Paging Doctor Google! Heuristics vs. technology

The most dramatic development in medical decision-making technology has been the advent of the Internet. This has had an impact not only on clinicians, but has also become an important resource for patients who often approach their doctors with medical information they have obtained from the Internet.  Increasingly, medical students, residents and attending physicians have been using the Internet as a tool for diagnosing and treating disease. Internet-based resources that are available take various forms, including informational websites, online journals and textbooks, and social media.  Search engines such as Google have been increasingly used to help in making diagnoses of disease entities. Do these search methods fare better than experienced heuristic methods? In a small study, we examined the comparative role of heuristics versus the 'Google' mode of thinking. Internal medicine residents were asked to “google” key words to come up with a diagnosis. Their results were compared to experienced nephrology faculty and fellows in training using heuristics and no additional help of internet. Overall, with the aid of Google, the novices (internal medicine residents) correctly diagnosed renal diseases less often than the experts (the attendings) but with the same frequency as the intermediates (nephrology fellows).  However, in a subgroup analysis of both common diseases and rare diseases, the novices correctly diagnosed renal diseases less often than the experts but more often than the intermediates in each analysis.  The novices correctly diagnosed renal diseases with the same frequency as nephrology fellows in training

Differentiating SIADH from Cerebral/Renal Salt Wasting: Failure of the Volume Approach and Need for a New Approach to Hyponatremia

Hyponatremia is the most common electrolyte abnormality. Its diagnostic and therapeutic approaches are in a state of flux. It is evident that hyponatremic patients are symptomatic with a potential for serious consequences at sodium levels that were once considered trivial. The recommendation to treat virtually all hyponatremics exposes the need to resolve the diagnostic and therapeutic dilemma of deciding whether to water restrict a patient with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or administer salt and water to a renal salt waster. In this review, we briefly discuss the pathophysiology of SIADH and renal salt wasting (RSW), and the difficulty in differentiating SIADH from RSW, and review the origin of the perceived rarity of RSW, as well as the value of determining fractional excretion of urate (FEurate) in differentiating both syndromes, the high prevalence of RSW which highlights the inadequacy of the volume approach to hyponatremia, the importance of changing cerebral salt wasting to RSW, and the proposal to eliminate reset osmostat as a subtype of SIADH, and finally propose a new algorithm to replace the outmoded volume approach by highlighting FEurate. This algorithm eliminates the need to assess the volume status with less reliance on determining urine sodium concentration, plasma renin, aldosterone and atrial/brain natriuretic peptide or the BUN to creatinine ratio

Seed germination studies of Sarcopoterium spinosum (L.) Spach (Rosaceae)

Sarcopoterium spinosum (L.) Spach (Rosaceae) is a dwarf shrub, 30–60 cm in height, with branches ending in dichotomous, leafless thorns (1), that recruits both sexually and clonally (Figure 1, 2). It dominates eastern-mediterranean shrublands known as “bathah” in Israel and “phrygana” in Greece (2). Its southern distribution is in the Northern Negev of Israel. In semi-arid ecosystems, shrublands dominated by S. spinosum are often formed following recolonization of old-fields (1). In the W-Mediterranean basin the species occurs in locations on the Balkan Coast, in Italy and in Tunisia (Djerba); in addition, a small population of S. spinosum is also recognizable in Malta (3). The germination behaviour of three populations (Sardinia - Italy, Chios – Greece and Malta) of Sarcopoterium spinosum was investigated under controlled laboratory conditions at the Sardinian Germplasm Bank (BG-SAR). Chios population is situated in the central part of the distribution area, while Malta and Sardinia represent two disjunct populations at its western margin (Figure 3). The seed germination occurs inside the fruits (1,4). Each fruit contains several seeds but usually produces one seedling (1,4). Aim of this work was to study seed viability and germination of Sarcopoterium spinosum and also to compare the germinative behavior of central and border populations.peer-reviewe

Roadmap on printable electronic materials for next-generation sensors

The dissemination of sensors is key to realizing a sustainable, ‘intelligent’ world, where everyday objects and environments are equipped with sensing capabilities to advance the sustainability and quality of our lives—e.g., via smart homes, smart cities, smart healthcare, smart logistics, Industry 4.0, and precision agriculture. The realization of the full potential of these applications critically depends on the availability of easy-to-make, low-cost sensor technologies. Sensors based on printable electronic materials offer the ideal platform: they can be fabricated through simple methods (e.g., printing and coating) and are compatible with high-throughput roll-to-roll processing. Moreover, printable electronic materials often allow the fabrication of sensors on flexible/stretchable/biodegradable substrates, thereby enabling the deployment of sensors in unconventional settings. Fulfilling the promise of printable electronic materials for sensing will require materials and device innovations to enhance their ability to transduce external stimuli—light, ionizing radiation, pressure, strain, force, temperature, gas, vapours, humidity, and other chemical and biological analytes. This Roadmap brings together the viewpoints of experts in various printable sensing materials—and devices thereof—to provide insights into the status and outlook of the field. Alongside recent materials and device innovations, the roadmap discusses the key outstanding challenges pertaining to each printable sensing technology. Finally, the Roadmap points to promising directions to overcome these challenges and thus enable ubiquitous sensing for a sustainable, ‘intelligent’ world

Bordetella bronchiseptica pneumonia a thread in the diagnosis of human immunodeficiency virus infection

Bordetella (B.) bronchiseptica is primarily a zoonotic pathogen, which is often found in upper respiratory tract of various domestic and wild animals. Human infections are rarely reported in immunocompromised patients and are associated with a wide spectrum of presentation ranging from mild cough, tracheobronchitis to sepsis and death. Here, we describe a case of B. bronchiseptica pneumonia that led to the diagnosis of human immunodeficiency virus infection.The diagnosis of B. bronchiseptica infection can be challenging, as there are no distinctive imaging features. This infection mimics Pneumocystis jiroveci infection and unless a detailed evaluation of an unusual presentation is done it may be missed, resulting in increased morbidity and mortality. This case emphasizes the importance of a systematic detailed investigation of patients with unusual pneumonia presentations. Keywords: Bordetella bronchiseptica, Pneumonia, HI