Improving diagnostic accuracy of dermoscopically equivocal pink cutaneous lesions with reflectance confocal microscopy in telemedicine settings : double reader concordance evaluation of 316 cases

Solitary pink lesions in differential diagnosis with hypopigmented/amelanotic melanoma present a diagnostic challenge in daily practice and are regularly referred for second expert opinion. Reflectance confocal microscopy (RCM) has been shown to improve diagnostic accuracy of dermoscopically equivocal pink lesions. No studies have been performed to evaluate the effect of adding a second expert reader and automatic removal of lesions with discordant management recommendations and its potential effect on diagnostic sensitivity and final management of these lesions in retrospective or telemedicine settings.To improve diagnostic accuracy and reduce potential mismanagement of dermoscopically equivocal pink cutaneous lesions by implementing double reader concordance evaluation of RCM images.316 dermoscopically equivocal pink lesions with dermoscopy-RCM image sets were evaluated retrospectively. Accuracy of three readers was evaluated by single reader evaluation of dermoscopy only and dermoscopy-RCM image sets and finally by double reader evaluation of dermoscopy-RCM image sets. Lesions with discordant diagnosis between two readers were automatically recommended for excision.Dermoscopy only evaluation resulted in an overall sensitivity of 95.9% and specificity of 33.6%, with 1 of 12 amelanotic melanomas mismanaged. Dermoscopy-RCM image set single reader evaluation resulted in an overall sensitivity of 93.9% and overall specificity of 54.2%, with 1 of 12 melanomas mismanaged. Dermoscopy-RCM image set double reader concordance evaluation resulted in an overall sensitivity of 98.3% and specificity of 42.7%, with no amelanotic melanoma mismanagement.Evaluation of dermoscopy-RCM image sets of equivocal pink lesions by a single reader in telemedicine settings is limited by the potential for misdiagnosis of dangerous malignant lesions. Double reader concordance evaluation with automatic referral of lesions for removal in the case of discordant diagnosis improves the diagnostic sensitivity in this subset of lesions and reduce potential misdiagnosis in settings where a second expert opinion may be employed

Conservative Newswork: A Report on the Values and Practices of Online Journalists on the Right

Renewed popularity and commercial viability of openly partisan media in the United States can be traced back to the rise of conservative talk radio in the late 1980s, but the expansion of partisan news outlets has accelerated most rapidly online. This expansion has coincided with debates within many digital newsrooms. Should the ideals journalists adopted in the 20th century be preserved in a digital news landscape? Or must today’s news workers forge new relationships with their publics and find alternatives to traditional notions of journalistic objectivity, fairness, and balance? Despite the centrality of these questions to digital newsrooms, little research on “innovation in journalism” or the “future of news” has explicitly addressed how digital journalists and editors in partisan news organizations are rethinking norms. In particular, researchers have almost entirely ignored news workers in conservative-leaning outlets. We interviewed 22 journalists and editors at 14 online conservative news organizations about what guides their news judgments, how they engage audiences, and how they think conservative news outlets should operate. Our findings, since they are largely based on this interview data, offer insights into the aspirational ideals of our participants and their newsrooms

Philanthropy-Supported Journalism

There is a widespread perception that the market is failing to ensure the provision of high quality, impactful journalism, especially investigative work and in‐depth coverage of governmental and international affairs. One answer to that market failing has been the development of philanthropy‐supported journalism. Some writers see this as a potentially important, if partial, solution to journalism\u27s problems, strengthening the editorial focus on creating social and policy impacts. Others have expressed concern that philanthropic support draws journalists toward elite orientations, with both funders themselves and their desired audiences representing the socioeconomic upper tiers

Plausible role of estrogens in pathogenesis, progression and therapy of lung cancer

Malignant neoplasms are among the most common diseases and are responsible for the majority of deaths in the developed world. In contrast to men, available data show a clear upward trend in the incidence of lung cancer in women, making it almost as prevalent as breast cancer. Women might be more susceptible to the carcinogenic effect of tobacco smoke than men. Furthermore, available data indicate a much more frequent mutation of the tumor suppressor genep53 in non-small cell lung cancer (NSCLC) female patients compared to males. Another important factor, however, might lie in the female sex hormones, whose mitogenic or carcinogenic effect is well known. Epidemiologic data show a correlation between hormone replacement therapy (HRT) or oral contraceptives (OCs), and increased mortality rates due to the increased incidence of malignant tumors, including lung cancer. Interestingly, two types of estrogen receptors have been detected in lung cancer cells: ERα and ERβ. The presence of ERα has been detected in tissues and non-small-cell lung carcinoma (NSCLC) cell lines. In contrast, overexpression of ERβ is a prognostic marker in NSCLC. Herein, we summarize the current knowledge on the role of estrogens in the etiopathogenesis of lung cancer, as well as biological, hormonal and genetic sex-related differences in this neoplasm

Obesidad sarcopénica y disfuncionalidad en población con síndrome metabólico

The sarcopenic obesity (SO) is a new category of obesity, specially related with the elderly population, characterized by high fat mass and low muscle mass. It is intended to analyze the relation between SO and disability, in a population older than 55 years with overweight or obesity and metabolic syndrome.  For the body composition analyzes we used DXA in 303 patients, and for the assessment of disability we used 5 physical validated test in a subsample of 53 patients. We constructed a global physical capacity score and we studied the association with SO phenotypes, defined using the skeletal muscle mass and the total body fat.  It has not been found significant associations between SO and disability in our sample. Studies with a large sample are needed. La obesidad sarcopénica (OS) es una nueva categoría de obesidad, especialmente asociada a población envejecida, caracterizada por una elevada masa grasa y baja masa muscular. Se pretende analizar la relación entre la OS y la disfuncionalidad en una población mayor de 55 años con sobrepeso u obesidad y síndrome metabólico.Para el análisis de la composición corporal se ha utilizado la absorciometria dual de rayos X (DXA) en un total de 303 participantes, y para la valoración de la disfuncionalidad se han realizado 5 test físicos validados en una submuestra de 53 participantes. Se ha realizado una puntuación global de capacidad física y se ha mirado su asociación con los fenotipos de OS, definidos en función de la masa muscular esquelética y la grasa corporal total. No se observó una asociación significativa entre la OS y la disfuncionalidad en esta muestra. Son necesarios estudios con mayor tamaño muestral

The Tulczyjew triple for classical fields

The geometrical structure known as the Tulczyjew triple has proved to be very useful in describing mechanical systems, even those with singular Lagrangians or subject to constraints. Starting from basic concepts of variational calculus, we construct the Tulczyjew triple for first-order Field Theory. The important feature of our approach is that we do not postulate {\it ad hoc} the ingredients of the theory, but obtain them as unavoidable consequences of the variational calculus. This picture of Field Theory is covariant and complete, containing not only the Lagrangian formalism and Euler-Lagrange equations but also the phase space, the phase dynamics and the Hamiltonian formalism. Since the configuration space turns out to be an affine bundle, we have to use affine geometry, in particular the notion of the affine duality. In our formulation, the two maps $\alpha$ and $\beta$ which constitute the Tulczyjew triple are morphisms of double structures of affine-vector bundles. We discuss also the Legendre transformation, i.e. the transition between the Lagrangian and the Hamiltonian formulation of the first-order field theor

Nieoperowana tetralogia Fallota u 67-letniego mężczyzny

Tetralogy of Fallot is the most common cyanotic congenital heart disease. Total surgical correction of this defect during infancyallows for long-term survival in most of the patients. The long-term prognosis for untreated tetralogy of Fallot is poor and patients who have not undergone total surgical repair rarely live to old age. We present a case of 67-year-old man with not corrected tetralogy of Fallot diagnosed at the age of 44 years without typical clinical symptoms