Non-expert Readers Research Articles

Hall-Effect Current Sensors: Principles of Operation and Implementation Techniques

Isolated current sensing is fundamental in several contexts, including power electronics, automotive, and smart buildings. In order to meet the requirements of modern applications, current sensors should feature ever larger bandwidth and dynamic range, as well as reduced power consumption and dimension. Among the available current sensing technologies, Hall-based current sensors have gained an increased popularity owing to their advantages in terms of size, economic feasibility, low power consumption, high dynamic range, and integrability with standard CMOS technologies. This tutorial aims at providing a comprehensive insight into the interdisciplinary world of Hall-effect current sensors, encompassing the fundamental principles of operation, the design of the semiconductor device, the implementation techniques, as well as the methods for sensor modeling and characterization. In particular, this manuscript focuses on Hall-effect sensors realized on standard silicon technologies, and it reviews some typical architectures for the transduction of the measurand current into a magnetic field, as well as the electronic front-end. While this tutorial is mainly addressed to students and non-expert readers, specific design aspects and dispersion effects due to temperature and other external phenomena are also discussed.

Measuring expertise in identifying interictal epileptiform discharges.

Interictal epileptiform discharges on EEG are integral to diagnosing epilepsy. However, EEGs are interpreted by readers with and without specialty training, and there is no accepted method to assess skill in interpretation. We aimed to develop a test to quantify IED recognition skills. A total of 13,262 candidate IEDs were selected from EEGs and scored by eight fellowship-trained reviewers to establish a gold standard. An online test was developed to assess how well readers with different training levels could distinguish candidate waveforms. Sensitivity, false positive rate and calibration were calculated for each reader. A simple mathematical model was developed to estimate each reader's skill and threshold in identifying an IED, and to develop receiver operating characteristics curves for each reader. We investigated the number of IEDs needed to measure skill level with acceptable precision. Twenty-nine raters completed the test; nine experts, seven experienced non-experts and thirteen novices. Median calibration errors for experts, experienced non-experts and novices were -0.056, 0.012, 0.046; median sensitivities were 0.800, 0.811, 0.715; and median false positive rates were 0.177, 0.272, 0.396, respectively. The number of test questions needed to measure those scores was 549. Our analysis identified that novices had a higher noise level (uncertainty) compared to experienced non-experts and experts. Using calculated noise and threshold levels, receiver operating curves were created, showing increasing median area under the curve from novices (0.735), to experienced non-experts (0.852) and experts (0.891). Expert and non-expert readers can be distinguished based on ability to identify IEDs. This type of assessment could also be used to identify and correct differences in thresholds in identifying IEDs.

Athlete ECG T-wave abnormality interpretation patterns by non-experts

BackgroundThe presence of T-wave abnormalities (TWA) on an athlete's electrocardiogram (ECG) presents as a diagnostic challenge for physicians. Types of TWA patterns classified as abnormal by inexperienced readers have not been systematically analyzed. MethodsECGs from the 2011–2015 National Football League Scouting Combine (initially interpreted by general cardiologists) were retrospectively reviewed by expert sports cardiologists with strict application of the 2017 International Criteria. Patterns of TWA that were altered from the original interpretation were analyzed. ResultsThe study included 1643 athletes (mean age 22 years). There was a 67 % reduction in the number of athletes with any TWA (p < 0.001) with 111 ECGs changed to normal. Inferior TWA was the most common interpreted initial ECG abnormality altered followed by anterior and lateral. DiscussionThis analysis revealed an initial high rate of TWA by non-expert readers. Tailored education programs to physicians who interpret athlete ECGs should highlight these specific T-wave patterns. We see this as an opportunity to make more clinicians aware of ECG interpretation guidelines as sports trained cardiologists are mostly self-taught.

Recovery of precious metals from industrial wastewater towards resource recovery and environmental sustainability: A critical review

Nowadays, the recovery processes of precious metals (PMs) from industrial wastewater streams have found significant attractions among various investigators worldwide. PMs are known as rare/noble chemical elements that their fundamental characteristics such as ductility, electrical conductivity, and resistance against corrosion have made them promising for application in industrial-based activities such as jewelry, petrochemistry, and catalysis. The main objective of this review paper is to provide an opportunity for expert as well as non-expert readers to be familiar with the state-of-the-art breakthroughs in the recovery of PMs (i.e., gold (Au), silver (Ag), platinum (Pt), palladium (Pd), ruthenium (Ru), rhodium (Rh), iridium (Ir), osmium (Os), Rhenium (Re) and so on.) from wastewater streams. Apart from the explanation of industrial applications, the recovery process of PMs using various approaches is aimed to be interpreted comprehensively. Eventually, the advantages and disadvantages of applied techniques for the recovery of PMs are discussed, and different approaches as well as future perspectives towards their sustainable use are introduced.

Clinical utility of the Bosniak classification version 2019: Diagnostic value of adding magnetic resonance imaging to computed tomography examination

PurposeTo assess the impact of the updated Bosniak classification (BC2019) for cystic renal masses (CRMs) on interobserver agreement between radiologists and urologists and the diagnostic value of adding MRI to CT examination (combined CT/MRI). MethodThis study included 103 CRMs from 83 consecutive patients assessed using contrast-enhanced CT and MRI between 2010 and 2016. Nine readers in three groups (three radiologists, three radiology residents, and three urologists) reviewed CT alone and the combined CT/MRI using BC2019. Bosniak category was determined by consensus in each group for diagnosing malignancy, with a cut-off category of ≧III. Interobserver agreement was assessed using Fleiss’ kappa values. The effect of CT or combined CT/MRI on the diagnosis of malignancy was assessed using McNemar’s test. ResultsInterobserver agreement of BC2019 for CT alone was substantial for radiologists and residents, moderate for urologists (0.77, 0.63, and 0.58, respectively). Interobserver agreement of BC2019 for combined CT/MRI was substantial for all three groups (radiologists: 0.78; residents: 0.65; and urologists: 0.61). Among residents, the sensitivity/specificity/accuracy rates of combined CT/MRI vs. CT alone were 82.1/74.7/76.7% vs. 75.0/66.7/68.9%, and specificity and accuracy were significantly higher for combined CT/MRI than that for CT alone (p = 0.03 and 0.008, respectively). Similarly, sensitivity/specificity/accuracy values were significantly higher for combined CT/MRI among urologists (78.6/73.3/74.8% vs. 64.3/64.0/64.1%, p = 0.04/0.04/0.008). However, sensitivity/specificity/accuracy did not significantly differ between the two among radiologists (89.3/74.7/78.6% vs. 85.7/73.3/76.7%, p = 0.32/0.56/0.32). ConclusionsCombined CT/MRI is useful for diagnosing malignancy in patients with CRMs using BC2019, especially for non-expert readers.

RELIABILITY AND VALIDITY OF SINGLE AXIAL SLICE VS. MULTIPLE SLICE QUANTITATIVE MEASUREMENT OF KNEE EFFUSION-SYNOVITIS ON 3T MRI

Inflammation is increasingly recognized as critical in the pathogenesis of KOA, and effusion-synovitis (ES) on knee MRI has been identified as an important biomarker of OA. Semi-automated software methods offer objective measurements of ES volume on MRI, but efficiency is crucial, especially for studies involving large numbers of scans. We have developed a single-slice quantitative measurement of ES using the single axial slice with the largest area of ES, and compared this to previously validated multi-slice measurements. We evaluated the reliability of a new single-slice quantitative measurement of ES in knees with radiographic OA, and correlated this measurement of ES with a validated multi-slice quantitative measurement of ES, and with a validated semi-quantitative scoring of ES in order to demonstrate that the more efficient single-slice ES method is a valid substitute for the multi-slice approach. OAI participants with radiographic OA (i.e., Kellgren-Lawrence [KL] 2,3) in at least one knee at baseline with prior semi-quantitative assessment of ES by a MSK radiologist were randomly selected (n=50 knees; 1 knee per participant). Four non-expert readers were trained to use custom-designed semi-automated software to measure ES volume on 3T MRI, under the direction of a MSK radiologist, and then read scans from the KL 2,3 sample blinded to prior assessments (twice for 3 readers and once for 1 reader). Intra- and inter-reader reliability was evaluated based on intraclass correlation coefficients (ICC) from a linear mixed model with random effects for knee, reader, and interaction between knee and reader. We assessed agreement with the mean absolute difference (MAD). In a subset of the FNIH study (n=301), one reader measured single-slice ES volume, blinded to prior multi-slice quantitative measurement of ES. We estimated the Spearman correlation coefficient between single-slice and multi-slice volume of ES in the FNIH subset. Validity was evaluated based on Spearman correlation between single-slice ES volume and semi-quantitative ES MRI Osteoarthritis Knee Score (MOAKS) in the KL 2,3 sample and the FNIH subset. 95% confidence intervals (CI) were generated from bias-corrected and acceleration-adjusted bootstrap. In the sample of KL 2,3 knees, the mean single-slice ES volume was 312.8 mm 3 with standard deviation 218.4 mm 3 . The intra-reader ICC was 0.96 (95%CI: 0.93, 0.97), and inter-reader ICC was 0.90 (95%CI: 0.87, 0.95); the intra-reader MAD was 36 mm 3 (95%CI: 28, 44), and inter-reader MAD was 61 mm 3 (95%CI: 48, 75). The estimated correlation between single-slice and multi-slice ES volume was 0.75 (95%CI: 0.68, 0.81; Figure 1). Correlation between single-slice ES volume and MOAKS ES was 0.62 (95%CI: 0.39, 0.79) in the KL 2,3 sample and 0.67 (95%CI: 0.59, 0.73) in the FNIH subset (Figure 2A), while correlation between multi-slice ES volume and MOAKS ES was 0.74 (95%CI: 0.68, 0.79) in the FNIH subset (Figure 2B). Single-slice quantitative measurement of ES had excellent intra-and inter-reader reliability with non-expert readers, and good correlation with both multi-slice quantitative ES measurement and with MOAKS. Single-slice quantitative measurement is an efficient surrogate for multi-slice assessment, having shown similar validity based on comparison to semi-quantitative scoring by MSK radiologists. None CKK is consultant to Regeneron, LG Chem, and Express Scripts. He is principal investigator for pharma sponsored clinical trials to Abbvie, Cumberland, and GSK and DSMB to Kolon TissueGene and Avalor Therapeutics. CORRESPONDENCE ADDRESS: kwoh@arthritis.arizona.edu

Public Works Heritage 3D Model Digitisation, Optimisation and Dissemination with Free and Open-Source Software and Platforms and Low-Cost Tools

This paper describes an innovative, accessible, and sustainable method for enhancing cultural heritage. Documenting and disseminating the public works heritage have now come of age, digitally speaking, with the adoption of new technologies both to further research on and heighten the esteem attributed to the public works heritage. Nonetheless, academic discourse rarely describes procedures for the 3D digitisation of heritage works comprehensible to non-expert readers with limited resources. Taking that premise as a starting point, with special attention to the determinants of the public works heritage, this article aims to define the general, open-source methodology covering 3D model data capture, information processing and optimisation. The article also discusses model dissemination strategies using free platforms and low-cost tools. The general discussion is illustrated with the case study of Ariza Bridge in Spain. This Renaissance-style structure dates from the second half of the sixteenth century. Despite its listing as a cultural heritage asset, the monument was flooded by the Giribaile reservoir waters in 1998 and is now only wholly visible during droughts. The application, developed with open-source software and implemented with free platforms and low-cost tools, features geo-referencing and is designed to be accessible to non-expert users. The methodology proposed is intended as a suitable instrument for the sustainable study, valorisation and dissemination of the built heritage.

Needham’s Systematic Curiosity

That historians of science view Science and Civilisation in China as an outdated classic and non-expert readers approach it as an exotic encyclopedia would be quite to its founder’s disappointment.

An easy (horizontal) walk through fake octagons

A fake octagon is a genus two translation surface with only one singular point and the same periods as the octagon. Existence of infinitely many fake octagons was established first by McMullen (2007), and more generally follows from dynamical properties of the isoperiodic foliation.The purpose of this note is to describe an infinite family of fakes constructed by means of elementary methods. We describe an easy cut-and-paste surgery and show that the nth iterate of that surgery is a fake octagon Octn. Moreover we show that Octn≠Octm for n≠m, and that any Octn can be approximated arbitrarily well by some other Octm. This note is intended to be elementary and fully accessible to non-expert readers.

Artificial Intelligence to Automatically Assess Scan Quality in Hip Ultrasound.

Since it is fast, inexpensive and increasingly portable, ultrasound can be used for early detection of Developmental Dysplasia of the Hip (DDH) in infants at point-of-care. However, accurate interpretation\is highly dependent on scan quality. Poor-quality images lead to misdiagnosis, but inexperienced users may not even recognize the deficiencies in the images. Currently, users assess scan quality subjectively, based on image landmarks which are prone to human errors. Instead, we propose using Artificial Intelligence (AI) to automatically assess scan quality. We trained separate Convolutional Neural Network (CNN) models to detect presence of each of four commonly used ultrasound landmarks in each hip image: straight horizontal iliac wing, labrum, os ischium and midportion of the femoral head. We used 100 3D ultrasound (3DUS) images for training and validated the technique on a set of 107 3DUS images also scored for landmarks by three non-expert readers and one expert radiologist. We got AI ≥ 85% accuracy for all four landmarks (ilium = 0.89, labrum = 0.94, os ischium = 0.85, femoral head = 0.98) as a binary classifier between adequate and inadequate scan quality. Our technique also showed excellent agreement with manual assessment in terms of Intraclass Correlation Coefficient (ICC) and Cohen's kappa coefficient (K) for ilium (ICC = 0.81, K = 0.56), os ischium (ICC = 0.89, K = 0.63) and femoral head (ICC = 0.83, K = 0.66), and moderate to good agreement for labrum (ICC = 0.65, K = 0.33). This new technique could ensure high scan quality and facilitate more widespread use of ultrasound in population screening of DDH.

Inter-Reader Agreement of Diffusion-Weighted Magnetic Resonance Imaging for Breast Cancer Detection: A Multi-Reader Retrospective Study.

Simple SummaryThe role of magnetic resonance imaging (MRI) in breast cancer has expanded in the last decade, and studies have demonstrated good sensitivity and specificity of diffusion-weighted imaging (DWI), a functional imaging technique reflecting water diffusion properties in tissues. However, clear results about the reproducibility of DWI are still missing. To utilize DWI as a reliable stand-alone technique for breast cancer detection, the inter-reader agreement of the measurement must be assessed. Accordingly, in this study, we assess the inter-reader reproducibility to retrospectively evaluate the agreement of breast cancer detection using DWI as a stand-alone technique. As our results show a good agreement only in expert readers, the assumption that a breast MRI based only on qualitative analysis of DWI, with fewer variables, may be easier for a non-expert reader to learn seems disproved, and future prospective studies should assess the right time for appropriate training for radiologists to investigate the potential role of DWI as a stand-alone method for un-enhanced breast MRI.Purpose: In order to evaluate the use of un-enhanced magnetic resonance imaging (MRI) for detecting breast cancer, we evaluated the accuracy and the agreement of diffusion-weighted imaging (DWI) through the inter-reader reproducibility between expert and non-expert readers. Material and Methods: Consecutive breast MRI performed in a single centre were retrospectively evaluated by four radiologists with different levels of experience. The per-breast standard of reference was the histological diagnosis from needle biopsy or surgical excision, or at least one-year negative follow-up on imaging. The agreement across readers (by inter-reader reproducibility) was examined for each breast examined using Cohen’s and Fleiss’ kappa (κ) statistics. The Wald test was used to test the difference in inter-reader agreement between expert and non-expert readers. Results: Of 1131 examinations, according to our inclusion and exclusion criteria, 382 women were included (49.5 ± 12 years old), 40 of them with unilateral mastectomy, totaling 724 breasts. Overall inter-reader reproducibility was substantial (κ = 0.74) for expert readers and poor (κ = 0.37) for non- expert readers. Pairwise agreement between expert readers and non-expert readers was moderate (κ = 0.60) and showed a statistically superior agreement of the expert readers over the non-expert readers (p = 0.003). Conclusions: DWI showed substantial inter-reader reproducibility among expert-level readers. Pairwise comparison showed superior agreement of the expert readers over the non-expert readers, with the expert readers having higher inter-reader reproducibility than the non-expert readers. These findings open new perspectives for prospective studies investigating the actual role of DWI as a stand-alone method for un-enhanced breast MRI.

Putting the “Public” in Rhetoric &amp; Public Affairs

Abstract We argue that part of Rhetoric &amp; Public Affairs’ future should center public-facing scholarship in rhetorical studies. We begin by chronicling some of the work colleagues are doing to bridge expert and lay publics: podcasts, popular and trade press interviews, social media content development and management, and activist engagements. Centering public-facing scholarship creates several notable shifts: (1) it changes the “so what?” for traditional scholarship by inviting scholars to think about audiences outside of journal readership; (2) it opens space for different stylistic conventions in scholarly writing; and (3) it indicates that nonexpert audiences are valuable as readers. We note the considerable barriers to entry to public scholarship including gatekeeping, framing public scholarship for tenure, and training. We contend that Rhetoric &amp; Public Affairs could lead other journals through an updated definition of impact that takes into account contemporary modes of circulation and sharing, should accept pieces written for nonexpert readers in rhetoric, and should consider, if possible, making available for public reading one scholarly article every month or every quarter.

Incoherence in L2 writing

Abstract Current knowledge of the functional dimensions (e.g., coherence) of L2 written performance is mainly based on expert readers’ views. Non-expert native readers’ perspectives of L2 written productions are not often examined, which prevents a comprehensive and objective understanding of how an L2 writer’s performance may be perceived and evaluated by the target discourse community. Studies to date also lack clear findings of both the types of incoherence phenomena that may exist in L2 texts and the factors that may contribute to such incoherencies. The current study investigates how expert and non-expert native readers evaluate incoherence in L2 Chinese argumentative essays, as well as how their evaluations may differ quantitatively or qualitatively. The findings reveal that although expert readers marked incoherence in L2 writing significantly more frequently than non-expert readers did, expert and non-expert readers displayed similar patterns and tendencies in their judgments pertaining to the frequency with which incoherence instances appeared in the essays and in the severity of the incoherence.

Evaluation of Biomarkers in Critical Care and Perioperative Medicine: A Clinician’s Overview of Traditional Statistical Methods and Machine Learning Algorithms

Interest in developing and using novel biomarkers in critical care and perioperative medicine is increasing. Biomarkers studies are often presented with flaws in the statistical analysis that preclude them from providing a scientifically valid and clinically relevant message for clinicians. To improve scientific rigor, the proper application and reporting of traditional and emerging statistical methods (e.g., machine learning) of biomarker studies is required. This Readers' Toolbox article aims to be a starting point to nonexpert readers and investigators to understand traditional and emerging research methods to assess biomarkers in critical care and perioperative medicine.

Variance-Reduced Methods for Machine Learning

Stochastic optimization lies at the heart of machine learning, and its cornerstone is stochastic gradient descent ( SGD ), a method introduced over 60 years ago. The last eight years have seen an exciting new development: variance reduction for stochastic optimization methods. These variance-reduced ( VR ) methods excel in settings where more than one pass through the training data is allowed, achieving a faster convergence than SGD in theory and practice. These speedups underline the surge of interest in VR methods and the fast-growing body of work on this topic. This review covers the key principles and main developments behind VR methods for optimization with finite data sets and is aimed at nonexpert readers. We focus mainly on the convex setting and leave pointers to readers interested in extensions for minimizing nonconvex functions.

Combining radiomics with ultrasound-based risk stratification systems for thyroid nodules: an approach for improving performance

To develop a radiomics score using ultrasound images to predict thyroid malignancy and to investigate its potential as a complementary tool to improve the performance of risk stratification systems. We retrospectively included consecutive patients who underwent fine-needle aspiration (FNA) for thyroid nodules that were cytopathologically diagnosed as benign or malignant. Nodules were randomly assigned to a training and test set (8:2 ratio). A radiomics score was developed from the training set, and cutoff values based on the maximum Youden index (Rad_maxY) and for 5%, 10%, and 20% predicted malignancy risk (Rad_5%, Rad_10%, Rad_20%, respectively) were applied to the test set. The performances of the American College of Radiology (ACR) and the American Thyroid Association (ATA) guidelines were compared with the combined performances of the guidelines and radiomics score with interpretations from expert and nonexpert readers. A total of 1624 thyroid nodules from 1609 patients (mean age, 50.1 years [range, 18-90 years]) were included. The radiomics score yielded an AUC of 0.85 (95% CI: 0.83, 0.87) in the training set and 0.75 (95% CI: 0.69, 0.81) in the test set (Rad_maxY). When the radiomics score was combined with the ACR or ATA guidelines (Rad_5%), all readers showed increased specificity, accuracy, and PPV and decreased unnecessary FNA rates (all p < .05), with no difference in sensitivity (p > .05). Radiomics help predict thyroid malignancy and improve specificity, accuracy, PPV, and unnecessary FNA rate while maintaining the sensitivity of the ACR and ATA guidelines for both expert and nonexpert readers. • The radiomics score yielded an AUC of 0.85 and 0.75 in the training and test set, respectively. • For all readers, combining a 5% predicted malignancy risk cutoff for the radiomics score with the ACR and ATA guidelines significantly increased specificity, accuracy, and PPV and decreased unnecessary FNA rates, with no decrease in sensitivity. • Radiomics can help predict malignancy in thyroid nodules in combination with risk stratification systems, by improving specificity, accuracy, and PPV and unnecessary FNA rates while maintaining sensitivity for both expert and nonexpert readers.

Effects of Training in Figures of Speech on EFL Learners’ Literary Reading Comprehension Ability

One of the major areas of interest in SLA research is the study of the ways in which expert and non-expert readers respond to L2 texts and the fundamental changes that can be brought about in their L2 reading processes through formal instruction. In line with this research tradition, the present quasi-experimental study investigated the effects of formal training in figures of speech on university EFL learners’ appreciation of an unseen literary text, Martin Luther King’s “I Have a Dream” in the case of this study. Understanding literature requires knowledge of figures of speech.An experimental group (n=29) and a control group (n=26) of intermediate 3rd year EFL learners, studying English for a B.A. degree at Kashan University, Iran, participated in the study. The participants were first pre-tested and matched for their level of proficiency in English and their initial reading comprehension ability. In addition to the normal curriculum content, the experimental group received instruction in figures of speech through a course called "Fonun va Sana'at" (Figures of Speech). The control group did not receive this instruction. Both groups were post-tested on their ability to read a literary passage and to appreciate it.The results of t-test analysis of the resulting data revealed significant differences between the means of the two groups. The experimental group that had received instruction in figures of speech significantly outperformed the control group. The findings of the study have practical implications for material development, curriculum planning, teaching English through literature, and second language acquisition.

Recommendations for designing genetic test reports to be understood by patients and non-specialists

Patients and non-specialist healthcare professionals are increasingly expected to understand and interpret the results of genetic or genomic testing. These results are currently reported using a variety of templates, containing different amounts, levels, and layouts of information. We set out to establish a set of recommendations for communicating genetic test results to non-expert readers. We employed a qualitative-descriptive study design with user-centred design principles, including a mixture of in-person semi-structured interviews and online questionnaires with patients, healthcare professionals and the general public. The resulting recommendations and example template include providing at-a-glance comprehension of what the test results mean for the patient; suggested next steps; and details of further information and support. Separation and inclusion of technical methodological details enhances non-specialists’ understanding, while retaining important information for specialists and the patients’ records. The recommendations address the high-level needs of patients and their non-specialist clinicians when receiving genetic test results. These recommendations provide a solid foundation for the major content and structure of reports, and we recommend further engagement with patients and clinicians to tailor reports to specific types of test and results.

A Concise Overview of Chemotherapeutic Drugs in Gastrointestinal Cancers: Mechanisms of Action and Resistance

Gastrointestinal (GI) cancers are malignancies of the gastrointestinal tract and accessory organs of the digestive system including the esophagus, pancreas, stomach, colon, rectum, anus, liver, gallbladder, biliary system, and small intestine. These account for 28% of global cancer incidence and 35% of cancer-related mortalities. The most common type of GI cancers: colorectal and gastric cancers, rank among the top five cancers. Surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy are available options for GI cancer treatment. With surgery being the first-line of choice, pre or post-operative chemotherapy is the second most-often used. Nevertheless, the long-term survival rate in GI cancer patients is modest due to the development of drug resistance, which can be overcome by administering various combinations of chemotherapeutic and targeted therapeutic drugs. The classic example is fluoropyrimidine, a class of cytotoxic drug used in combination with irinotecan, gemcitabine, and docetaxel to increase overall and progression-free survival in colorectal, pancreatic, and gastric cancers, respectively. Although in-depth expert reviews on select chemotherapies for the most common GI cancer types can be found, a concise overview of different drugs approved for all GI cancers is not available. In this review, we have compiled a list of the most common chemotherapeutic drugs used for GI cancers and summarized their major modes of action, intrinsic/adaptive resistance, and a few pre-clinical/clinical approaches to overcoming such resistance. We hope this manuscript will be useful for non-expert readers interested in a general overview of GI cancer chemotherapies.

The Impact of OCT on Diagnostic Accuracy of the Technology-Based Eye Care Services Protocol: Part II of the Technology-Based Eye Care Services Compare Trial

Ophthalmologic telemedicine programs help to address the growing demand for eye care and lessen healthcare disparities for patients. One example is Technology-Based Eye Care Services (TECS), implemented in the Veteran Affairs Healthcare System in 2015. Accuracy and quality data for TECS both have been reported, and data suggest that although the TECS examination is comparable with an in-person examination, sensitivity for glaucoma and glaucoma suspect detection is less than that for other diseases, such as macular degeneration. Several articles suggest that OCT can improve disease detection for glaucoma. Therefore, this study was undertaken to test the impact of OCT on the accuracy of the TECS protocol. This article reports the data from part II of the TECS Compare trial; results from part I are discussed in a previous article. Prospective comparison between the TECS protocol with OCT versus a face-to-face (FTF) examination for 256 patients. An eligible patient was defined as a patient with no known ocular disease who desired a routine eye examination. Patient underwent the TECS protocol workup and OCT nerve, OCT macula, and FTF examination on the same day. Percent agreement, κ values, sensitivity, and specificity were calculated for nonexpert readers after OCT interpretation of the TECS protocol using the FTF examination as the clinical gold standard. OCT did not improve the diagnostic accuracy of the TECS protocol when compared with an FTF examination. In most cases, OCT had no impact, and in the case of reader 2, OCT actually reduced the κ value from moderate agreement to agreement equal to chance while lowering the percent agreement by 10%. OCT also did not impact inter- or intrareader variability parameters. In this study, OCT did not seem to improve the accuracy of glaucoma or retinal disease detection when added to the standard TECS protocol. In one case, OCT worsened the agreement of the reader compared with the FTF. Further study is necessary to confirm these findings, and results may change if the readers are glaucoma or retina specialists instead of nonexpert OCT readers, comprehensive and anterior segment specialists.