Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial.

INTRODUCTION: Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel artificial intelligence (AI) system, compared with standard high-definition colonoscopy, for APC measurement. METHODS: This was a US-based, multicenter, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE). Eligible average-risk subjects (45 years or older) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified intention-to-treat analysis was performed for all patients who completed colonoscopy with the primary outcome of APC. Secondary outcomes included positive predictive value (total number of adenomas divided by total polyps removed) and adenoma detection rate. RESULTS: In modified intention-to-treat analysis, of 1,031 subjects (age: 59.1 ± 9.8 years; 49.9% male), 510 underwent CAC vs 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared with CC: 0.99 ± 1.6 vs 0.85 ± 1.5, P = 0.02, incidence rate ratio 1.17 (1.03-1.33, P = 0.02) with no significant difference in the withdrawal time: 11.28 ± 4.59 minutes vs 10.8 ± 4.81 minutes; P = 0.11 between the 2 groups. Difference in positive predictive value of a polyp being an adenoma among CAC and CC was less than 10% threshold established: 48.6% vs 54%, 95% CI -9.56% to -1.48%. There were no significant differences in adenoma detection rate (46.9% vs 42.8%), advanced adenoma (6.5% vs 6.3%), sessile serrated lesion detection rate (12.9% vs 10.1%), and polyp detection rate (63.9% vs 59.3%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared with CC: 1.68 ± 2.1 vs 1.33 ± 1.8 (incidence rate ratio 1.27; 1.15-1.4; P < 0.01). DISCUSSION: Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared with conventional high-definition colonoscopy without any increase in colonoscopy withdrawal time, thus supporting the use of AI-assisted colonoscopy to improve colonoscopy quality ( ClinicalTrials.gov NCT04979962).

Tattoos in Nursing: Do We Practice What We Preach?

Tattoos have become increasingly popular in the United States among the general population. Furthermore, the popularity of body art, primarily tattoos, among nursing students generates issues about professionalism in academics and in clinical settings. Nursing faculty are faced with conflicting views on cultural awareness, professionalism, and self-expression. With nursing viewed as one of the most trusted professions, the policy of covering tattoos should be discussed, and more research is necessary.

Axinopsida serricata shell encrustation: a potential indicator of organic enrichment conditions in sediments in the southern Strait of Georgia, British Columbia, Canada.

We evaluate the potential of the geographic and within-sediment distribution patterns of rust-coloured shell encrustations on an abundant subtidal bivalve, Axinopsida serricata (Carpenter, 1864) as geochemical indicators of organic enrichment from marine municipal outfalls. The progressive development of shell encrustation over the life of the animals is suggested by heavier encrustations on large shells compared to smaller shells regardless of the geochemical conditions of the habitat. Heavy encrustations decline in an exponential manner at sediment acid volatile sulphide (AVS) levels>7 micromol/g. Analyses show that the reddish shell encrustations are from an amorphous iron oxide or hydroxy-oxide likely micro-biologically mediated; the oxides appear to be embedded within the inner matrix of an organic layer, with a chemically distinct outer layer. A schematic model is proposed which shows how enrichment of labile organic carbon around outfalls affects the availability of dissolved iron in sediments and leads to less extensive encrustations on bivalve shells. Predominantly sandy sediments with low organic loading have much less potential for iron oxide deposition than silty sediments due to greater oxygen penetration into the surface sediment. Shell encrustation appears to be relatively persistent and indicative of long-term conditions, regardless of spatial and temporal fluctuations in sediment geochemistry. With more research on development over the life-cycle of the animal, the pattern of A. serricata shell encrustation has the potential to rapidly provide a map of cumulative labile organic loading and oxygen penetration of sediments around municipal outfalls on the west coast of North America where this species is common. However, caution must be used in interpreting results, since background sediment characteristics (substrate type, bottom currents and sediment transport) can affect encrustation patterns.

The National Down Syndrome Project: design and implementation.

OBJECTIVE: The National Down Syndrome Project (NDSP), based at Emory University in Atlanta, Georgia, represents a multi-site, population-based, case-control study with two major aims: (1) to identify molecular and epidemiological factors contributing to chromosome nondisjunction and the consequent packaging of an extra chromosome into an egg or sperm, and (2) to identify risk factors for Down syndrome-associated birth defects. METHODS: The six national sites represent approximately 11% of U.S. births. Cases were newborns with Down syndrome (trisomy 21), and controls were infants without major birth defects randomly selected from the same birth populations. Biological samples were collected from case infants and their parents, and genetic markers were typed to determine the parental origin of chromosome 21 nondisjunction. Each site interviewed parents of case and control infants addressing pregnancy, medical and family history, occupation, and exposures. Sites collected medical information on case infants. RESULTS: The NDSP enrolled 907 infants as cases and 977 infants as controls (participation rates: 60.7% for cases; 56.9% for controls). Participation rates varied widely by site as did important demographic factors such as maternal age, race, and education. Nondisjunction during oogenesis accounted for 93.2% of the cases. Errors in spermatogenesis were found in 4.1%, and 2.7% were post-zygotic errors. CONCLUSIONS: This exceptional compilation of questionnaire, clinical, and molecular data makes the NDSP a unique resource for ongoing studies of the etiology and phenotypic consequences of trisomy 21. The combined approach increases study power by defining subgroups of cases by the origin of nondisjunction. This report describes the design and successful implementation of the