Comparing the performance of full-field digital mammography and digital breast tomosynthesis in the post-treatment surveillance of patients with a history of breast cancer: A retrospective study.

INTRODUCTION: The purpose of our study was to compare the performance of 2D (FFDM) against 3D (FFDM plus DBT) examinations in the post-treatment surveillance of asymptomatic breast cancer survivors. METHODS: A list of women with a history of breast cancer who underwent screening mammography (2D or 3D) from 5/2017 to 5/2020 was retrieved. A total of 20,210 examinations were identified and performance metrics were compared. RESULTS: There were no statistically significant difference in cancer detection rate (CDR) (p = 0.38), recall rate (RR) (p = 0.087), or positive predictive value (PPV) (p = 0.74) between 2D vs. 3D examinations. Stratification by breast tissue identified no statistically significant difference in CDR (p = 0.581 and p = 0.428), RR (p = 0.230 and p = 0.205), or PPV (p = 0.908 and p = 0.721) between fatty/scattered and heterogeneous/extremely dense breast tissue when comparing 2D vs 3D examinations. Stratification by age did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 2D vs. 3D examinations in the 60-69 years group (p = 0.021). Stratification by race did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased with 3D vs. 2D examinations in white women (p = 0.036). Stratification by laterality (bilateral vs. unilateral post mastectomy) did not identify a significant difference in RR or PPV between the two groups. CDR was statistically increased in 2D vs. 3D examinations in unilateral studies (p = 0.009). CONCLUSION: For asymptomatic women with a history of breast cancer, there is no evidence that the addition of DBT to FFDM improves CDR, RR, or PPV. IMPLICATIONS FOR PRACTICE: More studies are needed concerning screening methodologies supplementing FFDM in the screening regimens of breast cancer survivors.

Making medication communication visible in community pharmacies-pharmacists' experience using a question prompt list in the patient meeting.

BACKGROUND: Even though patient engagement in the pharmacy encounter is low, few studies focus on activating patients. A Question Prompt List (QPL) has been used successfully in other parts of healthcare to encourage patients to raise their questions and concerns. For a QPL to be useful in a pharmacy setting, it first must be considered valuable and be accepted by pharmacists. OBJECTIVE: To investigate the experience of community pharmacists using a QPL in counseling patients about prescribed medications. METHODS: An explorative, qualitative study was conducted in 2020. A QPL, for use in pharmacy counseling, was developed based on previous literature. Semi-structured interviews were held with pharmacists. A thematic analysis approach was conducted, and the analytical framework Technology Acceptance Model (TAM) was used. RESULTS: Data were collected in 7 Swedish community pharmacies in interviews with 29 purposefully selected pharmacists. Three themes were identified: Perceived usefulness: the impact of the QPL on patient activation in the encounter, Perceived ease of use of the QPL in pharmacies, and Increasing the perceived usefulness and ease of use of the QPL. The pharmacists perceived patients as more active in the meeting when using the QPL. The list focused the conversation on medications, which the pharmacists appreciated from a professional point of view. They described the QPL as a useful tool that could easily be integrated into the dispensing process and required little training; however, challenges described were, for example, time constraints and stress. CONCLUSIONS: Pharmacists reported that using a QPL improved patient participation in the encounter. Encouraging counseling on medications was seen as beneficial from a professional point of view. In the early adoption phase, the QPL was easy to implement and did not increase the pharmacists' workload. A QPL appears to be a promising tool for pharmacists to improve the quality of the consultation experience.

Ancient mitogenomes of Phoenicians from Sardinia and Lebanon: A story of settlement, integration, and female mobility.

The Phoenicians emerged in the Northern Levant around 1800 BCE and by the 9th century BCE had spread their culture across the Mediterranean Basin, establishing trading posts, and settlements in various European Mediterranean and North African locations. Despite their widespread influence, what is known of the Phoenicians comes from what was written about them by the Greeks and Egyptians. In this study, we investigate the extent of Phoenician integration with the Sardinian communities they settled. We present 14 new ancient mitogenome sequences from pre-Phoenician (~1800 BCE) and Phoenician (~700-400 BCE) samples from Lebanon (n = 4) and Sardinia (n = 10) and compare these with 87 new complete mitogenomes from modern Lebanese and 21 recently published pre-Phoenician ancient mitogenomes from Sardinia to investigate the population dynamics of the Phoenician (Punic) site of Monte Sirai, in southern Sardinia. Our results indicate evidence of continuity of some lineages from pre-Phoenician populations suggesting integration of indigenous Sardinians in the Monte Sirai Phoenician community. We also find evidence of the arrival of new, unique mitochondrial lineages, indicating the movement of women from sites in the Near East or North Africa to Sardinia, but also possibly from non-Mediterranean populations and the likely movement of women from Europe to Phoenician sites in Lebanon. Combined, this evidence suggests female mobility and genetic diversity in Phoenician communities, reflecting the inclusive and multicultural nature of Phoenician society.

A case of semi-combusted pregnant female in the Phoenician-Punic necropolis of Monte Sirai (Carbonia, Sardinia, Italy).

We present a case of a pregnant woman with the fetus skeletal remains in situ, belonging to the Phoenician-Punic necropolis of Monte Sirai (Sardinia, Italy). The burial dates back to the late 6th to early 5th century BCE. Of the unborn fetal cases documented in the literature this is amongst the oldest four and it represents the first documented case of a pregnant woman in the Phoenician and Punic necropolis literature. A physico-chemical investigation of bones combining X-ray diffraction and Fourier transform-infrared spectroscopy suggests that the female skeleton and fetus were subjected to an incomplete heat treatment according to a funerary practice, perhaps limited to the period of early 5th century BCE, that appears to be peculiar to this site.

CT imaging of complications of catheter ablation for atrial fibrillation.

The complication rate following radiofrequency catheter ablation for atrial fibrillation is low (<5%). Complications include pericardial effusion, cardiac tamponade, pulmonary vein stenosis, oesophageal ulceration or perforation, atrio-oesophageal fistula formation, stroke/transient ischaemic attack, phrenic nerve injury, haematoma at the puncture site, and femoral arteriovenous fistula. Among available imaging tools, computed tomography (CT) can be very useful in diagnosing complications of the procedure, particularly in the subacute and delayed stages after ablation. This review illustrates CT imaging of several of the common and uncommon complications of radiofrequency catheter ablation.

The antibody response to Epstein-Barr virions is altered in multiple sclerosis.

Infection with Epstein-Barr virus (EBV) is associated with multiple sclerosis (MS), and patients with MS have an increased antibody response to some EBV antigens. The major antigens of EBV are only partly defined. Our hypothesis is that the antibody response to EBV is altered in MS. With ELISA, we found that antibodies to EB virions were increased in both serum and CSF of MS patients. Western blots demonstrated that there are multiple different antigens recognized. The antibody response was generally higher in MS to all EBV antigens, with particularly significant increases for certain antigens. We conclude that the antibody response to EBV in MS is generally increased with altered specificity.

Excessive use of force by police: a survey of academic emergency physicians.

OBJECTIVE: To determine the clinical experience, management and training of emergency physicians in the suspected use of excessive force by law enforcement officers. METHODS: Surveys were mailed to a random sample of academic emergency physicians in the USA. RESULTS: Of 393 emergency physicians surveyed, 315 (80.2%) responded. Of the respondents, 99.8% (95% CI 98.2% to 100.0%) believed excessive use of force actually occurs and 97.8% (95% CI 95.5% to 99.1%) replied that they had managed patients with suspected excessive use of force. These incidents were not reported by 71.2% (95% CI 65.6% to 76.4%) of respondents, 96.5% (95% CI 93.8% to 98.2%) had no departmental policies and 93.7% (95% CI 90.4% to 96.1%) had not received training in the management of these cases. CONCLUSIONS: Suspected excessive use of force is encountered by academic emergency physicians in the USA. There is only limited training or policies for the management of these cases.

Pharmacokinetics of celecoxib in the presence and absence of interferon-induced acute inflammation in the rat: application of a novel HPLC assay.

PURPOSE: Celecoxib (CEL) is a relatively new cyclooxygenase-2 specific inhibitor nonsteroidal anti-inflammatory drug with low incidents of the toxic side effects. We developed and validated an HPLC assay for CEL and delineated pharmacokinetics of the drug in the rat in the presence and absence of inflammation. METHODS: Rat plasma (0.1 mL plasma) was spiked with CEL and ibuprofen as internal standard. The solution was acidified and constituents were extracted with isooctane-isopropanol (95:5). The organic solvent was separated, evaporated and the residue was dissolved in the HPLC mobile phase [acetonitrile-water-acetic acid-triethylamine (47:53:0.1:0.03)]. The HPLC system consisted of an auto-injector, an isocratic pump, a 10 cm C(18) analytical column packed with 5-microm of reversed-phase particles, a UV detector set at 254 nm, and an integrator. Control adult male Sprague-Dawley rats were dosed with CEL [5 mg/kg i.v. (n=8), p.o. (n=6) or i.p. (n=3)]. Acute inflammation was brought about by two (12 and 1 h pre-CEL) s.c. injection of 50,000IU/200 microL interferonalpha2a. Inflamed rats (n=6) received 5 mg oral CEL. Serial blood samples were collected via a inserted catheter at the right jugular vein, and plasma samples were analyzed for CEL. RESULTS: The assay yielded linear response within the examined ranges of 20-1000 ng/mL and 1-100 microg/mL (r(2)>0.99) with an extraction efficiency of >70%, intra- and inter-day variability of <10% and accuracy of >90%. In control rats, CEL had an oral bioavailability of 0.59 due mainly to presystemic hepatic metabolism. A multi-compartmental disposition kinetics with an average terminal t(1/2) of 2.8 +/- 0.7 h, and volume of distribution of 2.3 +/- 0.6 L/kg were found. Acute inflammation had no significant effect on the pharmacokinetics of CEL, although a trend towards increased plasma concentration was noticed. CONCLUSIONS: The validated assay has sufficient accuracy and precision for pharmacokinetic studies of CEL in the rat. The lack of change in CEL pharmacokinetics after acute inflammation maybe due to 1) insensitivity of its metabolic system to the acknowledged inhibitory effect of inflammation, and/or 2) the relatively low pre-systemic metabolism of the drug.

Meningococcal septicemia post adenotonsillectomy in a child: case report.

Hemorrhage, nausea and vomiting and poor oral intake remain the most commonly encountered complications after adenotonsillectomy in the pediatric population. Life-threatening infectious complications such as meningitis have rarely been reported. We report a case of meningococcal septicemia complicating adenotonsillectomy in a 3-year-old male child. Possible etiologies postulated include: septicemia following transient bacteremia, increased meningococcal carrier rate, transient immune deficiency, and mucosal damage promoting bacterial translocation. This case highlights the responsibility of the otolaryngologist to maintain medical review, especially when recovery following TA is slow.

Dose-dependent toxicity of diphenhydramine overdose.

BACKGROUND: Diphenhydramine (DPHM) overdose is a frequent cause of acute poisoning. Although its clinical features are well known, information about the dose-dependent toxicity of DPHM is still scarce. The objective of this study was to investigate the dose-dependent toxicity of DPHM in patients with acute DPHM poisoning. METHODS: We have analyzed retrospectively all well-documented cases with DPHM monointoxications reported by physicians to the Swiss Toxicological Information Centre (STIC) between January 1984 and April 1996. In addition, a prospective study focusing on ingested DPHM doses and severity of symptoms was performed between May 1996 and December 1998. RESULTS: The retrospective and prospective studies included 232 and 50 patients with DPHM monointoxications, respectively. In both studies, mild symptoms (somnolence, anticholinergic signs, tachycardia, nausea/vomiting) occurred in 55-64%, moderate symptoms (isolated and spontaneously resolving agitation, confusion, hallucinations and ECG disturbances) in 22-27% and severe symptoms (delirium/psychosis, seizures, coma) in 14-18% of patients. Moderate symptoms occurred above ingested doses of 0.3 g DPHM. For severe symptoms the critical dose limit was 1.0 g DPHM. Although the frequency of delirium/psychosis remained constant or even decreased, coma and seizures were significantly (p<0.05) more frequent in the >1.5-g compared with the 1.0- to 1.5-g-dose group. CONCLUSIONS: These data demonstrate a clear dose-dependent acute toxicity of DPHM. They indicate that only patients with DPHM ingestions above 1.0 g are at risk for the development of severe symptoms and, therefore, should be hospitalized. Thus, the results contribute to the data basis required for a cost effective management of patients with DPHM overdose.

Laparoscopic surgical management of ectopic pregnancy: a district general hospital experience.

This is an audit of laparoscopic management of ectopic pregnancy in a District General Hospital (DGH), using a retrospective casenote review. The study was conducted at New Cross Hospital, Wolverhampton, a large DGH. We recorded the duration of operation, postoperative opiate requirement, length of hospital stay, operative and postoperative complications. Case notes of patients with surgically treated ectopic pregnancies between January 1996 and June 1998 (n=106) were reviewed and grouped into three categories: (1) immediate laparotomy, (2) laparoscopy followed by laparotomy, and (3) laparoscopic management. Comparisons were made between the three groups. The incidence of ectopic pregnancy was 1-91 live births. The mean age of the patients was 29.9 years (range 14-41). Seven (6.6%) patients were haemodynamically unstable and underwent immediate laparotomy, 66 (62%) patients had laparoscopic management while 33 (31%) patients had laparotomy following preliminary laparoscopy. Mean operative time in the laparoscopic management group was 61.9 minutes. The mean +/- 2 SD was 61.9+/-37.4 (range 27-107) with a mean length of hospital stay of 1.9 days (range 1-4), compared with 49.9 minutes (+/-SD 16.5 (range 35-98) and 3.9 days (range 2-8), respectively, in the laparotomy following preliminary laparoscopy group. Only one patient in the laparoscopic management group required opiate analgesia 24 hours postoperatively compared with all the patients in the immediate laparotomy group and seven patients (21%) in laparotomy following the preliminary laparoscopy group. Complications in the laparoscopic management group included wound infection and a persistent ectopic. One patient in the laparotomy group required subtotal hysterectomy for persistent bleeding from cornual ectopic, while complications in the laparotomy following the laparoscopy group consisted of minor wound infection and a case of deep venous thrombosis (DVT). Laparoscopic management of ectopic pregnancy is safe and can be carried out successfully in a DGH setting with clear advantages, including shorter hospital stay and reduced postoperative opiate requirement.

Cross-validated factor structures and factor-based subscales for PASS and PASSING.

Program Analysis of Service Systems (PASS 3) and Program Analysis of Service Systems' Implementation of Normalization Goals (PASSING) are used internationally to assess service quality in mental retardation and other fields. In two studies, we derived and cross-validated the factor structures of these program evaluation instruments. In Study 1, based on 626 PASS 3 evaluations, four factors provided a good fit to the cross-validation data. In Study 2, based on 633 PASSING evaluations, three factors furnished a good fit to the cross-validation data. Similarities between the two factor structures, parallels with the structural and functional service dimensions emphasized in ecological approaches to evaluation, and practical uses in program evaluation of subscales based on the factors were discussed.

Asymmetrical hemispheric activation and behavioral persistence: effects of unilateral muscle contractions.

Contractions of the left hand and of the left side of the lower third of the face induce negative emotional states whereas right-sided contractions induce positive states. Contractions also have mood-congruent influences on perception. This article reports that contractions affect behavior as well. Persistence in attempting to solve insoluble problems is greater following right-sided contractions than following left-sided contractions. This effect is unrelated to dominance of the contracted muscles because right-handed individuals tend to be left-face dominant. Results support the hypothesis that unilateral contractions activate the contralateral cerebral hemispheres and arouse the hemispheres' respective functions with regard to emotion and behavior.

Assessing intellectual functioning in persons with schizophrenia spectrum disorders using a seven subtest short form of the WAIS-R.

The purpose of this study was to examine the concurrent validity of a Wechsler Adult Intelligence Scale-Revised (WAIS-R) seven subtest short form. Researchers have shown that the IQ scores estimated by this short form correlate highly with full-form IQ scores in several patient populations. We compared the full WAIS-R scores with the seven subtest short form estimated IQs in a sample of patients with psychotic disorders (n = 190). The VIQs, PIQs, and FSIQs estimated by the short form were highly correlated with the full form IQs (rs ranging from 0.95 to 0.98). Similar to previous research, the mean difference scores were small (ranging from one point to virtually no difference). In general, the seven subtest short from has adequate concurrent validity and is suitable for assessing intellectual functioning in persons with psychotic disorders.

A priming methodology for studying self-representation in major depressive disorder.

The authors investigated processing of self-descriptive emotional information in depression using a modified Stroop color-naming task. Depressed (n = 58) and nondepressed control (n = 44) participants were required to name the color in which positive and negative adjectives, differing in the degree to which they described the person, were presented. These target adjectives were primed by emotional phrases that also varied according to degree of self-reference. Analyses indicated that depressed participants showed slower color-naming latencies for self-descriptive negative targets primed by self-descriptive negative phrases than for any other prime-target condition. No effect of prime-target relation was found for positive material with depressed participants, and nondepressed controls showed no effect of prime-target relation for material in either valence. These results support the hypothesis that negative information about the self is highly interconnected in the cognitive system of depressed patients.

The Role of the Cardioregulatory Nerves in Mediating Heart Rate Responses to Locomotion, Reduced Stroke Volume, and Neurohormones in Homarus americanus.

Control of decapod crustacean heart activity is believed to be dependent on the regulation of the cardiac ganglion by external input from the central nervous system as well as by circulating neurohormones. This study investigated the roles of these inputs on the heart rates of lobsters exercising on a treadmill. Heart rate increased rapidly at the onset of walking in control animals. This rapid phase was lost after the regulatory nerves were cut, but small increases still occurred. When stroke volume was reduced by cutting alary ligaments, the animals compensated by increasing heart rate; this compensation was lost when the regulatory nerves were cut. In resting animals, injection of serotonin, octopamine, and dopamine induced increases in heart rate. After the regulatory nerves were cut, only dopamine and serotonin injections caused increases in heart rate, suggesting that these amines act on the cardiac ganglion as independent effectors.