Coccidiomycosis infection of the patella mimicking a neoplasm - two case reports.

BackgroundCoccidioidomycosis is an endemic fungal infection in the southwestern of United States. Most infections are asymptomatic or manifest with mild respiratory complaints. Rare cases may cause extrapulmonary or disseminated disease. We report two cases of knee involvement that presented as isolated lytic lesions of the patella mimicking neoplasms.Case presentationThe first case, a 27 year-old immunocompetent male had progressive left anterior knee pain for four months. The second case was a 78 year-old male had left anterior knee pain for three months. Both of them had visited general physicians without conclusive diagnosis. A low attenuation lytic lesion in the patella was demonstrated on their image studies, and the initial radiologist's interpretation was suggestive of a primary bony neoplasm. The patients were referred for orthopaedic oncology consultation. The first case had a past episode of pulmonary coccioidomycosis 2 years prior, while the second case had no previous coccioidal infection history but lived in an endemic area, the central valley of California. Surgical biopsy was performed in both cases due to diagnostic uncertainty. Final pathologic examination revealed large thick walled spherules filled with endospores establishing the final diagnosis of extrapulmonary coccidioidomycosis.ConclusionsThough history and laboratory findings are supportive, definitive diagnosis still depends on growth in culture or endospores identified on histology. We suggest that orthopaedic surgeons and radiologists keep in mind that chronic fungal infections can mimic osseous neoplasm by imaging

Characterization of patients with idiopathic normal pressure hydrocephalus using natural language processing within an electronic healthcare record system

OBJECTIVE: Idiopathic normal pressure hydrocephalus (iNPH) is an underdiagnosed, progressive, and disabling condition. Early treatment is associated with better outcomes and improved quality of life. In this paper, the authors aimed to identify features associated with patients with iNPH using natural language processing (NLP) to characterize this cohort, with the intention to later target the development of artificial intelligence–driven tools for early detection. / METHODS: The electronic health records of patients with shunt-responsive iNPH were retrospectively reviewed using an NLP algorithm. Participants were selected from a prospectively maintained single-center database of patients undergoing CSF diversion for probable iNPH (March 2008–July 2020). Analysis was conducted on preoperative health records including clinic letters, referrals, and radiology reports accessed through CogStack. Clinical features were extracted from these records as SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) concepts using a named entity recognition machine learning model. In the first phase, a base model was generated using unsupervised training on 1 million electronic health records and supervised training with 500 double-annotated documents. The model was fine-tuned to improve accuracy using 300 records from patients with iNPH double annotated by two blinded assessors. Thematic analysis of the concepts identified by the machine learning algorithm was performed, and the frequency and timing of terms were analyzed to describe this patient group. / RESULTS: In total, 293 eligible patients responsive to CSF diversion were identified. The median age at CSF diversion was 75 years, with a male predominance (69% male). The algorithm performed with a high degree of precision and recall (F1 score 0.92). Thematic analysis revealed the most frequently documented symptoms related to mobility, cognitive impairment, and falls or balance. The most frequent comorbidities were related to cardiovascular and hematological problems. / CONCLUSIONS: This model demonstrates accurate, automated recognition of iNPH features from medical records. Opportunities for translation include detecting patients with undiagnosed iNPH from primary care records, with the aim to ultimately improve outcomes for these patients through artificial intelligence–driven early detection of iNPH and prompt treatment

Design and Implementation of a Facility for Discovering New Scintillator Materials

We describe the design and operation of a high-throughput facility for synthesizing thousands of inorganic crystalline samples per year and evaluating them as potential scintillation detector materials. This facility includes a robotic dispenser, arrays of automated furnaces, a dual-beam X-ray generator for diffractometery and luminescence spectroscopy, a pulsed X-ray generator for time response measurements, computer-controlled sample changers, an optical spectrometer, and a network-accessible database management system that captures all synthesis and measurement data

Uranium Hydride Nucleation Kinetics: Effects of Oxide Thickness and Vacuum Outgassing

Many factors such as impurities in the oxide and metal, microstructure, gas impurities, and oxide thickness may influence the rate and location of the nucleation of hydride on uranium. This work has concentrated on isolating one of these variables, the oxide thickness, and measuring the effect of the oxide thickness on uranium hydride nucleation. Uranium samples, all from the same lot, were prepared with different oxide thicknesses. The oxide thickness was measured using Rutherford Backscattering Spectroscopy. Oxidized uranium samples were then exposed to ultra-high purity hydrogen gas under constant volume conditions. Decreases in pressure indicated hydrogen uptake by the sample. The time for hydride nucleation--as well as the maximum hydriding rate--was then calculated from the measured decreases in pressure. The time to nucleate a hydride was found to increase whereas the maximum hydriding rate was found to decrease with increasing oxide thickness. The density of hydride pits also decreased with increasing oxide thickness. The observed results support the argument that the nucleation of hydride is controlled somewhat by diffusion of hydrogen through the oxide layer. Vacuum outgassing of samples, thereby removing the oxide impurities and keeping the oxide thickness constant, dramatically decreased the nucleation time and increased the maximum hydriding rate. Again, this is consistent with hydrogen diffusion through the oxide controlling the nucleation of hydride. Impurities in the oxide layer can decrease the diffusivity of hydrogen and therefore delay the nucleation of uranium hydride

Performing under pressure in private: activation of self-focus traits

Self-focus and self-presentation traits have been found to predict performance under pressure. The interactionist principle of trait activation indicates that situational demands encourage different traits to be relevant to performance in high-pressure situations. Thus, the purpose of the current study was to investigate the relationship of self-focus and self-presentation traits with performance in a private high-pressure setting. Because the private high-pressure situation offered motivational incentives but only minimal self-presentation cues, only a self-focus trait (private self-consciousness), but not self-presentation traits (public self-consciousness and narcissism), was hypothesized to predict performance under pressure in a private setting. After completing personality questionnaires, future physical education university students (N = 59) with experience in sport competitions performed eight throws at a target in low-pressure and high-pressure conditions. The conditions were identical with the exception that the high-pressure condition involved a monetary incentive and a cover story. Participants' state anxiety increased from low to high pressure. Neither self-focus nor self-presentation traits predicted performance under low pressure. Only the self-focus trait, but not self-presentation traits, negatively contributed to the prediction of high-pressure performance. Hence, findings support the applicability of the trait activation principle and underline that the situational demands of private high-pressure situations activate self-focus personality traits

Testing an interactionist perspective on the relationship between personality traits and performance under public pressure

Objectives: The interactionist principle of trait activation [Tett & Gutermann (2000). Situation trait relevance, trait expression, and cross-situational consistency: testing a principle of trait activation. Journal of Research in Personality, 34, 397-423.] explains human behavior through the stimulation of traits by trait-relevant situational cues (i.e., situation-trait relevance). In applied (real-world) high-pressure situations, audiences provide the situational demand of public evaluation. Therefore, traits that are related to public evaluation are appraised as situation-relevant. The purpose of the current study was to test if situation-relevant traits (i.e., narcissism, public self-consciousness) predict performance in applied high-pressure situations, while situation-irrelevant traits (i.e., private self-consciousness) do not contribute to the performance explanation

Activation of self-focus and self-presentation traits under private, mixed, and public pressure

Trait activation theorists suggest that situational demands activate traits in (pressure) situations. In a comparison of situational demands of private (monetary incentive, cover story), mixed (monetary incentive, small audience), and public (large audience, video taping) high-pressure situations, we hypothesized that situational demands of private and mixed high-pressure conditions would activate self-focus traits and those of a public high-pressure condition would activate self-presentation traits. Female handball players (N = 120) completed personality questionnaires and then performed a throwing task in a low-pressure condition and one of three high-pressure conditions (n = 40). Increased anxiety levels from low to high pressure indicated successful pressure manipulations. A self-focus trait negatively predicted performance in private and mixed high-pressure conditions, and self-presentation traits positively predicted performance in the public high-pressure condition. Thus, pressure situations differed in their trait-activating situational demands. Experimental research investigating the trait-performance relationship should therefore use simulations of real competitions over laboratory-based scenarios

Coccidiomycosis infection of the patella mimicking a neoplasm - two case reports.

BackgroundCoccidioidomycosis is an endemic fungal infection in the southwestern of United States. Most infections are asymptomatic or manifest with mild respiratory complaints. Rare cases may cause extrapulmonary or disseminated disease. We report two cases of knee involvement that presented as isolated lytic lesions of the patella mimicking neoplasms.Case presentationThe first case, a 27 year-old immunocompetent male had progressive left anterior knee pain for four months. The second case was a 78 year-old male had left anterior knee pain for three months. Both of them had visited general physicians without conclusive diagnosis. A low attenuation lytic lesion in the patella was demonstrated on their image studies, and the initial radiologist's interpretation was suggestive of a primary bony neoplasm. The patients were referred for orthopaedic oncology consultation. The first case had a past episode of pulmonary coccioidomycosis 2 years prior, while the second case had no previous coccioidal infection history but lived in an endemic area, the central valley of California. Surgical biopsy was performed in both cases due to diagnostic uncertainty. Final pathologic examination revealed large thick walled spherules filled with endospores establishing the final diagnosis of extrapulmonary coccidioidomycosis.ConclusionsThough history and laboratory findings are supportive, definitive diagnosis still depends on growth in culture or endospores identified on histology. We suggest that orthopaedic surgeons and radiologists keep in mind that chronic fungal infections can mimic osseous neoplasm by imaging

Weightbearing computed tomography of the foot and ankle : emerging technology topical review

In the last decade, cone-beam computed tomography technology with improved designs allowing flexible gantry movements has allowed both supine and standing weight-bearing imaging of the lower extremity. There is an increasing amount of literature describing the use of weightbearing computed tomography in patients with foot and ankle disorders. To date, there is no review article summarizing this imaging modality in the foot and ankle. Therefore, we performed a systematic literature review of relevant clinical studies targeting the use of weightbearing computed tomography in diagnosis of patients with foot and ankle disorders. Furthermore, this review aims to offer insight to those with interest in considering possible future research opportunities with use of this technology. Level of Evidence: Level V, expert opinion