How Anchoring Can Sink The Ship

Introduction: Anchoring bias is a type of heuristic that uses an initial source of information as an “anchor” for basis of decision making. Then judgments and thought processes are led by this sole foundation. There are many different types of influences and bias used in medical decision making, which has prompted concerns regarding their impact on diagnostic inaccuracies. Studies have identified “anchoring” conducted in medical literature, clinical vignettes and real life scenarios. These cognitive bias and aversions to ambiguities can lead to medical errors, inappropriate use of resources, and harm to the patient. We focus our case on the effects of anchoring diagnosis. Case Report: We describe a case of a 29 year old male with past medical history significant of chronic headaches, who presented to the emergency department from home via police escort for suspected polysubstance overdose. Police were called for questionable seizure and medication overdose. They were unsure what medications the patient took. The patient stated taking an unknown amount of prescribed clonazepam, sumatriptan and ibuprofen. He was unable to provide the timing or amount of ingestion. Physical exam was positive for confusion, bradycardia and hypertension. Urine drug screen was positive for amphetamine, benzodiazepine and cannabinoids. A few hours later the patient continued to appear drowsy with intermittent agitation requiring soft restraints. On hospital day 1, he was noted to be very lethargic, unresponsive and hypoxic on room air. Code blue was called and patient was intubated and transferred to the ICU. Upon reexamination, the patient’s pupils were dilated and fixed. Subsequent CT head showed a large 10 cm hyperdense right frontal lobe mass with resultant uncal herniation and severe hydrocephalus. This was suspicious for meningioma or tumor. After successful contact with the family and getting a history from the mother, she reported significant personality changes, increasingly odd behaviors, memory loss, worsened headaches and gait disturbances over multiple years. The mother had assumed the patient was using drugs. She also confirmed the number of pills left in the prescription bottles was accurate. At this point, the patient was transferred to a tertiary hospital for escalation of care and neurosurgical intervention where he ultimately died. Conclusion: We present a unique case of acute metabolic encephalopathy impacted by anchoring diagnosis of drug overdose that later confirmed a diagnosis of brain tumor. If we had spent more time obtaining all the facts, we could have gotten a CT head and arrived at a diagnosis before the patient herniated. Inability to recognize cognitive bias, runs the risk of diagnostic inaccuracies, unnecessary prescribed medications and underestimation of testing. More importantly, addressing anchoring allows the opportunity to decrease patient harm, guide future occurrences and tailor research towards minimizing these outcomes.https://scholarlycommons.henryford.com/merf2020caserpt/1107/thumbnail.jp

Oligohydramnios and its perinatal outcome

Background: Oligohydramnios is one of the major causes of perinatal morbidity and mortality. The sonographic diagnosis of oligohydramnios is usually based on an AFI≤5 cm or on a single deepest pocket of amniotic fluid≤2 cm3. Our study was aimed to study the perinatal outcome in oligohydramnios. Aim and objective were to study obstetric risk factors associated with oligohydramnios and maternal outcome in the form of mode of delivery, and to assess neonatal complications in terms of APGAR score at birth, NICU admission rates, meconium stained liquor and still birth rates.Methods: It was an Observational, Prospective, clinical study of 100 pregnant patients diagnosed with oligohydramnios by ultrasound, carried out in Geetanjali medical college and hospital, Udaipur for period of from January 2020-August 2020. The study was conducted after ethical clearance and with informed consent. Detailed history on demographic profile, medical illness, obstetric history and antenatal complication if any in the present pregnancy; general examination, obstetric examination and bimanual examination were performed meticulously.Results: In our study 53% cases of oligohydramnios were associated with some of the risk factors like PIH (29%), IUGR (22%), fetal anomaly (1%), systemic maternal disease (1%) and 47% of the cases were Idiopathic. LSCS was done in 85.71% cases with AFI<5 cm. Low birth weight was found in 51.43% cases with AFI<5 cm. NICU admission was required for 28.57% cases with AFI<5 cm.Conclusions: AFI is an important and convenient screening test for prediction of perinatal outcome. In presence of oligohydramnios, the risk of fetal distress, operative delivery, low Apgar score, low birth weight, perinatal morbidity and mortality are more. Hence early detection of oligohydramnios, associated antenatal risk factors and timely management can improve the maternal and fetal outcome

Association between falls in elderly women and chronic diseases and drug use: cross sectional study.

OBJECTIVE: To assess the associations between having had a fall and chronic diseases and drug use in elderly women. DESIGN: Cross sectional survey, using data from the British women's heart and health study. SETTING: General practices in 23 towns in Great Britain. PARTICIPANTS: 4050 women aged 60-79 years. MAIN OUTCOME MEASURE: Whether women had had falls in the previous 12 months. RESULTS: The prevalence of falling increased with increasing numbers of simultaneously occurring chronic diseases. However, no such relation with falling was found in the fully adjusted data for the number of drugs used. Circulatory disease, chronic obstructive pulmonary disease, depression, and arthritis were all associated with an increased odds of falling. The fully adjusted, population attributable risk of falling associated with having at least one chronic disease was 32.2% (95% confidence interval 19.6% to 42.8%). Only two classes of drugs (hypnotics and anxiolytics, and antidepressants) were independently associated with an increased odds of falling. Each class was associated with an increase of about 50% in the odds of falling, and each had a population attributable risk of < 5%. CONCLUSION: Chronic diseases and multiple pathology are more important predictors of falling than polypharmacy

The Impact of Math Teachers’ Circles on Teacher Dispositions toward Inquiry-based Learning: A Comparison between a Three-day and a One-day Summer Workshop

High-quality professional development for K-12 teachers is a critical need for both teachers and their students. For teachers to provide more engaging and powerful learning opportunities for their students, researchers suggest that we provide similar opportunities for teachers. That is, professional development should model high-impact instructional strategies. Math Teachers\u27 Circles provide one such model for this type of training. In this paper, we discuss the impact on participants of a one-day and participants of a three-day Math Teachers\u27 Circle workshop. In particular, we compare how teacher dispositions regarding the teaching of mathematics and inquiry-based learning changed between the workshops

Effects of Vocal Fold Nodules on Glottal Cycle Measurements Derived from High-Speed Videoendoscopy in Children

The goal of this study is to quantify the effects of vocal fold nodules on vibratory motion in children using high-speed videoendoscopy. Differences in vibratory motion were evaluated in 20 children with vocal fold nodules (5–11 years) and 20 age and gender matched typically developing children (5–11 years) during sustained phonation at typical pitch and loudness. Normalized kinematic features of vocal fold displacements from the mid-membranous vocal fold point were extracted from the steady-state high-speed video. A total of 12 kinematic features representing spatial and temporal characteristics of vibratory motion were calculated. Average values and standard deviations (cycle-to-cycle variability) of the following kinematic features were computed: normalized peak displacement, normalized average opening velocity, normalized average closing velocity, normalized peak closing velocity, speed quotient, and open quotient. Group differences between children with and without vocal fold nodules were statistically investigated. While a moderate effect size was observed for the spatial feature of speed quotient, and the temporal feature of normalized average closing velocity in children with nodules compared to vocally normal children, none of the features were statistically significant between the groups after Bonferroni correction. The kinematic analysis of the mid-membranous vocal fold displacement revealed that children with nodules primarily differ from typically developing children in closing phase kinematics of the glottal cycle, whereas the opening phase kinematics are similar. Higher speed quotients and similar opening phase velocities suggest greater relative forces are acting on vocal fold in the closing phase. These findings suggest that future large-scale studies should focus on spatial and temporal features related to the closing phase of the glottal cycle for differentiating the kinematics of children with and without vocal fold nodules

The Effects of Alloying Elements and Exposure Atmospheres on Sigma Formation in Ferritic Alloys

Tests were performed on a variety of model and commercial ferritic steels in simulated cathode and anode environments of an intermediate temperature solid oxide fuel cell (SOFC). The alloys were picked for their similarity to currently used interconnect materials. Results from the test provide inside into the effect of exposure atmospheres and alloying elements on the nucleation and growth of sigma phase in the ferritic alloys. Two possible mechanisms for sigma phase transformation were discussed, but the exact method was not able to be determined based on the results shown. The cathode environment was simulated by either using dry laboratory air, or in the case of a pipe-sealant leak in the SOFC, dry air with 10% water vapor at 700 °C. Three model alloys were tested in these environments to determine the effect of water vapor and alloying elements on the nucleation and growth of sigma phase. It was confirmed that molybdenum is a sigma phase promoter and allows for the nucleation and growth to occur. The presence of water vapor in the exposure environment caused an increased amount of sigma phase formation, although the exact reason why remains unknown. The anode environment was simulated by using an Ar-4%H2-10%H2O gas-water vapor mixture at 700 °C. A variety of model alloys and commercial alloys were tested in this environment. To simulate the effect of a nickel mesh touching the interconnect in the SOFC cell, nickel was electroplated onto some specimens prior to exposure. The pre-coat of nickel caused the formation of an austenitic interdiffusion zone in all alloys, and in all but the low-Cr alloy, this also lead to the formation of sigma phase. Two possible mechanisms for sigma phase formation were suggested. The first is that the ferrite phase decomposed directly into austenite and sigma phase. The second is that the ferrite phase first transformed into austenite, which then transformed into sigma phase. Neither method could be confirmed based on the results obtained