Low Detection Rate Research Articles

Increasing exposure to the UV filters octocrylene and 2-ethylhexyl salicylate in Germany from 1996 to 2020: Human biomonitoring in 24-h urine samples of the German Environmental Specimen Bank (ESB)

The UV filters octocrylene (OC) and 2-ethylhexyl salicylate (EHS) are commonly used in sunscreens and frequently detected in environmental media. However, knowledge on human exposures is scarce.In this human biomonitoring (HBM) study, we analyzed concentrations of exposure biomarkers specific to OC (CPAA, DOCCA, 5OH-OC) and EHS (5OH-EHS, 5oxo-EHS, 5cx-EPS) in 24-h urine samples (n = 420) from the German Environmental Specimen Bank (ESB). These samples were collected from German students (20–29 years; 30 males/30 females per year) between 1996 and 2020 (4-year intervals; collection in winter).We found continuously increasing OC and EHS exposures (Jonckheere-Terpstra; p < 0.001) documented by very few to no samples with concentrations of the most sensitive biomarkers CPAA and 5cx-EPS above the limit of quantification (LOQ) in 1996 (5 % and 0 %, respectively) and reaching 100 % and 93 % above the LOQ in 2016, with median concentrations of 4.79 and 0.071 µg/L, respectively. In 2020, biomarker concentrations slightly decreased to 3.12 µg/L CPAA (97 %>LOQ) and 0.060 µg/L 5cx-EPS (88 %>LOQ). This general trend was confirmed by the other biomarkers, however at lower detection rates. Based on metabolite excretion in the 24-h urine samples and human toxicokinetic data, we calculated maximum daily intakes (DI) of 17 µg/(kg bw * d) OC and 59 µg/(kg bw * d) EHS. Based on a derived no-effect level (DNEL) of 0.8 mg/(kg bw * d), the OC exposures of individuals in our study did not indicate any health risk. Similarly, for EHS all biomarker concentrations were well below the HBM-I values of 12 µg/L 5OH-EHS and 11 µg/L 5cx-EPS.Our data proves the general applicability of specific OC and EHS metabolites for HBM in the general population and shows clearly increasing exposures. Higher (co-)exposures must be expected in populations with increased sunscreen use such as (summer) vacationers, children and outdoor workers.

The effect of visual rivalry in peripheral head-mounted displays on mobility

Recent head-mounted displays and smart glasses use vision multiplexing, an optical approach where two or more views are superimposed on each other. In vision multiplexing, augmented information is presented over an observer’s natural field of view, providing field expansion and critical information during mobility situations like walking and driving. Yet despite its utility, vision multiplexing may produce visual rivalry, a phenomenon where perception alternates between the augmented information and the background scene for seconds at a time. To investigate, we compared the effect of different peripheral vision multiplexing configurations (unilateral opaque, unilateral see-through and bilateral see-through) on the detection of augmented information, incorporating at the same time real-world characteristics (target eccentricity, depth condition, and gaze movement) for a more realistic assessment. Results showed a persistently lower target detection rate in unilateral configurations than the bilateral configuration, suggesting a larger effect of binocular rivalry on target visibility. Nevertheless, this effect does become attenuated when more naturalistic elements are incorporated, and we discuss recommendations for vision multiplexing design and possible avenues for further research.

Development of an LFD-RPA Assay for Rapid Detection of Pentatrichomonas hominis Infection in Dogs.

Pentatrichomonas hominis is a trichomonad protozoan that infects the cecum and colon of humans and other mammals. It is a zoonotic pathogen that causes diarrhea in both animals and humans. As companion animals, dogs infected with P. hominis pose a risk of transmitting it to humans. Current methods, such as direct smears and polymerase chain reaction (PCR), used for P. hominis detection have limitations, including low detection rates and the need for specialized equipment. Therefore, there is an urgent need to develop rapid, sensitive, and simple detection methods for clinical application. Recombinase polymerase amplification (RPA) has emerged as a technology for rapid pathogen detection. In this study, we developed a lateral flow dipstick (LFD)-RPA method based on the highly conserved SPO11-1 gene for detecting P. hominis infection by optimizing the primers, probes, and reaction conditions, and evaluating cross-reactivity with genomes of Giardia duodenalis and other parasites. The LFD-RPA method was then used to test 128 dog fecal samples collected from Changchun. The results confirmed the high specificity of the method with no cross-reactivity with the five other parasites. The lowest detection limit of the method was 102 copies/µL, and its sensitivity was 100 times higher than that of the conventional PCR method. Consistent with the positivity rate observed using nested PCR, 12 samples (out of 128) tested positive using this method (positivity rate, 9.38%). In conclusion, the LFD-RPA method developed in this study represents a simple and sensitive assay that allows for the rapid detection of P. hominis infection in dogs, especially in this field.

Clump-scale Gas Infall in High-mass Star Formation: A Multitransition View with James Clerk Maxwell Telescope HCN (4–3) Mapping

Gas infall motions play a crucial role in high-mass star formation and are characterized by observable signatures of blueshifted asymmetric spectral line profiles (“blue profiles”). However, the connection between blue profiles and infall motions is unclear due to complex gas motions at parsec scales. In this study, we present the results of an HCN (4–3) mapping survey conducted with the James Clerk Maxwell Telescope, toward 38 massive clumps exhibiting blue profiles in HCO+ (3–2). We extract 34 HCN cores from the 38 observed fields. The core-averaged spectra show various line profiles, indicating that blue-profile HCO+ (3–2) does not guarantee the same in HCN (4–3). Through non-LTE radiative-transfer calculations, we attribute the low detection rate of high-J blue profiles to a combination of insufficient HCN (4–3) opacity and the intricate gas motion across different density layers. A comparison between the MALT90 and Bolocam Galactic Plane Survey line surveys highlights the importance of appropriate tracers, high spectral resolution, and column density thresholds when searching for blue profiles. We select 11 reliable infall candidates and adopt the Hill5 model to fit the infall velocity of 0.2–1.6 km s−1, corresponding to 5%–74% of freefall velocity. Assuming a spherically collapsing model, we estimate the median and mean mass infall rates to be 4.5 × 10−3 and 7.6 × 10−3 M ⊙ yr−1, respectively. The consistency of the mass infall rates among different transitions suggests a steady accretion process from the clump gas envelope to the inner region.

An Effective and Efficient Intrusion Detection System of Network Attacks Using Stacked CNN and Voting Technique

IDS are crucial to network security because they can identify malicious activity and halt it in its tracks. Network intrusion data is often masked by a sea of benign data, making it difficult to train a model or perform a detection with a high FPR. This is because networks are inherently dynamic and change over time. In this research, we offer a ML &amp; DL model-based method to ID, and we demonstrate how to deal with the issue of data imbalance by using a hybrid sampling technique. Conventional firewalls and data encryption technologies are unable to provide the level of security required by current networks. As a result, IDSs have been endorsed for use against network threats. Recent mainstream ID approaches have benefited from ML, but they have low detection rates &amp; need a lot of feature engineering to be truly useful. Using layered CNN and Voting classifier (XGBoost and LGBM), this study introduces ML-DL-NIDS to address the issue of subpar detection precision. Using a publicly available NSL-KDD &amp; UNSW-15 benchmark datasets for network intrusion detection, we find that this model outperforms competing methods according to accuracy and F1-score obtained from experimental evaluations.

Trisomy 21 screening with αlpha software and the Fetal Medicine Foundation algorithm

Background. Screening for trisomy 21 provides pregnant women with accurate risk information. Different algorithms are used to screen for trisomy 21 in South Africa (SA). The Fetal Medicine Foundation (FMF) provides software to screen for trisomy 21 in the first trimester by ultrasound or a combination of ultrasound and biochemistry (combined screening), and requires regular and stringent quality control. With αlpha software, first trimester combined screening and screening with biochemistry alone in the first or second trimester are possible. The αlpha screening requires quality control of biochemical tests, but not of ultrasound measurements. Ideally, a screening test should have a high detection and a low screen positive rate. Despite the availability of these screening programmes, only a minority of infants with trisomy 21 are detected prenatally, raising questions about the effectiveness of screening. Objectives. To determine the screen positive and detection rates of prenatal screening for trisomy 21 in the SA private healthcare system. Methods. Data from the three largest laboratories collected between 2010 and 2015 were linked with genetic tests to assess screen positive and detection rates. Biochemical screening alone with αlpha software (first or second trimester) and combined screening using either FMF or αlpha software were compared. Results. One-third of an estimated 675 000 pregnancies in private practice in the 6-year study period underwent screening. There were 687 cases of trisomy 21 in 225 021 pregnancies, with only 239 (35%) diagnosed prenatally. The screen positive rates were 11.8% for first trimester biochemistry, 7.6% for second trimester biochemistry, 7.3% for first trimester FMF software ultrasound alone, 3.7% for combined first trimester screening with FMF software, and 3.5% for combined first trimester screening with αlpha software. The detection rates for a 5% false positive rate were 63% for first trimester biochemistry, 69% for second trimester biochemistry, 95% for combined first trimester screening with FMF software and 80% for combined first trimester screening with αlpha software. Detection and confirmation rates were highest with FMF software. Conclusion. Screening with FMF software has a similar screen positive rate and better detection rate than screening with αlpha software. The low prenatal detection rate of trisomy 21 is mainly due to a low prevalence of screening. More research is needed in the SA setting to explore why screening and confirmatory testing after high-risk results are not performed in many pregnancies.

Android ransomware detection using binary Jaya optimization algorithm

AbstractRansomware is a serious security concern to mobile devices, as it prevents the use of the device and its contents until a ransom is paid, resulting in considerable financial losses for both people and corporations. The existing anti‐malware measures have shown to be inadequate in combatting new malware variants that utilize advanced evasion strategies like Polymorphic, Metamorphic, Dynamic Code Loading, Time‐based evasion, and Reflection. Furthermore, these primary defences have also suffered from low detection rates, significant false positives, high processing times, and excessive processing and power consumption that is inappropriate for smartphones. This paper offers the binary JAYA (BJAYA) for ransomware detection in Android mobile devices using the BJAYA optimization‐based algorithm. The developed algorithm's effectiveness has been assessed against two datasets, the 0–1 knapsack, and real ransomware dataset. The proposed BJAYA method surpassed the other algorithms on 85% of the 0–1 knapsack datasets. The suggested BJAYA method was also tested on a ransomware dataset in two phases. In the first stage of testing, BJAYA outperformed other standard classifiers with sensitivity and Gmean values of 97% and 98.2%, respectively. In the second stage of testing, BJAYA outperformed other GA, FPA, and PSO metaheuristic algorithms in terms of specificity, sensitivity, and Gmean. These findings indicate the applicability of the suggested BJAYA algorithm for ransomware detection.

Testing a non-destructive assay to track Plasmodium sporozoites in mosquitoes over time

BackgroundThe extrinsic incubation period (EIP), defined as the time it takes for malaria parasites in a mosquito to become infectious to a vertebrate host, is one of the most influential parameters for malaria transmission but remains poorly understood. The EIP is usually estimated by quantifying salivary gland sporozoites in subsets of mosquitoes, which requires terminal sampling. However, assays that allow repeated sampling of individual mosquitoes over time could provide better resolution of the EIP.MethodsWe tested a non-destructive assay to quantify sporozoites of two rodent malaria species, Plasmodium chabaudi and Plasmodium berghei, expelled throughout 24-h windows, from sugar-soaked feeding substrates using quantitative-PCR.ResultsThe assay is able to quantify sporozoites from sugar-soaked feeding substrates, but the prevalence of parasite-positive substrates was low. Various methods were attempted to increase the detection of expelled parasites (e.g. running additional technical replicates; using groups rather than individual mosquitoes), but these did not increase the detection rate, suggesting that expulsion of sporozoites is variable and infrequent.ConclusionsWe reveal successful detection of expelled sporozoites from sugar-soaked feeding substrates. However, investigations of the biological causes underlying the low detection rate of sporozoites (e.g. mosquito feeding behaviour, frequency of sporozoite expulsion or sporozoite clumping) are needed to maximise the utility of using non-destructive assays to quantify sporozoite dynamics. Increasing detection rates will facilitate the detailed investigation on infection dynamics within mosquitoes, which is necessary to explain the highly variable EIP of Plasmodium and to improve understanding of malaria transmission dynamics.Graphical

Cell-Free DNA from Blood or Bone Marrow as Alternatives to Bone Marrow Cells for Molecular Diagnostics and Monitoring of Multiple Myeloma

Introduction: Molecular profiling of bone marrow (BM) tumor cells in multiple myeloma (MM) can be limited by low tumor cell content for analysis by multiple assays. We therefore evaluated the concordance of molecular profiles of cancer cells enriched from BM versus cell-free DNA (cfDNA) derived from peripheral blood (PB) and BM plasma collected at diagnosis. Use of cfDNA has the potential to enable the prioritization of scarce cancer cells for single-cell RNA-sequencing or other applications that require intact cells. Methods: The MM Molecular Monitoring (M4) Study is a prospective cohort study of newly diagnosed MM patients (pts) receiving standard-of-care treatment at 12 sites across Canada. From 27 pts in this study, we analyzed diagnostic BM-derived CD138+ enriched plasma cell (PC) DNA (n=27, 15-20 mL BM per pt), BM plasma cfDNA (n=26 same tube as BM sampling), PB cfDNA (n=27, 15-20 mL), and PB buffy coat DNA (n=27, 4-6mL) using a combination of a targeted next generation sequencing (NGS) panel (10,000X coverage) and shallow (0.1-1X) whole-genome sequencing (sWGS). PB and BM samples collected in STRECK and EDTA tubes, respectively incurred overnight shipping to a central lab for initial processing. The targeted panel includes exons from 37 genes of potential clinical relevance, all immunoglobulin (Ig) loci, and 5 MM-specific translocation hotspots. CD138+ PCs were profiled by clinical FISH for recurrent MM translocations and copy number variations (CNVs). Results: All PB and BM cfDNA samples yielded sufficient DNA quantity for analyses (&amp;gt;20ng), yet only 19/26 BM cfDNA samples passed quality control and were sequenced. Various strategies such as shearing, dilution, and the use of heparinase were not effective in salvaging the failed BM cfDNA. However, the high success rate in a separate local study (24/25 BM cfDNA samples) suggests shipping in non-cell stabilizing tubes may have contributed to failures. The average DNA yield for PB and BM cfDNA samples was 1408ng (sd = 2752ng) and 2462ng (sd = 4301ng), respectively. We estimated tumor fraction (TF) by examining the proportion of genome altered by CNVs using ichorCNA in samples with sWGS. 14/24 (58%) of PB cfDNA samples and 10/18 (56%) of BM cfDNA samples had a high TF (&amp;gt;5%). TF in PB and BM cfDNA were significantly correlated (rho = 0.85, p &amp;lt; 0.001, n = 18 pairs), but were consistently higher in PB cfDNA (p = 0.03, n = 18 pairs). We first compared mutations between BM-derived PCs and cfDNA. We found 12 distinct somatic mutations (variant allele fraction &amp;gt;1%) that were previously reported to have a pathogenic effect in 11/27 (41%) PC samples. This consisted of 10 single nucleotide variants (SNVs) and 2 deletions across NRAS, BRAF, KRAS, CYLD and PRDM1. We found 9/12 mutations in matched PB cfDNA samples [sensitivity (SN)=75%] and 4/8 mutations in matched BM cfDNA (SN = 50%). We next searched for FISH-validated chromosome rearrangements among enriched BM PCs. From these, we correctly detected 5/8 (63%) fusions using the targeted panel that were called out by clinical FISH. These were further detected in matched PB cfDNA (4/5) and BM cfDNA (2/4) samples. Recurrent MM CNVs (amplification at chromosome 1q or deletions at chromosomes 1p, 13p or 17p) were identified in 18/27 (67%) PC samples by sWGS. These CNVs were successfully detected in 8/9 matched PB cfDNA samples with high TF (by sWGS) and in 2/7 samples with low TF. In BM cfDNA, CNVs were successfully detected in 7/8 high TF samples and 1/6 low TF samples. Lastly, we evaluated BCR Ig rearrangements. We detected a clonal Ig rearrangement in 26/27 (96%) BM-derived PC samples. These clones were detected in 25/26 (96%) matched PC to PB cfDNA pairs and in 16/18 (89%) PC to BM cfDNA pairs. The proportion of fragments at Ig loci which corresponded to productive Ig rearrangements was significantly correlated with TF in PB cfDNA (rho = 0.62, p = 0.002, n = 23) but not in BM cfDNA (rho = 0.37, p = 0.14, n = 17). Conclusions: PB cfDNA yielded 78% of the aberrations detected in BM-derived PCs, whereas BM cfDNA yielded 62%. The lower rate of detection in BM cfDNA may reflect DNA contamination from dying white blood cells as a result of shipping BM samples in non-cell stabilizing preservative tubes. BM and PB cfDNA contain highly concordant CNV calls to PCs when cfDNA TF estimates were &amp;gt;5%. Tumor Ig rearrangements were more readily detected in cfDNA compared to other sources of variation and may provide a less-invasive alternative for disease monitoring.

Spatiotemporal description of African swine fever virus nucleic acid and antibodies detected in pigs sampled at abattoirs in the greater Kampala metropolitan area, Uganda from May 2021 through June 2022

BackgroundAfrican swine fever virus (ASFV) infections in Africa cause hemorrhagic disease in domestic pigs and is maintained by a sylvatic cycle in warthogs. It is endemic in Uganda, leading to significant economic losses. Previous studies performed in rural areas and in Kampala had differing diagnostic results. The purpose of this study was to provide a robust spatial, temporal, and diagnostic summary of pigs slaughtered in the greater Kampala metropolitan area over the course of one year. This study characterized 1208 to 1323 serum, blood, and tissue samples collected from pigs at six abattoirs in the greater Kampala metropolitan area of Uganda monthly from May 2021 through June 2022. Validated and standardized serologic and molecular diagnostics were used.ResultsOnly 0.15% of pigs had detectable antibodies against ASFV, suggesting low survival rates or pre-clinical diagnosis. Yet, 59.5% of pigs were positive for ASFV DNA. Blood had the lowest detection rate (15.3%) while tonsil and lymph nodes had the highest (38% and 37.5%, respectively), spleen samples (31.5%) were in between. Agreement between sample types was fair to moderate overall. A significant seasonality of ASFV infections emerged with infections found predominately in the dry seasons. Spatial assessments revealed that the greater Kampala metropolitan area abattoirs have a catchment area that overlaps with Uganda’s most pig dense regions.ConclusionsPigs at greater Kampala metropolitan area abattoirs can be sentinels for acute disease throughout the pig dense region of Uganda, particularly in the dry seasons. The high prevalence detected suggests that pigs are sold in response to local reports of ASFV infections (panic sales). Serological surveillance is not useful, as very few pigs seroconverted in this study prior to slaughter. In contrast, tissue samples of pigs can be used to detect disease using qPCR methods.

Early and Consistent CRS Detection Using Wearable Device for Remote Patient Monitoring Following CAR-T Therapy in Relapsed/Refractory Multiple Myeloma (RRMM): Early Results of an Investigator-Initiated Trial

The administration of Chimeric Antigen Receptor T-cell (CAR-T) therapy for relapsed refractory multiple myeloma (RRMM) predominantly takes place in the inpatient setting to monitor for adverse effects like cytokine release syndrome (CRS) and neurotoxicity leading to increased healthcare utilization, infection risk and patient discomfort. Shifting the administration model to the outpatient setting may improve patient experience, optimize hospital bed utilization and decrease costs, but requires an objective and reliable method for CRS detection to monitor patients remotely and safely. The feasibility of using a wearable device for detecting CRS following CAR-T therapy in RRMM was compared to standard of care (SoC) nursing-recorded vital signs in this investigator initiated clinical trial (IIT). Patients wore a wearable device that collected continuous measures of temperature, pulse, respiratory rate, and O2 saturation in addition to SoC while receiving CAR-T therapy from the day infusion to discharge. Changes in vital signs captured by the device were analyzed based on 2 thresholds: (i) CRS timestamps were tagged in wearable data when pt's temperature breached a fixed threshold of 38 0C ( Tf) defined as fever by the American Society of Transplantation and Cellular Therapy (ASTCT), and (ii) when pt's temperature breached an individualized threshold of 2 standard deviations above their baseline temperature ( Ti) [see Figure 1]. Outcomes were time to first detection of CRS in wearable data vs. SoC. Wearable adherence was the duration pts wore the device over the total monitoring period. To date, 34 pts were screened, 28 enrolled (82.3% uptake), 1 was excluded from the dataset because of concurrent COVID-19, and 2 pts with CRS were excluded from time to detection comparison because of wearable adherence &amp;lt;50% during high-risk windows (defined as the time period where CRS is expected per known data for the CAR-T product). Max CRS grades were 1 (17 pts), 2 (1 pt), 3 (2 pts), and 4 (1 pt); 5 pts did not have clinical CRS. Patients wore the device for a median of 13 (12-15) days out of a median of 15.5 (14-17) days of inpatient admission for CAR-T infusion. Median individualized temperature threshold was 37.4 (37-37.6) C. Wearable adherence was 64 (51 - 77) % and 72 (57 - 87) % for the overall monitoring and high-risk periods, respectively. The wearable detected the initial CRS events at a median of 22 (-43 - 113.5) min earlier than SoC with Tf and a median of 184 (53 - 312) mins earlier than SoC with Ti method. In the no CRS subgroup, false CRS detection occurred in 1 pt with the Tf and 2 pts with the Ti method. Preliminary results suggest that time to CRS detection by the wearable device preceded SoC detection by a median of 103 minutes corroborated by both threshold methods. Temperature thresholds calibrated to the baseline temperature of individual patients facilitate earlier detection of CRS than fixed thresholds per clinical/ASTCT criteria. While the low false detection rate in is encouraging, these may also potentially be attributed to subclinical events. Both pts who had “false positive” triggers breached their individualized temperature thresholds via device readings while only recording low-grade temperatures that did not meet clinical CRS criteria per ASTCT, indicating possible capture of subclinical events. The study showcases the utility of continuous remote patient vital signs monitoring by wearable devices in efficiently capturing CRS, including subclinical events, earlier than SoC. Objective and reliable CRS monitoring may help safely transition workflows to outpatient CAR-T administration models. Analysis of trends in cytokine biomarkers for early CRS detection signal(s) is currently underway. Cytokine signals, alone and in combination with device data, are planned to be incorporated into machine learning models to build a CRS prediction index in future analyses. Figure 1: Snapshot in time of the continuous temperature data generated by the wearable device after CAR-T infusion showing capture of cytokine release syndrome. – Ti (solid line) represents the median baseline temperature of the patient over the entire duration of the data capture by the wearable device – Tf (dotted line) represents the temperature threshold of 38 0C, the clinical definition of fever as per ASTCT – Black diamond: clinical CRS event, when temperature &amp;gt;38 0C as recorded by nursing

Presence of SARS-CoV-2 virus in wastewater in the Kingdom of Bahrain during the COVID-19 pandemic.

Several countries, including Bahrain, used wastewater surveillance for disease activity monitoring. This study aimed to determine the presence of SARS-CoV-2in untreated wastewater and to correlate it with the disease spread. A retrospective review was conducted for all wastewater samples tested for SARS-CoV-2 in public health laboratories from November 2020 to October 2022. Samples were collected weekly between February and October 2022 from different areas across Bahrain. Real-time polymerase chain reaction was used to test for the presence of SARS-CoV-2 in wastewater, and the results were correlated with the number of COVID-19 cases in the same area. Of 387 wastewater samples, 103 (26.6%) samples tested positive for SARS-CoV-2. In late 2020, of 42 samples collected initially, four (9.5%) samples tested positive for SARS-CoV-2 in the four locations that hosted COVID-19 isolation facilities. Between February and October 2022, 345 specimens of wastewater were tested, and 99 (28.7%) were positive. The highest detection rate was in February, June, and July (60%, 45%, and 43%, respectively), which corresponded to COVID-19 peaks during 2022, and the lowest detection rate was in August and September (11% and 0%, respectively), corresponding to the low number of COVID-19 cases. The detection rate of SARS-CoV-2 in wastewater samples from Bahrain was high and was significantly correlated with the number of reported COVID-19 cases. Wastewater surveillance can aid the existing surveillance system in monitoring SARS-CoV-2 spread.

Efforts to increase the application of low-dose computed tomography (LDCT): A resident-led strategy to improve lung cancer screening in an urban primary care clinic.

132 Background: Lung cancer carries the highest mortality rate of all malignancies, implicated in approximately 20% of cancer-related deaths in the United States. The 2011 National Lung Screening Trial (NLST) established a 20% reduction in lung cancer-associated mortality associated with annual LDCT screening in high-risk populations compared to screening chest radiography. In 2013 the United States Preventative Services Task Force (USPSTF) adopted this approach into their recommendations, with a subsequent update in 2021 establishing a recommended annual LDCT screening for those at high risk. There remains a concerning lack of access to PCP-initiated LDCT screening in medically underserved (e.g., urban, rural) areas, translating to relatively low rates of early lung cancer detection. Methods: Any patient meeting the 2021 USPSTF criteria (at least 20-pack-year history of tobacco use, who still smoke or have quit within the past 15 years) was deemed eligible. Excluded were those meeting these criteria and any patient who had received LDCT within the past 12 months. The pre-intervention stage of this study included a 15-week data collection of chart review to establish baseline rates. The intervention involved an educational flyer detailing the guidelines for lung cancer screening, placed in each clinic exam room to promote patient self-assessment of eligibility. Results: In the 15-week control group (i.e., pre-intervention), 177 patients were eligible for LDCT screening, with 65 successful LDCT orders and 112 not ordered (36.7% screened appropriately) and 27 (41.5%) LDCT orders completed. Through the 15 weeks of post-intervention data, 193 patients were eligible for LDCT screening, with 99 orders placed and 94 not (51.3% screened appropriately), and 42 (42.4%) of these LDCT orders were completed. Conclusions: The initial goal set for this project was a 50% lung cancer screening rate among eligible patients, with at least 50% of those LDCT orders performed by the patient. There was a remarkable improvement in LDCT ordering rates; however, the primary goal of these ordering improvement rates was to translate them into a higher percentage of patients completing these orders. Despite the increase in LDCT orders, the percentage completed stagnated (41.5% pre-intervention, 42.4% post-intervention). It was essential to our team that the interventions remain cost-effective. We did achieve this using printed flyers, allowing for patient-initiated involvement in the process. Using these interventions as a template, a clinic in any setting may benefit their LDCT ordering rates. However, these measures alone will not improve the percentage of patients completing the LDCT orders. As our project continues, we plan to modify the intervention to reflect constructive feedback from the resident physicians and patients involved.

Performance of targeted next-generation sequencing in the detection of respiratory pathogens and antimicrobial resistance genes for children.

Introduction. Respiratory tract infection, which is associated with high morbidity and mortality, occurs frequently in children. At present, the main diagnostic method is culture. However, the low pathogen detection rate of the culture approach prevents timely and accurate diagnosis. Fortunately, next-generation sequencing (NGS) can compensate for the deficiency of culture, and its application in clinical diagnostics has become increasingly available.Gap Statement. Targeted NGS (tNGS) is a platform that can select and enrich specific regions before data enter the NGS pipeline. However, the performance of tNGS in the detection of respiratory pathogens and antimicrobial resistance genes (ARGs) in infections in children is unclear.Aim and methodology. In this study, we estimated the performance of tNGS in the detection of respiratory pathogens and ARGs in 47 bronchoalveolar lavage fluid (BALF) specimens from children using conventional culture and antimicrobial susceptibility testing (AST) as the gold standard.Results. RPIP (Respiratory Pathogen ID/AMR enrichment) sequencing generated almost 500 000 reads for each specimen. In the detection of pathogens, RPIP sequencing showed targeted superiority in detecting difficult-to-culture bacteria, including Mycoplasma pneumoniae. Compared with the results of culture, the sensitivity and specificity of RPIP were 84.4 % (confidence interval 70.5-93.5 %) and 97.7 % (95.9 -98.8%), respectively. Moreover, RPIP results showed that a single infection was detected in 10 of the 47 BALF specimens, and multiple infections were detected in 34, with the largest number of bacterial/viral coinfections. Nevertheless, there were also three specimens where no pathogen was detected. Furthermore, we analysed the drug resistance genes of specimens containing Streptococcus pneumoniae, which was detected in 25 out of 47 specimens in the study. A total of 58 ARGs associated with tetracycline, macrolide-lincosamide-streptogramin, beta-lactams, sulfonamide and aminoglycosides were identified by RPIP in 19 of 25 patients. Using the results of AST as a standard, the coincidence rates of erythromycin, tetracycline, penicillin and sulfonamides were 89.5, 79.0, 36.8 and 42.1 %, respectively.Conclusion. These results demonstrated the superiority of RPIP in pathogen detection, particularly for multiple and difficult-to-culture pathogens, as well as in predicting resistance to erythromycin and tetracycline, which has significance for the accurate diagnosis of pathogenic infection and in the guidance of clinical treatment.

A multicentre review of the direct-access mammography programme in Ireland for women with breast pain

To assess the current use of the direct access mammography pathway for breast pain and the rate of breast cancer detection in this patient cohort. A retrospective review of general practitioner (GP)-referred mammograms performed during a 12-month period from January to December 2022 across four tertiary referral centres. With the use of medical records and GP referrals, patient demographics, presenting symptoms, family history, and clinical outcomes were recorded. The present study comprised 2,046 patients of which 21.6% did not report breast pain at the time of referral. Thirty-five per cent had a positive family history with 40% of these patients having no breast pain. Twelve per cent were recalled with 30% of these patients requiring biopsy. An overall cancer detection rate (CDR) of 7 per 1000 was determined for women with mastalgia. A CDR of 0 per 1,000 was determined for women <50 years with mastalgia alone and no additional risk factors for malignancy. Fisher's exact test showed no statistically significant association between breast pain and breast cancer. There was no statistically significant relationship found between breast pain and breast cancer. This review suggests a low cancer detection rate in women <50 years. In women <50 years with mastalgia without additional symptoms or family history, breast imaging is not required.

Screening and Colonoscopy Quality Measures: Ethnic Disparities and Impact on Patients' Outcome.

Recent reports have confirmed the improving trends in colorectal cancer (CRC) incidence and outcomes. Still, disparities in incidence and mortality in CRC continue to persist between major ethnic groups despite the provision of widespread screening and improved care. We aimed to outline, from an endoscopic point of view, ethnic disparities in major endoscopic measures concerned with CRC screening and detection and track their impact on patients' outcomes. We reviewed electronic reports of patients referred for colonoscopy procedures over 20 years. We compared demographic, clinical, and endoscopic findings between major ethnic population groups in Israel. In addition, trends of screening utilization, bowel preparation, and polyp detection rates were tracked, and the incidence of CRC diagnosis was followed. A total of 51307 patients had undergone colonoscopies, of whom 16% were Arabs, and 84% were Jewish. The procedures performed for CRC screening throughout the study period were significantly lower in Arabs (5% vs. 13.1%; P < 0.0001). In parallel, for most of the follow-up period, the Arab patients had higher rates of inadequate bowel preparation (overall: 19.9% vs. 12%; P < 0.001) and a lower polyp detection rate (16.7% vs. 22.5%; P < 0.0001). Expectedly, the incidence of CRC has steadily decreased in the Jewish group, while an adverse pattern of increasing incidence was documented in the Arab patient during the follow-up period. Characterized by lower screening utilization and poor bowel preparation, the incidence of CRC development in Arab patients is increasing, while improving trends of CRC were observed in their Jewish counterparts.

Enhanced Detection Method for Small and Occluded Targets in Large-Scene Synthetic Aperture Radar Images

Ship detection in large-scene offshore synthetic aperture radar (SAR) images is crucial in civil and military fields, such as maritime management and wartime reconnaissance. However, the problems of low detection rates, high false alarm rates, and high missed detection rates of offshore ship targets in large-scene SAR images are due to the occlusion of objects or mutual occlusion among targets, especially for small ship targets. To solve this problem, this study proposes a target detection model (TAC_CSAC_Net) that incorporates a multi-attention mechanism for detecting marine vessels in large-scene SAR images. Experiments were conducted on two public datasets, the SAR-Ship-Dataset and high-resolution SAR image dataset (HRSID), with multiple scenes and multiple sizes, and the results showed that the proposed TAC_CSAC_Net model achieves good performance for both small and occluded target detection. Experiments were conducted on a real large-scene dataset, LS-SSDD, to obtain the detection results of subgraphs of the same scene. Quantitative comparisons were made with classical and recently developed deep learning models, and the experiments demonstrated that the proposed model outperformed other models for large-scene SAR image target detection.

Contrast-enhanced computed tomography in the venous rather than the arterial phase is essential for the evaluation of the right phrenic nerve.

Preprocedural detection of the running course of the right pericardiophrenic bundles (PBs) is considered to be useful in preventing phrenic nerve (PN) injury during catheter ablation for atrial fibrillation (AF). However, previous studies using the arterial phase of contrast-enhanced computed tomography (CT) reported a relatively low right PBs detection rate. This study included 63 patients with AF who underwent catheter ablation and preoperative contrast-enhanced CT imaging of the venous and arterial phases (66.7±10.2 years; 44 male). The venous phase of contrast-enhanced CT significantly improved the detection rate of PBs compared to the arterial phase (96.8%vs. 60.3%, p<.001), and PBs were detected in the venous phase only in 23 (36.7%) patients. No significant differences were observed between the right PBs detection rate using non-contrast CT versus the arterial phase of contrast-enhanced CT (p=.37). Patients without visualization of the right PBs during the arterial phase had a higher frequency of chronic heart failure (p=.0083), lower left ventricular ejection fraction (p=.021), and a higher CHADS2 score (p=.048) than those with visualization. In five patients whose right PBs could only be detected during the venous phase of contrast-enhanced CT, the reconstructed running course of the right PBs corresponded with the PN generated by electrical high-output pacing. Contrast-enhanced CT images of the venous phase, rather than the arterial phase, are useful in detecting the right PBs, especially in patients with heart failure or reduced left ventricular ejection fraction.

Composition of pathogenic microorganism in chronic osteomyelitis based on metagenomic sequencing and its application value in etiological diagnosis

BackgroundTraditionally, conventional microbiological culture methods have been used to detect pathogenic microorganisms in chronic osteomyelitis. However, these methods have been found to have a low detection rate, complicating the precise guidance of infection treatment. This study employed metagenomic next-generation sequencing (mNGS) to detect these microorganisms in chronic osteomyelitis with three main objectives: 1). Gain a deeper understanding of the composition of pathogenic microorganisms in chronic osteomyelitis. 2). Compare the microbial detection rates between mNGS and the standard culture methods used in laboratories to enhance the effectiveness of the traditional culture methods. 3). Explore the potential of mNGS in etiological diagnosis.MethodsFifty clinically confirmed intraoperative bone tissue samples of chronic osteomyelitis from January 2021 to December 2021 were collected and subjected to mNGS and microbiological testing, respectively. The orthopaedic surgeon combined clinical manifestations and related examinations to determine the causative pathogens.ResultsThe culture method obtained 29 aerobic and parthenogenic anaerobic bacteria, 3 specific anaerobic bacteria, and 1 yeast-like fungus. Thirty-six aerobic and parthenogenic anaerobic bacteria, 11 specific anaerobic bacteria, and 1 yeast-like fungus were obtained by mNGS, and 2 Mycobacterium tuberculosis(MTB) strains were detected. However, there was no significant difference in the overall positive detection rate between mNGS and the culture method (P = 0.07), and the two were not statistically significant in detecting aerobic and partly anaerobic bacteria (P = 0.625). But, mNGS was significantly superior to culture in detecting anaerobic bacteria and Mycobacterium tuberculosis (P<0.05).ConclusionsThe mNGS method has enhanced our understanding of the distribution of pathogenic microorganisms in chronic osteomyelitis. Traditional culture methods help isolate and cultivate aerobic and facultative anaerobic bacteria, and fungi, and are also utilized for antibacterial drug sensitivity tests. However, mNGS has shown superior capabilities in detecting anaerobic bacteria, MTB, and mixed infection bacteria. This finding offers invaluable guidance for improving laboratory microbial culture and detection conditions. Hence, mNGS should be judiciously used for chronic osteomyelitis, and PCR can be implemented for certain difficult-to-culture microorganisms, such as MTB.

Management of the intraoperative loss of microsurgical needles: A literature review and clinical survey

Data on the incidence, management, and consequences of retained microsurgical needles in plastic and reconstructive surgery remains sparse. Research suggests that a mobile C-arm x-ray has a low detection rate for needles of size 8-0 or smaller. By means of a literature review, and survey, we aimed to investigate the current practice employed in the event of the intraoperative loss of a microsurgical needle.A literature review was conducted investigating the incidence, current management strategies, and consequences of retained microsurgical needles. This informed the questions included in a survey investigating management strategies employed in the intra-operative loss of a microsurgical needle.Results from the literature review show an overall low detection rate of microsurgical needles on imaging. Of the forty responders who completed the survey, 80% did not use a mobile C-arm x-ray to locate a missing microsurgical needle. Of the 20% that had done so, x-ray had been unsuccessful in locating the needle in all cases.Portable x-ray has a definite role to play in locating needles of size 7-0 or larger. This study suggests that suture needles of size 8-0 or smaller cannot be reliably detected on x-ray. Regarding management of this event, one should consider the risk of harm to the patient if retained, against the risk of searching for the needle. Based on the results of this work as well as existing published data, we advise against obtaining intra-operative x-rays in the event of a lost needle size 8-0 and above. Appropriate documentation should be completed.