A Prospective Analysis of Screen-Detected Cancers Recalled and Not Recalled by Artificial Intelligence.

OBJECTIVE: The use of artificial intelligence has potential in assisting many aspects of imaging interpretation. We undertook a prospective service evaluation from March to October 2022 of Mammography Intelligent Assessment (MIA) operating "silently" within our Breast Screening Service, with a view to establishing its performance in the local population and setting. This evaluation addressed the performance of standalone MIA vs conventional double human reading of mammograms. METHODS: MIA analyzed 8779 screening events over an 8-month period. The MIA outcome did not influence the decisions made on the clinical pathway. Cases were reviewed approximately 6 weeks after the screen reading decision when human reading and/or MIA indicated a recall. RESULTS: There were 146 women with positive concordance between human reading and MIA (human reader and MIA recalled) in whom 58 breast cancers were detected. There were 270 women with negative discordance (MIA no recall, human reader recall) for whom 19 breast cancers and 1 breast lymphoma were detected, with 1 cancer being an incidental finding at assessment. Six hundred and four women had positive discordance (MIA recall, human reader no recall) in whom 2 breast cancers were detected at review. The breast cancers demonstrated a wide spectrum of mammographic features, sites, sizes, and pathologies, with no statistically significant difference in features between the negative discordant and positive concordant cases. CONCLUSION: Of 79 breast cancers identified by human readers, 18 were not identified by MIA, and these had no specific features or site to suggest a systematic error for MIA analysis of 2D screening mammograms.

Role of grinding method on granular activated carbon characteristics.

A coconut shell (AC1230CX) and a bituminous coal based (F400) granular activated carbon (GAC) were ground with mortar and pestle (MP), a blender, and a bench-scale ball milling unit (BMU). Blender was the most time-efficient for particle size reduction. Four size fractions ranging from 20 × 40 to 200 × 325 were characterized along with the bulk GACs. Compared to bulk GACs, F400 blender and BMU 20 × 40 fractions decreased in specific surface area (SSA, -23% and -31%, respectively) while smaller variations (-14% to 5%) occurred randomly for AC1230CX ground fractions. For F400, the blender and BMU size fraction dependencies were attributed to the combination of (i) radial trends in the F400 particle properties and (ii) importance of shear (outer layer removal) versus shock (particle fracturing) size reduction mechanisms. Compared to bulk GACs, surface oxygen content (At%-O1s) increased up to 34% for the F400 blender and BMU 20 × 40 fractions, whereas all AC1230CX ground fractions, except for the blender 100 × 200 and BMU 60 × 100 and 100 × 200 fractions, showed 25-29% consistent increases. The At%-O1s gain was attributed to (i) radial trends in F400 properties and (ii) oxidization during grinding, both of which supported the shear mechanism of mechanical grinding. Relatively small to insignificant changes in point of zero charge (pHPZC) and crystalline structure showed similar trends with the changes in SSA and At%-O1s. The study findings provide guidance for informed selection of grinding methods based on GAC type and target particle sizes to improve the representativeness of adsorption studies conducted with ground GAC, such as rapid small-scale column tests. When GACs have radial trends in their properties and when the target size fraction only includes larger particle sizes, manual grinding is recommended.

Anion Exchange Resin and Inorganic Anion Parameter Determination for Model Validation and Evaluation of Unintended Consequences during PFAS Treatment.

When implementing anion exchange (AEX) for per- and polyfluoroalkyl substances treatment, temporal drinking water quality changes from concurrent inorganic anion (IA) removal can create unintended consequences (e.g., corrosion control impacts). To understand potential effects, four drinking water-relevant IAs (bicarbonate, chloride, sulfate, and nitrate) and three gel-type, strong-base AEX resins were evaluated. Batch binary isotherm experiments provided estimates of IA selectivity with respect to chloride ( K x ∕ C ) for IA/resin combinations where bicarbonate < sulfate ≤ nitrate at studied conditions. A multi-IA batch experiment demonstrated that binary isotherm-determined K x ∕ C values predicted competitive behavior. Subsequent column experiments with and without natural organic matter (NOM) allowed for the validation of a new ion exchange column model (IEX-CM; https://github.com/USEPA/Water_Treatment_Models). IA breakthrough was well-simulated using binary isotherm-determined K x ∕ C values and was minimally impacted by NOM. Initial AEX effluent water quality changes with corrosion implications included increased chloride and decreased sulfate and bicarbonate concentrations, resulting in elevated chloride-to-sulfate mass ratios (CSMRs) and Larson ratios (LRs) and depressed pH until the complete breakthrough of the relevant IA(s). IEX-CM utility was further illustrated by simulating the treatment of low-IA source water and a change in the source water to understand the resulting duration of changes in IAs and water quality parameters.

Strong Base Anion Exchange Selectivity of Nine Perfluoroalkyl Chemicals Relevant to Drinking Water.

Selectivity with respect to chloride (KPFAS∕C) was determined for nine drinking water relevant perfluoroalkyl and polyfluoroalkyl substances (PFAS): perfluoro-2-propoxypropanoic acid (GenX), five perfluoroalkyl carboxylic acids (PFCAs), and three perfluoroalkyl sulfonic acids (PFSAs). Three single-use strong base anion exchange gel resins were investigated, targeting drinking water relevant equilibrium PFAS liquid concentrations (≤500 ng/L). Except for the longest carbon chain PFCA (perfluorodecanoic acid) and PFSA (perfluorooctanesulfonic acid) studied, PFAS followed traditional ion exchange theory (law of mass action), including increasing equilibrium PFAS liquid concentrations with increasing equilibrium chloride liquid concentrations. Overall, KPFAS∕C values were (i) similar among resins for a given PFAS, (ii) 1-5 orders of magnitude greater than the selectivity of inorganic anions (e.g., nitrate) previously studied, (iii) 2 orders of magnitude greater for the same carbon chain length PFSA versus PFCA, (iv) found to proportionally increase with carbon chain length for both PFSAs and PFCAs, and (v) similar for GenX and perfluorohexanoic acid (six-carbon PFCA). A multisolute competition experiment demonstrated binary isotherm-determined KPFAS∕C values could be applied to simulate a multisolute system, extending work previously done with only inorganic anions to PFAS. Ultimately, estimated KPFAS∕C values allow future extension and validation of an open-source anion exchange column model to PFAS.

Practical implications of perfluoroalkyl substances adsorption on bottle materials: Isotherms.

To assess the practical implications of various bottle materials used in anion exchange (IX) or granular activated carbon (GAC) isotherm experiments, adsorption of seven per- and polyfluoroalkyl substances (PFAS) onto three common bottle materials (silanized glass, polypropylene, and high-density polyethylene [HDPE]) were screened. Results were similar between bottle materials; therefore, only HDPE was used in a detailed bottle material isotherm study with 11 PFAS. For each PFAS, an HDPE bottle isotherm was generated with equilibrium liquid phase concentrations relevant to drinking water (<2000 ng/L). Percent PFAS recoveries between 90% and 103%, 85% and 114%, and 54% and 108% were determined for perfluoro-2-propoxypropanoic acid (GenX), five perfluoroalkyl carboxylic acids, and five perfluoroalkyl sulfonic acids (PFSA), respectively. These results indicated only the five PFSA adsorbed to the HDPE bottles in a concentration-dependent manner. Furthermore, linear isomer versions of two PFSA exhibited greater adsorption. For each PFSA studied, a linear isotherm was generated and used to develop guidance for conducting future IX and GAC isotherm studies. Specifically, the minimum initial isotherm concentration was established such that a maximum 1% loss would be expected to the HDPE bottles, resulting in required initial concentrations of the five PFSA between 21 and 75 times that of the design isotherm liquid equilibrium concentration.

Persistent post-discharge opioid prescribing after traumatic brain injury requiring intensive care unit admission: A cross-sectional study with longitudinal outcome.

Traumatic brain injury (TBI) is associated with increased risk for psychological and substance use disorders. The study aim is to determine incidence and risk factors for persistent opioid prescription after hospitalization for TBI. Electronic medical records of patients age ≥ 18 admitted to a neuroscience intensive care unit between January 2013 and February 2017 for an intracranial injury were retrospectively reviewed. Primary outcome was opioid use through 12 months post-hospital discharge. A total of 298 patients with complete data were included in the analysis. The prevalence of opioid use among preadmission opioid users was 48 (87%), 36 (69%) and 22 (56%) at 1, 6 and 12-months post-discharge, respectively. In the opioid naïve group, 69 (41%), 24 (23%) and 17 (19%) were prescribed opioids at 1, 6 and 12 months, respectively. Preadmission opioid use (OR 324.8, 95% CI 23.1-16907.5, p = 0.0004) and higher opioid requirements during hospitalization (OR 4.5, 95% CI 1.8-16.3, p = 0.006) were independently associated with an increased risk of being prescribed opioids 12 months post-discharge. These factors may be used to identify and target at-risk patients for intervention.

Occurrence of Per- and Polyfluoroalkyl Substances (PFAS) in Source Water and Their Treatment in Drinking Water.

Per-and polyfluoroalkyl substances (PFAS) occurrence in drinking water and treatment methods for their removal are reviewed. PFAS are fluorinated substances whose unique properties make them effective surface-active agents with uses ranging from stain repellants to fire-fighting foams. In response to concerns about drinking water contamination and health risks from PFAS exposure, the United States Environmental Protection Agency published Health Advisories (HAs) for perfluorooctanoic acid and perfluorooctane sulfonic acid. The occurrence of six PFAS in drinking water has been reported in the Third Unregulated Contaminant Monitoring Rule (UCMR3), and subsequent analysis of the dataset suggested that four percent of water systems reported at least one detectable PFAS compound and 1.3 percent of water systems reported results above the HAs. Many treatment technologies have been evaluated in the literature, with the most promising and readily applied treatment technologies being activated carbon, anion exchange resins, and high-pressure membrane systems. From these data and literature reports, research and data gaps were identified and suggestions for future research are provided.

Attitudes toward monitoring blood pressure and blood sugar at a New York State dental school.

The aim of this retrospective study was to assess dental patient, physician and dental student attitudes toward blood pressure and glycemic monitoring within a dental school environment. The responses of these cohort groups were analyzed by using an Institutional Review Board-approved survey. Physicians and dental students viewed blood pressure monitoring positively, while patients were less enthusiastic. All three groups viewed measuring blood sugar on diabetic patients prior to dental surgery as important, but not on a routine basis.

Intra-dance variation among waggle runs and the design of efficient protocols for honey bee dance decoding.

Noise is universal in information transfer. In animal communication, this presents a challenge not only for intended signal receivers, but also to biologists studying the system. In honey bees, a forager communicates to nestmates the location of an important resource via the waggle dance. This vibrational signal is composed of repeating units (waggle runs) that are then averaged by nestmates to derive a single vector. Manual dance decoding is a powerful tool for studying bee foraging ecology, although the process is time-consuming: a forager may repeat the waggle run 1- >100 times within a dance. It is impractical to decode all of these to obtain the vector; however, intra-dance waggle runs vary, so it is important to decode enough to obtain a good average. Here we examine the variation among waggle runs made by foraging bees to devise a method of dance decoding. The first and last waggle runs within a dance are significantly more variable than the middle run. There was no trend in variation for the middle waggle runs. We recommend that any four consecutive waggle runs, not including the first and last runs, may be decoded, and we show that this methodology is suitable by demonstrating the goodness-of-fit between the decoded vectors from our subsamples with the vectors from the entire dances.