Aspergillus nodules; another presentation of Chronic Pulmonary Aspergillosis

BACKGROUND: There are a number of different manifestations of pulmonary aspergillosis. This study aims to review the radiology, presentation, and histological features of lung nodules caused by Aspergillus spp. METHODS: Patients were identified from a cohort attending our specialist Chronic Pulmonary Aspergillosis clinic. Patients with cavitating lung lesions, with or without fibrosis and those with aspergillomas or a diagnosis of invasive aspergillosis were excluded. Demographic, laboratory, and clinical data and radiologic findings were recorded. RESULTS: Thirty-three patients with pulmonary nodules and diagnostic features of aspergillosis (histology and/or laboratory findings) were identified. Eighteen (54.5 %) were male, mean age 58 years (range 27–80 years). 19 (57.6 %) were former or current smokers. The median Charleston co-morbidity index was 3 (range 0–7). All complained of a least one of; dyspnoea, cough, haemoptysis, or weight loss. None reported fever. Ten patients (31 %) did not have an elevated Aspergillus IgG, and only 4 patients had elevated Aspergillus precipitins. Twelve patients (36 %) had a single nodule, six patients (18 %) had between 2 and 5 nodules, 2 (6 %) between 6 and 10 nodules and 13 (39 %) had more than 10 nodules. The mean size of the nodules was 21 mm, with a maximum size ranging between 5–50 mm. No nodules had cavitation radiographically. The upper lobes were most commonly involved. Histology was available for 18 patients and showed evidence of granulation tissue, fibrosis, and visualisation of fungal hyphae. CONCLUSION: Pulmonary nodules are a less common manifestation of aspergillosis in immunocompetent patients. Distinguishing these nodules from other lung pathology may be difficult on CT findings alone

Genetic programming and serial processing for time series classification

This work describes an approach devised by the authors for time series classification. In our approach genetic programming is used in combination with a serial processing of data, where the last output is the result of the classification. The use of genetic programming for classification, although still a field where more research in needed, is not new. However, the application of genetic programming to classification tasks is normally done by considering the input data as a feature vector. That is, to the best of our knowledge, there are not examples in the genetic programming literature of approaches where the time series data are processed serially and the last output is considered as the classification result. The serial processing approach presented here fills a gap in the existing literature. This approach was tested in three different problems. Two of them are real world problems whose data were gathered for online or conference competitions. As there are published results of these two problems this gives us the chance to compare the performance of our approach against top performing methods. The serial processing of data in combination with genetic programming obtained competitive results in both competitions, showing its potential for solving time series classification problems. The main advantage of our serial processing approach is that it can easily handle very large datasets.Alfaro Cid, E.; Sharman, KC.; Esparcia Alcázar, AI. (2014). Genetic programming and serial processing for time series classification. Evolutionary Computation. 22(2):265-285. doi:10.1162/EVCO_a_00110S265285222Adeodato, P. J. L., Arnaud, A. L., Vasconcelos, G. C., Cunha, R. C. L. V., Gurgel, T. B., & Monteiro, D. S. M. P. (2009). The role of temporal feature extraction and bagging of MLP neural networks for solving the WCCI 2008 Ford Classification Challenge. 2009 International Joint Conference on Neural Networks. doi:10.1109/ijcnn.2009.5178965Alfaro-Cid, E., Merelo, J. J., de Vega, F. F., Esparcia-Alcázar, A. I., & Sharman, K. (2010). Bloat Control Operators and Diversity in Genetic Programming: A Comparative Study. Evolutionary Computation, 18(2), 305-332. doi:10.1162/evco.2010.18.2.18206Alfaro-Cid, E., Sharman, K., & Esparcia-Alcazar, A. I. (s. f.). Evolving a Learning Machine by Genetic Programming. 2006 IEEE International Conference on Evolutionary Computation. doi:10.1109/cec.2006.1688316Arenas, M. G., Collet, P., Eiben, A. E., Jelasity, M., Merelo, J. J., Paechter, B., … Schoenauer, M. (2002). A Framework for Distributed Evolutionary Algorithms. Lecture Notes in Computer Science, 665-675. doi:10.1007/3-540-45712-7_64Blankertz, B., Muller, K.-R., Curio, G., Vaughan, T. M., Schalk, G., Wolpaw, J. R., … Birbaumer, N. (2004). The BCI Competition 2003: Progress and Perspectives in Detection and Discrimination of EEG Single Trials. IEEE Transactions on Biomedical Engineering, 51(6), 1044-1051. doi:10.1109/tbme.2004.826692Borrelli, A., De Falco, I., Della Cioppa, A., Nicodemi, M., & Trautteur, G. (2006). Performance of genetic programming to extract the trend in noisy data series. Physica A: Statistical Mechanics and its Applications, 370(1), 104-108. doi:10.1016/j.physa.2006.04.025Eads, D. R., Hill, D., Davis, S., Perkins, S. J., Ma, J., Porter, R. B., & Theiler, J. P. (2002). Genetic Algorithms and Support Vector Machines for Time Series Classification. Applications and Science of Neural Networks, Fuzzy Systems, and Evolutionary Computation V. doi:10.1117/12.453526Eggermont, J., Eiben, A. E., & van Hemert, J. I. (1999). A Comparison of Genetic Programming Variants for Data Classification. Lecture Notes in Computer Science, 281-290. doi:10.1007/3-540-48412-4_24Holladay, K. L., & Robbins, K. A. (2007). Evolution of Signal Processing Algorithms using Vector Based Genetic Programming. 2007 15th International Conference on Digital Signal Processing. doi:10.1109/icdsp.2007.4288629Kaboudan, M. A. (2000). Computational Economics, 16(3), 207-236. doi:10.1023/a:1008768404046Kishore, J. K., Patnaik, L. M., Mani, V., & Agrawal, V. K. (2000). Application of genetic programming for multicategory pattern classification. IEEE Transactions on Evolutionary Computation, 4(3), 242-258. doi:10.1109/4235.873235Kishore, J. K., Patnaik, L. M., Mani, V., & Agrawal, V. K. (2001). Genetic programming based pattern classification with feature space partitioning. Information Sciences, 131(1-4), 65-86. doi:10.1016/s0020-0255(00)00081-5Langdon, W. B., McKay, R. I., & Spector, L. (2010). Genetic Programming. International Series in Operations Research & Management Science, 185-225. doi:10.1007/978-1-4419-1665-5_7Yi Liu, & Khoshgoftaar, T. (s. f.). Reducing overfitting in genetic programming models for software quality classification. Eighth IEEE International Symposium on High Assurance Systems Engineering, 2004. Proceedings. doi:10.1109/hase.2004.1281730Luke, S. (2000). Two fast tree-creation algorithms for genetic programming. IEEE Transactions on Evolutionary Computation, 4(3), 274-283. doi:10.1109/4235.873237Luke, S., & Panait, L. (2006). A Comparison of Bloat Control Methods for Genetic Programming. Evolutionary Computation, 14(3), 309-344. doi:10.1162/evco.2006.14.3.309Mensh, B. D., Werfel, J., & Seung, H. S. (2004). BCI Competition 2003—Data Set Ia: Combining Gamma-Band Power With Slow Cortical Potentials to Improve Single-Trial Classification of Electroencephalographic Signals. IEEE Transactions on Biomedical Engineering, 51(6), 1052-1056. doi:10.1109/tbme.2004.827081Muni, D. P., Pal, N. R., & Das, J. (2006). Genetic programming for simultaneous feature selection and classifier design. IEEE Transactions on Systems, Man and Cybernetics, Part B (Cybernetics), 36(1), 106-117. doi:10.1109/tsmcb.2005.854499Oltean, M., & Dioşan, L. (2009). An autonomous GP-based system for regression and classification problems. Applied Soft Computing, 9(1), 49-60. doi:10.1016/j.asoc.2008.03.008Otero, F. E. B., Silva, M. M. S., Freitas, A. A., & Nievola, J. C. (2003). Genetic Programming for Attribute Construction in Data Mining. Genetic Programming, 384-393. doi:10.1007/3-540-36599-0_36Poli, R. (2010). Genetic programming theory. Proceedings of the 12th annual conference comp on Genetic and evolutionary computation - GECCO ’10. doi:10.1145/1830761.1830905Tsakonas, A. (2006). A comparison of classification accuracy of four genetic programming-evolved intelligent structures. Information Sciences, 176(6), 691-724. doi:10.1016/j.ins.2005.03.012Wolpaw, J. R., Birbaumer, N., Heetderks, W. J., McFarland, D. J., Peckham, P. H., Schalk, G., … Vaughan, T. M. (2000). Brain-computer interface technology: a review of the first international meeting. IEEE Transactions on Rehabilitation Engineering, 8(2), 164-173. doi:10.1109/tre.2000.84780

Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals.

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18-94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was -10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (-8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients