Methods for improving colorectal cancer annotation efficiency for artificial intelligence-observer training.

BACKGROUND: Missing occult cancer lesions accounts for the most diagnostic errors in retrospective radiology reviews as early cancer can be small or subtle, making the lesions difficult to detect. Second-observer is the most effective technique for reducing these events and can be economically implemented with the advent of artificial intelligence (AI). AIM: To achieve appropriate AI model training, a large annotated dataset is necessary to train the AI models. Our goal in this research is to compare two methods for decreasing the annotation time to establish ground truth: Skip-slice annotation and AI-initiated annotation. METHODS: We developed a 2D U-Net as an AI second observer for detecting colorectal cancer (CRC) and an ensemble of 5 differently initiated 2D U-Net for ensemble technique. Each model was trained with 51 cases of annotated CRC computed tomography of the abdomen and pelvis, tested with 7 cases, and validated with 20 cases from The Cancer Imaging Archive cases. The sensitivity, false positives per case, and estimated Dice coefficient were obtained for each method of training. We compared the two methods of annotations and the time reduction associated with the technique. The time differences were tested using Friedman's two-way analysis of variance. RESULTS: Sparse annotation significantly reduces the time for annotation particularly skipping 2 slices at a time (P < 0.001). Reduction of up to 2/3 of the annotation does not reduce AI model sensitivity or false positives per case. Although initializing human annotation with AI reduces the annotation time, the reduction is minimal, even when using an ensemble AI to decrease false positives. CONCLUSION: Our data support the sparse annotation technique as an efficient technique for reducing the time needed to establish the ground truth.

The effectiveness of virtual interviews for postgraduate orthodontic residencies in North America.

PURPOSE: The purpose of this study was to collect information regarding how orthodontic program directors are conducting their resident interviews due to changes brought about by COVID-19, their beliefs about the advantages and disadvantages ofadapting to a new process, and their thoughts after the 2020 application cycle. METHODS: Two surveys, an initial and follow-up, were sent to all 74 North Americanpostgraduate orthodontic residency program directors/chairs. Anonymous responseswere analyzed. RESULTS: Thirty-five of 74 program directors responded (47.3%) to the initial survey, and 85.7% (n=30) of the program directors who responded to the initials urvey also responded to the follow-up survey. Program directors felt thought the top three advantages of virtual interviews were: 1) "Cost-effectiveness for candidates;" 2) "Saves travel time for candidates;" and 3) "safe environment from COVID-19." They believed the top three disadvantages of virtual interviews were: 1) "Assessing interpersonal skills/personality;" 2) "Inability to explore the city;" and 3) "Lack ofpersonal interaction." Nearly half of the program directors (46.7%) did not believe virtual interviews are as valuable as in-person interviews. CONCLUSIONS: Most respondents did not believe virtual interviews were as effective as in-person interviews.This study may be useful when considering the use of virtual interviews in the future,whether for another pandemic or if an applicant is unable to attend an in-personinterview.

Sport Specialization and Risk of Overuse Injuries: A Systematic Review With Meta-analysis.

CONTEXT: Sport specialization is theorized to increase the risk of sustaining overuse musculoskeletal injuries. OBJECTIVE: To complete a systematic review and meta-analysis of the literature to determine if sport specialization is associated with overuse musculoskeletal injuries. DATA SOURCES: An electronic search was conducted using the search terms "specialization," "year-round," "overuse," "repetitive stress," "injury," "young," "pediatric," and "sports." STUDY SELECTION: Studies were included if their population was ≤18 years of age, if they compared athletes with high or single-sport specialization with athletes with low or multisport specialization, and focused on overuse injuries. DATA EXTRACTION: Of the 12 articles that were identified for full-text review, 5 studies met all the inclusion criteria. Four studies provided adequate data for the meta-analysis. Quality scores on the modified Downs and Black scale ranged from 69% to 81%. RESULTS: Athletes with high specialization were at an increased risk of sustaining an overuse injury compared with athletes with low (pooled relative risk [RR] ratio: 1.81; 95% confidence interval [CI]: 1.26-2.60) and moderate (pooled RR: 1.18; 95% CI: 1.05-1.33) specialization. Athletes with moderate specialization were at a higher risk of injury compared with athletes with low specialization (RR: 1.39 [95% CI: 1.04-1.87]). LIMITATIONS: Four of the 5 studies included in this systematic review were included in the meta-analysis because of the lack of access to the original data set for 1 article. CONCLUSIONS: Sport specialization is associated with an increased risk of overuse musculoskeletal injuries (Strength of Recommendation Taxonomy grade: B).

Multimodal Counseling Interventions: Effect on Human Papilloma Virus Vaccination Acceptance.

Human papilloma virus (HPV) vaccine was developed to reduce HPV-attributable cancers, external genital warts (EGW), and recurrent respiratory papillomatosis. Adolescent HPV vaccination series completion rates are less than 40% in the United States of America, but up to 80% in Australia and the United Kingdom. Population-based herd immunity requires 80% or greater vaccination series completion rates. Pro-vaccination counseling facilitates increased vaccination rates. Multimodal counseling interventions may increase HPV vaccination series non-completers' HPV-attributable disease knowledge and HPV-attributable disease prophylaxis (vaccination) acceptance over a brief 14-sentence counseling intervention. An online, 4-group, randomized controlled trial, with 260 or more participants per group, found that parents were more likely to accept HPV vaccination offers for their children than were childless young adults for themselves (68.2% and 52.9%). A combined audiovisual and patient health education handout (PHEH) intervention raised knowledge of HPV vaccination purpose, p = 0.02, and HPV vaccination acceptance for seven items, p < 0.001 to p = 0.023. The audiovisual intervention increased HPV vaccination acceptance for five items, p < 0.001 to p = 0.006. That HPV causes EGW, and that HPV vaccination prevents HPV-attributable diseases were better conveyed by the combined audiovisual and PHEH than the control 14-sentence counseling intervention alone.

Universal decolonization with hypochlorous solution in a burn intensive care unit in a tertiary care community hospital.

Infections are the leading cause of morbidity and mortality in burn patients. Patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at higher risk of developing an invasive infection, and MRSA is endemic in many burn units. The typical decolonization regimen of mupirocin and chlorhexidine bathing is not optimal in burn patients because of chlorhexidine limitations on nonintact skin. We studied the impact of universal decolonization using mupirocin and hypochlorous acid bathing on health care-associated MRSA infections in a burn intensive care unit. We show a significant decrease in total MRSA infections.

Effects of a catheter-associated urinary tract infection prevention campaign on infection rate, catheter utilization, and health care workers' perspective at a community safety net hospital.

Preventing catheter-associated urinary tract infections is in the forefront of health care quality. However, nurse and physician engagement is a common barrier in infection prevention efforts. After implementation of a multidisciplinary catheter-associated urinary tract infection (CAUTI) prevention campaign, we studied the impact of our campaign and showed its association with reducing the CAUTI rate and catheter utilization and the positive effect on health care workers' engagement and perspectives. CAUTI prevention campaigns can lead to lower infection rates and change health care workers' perspective.

Prevalence of metabolic syndrome and individual criterion in US adolescents: 2001-2010 National Health and Nutrition Examination Survey.

BACKGROUND: The prevalence of metabolic syndrome has increased in adolescents in previous years. The objectives of this study were to examine the prevalence in the past decade and the individual criteria in a nationally representative sample of US adolescents. METHODS: This study was a descriptive analysis of 3495 US adolescents between the ages of 12 and 19 years using the National Health and Nutrition Examination Survey (NHANES) 2000-2010. Metabolic syndrome was defined as having three of the five following conditions: Waist circumference (WC),≥90(th) percentile (sex-specific); elevated resting blood pressure,≥90(th) percentile (age, height, sex-specific); elevated triglycerides (TGs); low high-density lipoprotein cholesterol; and/or impaired fasting glucose. RESULTS: Approximately 73.2% of the participants had at least one criterion, with the estimated metabolic syndrome prevalence being 10.1%. Prevalence was higher in males than females (13.0% vs. 6.4%, P<0.05). Both Hispanic males and females had significantly greater odds of metabolic syndrome. Abnormal WC and abnormal TG levels were the most common individual criteria; in comparison, abnormal blood pressure was the least common across racial ethnic backgrounds. CONCLUSIONS: An estimated one in 10 US adolescents has metabolic syndrome. These findings have important public health implications due to the known cardiovascular disease risk factors associated with metabolic syndrome.

The home stroke rehabilitation and monitoring system trial: a randomized controlled trial.

RATIONALE: Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program. AIMS/HYPOTHESIS: The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life. DESIGN: A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial. STUDY OUTCOMES: The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale). DISCUSSION: Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke.

The reported effects of bullying on burn-surviving children.

There is a trend of increasing childhood aggression in America, which has been tied to bullying. Although there is growing research concerning bullying in the general pediatric population, there are limited data on bullying and its effects on children with disfigurements and physical limitations. This study was conducted to assess burned children's experience with bullying. A pretest was administered regarding experience with bullying and teasing. A curriculum regarding bullying, which incorporated the Harry Potter and the Sorcerer's Stone movie, was presented. After reviewing bullying depicted in the film and participating in a class regarding bullying, children were invited to complete a survey regarding their experience with bullying. A total of 61% of these children reported being bullied at school; 25% reported experiencing headaches or stomachaches due to bullying, and 12% reported staying home from school. Nearly 25% reported bullying as a big problem. Of those with visible scars (55%), a full 68% reported bullying as a problem, versus 54% with hidden scars (P < .05). However, those with visible scars were no more likely to tell an adult (54%) than those without (56%). Children were much more willing to disclose personal bullying experiences after participating in the class (57%) than before (45%) (P < .01). This study revealed that bullying impacts many burn-injured children and has negative effects on their physical and mental well-being. Many children (with visible or hidden scars) did not seek adult intervention for the problem. Participation in a bullying course appears to give children a forum that increases their willingness to disclose personal bullying experiences and can provide them with prevention information and a safe place to seek help.

Impact of a pediatric residential burn camp experience on burn survivors' perceptions of self and attitudes regarding the camp community.

Summer camp is reported to be a positive and valuable experience for burn and nonburned children. Objective studies comparing the effectiveness, similarities, and differences of rehabilitative vs recreational camps are limited. The aim of this study, year 1, was to assess the effect of burn camp on self-esteem and integration as reported by burn children via the Rosenberg Self-Esteem Scale and a community integration survey. During year 2, burn campers completed these measures again and their self-esteem and integration scores were compared with a group of nonburn campers. The first year results showed significant improvement in burn camper's self-esteem from the beginning to end of camp and successful integration into the camp community. During year 2, burn surviving children reported significantly lower self-esteem before camp than the comparison group, but after camp, burn children's self-esteem was comparable with that of nonburn campers. White non-Hispanic campers reported more sustained improvement in self-esteem than other ethnic groups. Burn campers reported a high level of integration into the camp across sex, years since burn, years at camp, or ethnicity, scoring slightly higher than the comparison group. Age was positively correlated with integration among the burn, but not the nonburn campers. Helping children deal with their burn injuries through a rehabilitative program such as burn camp appears to provide benefit for child burn survivors.

Differential role of proline-rich tyrosine kinase 2 and focal adhesion kinase in determining glioblastoma migration and proliferation.

The propensity of malignant gliomas to invade surrounding brain tissue contributes to poor clinical outcome. Integrin-mediated adhesion to extracellular matrix regulates the migration and proliferation of many cell types, but its role in glioma progression is undefined. We investigated the role of the cytoplasmic tyrosine kinases FAK and Pyk2, potential integrin effectors, in the phenotypic determination of four different human glioblastoma cell lines. While FAK expression was similar between the four cell lines, increased FAK activity correlated with high proliferation and low migratory rates. In contrast, Pyk2 activity was significantly increased in migratory cell lines and depressed in proliferative cell lines. Overexpression of Pyk2 stimulated migration, whereas FAK overexpression inhibited cell migration and stimulated cellular proliferation. These data suggest that FAK and Pyk2 function as important signaling effectors in gliomas and indicate that their differential regulation may be determining factors in the temporal development of proliferative or migrational phenotypes.