Carcinogenicity of chloroform.

Chloroform is carcinogenic in rats, mice, and probably in dogs. Chloroform induced carcinomas of the liver and kidney and malignant tumors in other organs in rats and mice. Liver neoplasms have been described in three strains of mice. Carcinomas of the kidney were found in a first study in mice and in the repeat of that study. Dogs given chloroform developed neoplasms of the liver as well as in other organs. Rats given chloroform also developed toxic changes, particularly male rats, as a result of treatment. These lesions included interstitial fibrosis of the kidney; polyarteritis of the mesenteric, pancreatic, and other arterioles and arteries; and atrophy of the testes. These toxic changes may have interfered with the development of neoplasms in male rats

Diagnosing people with dementia using automatic conversation analysis

A recent study using Conversation Analysis (CA) has demonstrated that communication problems may be picked up during conversations between patients and neurologists, and that this can be used to differentiate between patients with (progressive neurodegenerative dementia) ND and those with (nonprogressive) functional memory disorders (FMD). This paper presents a novel automatic method for transcribing such conversations and extracting CA-style features. A range of acoustic, syntactic, semantic and visual features were automatically extracted and used to train a set of classifiers. In a proof-of-principle style study, using data recording during real neurologist-patient consultations, we demonstrate that automatically extracting CA-style features gives a classification accuracy of 95%when using verbatim transcripts. Replacing those transcripts with automatic speech recognition transcripts, we obtain a classification accuracy of 79% which improves to 90% when feature selection is applied. This is a first and encouraging step towards replacing inaccurate, potentially stressful cognitive tests with a test based on monitoring conversation capabilities that could be conducted in e.g. the privacy of the patient’s own home

Response to Open Peer Commentaries on "Diagnosis By Television Documentary: Professional Responsibilities in Informal Encounters".

In presenting the situation of a health professional witnessing an instance of misdiagnosis and mistreatment in a television documentary, we hoped to stimulate discussion of the professional responsibilities of health workers in informal encounters in a rapidly changing environment comprising print, television, and more recently social media platforms. The commentaries on our article do not disappoint in this respect, providing insightful and sometimes challenging reactions to the position we outlined in response to our original case. In our reply here, we choose to focus on two themes running through all of the commentaries: (1) the distinction between axiological and deontic perspectives invoked by Salloch, and the open-endedness of the former that we see as crucial in addressing the constantly changing media landscape through which health workers may confront medical need; and (2) the role of institutional, structural, and social factors in constraining or enabling virtuous professional practice—suggesting perhaps a further need for health workers to take action directly against structural injustices that prevent them from fulfilling their professional responsibilities

Memory difficulties are not always a sign of incipient dementia: a review of the possible causes of loss of memory efficiency

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Toward the Automation of Diagnostic Conversation Analysis in Patients with Memory Complaints.

BACKGROUND: The early diagnosis of dementia is of great clinical and social importance. A recent study using the qualitative methodology of conversation analysis (CA) demonstrated that language and communication problems are evident during interactions between patients and neurologists, and that interactional observations can be used to differentiate between cognitive difficulties due to neurodegenerative disorders (ND) or functional memory disorders (FMD). OBJECTIVE: This study explores whether the differential diagnostic analysis of doctor-patient interactions in a memory clinic can be automated. METHODS: Verbatim transcripts of conversations between neurologists and patients initially presenting with memory problems to a specialist clinic were produced manually (15 with FMD, and 15 with ND). A range of automatically detectable features focusing on acoustic, lexical, semantic, and visual information contained in the transcripts were defined aiming to replicate the diagnostic qualitative observations. The features were used to train a set of five machine learning classifiers to distinguish between ND and FMD. RESULTS: The mean rate of correct classification between ND and FMD was 93% ranging from 97% by the Perceptron classifier to 90% by the Random Forest classifier.Using only the ten best features, the mean correct classification score increased to 95%. CONCLUSION: This pilot study provides proof-of-principle that a machine learning approach to analyzing transcripts of interactions between neurologists and patients describing memory problems can distinguish people with neurodegenerative dementia from people with FMD

Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics

Objective: This study explores whether the profile of patients' interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases. Methods: Conversation Analysis of video recordings of neurologists' interactions with patients attending a specialist memory clinic. "Gold standard" diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging. Results: Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients' responses to neurologists' questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent "I don't know" responses. Conclusion: Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD. Practical implications: Our findings demonstrate that conversational profiles based on patients' contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care

Diagnostic and treatment services for patients with Psychogenic Nonepileptic Seizures (PNES): A survey of health professionals in urban China

PURPOSE: This study is intended to provide an overview of diagnostic and treatment services for patients with psychogenic nonepileptic seizures (PNES) across China. METHODS: Using a questionnaire devised by the PNES Task Force of Neuropsychiatry Commission of the International League Against Epilepsy (ILAE), we conducted a survey among Chinese health professionals at the Sixth Advanced International Course: Clinical Epileptology. Descriptive analyses were performed. RESULTS: Responses from 102 eligible clinicians were analysed. Responses were received from urban areas in 20 provinces/municipalities around China. Most respondents were neurologists. The results showed that hospitals in urban China were mostly well-equipped, and that health professionals' understanding of PNES largely reflected current international expert opinion. However, many of the participants would not actually make the diagnosis, and most provided neither follow-up nor treatment (especially psychotherapy) for patients with PNES. Only about one third of the patients diagnosed with PNES were estimated to receive at least one appointment for psychological treatment. In the opinion of the respondents, tacit trauma (neglect and stress) play an important role in the development of PNES. The main obstacles to patients with PNES accessing health services for their condition were thought to be lack of knowledge or awareness among health professionals, patients and society. CONCLUSION: Despite good access to equipment, diagnostic and treatment services for patients with PNES in China are currently deficient. Education programs about PNES with different target groups, and more effective referral and social security systems emerge as particular development needs from this survey