More scanning, but not zooming, is associated with diagnostic accuracy in evaluating digital breast pathology slides.

Diagnoses of medical images can invite strikingly diverse strategies for image navigation and visual search. In computed tomography screening for lung nodules, distinct strategies, termed scanning and drilling, relate to both radiologists clinical experience and accuracy in lesion detection. Here, we examined associations between search patterns and accuracy for pathologists (N = 92) interpreting a diverse set of breast biopsy images. While changes in depth in volumetric images reveal new structures through movement in the z-plane, in digital pathology changes in depth are associated with increased magnification. Thus, drilling in radiology may be more appropriately termed zooming in pathology. We monitored eye-movements and navigation through digital pathology slides to derive metrics of how quickly the pathologists moved through XY (scanning) and Z (zooming) space. Prior research on eye-movements in depth has categorized clinicians as either scanners or drillers. In contrast, we found that there was no reliable association between a clinicians tendency to scan or zoom while examining digital pathology slides. Thus, in the current work we treated scanning and zooming as continuous predictors rather than categorizing as either a scanner or zoomer. In contrast to prior work in volumetric chest images, we found significant associations between accuracy and scanning rate but not zooming rate. These findings suggest fundamental differences in the relative value of information types and review behaviors across two image formats. Our data suggest that pathologists gather critical information by scanning on a given plane of depth, whereas radiologists drill through depth to interrogate critical features

Rapid development of interprofessional in situ simulation-based training in response to the COVID-19 outbreak in a tertiary-level hospital in Ireland:Initial response and lessons for future disaster preparation.

INTRODUCTION: The first case of COVID-19 in Ireland was diagnosed on 29 February 2020. Within the same week, our Department of Anaesthesia and Critical Care at University Hospital Galway began to tackle the educational challenge by developing an  in situ interprofessional simulation programme to prepare staff for the impending outbreak. PRINCIPLES AND APPROACHES USED FOR SIMULATION-BASED TRAINING: We describe principles applied to identify core educational and system engineering objectives to prepare healthcare workers (HCWs) for infection control, personal and psychological safety, technical and crisis resource management skills. We discuss application of educational theories, rationale for simulation modes and debriefing techniques. DEVELOPMENT OF THE SIMULATION PROGRAMME: 3 anaesthesia (general, obstetric, paediatric) and 1 critical care silo were created. 13 simulated scenarios were developed for teaching as well as for testing workflows specific to the outbreak. To support HCWs and ensure safety, management guidelines, cognitive aids and checklists were developed using simulation. The cumulative number of HCWs trained in simulation was 750 over a 4-week period. CHALLENGES AND FUTURE DIRECTIONS: Due to the protracted nature of the pandemic, simulation educators should address questions related to sustainability, infection control while delivering simulation, establishment of hybrid programmes and support for psychological preparedness

Bimodal Nuclear Thermal Rocket Analysis Developments

Nuclear thermal propulsion has long been considered an enabling technology for human missions to Mars and beyond. One concept of operations for these missions utilizes the nuclear reactor to generate electrical power during coast phases, known as bimodal operation. This presentation focuses on the systems modeling and analysis efforts for a NERVA derived concept. The NERVA bimodal operation derives the thermal energy from the core tie tube elements. Recent analysis has shown potential temperature distributions in the tie tube elements that may limit the thermodynamic efficiency of the closed Brayton cycle used to generate electricity with the current design. The results of this analysis are discussed as well as the potential implications to a bimodal NERVA type reactor

Multicomponent frailty assessment tools for older people with psychiatric disorders: a systematic review

Objective: To review evidence evaluating the use of multi-component frailty assessment tools in assessing frailty in older adults with psychiatric disorders. Methods: A systematic literature review was conducted to identify all multi-component frailty assessment tools (i.e. a tool that assesses ≥2 indicators of frailty). The items of each frailty assessment tool were compared to DSM-5 diagnostic criteria for psychiatric disorders to assess construct overlap. Studies conducted in community, inpatient and outpatient clinical settings were considered for inclusion. Participants: Adults aged ≥60 years old. Results: 5,639 studies in total were identified following the removal of duplicates; 97 of which were included for review. Of the 48 multi-component frailty assessment tools identified, no tool had been developed for, or validated in, older adult populations with psychiatric disorder. 24/48 frailty assessment tools contained a psychological assessment domain, with 18/48 tools using presence of depressed mood and/or anxiety as a frailty indicator. Common areas of construct overlap in frailty assessment tools and DSM-5 diagnostic criteria included weight loss (29/48) and fatigue (21/48). Conclusions: Significant construct overlap exists between the indicators of frailty as conceptualised in existing frailty assessment tools and DSM-5 diagnostic criteria for common psychiatric disorders, including Major Depressive Episode and Generalised Anxiety Disorder, which has the potential to confound frailty assessment results. Further research is necessary to establish a reliable and valid tool to assess frailty in this population

Through the eyes of the expert: Evaluating holistic processing in architects through gaze-contingent viewing

Studies in the psychology of visual expertise have tended to focus on a limited set of expert domains, such as radiology and athletics. Conclusions drawn from these data indicate that experts use parafoveal vision to process images holistically. In this study, we examined a novel, as-of-yet-unstudied class of visual experts—architects—expecting similar results. However, the results indicate that architects, though visual experts, may not employ the holistic processing strategy observed in their previously studied counterparts. Participants (n = 48, 24 architects, 24 naïve) were asked to find targets in chest radiographs and perspective images. All images were presented in both gaze-contingent and normal viewing conditions. Consistent with a holistic processing model, we expected two results: (1) architects would display a greater difference in saccadic amplitude between the gaze- contingent and normal conditions, and (2) architects would spend less time per search than an undergraduate control group. We found that the architects were more accurate in the perspectival task, but they took more time and displayed a lower difference in saccadic amplitude than the controls. Our research indicates a disjunctive conclusion. Either architects are simply different kinds of visual experts than those previously studied, or we have generated a task that employs visual expertise without holistic processing. Our data suggest a healthy skepticism for across-the-board inferences collected from a single domain of expertise to the nature of visual expertise generally. More work is needed to determine whether holism is a feature of all visual expertise

Water Permeability of Asymmetric Planar Lipid Bilayers: Leaflets of Different Composition Offer Independent and Additive Resistances to Permeation

To understand how plasma membranes may limit water flux, we have modeled the apical membrane of MDCK type 1 cells. Previous experiments demonstrated that liposomes designed to mimic the inner and outer leaflet of this membrane exhibited 18-fold lower water permeation for outer leaflet lipids than inner leaflet lipids (Hill, W.G., and M.L. Zeidel. 2000. J. Biol. Chem. 275:30176–30185), confirming that the outer leaflet is the primary barrier to permeation. If leaflets in a bilayer resist permeation independently, the following equation estimates single leaflet permeabilities: 1/PAB = 1/PA + 1/PB (Eq. l), where PAB is the permeability of a bilayer composed of leaflets A and B, PA is the permeability of leaflet A, and PB is the permeability of leaflet B. Using for the MDCK leaflet–specific liposomes gives an estimated value for the osmotic water permeability (Pf) of 4.6 × 10−4 cm/s (at 25°C) that correlated well with experimentally measured values in intact cells. We have now constructed both symmetric and asymmetric planar lipid bilayers that model the MDCK apical membrane. Water permeability across these bilayers was monitored in the immediate membrane vicinity using a Na+-sensitive scanning microelectrode and an osmotic gradient induced by addition of urea. The near-membrane concentration distribution of solute was used to calculate the velocity of water flow (Pohl, P., S.M. Saparov, and Y.N. Antonenko. 1997. Biophys. J. 72:1711–1718). At 36°C, Pf was 3.44 ± 0.35 × 10−3 cm/s for symmetrical inner leaflet membranes and 3.40 ± 0.34 × 10−4 cm/s for symmetrical exofacial membranes. From , the estimated permeability of an asymmetric membrane is 6.2 × 10−4 cm/s. Water permeability measured for the asymmetric planar bilayer was 6.7 ± 0.7 × 10−4 cm/s, which is within 10% of the calculated value. Direct experimental measurement of Pf for an asymmetric planar membrane confirms that leaflets in a bilayer offer independent and additive resistances to water permeation and validates the use of

Use of a choice survey to identify adult, adolescent and parent preferences for vaccination in the United States

Abstract Background Adult and adolescent vaccination rates are far below coverage targets in the United States. Our objective was to identify the most influential factors related to vaccine uptake among adults, adolescents, and parents of adolescents (parents) in the United States. Methods We used a fractional factorial design to create a binary choice survey to evaluate preferences for vaccination. The national survey was fielded to a sample of adults, adolescents ages 13–17 years, and parents, using a national probability-based online research panel in November 2015. Respondents were presented with 5 profiles of a hypothetical vaccine and asked in a series of questions whether they would accept each vaccine. We analyzed the binary choice data using logistic regression in STATA v13 (College Station, TX) to calculate the odds that a participant would choose to accept the vaccine. Results We received completed responses from 334 (51%) of 652 adults, 316 (21%) of 1516 adolescents, and 339 (33%) of 1030 parents. Respondents were generally representative of the U.S. population. Vaccine effectiveness was the most influential factor in the choice to vaccinate for all groups. Other most influential factors were primary care provider (PCP) recommendation and the out-of-pocket cost of the vaccine. Other factors such as risk of illness, risk of vaccine side effects, vaccination location, and time for vaccination were not important in the decision to get vaccinated. Conclusions Adults, adolescents, and parents are most sensitive to vaccine effectiveness, PCP recommendation, and out-of-pocket cost for vaccination in their decision to get vaccinated. Strong PCP recommendations that focus on vaccine effectiveness and health care policies that minimize out-of-pocket costs for vaccinations may increase vaccine uptake by adults and adolescents.https://deepblue.lib.umich.edu/bitstream/2027.42/152264/1/41687_2019_Article_135.pd

Comparison of the efficacy of four drug combinations for immobilization of wild pigs

Field immobilization of native or invasive wild pigs (Sus scrofa) is challenging. Drug combinations commonly used often result in unsatisfactory immobilization, poor recovery, and adverse side effects, leading to unsafe handling conditions for both animals and humans. We compared four chemical immobilization combinations, medetomidine–midazolam–butorphanol (MMB), butorphanol–azaperone–medetomidine (BAM™), nalbuphine–medetomidine–azaperone (NalMed-A), and tiletamine– zolazepam–xylazine (TZX), to determine which drug combinations might provide better chemical immobilization of wild pigs. We achieved adequate immobilization with no post-recovery morbidity withMMB. Adequate immobilization was achieved with BAM™; however, we observed post-recovery morbidity. Both MMB and BAM™ produced more optimal results relative to body temperature, recovery, and post-recovery morbidity and mortality compared to TZX. Adequate immobilization was not achieved with NalMed-A. Of the four drug combinations examined, we conclude that MMB performed most optimally for immobilization and recovery of wild pigs

Self-Assemblage and Quorum in the Earthworm Eisenia fetida (Oligochaete, Lumbricidae)

Despite their ubiquity and ecological significance in temperate ecosystems, the behavioural ecology of earthworms is not well described. This study examines the mechanisms that govern aggregation behaviour specially the tendency of individuals to leave or join groups in the compost earthworm Eisenia fetida, a species with considerable economic importance, especially in waste management applications. Through behavioural assays combined with mathematical modelling, we provide the first evidence of self-assembled social structures in earthworms and describe key mechanisms involved in cluster formation. We found that the probability of an individual joining a group increased with group size, while the probability of leaving decreased. Moreover, attraction to groups located at a distance was observed, suggesting a role for volatile cues in cluster formation. The size of earthworm clusters appears to be a key factor determining the stability of the group. These findings enhance our understanding of intra-specific interactions in earthworms and have potential implications for extraction and collection of earthworms in vermicomposting processes

Reading Redaction: Symptomatic Metadata, Erasure Poetry, and Mark Blacklock’s I’m Jack

In this article, through a reading of Mark Blacklock’s 2015 novel, I’m Jack, alongside the history of erasure poetry, I suggest that an apt literary-critical metaphor for reading redaction in contemporary literature comes from the term “metadata”. The article schematizes the ways in which redaction can work in literary contexts and points to the modalities through which supposedly blank surfaces are, in fact, textured depths that can be read