Diagnostic error - Mini review and case report of patient death resulting from delayed diagnosis of acute prostatitis

A 57-year old man presenting with frequent and painful urination and negative initial urinalysis for infection was given a diagnosis of benign prostate hypertrophy, which was never revised by subsequent providers. Instead, the patient continued to be treated for urinary retention and pain. A potent NSAID, Toradol (ketorolac), was included in his regimen. One day prior to his demise, the patient was diagnosed with prostatic abscess and admitted for treatment with intravenous antibiotics. However the patient died on hospital day one from massive GI bleeding. Autopsy revealed an underlying peptic ulcer. This case shines a light on diagnostic error: missed, wrong, or delayed diagnosis. It also uncovers the multifaceted nature of diagnostic errors and highlights the importance of system- related interventions, in particular, better communication between health care providers. Based on malpractice claims data, diagnostic error is the most frequent and costly of all medical mistakes, yet it remains one of the least studied areas of patient safety. While the field has some barriers to study, many opportunities exist for impact in the field of diagnostic errors

Social media policies at US medical schools

Background/Purpose: Today's medical students are learning in a social media era in which patient confidentiality is at risk yet schools’ social media policies have not been elucidated. The purpose of this study is to describe the presence of medical schools on top social media sites and to identify whether student policies for these schools explicitly address social media use. Method: Websites of all 132 accredited US medical schools were independently assessed by two investigators for their presence (as of March 31, 2010) on the most common social networking and microblogging sites (Facebook and Twitter) and their publicly available policies addressing online social networking. Key features from these policies are described. Results: 100% (n=132) of US medical schools had websites and 95.45% (126/132) had any Facebook presence. 25.76% (34/132) had official medical school pages, 71.21% (94/132) had student groups, and 54.55% (72/132) had alumni groups on Facebook. 10.6% of medical schools (14/132) had Twitter accounts. 128 of 132 medical schools (96.97%) had student guidelines or policies publicly available online. 13 of these 128 schools (10.16%) had guidelines/policies explicitly mentioning social media. 38.46% (5/13) of these guidelines included statements that defined what is forbidden, inappropriate, or impermissible under any circumstances, or mentioned strongly discouraged online behaviors. 53.85% (7/13) encouraged thoughtful and responsible social media use. Conclusions: Medical schools and their students are using social media. Almost all US medical schools have a Facebook presence, yet most do not have policies addressing student online social networking behavior. While social media use rises, policy informing appropriate conduct in medical schools lags behind. Established policies at some medical schools can provide a blueprint for others to adopt and adapt

Pathological Narcissism in Adolescents: Relationships with Childhood Maltreatment and Internalizing and Externalizing Difficulties

Background: There are significant gaps in our understanding of vulnerable and grandiose narcissism in adolescents and whether it is associated with psychosocial difficulties as well as risk factors such as child maltreatment. Objective: The aim of this study was to examine vulnerable and grandiose narcissism in adolescents and young adults. Method: 570 participants (ages 14-21) from the community completed an online survey. Vulnerable and grandiose narcissism were assessed with the Pathological Narcissism Inventory, while psycho-social difficulties were assessed with the Child Behaviour Checklist and maltreatment with the Childhood Experiences of Care and Abuse Questionnaire. Results: Gender-specific age trends were identified, with narcissism appearing to decrease with age for females, while increasing for males into early adulthood. For females, vulnerable and grandiose narcissism was associated with maltreatment and partially mediated the relationship between abuse and neglect and internalizing and externalizing difficulties. Conclusion: These findings underscore the importance of considering the relationship between childhood maltreatment experiences and suggest that the relationship between such experiences and adolescent psychosocial difficulties may be partially accounted for by the negative impact that maltreatment has on narcissism

The Antarctic Coastal Current in the Bellingshausen Sea

The ice shelves of the West Antarctic Ice Sheet experience basal melting induced by underlying warm, salty Circumpolar Deep Water. Basal meltwater, along with runoff from ice sheets, supplies fresh buoyant water to a circulation feature near the coast, the Antarctic Coastal Current (AACC). The formation, structure, and coherence of the AACC has been well documented along the West Antarctic Peninsula (WAP). Observations from instrumented seals collected in the Bellingshausen Sea offer extensive hydrographic coverage throughout the year, providing evidence of the continuation of the westward flowing AACC from the WAP towards the Amundsen Sea. The observations reported here demonstrate that the coastal boundary current enters the eastern Bellingshausen Sea from the WAP and flows westward along the face of multiple ice shelves, including the westernmost Abbot Ice Shelf. The presence of the AACC in the western Bellingshausen Sea has implications for the export of water properties into the eastern Amundsen Sea, which we suggest may occur through multiple pathways, either along the coast or along the continental shelf break. The temperature, salinity, and density structure of the current indicates an increase in baroclinic transport as the AACC flows from the east to the west, and as it entrains meltwater from the ice shelves in the Bellingshausen Sea. The AACC acts as a mechanism to transport meltwater out of the Bellingshausen Sea and into the Amundsen and Ross seas, with the potential to impact, respectively, basal melt rates and bottom water formation in these regions

Optimising observing strategies for monitoring animals using drone-mounted thermal infrared cameras

The proliferation of relatively affordable off-the-shelf drones offers great opportunities for wildlife monitoring and conservation. Similarly the recent reduction in cost of thermal infrared cameras also offers new promise in this field, as they have the advantage over conventional RGB cameras of being able to distinguish animals based on their body heat and being able to detect animals at night. However, the use of drone-mounted thermal infrared cameras comes with several technical challenges. In this paper we address some of these issues, namely thermal contrast problems due to heat from the ground, absorption and emission of thermal infrared radiation by the atmosphere, obscuration by vegetation, and optimizing the flying height of drones for a best balance between covering a large area and being able to accurately image and identify animals of interest. We demonstrate the application of these methods with a case study using field data, and make the first ever detection of the critically endangered riverine rabbit (Bunolagus monticularis) in thermal infrared data. We provide a web-tool so that the community can easily apply these techniques to other studies (http://www.astro.ljmu.ac.uk/~aricburk/uav_calc/)

Direct Binding of pRb/E2F-2 to GATA-1 Regulates Maturation and Terminal Cell Division during Erythropoiesis

Cell differentiation is often coupled with cell cycle arrest. Here, we show that direct binding of the erythroid transcription factor GATA-1 to the retinoblastoma protein and the pRb/E2F transcription factor complex is critical for red blood cell formation

Factors that contribute to social media influence within an Internal Medicine Twitter learning community

Medical societies, faculty, and trainees use Twitter to learn from and educate other social media users. These social media communities bring together individuals with various levels of experience. It is not known if experienced individuals are also the most influential members. We hypothesize that participants with the greatest experience would be the most influential members of a Twitter community. We analyzed the 2013 Association of Program Directors in Internal Medicine Twitter community. We measured the number of tweets authored by each participant and the number of amplified tweets (re-tweets). We developed a multivariate linear regression model to identify any relationship to social media influence, measured by the PageRank. Faculty (from academic institutions) comprised 19% of the 132 participants in the learning community (p < 0.0001). Faculty authored 49% of all 867 tweets (p < 0.0001). Their tweets were the most likely to be amplified (52%, p < 0.01). Faculty had the greatest influence amongst all participants (mean 1.99, p < 0.0001). Being a faculty member had no predictive effect on influence (β = 0.068, p = 0.6). The only factors that predicted influence (higher PageRank) were the number of tweets authored (p < 0.0001) and number of tweets amplified (p < 0.0001) The status of “faculty member� did not confer a greater influence. Any participant who was able to author the greatest number of tweets or have more of his/her tweets amplified could wield a greater influence on the participants, regardless of his/her authority

Automated Analysis of Cryptococcal Macrophage Parasitism Using GFP-Tagged Cryptococci

The human fungal pathogens Cryptococcus neoformans and C. gattii cause life-threatening infections of the central nervous system. One of the major characteristics of cryptococcal disease is the ability of the pathogen to parasitise upon phagocytic immune effector cells, a phenomenon that correlates strongly with virulence in rodent models of infection. Despite the importance of phagocyte/Cryptococcus interactions to disease progression, current methods for assaying virulence in the acrophage system are both time consuming and low throughput. Here, we introduce the first stable and fully characterised GFP–expressing derivatives of two widely used cryptococcal strains: C. neoformans serotype A type strain H99 and C. gattii serotype B type strain R265. Both strains show unaltered responses to environmental and host stress conditions and no deficiency in virulence in the macrophage model system. In addition, we report the development of a method to effectively and rapidly investigate macrophage parasitism by flow cytometry, a technique that preserves the accuracy of current approaches but offers a four-fold improvement in speed

Detailed spectral and morphological analysis of the shell type SNR RCW 86

Aims: We aim for an understanding of the morphological and spectral properties of the supernova remnant RCW~86 and for insights into the production mechanism leading to the RCW~86 very high-energy gamma-ray emission. Methods: We analyzed High Energy Spectroscopic System data that had increased sensitivity compared to the observations presented in the RCW~86 H.E.S.S. discovery publication. Studies of the morphological correlation between the 0.5-1~keV X-ray band, the 2-5~keV X-ray band, radio, and gamma-ray emissions have been performed as well as broadband modeling of the spectral energy distribution with two different emission models. Results:We present the first conclusive evidence that the TeV gamma-ray emission region is shell-like based on our morphological studies. The comparison with 2-5~keV X-ray data reveals a correlation with the 0.4-50~TeV gamma-ray emission.The spectrum of RCW~86 is best described by a power law with an exponential cutoff at $E_{cut}=(3.5\pm 1.2_{stat})$ TeV and a spectral index of $\Gamma$~$1.6\pm 0.2$. A static leptonic one-zone model adequately describes the measured spectral energy distribution of RCW~86, with the resultant total kinetic energy of the electrons above 1 GeV being equivalent to $\sim$0.1\% of the initial kinetic energy of a Type I a supernova explosion. When using a hadronic model, a magnetic field of $B$~100$\mu$G is needed to represent the measured data. Although this is comparable to formerly published estimates, a standard E$^{-2}$ spectrum for the proton distribution cannot describe the gamma-ray data. Instead, a spectral index of $\Gamma_p$~1.7 would be required, which implies that ~$7\times 10^{49}/n_{cm^{-3}}$erg has been transferred into high-energy protons with the effective density $n_{cm^{-3}}=n/ 1$ cm^-3. This is about 10\% of the kinetic energy of a typical Type Ia supernova under the assumption of a density of 1~cm^-3.Comment: accepted for publication by A&