Reversal of the hanging protocol of Contrast Enhanced Mammography leads to similar diagnostic performance yet decreased reading times

Objectives: Contrast-enhanced mammography (CEM) was found superior to Full-Field Digital Mammography (FFDM) for breast cancer detection. Current hanging protocols show low-energy (LE, similar to FFDM) images first, followed by recombined (RC) images. However, evidence regarding which hanging protocol leads to the most efficient reading process and highest diagnostic performance is lacking. This study investigates the effects of hanging-protocol ordering on the reading process and diagnostic performance of breast radiologists using eye-tracking methodology. Furthermore, it investigates differences in reading processes and diagnostic performance between LE, RC and FFDM images. Materials and methods: Twenty-seven breast radiologists were randomized into three reading groups: LE–RC (commonly used hangings), RC-LE (reversed hangings) and FFDM. Thirty cases (nine malignant) were used. Fixation count, net dwell time and time-to-first fixation on malignancies as visual search measures were registered by the eye-tracker. Reading time per image was measured. Participants clicked on suspicious lesions to determine sensitivity and specificity. Area-under-the-ROC-curve (AUC) values were calculated. Results: RC-LE scored identical on visual search measures, t(16)= -1.45, p =.17 or higher-p values, decreased reading time with 31%, t(16)= -2.20, p =.04, while scoring similar diagnostic performance compared to LE-RC, t(13.2)= -1.39, p -.20 or higher p-values. The reading process was more efficient on RC compared to LE. Diagnostic performance of CEM was superior to FFDM; F (2,26)= 16.1, p <.001. Average reading time did not differ between the three groups, F (2,25)= 3.15, p =.06. Conclusion: The reversed CEM hanging protocol (RC-LE) scored similar on diagnostic performance compared to LE-RC, while reading time was a third faster. Abnormalities were interpreted quicker on RC images. A RC-LE hanging protocol is therefore recommended for clinical practice and training. Diagnostic performance of CEM was (again) superior to FFDM

Superconducting single photon detectors integrated with diamond nanophotonic circuits

Photonic quantum technologies promise to repeat the success of integrated nanophotonic circuits in non-classical applications. Using linear optical elements, quantum optical computations can be performed with integrated optical circuits and thus allow for overcoming existing limitations in terms of scalability. Besides passive optical devices for realizing photonic quantum gates, active elements such as single photon sources and single photon detectors are essential ingredients for future optical quantum circuits. Material systems which allow for the monolithic integration of all components are particularly attractive, including III-V semiconductors, silicon and also diamond. Here we demonstrate nanophotonic integrated circuits made from high quality polycrystalline diamond thin films in combination with on-chip single photon detectors. Using superconducting nanowires coupled evanescently to travelling waves we achieve high detection efficiencies up to 66 % combined with low dark count rates and timing resolution of 190 ps. Our devices are fully scalable and hold promise for functional diamond photonic quantum devices.Comment: 28 pages, 5 figure

Fibrates for the treatment of cholestatic itch (FITCH): study protocol for a randomized controlled trial

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Ouerbegeleiding — 'n opgawe vir opvoedkundige sielkundigesParental guidance — a task for educational psychologists

Parental guidance within specific educational settings requires distinct emphasis because of parents' unique needs. In order to guide and assist white Afrikaans-speaking Christian parents effectively, it is necessary, firstly, to determine the nature and content of such intervention. This is possible only if the parents' needs regarding the education of their children are known. For this reason, white Afrikaansspeaking Christian parents' needs regarding general educational matters and their need for Christian-based parental guidance on the spiritual education of their children were investigated, with the aim of determining the impact their needs may have in respect of the practice of educational psychology. The data collected indicated that white Afrikaans-speaking Christian parents have a very strong need for guidance regarding the discipline and spiritual education of, and communication with, their children, whilst they appear to have little need for guidance concerning political issues. These findings necessitate that educational psychologists note these parents' strong, weak or divergent parental guidance needs. Educational psychologists should also consider, from the perspective of their field of speciality, which educational matters should be addressed during intervention with these parents, even though these matters are not specifically indicated by the parents as a particular need (such as the political issues). Furthermore, in the event that educational psychologists are not (or do not feel themselves) able to assist these parents on a spiritual level, they should refer them to a Christian counsellor. South African Journal of Education Vol. 26(2) 2006: 319–33

What We Do and Do Not Know about Teaching Medical Image Interpretation

Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation

The Neural Implementation of Surgical Expertise Within the Mirror-Neuron System : An fMRI Study

Motor expertise is an important aspect of high-level performance in professional tasks such as surgery. While recently it has been shown that brain activation as measured by functional magnetic resonance imaging (fMRI) within the mirror-neuron system (MNS) is modulated by expertise in sports and music, little is known about the neural underpinnings of professional, e.g., surgical expertise. Here, we investigated whether and (if so) how surgical expertise is implemented in the MNS in medical professionals across three levels of surgical qualification. In order to answer the more specific research question, namely, if the neural implementation of motor expertise develops in a linear or non-linear fashion, the study compares not only brain activation within the MNS related to action observation of novices and experts, but also intermediates. Ten novices (medical students), ten intermediates (residents in orthopedic surgery) and ten experts (orthopedic surgeons) watched 60 video clips (5 s each) of daily-life activities and surgical procedures each while their brain activation was measured using a 3-T fMRI scanner. An established localization procedure was followed to functionally define the MNS for each participant individually. A 2 (video type: daily-life activities, surgical procedures) × 3 (expertise level: novice, intermediate, expert) ANOVA yielded a non-significant interaction. Furthermore, separate analyses of the precentral and parietal part of the MNS also yielded non-significant interactions. However, post hoc comparisons showed that intermediates displayed marginally significantly lower brain activation in response to surgery-related videos within the MNS than novices. No other significant differences were found. We did not find evidence for the hypothesis that the brain-activation level in the MNS evoked by observing surgical videos reflects the level of surgical expertise in the professional task of (orthopedic) surgery. However, the results suggest a potential non-linear relationship between expertise level and MNS-activation level