudes toward eHealth. Results: A total of 1160 participants completed the survey. Healthcare professionals (92%) and private networks (77%) were the primary sources of information. Women expressed a strong preference for app features such as data access (73%), prescription management (73%), and scheduling appointments with healthcare professionals (71%). However, they also raised concerns about the impersonal nature of digital healthcare interactions (71%). Overall, rural women had more negative attitudes toward online health information seeking, which can be attributed to differences in education levels. Conclusion: The findings indicate that while Swiss women in the perinatal period do utilize digital tools, they focus more on nonmedical topics such as tracking physiological development. The study underscores the importance of adapting digital health solutions to the specific needs of women in the perinatal period. Emphasis should be placed on developing applications that are not only informative but also empower women on their healthcare journey while ensuring data privacy and supporting personal interactions with healthcare providers.

Missed opportunities to provide sexually transmitted and blood-borne infections testing in British Columbia: An interpretive description of users' experiences of Get Checked Online's design and implementation.

Background: Digital testing services for sexually transmitted and blood-borne infections (STBBIs), such as GetCheckedOnline, experience significant user drop-offs. For example, 32% of GetCheckedOnline users needing testing at account creation do not test, constituting missed opportunities. We explored the influence of users' expectations and experiences of GetCheckedOnline's web design and implementation on missed opportunities. Methods: This interpretive description purposively sampled 14 GetCheckedOnline users who created accounts between April 2022 and February 2023, indicated needed testing at account creation but did not test. We conducted semi-structured interviews and cognitive walkthroughs of GetCheckedOnline on Zoom, exploring participants' expectations and experiences, including problems using the service. Interviews were audio recorded, transcribed verbatim, and analyzed using reflexive thematic analyses. Results: Three themes were identified: (a) transitioning between GetCheckedOnline and laboratory services is a major testing barrier; (b) users' appraisal of their health and social contexts is a determinant of testing through GetCheckedOnline; and (c) tailoring GetCheckedOnline's design and implementation to accommodate varying user needs can promote equitable testing. Health equity issues occurred along sociodemographic gradients as the GetCheckedOnline-laboratory transition was more onerous for older users. Users' appraisal of their testing needs which varied by age and gender, and their assessment of time, and travel requirements for testing in remote communities influenced testing. Learning about GetCheckedOnline from healthcare providers improved testing compared with learning about the service through Google search which raised trust concerns regarding GetCheckedOnline's authenticity. Suggested improvements to promote health equity include personalized education, mail-in testing options, and simpler seamless web experiences. Conclusions: To promote equitable access to digital STBBI testing services such as GetCheckedOnline, we can adapt web-design and implementation to suit user needs and contexts, ensuring simplicity and options for testing that reduce user burdens.

Global bibliometric mapping of the research trends in artificial intelligence-based digital pathology for lung cancer over the past two decades.

Background and Objective: The rapid development of computer technology has led to a revolutionary transformation in artificial intelligence (AI)-assisted healthcare. The integration of whole-slide imaging technology with AI algorithms has facilitated the development of digital pathology for lung cancer (LC). However, there is a lack of comprehensive scientometric analysis in this field. Methods: A bibliometric analysis was conducted on 197 publications related to digital pathology in LC from 502 institutions across 39 countries, published in 97 academic journals in the Web of Science Core Collection between 2004 and 2023. Results: Our analysis has identified the United States and China as the primary research nations in the field of digital pathology in LC. However, it is important to note that the current research primarily consists of independent studies among countries, emphasizing the necessity of strengthening academic collaboration and data sharing between nations. The current focus and challenge of research related to digital pathology in LC lie in enhancing the accuracy of classification and prediction through improved deep learning algorithms. The integration of multi-omics studies presents a promising future research direction. Additionally, researchers are increasingly exploring the application of digital pathology in immunotherapy for LC patients. Conclusions: In conclusion, this study provides a comprehensive knowledge framework for digital pathology in LC, highlighting research trends, hotspots, and gaps in this field. It also provides a theoretical basis for the application of AI in clinical decision-making for LC patients.

Digital health utilization during pregnancy and the likelihood of preterm birth.

Objective: Given the complex nature of preterm birth, interventions to reduce rates of preterm birth should be multifaceted. This analysis aimed to explore the association between the duration of using Maven, a digital health platform for women's and family health, and the odds of preterm birth. Methods: Data came from 3326 pregnant, nulliparous Maven users who enrolled in Maven during their pregnancy between January 2020 and September 2022. Chi-square and Fisher's exact tests compared characteristics between users who developed gestational conditions and users who did not. This retrospective cohort study used logistic regression models to estimate the association between the duration of Maven use and odds of preterm birth, stratified by the presence of gestational conditions. Results: Compared to those without gestational conditions, individuals who developed gestational conditions were more likely to have a preterm birth (8.7% vs. 3.4%; p < 0.001). For every 1 h of Maven use, users experienced a 2% reduction in their odds of experiencing a preterm birth [adjusted odds ratio (AOR) (95% confidence interval (CI)) = 0.98 (0.95, 0.998), p = 0.04]. Among individuals who developed gestational conditions, every 1 h increase in Maven use was associated with a 5% reduction in the odds of experiencing a preterm birth [AOR (95% CI) = 0.95 (0.91, 0.99), p = 0.037]. There was no statistically significant association between Maven use and preterm birth in individuals without gestational conditions. Conclusion: Among those who developed gestational conditions, use of a digital health platform was associated with a decreased likelihood of preterm birth.

Operationalizing data-driven campaigning: designing a new tool for mapping and guiding regulatory intervention.

Since the Cambridge Analytica scandal, governments are increasingly concerned about the way in which citizens' personal data are collected, processed and used during election campaigns To develop the appropriate tools for monitoring and controlling this new mode of "data-driven campaigning" (DDC) regulators require a clear understanding of the practices involved. This paper provides a first step toward that goal by proposing a new organizational and process-centred operational definition of DDC from which we derive a set of empirical indicators. The indicators are applied to the policy environment of a leading government in this domain - the European Union (EU) - to generate a descriptive "heat map" of current regulatory activity toward DDC. Based on the results of this exercise, we argue that regulation is likely to intensify on existing practices and extend to cover current "cold spots". Drawing on models of internet governance, we argue that this expansion is likely to occur in one of two ways. A "kaleidoscopic" approach, in which current legislation extends to absorb DDC practices and a more "designed" approach that involves more active intervention by elites, and ultimately the generation of a new regulatory regime.

Community nursing and the digital technology revolution: the past, present and future.

While very much in its infancy in terms of becoming an established tool, the use of digital technology in community nursing is steadily growing, despite the persistent barriers to, and challenges encountered in its uptake and implementation. The mobile nature and high workload of a community nurse's daily practice should facilitate the rapid uptake of time-saving technology. However, there are indications that technology may not be the panacea it was originally proclaimed to be. Francesca Ramadan elaborates on the past and present applications of digital technology in community nursing and delves into the principles that should shape the future potential of tools such as artificial intelligence, automation technologies and clinical decision support systems.

Quantifying body size estimation accuracy and body dissatisfaction in body dysmorphic disorder using a digital avatar.

BACKGROUND: A core feature of body dysmorphic disorder (BDD) is body image disturbance. Many with BDD misperceive and are dissatisfied with the sizes and shapes of body parts, but detailed quantification and analysis of this has not yet been performed. To address this gap, we applied Somatomap 3D, a digital avatar tool, to quantify body image disturbances by assessing body size estimation (BSE) accuracy and body dissatisfaction. METHODS: Sixty-one adults (31 with BDD, 30 healthy controls) created avatars to reflect their perceived current body and ideal body by altering 23 body part sizes and lengths using Somatomap 3D. Physical measurements of corresponding body parts were recorded for comparison. BSE accuracy (current minus actual) and body dissatisfaction (ideal minus current) were compared between groups and in relation to BDD symptom severity using generalized estimating equations. RESULTS: Individuals with BDD significantly over- and under-estimated certain body parts compared to healthy controls. Individuals with BDD overall desired significantly thinner body parts compared to healthy controls. Moreover, those with worse BSE accuracy had greater body dissatisfaction and poorer insight. CONCLUSION: In sum, this digital avatar tool revealed disturbances in body image in individuals with BDD that may have perceptual and cognitive/affective components.

Instant messengers and health professionals' agency in Russian clinical settings.

This research examines how Russian healthcare professionals use instant messengers (in particular, the group chat function on instant messengers) for work-related tasks. Based on qualitative interviews with Russian doctors and nurses conducted in spring 2020, the article explores how the informal implementation of instant messenger's group chat function facilitated and shaped health professionals' agency in two key areas of professional control: work regulation and medical knowledge. In the first case, front-line healthcare professionals used instant messengers to make horizontal connections, share relevant regulatory information, and smooth over organizational discrepancies. Hospital management, on the other hand, employed this technology as an additional tool for imposing top-down control on employees. The adoption of instant messengers for medical knowledge dissemination is more consistently linked with professional logic. By utilizing this technology, healthcare personnel not only shared clinical recommendations, publications, and clinical experience, but also fostered solidarity within the country's medical community and forged connections with international medical professionals. These findings support the social science assumption concerning the contextualized character of both professionalism and digital innovations in healthcare. In state-dominated Russian healthcare, instant messengers not only assist structurally disempowered professionals in dealing with pragmatic challenges, but also create more space for their ground-level discretion in the face of intense administrative pressure. Moreover, since the messaging technology helps Russian health workers in navigating and agentially connecting different knowledge and regulatory landscapes, it also fosters a new - trans-local and more reflexive - form of professionalism in post-socialist medicine.

Reducing Health Care Resource Utilization in COPD: A Retrospective Matched Control Analysis of a Digital Quality Improvement Program.

Introduction: COPD is a progressive lung disease that adds significant economic burden to the healthcare system in the United States. Digital platforms integrated into clinical workflows have demonstrated success in improving patient outcomes in COPD, but few studies have explored the impact of an integrated digital and clinical approach on drivers of direct healthcare costs (COPD-related prescriptions, emergency department (ED) visits and hospitalizations) in a real-world setting. Methods: We conducted a six-month retrospective matched control analysis to assess the impact of a digital quality improvement (QI) program delivered by clinical pharmacists on healthcare resource utilization among people living with COPD. Results: Compared to matched controls at six months, participants in the digital QI program had a nearly two-third relative reduction in COPD-related ED visits and hospitalizations (p=0.044), as well as a 47% reduction in all-cause ED visits and hospitalizations (p=0.059). Participants in the digital QI program also had higher rates of COPD-related prescription fills for antibiotics and oral corticosteroids, as well as a greater number of non-acute care visits compared to matched controls. Conclusion: Digital health platforms integrated into a virtual clinical pharmacist workflow can help reduce costly COPD-related emergency department visits and hospitalizations. Care models integrating digital platforms may also offer a scalable approach to managing COPD and should be explored in different clinical settings.

Optimizing the Distribution of Ablation Lesions to Prevent Postablation Atrial Tachycardia: A Personalized Digital-Twin Study.

BACKGROUND: Although targeting atrial fibrillation (AF) drivers and substrates has been used as an effective adjunctive ablation strategy for patients with persistent AF (PsAF), it can result in iatrogenic scar-related atrial tachycardia (iAT) requiring additional ablation. Personalized atrial digital twins (DTs) have been used preprocedurally to devise ablation targeting that eliminate the fibrotic substrate arrhythmogenic propensity and could potentially be used to predict and prevent postablation iAT. OBJECTIVES: In this study, the authors sought to explore possible alternative configurations of ablation lesions that could prevent iAT occurrence with the use of biatrial DTs of prospectively enrolled PsAF patients. METHODS: Biatrial DTs were generated from late gadolinium enhancement-magnetic resonance images of 37 consecutive PsAF patients, and the fibrotic substrate locations in the DT capable of sustaining reentries were determined. These locations were ablated in DTs by representing a single compound region of ablation with normal power (SSA), and postablation iAT occurrence was determined. At locations of iAT, ablation at the same DT target was repeated, but applying multiple lesions of reduced-strength (MRA) instead of SSA. RESULTS: Eighty-three locations in the fibrotic substrates of 28 personalized biatrial DTs were capable of sustaining reentries and were thus targeted for SSA ablation. Of these ablations, 45 resulted in iAT. Repeating the ablation at these targets with MRA instead of SSA resulted in the prevention of iAT occurrence at 15 locations (18% reduction in the rate of iAT occurrence). CONCLUSIONS: Personalized atrial DTs enable preprocedure prediction of iAT occurrence after ablation in the fibrotic substrate. It also suggests MRA could be a potential strategy for preventing postablation AT.

Celiac trunk arterial variations and their clinical implications: Role of imaging.

The awareness of anatomical variations of hepatic arteries and celiac trunk is very important in interventional radiology, liver transplant and intra-abdominal oncologic surgeries. Radiology plays an important role in the identification of these variants non-invasively. Digital subtraction angiography was the gold standard for their identification. Computed tomography (CT) angiography non-invasively provides detailed knowledge of various anatomical vascular variations. This pictorial review highlights the role of multidetector computed tomography (MDCT) in the identification of celiac trunk-hepatic arterial system variations and clinical consequences.