Case-related Information Research Articles

Incidence of post-COVID psychiatric disorders according to the periods of SARS-CoV-2 variant dominance: The LIFE study

This retrospective cohort study examined the incidence of post-COVID psychiatric disorders in older adults according to hospitalization status and SARS-CoV-2 variant period in Japan. Claims data, COVID-19 case-related information, and vaccination records were obtained from three Japanese municipalities. We identified individuals aged ≥65 years who had COVID-19 or other respiratory tract infection (RTI) between March 2021 and December 2022. Participants were categorized into non-hospitalized and hospitalized patients, and the study period was divided into the Alpha (March to May 2021), Delta (June to December 2021), Omicron BA.1/BA.2 (January to June 2022), and Omicron BA.5 (July to December 2022) periods. Modified Poisson regression analyses were performed to estimate the incidence rate ratios (IRRs) for the occurrence of psychiatric disorders (organic mental disorders, psychotic disorders, mood disorders, anxiety disorders, and insomnia) three months after COVID-19 (reference: other RTI). For overall psychiatric disorders, we analyzed 19,489 non-hospitalized patients (COVID-19: 6,728, Other RTI: 12,761) and 2925 hospitalized patients (COVID-19: 1,036, Other RTI: 1889). When compared with other RTI cases, COVID-19 cases had significantly lower IRRs for overall psychiatric disorders in both non-hospitalized (IRR: 0.59, P < 0.001) and hospitalized cases (IRR: 0. 83, P = 0.045) during the Omicron BA.1/BA.2 period, but only in non-hospitalized cases (IRR: 0.45, P < 0.001) during the Omicron BA.5 period. The incidences of the individual post-COVID psychiatric disorders varied according to disorder type, hospitalization status, and SARS-CoV-2 variant period. These findings provide a foundation for further research to explore these variations and improve the provision of psychiatric care in future epidemics.

Associations between COVID-19 vaccination and incident psychiatric disorders after breakthrough SARS-CoV-2 infection: The VENUS Study

BackgroundThe associations between COVID-19 vaccination and post-COVID psychiatric disorders are unclear. Furthermore, it is uncertain if these associations differ depending on the dominant SARS-CoV-2 variant at the time of infection. This retrospective cohort study aimed to clarify the associations between COVID-19 vaccination and incident psychiatric disorders after breakthrough infection according to the different variant periods in Japan. MethodsMedical claims data, COVID-19 case-related information, and vaccination records were collected from three Japanese municipalities. The study population comprised public insurance enrollees aged ≥65 years who developed COVID-19 between June 2021 and December 2022. The study exposure was each participant’s vaccination status 14 days before infection, and the outcomes were the occurrence of psychiatric disorders within three months of infection. Multivariable logistic regression analyses were performed to calculate the odds ratios (ORs) and 95 % confidence intervals (CIs) of vaccination for the occurrence of psychiatric disorders. Analyses were conducted for the Delta period (June to December 2021), Omicron BA.1/BA.2 period (January to June 2022), and Omicron BA.5 period (July to December 2022). ResultsWe analyzed 270 participants (vaccinated: 149) in the Delta period, 2,963 participants (vaccinated: 2,699) in the Omicron BA.1/BA.2 period, and 7,723 participants (vaccinated: 7,159) in the Omicron BA.5 period. During the Delta period, vaccinated participants had significantly lower odds for psychotic disorders (OR: 0.23, 95 % CI: 0.06–0.88, P = 0.032) than unvaccinated participants. During the Omicron BA.5 period, vaccinated participants had significantly lower odds for organic mental disorders (OR: 0.54, 95 % CI: 0.30–0.95, P = 0.033), psychotic disorders (OR: 0.31, 95 % CI: 0.19–0.53, P < 0.001), mood disorders (OR: 0.53, 95 % CI: 0.29–0.99, P = 0.046), and insomnia (OR: 0.48, 95 % CI: 0.32–0.72, P < 0.001) than unvaccinated participants. There were no significant differences in psychiatric disorders between the vaccinated and unvaccinated groups during the Omicron BA.1/BA.2 period. ConclusionsThis is the first study to demonstrate that the associations between COVID-19 vaccination and post-COVID psychiatric disorders vary among the different variant periods. Future studies on these associations should be conducted with consideration to the prevalent circulating variants.

Application of the MMPI-2 inventory in the differential diagnosis of psychotic disorders – based on profile analysis of a patient diagnosed with persistent delusional disorder and personality disorder

Aim: Paranoid states or traits can be present in various mental disorders; hence, their clarification is valuable for establishing a reliable nosological diagnosis. Clinical practice and literature on the subject highlight a range of defence mechanisms specific to the discussed nosological group. These mechanisms can impede the process of psychiatric and psychotherapeutic diagnosis and treatment. In contemporary evidence-based medical practice, the prevalent clinical approach is based on qualitative methods (e.g. free interviews and observations) complemented by standardised diagnostic tools. This approach assists the clinician in supplementing, organising, and objectifying clinical data related to the patient’s mental state. It is particularly beneficial for handling data that may be uncertain or unavailable in an observational study for various reasons. The article presents insightful and pragmatic theoretical, empirical, and case-related information on the potential application of the Minnesota Multiphasic Personality Inventory (MMPI-2) in the psychological diagnosis of patients with persistent delusional disorders. Methods: The paper explores theoretical issues and analyses a case study involving a female patient with a suspected diagnosis of delusional disorder and co-occurring personality disorder. In the case study, the authors employed qualitative methods, including observation and free psychological interview, and supplemented clinical data with insights gained through the use of a standardised psychometric method: the MMPI-2. Reflections and practical recommendations are divided into two groups. One group comprises the potential applications of the MMPI-2 in clinical psychological diagnosis. The other focuses on the importance of the diagnostic alliance and its roles in the process of planning the psychological diagnosis in patients with delusional disorders.

Online Health Information Seeking for Mpox in Endemic and Nonendemic Countries: Google Trends Study.

The recent global outbreak of mpox (monkeypox) has already been declared a public health emergency of international concern by the World Health Organization. Given the health, social, and economic impacts of the COVID-19 pandemic, there is understandable concern and anxiety around the emergence of another infectious disease-especially one about which little is known. We used Google Trends to explore online health information seeking patterns for mpox in endemic and nonendemic countries and investigated the impact of the publication of the first in-country case on internet search volume. Google Trends is a publicly accessible and free data source that aggregates worldwide Google search data. Google search data were used as a surrogate measure of online health information seeking for 178 days between February 18 and August 18, 2022. Searching data were downloaded across this time period for nonendemic countries with the highest case count (United States, Spain, Germany, United Kingdom, and France) and 5 endemic countries (Democratic Republic of Congo, Nigeria, Ghana, Central African Republic, and Cameroon). Joinpoint regression analysis was used to measure changes in searching trends for mpox preceding and following the announcement of the first human case. Online health information seeking significantly increased after the publication of the first case in all the nonendemic countries-United States, Spain, Germany, United Kingdom, and France, as illustrated by significant joinpoint regression models. Joinpoint analysis revealed that models with 3 significant joinpoints were the most appropriate fit for these data, where the first joinpoint represents the initial rise in mpox searching trend, the second joinpoint reflects the start of the decrease in the mpox searching trend, and the third joinpoint represents searching trends' return to searching levels prior to the first case announcement. Although this model was also found in 2 endemic countries (ie, Ghana and Nigeria), it was not found in Central African Republic, Democratic Republic of Congo, or Cameroon. Findings demonstrate a surge in online heath information seeking relating to mpox after the first in-country case was publicized in all the nonendemic countries and in Ghana and Nigeria among the endemic counties. The observed increases in mpox searching levels are characterized by sharp but short-lived periods of searching before steep declines back to levels observed prior to the publication of the first case. These findings emphasize the importance of the provision of accurate, relevant online public health information during disease outbreaks. However, online health information seeking behaviors only occur for a short time period, and the provision of accurate information needs to be timely in relation to the publication of new case-related information.

To be or not to be? A tale of immigrants’ entrepreneurial journey: the case of Sinorama’s international tourism empire

Theoretical basis Transnational entrepreneurs (TEs) are individuals that migrate from one country to another, concurrently maintaining business-related linkages with their former country of origin and currently adopted countries and communities. TEs are active social actors who enact networks, ideas, information and practices for the purpose of seeking business opportunities or maintaining businesses within dual-social fields, which, in turn, force them to engage in varied strategies of action to promote their entrepreneurial activities (Drori, Honig &amp; Wright, 2009). This case research focused on the ethic, legal and cultural challenges TE has been facing when operating their business across boards. Research methodology The data used in this case were collected from mainly third-parties, including the office de la protection du consommateur; Office of consumer protection (OPC), securities and exchange commission (SEC) reports, news as well as marketing materials posted on public media by Sinorama Corp. and Vacances Sinorama. The authors conducted interviews with former employees of Vacances Sinorama to gain the understanding of the owners and the business challenges faced during the years of operation. The authors also communicated with the OPC through to obtain specific case-related information through the Canadian freedom of information channels. Triangulation of such information from multiple resources had been conducted to validate and support the details described in the case content. Case overview/synopsis A Chinese immigrant couple migrated to Canada and started Vacances Sinorama Inc. (“Vacances Sinorama”) in 2005. The focus of this case is on the expansion of their travel businesses after 2015. In 2016, they established a financing shell company, Sinorama Corporation (“Sinorama Corp.”), in Florida, USA, which became the holding company to the operation subsidiaries. Born during the 1970s and raised in Mainland China, the owners were culturally traditional and operated the company with the values and norms from their heritage culture. Vacances Sinorama successfully penetrated the local tourism market using Web-based technology and aggressive low-pricing strategies after the scaling-up strategies. However, Vacances Sinorama was operating in the red for several consecutive years (2015–2018). Sinorama Corp. received additional capital of US$4.4m by listing a portion of its shares on the NASDAQ over-the-counter market during 2016 and 2017. Canadian regulators began to investigate its operational and financing activities in 2017. They found a comingling of client and operation funds, which directly violated Canadian consumer protection laws. As a result of these violations, the license for Vacances Sinorama was nonrenewed in August 2018. The majority of owners fought to overturn the regulators’ decision and failed at all levels of appeal, administrative and judicial. This entrepreneurial endeavor ended with Vacances Sinorama declaring bankruptcy in October of 2018. Complexity academic level This multipurpose teaching case aims to assist students from an integrated approach whom are learning about entrepreneurship, international business, business law and business ethics. It is best suited for advanced undergraduate courses in entrepreneurship, business ethics, international business and business law as well as specific teaching modules in MBA courses.

AutoPoD-Mobile—Semi-Automated Data Population Using Case-like Scenarios for Training and Validation in Mobile Forensics

The complexity and constant changes in mobile forensics require special training of investigators with datasets that are as realistic as possible. Even today, the generation of training data is almost exclusively done manually. This paper presents a novel open-source framework called AutoPoD-Mobile. The framework supports the creation of case-based scenarios. Even more, the semi-automated provision of datasets for mobile forensics is enabled. Thus, the behavior of suspects interacting with each other can be simulated. The result combines mobile device data from normal device usage and case-related information. This way helps validate mobile forensic tools, test new techniques, and create realistic training datasets in the mobile forensics domain. The results of a proof-of-concept trial in a realistic deployment environment will also be presented. The paper concludes with a discussion of the results and identifies options for future improvements.

Biased judgements of fairness in bargaining: A replication in the laboratory

In an influential paper, Babcock, Loewenstein, Issacharoff, and Camerer (1995) uncover evidence that knowledge about one's role in a settlement bargaining situation increases the frequency of bargaining impasse. The authors argue that role knowledge triggers self-serving interpretations of the case-related information that is the foundation of settlement bargaining. Self-servingly biased perception subsequently impedes successful settlement bargaining. We replicate the experiment in the computer laboratory. Our results are largely in line with the original findings. When participants know their bargaining role before studying the case materials rather than afterwards, settlement frequency decreases. This treatment effect is substantially smaller than in the original study. Given the new data, a Bayesian replication analysis reallocates the large share of credibility to a null model. We argue that this result is driven by the much smaller effect size that we observe in the highly controlled environment of the laboratory. Moreover, we extend the original analysis by estimating causal mediation effects of self-serving bias measures on the observed relationship between role-knowledge and settlement outcomes and find that self-servingly weighing legal arguments completely mediates the negative effect of role-knowledge on settlement frequency. In conclusion, we evaluate our replication as successful.

Operator-related aspects in endodontic malpractice claims in Finland

Objective: We analyzed operator-related differences in endodontic malpractice claims in Finland.Materials and methods: Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002–2006 and 2011–2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient’s age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist’s age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses.Results: Patients’ mean age was 44.7 (range 8–85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients’ gender, dentists’ age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator’s age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists.Conclusions: Operator-related factors had no impact on endodontic malpractice claims.

Digital forensic intelligence: Data subsets and Open Source Intelligence (DFINT[formula omitted]OSINT): A timely and cohesive mix

Advances in technologies and changing trends in consumer behaviour have led to an increase in the volume, variety, velocity, and veracity of data available for digital forensic analysis. A benefit of analysis of big digital forensic data is that there may be case-related information contained within disparate data sources. This paper presents a framework for entity identification and open source information cohesion to add value to data holdings from digital forensic data subsets. Application of the framework to test data resulted in locating additional information relating to the entities contained within the digital forensic data subsets, which led to adding intelligence value relating to the entities. Analysis of real-world data confirmed the potential to add value to big digital forensic data to uncover disparate information and open source information. The results demonstrate the benefits of applying the process to achieve greater understanding of digital forensic data in a timely manner.

Teaching points-do they occur and what do they contain? An observation study concerning the general practice rotation.

BackgroundA general practice rotation is mandatory in most undergraduate medical education programs. However, little is known about the student-teacher interaction which takes place in this setting. In this study we analyzed occurrence and content of teaching points.MethodsFrom April to December 2012, 410 individual patient consultations were observed in twelve teaching practices associated with the Philipps University Marburg, Germany. Material was collected using structured field-note forms and videotaping. Data analysis was descriptive in form. A teaching point is defined here as a general rule or specific, case–related information divulged by the teaching practitioner.ResultsAccording to the analysis of 410 consultations, teaching points were made in 66.3 % of consultations. During these consultations, 74.3 % general- and 46.3 % case related teaching points occurred; multiple categorizations were possible. Of seven possible topics, therapy was most common, followed, in frequency of occurrence, by patient history, diagnostic procedure, physical examination, disease pathology, differential diagnosis, risk factors and case presentation.ConclusionsThe majority of consultations conducted within student presence contained teaching points, most frequently concerning therapy. General teaching points were more common than specific teaching points. Whilst it is encouraging that most consultations included teaching points, faculty development aimed at raising awareness for teaching and learning techniques is important.

PACKING ISSUE IN CEMENT BLENDING FOR SUSTAINABILITY DEVELOPMENTS - APPROACH BY DISCRETE ELEMENT METHOD

Common cement blending materials for concrete like fly ashes, blast furnace slag, silica fume, metakaolin and rice husk ash have been investigated experimentally as to their impact on concrete’s mechanical, physical and sustainability capabilities. Such efforts offer but case-related information on involved materials and used procedures. Generalizations will be difficult because also contradicting information is provided: a weak basis to guide further developments. Published research data on blends with inert components (carbon black) confirm fineness to be the leading parameter governing their mechanics. Experimental efforts revealing blending effects on durability issues are more scarce because of their complicated, laborious and time-consuming nature. Hence, generalization capabilities are even more restricted. An approach is therefore presented for studying cementitious materials in the virtual reality, employing the concurrent algorithm-based dynamic discrete element method (DEM), HADES. Hydration simulation of the simulated (blended) Portland cement grain mixture is thereupon accomplished with an extended version of the vector approach. Robotics-based pore delineation provides topological information, while geometric characterization of the pore networks is accomplished by star volume measurements. Topological and geometric parameters can be combined in a hydraulic model for durability estimation. This approach allows covering a wide range of parameters. This would render possible more systematic and economic development of such materials for sustainability purposes, among other things. The production stages (DEM and hydration simulation) and the analysis stages (pore delineation and topology and geometry assessment) are briefly outlined. Application of the methodology is illustrated on finer and coarser grained cements blended with rice husk ash produced with different fineness. The effects of the gap in grading on the pore network characteristics relevant for transport-based durability items are outlined.

Do Safety Checklists Improve Teamwork and Communication in the Operating Room? A Systematic Review

The aim of this systematic review was to assess the impact of surgical safety checklists on the quality of teamwork and communication in the operating room (OR). Safety checklists have been shown to impact positively on patient morbidity and mortality following surgery, but it is unclear whether this clinical improvement is related to an improvement in OR teamwork and communication. A systematic search strategy of MEDLINE, EMBASE, PsycINFO, Google Scholar, and the Cochrane Database for Systematic Reviews was undertaken to obtain relevant articles. After de-duplication and the addition of limits, 315 articles were screened for inclusion by 2 researchers and all articles meeting a set of prespecified inclusion criteria were retained. Information regarding the type of checklist, study design, assessment tools used, outcomes, and study limitations was extracted. Twenty articles formed the basis of this systematic review. All articles described an empirical study relating to a case-specific safety checklist for surgery as the primary intervention, with some measure of change/improvement in teamwork and/or communication relating to its use. The methods for assessing teamwork and communication varied greatly, including surveys, observations, interviews, and 360° assessments. The evidence suggests that safety checklists improve the perceived quality of OR teamwork and communication and reduce observable errors relating to poor team skills. This is likely to function through establishing an open platform for communication at the start of a procedure: encouraging the sharing of critical case-related information, promoting team coordination and decision making, flagging knowledge gaps, and enhancing team cohesion. However, the evidence would also suggest that when used suboptimally or when individuals have not bought in to the process, checklists may conversely have a negative impact on the function of the team. Safety checklists are beneficial for OR teamwork and communication and this may be one mechanism through which patient outcomes are improved. Future research should aim to further elucidate the relationship between how safety checklists are used and team skills in the OR using more consistent methodological approaches and utilizing validated measures of teamwork such that best practice guidelines can be established.

Letter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivity

Free AccessCorrespondenceLetter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivityIngrid BöhmIngrid BöhmSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/bjr/65388056SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutThe Editor,It was with great interest I read the article by Garcia-Ortega et al [1] who presented a case with immediate reaction after iodinated contrast medium (ICM) injection. First of all I would like to congratulate the authors who published this interesting case; however, some facts remain unclear to me.First, what kind of hypersensitivity did the patient have? Angio-oedema of trunk and limbs is an unknown condition. Angio-oedema occurs in the face and involves the eyelids and lips [2]. I presume that the authors mean a generalised urticaria.Description of the clinical features is of great importance in the understanding of the pathological background, and planning of diagnostic procedures.Second, why was coronary angiography repeated 4 days later? Angiographic procedures with ICM at short intervals may be problematic, particularly in a patient with a previous immediate hypersensitivity reaction. Why was magnetic resonance angiography not considered as an alternative in this instance?Third, why was iodixanol used again? On one hand the authors present “new diagnostic tools”, and on the other the management is very old fashioned. Currently, radiologists do not usually use the ICM that has induced the hypersensitive reaction. Moreover, it is well known that pre-medication with antihistamines and corticosteroids do not prevent hypersensitive reactions. Furthermore, the doses of the drugs given 24 h before the start of the second angiography are missing in the case report.Fourth, why was the allergological work up started after the second hypersensitivity reaction?Hypersensitivity reactions after ICM reaction continue to be a challenge in radiological routine. To improve the safety of ICM application both clinical studies and case reports are of great importance. Case reports should be used to exactly describe the clinical features of adverse reactions in general, and of hypersensitivity reactions in particular [3].To conclude, in patients at high risk of hypersensitivity reaction, intradermal testing and the basophil degranulation test are of significant clinical impact, but other strategies such as avoidance of causative ICM should also be taken into account [4].References1 Garcia-Ortega P , Marin A , Quilez E , Rodriguez-Leor O . New tools for allergy diagnosis and clinical advice after immediate reactions to ICM. Br J Radiol 2010;83:632–3. Link ISI, Google Scholar2 Böhm I , Schild HH . A practical guide to diagnose less known immediate and delayed contrast media-induced adverse effects. Eur Radiol 2006;16:1570–9. Crossref Medline ISI, Google Scholar3 Böhm I , Medina J , Prieto P , Block W , Schild HH . Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence. Eur Radiol 2007;17:485–9. Crossref Medline ISI, Google Scholar4 Böhm I , Schild HH . KM-bedingte Anaphylaxie und Prävention durch Auswahl eines verträglichen Kontrastmittels. Fortschr Röntgenstr RöFo 2008;180:1127–8. Crossref Medline, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 84, Issue 1003July 2011Pages: 581-e150 2011 The British Institute of Radiology History ReceivedNovember 23,2010AcceptedJanuary 04,2011Published onlineJanuary 28,2014 Metrics Download PDF

Letter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivity

The Editor, We have read with interest the comments of Bohm and wish to clarify the clinical aspects requested. Our patient suffered a Type I hypersensitivity reaction during the first coronary angiography, since he developed generalised erythematous rash, areas of angio-oedema on the upper body, milder on the face and more evident on limbs (particularly hands and feet) and hypotension [1]. Nevertheless, as the patient also complained of feeling hot, chills, tremor and malaise, the reaction was not classified as an immunological Type I hypersensitivity reaction at that time and, the more common, anaphylactoid non-immunological histamine release reaction was considered more probable [2]. As diagnostic coronary angiography showed significant disease in the circumflex artery, a therapeutic coronary angiography was scheduled 4 days later for stent placement. The same iodinated contrast medium was used with the usual preventive treatment recommended for mild and moderate anaphylactoid reactions [2] and close observation of the patient. No other changes were made to the drug treatment between the first and second coronary angiographies. Magnetic resonance angiography was not considered because it is not an accurate technique to diagnose coronary artery disease owing to its low spatial resolution and motion artefacts [3]. In the second procedure, after only 20 ml of iodixanol had been infused, the patient complained of feeling hot, followed by tremor and generalised pruritic erythematous rash. The procedure was therefore stopped and, at that time, Type I iodixanol hypersensitivity was suspected and the patient was referred for allergological study. Until recently, iodinated contrast media were believed to induce mainly non-specific immediate reactions described as erythema or flushing, feeling hot, malaise, tremor and/or nausea; only in recent years has the immune nature of many of these immediate reactions, particularly anaphylactic events, been recognised, as emphasised by Bohm [4] and other authors [5]. Where non-specific histamine-release agents, such as iodinated contrast media are concerned, true immune hypersensitivity reactions may easily be mistaken, as occurred in the first coronary angiography in our patient. In this respect, the skin and laboratory tests performed in our patient were useful to confirm the immunological nature of such events and identify the culprit drug as well as other theoretically safer iodinated contrast media for future use, if required.

Development and use of a genitourinary pathology digital teaching set for trainee education

Background : Automated, high-speed, high-resolution whole slide imaging (WSI) robots are becoming increasingly robust and capable. This technology has started to have a significant impact on pathology practice in various aspects including resident education. To be sufficient and adequate, training in pathology requires gaining broad exposure to various diagnostic patterns through teaching sets, which are traditionally composed of glass slides. Methods: A teaching set of over 295 glass slides has been used for resident training at the Division of Genitourinary Pathology, Department of Pathology, University of Pittsburgh Medical Center. Whole slide images were prepared from these slides using an Aperio ScanScope CS scanner. These images and case-related information were uploaded on a web-based digital teaching model. Results: The web site is available at: https://www.secure.opi.upmc.edu/genitourinary/index.cfm. Once logged in, users can view the list of cases, or search cases with or without diagnoses shown. Each case can be accessed through an option button, where the clinical history, gross findings are initially shown. Whole slide images can be accessed through the links on the page, which allows users to make diagnoses on their own. More information including final diagnosis will display when the diagnosis-button is clicked. Conclusion: The web-based digital study set provides additional educational benefits to using glass slides. Residents or other users can remotely access whole slide images and related information at their convenience. Searching and sorting functions and self-testing mode allow a more targeted study. It would also prepare residents with competence to work with whole slide images. Further, the model can be expanded to include pre-rotation and post-rotation exams, and/or a virtual rotation system, which may potentially make standardization of pathology resident training possible in the future.

Assessing and predicting supervisors' evaluations of psychotherapists – an empirical study

Objective: The aim of this study was to analyze the dimensions used by supervisors to evaluate trainee therapists and to detect how supervisors' assessments are influenced by features of the case and of the therapist. Method: Data from 226 patients with diverse mental and social disorders who had been treated by 22 trainee therapists under the supervision of 12 supervisors were analyzed by factor- and regression analyses. Supervision was implemented as part of a psychotherapy training program. After treatment, each supervisor was asked to evaluate the trainee by using a list of 38 items proposed by Kanfer, Reinecker and Schmelzer (1996). Case characteristics and therapists' features were assessed by questionnaires and checklists and related to the supervisors' evaluations. Results: The statistical analyses indicated that supervisors could not easily integrate the multitude of relevant aspects into a differentiated schema of evaluation. A two-factor model best fitted the data. The two factors focus on specific aspects of therapeutic behavior. The evaluations were mainly related to the experience of the trainee therapist and to therapy outcome. For trainee therapists with more experience, the standards of comparison were set higher resulting in less positive evaluations. Discussion: The results are discussed with reference to a process-oriented view of supervision and therapist evaluation. It was concluded that supervisors of behavior therapy seem to weight therapist-related and case-related information differently. However, the way supervisors integrate these types of information into evaluations of trainee therapists still remains rather vague.

Prevalence of Multiple Sclerosis in Isfahan, Iran

Background: The prevalence of multiple sclerosis (MS) shows considerable variability all over the world. According to Kurtzke, Iran is considered to have a low prevalence. Objective: To estimate the period prevalence and risk factors of MS in Isfahan, central part of Iran. Methods: A cross-sectional case register study conducted between 2004 and 2005. In the province of Isfahan, Iran, all patients known to have definite MS during 2004 and 2005, being alive and resident within Isfahan as well as being a member of the Isfahan MS Association were included in the study. Demographic and case-related information was recorded. 1,391 definite MS patients (308 men and 1,083 women) from the Isfahan MS Association, Iran, have been identified. The disease was confirmed using clinical information and MRI findings by a neurologist and radiologist. The patients were evaluated by interview and a questionnaire. Population data were obtained from the year 1999 Iran Census. The mean (SD) age of the participants was 32.5 (9.3) years with a mean (SD) duration of the disease of 6.4 (5.1) years for men and 6.9 (5.3) years for women. Results: The period prevalence of MS was 35.5 per 100,000 [95% confidence interval (CI) 33.6–37.3] in a population of 3,923,255, with a higher rate in women than men [54.5 (95% CI: 51.1–57.8) for women and 14.9 (95% CI: 13.3–16.6) for men]. The female/male ratio was 3.6 (95% CI: 3.2–4.1). The direct age-adjusted period prevalence was 59.5 per 100,000 (95% CI: 44.8–75.2) for women and 17.0 per 100,000 (95% CI: 8.9–25.1) for men. MS rates were highest among 30- to 39-year-olds and decreased with increasing age. Sensory and visual disturbances were the most common initial presentations with a prevalence of 51.1% (95% CI: 48.4–53.7) and 47.0% (95% CI: 44.4–49.7), respectively. Conclusion: Isfahan could be considered as an area with a medium to high risk of MS. This is in sharp contrast with the gradient hypothesis.