Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study

BACKGROUND: Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. METHODS: We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5-15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. FINDINGS: 15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82-0·86). Applying score cutoffs of 3 points or lower for children aged 5-10 years and girls aged 11-15 years, and 2 points or lower for boys aged 11-15 years, the failure rate was 3·3% (95% CI 2·0-5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4-47·2; 521 of 1176), and positive predictive value was 41·4% (38·5-44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4-77·4) was similar to that of ultrasound scan (75·0%, 65·3-83·1). INTERPRETATION: The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. FUNDING: None

Lost in digitization – A systematic review about the diagnostic test accuracy of digital pathology solutions

Introduction Digital pathology solutions are increasingly implemented for primary diagnostics in departments of pathology around the world. This has sparked a growing engagement on validation studies to evaluate the diagnostic performance of whole slide imaging (WSI) regarding safety, reliability, and accuracy. The aim of this review was to evaluate the performance of digital pathology for diagnostic purposes compared to light microscopy (LM) in human pathology, based on validation studies designed to assess such technologies. Methods In this systematic review based on PRISMA guidelines, we analyzed validation studies of WSI compared with LM. We included studies of diagnostic performance of WSI regarding diagnostic test accuracy (DTA) indicators, degree of overdiagnosis, diagnostic concordance, and observer variability as a secondary outcome. Overdiagnosis is (for example) detecting a pathological condition that will either not progress or progress very slowly. Thus, the patient will never get symptoms from this condition and the pathological condition will never be the cause of death. From a search comprising four databases: PubMed, EMBASE, Cochrane Library, and Web of Science, encompassing the period 2010–2021, we selected and screened 12 peer-reviewed articles that fulfilled our selection criteria. Risk of bias was conducted through QUADAS-2 tool, and data analysis and synthesis were performed in a qualitative format. Results We found that diagnostic performance of WSI was not inferior to LM for DTA indicators, concordance, and observer variability. The degree of overdiagnosis was not explicitly reported in any of the studies, while the term itself was used in one study and could be implicitly calculated in another. Conclusion WSI had an overall high diagnostic accuracy based on traditional accuracy measurements; however, the degree of overdiagnosis is unknown

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis.Methods: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis).Results: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67.6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28.2 per cent) than men (120 of 993, 12.1 per cent) (relative risk 2.33, 95 per cent c.i. 1.92 to 2.84; P <0.001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut-off score 8 or less, specificity 63.1 per cent, failure rate 3.7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut-off score 2 or less, specificity 24.7 per cent, failure rate 2.4 per cent).Conclusion: Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision-making by identifying adults in the UK at low risk of appendicitis were identified

Using Global Honeypot Networks to Detect Targeted ICS Attacks

Defending industrial control systems (ICS) in the cyber domain is both helped and hindered by bespoke systems integrating heterogeneous devices for unique purposes. Because of this fragmentation, observed attacks against ICS have been targeted and skilled, making them difficult to identify prior to initiation. Furthermore, organisations may be hesitant to share business-sensitive details of an intrusion that would otherwise assist the security community. In this work, we present the largest study of high-interaction ICS honeypots to date and demonstrate that a network of internet-connected honeypots can be used to identify and profile targeted ICS attacks. Our study relies on a network of 120 high-interaction honeypots in 22 countries that mimic programmable logic controllers and remote terminal units. We provide a detailed analysis of 80,000 interactions over 13 months, of which only nine made malicious use of an industrial protocol. Malicious interactions included denial of service and replay attacks that manipulated logic, leveraged protocol implementation gaps and exploited buffer overflows. While the yield was small, the impact was high, as these were skilled, targeted exploits previously unknown to the ICS community. By comparison with other ICS honeypot studies, we demonstrate that high-quality deception over long periods is necessary for such a honeypot network to be effective. As part of this argument, we discuss the accidental and intentional reasons why an internet-connected honeypot might be targeted. We also provide recommendations for effective, strategic use of such networks.Gates Cambridge Trus

Get a Grip: Evaluating Grip Gestures for VR Input Using a Lightweight Pen

The use of Virtual Reality (VR) in applications such as data analysis, artistic creation, and clinical settings requires high precision input. However, the current design of handheld controllers, where wrist rotation is the primary input approach, does not exploit the human fingers' capability for dexterous movements for high precision pointing and selection. To address this issue, we investigated the characteristics and potential of using a pen as a VR input device. We conducted two studies. The first examined which pen grip allowed the largest range of motion---we found a tripod grip at the rear end of the shaft met this criterion. The second study investigated target selection via 'poking' and ray-casting, where we found the pen grip outperformed the traditional wrist-based input in both cases. Finally, we demonstrate potential applications enabled by VR pen input and grip postures

Autonomous Meridian Sensory Response: from Internet subculture to audiovisual therapy

ASMR (Autonomous Sensory Meridian Response) is the name given to a pleasant sensation that can be felt most commonly on the scalp and can be triggered by various gentle sounds (like whispers, crinkles or tapping), smooth and repetitive visual stimuli, personal attention (like the touch of a hairdresser or a masseur) or other events. ASMR is often associated with a general feeling of relaxation and peace. Whilst academic research on the sociological, artistic, sensory and cognitive dimensions is still in its infancy ASMR has grown into a worldwide, cross-disciplinary, inter-cultural, multi-lingual social media sensation. This paper outlines the rise of ASMR as Internet subculture from its inception as ‘whispering community’ on Internet platforms and blogs, to become a truly popular (i.e. made by the people) platform for creative expression, self-made holistic therapy and in some instances true artistic audiovisual endeavours. This paper comments on the reasons behind the rise of the ASMR community as a fertile ground for creative expression. Audiences’ expectations are dictated by the attention-induced nature of the sensory experience, a factor that spawned an exceptionally perceptive viewership if one considers the inherently fragmented essence of ubiquitous streaming media and the impatient scanning and skipping modes of reception it encourages. ‘ASMRtists’ thus enjoy a privileged relationship with audiences who are not impressed with the relentless pour of energy and information from social media platforms and treasure, instead, the slow, the quiet and the subtle. Examples from various ASMR content creators will be analysed from the compositional standpoint, highlighting technical and idiomatic similarities with forms of improvisatory practices and experimental artistic languages such as Musique Concrète. The paper will also illustrate recent audiovisual projects related to ASMR carried out at Keele University and will introduce the audience to planned developments towards ASMR related content delivered through mobile platforms

Accretion, structure and hydrology of intermediate spreading-rate oceanic crust from drillhole experiments and seafloor observations

Downhole measurements recorded in the context of the Ocean Drilling Program in Hole 504B, the deepest hole drilled yet into the oceanic crust, are analyzed in terms of accretion processes of the upper oceanic crust at intermediate spreading-rate. The upper part of the crust is found to support the non steady-state models of crustal accretion developed from seafloor observations (Kappel and Ryan, 1986; Gente, 1987). The continuous and vertical nature of borehole measurements provides stratigraphic and structural data that cannot be obtained solely from seafloor studies and, in turn, these models define a framework to analyze the structural, hydrological, and mineralogical observations made in the hole over the past decade.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43190/1/11001_2005_Article_BF01204282.pd

Optimizing Scientific Computations with the Sparse Polyhedral Framework

Scientific applications are computationally intensive and require expensive HPC resources. Optimizing scientific applications requires that we balance three competing goals: Performance, Productivity, and Portability. Performance is important because it reduces time to solution and power consumption. However, optimization has the potential to negatively impact scientific productivity due to obfuscating the code. Portable code, code that can be moved to different computers, tends to be slow and difficult to maintain. We propose to automate optimization by using the Sparse Polyhedral Framework as a compiler intermediate representation. In this work, we present SPF-IE, a tool for translating scientific applications from legacy C/C++ code to our internal representation, and present a high-level overview of our internal representation