Consumer preferences for scanning modality to diagnose focal liver lesions

Objectives: Differences in the process of using liver imaging technologies might be important to patients. This study aimed to investigate preferences for scanning modalities used in diagnosing focal liver lesions. Methods: A discrete choice experiment was administered to 504 adults aged 25 years. Respondents made repeated choices between two hypothetical scans, described according to waiting time for scan and results, procedure type, the chance of minor side-effects, and whether further scanning procedures were likely to be required. Choice data were analyzed using mixed-logit models with respondent characteristics used to explain preference heterogeneity. Results: Respondents preferred shorter waiting times, the procedure to be undertaken with a handheld scanner on a couch instead of within a body scanner, no side-effects, and no follow–up scans (p .01). The average respondent was willing to wait an additional 2 weeks for the scan if it resulted in avoiding side-effects, 1.5 weeks to avoid further procedures or to be told the results immediately, and 1 week to have the scan performed on a couch with a handheld scanner. However, substantial heterogeneity was observed in the strength of preference for desirable imaging characteristics. Conclusions: An average individual belonging to a general population sub–group most likely to require imaging to characterize focal liver lesions in the United Kingdom would prefer contrast–enhanced ultrasound over magnetic resonance imaging or computed tomography. Insights into the patient perspective around differential characteristics of imaging modalities have the potential to be used to guide recommendations around the use of these technologies

Explicit Delegation Using Configurable Cookies

Password sharing is widely used as a means of delegating access, but it is open to abuse and relies heavily on trust in the person being delegated to. We present a protocol for delegating access to websites as a natural extension to the Pico protocol. Through this we explore the potential characteristics of delegation mechanisms and how they interact. We conclude that security for the delegator against misbehaviour of the delegatee can only be achieved with the cooperation of the entity offering the service being delegated. To achieve this in our protocol we propose configurable cookies that capture delegated permissions.We are grateful to the European Research Council for funding this research through grant StG 307224 (Pico)

Is the Birthing Unit Design Spatial Evaluation Tool valid for diverse groups?

© 2018 Australian College of Midwives Background: Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care. Aim: To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds. Methods: Participants completed a Likert-scale survey to rate the relevance of The Birth Unit Design Spatial Evaluation Tool's 69 items. Item-level content validity and Survey-level validity indices were calculated, with the achievement of validity set at >0.78 and >0.9 respectively. Results: Item-level content validity was achieved on 37 items for birth unit midwives (n = 10); 35 items for Aboriginal or Torres Strait Islander women (n = 6); 33 items for women who had anticipated a vaginal birth after a caesarean (n = 6); and 28 items for women from refugee or culturally and linguistically diverse backgrounds (n = 20). Survey-level content validity was not demonstrated in any group. Conclusion: Birth environment design remains significant to women and midwives, but the Birth Unit Design Spatial Evaluation Tool was not validated for these participant groups. Further research is needed, using innovative methodologies to address the subconscious level on which environment may influence experience and to disentangle the influence of confounding factors

Use of expert knowledge in evaluating costs and benefits of alternative service provisions: A case study

Objectives: A treatment pathway model was developed to examine the costs and benefits of the current bowel cancer service in England and to evaluate potential alternatives in service provision. To use the pathway model, various parameters and probability distributions had to be specified. They could not all be determined from empirical evidence and, instead, expert opinion was elicited in the form of statistical quantities that gave the required information. The purpose of this study is to describe the procedures used to quantify expert opinion and note examples of good practice contained in the case study. Methods: The required information was identified and preparatory discussion with four experts refined the questions they would be asked. In individual elicitation sessions they quantified their opinions, mainly in the form of point and interval estimates for specified variables. New methods have been developed for quantifying expert opinion and these were implemented in specialized software that uses interactive graphics. This software was used to elicit opinion about quantities related to measurable covariates. Results: Assessments for thirty-four quantities were elicited and available checks supported their validity. Eight points of good practice in eliciting and using expert judgment were evident. Parameters and probability distributions needed for the pathway model were determined from the elicited assessments. Simulation results from the pathway model were used to inform policy on bowel cancer service provision. Conclusions: The study illustrates that quantifying and using expert judgment can be acceptable in real problems of practical importance. For full benefit to be gained from expert knowledge, elicitation must be conducted carefully and should be reported in detail

Clinical identification of feeding and swallowing disorders in 0-6 month old infants with Down syndrome

Feeding and swallowing disorders have been described in children with a variety of neurodevelopmental disabilities, including Down syndrome (DS). Abnormal feeding and swallowing can be associated with serious sequelae such as failure to thrive and respiratory complications, including aspiration pneumonia. Incidence of dysphagia in young infants with DS has not previously been reported. To assess the identification and incidence of feeding and swallowing problems in young infants with DS, a retrospective chart review of 174 infants, ages 0-6 months was conducted at a single specialty clinic. Fifty-seven percent (100/174) of infants had clinical concerns for feeding and swallowing disorders that warranted referral for Videofluroscopic Swallow Study (VFSS); 96/174 (55%) had some degree of oral and/or pharyngeal phase dysphagia and 69/174 (39%) had dysphagia severe enough to warrant recommendation for alteration of breast milk/formula consistency or nonoral feeds. Infants with certain comorbidities had significant risk for significant dysphagia, including those with functional airway/respiratory abnormalities (OR = 7.2). Infants with desaturation with feeds were at dramatically increased risk (OR = 15.8). All young infants with DS should be screened clinically for feeding and swallowing concerns. If concerns are identified, consideration should be given to further evaluation with VFSS for identification of dysphagia and additional feeding modifications

The Analyticity of a Generalized Ruelle's Operator

In this work we propose a generalization of the concept of Ruelle operator for one dimensional lattices used in thermodynamic formalism and ergodic optimization, which we call generalized Ruelle operator, that generalizes both the Ruelle operator proposed in [BCLMS] and the Perron Frobenius operator defined in [Bowen]. We suppose the alphabet is given by a compact metric space, and consider a general a-priori measure to define the operator. We also consider the case where the set of symbols that can follow a given symbol of the alphabet depends on such symbol, which is an extension of the original concept of transition matrices from the theory of subshifts of finite type. We prove the analyticity of the Ruelle operator and present some examples

Quantitative Susceptibility Mapping by Inversion of a Perturbation Field Model: Correlation With Brain Iron in Normal Aging

There is increasing evidence that iron deposition occurs in specific regions of the brain in normal aging and neurodegenerative disorders such as Parkinson's, Huntington's, and Alzheimer's disease. Iron deposition changes the magnetic susceptibility of tissue, which alters the MR signal phase, and allows estimation of susceptibility differences using quantitative susceptibility mapping (QSM). We present a method for quantifying susceptibility by inversion of a perturbation model, or “QSIP.” The perturbation model relates phase to susceptibility using a kernel calculated in the spatial domain, in contrast to previous Fourier-based techniques. A tissue/air susceptibility atlas is used to estimate B[subscript 0] inhomogeneity. QSIP estimates in young and elderly subjects are compared to postmortem iron estimates, maps of the Field-Dependent Relaxation Rate Increase, and the L1-QSM method. Results for both groups showed excellent agreement with published postmortem data and in vivo FDRI: statistically significant Spearman correlations ranging from Rho=0.905 to Rho=1.00 were obtained. QSIP also showed improvement over FDRI and L1-QSM: reduced variance in susceptibility estimates and statistically significant group differences were detected in striatal and brainstem nuclei, consistent with age-dependent iron accumulation in these regions.National Institutes of Health (U.S.) (Grant P41EB015902)National Institutes of Health (U.S.) (Grant P41RR013218)National Institutes of Health (U.S.) (Grant P41EB015898)National Institutes of Health (U.S.) (Grant P41RR019703)National Institutes of Health (U.S.) (Grant T32EB0011680-06)National Institutes of Health (U.S.) (Grant K05AA017168)National Institutes of Health (U.S.) (Grant R01AA012388

Pico without public keys

This document is the Accepted Manuscript version of the following paper: Frank Stajano, Bruce Christianson, Mark Lomas, Graeme Jenkinson, Jeunese Payne, Max Spencer, and Quentin Stafford Fraser, 'Pico without Public Keys', Security Protocols XXIII, 23rd International Workshop Cambridge, March 31- April 2, 2015, Revised Selected Papers, pp. 195-211, part of the Lecture Notes in Computer Science book series (LNCS, Vol. 9379), first online 25 November 2015, ISBN: 978-3-319-26095-2. The final publication is available at Springer via: https://link.springer.com/chapter/10.1007%2F978-3-319-26096-9_21v.Pico is a user authentication system that does not require remembering secrets. It is based on a personal handheld token that holds the user’s credentials and that is unlocked by a “personal aura” generated by digital accessories worn by the owner. The token, acting as prover, engages in a public-key-based authentication protocol with the verifier. What would happen to Pico if success of the mythical quantum computer meant secure public key primitives were no longer available, or if for other reasons such as energy consumption we preferred not to deploy them? More generally, what would happen under those circumstances to user authentication on the web, which relies heavily on public key cryptography through HTTPS/TLS? Although the symmetric-key-vs-public-key debate dates back to the 1990s, we note that the problematic aspects of public key deployment that were identified back then are still ubiquitous today. In particular, although public key cryptography is widely deployed on the web, revocation still doesn’t work. We discuss ways of providing desirable properties of public-key-based user authentication systems using symmetric-key primitives and tamperevident tokens. In particular, we present a protocol through which a compromise of the user credentials file at one website does not require users to change their credentials at that website or any other. We also note that the current prototype of Pico, when working in compatibility mode through the Pico Lens (i.e. with websites that are unaware of the Pico protocols), doesn’t actually use public key cryptography, other than that implicit in TLS. With minor tweaks we adopt this as the native mode for Pico, dropping public key cryptography and achieving much greater deployability without any noteworthy loss in security