Promoting Artificial Intelligence for Global Breast Cancer Risk Prediction and Screening in Adult Women: A Scoping Review.

Background: Artificial intelligence (AI) algorithms can be applied in breast cancer risk prediction and prevention by using patient history, scans, imaging information, and analysis of specific genes for cancer classification to reduce overdiagnosis and overtreatment. This scoping review aimed to identify the barriers encountered in applying innovative AI techniques and models in developing breast cancer risk prediction scores and promoting screening behaviors among adult females. Findings may inform and guide future global recommendations for AI application in breast cancer prevention and care for female populations. Methods: The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results. Results: In the field of breast cancer risk detection and prevention, the following AI techniques and models have been applied: Machine and Deep Learning Model (ML-DL model) (n = 1), Academic Algorithms (n = 2), Breast Cancer Surveillance Consortium (BCSC), Clinical 5-Year Risk Prediction Model (n = 2), deep-learning computer vision AI algorithms (n = 2), AI-based thermal imaging solution (Thermalytix) (n = 1), RealRisks (n = 2), Breast Cancer Risk NAVIgation (n = 1), MammoRisk (ML-Based Tool) (n = 1), Various MLModels (n = 1), and various machine/deep learning, decision aids, and commercial algorithms (n = 7). In the 11 included studies, a total of 39 barriers to AI applications in breast cancer risk prediction and screening efforts were identified. The most common barriers in the application of innovative AI tools for breast cancer prediction and improved screening rates included lack of external validity and limited generalizability (n = 6), as AI was used in studies with either a small sample size or datasets with missing data. Many studies (n = 5) also encountered selection bias due to exclusion of certain populations based on characteristics such as race/ethnicity, family history, or past medical history. Several recommendations for future research should be considered. AI models need to include a broader spectrum and more complete predictive variables for risk assessment. Investigating long-term outcomes with improved follow-up periods is critical to assess the impacts of AI on clinical decisions beyond just the immediate outcomes. Utilizing AI to improve communication strategies at both a local and organizational level can assist in informed decision-making and compliance, especially in populations with limited literacy levels. Conclusions: The use of AI in patient education and as an adjunctive tool for providers is still early in its incorporation, and future research should explore the implementation of AI-driven resources to enhance understanding and decision-making regarding breast cancer screening, especially in vulnerable populations with limited literacy.

The Association Between Catheter Type and Dialysis Treatment: A Retrospective Data Analysis at Two U.S.-Based ICUs.

Dialysis catheter type may be associated with differences in continuous renal replacement therapy (CRRT) treatment in the critically ill, with potential implications for patient outcomes and healthcare costs. OBJECTIVES: To evaluate the association between the catheter type and multiple dialysis treatment outcomes among the critically ill. DESIGN: Retrospective, observational study. SETTING: Two U.S.-based ICUs. PARTICIPANTS: Critically ill patients receiving CRRT between April 1, 2018, and July 1, 2020. A total of 1,037 CRRT sessions were analyzed. MAIN OUTCOMES AND MEASURES: Circuit life, alarm interruption frequency (including a subset of vascular access [VA]-related alarms), termination type (elective vs nonelective), and blood flow rates. Pre- (n = 530) and post-catheter change (n = 507) periods were assessed, and the post-change period was further divided into intervals of pre-COVID (n = 167) and COVID contemporaneous (n = 340) to account for the pandemic's impact. RESULTS: Compared with pre-change sessions, post-change sessions had 31% longer circuit life (95% CI, 1.14-1.49; p < 0.001), 3% higher blood flow rate (1.01-1.05; p < 0.01), and lower proportion of nonelective terminations (adjusted odds ratio [OR], 0.42 [0.28-0.62]; p < 0.001). There were fewer interruptions for all alarms (adjusted count ratio, 0.95 [0.87-1.05]; p = 0.31) and VA-related alarms (0.80 [0.66-0.96]; p = 0.014). The sessions during COVID period were statistically similar to pre-COVID sessions for all outcomes except a lower proportion of nonelective terminations (adjusted OR, 0.39 [0.22-0.70]; p < 0.01). CONCLUSIONS: A change in catheter type was associated with longer CRRT sessions with fewer interruptions and unexpected terminations in a population of critical patients.

Rupture of an ascending and descending thoracic aortic aneurysm causing tension hemothorax: a case report.

BACKGROUND: A ruptured thoracic aortic aneurysm is a life-threatening condition and can lead to a tension hemothorax. OBJECTIVES: To describe the presentation and management of a case of a tension hemothorax. CASE REPORT: An 84-year-old woman presented in respiratory distress and was found to have a tension hemothorax. The cause was the rupture of an ascending and descending thoracic aortic aneurysm. She was managed with intubation, mechanical ventilation, and chest tube placement with stabilization. Definitive operative repair was deferred due to the patient's comorbidities and wishes of the family. CONCLUSIONS/SUMMARY: A tension hemothorax can result from an ascending and descending thoracic aneurysm, as this case describes. Emergent therapy is necessary as this is a life-threatening condition.

Terrain park injuries.

BACKGROUND: This study examined demographics, injury pattern, and hospital outcome in patients injured in winter resort terrain parks. METHODS: The study included patients >/=12 years of age who presented to a regional trauma center with an acute injury sustained at a winter resort. Emergency department (ED) research assistants collected patient injury and helmet use information using a prospectively designed questionnaire. ED and hospital data were obtained from trauma registry and hospital records. RESULTS: Seventy-two patients were injured in a terrain park, and 263 patients were injured on non-terrain park slopes. Patients injured in terrain parks were more likely to be male [68/72 (94%) vs. 176/263 (67%), p<0.0001], younger in age [23 +/- 7 vs. 36 +/- 17, p<0.0001], live locally [47/72 (65%) vs. 124/263 (47%), p=0.006], use a snowboard [50/72 (69%) vs. 91/263 (35%), p<0.0001], hold a season pass [46/66 (70%) vs. 98/253 (39%), p<0.0001], and sustain an upper extremity injury [29/72 (40%) vs. 52/263 (20%), p<0.001] when compared to patients injured on non-terrain park slopes. There were no differences between the groups in terms of EMS transport to hospital, helmet use, admission rate, hospital length of stay, and patients requiring specialty consultation in the ED. CONCLUSIONS: Patients injured in terrain parks represent a unique demographic within winter resort patrons. Injury severity appears to be similar to those patients injured on non-terrain park slopes.

Asymmetric synthesis of corsifuran A by an enantioselective oxazaborolidine reduction.

Corsifuran A has been prepared in an enantiomerically pure form for the first time by an asymmetric reduction procedure, allowing confirmation of the absolute stereochemistry of the natural product as (R).

Synthetic applicability and in situ recycling of a B-methoxy oxazaborolidine catalyst derived from cis-1-amino-indan-2-ol.

A procedure is described that greatly simplifies the use of an oxazaborolidine catalyst derived from (1R,2S) cis-1-amino-indan-2-ol. This B-OMe catalyst has been employed in the asymmetric reduction of a number of structurally diverse prochiral ketones, in particular the reduction of alpha-amino acetophenone and its derivatives. A method for reducing the effective catalyst loading by "in situ recycling" is also presented. [structure: see text]