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Parent engagement examines the synchronous factors of parents’ active participation in NICU care targeting the acquisition of skills for problem solving and infant care. The purpose of this study is to examine parent engagement in the NICU. This descriptive cross-sectional survey design study consists of 51 mothers and 15 fathers of premature infants. A valid and reliable instrument is used to measure parent engagement. Over 50% of participants do not feel prepared to take their premature infant home, yet 85% of participants feel confident they can come up with solutions when caring for their infant. There are significant relationships regarding married participants (p

Study Objectives: The novel coronavirus (SARS-CoV-2) pandemic placed unprecedented strain on the supply of personal protective equipment (PPE) in health care settings, particularly the emergency department (ED) Innovative strategies were needed for PPE conservation Our ED deployed electronic PPE (ePPE) - a telehealth approach to conduct medical screening exams (MSEs) of COVID-19-suspected patients As part of our plan to scale this intervention, we sought to evaluate provider perceptions of ePPE-based MSEs Methods: We conducted a qualitative analysis at Vanderbilt University Medical Center in Nashville, TN Emergency clinicians were identified through use of structured ePPE documentation elements in the EHR Patients who received ePPE-based MSEs included English-speaking adults with fever or respiratory symptoms (inclusion criteria: age 94%;RR < 20;HR < 110;no cardiovascular, respiratory, or immunosuppressive history) We invited providers to participate in semi-structured video interviews (Zoom, San Jose, CA) A Likert scale between 1 [Not at all effective] and 5 [Extremely effective] was used to gauge perceived ePPE effectiveness We recorded and transcribed interviews, subsequently extracting then encoding notable excerpts using Dedoose (SocioCultural Research Consultants, Los Angeles, CA) Thematic analysis was performed using intervention characteristics from the Consolidated Framework for Implementation Research (CFIR): intervention source, evidence strength and quality, relative advantage, adaptability, trialability, complexity, design quality and packaging, and cost Results: We identified 18 clinicians who documented ePPE use On review, 2 never used ePPE and 5 only supervised other clinicians who used ePPE Of the remaining 11, we interviewed 7 attending physicians and 1 physician assistant between 5/15/20 and 6/5/20 Providers gave ePPE a mean effectiveness score of 4 2 (SD 0 53) Identified advantages included improved patient and provider safety, PPE conservation, and improved patient-provider communication The primary perceived limitation was inability to auscultate the lungs While noting the risk of missed alternate diagnoses (eg, heart failure), providers asserted that video-based history-taking and respiratory exam sufficed for low-acuity patients and that auscultation’s absence was unlikely to change management Beyond MSEs, providers used ePPE for patient reassessment and counseling, as well as to facilitate supervision Many emphasized ePPE’s flexibility: “If I do pick up on a few things…I can always, sort of, abandon [ePPE] and go in and do my exam ” Barriers to use included potential for negative patient perceptions, poor audio quality, difficulty incorporating an interpreter, and workflow challenges related to staff coordination Clinicians revealed that many ePPE encounters were not fully documented, suggesting ePPE use may be underrepresented in this study Conclusion: In this trial implementation of ePPE, we found that ED clinicians perceived ePPE as an effective and useful technique for MSEs of COVID-19-suspected patients The benefits largely outweighed the disadvantages, particularly in the low-acuity population Our study may have been limited by early adoption from clinicians favorable to such technology, and future work should examine perceptions among clinicians with varying degrees of technology comfort

Comparative analysis of the effect of electrical and geometric heterogeneity of the surface of heterogeneous sulfocation-exchanger membranes Ralex CM Pes produced by MEGA a.s. (Czech Republic) and the Russian membranes MK-40 manufactured by JSC “Shchekinoazot” on current voltage characteristics (CVC), conditions of occurrence and intensity of electroconvective instability at the membrane/solution interface in intense current modes was carried out. Membranes MK-40 were prepared by hot-pressing technology ( https://www.n-azot.ru ), membranes Ralex CM Pes by hot-rolling technology ( https://www.mega.cz ). In the manufacture of the membranes Ralex CM Pes, the milling time for sulfocation-exchanger on a ball mill varied from 5 to 80 min, the volume ratio of cation-exchanger to polyethylene was kept the same. It was found that in the swollen state of the membranes with the increase in the milling time of the ion-exchanger, the ratio between the conducting (ion-exchanger grain) and inert (polyethylene) sections on the surface of the membranes remained constant, and the size of the conducting sections and the distances between them decreased, while the surface microrelief became smoother. Despite the decrease in roughness of the membrane surface, as the degree of dispersity of the initial sulfocation-exchanger increases, the CVC of the membranes show an increase in the limiting diffusion current, a reduction of the plateau section of the limiting current, and an increase in the size of the electroconvective instability region in the solution at the interphase boundary. These facts indicate that when the conditions of the membrane-preparing technology change, a more significant factor determining the conditions for the occurrence and intensity of the development of heteroelectroconvection is a decrease in the electrical heterogeneity of the membrane surface.

As the prominence and expressed need for creativity grows across multiple facets of society, so too do interests in understanding and enabling individuals’ own creative potential. These notions extend broadly to individuals living in myriad communities and contexts, highlighting the need to develop insights on creativity within the general population. To provide foundational insights, this study examines the general public's perspectives on what “creativity” is and the prevalence of conceptualizations of creativity from psychology and sociology literatures in these perspectives. We utilize a nationally representative sample of 3,298 adults living in the United States and code their open-ended responses to the question, “When you hear the word ‘creativity’, what do you think of?” Responses relate creativity to the generation of new thoughts and ideas (31.56%) and to art, artistry, and artistic practices (27.5%) with highest frequency, but only weakly correlate these conceptualizations of creativity. For further examination, this study uses logistic regressions to test for differences across socio-demographic characteristics and the degree to which they explain perceptions of creativity as artistic. Perceptions of creativity as artistic are more likely among White adults, women, and individuals with a college education; the strongest predictor is direct engagement in arts-making activities. This study reorients inquiry about creativity toward understanding the meaning that creativity has within the general population and speaks to the prevalence of persistent links between creativity and the arts.

Patients with inflammatory bowel disease (IBD) frequently experience chronic pain. Patients will often seek out care in the emergency department (ED) where short-term opioid use may be associated with potential treatment-related complications. We aimed to assess the rate and factors associated with opioid prescription in IBD patients discharged from the ED.We conducted a cross-sectional analysis of data collected in the US National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2006-2017. We determined the proportion of adult patients (≥18 years) with IBD prescribed an opioid in ED or at ED discharge. Logistic regression was used to evaluate predictors of opioid prescription. Time-trend analysis was performed to evaluate temporal patterns in opioid use. All analyses were adjusted for complex survey design.We identified ∼965,000 weighted discharges from the ED for patients with IBD. In total, 51.9% [95% CI: 42.2% -61.6%] of visits resulted in opioid administration in ED and 35.3% [95% CI: 26.5% -45.2%] of IBD-related ED discharges were associated with an opioid prescription. IBD patients with moderate/severe pain (adjusted odds ratio aOR 5.06 [95% CI: 1.72 -14.90], p 0.01) were more likely to receive opioids whereas older age (aOR 0.73 per decade [95% CI: 0.55 -0.98], p = 0.04) were less likely. In temporal analysis, a trend towards decreasing opioid use in ED and opioid prescriptions at discharge was observed in 2015-2017.More than one third of IBD patients are prescribed an opioid at discharge from ED, highlighting a potential gap in care for accessing effective pain management solutions in this population.

STUDY OBJECTIVE: A challenge in reducing unwanted care variation is effectively managing the wide variety of performed surgical procedures. While an organization may perform thousands of types of cases, privacy and logistical constraints prevent review of previous cases to learn about prior practices. To bridge this gap, we developed a system for extracting key data from anesthesia records. Our objective was to determine whether usage of the system would improve case planning performance for anesthesia residents. DESIGN: Randomized, cross-over trial. SETTING: Vanderbilt University Medical Center MEASUREMENTS: We developed a web-based, data visualization tool for reviewing de-identified anesthesia records. First year anesthesia residents were recruited and performed simulated case planning tasks (e.g., selecting an anesthetic type) across six case scenarios using a randomized, cross-over design after a baseline assessment. An algorithm scored case planning performance based on care components selected by residents occurring frequently among prior anesthetics, which was scored on a 0–4 point scale. Linear mixed effects regression quantified the tool effect on the average performance score, adjusting for potential confounders. MAIN RESULTS: We analyzed 516 survey questionnaires from 19 residents. The mean performance score was 2.55 ± SD 0.32. Utilization of the tool was associated with an average score improvement of 0.120 points (95% CI 0.060 to 0.179; p < 0.001). Additionally, a 0.055 point improvement due to the “learning effect” was observed from each assessment to the next (95% CI 0.034 to 0.077; p < 0.001). Assessment score was also significantly associated with specific case scenarios (p < 0.001). CONCLUSIONS: This study demonstrated the feasibility of developing of a clinical data visualization system that aggregated key anesthetic information and found that the usage of tools modestly improved residents’ performance in simulated case planning.

BACKGROUND: Patients with inflammatory bowel diseases (IBD) require repeated healthcare encounters, although the focus of care differs when patients are seen in ambulatory, emergency department (ED), or inpatient settings. We examined contemporary trends and disparities in IBD-related healthcare visits. METHODS: We used data from the National Ambulatory Medical Care Survey, Nationwide Emergency Department Sample, and National Inpatient Sample to estimate the total number of annual IBD-related visits from 2005 through 2016. We performed logistic regression analyses to test temporal linear trends. Slope and differences in distributions of patient demographics were compared across time and treatment settings. RESULTS: From 2005 through 2016, approximately 2.2 million IBD-related ambulatory visits (95 CI, 1.9–2.5 million IBD-related ambulatory visits) occurred annually on average, increasing by 70.3% from the time period of 2005–2007 through the time period of 2008–2010, and decreasing by 19.8% from the time period of 2011–2013 through the time period of 2014–2016. An average of 115,934 IBD-related ED visits (95% CI, 113,758–118,111 IBD-related ED visits) and 89,111 IBD-related hospital discharges (95% CI, 87,416–90,807 IBD-related hospital discharges) occurred annually. Significant increases in the rate of IBD-related ED visits (3.2 visits/10,000 encounters, P

Thirty million Americans currently have diabetes, and a substantial portion do not reach the goals of clinical treatment. This is in part due to the complex barriers to effective self-care faced by people with diabetes. This study uses a patient work perspective, focusing on the everyday, lived experience of managing diabetes. Our primary research goal was to explore how the work of self-care is embedded in the other routines of everyday living. We found that everyday objects and spaces were instrumental in the incorporation of diabetes work into daily routines. Objects anchored diabetes tasks by linking illness-specific artifacts to space and time (e.g. a morning routine), and by enabling the performance on diabetes tasks while on the move in either planned or unplanned ways.

AUTISM SPECTRUM DISORDER (ASD) is characterized by a core deficit in social communication with concomitant repetitive/perseverative behaviors and restriction in interests, 1 and individuals with ASD experience varying degrees of impairment. 2 The estimated prevalence of ASD in pediatric populations has climbed dramatically during the past decade, with approximately 1 in every 68 children currently meeting diagnostic criteria in the United States. 3 High prevalence occurs against a backdrop of increased health care costs 4 and social burden. 5 Medical comorbidities are significantly overrepresented compared with other pediatric populations, and children with ASD often present with medical conditions affecting multiple organ systems. 6 Dysfunction of the gastrointestinal (GI) tract is among the most frequently cited comorbidities. A recent meta-analysis indicated that children with ASD were four times more likely to experience general GI complaints, are more than three times more prone to experience constipation and diarrhea, and complain twice as frequently about abdominal pain compared with peers. 7 Lack of data prevented analysis of other GI symptoms (eg, gastroesophageal reflux, celiac disease, lactose intolerance) typically associated with organic etiologies; however, a 2010 consensus report concluded that, at a minimum, rates of other GI pathophysiology in ASD should be viewed as occurring at similar levels to

We describe a novel conservative algorithm for parabolic problems in domains with moving boundaries developed for modeling in cell biology. The spatial discretization is accomplished by applying Voronoi decomposition to a fixed rectangular grid. In the vicinity of the boundary, the procedure generates irregular Voronoi cells that conform to the domain shape and merge seamlessly with regular control volumes in the domain interior. Consequently, our algorithm is free of the CFL stability issue due to moving interfaces and does not involve cell-merging or mass redistribution. Local mass conservation is ensured by finite-volume discretization and natural-neighbor interpolation. Numerical experiments with two-dimensional geometries demonstrate exact mass conservation and indicate an order of convergence in space between one and two. The use of standard meshing techniques makes extension of the method to three dimensions conceptually straightforward.

While there is a growing interest in addressing social determinants of health in clinical settings, there are limited data on the relationship between unstable housing and both obstetric outcomes and health care utilization.The objective of the study was to investigate the relationship between unstable housing, obstetric outcomes, and health care utilization after birth.This was a retrospective cohort study. Data were drawn from a database of liveborn neonates linked to their mothers' hospital discharge records (2007-2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age of 20 and 44 weeks, who presented at a hospital that documented at least 1 woman as having unstable housing using the International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and major birth defects were excluded. Women with unstable housing (lack of housing or inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm birth (37 weeks' gestational age), early term birth (37-38 weeks gestational age), preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth hospitalization length of stay after delivery (vaginal birth,2 days; cesarean delivery,4 days), emergency department visit within 3 months and 1 year after delivery, and readmission within 3 months and 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression.Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score-matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0-1.4, P.05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2-1.6, P.001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4-1.8, P.001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1-2.8, P.001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4-3.0, P.001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2-3.4, P.0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2-3.0, P.001).Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.

Purpose When barcode medication administration (BCMA) is implemented nurses are required to integrate not only a new set of procedures or artifacts into everyday work, but also an orientation to medication safety itself that is sometimes at odds with their own. This paper describes how the nurses' orientation (the Practice Frame) can collide with the orientation that is represented by the technology and its implementation (the System Frame), resulting in adaptations at the individual and organization levels. Methods The paper draws on two qualitative research studies that examined the implementation of BCMA in inpatient settings using observation and ethnographic fieldwork, content analysis of email communications, and interviews with healthcare professionals. Results Two frames of reference are described: the System Frame and the Practice Frame. We found collisions of these frames that prompted adaptations at the individual and organization levels. The System Frame was less integrated and flexible than the Practice Frame, less able to account for all of the dimensions of everyday patient care to which medication administration is tied. Conclusion Collisions in frames during implementation of new technology result in adaptations at the individual and organization level that can have a variety of effects. We found adaptations to be a means of evolving both the work routines and the technology. Understanding the frames of clinical workers when new technology is being designed and implemented can inform changes to technology or organizational structure and policy that can preclude unproductive or unsafe adaptations.

NUP98-HOXD13 (NHD13) and CALM-AF10 (CA10) are oncogenic fusion proteins produced by recurrent chromosomal translocations in patients with acute myeloid leukemia (AML). Transgenic mice that express these fusions develop AML with a long latency and incomplete penetrance, suggesting that collaborating genetic events are required for leukemic transformation. We employed genetic techniques to identify both pre-leukemic abnormalities in healthy transgenic mice as well as collaborating events leading to leukemic transformation. Candidate gene resequencing revealed that 6 out of 27 (22%) CA10 AMLs spontaneously acquired a Ras pathway mutation and 8 out of 27 (30%) acquired a Flt3 mutation. Two CA10 AMLs acquired a Flt3 internal-tandem duplication, demonstrating that these mutations can be acquired in murine as well as human AML. Gene expression profiles revealed a marked upregulation of Hox genes, particularly Hoxa5, Hoxa9, and Hoxa10 in both NHD13 and CA10 mice. Furthermore, mir196b, which is embedded within the Hoxa locus, was overexpressed in both CA10 and NHD13 samples. In contrast, the Hox cofactors Meis1 and Pbx3 were differentially expressed; Meis1 was increased in CA10 AMLs but not NHD13 AMLs, whereas Pbx3 was consistently increased in NHD13 but not CA10 AMLs. Silencing of Pbx3 in NHD13 cells led to decreased proliferation, increased apoptosis, and decreased colony formation in vitro, suggesting a previously unexpected role for Pbx3 in leukemic transformation.

Background The U.S. food and beverage industry recently released a new front-of-package nutrition labeling system called Facts Up Front that will be used on thousands of food products. Purpose To test consumer understanding of the Facts Up Front system (Facts Up Front) compared to the Multiple Traffic Light system (Traffic Light). Facts Up Front displays grams/milligrams and percentage daily value information for various nutrients; Traffic Light uses an interpretive color-coded scheme to alert consumers to low, medium, and high levels of certain nutrients. Design Participants in an Internet-based study were randomized to one of five front-of-package label conditions: (1) no label; (2) Traffic Light; (3) Traffic Light plus information about protein and fiber (Traffic Light+); (4) Facts Up Front; or (5) Facts Up Front plus information about “nutrients to encourage” (Facts Up Front+). Setting/participants A total of 703 adults recruited through an online database in May 2011 participated in this study, and data were analyzed in June 2011. Main outcome measures Total percentage correct quiz scores were generated reflecting participants' ability to compare two foods on nutrient levels, based on their labels, and to estimate amounts of saturated fat, sugar, sodium, fiber and protein in the foods. Results The front-of-package label groups outperformed the control group on nearly all of the nutrient quizzes (p 80% on all quizzes). Conclusions Overall, those in the Traffic Light+ condition performed better than those in the Facts Up Front conditions on measures of nutrition knowledge and label perceptions. Trial registration This study is registered at clinicaltrials.gov NCT01626729 .

Obesity is an epidemic that likely will worsen without substantive changes to the current environment. Although treatment of the individual has conventionally been the focus of the obesity field, prevention using a public health model will be essential for making progress on a population level. There are encouraging signs that communities across the country are acknowledging the complex causes of obesity and making impressive reforms to improve their health and that of their children. Public policy changes long have been used to combat infectious and chronic diseases and will be vital in the attempt to reduce the toll of poor diet, physical inactivity, and obesity.

An experiment was conducted to evaluate the effects of dietary enzymes on performance, tibia ash, and intestinal goblet cells of broilers administered a live coccidia oocyst vaccine (Coccivac B, Schering Plough, Kenilworth, NJ). Cobb 500 straight-run broilers were obtained and one-half of the chicks were sprayed with the live coccidia oocyst vaccine. Chicks were weighed and placed in battery brooders with respect to nonvaccinated or vaccinated group according to dietary treatment. The 8 dietary treatments were a positive control (0.90% Ca and 0.45% available P), a negative control (NC; 0.80% Ca and 0.35% available P), NC + phytase (PHY), NC + protease (PRO), NC + xylanase (XYL), NC + PHY+ PRO, NC + PHY + XYL, and NC + PHY + PRO + XYL. A diet x vaccination interaction (P > 0.05) was not observed for feed intake or BW gain. Feed conversion ratio was improved (P [less-than or equal to] 0.05) in birds fed NC + PHY + XYL compared with NC. Vaccination reduced (P [less-than or equal to] 0.05) feed intake and BW gain from d 0 to 18. Tibia ash was reduced (P [less-than or equal to] 0.05) in the NC and PRO or XYL diets. Vaccination increased goblet cell numbers in the duodenum of birds fed XYL, whereas no differences were found in goblet cell numbers between nonvaccinated and vaccinated birds in other dietary treatments, which resulted in a diet x vaccination interaction (P [less-than or equal to] 0.05). Protease decreased and NC + PHY+ PRO increased goblet cells in the jejunum at d 7, which resulted in a diet x vaccination interaction (P [less-than or equal to] 0.05). At d 18, NC + PHY + XYL was the only diet in which vaccination decreased goblet cells in the jejunum, resulting in a diet x vaccination interaction (P [less-than or equal to] 0.05). The data indicate that NC + PHY + XYL improved the feed conversion ratio in broilers fed corn-soybean meal diets. The vaccination x dietary enzyme interaction altered the number of goblet cells in the small intestine. Dietary enzyme supplementation did not alleviate reductions in growth performance associated with the use of a live coccidia oocyst vaccine.

Rationale and Objectives The aim of this study was to retrospectively evaluate an automated global scoring system for evaluating the extent and severity of disease in a known cohort of patients with documented bronchiectasis. On the basis of a combination of validated three-dimensional automated algorithms for bronchial tree extraction and quantitative airway measurements, global scoring combines the evaluation of bronchial lumen–to–artery ratios and bronchial wall–to–artery ratios, as well as the detection of mucoid-impacted airways. The result is an automatically generated global computed tomographic (CT) score designed to simplify and standardize the interpretation of scans in patients with chronic airway infections. Materials and Methods Twenty high-resolution CT data sets were used to evaluate an automated CT scoring method that combines algorithms for airway quantitative analysis that have been individually tested and validated. Patients with clinically documented atypical mycobacterial infections with visually assessed CT evidence of bronchiectasis varying from mild to severe were retrospectively selected. These data sets were evaluated by two independent experienced radiologists and by computer scoring, with the results compared statistically, including Spearman's rank correlation. Results Computer evaluation required 3 to 5 minutes per data set, compared to 12 to 15 minutes for manual scoring. Initial Spearman's rank tests showed positive correlations between automated and readers' global scores (r = 0.609, P = .01), extent of bronchiectasis (r = 0.69, P = .0004), and severity of bronchiectasis (r = 0.61, P = .01), while mucus plug detection showed a lesser extent of positive correlation between the scoring methods (r = 0.42, P = .07) and wall thickness a negative weak correlation (r = −0.10, P = .40). Further retrospective review of 24 lobes in which wall thickness scores showed the highest discrepancy between manual and automated methods was then performed, using electronic calipers and perpendicular cross-sections to reassess airway measurements. This resulted in an improved Spearman's rank correlation to r = 0.62 (P = .009), for a global score of r = 0.67 (P = .001). Conclusion Automated computerized scoring shows considerable promise for providing a standardized, quantitative method, demonstrating overall good correlation with the results of experienced readers' evaluation of the extent and severity of bronchiectasis. It is speculated that this technique may also be applicable to a wide range of other conditions associated with chronic bronchial inflammation, as well as of potential value for monitoring response to therapy in these same populations.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology that usually affects the lungs. Although flexible fiberoptic bronchoscopy with transbronchial lung biopsy (TBBx) has a high diagnostic yield in patients with pulmonary sarcoidosis, variously ranging from 40 to 90%, more invasive procedures often prove necessary. We report two cases of successful diagnosis of pulmonary sarcoidosis using a new technique that may increase the accuracy of TBBx. Previously described for diagnosis of peripheral lung cancer, this technique relies on real-time virtual bronchoscopic guidance to biopsy preselected peripheral areas of the lung preferentially affected by the disease using a pediatric bronchoscope. In each case, while procedures were performed under direct CT guidance allowing precise confirmation of the tip of the biopsy catheter, it is anticipated that this technique will be primarily used as a guide to bronchoscopic biopsies without the need for direct CT guidance, thus increasing routine utilization of multidetector low-dose high-resolution CT to improve histologic diagnosis.

The detection of pulmonary emboli (PE) is of critical importance in determining further treatment. PE visualization and detection methods applied to contrast-enhanced computed tomography (CT) images have been shown to facilitate diagnosis. Unfortunately, to date, these methods have imposed significant requirements for 3D navigation and manual vessel tracking. Consequently, we propose a novel method to minimize these requirements by visualizing the entire 3D tree structure within a single, though potentially very large, 2D image. The only navigation that is required is panning through a 2D image, similar to the way that a book is read: from left to right and top to bottom. Vessels are presented in a hierarchical order making them easy to trace, providing a straightforward systematic view of all portions of the vessel tree, without the necessity of viewing areas multiple times or potentially overlooking subtle abnormalities. We present preliminary results using this method.

Interactions of cell adhesions, Rho GTPases and actin in the endothelial cells' response to external forces are complex and not fully understood, but a qualitative understanding of the mechanosensory response begins to emerge. Here, we formulate a mathematical model of the coupled dynamics of cell adhesions, small GTPases Rac and Rho and actin stress fibers guiding a directional reorganization of the actin cytoskeleton. The model is based on the assumptions that the interconnected cytoskeleton transfers the shear force to the adhesion sites, which in turn transduce the force into a chemical signal that activates integrins at the basal surface of the cell. Subsequently, activated and ligated integrins signal and transiently de-activate Rho, causing the disassembly of actin stress fibers and inhibiting the maturation of focal complexes into focal contacts. Focal complexes and ligated integrins activate Rac, which in turn enhances focal complex assembly. When Rho activity recovers, stress fibers re-assemble and promote the maturation of focal complexes into focal contacts. Merging stress fibers self-align, while the elevated level of Rac activity at the downstream edge of the cell is translated into an alignment of the cells and the newly forming stress fibers in the flow direction. Numerical solutions of the model equations predict transient changes in Rac and Rho that compare well with published experimental results. We report quantitative data on early alignment of the stress fibers and its dependence on cell shape that agrees with the model.

Early detection of colon polyps through screening has been proven to save lives, and it is expected that Computed Tomography Colonography (CTC) will offer benefits comparable to screening colonoscopy. CTC offers a more comfortable method of screening for patients, but requires significant time and effort by radiologists to examine large data sets. High-resolution images from multi-slice CT machines offer the potential to detect smaller polyps, but at the cost of larger data sets to analyze. This paper introduces and evaluates a system for rapid Computer-Aided Detection (CAD) of colon polyps, intended for use as a second reader. The system runs to completion in less time than radiologists typically require for a first read of the data. The system achieved 95% sensitivity to polyps between 6 and 19 mm in diameter, with an average of 5.76 false positives per patient.

Early detection of lung nodules is an important clinical indication for obtaining routine CT studies of the thorax. To date, research has focused on the sensitivity of computer-aided diagnosis (CAD) compared with expert chest radiologists typically using data obtained from single detector CT scanners. The present study focuses on the use of CAD as a second reader supplementing four nonexpert “community level” radiologists using state-of-the-art multidetector high resolution data sets. Evaluations of 18 cases with a total of 87 nodules (average 4.8 per case) were subsequently validated by a panel of two expert dedicated chest radiologists. Only 21% of nodules were identified by all four readers; 17% were identified only by CAD. The mean sensitivity of readers before CAD was 49% while following CAD this improved to 72% (p

P-glycoprotein (P-gp), a multidrug resistance (MDR) protein encoded by the MDR1 gene in humans, is responsible for the efflux of structurally diverse drugs. Previous studies in our laboratory have shown that excipients such as poly(ethylene)glycol (PEG)-300, Cremophor EL, and Tween 80 inhibit P-gp activity in Caco-2 cell monolayers. The objective of this study was to determine the effects of these excipients in an MDR1- transfected Madin Darby Canine Kidney (MDR1-MDCK) cell line and to compare the results with those obtained from Caco-2 cells. The results presented herein show that PEG-300 (20%, v/v) causes almost complete inhibition of P-gp activity in both Caco-2 and MDR1-MDCK cell monolayers, whereas Cremophor EL (0.1%, w/v) and Tween 80 (0.05%, w/v) only partially inhibit P-gp activity in Caco-2 cells. Cremophor EL (0.1%, w/v) and Tween 80 (0.05%, w/v) were inactive as P-gp inhibitors in MDR1-MDCK cell monolayers. This inability of Tween 80 and Cremphor EL to inhibit P-gp activity in MDR1-MDCK cells may be related to differences in the interactions of the surfactants with these different cell membranes. PEG-induced changes in P-gp activity are probably related to changes in the fluidity of the polar head group regions of cell membranes.