Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study.

BACKGROUND: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. OBJECTIVE: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. METHODS: This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. RESULTS: The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (ß=-.35; t61=-3.05; P=.003), number of activities completed (ß=-.12; t61=-2.05; P=.04), days played (ß=-.12; t58=-2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (ß=-3.05; t45=-2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. CONCLUSIONS: Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression.

Two-point Dixon and six-point Dixon magnetic resonance techniques in the detection, quantification and grading of hepatic steatosis.

BACKGROUND: Hepatic steatosis is a very common problem worldwide. AIM: To assess the performance of two- and six-point Dixon magnetic resonance (MR) techniques in the detection, quantification and grading of hepatic steatosis. METHODS: A single-center retrospective study was performed in 62 patients with suspected parenchymal liver disease. MR sequences included two-point Dixon, six-point Dixon, MR spectroscopy (MRS) and MR elastography. Fat fraction (FF) estimates on the Dixon techniques were compared to the MRS-proton density FF (PDFF). Statistical tests used included Pearson's correlation and receiver operating characteristic. RESULTS: FF estimates on the Dixon techniques showed excellent correlation (≥ 0.95) with MRS-PDFF, and excellent accuracy [area under the receiver operating characteristic (AUROC) ≥ 0.95] in: (1) Detecting steatosis; and (2) Grading severe steatosis, (P < 0.001). In iron overload, two-point Dixon was not evaluable due to confounding T2* effects. FF estimates on six-point Dixon vs MRS-PDFF showed a moderate correlation (0.82) in iron overload vs an excellent correlation (0.97) without iron overload, (P < 0.03). The accuracy of six-point Dixon in grading mild steatosis improved (AUROC: 0.59 to 0.99) when iron overload cases were excluded. The excellent correlation (> 0.9) between the Dixon techniques vs MRS-PDFF did not change in the presence of liver fibrosis (P < 0.01). CONCLUSION: Dixon techniques performed satisfactorily for the evaluation of hepatic steatosis but with exceptions.

Unilateral renal agenesis, blind-ended ureter, and ectopic ureterocele inserting into the seminal vesicle: A very rare developmental association.

Congenital renal anomalies are common imaging findings and can often be detected antenatally. In some cases, these anomalies may go undetected and present in adulthood. We report a very rare case of unilateral renal agenesis in a 22-year-old male associated with an ipsilateral dilated blind-ended ureter that ectopically inserted into the seminal vesicle. This unique combination of developmental anomalies can lead to a variety of clinical presentations and requires careful monitoring and management.

Multiparametric MR assessment of liver fat, iron, and fibrosis: a concise overview of the liver "Triple Screen".

Chronic liver disease (CLD) is a common source of morbidity and mortality worldwide. Non-alcoholic fatty liver disease (NAFLD) serves as a major cause of CLD with a rising annual prevalence. Additionally, iron overload can be both a cause and effect of CLD with a negative synergistic effect when combined with NAFLD. The development of state-of-the-art multiparametric MR solutions has led to a change in the diagnostic paradigm in CLD, shifting from traditional liver biopsy to innovative non-invasive methods for providing accurate and reliable detection and quantification of the disease burden. Novel imaging biomarkers such as MRI-PDFF for fat, R2 and R2* for iron, and liver stiffness for fibrosis provide important information for diagnosis, surveillance, risk stratification, and treatment. In this article, we provide a concise overview of the MR concepts and techniques involved in the detection and quantification of liver fat, iron, and fibrosis including their relative strengths and limitations and discuss a practical abbreviated MR protocol for clinical use that integrates these three MR biomarkers into a single simplified MR assessment. Multiparametric MR techniques provide accurate and reliable non-invasive detection and quantification of liver fat, iron, and fibrosis. These techniques can be combined in a single abbreviated MR "Triple Screen" assessment to offer a more complete metabolic imaging profile of CLD.

Interobserver agreement between eight observers using IOTA simple rules and O-RADS lexicon descriptors for adnexal masses.

PURPOSE: To evaluate interobserver agreement in assigning imaging features and classifying adnexal masses using the IOTA simple rules versus O-RADS lexicon and identify causes of discrepancy. METHODS: Pelvic ultrasound (US) examinations in 114 women with 118 adnexal masses were evaluated by eight radiologists blinded to the final diagnosis (4 attendings and 4 fellows) using IOTA simple rules and O-RADS lexicon. Each feature category was analyzed for interobserver agreement using intraclass correlation coefficient (ICC) for ordinal variables and free marginal kappa for nominal variables. The two-tailed significance level (a) was set at 0.05. RESULTS: For IOTA simple rules, interobserver agreement was almost perfect for three malignant lesion categories (M2-4) and substantial for the remaining two (M1, M5) with k-values of 0.80-0.82 and 0.68-0.69, respectively. Interobserver agreement was almost perfect for two benign feature categories (B2, B3), substantial for two (B4, B5) and moderate for one (B1) with k-values of 0.81-0.90, 0.69-0.70 and 0.60, respectively. For O-RADS, interobserver agreement was almost perfect for two out of ten feature categories (ascites and peritoneal nodules) with k-values of 0.89 and 0.97. Interobserver agreement ranged from fair to substantial for the remaining eight feature categories with k-values of 0.39-0.61. Fellows and attendings had ICC values of 0.725 and 0.517, respectively. CONCLUSION: O-RADS had variable interobserver agreement with overall good agreement. IOTA simple rules had more uniform interobserver agreement with overall excellent agreement. Greater reader experience did not improve interobserver agreement with O-RADS.

Long term central venous catheters for haemodialysis causing an extra-cardiac right-to-left shunt.

Central venous catheters can provide long-term access for haemodialysis patients who cannot have an arteriovenous fistula or graft fashioned. However, long-term central venous catheter use for haemodialysis may lead to complications including central venous stenosis, and superior vena cava obstruction in its worst form. Here, we describe the case of a patient on haemodialysis via central venous catheters for over 20 years, in whom chronic superior vena cava obstruction led to the development of mediastinal collateral vessels. These drained deoxygenated systemic venous blood into the oxygenated pulmonary venous system. Over time, this caused a significant right-to-left shunt and resulting hypoxaemia. This is the first reported case of central venous catheters used for haemodialysis resulting in an acquired, extra-cardiac, right-to-left shunt.

Dispatcher-assisted CPR can it do harm as well as good?

Outcomes for patients with out-of-hospital cardiac arrest can be improved by bystander cardiopulmonary resuscitation (CPR). Dispatcher-assisted CPR increases both the likelihood of CPR being performed, and the chance of survival for the arrested patient. Due to the urgency of the situation, CPR may be advised in patients who are subsequently found not to be in cardiac arrest. Ng and colleagues look at whether bystander CPR causes harm in this group of patients.

SMAP-HydroBlocks, a 30-m satellite-based soil moisture dataset for the conterminous US.

Soil moisture plays a key role in controlling land-atmosphere interactions, with implications for water resources, agriculture, climate, and ecosystem dynamics. Although soil moisture varies strongly across the landscape, current monitoring capabilities are limited to coarse-scale satellite retrievals and a few regional in-situ networks. Here, we introduce SMAP-HydroBlocks (SMAP-HB), a high-resolution satellite-based surface soil moisture dataset at an unprecedented 30-m resolution (2015-2019) across the conterminous United States. SMAP-HB was produced by using a scalable cluster-based merging scheme that combines high-resolution land surface modeling, radiative transfer modeling, machine learning, SMAP satellite microwave data, and in-situ observations. We evaluated the resulting dataset over 1,192 observational sites. SMAP-HB performed substantially better than the current state-of-the-art SMAP products, showing a median temporal correlation of 0.73 ± 0.13 and a median Kling-Gupta Efficiency of 0.52 ± 0.20. The largest benefit of SMAP-HB is, however, the high spatial detail and improved representation of the soil moisture spatial variability and spatial accuracy with respect to SMAP products. The SMAP-HB dataset is available via zenodo and at https://waterai.earth/smaphb .

Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) Visualization Score: a reliability analysis on inter-reader agreement.

BACKGROUND & AIM: The American College of Radiology Ultrasound Liver Imaging Reporting and Data System (ACR US LI-RADS) Visualization Score conveys the expected level of sensitivity of screening and surveillance ultrasound exams in patients at risk for hepatocellular carcinoma (HCC). We sought to determine inter-reader agreement of the Visualization Score which is currently unknown. METHODS: Consecutive 6998 ultrasound HCC screening and surveillance studies in 3115 patients from 2017 to 2020 were retrospectively retrieved. Of these, 6154 (87.9%) studies were Visualization A (No or minimal limitations), 709 (10.1%) were Visualization B (Moderate limitations), and 135 (1.9%) were Visualization C (Severe limitations). Randomly sampled 90 studies, with 30 studies in each Visualization category, were included for analysis. Nine radiologists (3 senior attendings, 3 junior attendings and 3 body imaging fellows) blinded to the original categorization independently reviewed each study and assigned a Visualization Score. Intraclass correlation coefficient (ICC) was used to quantify inter-reader agreement. RESULTS: ICC among all 9 radiologists was 0.70 (95% CI 0.63-0.77). ICCs among senior attendings, junior attendings and body imaging fellows were 0.68 (CI 0.58-0.76), 0.72 (CI 0.62-0.80) and 0.76 (CI 0.68-0.83), respectively. Subgroup analysis by liver parenchyma was further performed. ICC was highest in the patient group with normal liver parenchyma (0.69, CI 0.56-0.81), followed by steatosis (0.66, CI 0.54-0.79) and cirrhosis (0.58, CI 0.43-0.73), respectively. CONCLUSIONS: US LI-RADS Visualization Score is a reliable tool with good inter-reader agreement that can be used to indicate the expected level of sensitivity of a screening and surveillance ultrasound examination for detecting focal liver observations.

Resident physician burnout: insights from a Canadian multispecialty survey.

BACKGROUND: Burnout results from chronic exposure to stress: comprising emotional exhaustion (EE), depersonalisation (DP) and a reduced sense of personal achievement (PA). Only a few studies have examined burnout in Canadian residents, and no multispecialty studies using the Maslach Burnout Inventory-Health Sciences Survey (MBI-HSS) exist. The purpose of our study is to identify burnout prevalence, contributory factors and solutions. METHODS: A prospective 62-item survey, including the 22-item MBI-HSS, was sent to all Alberta residents, with a resident population of 1745. The association between burnout, EE, DP and PA with items in the survey was performed. Continuous data were evaluated using Student's t-test or analysis of variance. Ordinal data were evaluated using Spearman's correlation coefficient and Mann-Whitney U test. Nominal data were evaluated using χ2 test. RESULTS: Response rate was 41.1% (n=718), with burnout prevalence of 69.4%. 61.6% of residents demonstrated high EE, 47.8% high DP and 29.0% low PA. More hours worked, poor work-life balance, poor service-education balance, poor mental health support, experiencing intimidation/harassment and being unhappy with programme and with career choice were associated with higher burnout (p<0.001). 53.5% of residents experienced intimidation/harassment. Solutions to burnout included improved teaching, improved call/working hours, more wellness days and a change in medicine culture. CONCLUSION: High prevalence of burnout in Canadian residents with contributory factors and solutions identified. We hope programmes across the world can use this information to improve the burden of burnout among residents.

Burnout in Canadian Radiology Residency: A National Assessment of Prevalence and Underlying Contributory Factors.

OBJECTIVE: To determine burnout prevalence in Canadian radiology residency and identify contributing factors. MATERIALS AND METHODS: A prospective 57-item survey, including the 22-item Maslach Burnout Inventory-Health Sciences Survey, was sent to all Canadian radiology residents, with a total resident population of 359. The association between emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA) scores with items in the survey was performed. Continuous data were evaluated using the Student t test for comparing the means between the 2 groups or the analysis of variance test for comparing the means between at least 3 groups. Spearman correlation coefficient was performed when evaluating ordinal categorical data. RESULTS: Response rate is 40.1% (n = 144); 50.7% of residents demonstrate high EE, 48.6% demonstrate high DP, and 35.9% demonstrate low PA. Being unhappy with residency and with radiology as a career is associated with burnout (P < .001). Age, sex, marital status, and children have no impact on burnout. More hours worked is associated with higher EE (P = .025) and DP (P = .004). In all, 47.2% residents experienced intimidation or harassment. Feeling unsupported by staff radiologists is associated with higher EE (P < .001), higher DP (P = .001), and lower PA (P = .008). In all, 45.1% of residents have poor work-life balance, and those residents demonstrate higher EE (P < .001), higher DP (P = .006), and lower PA (P = .01). In all, 25% of residents identify poor education-service balance in their residency, and those residents have higher EE (P < .001), higher DP (P = .042), and lower PA (P = .005). CONCLUSION: This study demonstrates significant burnout in Canadian radiology residents with major contributory factors identified.

Retrospective Analysis of the Computed Tomography Pulmonary Angiogram Utilization Patterns in the Emergency Department.

OBJECTIVES: Guidelines and high-quality studies recommend using clinical decision-making (CDM) tools over clinical gestalt when evaluating a patient for pulmonary embolism. The purpose of this study is to investigate our computed tomography pulmonary angiogram (CTPA) utilization patterns and identify causal factors. METHODS: A retrospective cohort study of CTPA studies ordered by emergency physicians in January, April, July, and October 2017 was undertaken. All necessary information to categorize patients by Wells' score, revised Geneva score, and pulmonary embolism rule-out criteria (PERC) was collected. In addition, various bloodwork, chest radiograph, and computed tomography results were collected. This data was analysed by the Pearson chi-square test or Fisher's exact test for categorical data and independent-samples t test for continuous variables. RESULTS: A total of 510 CTPA studies were performed, with a mean age was 61.6 and a 50.6% female population. 136 studies (26.7%) failed to appropriately follow any CDM tool. CDM tool failure rate was dependent on whether the study was ordered from a community (14.9%) or tertiary hospital (University of Alberta Hospital, 27.9% and Royal Alexandra Hospital, 24.6%) (P = .038). Of these 136 studies, 31 were low/moderate risk and the d-dimer was negative. The remainder were either PERC-negative or low/moderate risk without d-dimer performed. The cumulative positive pulmonary embolism rate was 12.5%. With utilization of a CDM tool, the positive pulmonary embolism rate was 15.0%, compared to 5.9% when using gestalt (P = .026). CONCLUSIONS: This study confirms a high rate of CDM tool use failure, and a higher positive CTPA rate for CDM tools compared to clinical gestalt.

Use of In-Game Rewards to Motivate Daily Self-Report Compliance: Randomized Controlled Trial.

BACKGROUND: Encouraging individuals to report daily information such as unpleasant disease symptoms, daily activities and behaviors, or aspects of their physical and emotional state is difficult but necessary for many studies and clinical trials that rely on patient-reported data as primary outcomes. Use of paper diaries is the traditional method of completing daily diaries, but digital surveys are becoming the new standard because of their increased compliance; however, they still fall short of desired compliance levels. OBJECTIVE: Mobile games using in-game rewards offer the opportunity to increase compliance above the rates of digital diaries and paper diaries. We conducted a 5-week randomized control trial to compare the completion rates of a daily diary across 3 conditions: a paper-based participant-reported outcome diary (Paper PRO), an electronic-based participant-reported outcome diary (ePRO), and a novel ePRO diary with in-game rewards (Game-Motivated ePRO). METHODS: We developed a novel mobile game that is a combination of the idle and pet collection genres to reward individuals who complete a daily diary with an in-game reward. Overall, 197 individuals aged 6 to 24 years (male: 100 and female: 97) were enrolled in a 5-week study after being randomized into 1 of the 3 methods of daily diary completion. Moreover, 157 participants (male: 84 and female: 69) completed at least one diary and were subsequently included in analysis of compliance rates. RESULTS: We observed a significant difference (F2,124=6.341; P=.002) in compliance to filling out daily diaries, with the Game-Motivated ePRO group having the highest compliance (mean completion 86.4%, SD 19.6%), followed by the ePRO group (mean completion 77.7%, SD 24.1%), and finally, the Paper PRO group (mean completion 70.6%, SD 23.4%). The Game-Motivated ePRO (P=.002) significantly improved compliance rates above the Paper PRO. In addition, the Game-Motivated ePRO resulted in higher compliance rates than the rates of ePRO alone (P=.09). Equally important, even though we observed significant differences in completion of daily diaries between groups, we did not observe any statistically significant differences in association between the responses to a daily mood question and study group, the average diary completion time (P=.52), or the System Usability Scale score (P=.88). CONCLUSIONS: The Game-Motivated ePRO system encouraged individuals to complete the daily diaries above the compliance rates of the Paper PRO and ePRO without altering the participants' responses. TRIAL REGISTRATION: ClinicalTrials.gov NCT03738254; http://clinicaltrials.gov/ct2/show/NCT03738254 (Archived by WebCite at http://www.webcitation.org/74T1p8u52).

QuantifyMe: An Open-Source Automated Single-Case Experimental Design Platform.

Smartphones and wearable sensors have enabled unprecedented data collection, with many products now providing feedback to users about recommended step counts or sleep durations. However, these recommendations do not provide personalized insights that have been shown to be best suited for a specific individual. A scientific way to find individualized recommendations and causal links is to conduct experiments using single-case experimental design; however, properly designed single-case experiments are not easy to conduct on oneself. We designed, developed, and evaluated a novel platform, QuantifyMe, for novice self-experimenters to conduct proper-methodology single-case self-experiments in an automated and scientific manner using their smartphones. We provide software for the platform that we used (available for free on GitHub), which provides the methodological elements to run many kinds of customized studies. In this work, we evaluate its use with four different kinds of personalized investigations, examining how variables such as sleep duration and regularity, activity, and leisure time affect personal happiness, stress, productivity, and sleep efficiency. We conducted a six-week pilot study (N = 13) to evaluate QuantifyMe. We describe the lessons learned developing the platform and recommendations for its improvement, as well as its potential for enabling personalized insights to be scientifically evaluated in many individuals, reducing the high administrative cost for advancing human health and wellbeing.

BET 2: Is early chemical thromboprophylaxis safe in patients with blunt trauma solid organ injury (SOI) undergoing non-operative management (NOM)?

A short cut review was carried out to establish whether chemical thromboprophylaxis was a safe early intervention in patients with solid organ injury that is being managed non-operatively. Eight papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is inadequate evidence assessing safety of low molecular weight heparin (LMWH) within 24 hours of trauma. The current available evidence does suggest that administration of LMWH within 48 hours is safe in non-operative management of patients who have sustained solid organ injury from blunt trauma.

A retrospective analysis of complication and adequacy rates of ultrasound-guided native and transplant non-focal renal biopsies.

PURPOSE: To assess non-focal ultrasound (US)-guided renal biopsy complication and adequacy rates at our institution. METHODS: A retrospective analysis of 1067 non-focal renal biopsy cases between 2012 and 2015. Information collected including type of US-guided procedure (US-localized by nephrology vs. real-time US-guided by radiology), sample adequacy, complications, blood work, and histologic data. RESULTS: 602 biopsies were performed by radiology (56.4%) and 465 (43.6%) by nephrology. The overall adequacy rate was 96.1%, with an US-localized rate of 95.7% and real-time US-guided rate of 96.3% (p = 0.58). A lower adequacy rate was noted for 1 biopsy core but there were no differences between 2 and 6 cores (p = 0.001). A lower adequacy rate was found for transplant biopsies vs. native biopsies (p = 0.03). Complication rates were as follows-minor 5.9%, major 4.3%, and life-threatening 0.8%. There were no differences in complication rates between the US-localized and real-time US-guided techniques (p = 0.63). Complications were more likely in patients with a lower hemoglobin, higher serum creatinine, and lower albumin (p < 0.05). No differences were found between the number of cores performed and the complication rates. The complication rate was similar between transplant biopsies vs. native biopsies (p = 0.2). The adequacy rate was lower in trainees (p = 0.01) than experienced radiologists. CONCLUSIONS: No significant differences were found between US-localized vs. real-time US-guided techniques. A lower adequacy rate was found for trainee radiologists and for transplant biopsies. A lower adequacy rate was also observed when only 1 biopsy pass was performed.

Safety and efficacy of microwave ablation for medically inoperable colorectal pulmonary metastases: Single-centre experience.

INTRODUCTION: To evaluate the safety and therapeutic efficacy of percutaneous microwave ablation (MWA) for colorectal pulmonary metastases. METHODS: Retrospective review of CT-guided lung MWA at a single tertiary institution. Adverse events within 30 days of MWA were considered procedure-related complications. Imaging follow-up was with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and contrast-enhanced CT. Response of index tumours was assessed using modified response evaluation criteria in solid tumours (mRECIST). RESULTS: The CT-guided lung MWA was performed in 14 patients with treatment of 20 colorectal pulmonary metastases during 19 procedures. Mean follow-up from completion of the treatment protocol was 24.4 ± 11.8 months. Primary and secondary technique effectiveness rates were 75% and 50% respectively. Mean pre- and post-procedural carcino-embryonic antigen (CEA) levels were 7.9 ± 10.8 µg/L and 2.5 ± 2.1 µg/L respectively. Procedure-related complications were major in three procedures (15.8%) and minor in six procedures (31.6%). No procedure-related deaths occurred. CONCLUSION: Microwave ablation is safe and efficacious in the local control of colorectal pulmonary metastases. The frequent systemic disease progression despite local control would favour a minimally invasive treatment option over invasive surgery in the setting of oligometastatic disease.