Search Results (18)

Background: Diagnostic delay and error represent pervasive problems in healthcare with grave implications for treatment and prognosis. Though characteristic of human cognition, cognitive biases commonly contribute to delays in the physician decision-making process, particularly in atypical or complex presentations in youth. Methods: We present a case series of three adolescent athletes with varied clinical presentations whose diagnostic conceptualization and treatment were delayed in part due to cognitive biases with consequences for overall health and development, as well as return to sport. Results: The first case depicts how an atypical presentation of celiac disease was attributed to growing pains, illustrating the contribution of anchoring bias and confirmation bias in medical decision making. The second case represents the misattribution of chronic exertional compartment syndrome pain to growing pains and post-exercise soreness, highlighting the influence of ascertainment bias on the initial misdiagnosis. The third case describes how a vertebral mass was misdiagnosed as a left shoulder strain from weightlifting, depicting the contribution of anchoring bias and ascertainment bias in medical decision making. Conclusions: Early recognition of cognitive biases, including confirmation bias, anchoring bias, and ascertainment bias, is crucial for improving medical decision making, particularly in cases of rare or atypical presentations, reducing unnecessary diagnostic delays, and setting more realistic patient expectations. Through discussion of these cases, we highlight concrete steps to manage bias to facilitate timely diagnosis within the primary care and sports medicine setting. Full article

Regulation of blood glucose levels depends on the property of beta cells to couple glucose sensing with insulin secretion. This is accomplished by the concentration-dependent flux of glucose through glycolysis and oxidative phosphorylation, generating ATP. The resulting rise in cytosolic ATP/ADP inhibits K_ATP channels, inducing membrane depolarization and Ca²⁺ influx, which prompts insulin secretion. Evidence suggests that this coupling of glucose sensing with insulin secretion may be compartmentalized in the submembrane regions of the beta cell. We investigated the subcellular responses of key components involved in this coupling and found mitochondria in the submembrane zone, some tethered to the cytoskeleton near capillaries. Using Fluorescent Lifetime Imaging Microscopy (FLIM), we observed that submembrane mitochondria were the fastest to respond to glucose. In the most glucose-responsive beta cells, glucose triggers rapid, localized submembrane increases in ATP and Ca²⁺ as synchronized ~4-min oscillations, consistent with pulsatile insulin release after meals. These findings are consistent with the hypothesis that glucose sensing is coupled with insulin secretion in the submembrane zone of beta cells. This zonal adaptation would enhance both the speed and energy efficiency of beta cell responses to glucose, as only a subset of the most accessible mitochondria would be required to trigger insulin secretion. Full article

Background/Objectives: The presence of seminal vesicle invasion (SVI) in prostate cancer (PCa) is associated with poorer postoperative outcomes. This study evaluates the predictive value of magnetic resonance imaging (MRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for SVI in PCa. Methods: This cohort study included consecutive robotic prostatectomy patients for PCa at three Australian tertiary referral centres between April 2016 and September 2022. MRI and PSMA PET/CT results, clinicopathological variables, including age, BMI, prostate-specific antigen (PSA), PSA density, DRE, Biopsy Gleason score, Positive biopsy cores, PIRADS v2.1 score, MRI volume and MRI lesion size were extracted. The sensitivity, specificity, and accuracy of MRI and PSMA PET/CT for predicting SVI were compared with the histopathological results by receiver operating characteristic (ROC) analysis. Subgroup univariate and multivariate analysis was performed. Results: Of the 528 patients identified, 86 had SVI on final pathology. MRI had a low sensitivity of 0.162 (95% CI: 0.088–0.261) and a high specificity of 0.963 (95% CI: 0.940–0.979). The PSMA PET/CT had a low sensitivity of 0.439 (95% CI: 0.294–0591) and a high specificity of 0.933 (95% CI: 0.849–0.969). When MRI and PSMA PET/CT were used in combination, the sensitivity and specificity improved to 0.514 (95%CI: 0.356–0.670) and 0.880 (95% CI: 0.813–0.931). The multivariate regression showed a higher biopsy Gleason score (p = 0.033), higher PSA (p < 0.001), older age (p = 0.001), and right base lesions (p = 0.003) to be predictors of SVI. Conclusions: MRI and PSMA PET/CT independently underpredicted SVI. The sensitivity and AUC improved when they were used in combination. Multiple clinicopathological factors were associated with SVI on multivariate regression and predictive models incorporating this information may improve oncological outcomes. Full article

Objectives: To determine if early (three months) and late (one year) post-operative continence is improved by performing a novel retropubic vascularised fascial sling (RoboSling) procedure concurrently with robot-assisted radical prostatectomy in men undergoing treatment for localised prostate cancer. To additionally assess surgical outcomes, quality of life and health economic outcomes in patients undergoing the novel RoboSling technique. Methods: This study aims to recruit 120 consecutive patients with clinically localised prostate cancer who have chosen to undergo robot-assisted radical prostatectomy in the Sydney Local Health District, Australia. A prospective assessment of early and late post-operative continence following robot-assisted radical prostatectomy with and without a RoboSling procedure will be performed in a two-group, 1:1, parallel, randomized controlled trial. Four surgeons will take part in the study, all of whom are beyond their learning curve. Patients will be blinded as to whether the RoboSling procedure is performed for them, as will be the research officers collecting the post-operative data on urinary function. Trial Registration: ACTRN12618002058257. Results: The trial is currently underway. Conclusions: The RoboSling technique is unique in that the sling is vascularised and has a broad surface area compared to previously described slings in the literature. If a clinically significant improvement in post-operative continence is established with the RoboSling, then, we can in turn expect improvements in quality of life for men undergoing this technique with radical prostatectomy. Full article

Objectives: The objective of this study was to determine the publication rate of abstracts presented at the Société Internationale d’Urologie (SIU) Congress and to analyse the characteristics associated with conversion to publication. Methods: All abstracts from the 36th Congress of the Société Internationale d’Urologie were identified from the published 2016 abstract book. A PubMed search was performed using key words and author names to identify published journal articles corresponding with the presented abstracts. Results: The conversion rate of presented abstracts to publication by April 2022 was 30.73% (224 of 729). Many abstracts were published prior to presentation (35.27%, 79 of 224). The average time to publication of abstracts published post presentation was 16.88 months. The majority of abstracts were presented in urology-specific journals (66.96%, 150 of 224). Publishing journals had an average impact factor of 3.068 with Urology (18 of 224) and World Journal of Urology (8 of 224) being the most common journals. Moderated ePosters had the highest conversion rate to publication (39.59%), whilst Unmoderated Videos had the lowest (11.32%). The abstract book assigned presentation topic groups to the moderated ePoster category; the most published abstract topic was sexual function (68.75%, 11 of 16). Conclusions: The conversion rate of abstracts presented at the SIU to publications in peer-reviewed journals has shown improvement since previous reports; however, it remains lower than the rates associated with other major urological conferences. Almost 70% of presented abstracts do not convert to publication and this should be considered when incorporating abstract findings into clinical practice. Full article

Objectives: To review the methods of surgical complication reporting in urological journals, to determine the current utilisation of the Clavien Dindo classification, and to make comparison with previous reports over the last 10 years. Methods: A search was performed of all journal articles published in 5 major urological journals from January 2021 to April 2022, inclusive. All articles reporting surgical outcomes or complications were analysed. The current trend in complication reporting was compared with the results of the systematic search of the same 5 urological journals performed in 2012 by Yoon et al. Results: A total of 137 articles were identified. The Clavien Dindo classification was the most common method used (105/137, 76.6%) followed by a text-based descriptive classification (31/137, 22.6%). Notably, the Clavien Dindo classification was the only standardised method used in any of the articles examined. The prevalence of Clavien Dindo classification usage is 76.6% in the articles analysed in our search compared with the 33.3% reported by Yoon et al. in their search of papers published in the same 5 urological journals between 2010 and 2012. Conclusions: There has been a significant increase in the adoption of the Clavien Dindo classification in the reporting of complications in major urological journals in the last decade. This is a favourable trend which is likely in response to the ad hoc EAU Guidelines Panel 2012 recommendations. With more than 20% of journal articles still using descriptive text-based classifications, we should continue to encourage further implementation of standardised criteria, particularly the Clavien Dindo classification. Full article

Photoacoustic imaging using external contrast agents is emerging as a powerful modality for real-time molecular imaging of deep-seated tumors. There are several chromophores, such as indocyanine green and IRDye800, that can potentially be used for photoacoustic imaging; however, their use is limited due to several drawbacks, particularly photostability. There is, therefore, an urgent need to design agents to enhance contrast in photoacoustic imaging. Naphthalocyanine dyes have been demonstrated for their use as photoacoustic contrast agents; however, their low solubility in aqueous solvents and high aggregation propensity limit their application. In this study, we report the synthesis and characterization of silicon-centered naphthalocyanine dyes with high aqueous solubility and near infra-red (NIR) absorption in the range of 850–920 nm which make them ideal candidates for photoacoustic imaging. A series of Silicon-centered naphthalocyanine dyes were developed with varying axial and peripheral substitutions, all in an attempt to enhance their aqueous solubility and improve photophysical properties. We demonstrate that axial incorporation of charged ammonium mesylate group enhances water solubility. Moreover, the incorporation of peripheral 2-methoxyethoxy groups at the α-position modulates the electronic properties by altering the π-electron delocalization and enhancing photoacoustic signal amplitude. In addition, all the dyes were synthesized to incorporate an N-hydroxysuccinimidyl group to enable further bioconjugation. In summary, we report the synthesis of water-soluble silicon-centered naphthalocyanine dyes with a high photoacoustic signal amplitude that can potentially be used as contrast agents for molecular photoacoustic imaging. Full article

There is increased adoption of cover cropping and conservation tillage in the USA. Many farmers view these practices as methods for improving their soils. However, different cover cropping and tillage practices conducted post-harvest can have a disparate impact on arthropods within the subsequent cash crop. Field experiments were conducted during 2017 and 2018 at two experimental sites to examine the influences of different post-harvest practices following corn (Zea mays L.) harvest on pests and beneficials in subsequent soybean [Glycine max (L.) Merr.] plantings. Experimental treatments included: (1) tillage via chisel plow (CP), (2) no-tillage in which corn residue/stubble remained on the soil surface (CS), and (3) planting a cover crop into corn residue (CC) following corn harvest. Overall, insect herbivore abundance was greater in the CP treatment. Foliar predator numbers were similar among treatments or of greater abundance in CP. The activity density of epigeal insect predators varied according to site and feeding guild. However, spider activity density was greatest in CP. Stink bug egg mortality due to predation and parasitism varied among treatments. However, the percentage of stink bug eggs that hatched was greatest in the CC during both years. Findings suggest that post-harvest practices investigated during this study will have a similar influence on most epigeal and foliar arthropods in soybean. Full article

As conservation efforts regarding green sea turtles, Chelonia mydas, continue, it is imperative to document behaviors and foraging habits/habitats of understudied populations. We have conducted an 18-month study dedicated to photographing the local population feeding alongside floating docks within the Guana Tolomato Matanzas estuary to determine the capability of matching head scale patterns efficiently through a pattern matching program: HotSpotter. To date, 195 unique sea turtles have been identified between two different marinas located in St. Augustine, FL. Of these, 98 were spotted more than once, with 39 of them being “tracked” for longer than a year. Temperature trends were also monitored in conjunction, showing that more individuals appeared during the warmer months of the year. The evidence, overall, indicates that these locations host a resident population of green sea turtles, leading to the need for a discussion on potential threats originating from the usage of these marinas by humans. Full article

Objective: Many studies have shown that severe (hospitalized) bronchiolitis during infancy is a risk factor for developing childhood asthma. However, the population subgroups at the highest risk remain unclear. Using large nationwide pediatric cohort data, namely the NIH Environmental influences on Child Health Outcomes (ECHO) Program, we aimed to quantify the longitudinal relationship of bronchiolitis hospitalization during infancy with asthma in a generalizable dataset and to examine potential heterogeneity in terms of major demographics and clinical factors. Methods: We analyzed data from infants (age <12 months) enrolled in one of the 53 prospective cohort studies in the ECHO Program during 2001–2021. The exposure was bronchiolitis hospitalization during infancy. The outcome was a diagnosis of asthma by a physician by age 12 years. We examined their longitudinal association and determined the potential effect modifications of major demographic factors. Results: The analytic cohort consisted of 11,762 infants, 10% of whom had bronchiolitis hospitalization. Overall, 15% subsequently developed asthma. In the Cox proportional hazards model adjusting for 10 patient-level factors, compared with the no-bronchiolitis hospitalization group, the bronchiolitis hospitalization group had a significantly higher rate of asthma (14% vs. 24%, HR = 2.77, 95%CI = 2.24–3.43, p < 0.001). There was significant heterogeneity by race and ethnicity (P_interaction = 0.02). The magnitude of the association was greater in non-Hispanic White (HR = 3.77, 95%CI = 2.74–5.18, p < 0.001) and non-Hispanic Black (HR = 2.39, 95%CI = 1.60–3.56; p < 0.001) infants, compared with Hispanic infants (HR = 1.51, 95%CI = 0.77–2.95, p = 0.23). Conclusions: According to the nationwide cohort data, infants hospitalized with bronchiolitis are at a higher risk for asthma, with quantitative heterogeneity in different racial and ethnic groups. Full article

Prostate cancer is the most common cancer and the second leading cause of cancer death in men. The imaging assessment and treatment of prostate cancer has vastly improved over the past decade. The introduction of PSMA PET-CT has improved the detection of loco-regional and metastatic disease. PSMA PET-CT also has a role in the primary diagnosis and staging, in detecting biochemical recurrence after curative treatment and in metastasis-directed therapy. In this paper we review the role of PSMA PET-CT in prostate cancer. Full article

Left ventricular (LV) hypertrophy (LVH) is an independent risk factor for cardiovascular disease, and African Americans experience a disparate high risk of LVH. Genetic studies have identified potential candidate genes and variants related to the condition. Epigenetic modifications may continue to help unravel disease mechanisms. We used methylation and echocardiography data from 636 African Americans selected from the Hypertension Genetic Epidemiology Network (HyperGEN) to identify differentially methylated regions (DMRs) associated with LVH. DNA extracted from whole blood was assayed on Illumina Methyl450 arrays. We fit linear mixed models to examine associations between co-methylated regions and LV traits, and we then conducted single CpG analyses within significant DMRs. We identified associations between DMRs and ejection fraction (XKR6), LV internal diastolic dimension (TRAK1), LV mass index (GSE1, RPS15 A, PSMD7), and relative wall thickness (DNHD1). In single CpG analysis, CpG sites annotated to TRAK1 and DNHD1 were significant. These CpGs were not associated with LV traits in replication cohorts but the direction of effect for DNHD1 was consistent across cohorts. Of note, DNHD1, GSE1, and PSMD7 may contribute to cardiac structural function. Future studies should evaluate relationships between regional DNA methylation patterns and the development of LVH. Full article

This paper describes the initial results of precipitation estimates from the Time-Resolved Observations of Precipitation structure and storm Intensity with a Constellation of Smallsats (TROPICS) Millimeter-wave Sounder (TMS) using the Precipitation Retrieval and Profiling Scheme (PRPS). The TROPICS mission consists of a Pathfinder CubeSat and a constellation of six CubeSats, providing a low-cost solution to the frequent sampling of precipitation systems across the Tropics. The TMS instrument is a 12-channel cross-track scanning radiometer operating at frequencies of 91.655 to 204.8 GHz, providing similar resolutions to current passive microwave sounding instruments. These retrievals showcase the potential of the TMS instrument for precipitation retrievals. The PRPS has been modified for use with the TMS using a database based upon observations from current sounding sensors. The results shown here represent the initial postlaunch version of the retrieval scheme, as analyzed for the Pathfinder CubeSat launched on 30 June 2021. In terms of monthly precipitation estimates, the results fall within the mission specifications and are similar in performance to retrievals from other sounding instruments. At the instantaneous scale, the results are very promising. Full article

Commercial airline cockpit crew (CCC) are potentially exposed to occupational risk factors that may have detrimental health effects. However, available literature on prostate cancer (PCa) as a health outcome is conflicted. Therefore, this review of cohort studies aims to evaluate the incidence of and mortality from PCa in CCC based on studies published to date. PubMed, Medline, EMBASE and SCOPUS were searched from 1946 to April 2021. Cohort studies reporting standardized incidence ratios (SIR) and/or standardized mortality ratios (SMR) of PCa in CCC were included. Military, cabin crew and service personnel data were excluded. Independent data extraction was conducted, and study quality assessed. Standardized ratios were pooled using a fixed effects model and expressed with 95% confidence intervals. 75 studies were assessed for eligibility from which 6 involving 129,374 licensed CCC were included in the final analysis: Two reported incidence only, 1 incidence and mortality and 3 reported mortalities only. The pooled SIR for PCa in CCC was 1.41 (95% CI 1.17 to 1.71) with moderate heterogeneity (I² = 53%) however, the pooled SMR was not statistically significant (1.08; 95% CI 0.94 to 1.24) also with moderate heterogeneity (I² = 70%). The available evidence shows that CCC are at a higher risk of developing PCa but there is no evidence to suggest a similarly higher risk of death from the disease. The effect of early detection through PSA testing in this cohort is unclear. Occupational exposure to radiation and sleep disturbance may play a role, but clear evidence of additional risk is lacking. Our review indicates that most evidence is dated and to confidently assess contemporary health outcomes of CCC, further research is required. Full article

A data-driven approach to characterizing the risk of cyanobacteria-based harmful algal blooms (cyanoHABs) was undertaken for the Ohio River. Twenty-five years of river discharge data were used to develop Bayesian regression models that are currently applicable to 20 sites spread-out along the entire 1579 km of the river’s length. Two site-level prediction models were developed based on the antecedent flow conditions of the two blooms that occurred on the river in 2015 and 2019: one predicts if the current year will have a bloom (the occurrence model), and another predicts bloom persistence (the persistence model). Predictors for both models were based on time-lagged average flow exceedances and a site’s characteristic residence time under low flow conditions. Model results are presented in terms of probabilities of occurrence or persistence with uncertainty. Although the occurrence of the 2019 bloom was well predicted with the modeling approach, the limited number of events constrained formal model validation. However, as a measure of performance, leave-one-out cross validation returned low misclassification rates, suggesting that future years with flow time series like the previous bloom years will be correctly predicted and characterized for persistence potential. The prediction probabilities are served in real time as a component of a risk characterization tool/web application. In addition to presenting the model’s results, the tool was designed with visualization options for studying water quality trends among eight river sites currently collecting data that could be associated with or indicative of bloom conditions. The tool is made accessible to river water quality professionals to support risk communication to stakeholders, as well as serving as a real-time water data monitoring utility. Full article