Cost-effectiveness requirements for implementing artificial intelligence technology in the Women’s UK Breast Cancer Screening service

The UK NHS Women’s National Breast Screening programme aims to detect breast cancer early. The reference standard approach requires mammograms to be independently double-read by qualified radiology staff. If two readers disagree, arbitration by an independent reader is undertaken. Whilst this process maximises accuracy and minimises recall rates, the procedure is labour-intensive, adding pressure to a system currently facing a workforce crisis. Artificial intelligence technology offers an alternative to human readers. While artificial intelligence has been shown to be non-inferior versus human second readers, the minimum requirements needed (effectiveness, set-up costs, maintenance, etc) for such technology to be cost-effective in the NHS have not been evaluated. We developed a simulation model replicating NHS screening services to evaluate the potential value of the technology. Our results indicate that if non-inferiority is maintained, the use of artificial intelligence technology as a second reader is a viable and potentially cost-effective use of NHS resources

Ice Particle Impacts on a Moving Wedge

This work presents the results of an experimental study of ice particle impacts on a moving wedge. The experiment was conducted in the Adverse Environment Rotor Test Stand (AERTS) facility located at Penn State University. The wedge was placed at the tip of a rotating blade. Ice particles shot from a pressure gun intercepted the moving wedge and impacted it at a location along its circular path. The upward velocity of the ice particles varied from 7 to 12 meters per second. Wedge velocities were varied from 0 to 120 meters per second. Wedge angles tested were 0 deg, 30 deg, 45 deg, and 60 deg. High speed imaging combined with backlighting captured the impact allowing observation of the effect of velocity and wedge angle on the impact and the post-impact fragment behavior. It was found that the pressure gun and the rotating wedge could be synchronized to consistently obtain ice particle impacts on the target wedge. It was observed that the number of fragments increase with the normal component of the impact velocity. Particle fragments ejected immediately after impact showed velocities higher than the impact velocity. The results followed the major qualitative features observed by other researchers for hailstone impacts, even though the reduced scale size of the particles used in the present experiment as compared to hailstones was 4:1

Diversity and dynamics of microarthropods from different biotopes of Las Sardinas cave (Mexico)

aBstract an ecological study of the microarthropod communities from las sardinas cave was undertaken. Four different biotopes were studied over the course of a year: bat guano, litter, soil under the chemoautotrophic bacteria colonies and as a control, plain soil without litter or guano. a total of 27,913 specimens of a total of 169 species were collected. analysis of Variance (anoVa) showed that there is a significant effect of biotope on the recorded density, and the post hoc Tukey's test showed that guano is the most different biotope with the highest value of density recorded. The interaction between season and biotope variables was not significant. In the most extreme case, 99 percent of the microarthropods in soil under chemoautotrophic bacteria were mites, mainly in the family Histiostomidae

Assessing and mapping cultural ecosystem services at community level in the Colombian Amazon

Understanding the significance that cultural ecosystem services (CES) have for traditional communities will provide useful input to the design of more appropriate regional or territorial plans for the area in which they are located. We conducted semi-structured surveys in 11 indigenous communities within the corregimiento La Pedrera, of the Colombian Amazon. We analysed the CES established in the region through a study of their preferences in relation to the service providing units (SPUs) identified, using the Shannon diversity index method as an indicator of ‘diversity of use’. More CES were identified in communities with a larger population; education and recreation were the two most prevalent CES categories in the study area. Our findings also highlight the cultural importance of bodies of water, which were strongly linked with Spiritual and Sense of Place CES. Furthermore, the integration of qualitative and quantitative assessments enables a better understanding of the importance CES which have for the local communities involved in the study and may assist in the management of the indigenous territory.EDITED BY Matthias Schröte

The CABI Trial: an Unblinded Parallel Group Randomised Controlled Feasibility Trial of Long-Course Antibiotic Therapy (28 Days) Compared with Short Course (≤ 10 Days) in the Prevention of Relapse in Adults Treated for Complicated Intra-Abdominal Infection

Purpose Relapse after complicated intra-abdominal infection (cIAI) remains common after treatment. The optimal antibiotic treatment duration for cIAIs is uncertain, especially in cases where source control is not achieved. We hypothesised that in patients with cIAIs, regardless of source control intervention, there would be a lower relapse rate with long-course antibiotics (28 days) compared with short course (≤ 10 days). We piloted a trial comparing ≤ 10-day with 28-day antibiotic treatment for cIAI. Methods A randomised controlled unblinded feasibility trial was conducted. Eligible participants were adult patients with a cIAI that were diagnosed ≤ 6 days prior to screening. Randomisation was to long-course (28 days) or short-course (≤10 days) antibiotic therapy. Choice of antibiotics was determined by the clinical team. Participants were followed up for 90 days. Primary outcomes were willingness of participants to be randomised and feasibility of trial procedures. Results In total, 172 patients were screened, 84/172 (48.8%) were eligible, and 31/84 (36.9%) were randomised. Patients were assigned to either the short-course arm (18/31, 58.0%) or the long-course arm (13/31, 41.9%). One patient in the short-course arm withdrew after randomisation. In the short-course arm, 4/17 (23.5%) were treated for a cIAI relapse vs 0/13 (0.0%) relapses in the long-course arm. Protocol violations included deviations from protocol-assigned antibiotic duration and interruptions to antibiotic therapy. Conclusions This feasibility study identified opportunities to increase recruitment in a full trial. This study demonstrates completion of a randomised controlled trial to further evaluate if the optimum antibiotic duration for cIAIs is feasible

Cost evaluation of point-of-care testing for community-acquired influenza in adults presenting to the emergency department

Background Rapid molecular point-of-care tests (POCTs) for influenza have potential to produce cost savings in emergency departments (EDs) and acute care settings. To date, published projected savings have been based on estimated costs. Objectives This study aimed to describe the cost implications of a rapid influenza POCT using accurate real-world patient level costing data. 204 adult patients receiving point-of-care (POC) influenza testing in the ED as part of a routine clinical service were identified retrospectively, alongside a control cohort of 104 patients from the same influenza season. Costs for all were calculated at the individual patient level. Cost comparison was performed using an instrumental variable (IV) regression to overcome potential bias within the observational dataset. Results Patients who had a POCT on average cost 67 % less than those who did not (average cost reduction: £2066: 95 % CI: £624 and £2665). Moderate to high NEWS score at arrival, presence of ≥1 comorbidity, and age ≥70 years increased overall costs across both groups (p < 0.05). Conclusions Savings from POC testing can be attributed to more targeted treatments, fewer admissions and reduced lengths of stay. The IV regression results are supported by a second method (ordinary least square against baseline characteristics). They are also in line with existing work that use estimated costs but indicate greater savings than predicted previously. In conclusion, POC influenza testing in the emergency department produces significant cost savings, this is demonstrated here through an analysis using individual real-world patient level costing data

rpoB Gene mutations in rifampin-resistant Mycobacterium tuberculosis identified by polymerase chain reaction single-stranded conformational polymorphism.

The use of polymerase chain reaction-single-stranded conformational polymorphism (PCR-SSCP) to study rpoB gene mutations in rifampin-resistant (RIFr) Mycobacterium tuberculosis has yielded contradictory results. To determine the sensitivity of this method, we analyzed 35 RIFr strains and 11 rifampin-susceptible (RIFs) strains, using the DNA sequencing of the core region of rpoB for comparison. Of the RIFr, 24 had a PCR-SSCP pattern identical to that of H37Rv; the other 11 had four different patterns. The 11 RIFs had PCR-SSCP patterns identical to that of H37Rv. The sensitivity of the assay was 31.4%; its specificity was 100%. We observed a strong correlation between the degree of resistance and the type of mutation