To compare recall rate, types of abnormalities recalled, additional imaging required, biopsy positive predictive value (PPV), and cancer detection rate before and after implementation of screening ...digital breast tomosynthesis (DBT).
This retrospective analysis was approved by the institutional review board and complied with HIPAA. The requirement to obtain informed consent was waived. Results from all screening digital mammography (DM) examinations performed without tomosynthesis from March 1, 2011, through February 29, 2012, and DBT examinations performed from March 1, 2012, through February 28, 2013, were reviewed to identify all Breast Imaging Reporting and Data System (BI-RADS) category 0 examinations (needs additional imaging). Radiology and pathology reports were reviewed. The recall rate, biopsy PPV, and cancer detection rate were calculated. Statistical analysis was performed by using a two-proportions z test.
The recall rate was 9.3% (1175 of 12 577 examinations; 95% confidence interval CI: 8.8%, 9.9%) for DM and 6.4% (827 of 12 921 examinations; 95% CI: 6.0%, 6.8%) for DBT, an overall reduction of 31% (P < .00001). The recall rate was lower with DM than with DBT for masses (8.9% vs 26.8%, respectively), distortions (0.6% vs 5.3%), and calcifications (13.4% vs 20.3%) (P < .0001 for all). The recall rate was lower with DBT than with DM for asymmetries (13.3% vs 32.2%, respectively) and focal asymmetries (18.2% vs 32.2%) (P < .0001 for both). Diagnostic evaluation with ultrasonography (US) increased with DBT at the time of additional imaging (2.6% for DM vs 28.3% for DBT, P < .0001). There was no significant difference between DM and DBT with regard to biopsy PPV (30.2% vs 23.8%, P = .21) or cancer detection rate per 1000 patients (5.4 vs 4.6, P = .44).
With DBT, the recall rate decreased and the biopsy PPV and cancer detection rate did not decrease. The distribution of recalled abnormalities changed, and more patients were evaluated with US only.
Pseudomonas aeruginosa uses quorum sensing, an interbacterial communication system, to regulate gene expression. The signaling molecule N-3-oxododecanoyl homoserine lactone (3OC12-HSL) is thought to ...play a central role in quorum sensing. Since 3OC12-HSL can be degraded by paraoxonase (PON) family members, we hypothesized that PONs regulate P. aeruginosa virulence in vivo. We chose Drosophila melanogaster as our model organism because it has been shown to be a tractable model for investigating host-pathogen interactions and lacks PONs. By using quorum-sensing-deficient P. aeruginosa, synthetic acyl-HSLs, and transgenic expression of human PON1, we investigated the role of 3OC12-HSL and PON1 on P. aeruginosa virulence. We found that P. aeruginosa virulence in flies was dependent upon 3OC12-HSL. PON1 transgenic flies expressed enzymatically active PON1 and thereby exhibited arylesterase activity and resistance to organophosphate toxicity. Moreover, PON1 flies were protected from P. aeruginosa lethality, and protection was dependent on the lactonase activity of PON1. Our findings show that PON1 can interfere with quorum sensing in vivo and provide insight into what we believe is a novel role for PON1 in the innate immune response to quorum-sensing-dependent pathogens. These results raise intriguing possibilities about human-pathogen interactions, including potential roles for PON1 as a modifier gene and for PON1 protein as a regulator of normal bacterial florae, a link between infection/inflammation and cardiovascular disease, and a potential therapeutic modality.
There has been a significant increase in obesity in the United States over the past 20 years. Reports in the literature identify the association of obesity-related osteoarthritis and the likelihood ...of future total hip arthroplasty (THA) and total knee arthroplasty (TKA) in this patient population. However, little is known about the effect of preoperative exercise on immediate postoperative mobility and discharge disposition in obese total joint replacement patients. The purpose of this study was to examine the effect of preoperative exercise in the obese total joint replacement patient on early postoperative mobility and discharge disposition. We retrospectively reviewed a consecutive series of patients with a body mass index (BMI) ≥30 kg/m(2) who underwent primary total joint replacement surgery from June 2005 through October 2005 at 1 institution. Two hundred seven patients met the inclusion criteria. Sixty-five patients performed self-reported preoperative exercise, defined as physical activity deemed above and beyond that of activities of daily living. Fewer exercise patients, 6.8%, required the assistance of ≥2 caregivers for mobility on postoperative day 1 vs 17.4% for nonexercisers. Fifty-four percent of patients participating in preoperative exercise were discharged home vs 46% who did not participate in exercise. A preoperative exercise program can improve postoperative functional mobility and increase the likelihood of discharge home in total joint replacement patients with a BMI of ≥30 kg/m(2).
Older adults are learning that education outside classroom walls provides immeasurable mental, physical, and emotional benefits. This article hails the results of music lessons for older adults while ...it charts the author's personal experiences with violin lessons begun in later years. The exhilaration and enjoyment of her music development were tempered by frustrations of coping with distractions, physical limitations, family obligations, even a natural disaster. The implications for educators are that education for seniors is an important direction for development, and it offers valuable returns for those adults who participate.
What Did They Know? Barry, Marilyn
Medical reference services quarterly,
2004-Winter, Letnik:
23, Številka:
4
Journal Article
Recenzirano
In the past three decades, knowledge professionals have made remarkable strides toward achieving clinicians' decision-support dream of immediately available short answers. Medical evidence, whatis ...truly known about health care effects and ready to be applied in patient care, can now much more easily be identified. Today's information delivery tools enable clinicians to seek answers to many more of their questions and to find the answers whenpatient encounters and teachable moments are occurring. Excerpted from a state health sciences library association presentation, this paper highlights efforts to speed clinician adoption of health care discoveries into routine patient care.
Visual Prostheticsprovides an in-depth analysis of the principles of operation, current state, anticipated developments, and functional aspects of visual prosthetics restoring sight to visually ...impaired individuals. This volume uniquely describes the human visual system in health and disease in a pedagogical and didactic manner, fitting to professionals and researchers with a bioengineering background. Readers will find a balanced overview of electrical, molecular chemical and synthetic chromophore stimulation, in addition to the biophysics and psychological aspects of vision restoration. Unlike competitive texts, this introduction also includes the need and methods for functional evaluation and rehabilitation.Professionals in the field of biomedical engineering and graduate and postgraduate researchers will find Visual Prostheticsa valuable reference.
Cigarette smoking is the strongest risk factor for COPD. Smoking burden is frequently measured in pack-years, but the relative contribution of cigarettes smoked per day versus duration towards the ...development of structural lung disease, airflow obstruction and functional outcomes is not known.
We analysed cross-sectional data from a large multicentre cohort (COPDGene) of current and former smokers. Primary outcome was airflow obstruction (FEV
/FVC); secondary outcomes included five additional measures of disease: FEV
, CT emphysema, CT gas trapping, functional capacity (6 min walk distance, 6MWD) and respiratory morbidity (St George's Respiratory Questionnaire, SGRQ). Generalised linear models were estimated to compare the relative contribution of each smoking variable with the outcomes, after adjustment for age, race, sex, body mass index, CT scanner, centre, age of smoking onset and current smoking status. We also estimated adjusted means of each outcome by categories of pack-years and combined groups of categorised smoking duration and cigarettes/day, and estimated linear trends of adjusted means for each outcome by categorised cigarettes/day, smoking duration and pack-years.
10 187 subjects were included. For FEV
/FVC, standardised beta coefficient for smoking duration was greater than for cigarettes/day and pack-years (P<0.001). After categorisation, there was a linear increase in adjusted means FEV
/FVC with increase in pack-years (regression coefficient β=-0.023±SE0.003; P=0.003) and duration over all ranges of smoking cigarettes/day (β=-0.041±0.004; P<0.001) but a relatively flat slope for cigarettes/day across all ranges of smoking duration (β=-0.009±0.0.009; P=0.34). Strength of association of duration was similarly greater than pack-years for emphysema, gas trapping, FEV
, 6MWD and SGRQ.
Smoking duration alone provides stronger risk estimates of COPD than the composite index of pack-years.
Post-results; NCT00608764.
Renewable Portfolio Standards (RPSs) are one of the most prevalent and impactful clean energy policies implemented by states in the United States. This paper investigates the regional spillover ...effect of RPS policies using a directed dyad panel dataset of renewable electricity generation in US states from 1991 to 2021. Regional spillover effect is measured in two ways: by considering the influence of an RPS enacted in neighboring states and in states in the same regional transmission organization or independent system operator region. We use dyadic fixed effects estimation and conclude that the neighboring state’s RPS stringency score is a strong determinant of a state’s total renewable electricity generation. For states without an RPS, the positive influence of an RPS in a neighboring state is larger when the non-RPS state has more abundant renewable energy resources than the neighboring RPS state. Our findings suggest that past RPS policy evaluation research using a confined within-state focus may have underestimated the holistic impact of an RPS, as the impacts of an RPS policy can extend beyond the enacting state’s borders. Overall, this study contributes to an improved understanding of the holistic impact of state RPS policies.
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