Artificial intelligence and echocardiography.

Echocardiography plays a crucial role in the diagnosis and management of cardiovascular disease. However, interpretation remains largely reliant on the subjective expertise of the operator. As a result inter-operator variability and experience can lead to incorrect diagnoses. Artificial intelligence (AI) technologies provide new possibilities for echocardiography to generate accurate, consistent and automated interpretation of echocardiograms, thus potentially reducing the risk of human error. In this review, we discuss a subfield of AI relevant to image interpretation, called machine learning, and its potential to enhance the diagnostic performance of echocardiography. We discuss recent applications of these methods and future directions for AI-assisted interpretation of echocardiograms. The research suggests it is feasible to apply machine learning models to provide rapid, highly accurate and consistent assessment of echocardiograms, comparable to clinicians. These algorithms are capable of accurately quantifying a wide range of features, such as the severity of valvular heart disease or the ischaemic burden in patients with coronary artery disease. However, the applications and their use are still in their infancy within the field of echocardiography. Research to refine methods and validate their use for automation, quantification and diagnosis are in progress. Widespread adoption of robust AI tools in clinical echocardiography practice should follow and have the potential to deliver significant benefits for patient outcome.

Demonstration of Einstein-Podolsky-Rosen Steering Using Hybrid Continuous- and Discrete-Variable Entanglement of Light.

Einstein-Podolsky-Rosen steering is known to be a key resource for one-sided device-independent quantum information protocols. Here we demonstrate steering using hybrid entanglement between continuous- and discrete-variable optical qubits. To this end, we report on suitable steering inequalities and detail the implementation and requirements for this demonstration. Steering is experimentally certified by observing a violation by more than 5 standard deviations. Our results illustrate the potential of optical hybrid entanglement for applications in heterogeneous quantum networks that would interconnect disparate physical platforms and encodings.

Continuous-Variable Instantaneous Quantum Computing is Hard to Sample.

Instantaneous quantum computing is a subuniversal quantum complexity class, whose circuits have proven to be hard to simulate classically in the discrete-variable realm. We extend this proof to the continuous-variable (CV) domain by using squeezed states and homodyne detection, and by exploring the properties of postselected circuits. In order to treat postselection in CVs, we consider finitely resolved homodyne detectors, corresponding to a realistic scheme based on discrete probability distributions of the measurement outcomes. The unavoidable errors stemming from the use of finitely squeezed states are suppressed through a qubit-into-oscillator Gottesman-Kitaev-Preskill encoding of quantum information, which was previously shown to enable fault-tolerant CV quantum computation. Finally, we show that, in order to render postselected computational classes in CVs meaningful, a logarithmic scaling of the squeezing parameter with the circuit size is necessary, translating into a polynomial scaling of the input energy.

Experimental verification of multipartite entanglement in quantum networks.

Multipartite entangled states are a fundamental resource for a wide range of quantum information processing tasks. In particular, in quantum networks, it is essential for the parties involved to be able to verify if entanglement is present before they carry out a given distributed task. Here we design and experimentally demonstrate a protocol that allows any party in a network to check if a source is distributing a genuinely multipartite entangled state, even in the presence of untrusted parties. The protocol remains secure against dishonest behaviour of the source and other parties, including the use of system imperfections to their advantage. We demonstrate the verification protocol in a three- and four-party setting using polarization-entangled photons, highlighting its potential for realistic photonic quantum communication and networking applications.

Data collection methods in health services research: hospital length of stay and discharge destination.

BACKGROUND: Hospital length of stay and discharge destination are important outcome measures in evaluating effectiveness and efficiency of health services. Although hospital administrative data are readily used as a data collection source in health services research, no research has assessed this data collection method against other commonly used methods. OBJECTIVE: Determine if administrative data from electronic patient management programs are an effective data collection method for key hospital outcome measures when compared with alternative hospital data collection methods. METHOD: Prospective observational study comparing the completeness of data capture and level of agreement between three data collection methods; manual data collection from ward-based sources, administrative data from an electronic patient management program (i.PM), and inpatient medical record review (gold standard) for hospital length of stay and discharge destination. RESULTS: Manual data collection from ward-based sources captured only 376 (69%) of the 542 inpatient episodes captured from the hospital administrative electronic patient management program. Administrative data from the electronic patient management program had the highest levels of agreement with inpatient medical record review for both length of stay (93.4%) and discharge destination (91%) data. CONCLUSION: This is the first paper to demonstrate differences between data collection methods for hospital length of stay and discharge destination. Administrative data from an electronic patient management program showed the highest level of completeness of capture and level of agreement with the gold standard of inpatient medical record review for both length of stay and discharge destination, and therefore may be an acceptable data collection method for these measures.

Experimental demonstration of graph-state quantum secret sharing.

Quantum communication and computing offer many new opportunities for information processing in a connected world. Networks using quantum resources with tailor-made entanglement structures have been proposed for a variety of tasks, including distributing, sharing and processing information. Recently, a class of states known as graph states has emerged, providing versatile quantum resources for such networking tasks. Here we report an experimental demonstration of graph state-based quantum secret sharing--an important primitive for a quantum network with applications ranging from secure money transfer to multiparty quantum computation. We use an all-optical setup, encoding quantum information into photons representing a five-qubit graph state. We find that one can reliably encode, distribute and share quantum information amongst four parties, with various access structures based on the complex connectivity of the graph. Our results show that graph states are a promising approach for realising sophisticated multi-layered communication protocols in quantum networks.

Experimental demonstration of a graph state quantum error-correction code.

Scalable quantum computing and communication requires the protection of quantum information from the detrimental effects of decoherence and noise. Previous work tackling this problem has relied on the original circuit model for quantum computing. However, recently a family of entangled resources known as graph states has emerged as a versatile alternative for protecting quantum information. Depending on the graph's structure, errors can be detected and corrected in an efficient way using measurement-based techniques. Here we report an experimental demonstration of error correction using a graph state code. We use an all-optical setup to encode quantum information into photons representing a four-qubit graph state. We are able to reliably detect errors and correct against qubit loss. The graph we realize is setup independent, thus it could be employed in other physical settings. Our results show that graph state codes are a promising approach for achieving scalable quantum information processing.

Quantification of total thyroxine in plasma from Xenopus laevis.

There is evidence that the endocrine systems of certain fish and wildlife can be affected by chemical contaminants, possibly resulting in developmental and reproductive problems. Perturbations in the hypothalamus-pituitary-thyroid (HPT) axis, in particular, can be detrimental during early development. Because the rate of amphibian metamorphosis is controlled by circulating thyroid hormones, tadpoles undergoing metamorphosis have been selected as relevant test organisms for evaluating the potential effects of a substance on the HPT axis in vertebrates. An indicative measure of HPT functioning in these assays is the concentration of the thyroid hormone, thyroxine (T4), in frog plasma. Therefore, there is a need for a validated method to measure T4 in plasma during amphibian metamorphosis. This study describes a method involving mixed-mode strong cation exchange solid-phase extraction (SPE) with ultrahigh-performance liquid chromatography and isotope dilution tandem mass spectrometry (UPLC-ID-MS-MS) to quantify total T4 in a small volume (10 µL) of plasma from Xenopus laevis (African clawed frog). The SPE procedure, together with MS detection, produced the required selectivity for the analysis of both T4 and the T4 internal standard. The limit of detection of the method was determined to be 0.2 ng/mL, whereas the lower limit of quantification was 0.5 ng/mL. The intra-day and inter-day precision values were less than ± 5 and ±10%, respectively. Concentrations of total T4 in the plasma of X. laevis tadpoles at metamorphic peak were calculated to be 10.7 ± 0.8 ng/mL, which is comparable to the results from radioimmunoassay. This validated UPLC-ID-MS-MS method for the determination of total T4 in plasma has demonstrated good accuracy and precision, with low susceptibility to interferences with the utilization of multiple reaction monitoring and ID.

Positron emission tomography detected thyroid incidentaloma.

We describe the case of a 48-year-old woman who presented with a thyroid lesion incidentally detected on positron emission tomography/computed tomography for a suspicious lung lesion. Subsequent clinical examination and investigations revealed a 3 cm nodule in the left lower pole of the thyroid. Fine needle aspiration was indeterminate for malignancy. A left hemithyroidectomy was performed and histology confirmed a benign thyroid adenoma with an incidental micropapillary carcinoma. The literature regarding the best management for thyroid incidentalomas remains uncertain and, as such, each patient must be managed on an individual basis.

Health insurance as a requirement to undergo cardiac transplantation: a national survey of transplant program practices.

BACKGROUND: Recent limitations in Medicaid coverage of transplantation in Arizona jeopardized transplantation of potential recipients in that state and called attention to financial barriers inherent in the present organ allocation system. Policies of cardiac transplant centers regarding insurance requirements for transplantation have not been previously assessed. We sought to determine the policies of adult cardiac transplant programs nationwide regarding insurance requirements for evaluation and listing for cardiac transplantation. METHODS: From December 15, 2008 to November 16, 2010, all active adult cardiac transplant programs in the United States were surveyed regarding insurance requirements for evaluation and listing for cardiac transplantation. RESULTS: Surveys were completed by 62 of 101 programs, accounting for 71% of adult cardiac transplants in 2007. Only 2% of recipients were uninsured. Insurance was required by 48% of programs to evaluate and 84% to list for transplantation. For uninsured patients, 81% of programs required a large amount of money upfront (median, $200,000; interquartile range, $10,000-$300,000) to list for transplantation and often (84%) educated patients about fundraising to acquire these resources. CONCLUSIONS: Adult cardiac transplant programs generally require candidates to have adequate health insurance to undergo transplantation. Uninsured patients typically need a significant amount of money upfront to be listed for transplantation and often are advised to fundraise to gather such resources.

Respiratory syncytial virus pneumonia treated with lower-dose palivizumab in a heart transplant recipient.

Respiratory syncytial virus (RSV) is an important community-acquired pathogen that can cause significant morbidity and mortality in patients who have compromised pulmonary function, are elderly, or are immunosuppressed. This paper describes a 70-year-old man with a remote history of heart transplantation who presented with signs and symptoms of pneumonia. Chest computed tomography (CT) imaging demonstrated new patchy ground glass infiltrates throughout the upper and lower lobes of the left lung, and the RSV direct fluorescence antibody (DFA) was positive. The patient received aerosolized ribavirin, one dose of intravenous immunoglobulin, and one dose of palivizumab. After two months of followup, the patient had improved infiltrates on chest CT, improved pulmonary function testing, and no evidence of graft rejection or dysfunction. There are few data on RSV infections in heart transplant patients, but this case highlights the importance of considering this potentially serious infection and introduces a novel method of treatment.

Successful use of the TandemHeart percutaneous ventricular assist device as a bridge to recovery for acute cellular rejection in a cardiac transplant patient.

In this report, we presented a patient who benefited from hemodynamic support with the TandemHeart percutaneous ventricular assist device (pVAD; Cardiac Assist, Inc) implantation in the setting of early acute graft rejection 2 months after orthotopic heart transplant. The TandemHeart initially had been used for temporary hemodynamic assistance during postcardiotomy heart failure and high-risk coronary interventions. More recently, its use in patients with cardiogenic shock from acute myocardial infarction, fulminant myocarditis, and critical aortic stenosis has been reported. To our knowledge, this is one of the first reported cases in which the TandemHeart pVAD served as a successful device for support during acute cardiac transplant rejection.

Long-term follow-up of a heart transplant recipient with documented seroconversion to HIV-positive status 1 year after transplant.

Whether human immunodeficiency virus (HIV) should be an absolute contraindication to heart transplantation has been a topic of recent discussion. There is a paucity of data regarding the expected outcome of heart transplantation in a recipient who is HIV positive. Herein, we report the case and long-term follow-up of a woman who was found to have seroconverted to HIV positive status 1 year after transplant.

Factors affecting the accuracy of bisphenol a and bisphenol a-monoglucuronide estimates in Mammalian tissues and urine samples.

ABSTRACT Bisphenol A (BPA) (CAS Number 80-05-7; EINECS Number 201-245-8) is used in the production of plastics having food contact applications. Some biomonitoring studies have reported free BPA in blood or urine of humans. Since complete first-pass metabolism of orally administered BPA to BPA-monoglucuronide (BPA-G) occurs in humans, the presence of free BPA in human specimens raises questions as to the origin and/or possible sources of the free BPA. We hypothesized that BPA-G instability during specimen collection and analysis contributes to the presence of free BPA in the biological samples. Investigation of the in vitro hydrolysis of BPA-G in blood plasma, tissue homogenates, and diluted urine from laboratory rats and in aqueous/organic solutions commonly used for extraction in BPA analyses lent support to the hypothesis of BPA-G instability as a possible source of free BPA determinations in the biological specimens. Hydrolysis of BPA-G occurred at neutral pH and room temperature in diluted urine and in rat placental or fetal tissue homogenates at room temperature. Hydrolysis of BPA-G in aqueous/organic solutions began within minutes at pH 2 and 80 degrees C. BPA-G was degraded to an unidentified compound in a urine/water mixture or when stored in a 25/75 mixture of urine/acetonitrile at pH 9 at either 22 or 80 degrees C. Based upon these experiments, it was concluded that methods demonstrating BPA-G stability or accounting for its instability during analysis are warranted in studies designed to measure free BPA in biological specimens.

Bounds on multipartite entangled orthogonal state discrimination using local operations and classical communication.

We show that entanglement guarantees difficulty in the discrimination of orthogonal multipartite states locally. The number of pure states that can be discriminated by local operations and classical communication is bounded by the total dimension over the average entanglement. A similar, general condition is also shown for pure and mixed states. These results offer a rare operational interpretation for three abstractly defined distancelike measures of multipartite entanglement.

Rapid uptake, metabolism, and elimination of inhaled sulfuryl fluoride fumigant by rats.

Sulfuryl fluoride (SO(2)F(2)) is a structural fumigant gas used to control drywood termites and wood-boring beetles. The pharmacokinetics and metabolism of inhaled SO(2)F(2) were evaluated in male Fischer-344 rats exposed to 30 or 300 ppm (35)S-labeled SO(2)F(2) for 4 h. Blood, urine and feces were collected during and after the exposures and analyzed for radioactivity, (35)S-labeled fluorosulfate and sulfate, and fluoride (urine and feces only). Selected tissues were collected 7 days post-exposure and analyzed for radioactivity. During and after unlabeled SO(2)F(2) exposures, blood, brain, and kidney were collected and analyzed for fluoride ion. SO(2)F(2) was rapidly absorbed, achieving maximum concentrations of radioactivity in both plasma and red blood cells (RBC) near the end of the 4-h exposure period. Radioactivity was rapidly excreted, mostly via the urine. Seven days post-exposure, small amounts of radioactivity were distributed among several tissues, with the highest concentration detected in respiratory tissues. Radioactivity associated with the RBC remained elevated 7 days post-exposure, and highly perfused tissues had higher levels of radioactivity than other non-respiratory tissues. Radioactivity cleared from plasma and RBC with initial half-lives of 2.5 h after 30 ppm and 1-2.5 h after 300 ppm exposures. The terminal half-life of radioactivity was 2.5-fold longer in RBC than plasma. Based on the radiochemical profiles, there was no evidence of parent (35)SO(2)F(2) in blood. Identification of fluorosulfate and sulfate in blood and urine suggests that SO(2)F(2) is hydrolyzed to fluorosulfate, with release of fluoride, followed by further hydrolysis to sulfate and release of the remaining fluoride.

Age and dose dependency of the pharmacokinetics and metabolism of bisphenol A in neonatal sprague-dawley rats following oral administration.

Previous studies demonstrated the rapid clearance of bisphenol A (BPA) from blood following oral administration to adult rats with the principal metabolite being BPA-monoglucuronide (BPA-glucuronide). Since the ontogeny of glucuronyl transferases (GT) differs with age, the pharmacokinetics of BPA were studied in neonatal animals. (14)C-BPA was administered via gavage at 1 or 10 mg/kg body weight to rats at postnatal day (pnd) 4, pnd 7, pnd 21, or to 11 week old adult rats (10 mg/kg dose only). Blood (neonates and adults) and selected tissues (neonates) were collected at 0.25, 0.75, 1.5, 3, 6, 12, 18, and 24 h postdosing. BPA and BPA-glucuronide in the plasma were quantified by high-performance liquid chromatography; radioactivity in the plasma and tissues was quantified by liquid scintillation spectrometry. The data indicate that neonatal rats at all three ages metabolized BPA to BPA-glucuronide, although an age dependency in the number and concentration of plasma metabolites was observed, consistent with the ontogeny of GT. BPA-glucuronide and BPA concentrations in the plasma were greater in neonates than in adults, except at 24 h postdosing, suggesting an immaturity in the development of hepatic excretory function in neonatal rats. Nevertheless, the half-lives for the elimination of BPA-glucuronide in plasma were more rapid in neonatal animals than in adults, likely due to reduced microflora beta-glucuronidase activity and an absence of enterohepatic recirculation. A dose dependency in the metabolism and pharmacokinetics of BPA administered to neonates was also observed with nearly complete metabolism of BPA to BPA-glucuronide (94-100% of the plasma radioactivity) at a dose of 1 mg/kg. This was in contrast to finding up to 13 different plasma metabolites observed at the 10 mg/kg dose. These data indicate that, from early in neonatal life through pnd 21, there is sufficient GT activity in rats to efficiently metabolize BPA to its nonestrogenic metabolite at low doses.

Metabolism and pharmacokinetics of bisphenol A (BPA) and the embryo-fetal distribution of BPA and BPA-monoglucuronide in CD Sprague-Dawley rats at three gestational stages.

The pharmacokinetics of bisphenol A (BPA), including the quantification of the major BPA metabolite BPA-monoglucuronide conjugate (BPA-glucuronide) was studied in Sprague-Dawley rats at different stages of gestation. 14C-BPA was administered orally at 10 mg BPA/kg body weight (0.2 mCi/rat) to nongravid rats and to other groups on gestation days (GD) 6, 14, and 17. GD 0 was when the vaginal smear was sperm positive or a copulatory plug was observed. Radioactivity derived from 14C-BPA was quantified in the maternal blood, selected tissues, and the embryo or fetus. BPA and BPA-glucuronide were quantified in maternal plasma and excreta. Additional rats were dosed orally at 10 mg 14C-BPA/kg (0.2 mCi/rat or 0.5 mCi/rat) on GD 11, 13, and 16 to further study the distribution of BPA and BPA-glucuronide to the embryo/fetal tissue. The tissue distribution, metabolism, or the rates or routes of excretion of BPA, or the plasma concentration-time profiles of BPA-glucuronide did not appear to be altered at any stage of gestation as compared to nonpregnant rats. In the GD 11 group, neither BPA nor BPA-glucuronide was detected in the yolk sacs or embryos, except for trace concentrations of BPA-glucuronide in the yolk sacs at 15 min postdosing. In the GD 13 group, both BPA and BPA-glucuronide were detected in the yolk sacs of the conceptus but not in the embryos/fetuses, except for BPA at 15 min. For the animals dosed with 0.2 mCi/rat on GD 16, both analytes were detected in the placentae at 15 min and 12 h, but not at 96 h. Traces of both analytes were detected in fetal tissue in two of five specimens at 15 min only. In rats dosed on GD 16 with 0.5 mCi/rat, the BPA-glucuronide and BPA concentrations in maternal plasma at 15 min were 1.7 and 0.06 mug equivalents (eq)/g plasma, respectively. At the same time postdosing in these animals, the placental BPA-glucuronide concentrations were lower (0.34 mug eq BPA [as glucuronide]/g), and the BPA concentrations were about equivalent (0.095 mug/g). Fetal BPA-glucuronide and BPA concentrations were markedly lower, 0.013 and 0.018 mug eq/g, respectively. Therefore, no selective affinity of either yolk sac/placenta or embryo/fetus for BPA or BPA metabolites relative to maternal plasma or tissues was observed in this study.

The use of dilute Calogen as a fat density oral contrast medium in upper abdominal computed tomography, compared with the use of water and positive oral contrast media.

AIM: Oral contrast media are commonly given prior to computed tomography (CT) examination of the upper abdomen. Although positive oral contrast media are normally used, there is increasing interest in using negative agents such as water and less commonly fat density products. The aim of this study was to compare a positive oral contrast medium, water, and a diluted emulsion of arachis oil Calogen, a fat density food supplement) for assessment of the upper abdomen. MATERIALS AND METHODS: Seventy-one patients referred for upper abdominal CT were randomized to receive either 500 ml water, 2% sodium diatrizoate or a dilute suspension of Calogen. The CT images were scored independently by three radiologists. Distension and anatomical identification was assessed for the stomach, duodenum and jejunum; with anatomical identification recorded for the pancreas, retroperitoneum, liver, gallbladder and spleen. RESULTS: Dilute Calogen produced a significant improvement (P < 0.01) in distension and anatomical visualization of the stomach and proximal duodenum. Only minimal differences were demonstrated between the three contrast media for visualization of more distal small bowel or identification of the other upper abdominal viscera. Significantly more artifacts were caused by positive contrast media than with the Calogen mixture. CONCLUSION: A dilute suspension of Calogen as an oral contrast medium is recommended when disease is suspected within the stomach or proximal duodenum.