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Prostate cancer is the most commonly diagnosed cancer in North American men, however, prognosis is relatively good given early diagnosis. This motivates the need for fast and reliable prostate cancer sensing. Diffusion weighted imaging (DWI) has gained traction in recent years as a fast non-invasive approach to cancer sensing. The most commonly used DWI sensing modality currently is apparent diffusion coefficient (ADC) imaging, with the recently introduced computed high-b value diffusion weighted imaging (CHB-DWI) showing considerable promise for cancer sensing. In this study, we investigate the efficacy of ADC and CHB-DWI sensing modalities when applied to zone-level prostate cancer sensing by introducing several radiomics driven zone-level prostate cancer sensing strategies geared around hand-engineered radiomic sequences from DWI sensing (which we term as Zone-X sensing strategies). Furthermore, we also propose Zone-DR, a discovery radiomics approach based on zone-level deep radiomic sequencer discovery that discover radiomic sequences directly for radiomics driven sensing. Experimental results using 12,466 pathology-verified zones obtained through the different DWI sensing modalities of 101 patients showed that: (i) the introduced Zone-X and Zone-DR radiomics driven sensing strategies significantly outperformed the traditional clinical heuristics driven strategy in terms of AUC, (ii) the introduced Zone-DR and Zone-SVM strategies achieved the highest sensitivity and specificity, respectively for ADC amongst the tested radiomics driven strategies, (iii) the introduced Zone-DR and Zone-LR strategies achieved the highest sensitivities for CHB-DWI amongst the tested radiomics driven strategies, and (iv) the introduced Zone-DR, Zone-LR, and Zone-SVM strategies achieved the highest specificities for CHB-DWI amongst the tested radiomics driven strategies. Furthermore, the results showed that the trade-off between sensitivity and specificity can be optimized based on the particular clinical scenario we wish to employ radiomic driven DWI prostate cancer sensing strategies for, such as clinical screening versus surgical planning. Finally, we investigate the critical regions within sensing data that led to a given radiomic sequence generated by a Zone-DR sequencer using an explainability method to get a deeper understanding on the biomarkers important for zone-level cancer sensing.

Background Worldwide, several clinical screening tools (including EWS, SOFA, qSOFA, SIRS and CURB65) are used on admission to identify patients at risk of sepsis-related mortality. However their ability to accurately predict mortality remains controversial. The purpose of this study was to evaluate whether the predictive performance of these tools is affected by the timing of their use. Methods A systematic literature search was performed using PubMed, identifying studies in adult patients with a suspected admission diagnosis of infection, sepsis or pneumonia, in which screening tools were used to predict mortality. Meta-regression analysis was performed on included studies to identify factors affecting the tool’s ability to predict mortality, with a focus on score timing. Results From 3901 abstracts screened, 49 studies met inclusion criteria, comprising 421,006 patients and 13 clinical screening tools. No significant difference was found between any predictive tool and mortality. Of all variables considered (size of study, setting, diagnostic group, timing), only the timing related to admission affected predictive value of the tool. Studies that reported using purely physiological measures were less sensitive, marginally more specific, but had generally poorer predictive ability than those which included additional biochemical measures. Conclusion Clinicians must recognise that the performance of clinical screening tools is largely related to when they are used, not the individual tool. Given such tools are used on admission to identify risk of sepsis-related mortality, future studies must consider admission scores rather than those further into patients’ admission, to avoid over-reporting any tool’s predictive ability.

BACKGROUND Excessive gingival display (EGD), or a gummy smile (GS), is a mucogingival deformity that can be of concern to patients. The prevalence of GS etiologies, such as altered passive eruption (APE) and hypermobile upper lip (HUL), has not been reported. The aim of this study was to assess the prevalence of APE and HUL in patients seeking to correct their GS, and to determine possible prevalence differences among patients with different gingival display (GD) levels. METHODS During clinical screening of patients interested in participating in a GS treatment study, GD diagnosis, GD level, and presence of APE and/or HUL were determined. Descriptive statistics were calculated for APE, HUL, and GD group prevalence. Fisher's exact test was used to determine difference in frequency of etiologies between GD groups. RESULTS Fifty-six patients were clinically screened (27.2 ± 7.2 years old; 85.7% females; 94.6% with GD, 5.4% without GD). Among patients having GD, 75.5% presented with GD≥4 mm and 24.5% with GD

Critical flicker frequency (CFF) is the minimum frequency at which a flickering light source appears fused to an observer. Measuring CFF can support early diagnosis of minimal hepatic encephalopathy (MHE), a condition affecting up to 80% of people with cirrhosis of the liver. However, adoption of CFF measurement in clinical practice has been hampered by the cost of a device for measuring CFF and the need for specialized training to administer the test. This paper presents Beacon, a portable, inexpensive device that enables people to measure their own critical flicker frequency. We adopt a mixed-methods approach to informing and evaluating the design of and potential opportunities for Beacon. We first report on a two-part formative study with 10 participants to evaluate the choice of certain parameters in the design of Beacon. We then report on a study of 41 healthy adults ranging from 18 to 99 years of age, finding that Beacon performs on par with Lafayette Flicker Fusion System, an established medical device, achieving a pearson correlation coefficient of 0.88. We finally report on a focus group with five hepatoligists who work with patients with cirrhosis of the liver, using our initial prototype development to examine their perspectives on potential opportunities and challenges in adoption of a device like Beacon. We discuss Beacon as an exploration of reframing critical flicker frequency measurement from a clinical screening tool into a self-administered self-tracking measure, thereby drawing upon and contributing to research in the health and personal informatics.

Background Cases of late diagnosed developmental dysplasia of the hip (DDH) have increased in Australia in recent years despite an ongoing clinical screening program and increasing use of selective ultrasonography screening. Objective The aim of this paper is to discuss an evidence-based approach that involves prevention and early detection of DDH using assessment and surveillance that is suitable for general practitioners (GPs) who see young children in their practices. Discussion Repeated, carefully performed clinical examinations of the paediatric hip from newborn to walking age remain the best method for early detection of DDH. GPs are ideally placed to conduct regular assessments to maximise detection of dislocated hips in early infancy and lower the age at detection for children who develop progressive signs of DDH outside the newborn period.

Despite the widespread use of the drug court model, standardized performance measures for drug courts are not uniformly utilized, and rarely include process measures. To ensure that drug courts are being implemented in the most effective manner, the use of performance measurement tools should be considered for wide scale adoption. Drug court effectiveness is moderated by participant characteristics, and is most effective for individuals with the highest substance use needs. Therefore, having quality clinical screening processes is crucial to ensuring that drug courts are serving the population for which they are effective. This paper examines clinical screening in drug courts, to answer the following 1) what is the current state of screening, 2) what works, and 3) why measurement matters. It also proposes a clinical screening performance measure to improve fidelity and ensure appropriate participant enrollment. The creation of a performance measure would create opportunities to improve drug court outcomes, and leverage pay-for-performance models.

Lumbale Ruckenschmerzen und ihre Neigung zur Chronifizierung stellen nicht nur in der Allgemeinbevolkerung, sondern auch im Leistungssport ein bedeutendes Gesundheitsproblem dar. Im Gegensatz zu Nichtathleten ist die Erforschung psychosozialer Risikofaktoren sowie von Screeningfragebogen, die moglichst fruhzeitig die Entwicklung chronischer Schmerzen erkennen und vorhersagen konnen, im Leistungssport noch in den Anfangen. Das vorliegende systematische Review gibt einen Uberblick uber den Stand der Risikofaktorenforschung in beiden Feldern und untersucht die pradiktive Qualitat verschiedener Screeningfragebogen bei Nichtathleten. Die Literatursuche erfolgte zwischen Marz und Juni 2016 in den Datenbanken MEDLINE, PubMed und PsycINFO mit den Suchbegriffen „psychosocial screening“, „low back pain“, „sciatica“ und „prognosis“, „athletes“. Eingeschlossen wurden prospektive Studien an Patienten mit lumbalen Ruckenschmerzen mit und ohne Ausstrahlung in das Bein, ≥18 Jahre und mit einem Follow-up von mindestens 3‑monatiger Dauer. In das Review zu Screeninginstrumenten wurden 16 Studien einbezogen. Alle waren an klinischen Stichproben der Allgemeingesellschaft durchgefuhrt worden. Zu den am haufigsten publizierten Screeningfragebogen gehoren der Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) mit einer zufriedenstellenden Fruherkennung der Wiederherstellung der Arbeitsfahigkeit sowie das STarT Back Screening Tool (SBT) mit guter Vorhersage schmerzbedingter Beeintrachtigung. Fur die Vorhersage kunftiger Schmerzen eignen sich die Risikoanalyse der Schmerzchronifizierung (RISC-R) und der Heidelberger Kurzfragebogen (HKF). Psychosoziale Risikofaktoren fur chronische Ruckenschmerzen, wie z. B. chronischer Stress, ungunstige Schmerzverarbeitung und depressive Stimmungslagen, werden zunehmend auch im Leistungssport erkannt. Screeninginstrumente, die sich in der Allgemeingesellschaft als hinreichend vorhersagestark erwiesen haben, werden aktuell im MiSpEx-Forschungsverbund auf ihre Eignung uberpruft.

The specialty of inherited metabolic disease is at the forefront of progress in medicine, with new methods in metabolomics and genomics identifying the molecular basis for a growing number of conditions and syndromes. This review presents an updated pathophysiologic classification of inborn errors of metabolism and a method of clinical screening in neonates, late-onset emergencies, neurologic deterioration, and other common clinical scenarios. When and how to investigate a metabolic disorder is presented to encourage physicians to use sophisticated biochemical investigations and not miss a treatable disorder.

Phosphatidylethanol (PEth) is increasingly used as a biomarker of heavy drinking. Many different forms of PEth can form in red blood cell membranes from the action of the enzyme phospholipase D. PEth has a very long duration in blood because, in contrast to other tissues, RBCs lack the enzymes that degrade PEth. Because this biomarker is relatively new, interpretations of the analytical measurements of PEth may be misinterpreted and the resulting predictions of actual alcohol consumption inaccurate. Hence, a simple pharmacokinetic model of PEth was developed to provide a means of contextualizing these analytical results. A number of alcohol consumption scenarios and current clinical screening levels were examined with the model.

Microfluidic technologies employ nano and microscale fabrication techniques to develop highly controllable and reproducible fluidic microenvironments. Utilizing microfluidics, lead compounds can be produced with the controlled physicochemical properties, characterized in a high-throughput fashion, and evaluated in in vitro biomimetic models of human organs; organ-on-a-chip. As a step forward from conventional in vitro culture methods, microfluidics shows promise in effective preclinical testing of nanoparticle-based drug delivery. This review presents a curated selection of state-of-the-art microfluidic platforms focusing on the fabrication, characterization, and assessment of nanoparticles for drug delivery applications. We also discuss the current challenges and future prospects of nanoparticle drug delivery development using microfluidics.

Objective Typical Brugada ECG pattern is the keystone in the diagnosis of Brugada syndrome. However, the exact prevalence remains unclear, especially in Asia. The present study was designed to systematically evaluate the prevalence of spontaneous Brugada ECG pattern recorded at standard leads. Methods We searched the Medline, Embase and Chinese National Knowledge Infrastructure (CNKI) for studies of the prevalence of Brugada ECG pattern, published between Jan 1, 2003, and September 1, 2016. Pooled prevalence of type 1 and type 2-3 Brugada ECG pattern were estimated in a random-effects model, and group prevalence data by the characteristic of studies. Meta-regression analyses were performed to explore the potential sources of heterogeneity, and sensitivity analyses were conducted to assess the effect of each study on the overall prevalence. Results Thirty-nine eligible studies involving 558,689 subjects were identified. Pooled prevalence of type 1 and 2-3 Brugada ECG pattern was 0.03% (95%CI, 0.01%–0.06%), and 0.42% (95%CI, 0.28%–0.59%), respectively. Regions, sample size, year of publication were the main source of heterogeneity. The prevalence of type 1 Brugada ECG pattern was higher in male, Asia, adult, patient, and fever subjects; but the relation between fever and type 2-3 Brugada ECG pattern was not significant. Sensitivity analysis showed that each study did not lonely affect the prevalence of type 1 and type 2-3 Brugada ECG pattern. Conclusion Brugada ECG pattern is not rare, especially preponderant in adult Asian males, and fever subjects. Clinical screening and further examination of Brugada syndrome in potential population need to be highlighted.

Objective: The aim of this study was to compare the ultrasonography (USG) measurements of anterior neck soft tissue and other clinical screening tests used to evaluate difficult laryngoscopy in mor...

Purpose A new multicontrast echo-planar imaging (EPI)-based sequence is proposed for brain MRI, which can directly generate six MR contrasts (T1 -FLAIR, T2 -w, diffusion-weighted (DWI), apparent diffusion coefficient (ADC), T2*-w, T2 -FLAIR) in 1 min with full brain coverage. This could enable clinical MR clinical screening in similar time as a conventional CT exam but with more soft-tissue information. Methods Eleven sequence modules were created as dynamic building blocks for the sequence. Two EPI readout modules were reused throughout the sequence and were prepended by other modules to form the desired MR contrasts. Two scan protocols were optimized with scan times of 55-75 s. Motion experiments were carried out on two volunteers to investigate the robustness against head motion. Scans on patients were carried out and compared to conventional clinical images. Results The pulse sequence is found to be robust against motion given its single-shot nature of each contrast. For excessive out-of-plane head motion, the T1 -FLAIR and T2 -FLAIR contrasts suffer from incomplete inversion. Despite lower signal-to-noise ratio (SNR) and resolution, the 1-min multicontrast EPI data show promising correspondence with conventional diagnostic scans on patients. Conclusion A 1 min multicontrast brain MRI scan based on EPI readouts has been presented in this feasibility study. Preliminary data show potential for clinical brain MRI use with minimal bore time for the patient. Such short examination time could be useful (e.g., for screening and acute stroke). The sequence may also help planning conventional brain MRI scans if run at the beginning of an examination. Magn Reson Med 79:3045-3054, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

4th International Symposium on Multidisciplinary Studies and Innovative Technologies, ISMSIT 2020 -- 22 October 2020 through 24 October 2020 -- -- 165025 2-s2.0-85097675812 Bacterial skin infections are one of the most common types of infections in medical sector. Normally, it is being diagnosed visually starting with an initial clinical screening and then possibly followed by dermoscopic analysis, Antibiotics both oral and topical histopathological examination. In this paper I would focus on deep learning approaches like CNN and Medical Data Classification for Predicting Bacterial Skin Infection. The Application of Deep learning is continuously being used to determine the accuracy of detecting different medical problems more effectively. A lot of new techniques have been discovered to fast forward the procedure with having highest percentage of accuracy. In this paper work, we have proposed a model to detect bacterial infections more effectively using image processing with convolutional neural network, a part of deep learning concept under machine learning. The dataset contains almost 3000+images of the patients having skin diseases classified into two classes, malignant and benign. We have introduced CNN along with its seven different architectures to find the accuracy of the images of skin bacterial infections and performed a comparative analysis to find out the best architecture that suits this type of problem. For the training, testing and validation of our dataset a well-known MATLAB R2019a software was used for this purpose. We performed the best results Using Deep Learning and Medical Data Classification with having almost 91.303% accuracy to determine skin infections. © 2020 IEEE.

The aim was to describe the experience of donation and clinical screening from the donor's perspective. This is a cross-sectional descriptive and analytical study, with non-probabilistic sampling, between November 2018 and March 2020. The scenario was a hemotherapy service in Rio de Janeiro. A self-administered questionnaire with 32 questions was used for blood donation candidates. Univariate and bivariate analyzes were performed, a chi-square test was applied, considering a significance level of 5%, using IBM's SPSS software. Of the 400 respondents, 54.8% were donating spontaneously; 71.5% declared to be repeat donors; 36% reported having an interest in the results of serological tests; 88.3% admitted to fully trusting the results of such exams; 65.8% declared they had no knowledge about the health units where they could be carried out; and 59.8% considered transmission of infections possible through transfusion. About repeat donors; 66.4% reported having been asked about vulnerabilities and risk situations in clinical screening; for 38.8%, the opportunity for self-exclusion was not clear. In this context, the nurse has a role both in approaching the donor in clinical screening, as well as in explaining the donation process, to allow conscious decision-making by self-exclusion, based on adequate guidance regarding their vulnerability.

Broad-scale untargeted biochemical phenotyping is a technology that supplements widely accepted assays, such as organic acid, amino acid, and acylcarnitine analyses typically utilized for the diagnosis of inborn errors of metabolism. In this study, we investigate the analyte changes associated with 4-aminobutyrate aminotransferase (ABAT, GABA transaminase) deficiency and treatments that affect GABA metabolism. GABA-transaminase deficiency is a rare neurodevelopmental and neurometabolic disorder caused by mutations in

The pathology of cervical neoplasia provides the best model for integrating the morphologic basis for diagnosis with the molecular pathogenesis of human papillomavirus (HPV) induced precancer and cancer. This chapter focuses on the process of clinical screening and diagnosis and how a contemporary understanding of HPV biology informs morphologic diagnostic criteria in both cytology and histopathology. The science has also led to refinement in classification systems and improved diagnostic tests based on HPV and related biomarkers.

Chest X-Ray (CXR) images are commonly used for clinical screening and diagnosis. Automatically writing reports for these images can considerably lighten the workload of radiologists for summarizing descriptive findings and conclusive impressions. The complex structures between and within sections of the reports pose a great challenge to the automatic report generation. Specifically, the section Impression is a diagnostic summarization over the section Findings; and the appearance of normality dominates each section over that of abnormality. Existing studies rarely explore and consider this fundamental structure information. In this work, we propose a novel framework that exploits the structure information between and within report sections for generating CXR imaging reports. First, we propose a two-stage strategy that explicitly models the relationship between Findings and Impression. Second, we design a novel cooperative multi-agent system that implicitly captures the imbalanced distribution between abnormality and normality. Experiments on two CXR report datasets show that our method achieves state-of-the-art performance in terms of various evaluation metrics. Our results expose that the proposed approach is able to generate high-quality medical reports through integrating the structure information., Comment: ACL 2019

As the treatment landscape continues to evolve towards the application of precision medicine in multiple myeloma (MM), there is a clear need to identify those patients who are at risk of not achieving the maximum benefit whilst exposed to the highest level of toxicity. This group of patients, defined as frail, is an unmet clinical need. However, how we define such a vulnerable group of patients with MM remains to be clarified. An integral aspect of this is to define the physiological age and capacity of patients with MM to deal with the burden of their disease and it’s treatment. Such assessments may include not only functional and clinical assessments but also laboratory-based biomarkers of frailty, aging and senescent cellular burden. A need to develop, test and validate clinical screening scores before their adoption into clinical practice is mandated. This position paper from the European Myeloma Network aims to review what is known about defining frailty in MM, and how we can advance this knowledge for the design of clinical trials and ultimately how we deliver treatment in the clinic.

Connectivity impairment has frequently been associated with the pathophysiology of attention-deficit/hyperactivity disorder (ADHD). Although the connectivity of the resting state has mainly been studied, we expect the transition between baseline and task may also be impaired in ADHD children. Twenty-three typically developing (i.e., control) and 36 disordered (ADHD and autism-comorbid ADHD) children were subjected to connectivity analysis. Specifically, they performed an attention task, visual oddball, while their brains were measured by functional near-infrared spectroscopy. The results of the measurements revealed three key findings. First, the control group maintained attentive connectivity, even in the baseline interval. Meanwhile, the disordered group showed enhanced bilateral intra- and interhemispheric connectivities while performing the task. However, right intrahemispheric connectivity was found to be weaker than those for the control group. Second, connectivity and activation characteristics might not be positively correlated with each other. In our previous results, disordered children lacked activation in the right middle frontal gyrus. However, within region connectivity of the right middle frontal gyrus was relatively strong in the baseline interval and significantly increased in the task interval. Third, the connectivity-based biomarker performed better than the activation-based biomarker in terms of screening. Activation and connectivity features were independently optimized and cross validated to obtain the best performing threshold-based classifier. The effectiveness of connectivity features, which brought significantly higher training accuracy than the optimum activation features, was confirmed (88% versus 76%). The optimum screening features were characterized by two trends: (1) strong connectivities of right frontal, left frontal, and left parietal lobes and (2) weak connectivities of left frontal, left parietal, and right parietal lobes in the control group. We conclude that the attentive task-based connectivity effectively shows the difference between control and disordered children and may represent pathological characteristics to be feasibly implemented as a supporting tool for clinical screening.

As food insecurity interventions are incorporated into hospitals' population health initiatives, addressing the needs of hospitals' patients and communities through the same interventions may be ineffective if the groups vary and have different needs. This study examined whether food insecurity predictors were different in the general population compared to individuals with hospital discharges, and also whether food-insecure hospital patients differed from food-insecure community members. National data were extracted from the 2016 Medical Expenditures Panel Survey. Summary statistics were compared to test for differences between food security status groups. Logistic regressions were estimated for the general population and for individuals with hospital discharges to identify associations between food insecurity and demographic, socioeconomic, and health characteristics. Food-insecure individuals with and without hospital discharges differed statistically across multiple variables, including 15 of 16 health-related variables. However, compared to food-secure individuals with hospital discharges, food-insecure individuals with hospital discharges differed on only half of the health variables. Food insecurity predictors also differed among the general population and hospital discharge samples; for instance, age and race were only associated with higher likelihoods of food insecurity in the population sample. Furthermore, 9 health-related variables were associated with food insecurity in the population sample relative to only 2 in the hospital discharge sample. Food insecurity predictors differed between the general population and individuals with hospital discharges; food-insecure individuals with and without hospital discharges also differed statistically. Therefore, hospitals should carefully consider their target populations when constructing population health initiatives.

We used quality improvement (QI) methodology in the acute paediatric setting to develop clinical screening tools and local resources for addressing child poverty in practice in a London district general hospital between March and August 2019.

Mutations of the Telomerase reverse transcriptase (TERT) gene promoter are recurrently found in follicular thyroid carcinoma (FTC) and follicular tumors of uncertain malignant potential (FT-UMP), but nearly never in follicular thyroid adenoma (FTA). We, therefore, believe these mutations could signify malignant potential. At our department, postoperative TERT promoter mutational testing of FT-UMPs was implemented in 2014, with a positive mutation screening leading to vigilant follow-up and sometimes adjuvant treatment. To date, we screened 51 FT-UMPs and compared outcomes to 40 minimally invasive FTCs (miFTCs) with known TERT genotypes. Eight FT-UMPs (16%) displayed TERT promoter mutations, of which four cases underwent a completion lobectomy at the discretion of the patient, and a single patient also opted in for radioiodine (RAI) treatment. Three mutation-positive patients developed distant metastases, registered in one patient receiving a completion lobectomy and in two patients with no additional treatment. Three out of four patients who received additional surgery, including the RAI-treated patient, are still without metastatic disease. We conclude that FT-UMPs with TERT promoter mutations harbor malignant potential and exhibit at least similar recurrence rates to TERT-promoter-mutated miFTCs. Mutational screening should constitute a cornerstone analysis in the histopathological work-up of FT-UMPs.

Mutations of the Telomerase reverse transcriptase (TERT) gene promoter are recurrently found in follicular thyroid carcinoma (FTC) and follicular tumors of uncertain malignant potential (FT-UMP), but nearly never in follicular thyroid adenoma (FTA). We, therefore, believe these mutations could signify malignant potential. At our department, postoperative TERT promoter mutational testing of FT-UMPs was implemented in 2014, with a positive mutation screening leading to vigilant follow-up and sometimes adjuvant treatment. To date, we screened 51 FT-UMPs and compared outcomes to 40 minimally invasive FTCs (miFTCs) with known TERT genotypes. Eight FT-UMPs (16%) displayed TERT promoter mutations, of which four cases underwent a completion lobectomy at the discretion of the patient, and a single patient also opted in for radioiodine (RAI) treatment. Three mutation-positive patients developed distant metastases, registered in one patient receiving a completion lobectomy and in two patients with no additional treatment. Three out of four patients who received additional surgery, including the RAI-treated patient, are still without metastatic disease. We conclude that FT-UMPs with TERT promoter mutations harbor malignant potential and exhibit at least similar recurrence rates to TERT-promoter-mutated miFTCs. Mutational screening should constitute a cornerstone analysis in the histopathological work-up of FT-UMPs.

This report describes the synthesis of a library of fluorogenic carbapenemase substrates consisting of carbapenem derivatives, fluorescence dyes, and active cleavable linkers and their evaluation for specifically detecting carbapenemase-producing organisms (CPOs). We synthesized a series of compounds having three different types of linkers such as benzyl ether, carbamate, and amine using hydroxymethyl carbapenem 7a and hydroxyallyl carbapenem 7b as key intermediates. Probe 1b exhibited high stability and a prompt turn-on fluorescence signal upon hydrolysis by carbapenemases. In particular, the screening of clinical samples indicated that the probe 1b exhibited excellent selectivity to the CPOs over other β-lactamases or non-carbapenemase producing bacteria, which may be of clinical use for the rapid and accurate detection of CPOs for timely diagnosis and treatment.

The General Data Protection Regulation (GDPR) is lengthy and it is essential to resume the impacts of it in specific use-cases to diminish the gap between system developers and regulators. Computer-aided diagnosis is one of such use-cases with increased importance on clinical screening programs. The regulation has distinct mentions that affect automated-decision solutions and healthcare records. This work identifies the fundamental legal issues, challenges and opportunities for this scenario and propose architectural guidelines to tackle them. The result is purely theoretical, however it is based on known architectures such as signaling networks, already applied in the telecommunication sector.

Cognitive performance is often found to be lower in older adults, especially when the task requires memory, executive functions, or selective attention. But this alleged deterioration may have been overestimated in the past due to ecologically invalid testing. To verify this possible misjudgment here we compared age-related memory performance in a typical, abstract computer task to a paper-pencil test with a real-world map and to an even more realistic task that took place in a real room with everyday objects. Retention and response intervals differed between the tasks as they had to be adjusted to the different settings. Twenty-seven younger (19-29 years old) and twenty-three older participants (61-77 years old) took part in the study. As expected younger participants outperformed the older ones in the computer task. However, although older adults' performance was better in both more realistic tasks, the delta to the young remained the same as in the computer task. Hence, these results do not support the general notion that older adults would profit from more realistic test scenarios. On the other hand, performance in a clinical screening task correlated only with the performance in the real world task suggesting that this task reflected the general cognitive status of participants better than the more abstract tasks. Finally, it was observed that the presence of task-irrelevant distractor items actually helped older adults to improve their performance in the paper pencil task arguing against the assumption of a general age-related impairment of inhibition. In sum, the present results show that age-related changes in memory are neither simply explained by reduced abilities to deal with abstract computer tasks nor by disturbed inhibition processes.

Background and objectives Smokers currently have no defined restrictions for blood donation. However, cigarette smoke contains toxic substances such as carbon monoxide (CO) and trace elements that can affect the packed red blood cells (PRBCs) quality and safety of transfusion. This study evaluated the effects of smoking on the concentration of essential and trace elements and on carboxyhemoglobin (COHb) levels in PRBCs from smoker donors. Materials and methods A matched case-control study was conducted to compare COHb levels, determined by the CO-oximetry method, and levels of trace (Cd, Pb, Cr, Ni, As and Hg) and essential (Ca, Mg, Cu, Fe, Mn, Mo, Se and Zn) elements evaluated by inductively coupled plasma mass spectrometry, in PRBCs from smoker (n = 36) and non-smoker (n = 36) donors at Hospital de Clinicas de Porto Alegre, Brazil. Results Mean COHb level was 14 times higher in the PRBCs obtained from smoker donors (5·9 [4·0-9·1] vs. 0·4 [0·2-0·8]%). Cadmium (1·0 [1·0-1·8] μg/l vs. undetectable) and lead (27 [21-36] vs. 19 [14-26] μg/l) levels were significantly higher in the PRBCs from smokers. Moreover, except for molybdenum, levels of all essential elements were lower in smoker PRBCs. Conclusion The PRBCs donated by smokers contain toxic elements that are probably not safe for transfusion in children. Our results might support changes in the current guidelines of blood banks to improve the transfusion safety through inclusion of inquiry about smoking in the clinical screening, labelling and reserve PRBCs from smoker donors for adults or less critical recipients.

Introduction: Metal on Metal (MoM) total hip arthroplasty (THA) has been largely abandoned in the United States secondary to high failure rates. Many of the failures are attributed to adverse local tissue reactions (ALTR). Therefore, patients that have a MoM THA are routinely screened by checking serum metal ion levels every two years, as was recommended by the FDA. However, there is limited data on the costs of current screening protocols. Materials and Methods: 318 consecutive patients who underwent a MoM THA at a single institution were retrospectively enrolled. The average follow-up was 8.2 years. Clinical data, metal ion levels, revision and reoperation rates were prospectively collected. The costs of clinical screening for this patient population was calculated and compared to the cost of an annual screening protocol. Results: 12 patients had either an elevated Co or Cr level (>4.5 ppb). Eight patients were revised secondary to ALTR. The total cost of screening during the study was $612,250. Additionally, if annual screening had been performed, total screening costs would be approximately $1,719,200. Discussion: Eight patients in the following study were revised secondary to ALTR with a total cost of screening of $612,500. These costs are substantially less than the cost of annual screening ($1,719,200). Due to the considerable costs of screening asymptomatic MoM THA patients, we recommend both optimizing the frequency of screening and evaluating the specific risk of the implant being screened.

The purpose of this study was to analyze the incidence and outcomes of unsuspected indeterminate but likely unimportant extracolonic findings (CT Colonography Reporting and Data System [C-RADS] category E3) at screening CT colonography (CTC).Over 99 months (April 2004 through June 2012), 7952 consecutive adults without symptoms of colorectal cancer (4277 women, 3675 men; mean age ± SD, 56.7 ± 7.3 years) underwent first-time screening CTC. Findings prospectively placed into C-RADS category E3 were retrospectively reviewed, including follow-up (range, 2-10 years) and ultimate clinical outcome.Unsuspected C-RADS category E3 extracolonic findings were detected in 9.1% (725/7952) of our patient population. A total of 751 category E3 findings were detected among these 725 patients; 25 patients had multiple findings. Commonly involved organ systems included gynecologic (24.4%, 183/751), genitourinary (20.9%, 157/751), lung (20.6%, 155/751), and gastrointestinal (16.1%, 121/751). Consideration for further imaging, if clinically warranted, was suggested in 83.8% (608/725). Sixty-five patients were lost to follow-up. Conditions requiring treatment or surveillance were ultimately diagnosed in 8.3% (55/660), including eight malignant neoplasms. In the remaining 605 patients, 25 (4.1%) underwent invasive biopsy or surgery to prove benignity (including 18 complex adnexal masses), and 278 (46.0%) received additional imaging follow-up.Indeterminate but likely unimportant extracolonic findings (C-RADS category E3) occurred in less than 10% of adults without symptoms of colorectal cancer who underwent screening CTC. Over 90% of these findings ultimately proved to be clinically insignificant, with fewer than 5% requiring an invasive procedure to prove benign disease, the majority of which (70%) were complex adnexal lesions in women.

An efficient electrochemical immunosensor can offer the potential for the detection of protein cancer biomarkers due to its high sensitivity, low cost and possible integration in compact analytical devices. In the last several years, researchers have developed various electrochemical immunoassay methods for the detection of protein cancer biomarkers. Significant progresses have been made in the study of electrochemical immunosensor that based on CNTs, especially in the fields of clinical screening and diagnosis of cancer field. This is because CNTs possess unique structural, mechanical and electronic properties that can decrease over-potential and improve the sensitivity of electrochemical immunosensor. This paper reviews recent advances in the different modified strategies of constructing electrochemical immunosensor based on CNTs for detecting protein cancer biomarkers. CNTs or CNTs hybrid nanomaterials modified electrodes have been firstly introduced as the sensing platforms for the detection of protein cancer biomarkers. On the other hand, CNTs or functional CNTs used as labels in sandwich-type electrochemical immunosensors have been systematically summarized. These novel strategies and the general principles could increase the sensitivity of the immunosensor, thereby overcoming the limitations of its application in the biosensing field.

KRAS mutations have emerged as powerful predictors of response to targeted therapies in the treatment of lung and colorectal cancers; thus, prospective KRAS genotyping is essential for appropriate treatment stratification. Conventional mutation testing technologies are not ideal for routine clinical screening, as they often involve complex, time-consuming processes and/or costly instrumentation. In response, we recently introduced a unique analytical strategy for revealing KRAS mutations, based on the allele-specific hybridization-induced aggregation (HIA) of oligonucleotide probe-conjugated microbeads. Using simple, inexpensive instrumentation, this approach allows for the detection of any common KRAS mutation in

Niemann–Pick disease type C (NP-C) is a rare multisystemic lysosomal disorder which, albeit treatable, is still starkly underdiagnosed. As NP-C features early onset ataxia (EOA) in 85–90 % of cases, EOA presents a promising target group for undiagnosed NP-C patients. Here, we assessed the ability of the previously established NP-C suspicion index (SI) and a novel abbreviated ‘2/3 SI’ tool for rapid appraisal of suspected NP-C in unexplained EOA. This was a retrospective observational study comparing ‘NP-C EOA’ cases (EOA patients with confirmed NP-C) with non-NP-C EOA controls (EOA patients negative for NP-C gene mutations). NP-C risk prediction scores (RPS) from both the original and 2/3 SIs were calculated and their discriminatory performance evaluated. Among 133 patients (47 NP-C EOA cases; 86 non-NP-C EOA controls), moderate (40–69 points) and high (≥70 points) RPS were common based on original SI assessments in non-NP-C EOA controls [16 (19 %) and 8 (9 %), respectively], but scores ≥70 points were far more frequent [46 (98 %)] among NP-C EOA cases. RPS cut-off values provided 98 % sensitivity and 91 % specificity for NP-C at 70-point cut-off, and ROC analysis revealed an AUC of 0.982. Using the 2/3 SI, 90 % of NP-C EOA cases had scores of 2 or 3, and RPS analysis showed an AUC of 0.961. In conclusion, the NP-C SI and the new, quick-to-apply 2/3 SI distinguished well between NP-C and non-NP-C patients, even in EOA populations with high background levels of broadly NPC-compatible multisystemic disease features. While the original SI showed the greatest sensitivity, both tools reliably aided identification of patients with unexplained EOA who warranted further investigation for NP-C. Electronic supplementary material The online version of this article (doi:10.1007/s00415-016-8178-0) contains supplementary material, which is available to authorized users.

Hypertrophic cardiomyopathy (HCM) is a variable disease both phenotypically and genetically with challenges surrounding identification of those individuals at risk of sudden death. Current guidelines by the American Heart Association (AHA)/American College of Cardiology (ACC) recommend clinical screening of children with first-degree family members with HCM starting at the age of 12 or the onset of puberty. We report a case of a child with known double-heterozygous mutations causative of HCM. The child had evidence of HCM by 4 months of age, and experienced aborted cardiac death starting at 7 years of age. This case suggests that multiple HCM-associated genetic mutations may portend a higher risk for severe HCM and predispose to early onset cardiac arrest, thereby requiring earlier clinical screening.

The objective of the present study was to evaluate the ability of the five times sit to stand test (5TSST), grip strength (GS) and step test (ST) to detect older women with reduced lower-limb muscle strength (LLMS), and to investigate the clinical usefulness of the combination of such tests. One hundred and nineteen older women were submitted to the 5TSST, GS, ST and lower limb peak torque by an isokinetic dynamometer. The capacity of the clinical tests to detect older women with reduced LLMS was measured using the ROC curve, followed by calculation of posttest probability (PoTP). The results show that a ST score of 0.24 cm per cm of participant’s height shows the best PoTP for a positive test (72%). However, the combination of the ST and 5TSST enhances the accuracy from 48% (prevalence of weakness in the population) to 82.6% if both tests are positive, and decreases the PoTP from 48% to 11.4% if both tests are negative. The inclusion of GS provided additional benefits of small magnitude. In conclusion, the ST performed alone or in combination with 5TSST could be an alternative for clinical screening of LLMS reduction in older women. The early identification of impairment of lower-limb muscle strength in independent older adults may favor early intervention and prevention of negative outcomes such as falls and functional limitations.