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Radiological evaluation of incidentally detected lung nodules on computed tomography (CT) influences management. We assessed international radiological variation in 1) pulmonary nodule characterisation; 2) hypothetical guideline-derived management; and 3) radiologists' management recommendations.107 radiologists from 25 countries evaluated 69 CT-detected nodules, recording: 1) first-choice composition (solid, part-solid or ground-glass, with percentage confidence); 2) morphological features; 3) dimensions; 4) recommended management; and 5) decision-influencing factors. We modelled hypothetical management decisions on the 2005 and updated 2017 Fleischner Society, and both liberal and parsimonious interpretations of the British Thoracic Society 2015 guidelines.Overall agreement for first-choice nodule composition was good (Fleiss' κ=0.65), but poorest for part-solid nodules (weighted κ 0.62, interquartile range 0.50–0.71). Morphological variables, including spiculation (κ=0.35), showed poor-to-moderate agreement (κ=0.23–0.53). Variation in diameter was greatest at key thresholds (5 mm and 6 mm). Agreement for radiologists' recommendations was poor (κ=0.30); 21% disagreed with the majority. Although agreement within the four guideline-modelled management strategies was good (κ=0.63–0.73), 5–10% of radiologists would disagree with majority decisions if they applied guidelines strictly.Agreement was lowest for part-solid nodules, while significant measurement variation exists at important size thresholds. These variations resulted in generally good agreement for guideline-modelled management, but poor agreement for radiologists' actual recommendations.

Autonomous underwater systems are very important as they could be a remarkable advancement in areas such as defence, pollution monitoring, deep sea mining, meteorology, flora and fauna exploration, etc. A fastidious static and dynam-ical model of the system is necessary for the implementation of an effective control system. The hydrodynamic parameters of the vehicle should also be considered for developing an accurate model of the vehicle. This paper presents the design, analysis and fabrication of an Autonomous Underwater Vehicle (AUV) with a simple yet effective design having 5 degrees of freedom. This paper also describes the static and dynamic modelling of the AUV. Hydrodynamic coefficients of the system are obtained through analysis and its aberrations are interpreted by varying different variables. The proposed AUV is equipped with six thrusters in order to achieve felicitous manoeuverability. The use of Aluminium extrusions for the frame of the vehicle makes the thruster configuration easily reconfigurable.

ObjectivesTo establish the level of observer variation for the current ATS/ERS/JRS/ALAT criteria for a diagnosis of usual interstitial pneumonia (UIP) on CT among a large group of thoracic radiologists of varying levels of experience.Materials and methods112 observers (96 of whom were thoracic radiologists) categorised CTs of 150 consecutive patients with fibrotic lung disease using the ATS/ERS/JRS/ALAT CT criteria for a UIP pattern (3 categories—UIP, possibly UIP and inconsistent with UIP). The presence of honeycombing, traction bronchiectasis and emphysema was also scored using a 3-point scale (definitely present, possibly present, absent). Observer agreement for the UIP categorisation and for the 3 CT patterns in the entire observer group and in subgroups stratified by observer experience, were evaluated.ResultsInterobserver agreement across the diagnosis category scores among the 112 observers was moderate, ranging from 0.48 (IQR 0.18) for general radiologists to 0.52 (IQR 0.20) for thoracic radiologists of 10–20 years’ experience. A binary score for UIP versus possible or inconsistent with UIP was examined. Observer agreement for this binary score was only moderate. No significant differences in agreement levels were identified when the CTs were stratified according to multidisciplinary team (MDT) diagnosis or patient age or when observers were categorised according to experience. Observer agreement for each of honeycombing, traction bronchiectasis and emphysema were 0.59±0.12, 0.42±0.15 and 0.43±0.18, respectively.ConclusionsInterobserver agreement for the current ATS/ERS/JRS/ALAT CT criteria for UIP is only moderate among thoracic radiologists, irrespective of their experience, and did not vary with patient age or the MDT diagnosis.

FLOW AND HEAT TRANSFER OF A VISCOELASTIC FLUID OVER A FLAT PLATE WITH A MAGNETIC FIELD AND A PRESSURE GRADIENT

UNSTEADY LAMINAR BOUNDARY LAYER FORCED FLOW OVER A MOVING WALL WITH A MAGNETIC FIELD

Copyright 2015 American Medical Association. All rights reserved. IMPORTANCE: Airflow obstruction on spirometry is universally used to define chronic obstructive pulmonary disease (COPD), and current or former smokers without airflow obstruction may assume that they are disease free. OBJECTIVE: To identify clinical and radiologic evidence of smoking-related disease in a cohort of current and former smokers who did not meet spirometric criteria for COPD, for whom we adopted the discarded label of Global Initiative for Obstructive Lung Disease (GOLD) 0. DESIGN, SETTING, AND PARTICIPANTS: Individuals from the Genetic Epidemiology of COPD (COPDGene) cross-sectional observational study completed spirometry, chest computed tomography (CT) scans, a 6-minute walk, and questionnaires. Participants were recruited from local communities at 21 sites across the United States. The GOLD 0 group (n = 4388) (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity >0.7 and FEV1 >80% predicted) from the COPDGene study was compared with a GOLD 1 group (n = 794), COPD groups (n = 3690), and a group of never smokers (n = 108). Recruitment began in January 2008 and ended in July 2011. MAIN OUTCOMES AND MEASURES: Physical function impairments, respiratory symptoms, CT abnormalities, use of respiratory medications, and reduced respiratory-specific quality of life. RESULTS: One or more respiratory-related impairments were found in 54.1% (2375 of 4388) of the GOLD 0 group. The GOLD 0 group had worse quality of life (mean [SD] St George's Respiratory Questionnaire total score, 17.0 [18.0] vs 3.8 [6.8] for the never smokers; P

Let (V,Γ) and (V′,Γ′) be Gamma-Banach algebras over the fields F1 and F2 isomorphic to a field F which possesses a real valued valuation, and (V,Γ)⊗p(V′,Γ′), their projective tensor product. It is shown that if D1 and D2 are α - derivation and α′ - derivation on (V,Γ) and (V′,Γ′) respectively and u=∑1x1⊗y1, is an arbitrary element of (V,Γ)⊗p(V′,Γ′), then there exists an α⊗α′- derivation D on (V,Γ)⊗p(V′,Γ′) satisfying the relation D(u)=∑1[(D1x1)⊗y1+x1⊗(D2y1)] and possessing many enlightening properties. The converse is also true under a certain restriction. Furthermore, the validity of the results ‖D‖=‖D1‖+‖D2‖ and sp(D)=sp(D1)+sp(D2) are fruitfully investigated.