Diagnostic Work Research Articles

Development of a checklist for systematic screening of precipitating factors in older patients admitted to hospital with delirium.

Causes of delirium are often multiple in older people and a significant number of them are missed at the initial assessment. We wanted to develop a checklist to help clinicians to systematically screen for the most frequent and important causes of delirium in this population. Three investigators, based on previous studies, drafted three possible checklist base models, comprising 18-29 items. A panel of 12 experts voted to choose one of the models, and then followed a modified Delphi consensus method to review each item and further develop the checklist. The consensus checklist was then tested in a small group of patients. The target population was older patients with delirium arriving to the emergency department or to a medical hospital ward. The longest of the three drafts was unanimously chosen by the panel. After three rounds, a consensus was reached and a final checklist agreed. It is composed by 27 items organized in five groups of causes: infections, hydro-electrolytic disturbances, drugs, acute neurological conditions, and other acute diseases. A pilot study conducted by 15 physicians in 21 consecutive patients showed that the checklist was easy to complete, quick (mean 4min) and most clinicians, though it helped them through the initial diagnostic work. We have developed and pilot tested a checklist for screening for acute precipitants of delirium in older patients, aimed to facilitate early recognition and treatment of the multiple causes that often coexists in this population.

Lymphoid Interstitial Pneumonia Without Known Cause: Diagnostic Work Up and Differential Considerations.

We present a case of diffuse cystic lung disease without any known underlying systemic disorder, biopsy confirmed as lymphoid interstitial pneumonia (LIP). This case highlights the benefit of histological confirmation in cases of diagnostic uncertainty if the clinical situation permits, particularly in the setting of symptomatic deterioration.

The Shape of Water: How Devon Energy Solved for Fracture Geometry Across Several Major Shale Plays

_ Shale producers have long sought to understand how fractures propagate underground, a fundamental question that shapes well spacing, completion strategies, and overall economics. A new study from Devon Energy (SPE 223547) aims to provide answers. It introduces the concept of fracture growth rate, which can “vary drastically” between formations, and examines the key geological and geomechanical factors driving those differences. Devon defines fracture growth rate by the area increased per the volume injected (ft2/bbl) to create the fracture. “We noticed that the Eagle Ford has much slower growth rates than in the Anadarko, and it could be up to a four- or five-times difference,” said Brendan Elliott, subsurface engineering manager at Devon Energy, speaking at the SPE Hydraulic Fracturing Technology Conference and Exhibition (HFTC) in Houston. According to the Oklahoma City-based firm, the variations in growth rate observed across thousands of fracture stages not only impact per-well economics but also dictate how many wells an operator can drill per section. “If you think about a barrel injected as a proxy for volume or frac size, in some areas of the world, you’re getting much less area per barrel,” Elliott said. “That’s important to understand, especially as we contextualize the differences across our plays.” He then presented data comparing fracture growth rates across Devon’s operating areas, emphasizing a key trend: “If you look at the plays with some of the fastest growth rates, those tend to be the ones with the least dense well spacing.” Elliott pointed to the Turner Sands formation in Wyoming’s Powder River Basin, where most 640-acre drilling sections today support only two to three wells. By comparison, in the Eagle Ford Shale, well spacing of 330 ft often allows for as many as 14 wells per section. Devon’s findings are the result of more than 5 years of diagnostic work using its proprietary technology, sealed wellbore pressure monitoring (SWPM), along with other corroborating methods such as fiber optics. Stress and Barriers What’s behind the striking differences reported by Devon? The firm’s extensive data-gathering effort shows that the two primary factors driving difference in fracture growth rate are the rock’s stress state and geomechanical barriers which represent the boundary between two distinct benches or formations. Horizontal stress magnitudes affect the extent to which fractures open. Additionally, the stress barriers between zones will influence vertical height and whether fractures propagate through different formations too quickly. Secondary natural fractures further affect fluid movement by controlling leakoff, as do the properties of in-situ fluids. Other important rock properties to consider include Young’s modulus. At HFTC, Elliott explained that in rocks with a high Young’s modulus, like those found in the Anadarko Basin, fractures tend to have very narrow apertures causing them to extend far more laterally than vertically. In contrast, the Delaware Basin in the Permian Basin has a lower Young’s modulus, which is one reason Devon has determined that fractures there can extend up to 4,000 ft laterally—or fracture tip to fracture tip—and up to 2,000 ft vertically in a 2:1 ratio.

Article Review: Advancements in Veterinary Histopathology: Linking Tissue Pathology to Clinical Outcomes

stressors. Histopathologists in veterinary pathology are therefore engaged in examining tissue alterations resulting from the direct or indirect influence of diseases on cells, tissues, organs, and/or body systems. Such microscopic alterations are collectively considered as 'lesions,' and the terminology used to describe these changes is unique to histopathology. Although mainly involved in Histopathology comprises the study of morphological changes occurring in tissues and organs during various pathological conditions or following exposure to chemicals, drugs, and other environmental diagnostic work, the veterinary histopathologist often plays a substantial role in understanding the pathogenesis of an individual case or collection of cases and may contribute to fundamental studies of the etiology and pathogenesis of a wide range of diseases affecting different species of animals. In review, where the aim is to understand why and how a disease develops, the broad term "anatomical pathology" is used.

Artificial Intelligence in Gynecological Oncology from Diagnosis to Surgery.

Background: The field of medicine, both clinical and surgical, has recently been overwhelmed by artificial intelligence technology, which promises countless application scenarios and, above all, implementation in clinical practice and research. Novelties are riding the wave fast, but where do we stand? A small overview in gynecological oncology of future challenges, evidence already investigated, and possible scenarios to be derived was conducted. Methods: Both diagnostic and surgical work in the field of gynecological oncology was conducted, selecting the most interesting articles on the subject. Results: From the narrative review of the literature, it emerged how much further ahead the diagnostic field is at present compared to the surgical one, which appeared to be more limited to ovarian surgery. Most current evidence focuses on the role of different biomarkers in predicting diagnostic, prognostic, and treatment-integrated patterns. Conclusions: Everything we know to date is related to a dynamic photograph that is constantly and rapidly changing as much as AI is becoming inextricably linked to our medical field.

Pathology of Clostridium colinum infection in quail.

Clostridium colinum causes ulcerative enteritis in several avian species. The disease is particularly prevalent in quail, and it is therefore colloquially known as quail disease. The pathogenesis of the infection is poorly understood. A retrospective study of C. colinum infection in quail submitted for necropsy and diagnostic work up to the California Animal Health and Food Safety Laboratory System between 1992 and 2022 was performed. The necropsy reports were reviewed, and polymerase chain reaction (PCR) for C. colinum (16S rRNA) was performed on formalin-fixed, paraffin-embedded tissues. C. colinum was isolated in 17% (4/24) and detected by PCR in 96% (23/24) of cases. Bobwhite quail (Colinus virginianus) were overrepresented, and the most affected quail were juveniles. Clinical history and signs were increased mortality (92%), lethargy (29%), depression (25%), diarrhea (21%), loss of nutritional condition (8%), and seizures (8%). Grossly, intestinal ulceration (100%) affecting the duodenum (79%), jejunum (100%), ileum (29%), and/or ceca (21%). Fibrinous celomitis (13%), hepatic necrosis (46%), and pectoral muscle atrophy (92%) were observed. Histologically, all quail showed multifocal ulcerative jejunitis, duodenitis, ileitis, and/or typhlitis with intralesional bacilli. Ulcerative enteritis was transmural in 92% of cases, associated with intestinal perforation in 38%, and causing celomitis in 50% of cases. Hepatic necrosis was confirmed in 63% of cases, and neuronal changes suggesting a combination of hypoxia-ischemia and hypoglycemia were found in 63% of cases. These results suggest that a diagnosis of C. colinum infection should be made based on gross and microscopic lesions, coupled with PCR.

Supraclavicular nodal metastasis at primary staging of prostate cancer using 18F-PSMA-1007 PET/CT

BackgroundThe most common sites of metastasis in prostate cancer are bone, pelvic and retroperitoneal lymph nodes, liver and lungs. This study aimed to evaluate the prevalence of supraclavicular nodal metastasis in newly diagnosed prostate cancer using 18F-PSMA-1007 PET/CT which has hitherto been understudied.Methods18F-PSMA-1007 PET/CT examinations performed at our institution between June 2020 and June 2022 for primary staging of prostate cancer were reviewed to identify supraclavicular nodal metastasis from prostate cancer. Data variables included age, stage of disease, PSA level, Gleason score and ISUP/WHO grade group and how these compare with the presence of supraclavicular nodal metastasis.ResultsA total of 240 patients with prostate cancer staged with 18F-PSMA-1007 PET/CT were analyzed. More than half of the patients presented with stage IVA or IVB disease, 54.1% (n = 130/240), and with high or very high-risk disease, 74.6% (n = 179/240). The prevalence of supraclavicular nodal metastasis in this cohort was 7.9% (n = 19/240). Advanced stage and high-risk groups were strongly associated with the presence of supraclavicular nodal metastasis.ConclusionThere is moderate prevalence of supraclavicular nodal metastasis in patients with intermediate to very high-risk prostate cancer which has likely previously been underdiagnosed with conventional imaging and has been brought to the fore with new-generation imaging such as PSMA PET/CT. It should therefore be an area of consideration during diagnostic work up and follow up of prostate cancer patients. The prognostic significance of supraclavicular nodal metastasis in prostate cancer requires further research.

Transport time as a potential limiting factor for thrombolytic treatment of stroke in Norway

BackgroundRapid diagnosis and treatment of stroke is important for good outcome. In some cases, patients with ischemic stroke arrive at hospital too late for reperfusion therapy. This may be the case especially in rural areas where time spent during transport may delay or even preclude thrombolytic treatment after hospital arrival. We aimed to estimate the extent and clinical relevance of this problem in the Norwegian population.MethodsWe collected data for all reported acute ischemic strokes for the years 2017 and 2018. Transport times from home to hospital were calculated from geographical data and related to frequency of thrombolysis, thrombectomy and clinical outcome after 3 months.ResultsThe frequency of reperfusion therapy decreased significantly as transport time increased. Six percent (564) of 9 428 patients were classified as having a prolonged time in transport. In this group, frequency of intravenous thrombolysis was 10,5% as opposed to 28,2% when prolonged transport was not present. Thrombectomy was performed in 2.1% versus 4.9% in the two groups respectively. We did not find a statistically significant difference between the two groups with regard to clinical outcome as judged by the modified Rankin Scale.ConclusionIn the years 2017 and 2018 a relatively small group of Norwegian patients with prolonged time in transport was disfavored concerning access to reperfusion therapy for ischemic stroke. In such cases a prehospital solution for diagnostic work up and treatment might improve access to acute stroke treatment.

Evaluation of factors associated with adult skeletal fluorosis in coal-burning type of endemic fluorosis and initial screening model based on machine learning in Guizhou, Southwest China.

Evaluation of factors associated with adult skeletal fluorosis in coal-burning type of endemic fluorosis and initial screening model based on machine learning in Guizhou, Southwest China.

Language Barriers in Appendicitis: What is the Cost?

In clinical scenarios, pediatricians prefer patient history over imaging to diagnose pediatric appendicitis because they wish to limit their patients' exposure to radiation. Language barriers between providers and patients with limited English proficiency may increase adverse outcomes, require more imaging studies, and lead to higher costs in cases of pediatric appendicitis. We queried the pediatric-National Surgical Quality Improvement Project database for patients under age 16 who received appendectomies from 2011-2021 at a single institution. Patients were propensity matched based on age, gender, Hispanic ethnicity, and insurance status. Medical records and hospital billing were merged to obtain primary language, initial hospitalization cost, diagnostic work up modalities, and operative findings. Patients identifying English as their primary language were termed English proficient (EP). Those selecting an alternate primary language made up the limited English proficiency (LEP) cohort. Health care utilization outcomes including cost, length of stay (LOS), and imaging usage were compared across cohorts. 400 patients were matched for analysis: 92 were EP and 109 LEP. When compared with the EP cohort, patients with LEP had higher rates of diagnostic imaging, longer median LOS, and higher median hospital costs. Imaging costs were also higher in patients with LEP. We also observed higher rates of negative appendectomy in the EP patients, compared to the LEP cohort. In patients with LEP, language diversity creates communication barriers resulting in higher health care utilization. Significant variations in the cost of care, efficiency of care, and clinical outcomes related to language diversity should be reduced to ensure equitable health care delivery to all pediatric surgical patients.

Automated system for diagnosing pulmonary fibrosis using crackle analysis in recorded lung sounds based on iterative envelope mean fractal dimension filter

Objective.Patients with pulmonary fibrosis (PF) often experience long waits before getting a correct diagnosis, and this delay in reaching specialized care is associated with increased mortality, regardless of the severity of the disease. Early diagnosis and timely treatment of PF can potentially extend life expectancy and maintain a better quality of life. Crackles present in the recorded lung sounds may be crucial for the early diagnosis of PF.Approach.This paper describes an automated system for differentiating lung sounds related to PF from other pathological lung conditions using the average number of crackles per breath cycle (NOC/BC). The system is divided into four main parts: (1) pre-processing, (2) separation of crackles from normal breath sounds using the iterative envelope mean fractal dimension filter, (3) crackle verification and counting, and (4) estimating NOC/BC. The system was tested on a dataset consisting of 48 (24 fibrotic and 24 non-fibrotic) subjects and the results were compared with an assessment by two expert respiratory physicians. The set of high-resolution computed tomography images, reviewed by two expert radiologists for the presence or absence of PF, was used as the ground truth for evaluating the PF and non-PF classification performance of the system.Main results.The overall performance of the automatic classifier based on receiver operating curve-derived cut-off value for average NOC/BC of 18.65 (AUC = 0.845, 95% CI 0.739-0.952,p< 0.001; sensitivity = 91.7%; specificity = 59.3%) compares favourably with the averaged performance of the physicians (sensitivity = 83.3%; specificity = 56.25%).Significance.Although radiological assessment should remain the gold standard for diagnosis of fibrotic interstitial lung disease (ILD), the automatic classification system has strong potential for diagnostic support, especially in assisting general practitioners in the auscultatory assessment of lung sounds to prompt further diagnostic work up of patients with suspect of ILD.

Towards Clinically Useful AI: From Radiology Practices in Global South and North to Visions of AI Support

Despite recent advancements, real-world use of Artificial Intelligence (AI) in radiology remains low, often due to the mismatch between AI offerings and the situated challenges faced by healthcare professionals. To bridge this gap, we conducted a field study at nine medical sites in Denmark and Kenya with two goals: (1) to understand the challenges faced by radiologists during chest X-ray practice; (2) to envision alternative AI futures that align with collaborative clinical work. This study uniquely grounds the AI design insights in the comprehensive characterisation of diagnostic work across multiple geographical and institutional contexts. Building on ideas articulated by interviewed radiologists (N=18), we conceptualised five visions that transcend the traditional notions of AI support. These visions emphasise that the clinical usefulness of AI-based systems depends on their configurability and flexibility across three dimensions: type of clinical site, expertise of medical professionals, and situational and patient contexts. Addressing these dependencies requires expanding the clinical AI design space by envisioning futures rooted in the realities of practice rather than solely following the trajectory of AI development.

Hydroxyurea-resistant primary erythrocytosis in a juvenile mixed-breed bitch

Primary erythrocytosis, also known as polycythemia vera, is a myoproliferative disease resulting in an increased red blood cell mass and is associated with increased hematocrit and hemoglobin concentrations. Patients have an augmented risk for thrombosis and bleeding. Typical clinical signs are weakness and central neurologic disturbances. An important clinical finding is the evidence of brick-red mucous membranes. Diagnosis of primary erythrocytosis is made by exclusion. Diagnostic work up includes measurement of erythropoietin levels as well as exclusion of common causes of secondary erythrocytosis (i.e. hypoxic disease, EPO-secreting tumors, kidney disorders). The treatment consists of initial phlebotomies, often combined with hydroxyurea as a chemotherapeutic agent. Patients may occasionally survive for years with long-term treatment. In this case report, a mixed-breed dog failed to show adequate response to chemotherapy with fever, diarrhoea and anorexia occurring during the hydroxyurea treatment period. Following the discontinuation of chemotherapy, clinical signs subsided. Due to rapid increases in hematocrit, phlebotomies were required very frequently (every 2 to 3 weeks) throughout the treatment. This case report demonstrates that control of clinical signs may be achieved with phlebotomy only and survival may exceed 30 months.

Acoustic calculation of process pipelines of a compressor station for assessing low-frequency pressure pulsations in dead-end branches

Relevance. The gas industry cannot be imagined without main gas pipelines, which are necessary to provide suppliers with the declared quantities of gas. To fulfill contractual obligations, compressor stations with high-flow compressor units are used. In order to ensure reliable operation and avoid premature failure of process equipment, periodic diagnostic work is carried out. Such measures allow increasing the service life of objects, but due to high static stresses and the occurrence of intense dynamic loads characteristic of process pipelines, this is not a sufficient condition for identifying potentially dangerous areas. In this regard, recently, engineering tools for calculating dynamic processes have been increasingly used to help solve such complex problems in order to study these processes in real systems and operating modes. Methods. Engineering analysis products to calculate the amplification of acoustic vibrations in dead-end branches of the technological piping of a compressor station. Results and conclusions. The authors have calculated the technological piping to assess the acoustic vibrations, the natural frequencies of vibrations of dead-end clarifications and the critical speeds, at which these vibrations occur. The paper introduces the results of the acoustic calculation carried out in the ANSYS Workbench software. According to these results the authors determined the pulsation amplifications in the dead-end branches, which are relatively large and can be the cause of high low-frequency vibrations.

Automated system for diagnosing pulmonary fibrosis using crackle analysis in recorded lung sounds based on iterative envelope mean fractal dimension filter.

Patients with pulmonary fibrosis (PF) often experience long waits before getting a correct diagnosis, and this delay in reaching specialized care is associated with increased mortality, regardless of the severity of the disease. Early diagnosis and timely treatment of PF can potentially extend life expectancy and maintain a better quality of life. Crackles present in the recorded lung sounds may be crucial for the early diagnosis of PF. This paper describes an automated system for differentiating lung sounds related to PF from other pathological lung conditions using the average number of crackles per breath cycle (NOC/BC). The system is divided into four main parts: (1) pre-processing, (2) separation of crackles from normal breath sounds using the iterative envelope mean fractal dimension (IEM-FD) filter, (3) crackle verification and counting, and (4) estimating NOC/BC. The system was tested on a dataset consisting of 48 (24 fibrotic and 24 non-fibrotic) subjects and the results were compared with an assessment by two expert respiratory physicians. The set of HRCT images, reviewed by two expert radiologists for the presence or absence of pulmonary fibrosis, was used as the ground truth for evaluating the PF and non-PF classification performance of the system. The overall performance of the automatic classifier based on receiver operating curve-derived cut-off value for average NOC/BC of 18.65 (AUC=0.845, 95 % CI 0.739-0.952, p<0.001; sensitivity=91.7 %; specificity=59.3 %) compares favorably with the averaged performance of the physicians (sensitivity=83.3 %; specificity=56.25 %). Although radiological assessment should remain the gold standard for diagnosis of fibrotic interstitial lung disease, the automatic classification system has strong potential for diagnostic support, especially in assisting general practitioners in the auscultatory assessment of lung sounds to prompt further diagnostic work up of patients with suspect of interstitial lung disease.

Diagnosing Crohn's disease in presumed cryptoglandular perianal fistulas: an expert Delphi consensus on early identification of patients at risk of Crohn's disease in perianal fistulas (PREFAB).

The aim of this Delphi study was to reach consensus on a new clinical decision tool to help identify or exclude Crohn's disease (CD) in patients with perianal fistula(s) (PAF). A panel of international experts in the field of proctology/inflammatory bowel disease was invited to participate. In the first round (electronic survey), participants were asked to anonymously provide their opinion probing (1) the relevance and use of clinical characteristics suggestive of underlying CD, (2) the use of fecal calprotectin (FCP) for screening for CD, and (3) on the diagnostic work-up for CD in PAF patients with raised clinical suspicion. In the second/third round (virtual consensus meetings), statements were paired/revised and presented in final sets of statements. Consensus was predefined as ≥70% (dis)agreement. Final consensus was reached on 12 statements, including screening of all PAF patients (regardless of the complexity, biological behavior, and co-existent perianal symptoms) and referral of PAF patients for a colonoscopy in case of elevated FCP levels (≥150 mcg/g) and/or in case of one clinical major criterion (defined as: unintentional weight loss, unexplained diarrhea, PSC, UC, >1 internal fistula openings, fistula involving other organs (vagina/bladder), recurrent fistulation (after initial healing), proctitis, and anal stenosis). Also, clinical (fistula-)characteristics that warrant raised suspicion for CD and an algorithm on the diagnostic work-/follow-up of patients with raised suspicion were defined. International consensus was reached on a new, clinical decision tool, including a practical and relevant algorithm for finding/excluding CD in PAF patients.

Psychological and Pedagogical Support for Mitigating Anxiety in Preschool Education: A Comprehensive Approach to Enhancing Cognitive and Emotional Development

The study investigates the organizational and pedagogical conditions of psychological and pedagogical support for children with manifestations of anxiety in preschool education institutions based on the personality-oriented model of interaction in the framework of a comprehensive approach to the organization of the educational and upbringing process. Proceeding from a theoretical analysis of the problem and an empirical study, the authors propose a system of work on the organization of psychological and pedagogical support of children with anxiety. The research goal is to explore the features of anxiety in preschool children and develop a program of psychological and pedagogical support for them in preschool. The authors employ theoretical analysis, empirical methods, and diagnostic techniques: the "Choose the right face" anxiety test, the "Stairs" method, the "Find and cross out" test (assessing productivity and attention span), the "Put marks" test, the diagnostic method for the level of development of emotional intelligence in older preschoolers, and the anxiety signs questionnaire, as well as mathematical statistics methods (Fisher's angular transformation). As a result of the study, the authors identify the features of anxiety in older preschool children. A project of a psychological and pedagogical support program for children with a high level of anxiety within the educational process of a preschool organization is proposed. The scientific novelty and theoretical significance of the research lie in the expansion and clarification of scientific knowledge about the specific features of anxiety among preschool children in the context of their inclusion in the education and upbringing process. The authors determine the organizational and pedagogical conditions necessary for psychological and pedagogical support of children with anxiety in preschool. Summarized results of the study can be utilized in professional practice by educators, educational psychologists, and other specialists in preschool education, in diagnostic and psycho-corrective work, and when developing programs and methodical materials to support children with anxiety in coping with the challenges of learning and development. Received: 10 September 2024 / Accepted: 19 December 2024 / Published: 05 January 2025

The SARS-CoV-2 test scale-up in the USA: an analysis of the number of tests produced and used over time and their modelled impact on the COVID-19 pandemic.

The SARS-CoV-2 test scale-up in the USA: an analysis of the number of tests produced and used over time and their modelled impact on the COVID-19 pandemic.

Моделирование режимов работы асинхронного двигателя с учетом несимметрии напряжения питающей сети

Induction motors are key elements of many electric power systems, especially electrification systems for technological installations of oil and gas facilities. Improving the efficiency, reliability and safety of induction motors requires accurate modelling of electromagnetic and mechanical processes, especially in transient conditions and with supply voltage asymmetry. This article presents a review of the mathematical model of a wound rotor induction motor based on the mesh-current method for interphase voltages. The model considers the influence of supply voltage asymmetry and provides an opportunity to study transients occurring in various operating modes, including starting. Using a proper model will enable prediction of machine main element service life and improved fault diagnostic work quality. This study provides modeling results, compares them to existing models, and demonstrates the effectiveness of the proposed method.

Coping behavior of students as a means of overcoming stressful situations under martial law.

Aim: The aim is to study the peculiarities of students' coping behavior in stressful situations under martial law. Materials and Methods: During the 2023-2024 academic year, the research was conducted based among 3rd-year students (n = 82) aged 20-22 years, including women (n = 42) and men (n = 40). Research methods: bibliosemantic, diagnostic, system analysis and generalization, statistical. The diagnostic work involved using the following methods: "Coping Inventory for Stressful Situations" and "Strategic Approach to Coping Scale." Results: It has been found that the problem of students being in a stressful situation of war is directly related to their coping behavior. It has been found that female students' indicators of emotion-oriented coping strategies are more pronounced than those of male students (p 0.05) high level of expression of the following models of behavior to overcome stressful phenomena: search for social support (women - 57.1 %; men - 55.0 %), social contact (women - 54.8 %; men - 52.5 %), precautionary actions (women - 52.4 %; men - 50.0 %). Conclusions: The effectiveness of any coping strategy depends on the current situation in students' lives and their existing personal resources. In stressful situations, students' coping behavior is effective, and the following coping strategies are rational: emotion-oriented, search for social support, and problem-oriented. This confirms students' productive personal standpoint, allowing them to adapt to any stressful situation under martial law.