Complexities in the estimation of overdiagnosis in breast cancer screening

There is interest in estimating and attributing temporal changes in incidence of breast cancer in relation to the initiation of screening programmes, in particular to estimation of overdiagnosis of breast cancer as a result of screening. In this paper, we show how screening introduces complexities of analysis and interpretation of incidence data. For example, lead time brings forward time- and age-related increases in incidence. In addition, risk factors such as hormone replacement therapy use have been changing contemporaneously with the introduction of screening. Although we do not indicate exactly how such complexities should be corrected for, we use some simple informal adjustments to show how they may account for a substantial proportion of increased incidence, which might otherwise erroneously have been attributed to overdiagnosis. We illustrate this using an example of analysis of breast cancer incidence data from Sweden

An alkali catalyzed trans-esterification of rice bran, cottonseed and waste cooking oil

In this research work, biodiesel production by trans-esterification of three raw materials including virgin and used edible oil and non edible oil has been presented. A two step method following acidic and alkali catalyst was used for non edible oil due to the unsuitability of using the straight alkaline-catalyzed trans-esterification of high FFA present in rice bran oil. The acid value after processing for rice bran, cottonseed and waste cooking oil was found to be 0.95, 0.12 and 0.87 respectively. The influence of three variables on percentage yield i.e., methanol to oil molar ratio, reaction temperature and reaction time were studied at this stage. Cottonseed oil, waste cooking oil and rice bran oil showed a maximum yield of 91.7%, 84.1% and 87.1% under optimum conditions. Fuel properties of the three biodiesel satisfied standard biodiesel fuel results

Classification of Melanoma and Nevus in Digital Images for Diagnosis of Skin Cancer

Melanoma is considered a fatal type of skin cancer. However, it is sometimes hard to distinguish it from nevus due to their identical visual appearance and symptoms. The mortality rate because of this disease is higher than all other skin-related consolidated malignancies. The number of cases is growing among young people, but if it is diagnosed at an earlier stage, then the survival rates become very high. The cost and time required for the doctors to diagnose all patients for melanoma are very high. In this paper, we propose an intelligent system to detect and distinguish melanoma from nevus by using the state-of-the-art image processing techniques. At first, the Gaussian filter is used for removing noise from the skin lesion of the acquired images followed by the use of improved K-mean clustering to segment out the lesion. A distinctive hybrid superfeature vector is formed by the extraction of textural and color features from the lesion. Support vector machine (SVM) is utilized for the classification of skin cancer into melanoma and nevus. Our aim is to test the effectiveness of the proposed segmentation technique, extract the most suitable features, and compare the classification results with the other techniques present in the literature. The proposed methodology is tested on the DERMIS dataset having a total number of 397 skin cancer images: 146 are melanoma and 251 are nevus skin lesions. Our proposed methodology archives encouraging results having 96% accuracy

Preparedness of Australian and British nurses and midwives about domestic violence and abuse

BACKGROUND: Domestic violence and abuse (DVA) is a major health problem that affects individuals across the world. Nurses, midwives and healthcare providers need to be confident and competent in identifying and responding to DVA. AIMS: To measure current levels of knowledge, opinions and preparedness towards DVA and how it is managed by registered nurses and midwives residing in Australia and the UK. METHODS: A cross-sectional study design was used. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) measuring the perceived preparation and knowledge, actual knowledge, opinions and practice issues. Australian data were collected in 2018 and UK data were collected in 2017-2018. Descriptive and inferential statistics were used to analyse the data and differences in knowledge and attitudes of British and Australian nurses. FINDINGS: Nurses and midwives (n = 368; 130 from Australia; 238 from the UK) responded to the survey. Minimal previous DVA training was reported by the participants. Participants had minimal knowledge about DVA, though had a positive attitude towards engaging with women experiencing DVA. DISCUSSION: Most participants felt unprepared to ask relevant questions about DVA and had inadequate knowledge about available resources. Australian participants scored better than British participants; however, the mean difference in all aspects remained statistically insignificant. CONCLUSION: Australian and British nurses and midwives have a positive attitude towards women experiencing DVA; however, the knowledge and skills to support women experiencing DVA are limited. IMPLICATIONS FOR NURSING POLICY: Nursing institutions should develop strategic policies regarding mandatory preparation and training of nurses for domestic violence assessment and management

Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

IntroductionSeveral single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).Methods160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.ResultsThe total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).ConclusionsThis multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.Trial registrationClinicalTrial.gov, NCT01401283

An Adequate Approach to Image Retrieval Based on Local Level Feature Extraction

ABSTRAC

Acute leukaemoid reaction following cardiac surgery

Chronic myelomonocytic leukaemia is an atypical myeloproliferative disorder with a natural history of progression to acute myeloid leukaemia, a complex and poorly understood response by the bone marrow to stress. Cardiac surgery activates many inflammatory cascades and may precipitate a systemic inflammatory response syndrome. We present a case of undiagnosed chronic myelomonocytic leukaemia who developed rapidly fatal multi-organ dysfunction following cardiac surgery due to an acute leukaemoid reaction

Effect of Micro- to Nanosize Inclusions upon the Thermal Conductivity of Powdered Composites with High and Low Interface Resistance

Materials for thermal management application require better control over the thermophysical properties, which has largely been achieved by fabricating powdered composite. There are, however, several factors like filler volume fraction, shape morphology, inclusion size, and interfacial thermal resistance that limit the effective properties of the medium. This paper presents a methodology to estimate the effective thermal conductivity of powdered composites where the filler material is more conductive than the matrix. Only a few theoretical models, such as Hasselman and Johnson (HJ) model, include the effect of interfacial resistance in their formulation. Nevertheless, HJ model does not specify the nature of the interfacial thermal resistance. Although Sevostianov and Kachanov (SK) method takes care of interface thickness, they, on the other hand, have not taken into account the interfacial resistance due to atomic imperfections. In the present work, HJ model has been modified using SK method and the results were compared with experimental ones from the literature. It has been found that the effect of interfacial resistance is significant in highly resistive medium at microscale compared to nanoscale, such as Cu/diamond system, while, in a highly conductive medium, like bakelite/graphite system, the effect of shape factor is more significant than interfacial thermal resistance

Effect of Gender On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmissions Database)

Women who undergo percutaneous coronary intervention (PCI) are at higher risk of adverse outcomes compared with men, but it is unknown whether gender affects early unplanned rehospitalization. We analyzed 832,753 patients who underwent PCI from 2013 to 2014 in the Nationwide Readmissions Database. We compared gender differences in incidences, predictors, causes, and cost of unplanned 30-day readmissions and examined the effect of co-morbidity. A total of 832,753 men and women who survived the index PCI and were not admitted for a planned readmission were included in the analysis. Overall, 9.4% of patients had an unplanned readmission within 30 days. Thirty-day readmission rates were higher in women compared with men (11.5% vs 8.4%, p <0.001) even after multivariate adjustment (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.001), although women had significantly lower costs associated with the readmission ($11,927 vs$12,758, p <0.001). The cause of readmission for women and men were similar and the majority of the readmissions were due to noncardiac causes (58% vs 55%), the most common of which were nonspecific chest pain, gastrointestinal disease, and infections. In contrast, for cardiac readmissions, women are more likely to be readmitted for heart failure (29.64% vs 22.34%), whereas men are more likely to be readmitted for coronary artery disease, including angina (33.47% vs 28.54%). In conclusion, gender disparities exist in rates of unplanned rehospitalization after PCI, where more than 1 in 10 women who undergo PCI are readmitted within 30 days. Gender differences were not observed for causes of noncardiac readmissions, whereas important differences were observed for cardiovascular causes