Opioid and Antimicrobial Prescription Patterns During Emergency Medicine Encounters Among Uninsured Patients.

The purpose of this study was to characterize opioid and antimicrobial prescribing among uninsured patients seeking emergency medical care and to build predictive machine learning models. Uninsured patients were less likely to receive an opioid medication, more likely to receive non-opioid alternatives, and less likely to receive an antimicrobial prescription. The most impactful contributing factors were housing status, comorbidities, and recidivism.

Exploring the Clinical Translation of Generative Models Like ChatGPT: Promise and Pitfalls in Radiology, From Patients to Population Health.

Generative artificial intelligence (AI) tools such as GPT-4, and the chatbot interface ChatGPT, show promise for a variety of applications in radiology and health care. However, like other AI tools, ChatGPT has limitations and potential pitfalls that must be considered before adopting it for teaching, clinical practice, and beyond. We summarize five major emerging use cases for ChatGPT and generative AI in radiology across the levels of increasing data complexity, along with pitfalls associated with each. As the use of AI in health care continues to grow, it is crucial for radiologists (and all physicians) to stay informed and ensure the safe translation of these new technologies.

Rates and Outcomes of Breast Lesions of Uncertain Malignant Potential (B3) benchmarked against the National Breast Screening Pathology Audit; Improving Performance in a High Volume Screening Unit.

INTRODUCTION: Our breast screening unit was identified as high outlier for B3 lesions with a low positive predictive value (PPV) compared to the England average. This prompted a detailed internal audit and review of B3 lesions and their outcomes to identify causes and address any variation in practice. PATIENTS AND METHODS: The B3 rate was calculated in 4168 breast core biopsies from 2019, using the subsequent excision to determine the PPV. Atypical intraductal epithelial proliferation (AIDEP) cases were subject to microscopic review to reassess the presence of atypia against published criteria. The B3 rate was re-audited in 2021, and the results compared. RESULTS: Screening cases had a high B3 rate of 12.4% (30% above the national average), and a PPV of 7.7% (9.7% with atypia). AIDEP was identified as a possible cause of this outlier status. On review and by consensus, AIDEP was confirmed in only 66% of cases reported as such, 17% were downgraded, and 16% did not reach consensus, the latter highlighting the difficulty and subjectivity in diagnosis of these lesions. Repeat audit of B3 rates after this extended review revealed a reduction from 12.4% to 9.11%, which is more in line with national standards. CONCLUSION: Benchmarking against national reporting standards is critical for service improvement. Through a supportive environment, team working, rigorous internal review and adherence to guidelines, interobserver variation and outlier status in breast pathology screening outliers can both be addressed. This study can serve as a model to other outlier units to identify and tackle underlying causes.

A Policy-Driven Approach to Secure Extraction of COVID-19 Data From Research Papers.

The entire scientific and academic community has been mobilized to gain a better understanding of the COVID-19 disease and its impact on humanity. Most research related to COVID-19 needs to analyze large amounts of data in very little time. This urgency has made Big Data Analysis, and related questions around the privacy and security of the data, an extremely important part of research in the COVID-19 era. The White House OSTP has, for example, released a large dataset of papers related to COVID research from which the research community can extract knowledge and information. We show an example system with a machine learning-based knowledge extractor which draws out key medical information from COVID-19 related academic research papers. We represent this knowledge in a Knowledge Graph that uses the Unified Medical Language System (UMLS). However, publicly available studies rely on dataset that might have sensitive data. Extracting information from academic papers can potentially leak sensitive data, and protecting the security and privacy of this data is equally important. In this paper, we address the key challenges around the privacy and security of such information extraction and analysis systems. Policy regulations like HIPAA have updated the guidelines to access data, specifically, data related to COVID-19, securely. In the US, healthcare providers must also comply with the Office of Civil Rights (OCR) rules to protect data integrity in matters like plasma donation, media access to health care data, telehealth communications, etc. Privacy policies are typically short and unstructured HTML or PDF documents. We have created a framework to extract relevant knowledge from the health centers' policy documents and also represent these as a knowledge graph. Our framework helps to understand the extent to which individual provider policies comply with regulations and define access control policies that enforce the regulation rules on data in the knowledge graph extracted from COVID-related papers. Along with being compliant, privacy policies must also be transparent and easily understood by the clients. We analyze the relative readability of healthcare privacy policies and discuss the impact. In this paper, we develop a framework for access control decisions that uses policy compliance information to securely retrieve COVID data. We show how policy compliance information can be used to restrict access to COVID-19 data and information extracted from research papers.

Metastatic renal cell carcinoma initially presenting as a unilateral breast lump.

Breast metastasis from primary renal cell carcinoma is a rare entity and infrequently reported in the literature. We present a case of a 65-year-old lady who presented to breast clinic with a 4-month history of rapidly growing right sided breast lump. She previously had a left mastectomy for breast cancer and a hysterectomy for endometrial cancer. Radiological evaluation with mammography and ultrasound revealed a large heterogeneous right breast lump with prominent vascularity which was biopsied. Histopathological and immunohistochemical features were not supportive of a primary breast carcinoma and favored metastasis from a renal tumor. The patient was unfortunately admitted to hospital due to increasing confusion and neurological symptoms and underwent whole-body cross-sectional CT imaging which demonstrated a giant tumor originating from the right kidney with associated intrathoracic, breast and intracranial metastasis. She was diagnosed with eosinophilic variant metastatic renal cell carcinoma. This case highlights the importance of considering alternative diagnoses to primary breast carcinoma in the context of an initial presentation of a unilateral breast lump.

Single-day HER2neu amplification assessment using chip-based digital PCR in formalin-fixed paraffin-embedded breast carcinoma tissue.

INTRODUCTION: Human epidermal growth factor receptor 2 (HER2) amplification is present in almost 15%-20% of breast cancer tumors, making it an important parameter for testing. The present study was designed to evaluate a chip-based digital PCR (dPCR) system for assessing HER2 amplification from formalin-fixed paraffin-embedded breast carcinoma tissue and to compare this system with immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). MATERIALS AND METHODS: A total of 84 breast carcinoma tissue samples were analyzed by IHC, FISH, and chip-based dPCR in a blinded manner. RESULTS: All nine IHC-positive and 35 IHC-negative samples had equivalent results with dPCR, taking an amplification ratio threshold of 1.8 as a positive result. Of the 40 IHC equivocal samples, 10 were assessed as positive, 27 as negative, and three as equivocal by dPCR. CONCLUSION: These results demonstrate that chip-based dPCR is suitable for HER2 amplification detection in formalin-fixed paraffin-embedded samples in a clinical setting, providing the advantages of superior turnaround time, cost-effectiveness, and increased precision with absolute quantification compared with conventional tests such as FISH and IHC. This methodology was especially beneficial in tissue samples with low DNA concentration.

Interfacial modification of clay nanotubes for the sustained release of corrosion inhibitors.

Long-lasting anticorrosive coatings for steel have been developed on the basis of halloysite nanotubes loaded with three corrosion inhibitors: benzotriazole, mercaptobenzothiazole, and mercaptobenzimidazole. The inhibitors' loaded tubes were admixed at 5-10 wt % to oil-based alkyd paint providing sustained agent release and corrosion healing in the coating defects. The slow 20-30 h release of the inhibitors at defect points caused a remarkable improvement in the anticorrosion efficiency of the coatings. Further time expansion of anticorrosion agent release has been achieved by the formation of release stoppers at nanotube ends with urea-formaldehyde copolymer and copper-inhibitor complexation. The corrosion protection efficiency was tested on ASTM A366 steel plates in a 0.5 M NaCl solution with the microscanning of corrosion current development by microscopy inspection and studying paint adhesion. The best protection was found using halloysite/mercaptobenzimidazole and benzotriazole inhibitors. Stopper formation with urea-formaldehyde copolymer provided an additional increase in corrosion efficiency as a result of the longer release of inhibitors.

Enlargement of halloysite clay nanotube lumen by selective etching of aluminum oxide.

Halloysite clay tubes have 50 nm diameter and chemically different inner and outer walls (inner surface of aluminum oxide and outer surface of silica). Due to this different chemistry, the selective etching of alumina from inside the tube was realized, while preserving their external diameter (lumen diameter changed from 15 to 25 nm). This increases 2-3 times the tube lumen capacity for loading and further sustained release of active chemical agents such as metals, corrosion inhibitors, and drugs. In particular, halloysite loading efficiency for the benzotriazole increased 4 times by selective etching of 60% alumina within the tubes' lumens. Specific surface area of the tubes increased over 6 times, from 40 to 250 m(2)/g, upon acid treatment.

Toxicity mitigation and solidification of municipal solid waste incinerator fly ash using alkaline activated coal ash.

Municipal solid waste (MSW) incineration is a common and effective practice to reduce the volume of solid waste in urban areas. However, the byproduct of this process is a fly ash (IFA), which contains large quantities of toxic contaminants. The purpose of this research study was to analyze the chemical, physical and mechanical behaviors resulting from the gradual introduction of IFA to an alkaline activated coal fly ash (CFA) matrix, as a mean of stabilizing the incinerator ash for use in industrial construction applications, where human exposure potential is limited. IFA and CFA were analyzed via X-ray fluorescence (XRF), X-ray diffraction (XRD) and Inductive coupled plasma (ICP) to obtain a full chemical analysis of the samples, its crystallographic characteristics and a detailed count of the eight heavy metals contemplated in US Title 40 of the Code of Federal Regulations (40 CFR). The particle size distribution of IFA and CFA was also recorded. EPA's Toxicity Characteristic Leaching Procedure (TCLP) was followed to monitor the leachability of the contaminants before and after the activation. Also images obtained via Scanning Electron Microscopy (SEM), before and after the activation, are presented. Concrete made from IFA, CFA and IFA-CFA mixes was subjected to a full mechanical characterization; tests include compressive strength, flexural strength, elastic modulus, Poisson's ratio and setting time. The leachable heavy metal contents (except for Se) were below the maximum allowable limits and in many cases even below the reporting limit. The leachable Chromium was reduced from 0.153 down to 0.0045 mg/L, Arsenic from 0.256 down to 0.132 mg/L, Selenium from 1.05 down to 0.29 mg/L, Silver from 0.011 down to .001 mg/L, Barium from 2.06 down to 0.314 mg/L and Mercury from 0.007 down to 0.001 mg/L. Although the leachable Cd exhibited an increase from 0.49 up to 0.805 mg/L and Pd from 0.002 up to 0.029 mg/L, these were well below the maximum limits of 1.00 and 5.00 mg/L, respectively.

Security policies and trust in ubiquitous computing.

Ubiquitous environments comprise resource-constrained mobile and wearable devices and computational elements embedded in everyday artefacts. These are connected to each other using both infrastructure-based as well as short-range ad hoc networks. Limited Internet connectivity limits the use of conventional security mechanisms such as public key infrastructures and other forms of server-centric authentication. Under these circumstances, peer-to-peer interactions are well suited for not just information interchange, but also managing security and privacy. However, practical solutions for protecting mobile devices, preserving privacy, evaluating trust and determining the reliability and accuracy of peer-provided data in such interactions are still in their infancy. Our research is directed towards providing stronger assurances of the reliability and trustworthiness of information and services, and the use of declarative policy-driven approaches to handle the open and dynamic nature of such systems. This paper provides an overview of some of the challenges and issues, and points out directions for progress.

Nuclear overexpression of the E2F3 transcription factor in human lung cancer.

BACKGROUND: The E2F3 transcription factor has an established role in controlling cell cycle progression. In previous studies we have provided evidence that nuclear E2F3 overexpression represents a mechanism that drives the development of human bladder cancer and that determines aggressiveness in human prostate cancer. We have proposed a model in which E2F3 overexpression co-operates with removal of the E2F inhibitor pRB to facilitate cancer development. Since small cell lung cancers (SCLC) have one of the highest reported frequencies of functional abnormalities in the pRB protein (90%) of any human cancer, we wish to assess to what extent E2F3 would be overexpressed in this and other classes of human lung cancer. METHODS: Immunohistochemical techniques were used to assess the E2F3 status in 428 samples of lung cancers, lung carcinoids, normal bronchial epithelium and normal lung tissue. RESULTS: E2F3 is overexpressed in 55-70% of squamous cell carcinomas and 79% of adenocarcinomas of the lung. In addition very high level expression of nuclear E2F3 is found in almost all small cell lung cancers analysed. When considered together with published data our observations indicate that co-operation between pRB functional knockouts and E2F3 overexpression may represent a mechanism of development of SCLC.