The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy

Objectives: Contrast-enhanced computed tomography (CT) provides essential cross-sectional imaging data in patients with suspected pleural malignancy (PM). The performance of CT in routine practice may be lower than in previously reported research. We assessed this relative to ‘real-life’ factors including use of early arterial-phase contrast enhancement (by CT pulmonary angiography (CTPA)) and non-specialist radiology reporting. Materials and methods: Routinely acquired and reported CT scans in patients recruited to the DIAPHRAGM study (a prospective, multi-centre observational study of mesothelioma biomarkers) between January 2014 and April 2016 were retrospectively reviewed. CT reports were classified as malignant if they included specific terms e.g. “suspicious of malignancy”, “stage M1a” and benign if others were used e.g. “indeterminate”, “no cause identified”. All patients followed a standard diagnostic algorithm. The diagnostic performance of CT (overall and based on the above factors) was assessed using 2 × 2 Contingency Tables. Results: 30/345 (9%) eligible patients were excluded (non-contrast (n = 13) or non-contiguous CT (n = 4), incomplete follow-up (n = 13)). 195/315 (62%) patients studied had PM; 90% were cyto-histologically confirmed. 172/315 (55%) presented as an acute admission, of whom 31/172 (18%) had CTPA. Overall, CT sensitivity was 58% (95% CI 51–65%); specificity was 80% (95% CI 72–87%). Sensitivity of CTPA (performed in 31/315 (10%)) was lower (27% (95% CI 9–53%)) than venous-phase CT (61% (95% CI 53–68%) p = 0.0056). Sensitivity of specialist thoracic radiologist reporting was higher (68% (95% CI 55–79%)) than non-specialist reporting (53% (95% CI 44–62%) p = 0.0488). Specificity was not significantly different. Conclusion: The diagnostic performance of CT in routine clinical practice is insufficient to exclude or confirm PM. A benign CT report should not dissuade pleural sampling where the presence of primary or secondary pleural malignancy would alter management. Sensitivity is lower with non-thoracic radiology reporting and particularly low using CTPA

The Value of Comparative Animal Research : Krogh’s Principle Facilitates Scientific Discoveries

There are no conflicts of interest to declare. This paper developed from the 2016 Early Career Impact Award from the Federation of Associations in Behavioral & Brain Sciences to TJS. TJS has received funding from The Leverhulme Trust. FJPE is in receipt of funding from the BBSRC (BB/M001555/1). The National Institutes of Health has funded RDF (NS 034950, NS093277, NIMH 087930), AGO (HD079573, IOS-1354760) and AMK (HD081959). BAA is an Arnold O. Beckman postdoctoral fellow.Peer reviewedPostprin

TRON 2.0 - The Experience

The goal of this senior project was to come up with a structural-engineering-related schematic design for a roller coaster to be installed in Disneyland called TRON 2.0: The Experience. This involved looking at both design processes that we had already learned through our curriculum as well as researching concepts that were previously foreign to us, namely the dynamic application of loads and the effects of fatigue stresses. A story was established based on the source material: the TRON movies produced by Walt Disney Studios. Thematic elements from the story were used as the basis for design implications that would become necessary as the process continued. These design implication influenced the design of the Ride System, Track Layout, and Ride Vehicle Design. These factors would end up influencing applicable loads, which would be utilized in the design of the Track Layout. The site was chosen to be constructed on Disneyland proper so that realistic site parameters and dimensions would give a sense of scale to the project and eliminate ambiguity. However, existing elements on the site would cause challenges for us to work around. Once the site was chosen, Queue and Show buildings were designated simple designs to tie back to story-driven implications and reinforce the standards set by the Walt Disney Imagineering process model. In addition, we gained more information such as crowd capacity to dictate further mechanical design and dynamic applications. The mechanical side of the process saw the development of a ride system used to propel the Ride Vehicles, all designed by the Mechanical Engineers on the project. The Ride Vehicle weights became relevant for the design of the track. A Track Layout was created and inputted into simulation software so that dynamic accelerations could be developed as new loading conditions for Track Design. Finally, all of the preceding elements of design were culminated into a schematic design of a roller coaster track making sure to account for subjects such as dynamic applications, torsion, and fatigue. All designs were replicated in modeling software to confirm constructability and viability of the resulting schematic design

Early Contrast Enhancement: a novel Magnetic Resonance Imaging biomarker of pleural malignancy

Introduction: Pleural Malignancy (PM) is often occult on subjective radiological assessment. We sought to define a novel, semi-objective Magnetic Resonance Imaging (MRI) biomarker of PM, targeted to increased tumour microvessel density (MVD) and applicable to minimal pleural thickening. Materials and methods: 60 consecutive patients with suspected PM underwent contrast-enhanced 3-T MRI then pleural biopsy. In 58/60, parietal pleura signal intensity (SI) was measured in multiple regions of interest (ROI) at multiple time-points, generating ROI SI/time curves and Mean SI gradient (MSIG: SI increment/time). The diagnostic performance of Early Contrast Enhancement (ECE; which was defined as a SI peak in at least one ROI at or before 4.5 min) was compared with subjective MRI and Computed Tomography (CT) morphology results. MSIG was correlated against tumour MVD (based on Factor VIII immunostain) in 31 patients with Mesothelioma. Results: 71% (41/58) patients had PM. Pleural thickening was <10 mm in 49/58 (84%). ECE sensitivity was 83% (95% CI 61–94%), specificity 83% (95% CI 68–91%), positive predictive value 68% (95% CI 47–84%), negative predictive value 92% (78–97%). ECE performance was similar or superior to subjective CT and MRI. MSIG correlated with MVD (r = 0.4258, p = .02). Discussion: ECE is a semi-objective, perfusion-based biomarker of PM, measurable in minimal pleural thickening. Further studies are warranted

Sympathectomy for truncal hyperhydrosis after traumatic paraplegic injury

AbstractJ Thorac Cardiovasc Surg 2002;124:636-

Planned Missing Data Designs & Small Sample Size: How Small is Too Small?

Utilizing planned missing data (PMD) designs (ex. 3-form surveys) enables researchers to ask participants fewer questions during the data collection process. An important question, however, is just how few participants are needed to effectively employ planned missing data designs in research studies. This paper explores this question by using simulated three-form planned missing data to assess analytic model convergence, parameter estimate bias, standard error bias, mean squared error (MSE), and relative efficiency (RE).Three models were examined: a one-time point, cross-sectional model with 3 constructs; a two-time point model with 3 constructs at each time point; and a three-time point, mediation model with 3 constructs over three time points. Both full-information maximum likelihood (FIML) and multiple imputation (MI) were used to handle the missing data. Models were found to meet convergence rate and acceptable bias criteria with FIML at smaller sample sizes than with MI

Three qubit entanglement within graphical Z/X-calculus

The compositional techniques of categorical quantum mechanics are applied to analyse 3-qubit quantum entanglement. In particular the graphical calculus of complementary observables and corresponding phases due to Duncan and one of the authors is used to construct representative members of the two genuinely tripartite SLOCC classes of 3-qubit entangled states, GHZ and W. This nicely illustrates the respectively pairwise and global tripartite entanglement found in the W- and GHZ-class states. A new concept of supplementarity allows us to characterise inhabitants of the W class within the abstract diagrammatic calculus; these method extends to more general multipartite qubit states.Comment: In Proceedings HPC 2010, arXiv:1103.226