Evaluation of the impact of artificial intelligence-assisted image interpretation on the diagnostic performance of clinicians in identifying pneumothoraces on plain chest X-ray: a multi-case multi-reader study.

BACKGROUND: Artificial intelligence (AI)-assisted image interpretation is a fast-developing area of clinical innovation. Most research to date has focused on the performance of AI-assisted algorithms in comparison with that of radiologists rather than evaluating the algorithms' impact on the clinicians who often undertake initial image interpretation in routine clinical practice. This study assessed the impact of AI-assisted image interpretation on the diagnostic performance of frontline acute care clinicians for the detection of pneumothoraces (PTX). METHODS: A multicentre blinded multi-case multi-reader study was conducted between October 2021 and January 2022. The online study recruited 18 clinician readers from six different clinical specialties, with differing levels of seniority, across four English hospitals. The study included 395 plain CXR images, 189 positive for PTX and 206 negative. The reference standard was the consensus opinion of two thoracic radiologists with a third acting as arbitrator. General Electric Healthcare Critical Care Suite (GEHC CCS) PTX algorithm was applied to the final dataset. Readers individually interpreted the dataset without AI assistance, recording the presence or absence of a PTX and a confidence rating. Following a 'washout' period, this process was repeated including the AI output. RESULTS: Analysis of the performance of the algorithm for detecting or ruling out a PTX revealed an overall AUROC of 0.939. Overall reader sensitivity increased by 11.4% (95% CI 4.8, 18.0, p=0.002) from 66.8% (95% CI 57.3, 76.2) unaided to 78.1% aided (95% CI 72.2, 84.0, p=0.002), specificity 93.9% (95% CI 90.9, 97.0) without AI to 95.8% (95% CI 93.7, 97.9, p=0.247). The junior reader subgroup showed the largest improvement at 21.7% (95% CI 10.9, 32.6), increasing from 56.0% (95% CI 37.7, 74.3) to 77.7% (95% CI 65.8, 89.7, p<0.01). CONCLUSION: The study indicates that AI-assisted image interpretation significantly enhances the diagnostic accuracy of clinicians in detecting PTX, particularly benefiting less experienced practitioners. While overall interpretation time remained unchanged, the use of AI improved diagnostic confidence and sensitivity, especially among junior clinicians. These findings underscore the potential of AI to support less skilled clinicians in acute care settings.

Practical vs theoretical ethics: A response to Cox.

In the recent article, "Descriptive and Normative Ethical Behavior Appear to be Functionally Distinct," the case was presented for an analysis of ethical conduct based on the Western philosophical approach derived from descriptive and normative ethics (Cox, 2020). The author conducted two experiments with graduate students evaluating whether these two approaches were functionally related. Participants gave forced-choice as well as free responses that were later hand-coded. Cox concluded that descriptive and normative ethics are functionally distinct. A critique of this general approach is offered based on a concern that this approach may not be steering the field in a direction that is ultimately useful for practitioners or relevant in therapeutic settings. Suggestions for future directions for practical ethical research are offered which, we might hope, should provide us with a better understanding of the variables controlling ethical conduct in practical situations.

Prolonged unconsciousness in perampanel overdose.

Clinical experience of perampanel overdoses is markedly limited and the relevant literature is sparse. Perampanel is a novel antiepileptic drug (an amino-3-hydroxy-5-methyl-4-isoxazlepropionic acid glutamate receptor antagonist) with a long half-life, which is used for the adjunctive treatment of epilepsy. The literature available identifies a potential for prolonged unconsciousness in overdose. We report a case of prolonged unconsciousness for 14 days following a perampanel overdose of 3.5 times the maximum daily dose, requiring protracted intubation and ventilation on intensive care, with eventual complete neurological recovery. This represents the longest known period of unconsciousness with full recovery and the first reported in a perampanel naïve patient. This case helps to inform decision-making in critical care, particularly the early consideration of admission and intubation. It highlights that while perampanel overdose may not initially cause systemic effects such as cardiac toxicity, it can cause protracted altered consciousness with secondary compromise requiring prolonged intensive care management.

Antibiotic use among older adults on an acute care general surgery service.

BACKGROUND: Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital. METHODS: Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines. RESULTS: During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. CONCLUSION: Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.

CONTEXTE: Les antibiotiques jouent un rôle important dans de nombreux cas de chirurgie chez les adultes âgés, et le risque d'utilisation inappropriée de ces médicaments est élevé. Notre objectif était de décrire l'utilisation des antibiotiques chez les patients âgés admis au service chirurgical d'urgence d'un centre hospitalier universitaire de soins tertiaires. MÉTHODES: Nous avons recueilli de manière rétrospective les données détaillées sur le diagnostic, les comorbidités, la chirurgie et l'utilisation d'antibiotiques chez les patients de 70 ans et plus admis dans un service chirurgical d'urgence. Nous avons évalué le bien-fondé du recours aux antibiotiques (prophylaxie et traitement périopératoire) en fonction des lignes directrices publiées. RÉSULTATS: Durant la période de l'étude, 453 patients ont été admis au service chirurgical d'urgence et 229 ont subi une chirurgie. Les diagnostics les plus fréquents étaient : occlusion de l'intestin grêle (27,2 %) et cholécystite aigüe (11,0 %). En tout, 251 interventions abdominales urgentes ont été effectuées et l'antibioprophylaxie périopératoire était justifiée dans 49,5 % des cas. Les erreurs les plus fréquentes en matière de prophylaxie ont été : moment mal choisi (15,5 %) et dose incorrecte (12,4 %). En tout, 206 patients ont reçu une antibiothérapie pour un processus pathologique sous-jacent et 44,2 % ont reçu un traitement antibiotique de première intention approprié. Les erreurs thérapeutiques les plus fréquentes concernaient l'administration d'antibiotiques de deuxième ou de troisième intention sans indication (37,9 %) et l'utilisation d'antibiotiques lorsque cela n'était pas indiqué (12,1 %). On a noté une variation considérable de la durée des traitements chez des patients porteurs de diagnostics semblables. CONCLUSION: L'utilisation inappropriée des antibiotiques a été fréquente chez les patients adultes admis dans un service chirurgical d'urgence. Des initiatives s'imposent sur le plan de l'amélioration de la qualité pour s'assurer ainsi que les patients reçoivent des soins optimaux dans cet environnement hospitalier complexe.

What shape do UK trainees want their training to be? Results of a cross-sectional study.

OBJECTIVES: The British Government is acting on recommendations to overhaul postgraduate training to meet the needs of the changing population, to produce generalist doctors undergoing shorter broad-based training (Greenaway Review). Only 45 doctors in training were involved in the consultation process. This study aims to obtain a focused perspective on the proposed reforms by doctors in training from across specialities. DESIGN: Prospective, questionnaire-based cross-sectional study. SETTING/PARTICIPANTS: Following validation, a 31-item electronic questionnaire was distributed via trainee organisations and Postgraduate Local Education and Training Board (LETB) mailing lists. Throughout the 10-week study period, the survey was publicised on several social media platforms. RESULTS: Of the 3603 demographically representative respondents, 69% knew about proposed changes. Of the respondents, 73% expressed a desire to specialise, with 54% keen to provide general emergency cover. A small proportion (12%) stated that current training pathway length is too long, although 86% felt that it is impossible to achieve independent practitioner-level proficiency in a shorter period of time than is currently required. Opinions regarding credentialing were mixed, but tended towards disagreement. The vast majority (97%) felt credentialing should not be funded by doctors in training. Respondents preferred longer placement lengths with increasing career progression. Doctors in training value early generalised training (65%), with suggestions for further improvement. CONCLUSIONS: This is the first large-scale cross-specialty study regarding the Shape of Training Review. Although there are recommendations which trainees support, it is clear that one size does not fit all. Most trainees are keen to provide a specialist service on an emergency generalist background. Credentialing is a contentious issue; however, we believe removing aspects from curricula into post-Certificate of Completion of Training (CCT) credentialing programmes with shortened specialty training routes only degrades the current consultant expertise, and does not serve the population. Educational needs, not political winds, should drive changes in postgraduate medical education and all stakeholders should be involved.

B→πll Form Factors for New Physics Searches from Lattice QCD.

The rare decay B→πℓ^{+}ℓ^{-} arises from b→d flavor-changing neutral currents and could be sensitive to physics beyond the standard model. Here, we present the first ab initio QCD calculation of the B→π tensor form factor f_{T}. Together with the vector and scalar form factors f_{+} and f_{0} from our companion work [J. A. Bailey et al., Phys. Rev. D 92, 014024 (2015)], these parametrize the hadronic contribution to B→π semileptonic decays in any extension of the standard model. We obtain the total branching ratio BR(B^{+}→π^{+}µ^{+}µ^{-})=20.4(2.1)×10^{-9} in the standard model, which is the most precise theoretical determination to date, and agrees with the recent measurement from the LHCb experiment [R. Aaij et al., J. High Energy Phys. 12 (2012) 125].

A novel solid-state fractionation of naphthenic acid fraction components from oil sands process-affected water.

Various sorbent materials were evaluated for the fractionation of naphthenic acid fraction components (NAFCs) from oil sand process-affected water (OSPW). The solid phase materials include activated carbon (AC), cellulose, iron oxides (magnetite and goethite), polyaniline (PANI) and three types of biochar derived from biomass (BC-1; rice husks, BC-2; acacia low temperature and BC-3; acacia high temperature). NAFCs were semi-quantified using electrospray ionization high resolution Orbitrap mass spectrometry (ESI-MS) and the metals were assessed by inductively coupled plasma optical emission spectrometry (ICP-OES). The average removal efficacy of NAFCs by AC was 95%. The removal efficacy decreased in the following order: AC, BC-1>BC-2, BC-3, goethite>PANI>cellulose, magnetite. The removal of metals did not follow a clear trend; however, there was notable leaching of potassium by AC and biochar samples. The bound NAFCs by AC were desorbed efficiently with methanol. Methanol regeneration and recycling of AC revealed 88% removal on the fourth cycle; a 4.4% decrease from the first cycle. This fractionation method represents a rapid, cost-effective, efficient, and green strategy for NAFCs from OSPW, as compared with conventional solvent extraction.

Improving turnout in university dancers.

A high degree of turnout is desired by many dancers. Turnout enables the efficient transfer of weight, allows for greater extension and control, and reduces injury risk when used correctly. The purpose of this study was to determine whether participation in a targeted training program beyond technique classes would improve university dancers' ability to use a greater proportion of the turnout their bodies could accommodate without compensation. Six dancers' ability to produce turnout without distorting their alignment was assessed daily, and a multiple baseline experimental design was used to measure the effects of turnout training. Results showed an average increase of 14° in Total Active Turnout (TAT) for all six dancers. In addition, a dance teacher with special experience in the dance sciences rated all of the dancers as showing better control of turnout while performing an adagio phrase following training than before training. These findings suggest that targeted training may offer a useful approach to helping dancers improve skills that enhance performance and promote good health.

Removal of dicyclohexyl acetic acid from aqueous solution using ultrasound, ozone and their combination.

Naphthenic acids are a complex mixture of organic components, some of which include saturated alkyl-substituted cycloaliphatic carboxylic acids and acyclic aliphatic acids. They are naturally found in hydrocarbon deposits like oil sand, petroleum, bitumen and crude oil. In this study, the oxidation of a relatively high molecular weight naphthenic acid (Dicyclohexyl acetic acid) was investigated using ozonation, ultrasonication and hydrogen peroxide alone and their combinations. Effects on oxidation of dicyclohexyl acetic acid (DAA) were measured for different concentrations of ozone ranging between 0.7 to 3.3 mg L(-1) and pH in the range 6 to 10. Ultrasonication and hydrogen peroxide alone were not effective to oxidize dicyclohexyl acetic acid, but combining ultrasonication with H2O2 had a significant effect on oxidation of dicyclohexyl acetic acid with maximum removal reaching to 84 ± 2.2% with 81 ± 2.1% reduction in chemical oxygen demand (COD). Synergistic effects were observed for combining ultrasonication with ozonation and resulted in 100% DAA removal with 98 ± 0.8% reduction in COD within 15 min at 3.3 mg L(-1) ozone concentration and 130 Watts ultrasonication power. The reaction conditions obtained for the maximum oxidation of DAA and COD removal were used for the degradation of naphthenic acids mixture extracted from oil sands process water (OSPW). The percentage oxidation of NAs mixture extracted from OSPW was 89.3 ± 1.1% in ozonation and combined ozonation and ultrasonication, but COD removal observed was 65 ± 1.2% and 78 ± 1.4% for ozonation and combined ozonation and ultrasonication treatments, respectively.

Refining new-physics searches in B→Dτν with lattice QCD.

The semileptonic decay channel B→Dτν is sensitive to the presence of a scalar current, such as that mediated by a charged-Higgs boson. Recently, the BABAR experiment reported the first observation of the exclusive semileptonic decay B→Dτ(-)ν, finding an approximately 2σ disagreement with the standard-model prediction for the ratio R(D)=BR(B→Dτν)/BR(B→Dℓν), where ℓ = e,µ. We compute this ratio of branching fractions using hadronic form factors computed in unquenched lattice QCD and obtain R(D)=0.316(12)(7), where the errors are statistical and total systematic, respectively. This result is the first standard-model calculation of R(D) from ab initio full QCD. Its error is smaller than that of previous estimates, primarily due to the reduced uncertainty in the scalar form factor f(0)(q(2)). Our determination of R(D) is approximately 1σ higher than previous estimates and, thus, reduces the tension with experiment. We also compute R(D) in models with electrically charged scalar exchange, such as the type-II two-Higgs-doublet model. Once again, our result is consistent with, but approximately 1σ higher than, previous estimates for phenomenologically relevant values of the scalar coupling in the type-II model. As a by-product of our calculation, we also present the standard-model prediction for the longitudinal-polarization ratio P(L)(D)=0.325(4)(3).

The association for behavior analysis international position statement on restraint and seclusion.

A task force authorized by the Executive Council of the Association for Behavior Analysis International (ABAI) generated the statement below concerning the techniques called restraint and seclusion. Members of the task force independently reviewed the scientific literature concerning restraint and seclusion and agreed unanimously to the content of the statement. The Executive Council accepted the statement, and it was subsequently approved by a two-thirds majority vote of the general membership. It now constitutes official ABAI policy. The position statement is posted on the ABAI Web site (www.abainternational.org/ABA/statements/RestraintSeclusion.asp). The purpose of the position statement is to provide guidance to behavior analysts and other professionals interested in the position of ABAI on these controversial topics. In extreme cases, abuses of procedures erroneously used in the name of behavior analysis are not defensible. On the other hand, behavior analysts acting ethically and in good faith are provided with guidelines for sound and acceptably safe practice. To the extent that behavior-analytic positions influence public policy and law, this statement can be presented to officials and lawmakers to guide informed decision making. At the conclusion of the document, a bibliography is provided of articles and presentations considered by one or more task force members in developing the position statement.

An analysis of a contingency program on designated drivers at a college bar.

The present study evaluated the effects of prompts and incentives on designated drivers in a bar. We defined the dependent variable as the percentage of customers either functioning as or riding with a designated driver. We used an ABCA design to evaluate the effectiveness of prompts and incentives on the dependent variable. Results indicated that the intervention was successful at increasing the ratio of safe to unsafe passengers in a bar.

A review of empirical support for differential reinforcement of alternative behavior.

Differential reinforcement of alternative behavior (DRA) is one of the most common behavior analytic interventions used to decrease unwanted behavior. We reviewed the DRA literature from the past 30 years to identify the aspects that are thoroughly researched and those that would benefit from further emphasis. We found and coded 116 empirical studies that used DRA, later grouping them into categories that met APA Division 12 Task Force criteria. We found that DRA has been successful at reducing behaviors on a continuum from relatively minor problems like prelinguistic communication to life-threatening failure to thrive. DRA with and without extinction is well established for treating destructive behavior of those with developmental disabilities, and to combat food refusal.

Comparing main and collateral effects of extinction and differential reinforcement of alternative behavior.

This study evaluated the effects and collateral effects of extinction (EXT) and differential reinforcement of alternative behavior (DRA) interventions with inappropriate vocalizations and work refusal. Both interventions have been used frequently to reduce problem behaviors. The benefits of these interventions have been established yet may be outweighed by the reported negative side effects that result. However, these collateral effects have rarely been measured or reported. DRA produced the most rapid reductions in behavior for 4 of the 5 participants. Other behaviors were measured for changes and showed that the desirable collateral effect of academic engagement tended to be higher during EXT than DRA. No evidence of EXT bursts was present with any participant, although EXT-induced aggression occurred with 1 participant.

Effects of training, prompting, and self-monitoring on staff behavior in a classroom for students with disabilities.

This study extended the limited research on the utility of tactile prompts and examined the effects of a treatment package on implementation of a token economy by instructional assistants in a classroom for students with disabilities. During baseline, we measured how accurately the assistants implemented a classroom token economy based on the routine training they had received through the school system. Baseline was followed by brief in-service training, which resulted in no improvement of token-economy implementation for recently hired instructional assistants. A treatment package of prompting and self-monitoring with accuracy feedback was then introduced as a multiple baseline design across behaviors. The treatment package was successfully faded to a more manageable self-monitoring intervention. Results showed visually significant improvements for all participants during observation sessions.

Enhancing frequency recording by developmental disabilities treatment staff.

We evaluated a staff training and management package for increasing accuracy of recording frequency of problem behavior in a residential care facility. A multiple baseline design across the first and second work shifts showed that 2 of 8 participants increased their accuracy following in-service training, and all 8 improved during a condition with supervisor presence and feedback. Improvements were maintained when feedback was removed and generalized to activity periods when neither supervisor presence nor feedback was provided. Other staff behavior was not adversely affected by the intervention package.

The effects of celeration lines on visual data analysis.

Previous visual analysis research reported that the overall agreement between visual analysis and statistical analysis was poor. In response, some researchers suggested the use of celeration lines to improve the accuracy and reliability of visual analysis. However, subsequent research reported little or no improvement in accuracy with such lines. The present study presented 5 board-certified behavior analysts with a series of behavioral graphs. The participants were asked to answer questions similar to those posed in previous studies but were also asked to talk aloud as they viewed each graph. Results indicate that the participants made accurate decisions for only 72% of the graphs and that celeration lines did not improve overall accuracy. The verbal protocol analysis suggests that participants were as likely to attend to trend when celeration lines were absent as they were when they were present, with the most differences attributable to varying participant competencies and not graph (i.e., celeration line) characteristics.