Inaccurate Interpretation Research Articles

Misdiagnosis of atrial fibrillation and its clinical consequences

Computer algorithms are often used for cardiac rhythm interpretation and are subsequently corrected by an overreading physician. The purpose of this study was to assess the incidence and clinical consequences of misdiagnosis of atrial fibrillation based on a 12-lead electrocardiogram (ECG). We retrieved 2298 ECGs with the computerized interpretation of atrial fibrillation from 1085 patients. The ECGs were reinterpreted to determine the accuracy of the interpretation. In patients in whom the interpretation was incorrect, we reviewed the medical records to assess the clinical consequences resulting from misdiagnosis. We found that 442 ECGs (19%) from 382 (35%) of the 1085 patients had been incorrectly interpreted as atrial fibrillation by the computer algorithm. In 92 patients (24%), the physician ordering the ECG had failed to correct the inaccurate interpretation, resulting in change in management and initiation of inappropriate treatment, including antiarrhythmic medications and anticoagulation in 39 patients (10%), as well as unnecessary additional diagnostic testing in 90 patients (24%). A final diagnosis of paroxysmal atrial fibrillation based on the initial incorrect interpretation of the ECGs was generated in 43 patients (11%). Incorrect computerized interpretation of atrial fibrillation, combined with the failure of the ordering physician to correct the erroneous interpretation, can result in the initiation of unnecessary, potentially harmful medical treatment as well as inappropriate use of medical resources. Greater efforts should be directed toward educating physicians about the electrocardiographic appearance of atrial dysrhythmias and in the recognition of confounding artifacts.

Invited commentary

Invited commentary

Requesting and interpreting trauma radiographs: a role extension for accident & emergency nurses

Government supported expansion of the nursing role within Accident & Emergency (A&E) departments in the United Kingdom (UK) has begun to break down the traditional barriers to professional practice. Today, many nurses working within A&E departments are both requesting and interpreting radiographic examinations as part of their normal working practice. However, role expansion does not occur without increased responsibility. Unsatisfactory requests for radiography and inaccurate radiographic interpretation may result in inappropriate patient treatment, misuse of resources, patient recall and litigation. Nurses undertaking these role extensions need to ensure that their levels of knowledge and skill to perform the role are appropriate and adequately supported. This article summarises the results of a national questionnaire survey of A&E nurse managers that aimed to identify current working practices, including education, training and limitations to practice, with respect to the requesting and interpretation of trauma radiographs by A&E nurses.

Comparison of a DC Integral Solution with a 3D EM Solution of the Magnetometric Resistivity Problem.

We have completed three-dimensional electro-magnetic (EM) modelling to verify the applicability of a direct current (DC) forward modelling solution for interpreting data collected by an experimental electrical resistivity tomography/magnetometric resistivity (ERT/MMR) system. Comparison of the EM solution to the static solution defines the range of environments where the zero frequency solution is applicable.The DC algorithm was determined to apply to a wide range of target resistivities (lxlO8 ohm-m – 10 ohm-m) for operating frequencies up to 8kHz. However, magnetically permeable targets result in inaccurate interpretation and inversion results.

Attempting to limit the attribution of capital gains

Paragraphs 68 to 72 of the Eighth Schedule to the Income Tax Act No. 58 of 1962 (the Act’) were inserted to perform the same function as that of section 7, namely to attribute income in cases in which the taxpayer has disposed of that source of income by means of donation, settlement or other disposition. Paragraph 73 of the Eighth Schedule to the Act was inserted to limit the total amount that is attributed to the donor in a year in which both income (in terms of section 7) and a capital gain (in terms of the attribution paragraphs 68 to 72) are to be attributed. The unclear construction of the section and, it is submitted, the inaccurate interpretation of this paragraph by the South African Revenue Services (SARS’) has made it difficult to interpret this paragraph. This article attempts to evaluate prevailing legal precedent and to apply such precedent to the paragraphs on attribution in order to arrive at an appropriate interpretation of paragraph 73. The approach adopted by SARS is also examined in the light of the above interpretation and application of prevailing legal precedent. Lastly, amendments to the legislation are proposed to clarify the legislation and to provide a structured approach in the consideration of the intention of the legislature.

Application of modern well test analysis techniques to pressure transient tests in Kizildere geothermal field, Turkey

The analyses of two build-up tests and one interference test in the Kizildere geothermal field, Turkey, are presented. Modern well test analysis methods based on pressure-derivative (logarithmic time rate of pressure) and non-linear regression, as well as conventional log–log and semi-log straight-line methods, have been used in the interpretation of these field pressure tests. Pressure transient models based on both homogeneous reservoirs and fractal reservoirs without matrix participation are considered in the analysis. It is shown that the use of conventional analysis methods alone can lead to an inaccurate interpretation of these field tests, and the use of modern analysis techniques in conjunction with conventional analysis techniques provides a more reliable and accurate interpretation of the well test data in the Kizildere geothermal field. The information obtained (e.g., estimates of permeability thickness and fractal dimensions) from analyses of these tests should prove useful for reservoir characterization studies in the Kizildere field, where reinjection is scheduled to begin soon. Finally, the modern interpretation methods described in this paper are recommended for analysis of well test pressure data from geothermal reservoirs.

Histoire de l'anatomie du thalamus de l'antiquité à la fin du XIXe siècle

The physicians of the Alexandrine school seem to have been able to follow the way of the optic nerves from the retina to the brain. It was very probable that they should discover the thalamus. Sadly, anatomic knowledge, deriving from the first scientific human dissection performed in history, was destroyed in the fire of the Alexandrine Library. When, in the second century A.D., Galen introduced the term opticus, he was describing the central part of the lateral ventricles of the brain. After Galen, an anatomy with philosophical inferences substituted an anatomy based on direct observation. At that time the purpose was to find the site of the soul. During the thirteen centuries following Galen, including the Byzantine epoch and the High Middle Ages, the knowledge of the anatomy of the central nervous system did not make any substantial progress. The deep location of the contributed, for a very long time, to make it invisible to the eyes of the anatomists. It was Mondino da Luzzi, during the thirteenth century A.D., who gave the first incontestable description of the thalamus. He named the anchae (buttocks). Nevertheless, we should also consider the hypothesis that Galen, from whom Mondino always got his inspiration, could already have used the Latin term nates to name the pulvinar of the thalamus. Three centuries later, Andreas Vesalius, the true father of modern anatomy, first illustrated the in his artwork De humani corporis fabrica (1543). The was perfectly represented by Vesalio. He provided figures of the with accurate legends in many brain sections with different perspectives but, strangely, he did not mention it in the text. In the seventeenth century, Jean Riolan and Thomas Willis inaugurated the use of the term thalamus in its actual meaning, probably as a consequence of an inaccurate interpretation or the transcription of Galen's writings. The has superbly been represented by Willis and Vieussens in their De CerebriAnatome (1664) and Neuronographia Universalis (1684). These works were the first monographs of the human history to be integrally devoted to the central nervous system. During the eighteenth century the anatomic illustration began to conform itself more to a scientific than an artistic approach. Nevertheless, despite the presence of the in most atlases, only little scientific progress was made in its understanding. During that century,Alexander Monro (Monro Primus, 1697-1767) described the hypothalamic sulcus and the interventricular foramens clarifying their topography with the thalamic walls. Giovanni Domenico Santorini (1681-1737) accurately reported the link between the optic tracts and the structure he first named as the lateral geniculate body of the thalamus. Francois Pourfour du Petit (1664-1741), Santorini and then Felix Vicq d'Azyr (1748-1794) described the mammillothalamic tract. The modern approach to thalamic morphology began with the improving of the microscopy and histology techniques. In this context, K. F. Burdach proposed to separate the into distinct nuclei (1823) and later Jean Luys established the link between this anatomic subdivision and the idea of a functional specialisation (1865). Since then, a great amount of, often imprecise or contradictory, anatomic-functional data has accumulated rapidly.

Estimating with confidence the risk of rare adverse events, including those with observed rates of zero

Omission of a confidence interval (CI) associated with the risk of a serious complication can lead to inaccurate interpretation of risk data. The calculation of a CI for a risk or a single proportion typically uses the familiar Gaussian (normal) approximation. However, when the risk is small, [ldquo ]exact[rdquo ] methods or other special techniques should be used to avoid overshooting (risks that include values outside of [0,1]) and zero width interval degeneration. Computer programs and simple equations are available to construct CIs reasonably accurately. In the special case in which the complication has not occurred, the risk estimated with 95% confidence is no worse than 3/n, where n is the number of trials. Reg Anesth Pain Med 2002;27:207-210.

Land Use and Transportation Interaction: Implications on Public Health and Quality of Life

Increases in per capita vehicle usage and associated emissions have spawned an increased examination of the ways in which our communities and regions are developing. Associated with increased vehicle usage are decreased levels of walking and biking, two valid forms of physical activity. The Surgeon General’s 1996 report, Physical Activity and Health, highlights the increasing level of physical inactivity as a growing cause of mortality. The costs and benefits of contrasting land development and transportation investment practices have been the subject of considerable debate in the literature. Findings have been refuted based on methodological grounds and inaccurate interpretation of data. Several of these studies, their methodological approaches, and their critiques are analyzed. While most agree that the built environment influences travel, considerable disagreement exists over the likely impacts of increased density, mix, and street connectivity on air quality, and on transportation system performance and household activity patterns.

Land Use and Transportation Interaction

Increases in per capita vehicle usage and associated emissions have spawned an increased examination of the ways in which our communities and regions are developing. Associated with increased vehicle usage are decreased levels of walking and biking, two valid forms of physical activity. The Surgeon General’s 1996 report, Physical Activity and Health, highlights the increasing level of physical inactivity as a growing cause of mortality. The costs and benefits of contrasting land development and transportation investment practices have been the subject of considerable debate in the literature. Findings have been refuted based on methodological grounds and inaccurate interpretation of data. Several of these studies, their methodological approaches, and their critiques are analyzed. While most agree that the built environment influences travel, considerable disagreement exists over the likely impacts of increased density, mix, and street connectivity on air quality, and on transportation system performance and household activity patterns.

00/00893 A CdTe/PMeT photovoltalc structure formed by electrodeposition and processing

The analyses of two build-up tests and one interference test in the Kizildere geothermal field, Turkey, are presented. Modern well test analysis methods based on pressure-derivative (logarithmic time rate of pressure) and non-linear regression, as well as conventional log–log and semi-log straight-line methods, have been used in the interpretation of these field pressure tests. Pressure transient models based on both homogeneous reservoirs and fractal reservoirs without matrix participation are considered in the analysis. It is shown that the use of conventional analysis methods alone can lead to an inaccurate interpretation of these field tests, and the use of modern analysis techniques in conjunction with conventional analysis techniques provides a more reliable and accurate interpretation of the well test data in the Kizildere geothermal field. The information obtained (e.g., estimates of permeability thickness and fractal dimensions) from analyses of these tests should prove useful for reservoir characterization studies in the Kizildere field, where reinjection is scheduled to begin soon. Finally, the modern interpretation methods described in this paper are recommended for analysis of well test pressure data from geothermal reservoirs.

Ship-mounted satellite tracking antenna with fuzzy logic control

A robust satellite tracking antenna is designed to cope with the sensor imprecision and the highly noisy sea environment. Fuzzy logic is utilized for the controller imprecision and the highly noisy sea environment. Fuzzy logic is utilized for the controller design as well as inaccurate data interpretation. The fuzzy-rule based controller eliminates the need to model the nonlinear and noisy ship-mounted antenna system. With Global Positioning System and the tracking controller the antenna can be brought to a neighborhood of the desired orientation. Spiral search with signal power feedback can then servo the antenna to the true orientation. Computer simulations and antenna experiments verify our design is indeed robust and effective.

Cytologically low grade malignancies: an important interpretative pitfall responsible for false negative diagnoses in fine-needle aspiration of the breast.

Failure to diagnose breast carcinoma by fine-needle aspiration (FNA) is a major obstacle to expanded use of that technique. While the majority of false negative diagnoses are due to inadequate sampling and insufficient specimens, a significant minority of false negative cases result from inaccurate interpretation of adequate material. Low grade carcinomas including lobular, tubular, low grade adenosquamous, and papillary carcinomas appear to account for many of these diagnostic errors. Careful attention to nuclear detail, monomorphism of cell population and the presence of neoplastic cells with retained cytoplasm should allow the recognition of the majority of these neoplasms as malignant by cytologic examination.

The Portrait of Julius II in London's National Gallery. The Goose That Turned into a Gander

The author rejects the attribution of the discussed painting to Raphael, which has been admitted almost unanimously since 1970. The previous idea was based on two mistakes: an inaccurate interpretation of the results of conservation carried then and the groundless identification of the London painting with the one exhibited in the sixteenth century in the church of Santa Maria del Popolo in Rome. The detailed examination of the stylistic features of the both famous portraits of Julius II - in London and the Uffizi Gallery - leads the author to the primacy of the latter one, which is probably the original of Raphael, painted possibly after the cartoon preserved in the Collezine Corsini in Florence, but not after the one from Chatsworth as supposed before. The London painting was a workshop copy painted probably ca 1516 by Giovanni Francesco Penni.

Diagnostic pitfalls in abdominal CT.

Many factors result in suboptimal performance of abdominal computed tomography (CT) or inaccurate interpretation of the images. Improper technique, observers' errors, and lack of clinical information are major contributors to misdiagnoses. Because of inadequate oral administration of contrast material, normal structures (eg, bowel) may remain unopacified and simulate tumors. Repeat scanning with additional contrast material and sodium bicarbonate, at selected levels, and perhaps with changes in patient position often reveals the true nature of pseudotumors in the gastrointestinal tract. Dynamic CT of the liver, performed during contrast material injection, yields the best results. Occasionally, reconstruction of axial images in coronal or sagittal planes helps delineate normal sectional anatomic variations of the diaphragm and liver and avoid misdiagnosis of pseudomasses. Volume averaging can cause problems when the section thicknesses are larger than the lesions (eg, small hepatic cysts) or structures are very close (eg, kidney and spleen); repeat CT with thinner sections is needed to obtain accurate attenuation values or delineate normal anatomic relationships. The gallbladder, spleen, and pancreas can change position due to prior surgery and raise suspicion of a mass unless clinical history is known. Familiarity with these and other pitfalls described herein should lead to accurate interpretation of CT scans.

Missed myocardial ischaemia in the accident & emergency department: E.C.G. a need for audit?

Accident & Emergency Department Senior House Officers rely heavily on their ECG interpretation skills in the diagnosis and management of patients with chest pain. This prospective double-blind study was designed to test the accuracy with which Accident & Emergency Senior House Officers interpret ECGs, by comparing their interpretation with that of a Consultant Cardiologist. ECGs from 279 of 314 consecutive patients with chest pain were analysed. Ninety per cent of normal electrocardiographs and 57% of abnormal ECGs were correctly interpreted. Despite the inaccurate interpretation of 43% of abnormal ECGs, 96.5% of the patients in the study were considered to have been managed correctly. Audit of all ECGs recorded in the Accident & Emergency Department should be undertaken by someone with experience of ECG interpretation. New A&E staff should receive training in the interpretation of ECGs.

Hegel and International Ethics

The collapse of the Eastern European communist regimes led to a re-evaluation of Hegel's philosophies as inspiration for shaping the post-communist governments. Concerned that the reappearance of literature on Hegel's ideas often expresses inaccurately and one-sidedly the philosopher's views, Brown attempts to clarify Hegelian ideas of absolute knowledge and self-knowledge that lead to the model of the modern state as “the vehicle for the self-expression of spirit…governed only by the requirements of reason” upon which Hegel grounds international ethics. The author links Hegel's work to some practical international concerns, such as internationalism, ethnocentrism, relativism, and the vision of the end of history. The author refers to Francis Fukuyama's essay “The End of History?” (1989) celebrating the triumph of political and economic history, and showing how it was based on an inaccurate interpretation of Hegel. When evaluating recent interpretations of Hegel's work, Brown shows that one must be cautious to review the accuracy of his explicit views.

The Relationship Between Postnatal Skin Maturation and Electrical Skin Impedance

Electrical impedance, which is the resistance to an alternating current, is a parameter that is used to determine the condition of the electrode-skin interface before evoked potentials are recorded. High electrical impedance can result in inaccurate interpretation of evoked potentials due to excessive artifacts. This study investigated the electrical skin impedance in 36 full-term infants who ranged from 0 to 1 year of age to delineate the temporal relationship between skin maturation and skin impedance. Correlation and regression analyses demonstrated a statistically significant inverse relationship between electrical skin impedance and age during the first year of life. This drop in skin impedance during the first few postnatal months was attributed to an increase in skin hydration as a result of the greater functional maturity of eccrine sweat glands.

Minority MMR overrepresentation and special education reform.

The National Academy of Sciences (NAS) panel recommendations are examined critically in view of past and current classification and placement practices for exceptional students. The NAS panel emphasis on instructional validity is strongly endorsed. However, the NAS panel was perhaps naive in certain other recommendations, particularly those dealing with use of biomedical data and learning-process assessment. Special problems in mild mental retardation and inaccurate interpretation of overrepresentation phenomena are discussed, as well as the use of prereferral interventions, cross categorical programming, application of an outcomes criterion, and expansion of regular education options for mildly handicapped students, including prereferral services.

The Safety of Aspartame

To the Editor.— In Letter to the Editor, Dr Pardridge 1 interpreted our data 2 on effects of maternal hyperphenylalaninemia on offspring IQ as indicating a 10.5-point drop in the IQ of babies born of mothers with 250-μmol/L increments in the blood phenylalanine This is an inaccurate interpretation of the data, as we have previously pointed out. 3 By categorizing the information in Fig 1 of our report according to the maternal plasma phenylalanine levels represented in our sample, we obtained the following mean IQ scores for offspring: This does not represent 10.5-point drop in IQ of offspring for each 250-μmol/L increment in the maternal plasma phenylalanine level. In fact, the mean IQ of 119 for offspring at maternal plasma phenylalanine levels of 200 to 300 μmol/L—which are higher than the plasma phenylalanine levels that normal individuals or those who carry the gene for phenylketonuria have even