knowledge, Attitude and Practice of Rational usage of antibiotics for Preoperative Prophylaxis Among Surgeons in Shahid Beheshti University of Medical Sciences hospitals in 2014

Background: Optimal and appropriate antibiotic prescription for preoperative prophylaxis is an essential issue in hospitals. The nobility of the present study was to determine the rate of optimal antibiotic usage for preoperative prophylaxis in Shahid­ Beheshti University hospitals in 2014.Materials and Methods: In this observational cross­-sectional study, 200 physicians employed in Shahid­ Beheshti University hospitals who performed surgical procedures were enrolled in the study and the rate of optimal antibiotic utilization for preoperative prophylaxis was evaluated.Results: It was obtained that 64% of physicians had appropriate attitude and 41% had sufficient practice. The concordance rate according to the guidelines was medium in 52%, high in 29%, and low in 19%Conclusion: It was ultimately attained that optimal antibiotic for preoperative prophylaxis is used by nearly half of physicians and also two­ third have appropriate perspective regarding the antibiotic usage

Retrieval of Radiology Reports Citing Critical Findings with Disease-Specific Customization

Background: Communication of critical results from diagnostic procedures between caregivers is a Joint Commission national patient safety goal. Evaluating critical result communication often requires manual analysis of voluminous data, especially when reviewing unstructured textual results of radiologic findings. Information retrieval (IR) tools can facilitate this process by enabling automated retrieval of radiology reports that cite critical imaging findings. However, IR tools that have been developed for one disease or imaging modality often need substantial reconfiguration before they can be utilized for another disease entity. Purpose: This paper: 1) describes the process of customizing two Natural Language Processing (NLP) and Information Retrieval/Extraction applications – an open-source toolkit, A Nearly New Information Extraction system (ANNIE); and an application developed in-house, Information for Searching Content with an Ontology-Utilizing Toolkit (iSCOUT) – to illustrate the varying levels of customization required for different disease entities and; 2) evaluates each application’s performance in identifying and retrieving radiology reports citing critical imaging findings for three distinct diseases, pulmonary nodule, pneumothorax, and pulmonary embolus. Results: Both applications can be utilized for retrieval. iSCOUT and ANNIE had precision values between 0.90-0.98 and recall values between 0.79 and 0.94. ANNIE had consistently higher precision but required more customization. Conclusion: Understanding the customizations involved in utilizing NLP applications for various diseases will enable users to select the most suitable tool for specific tasks

Soft-switching non-isolated high step-up three-level boost converter using single magnetic element

Here, a soft switched three-level boost converter with high voltage gain is proposed which is suitable for high step-up applications with wide output power range. In this converter, a ZVT auxiliary circuit is used which provides soft switching in a wide range of output power independent of load variation. Utilizing coupled-inductors with one magnetic core removes extra auxiliary core in the soft switching circuit and provides high voltage gain in conjunction with size reduction. Also, the secondary and tertiary leakage inductances of the coupled-inductors minimize the reverse recovery problem of the output diodes. Due to its three-level structure, it has very low voltage stress over semiconductor elements in comparison to the existing interleaved structures, resulting in using MOSFETs with low on-resistance and thus lower conduction losses and cost. Operating modes as well as analytical analysis of the proposed converter are discussed. Finally, in order to validate the proposed converter performance, experimental results from a 200-W laboratory prototype are presented.Peer ReviewedPostprint (published version

An Interleaved Soft Switched High Step-Up Boost Converter With High Power Density for Renewable Energy Applications

In this article, a novel soft switched interleaved boost structure with a simple auxiliary circuit is proposed which is suitable for stand-alone loads or ac grid applications. In this topology, coupled inductors and switched capacitor cells of parallel modules are merged to obtain high voltage conversion ratio. The converter also has the capability of adding extra switched capacitor cells to attain very high voltage gain. To provide soft-switching condition in the wide range of output power, a new zero-voltage transition auxiliary circuit is employed which is responsible for soft switching of both phases and benefits from low conduction losses, the minimum number of semiconductor elements, and only one auxiliary gate-driver. These merits provide very high efficiency at both full-load and light loads. More importantly, no auxiliary magnetic components are utilized by taking advantage of the leakage inductance of coupled inductors for the resonant network. All semiconductor components operate under soft switching alleviating the reverse recovery problem and switching losses. Besides, the converter benefits from common ground between input and output which simplify voltage feedback. The experimental results of the interleaved converter prototype with 400-V output voltage at 400 W and 100 kHz switching frequency are provided. The full load efficiency of 98% was achieved and the power density was observed 1.9 W/Cm3

Soft‐switching non‐isolated high step‐up three‐level boost converter using single magnetic element

Abstract Here, a soft switched three‐level boost converter with high voltage gain is proposed which is suitable for high step‐up applications with wide output power range. In this converter, a ZVT auxiliary circuit is used which provides soft switching in a wide range of output power independent of load variation. Utilizing coupled‐inductors with one magnetic core removes extra auxiliary core in the soft switching circuit and provides high voltage gain in conjunction with size reduction. Also, the secondary and tertiary leakage inductances of the coupled‐inductors minimize the reverse recovery problem of the output diodes. Due to its three‐level structure, it has very low voltage stress over semiconductor elements in comparison to the existing interleaved structures, resulting in using MOSFETs with low on‐resistance and thus lower conduction losses and cost. Operating modes as well as analytical analysis of the proposed converter are discussed. Finally, in order to validate the proposed converter performance, experimental results from a 200‐W laboratory prototype are presented

Impact of an Information Technology–Enabled Initiative on the Quality of Prostate Multiparametric MRI Reports

Rationale and Objectives: Assess the impact of implementing a structured report template and a computer-aided diagnosis (CAD) tool on the quality of prostate multiparametric MRI (mp-MRI) reports. Materials and Methods: Institutional Review Board approval was obtained for this HIPAA-compliant study performed at an academic medical center. The study cohort included all prostate mp-MRI reports (n=385) finalized 6 months before and after implementation of a structured report template and a CAD tool (collectively the IT tools) integrated into the PACS workstation. Primary outcome measure was quality of prostate mp-MRI reports. An expert panel of our institution’s subspecialty trained abdominal radiologists defined prostate mp-MRI report quality as optimal, satisfactory or unsatisfactory based on documentation of 9 variables. Reports were reviewed to extract the predefined quality variables and determine whether the IT tools were used to create each report. Chi-square and Student’s t-tests were used to compare report quality before and after implementation of IT tools. Results: The overall proportion of optimal or satisfactory reports increased from 29.8% (47/158) to 53.3% (121/227) (p<0.001) after implementing the IT tools. While the proportion of optimal or satisfactory reports increased among reports generated using at least one of the IT tools (47/158=[29.8%] vs. 105/161=[65.2%]; p<0.001), there was no change in quality among reports generated without use of the IT tools (47/158=[29.8%] vs. 16/66=[24.2%]; p=0.404). Conclusion: The use of a structured template and CAD tool improved the quality of prostate mp-MRI reports compared to free-text report format and subjective measurement of contrast enhancement kinetic curve

Assessing Strength of Evidence of Appropriate Use Criteria for Diagnostic Imaging Examinations

Objective For health information technology tools to fully inform evidence-based decisions, recommendations must be reliably assessed for quality and strength of evidence. We aimed to create an annotation framework for grading recommendations regarding appropriate use of diagnostic imaging examinations. Methods The annotation framework was created by an expert panel (clinicians in three medical specialties, medical librarians, and biomedical scientists) who developed a process for achieving consensus in assessing recommendations, and evaluated by measuring agreement in grading the strength of evidence for 120 empirically selected recommendations using the Oxford Levels of Evidence. Results Eighty-two percent of recommendations were assigned to Level 5 (expert opinion). Inter-annotator agreement was 0.70 on initial grading (κ = 0.35, 95% CI, 0.23-0.48). After systematic discussion utilizing the annotation framework, agreement increased significantly to 0.97 (κ = 0.88, 95% CI, 0.77-0.99). Conclusions A novel annotation framework was effective for grading the strength of evidence supporting appropriate use criteria for diagnostic imaging exams