Presentation Protocols Research Articles

Novel presentation of a feline patient with visceral and cervical lymph node hemangiosarcoma.

To report a novel presentation of feline hemangiosarcoma. A 14-year-old spayed female feline patient diagnosed with hemangiosarcoma of the spleen and a cervical lymph node. The patient presented to the emergency service following a 1-week history of lethargy and hiding. Abdominal ultrasound revealed splenomegaly with multiple nodules and peritoneal fluid that was consistent with hemorrhagic effusion. The patient underwent a routine splenectomy and was started on doxorubicin. Histopathologic evaluation of the spleen confirmed visceral hemangiosarcoma. When the disease showed signs of progression, combination chemotherapy with cyclophosphamide and vincristine was initiated. Four months following presentation, a submandibular lymph node was removed and found to have metastatic hemangiosarcoma. From presentation to euthanasia, the patient survived 205 days. Hemangiosarcoma is a rare cancer in feline patients, with a lack of veterinary literature on its presentation and chemotherapy protocols. The subject of this case report had a novel presentation of hemangiosarcoma and responded favorably to a chemotherapy protocol not previously described for this disease.

Myopathies of endocrine origin: A review for physicians

Myopathies are a common manifestation of endocrine disorders. Endocrine myopathies are often overlooked while considering differential diagnoses in patients with musculoskeletal symptoms. The hindrance to mobility and the musculoskeletal discomfort owing to these myopathies are important causes of disability and depreciated quality of life in these patients. Endocrine myopathies occur due to the effects of endogenous or iatrogenic hormonal imbalance on skeletal muscle protein and glucose metabolism, disrupting the excitation-contraction coupling. Abnormalities of the pituitary, thyroid, parathyroid, adrenal, and gonadal hormones have all been associated with myopathies and musculoskeletal symptoms. Endocrine myopathies can either be the complication of a secondary endocrine disorder or a presenting symptom of a missed underlying disorder. Therefore, an underlying endocrine abnormality must always be excluded in all patients with musculoskeletal symptoms. This review presents a compilation of various endocrine myopathies, their etiopathogenesis, clinical presentation, diagnostic modalities, and treatment protocols.

Modeling the Directed Evolution of Broad Host Range Phages.

Background: The host ranges of individual phages tend to be narrow, yet many applications of phages would benefit from expanded host ranges. Empirical methods have been developed to direct the evolution of phages to attack new strains, but the methods have not been evaluated or compared for their consequences. In particular, how do different methods favor generalist (broad host range) phages over specialist phages? All methods involve exposing phages to two or more novel bacterial strains, but the methods differ in the order in which those hosts are presented through time: Parallel presentation, Sequential presentation, and Mixed presentation. Methods: We use a combination of simple analytical methods and numerical analyses to study the effect of these different protocols on the selection of generalist versus specialist phages. Results: The three presentation protocols have profoundly different consequences for the evolution of generalist versus specialist phages. Sequential presentation favors generalists almost to the exclusion of specialists, whereas Parallel presentation does the least so. However, other protocol attributes (the nature of dilution between transfers of phages to new cultures) also have effects on selection and phage maintenance. It is also noted that protocols can be designed to enhance recombination to augment evolution and to reduce stochastic loss of newly arisen mutants.

Kikuchi\u2013Fujimoto disease in the Eastern Mediterranean zone

Kikuchi–Fujimoto disease (KFD) is a rare benign and self-limiting syndrome. We aim to review cases of KFD at our institution as a rare illness in the Arab ethnic descent and to analyse reports from most countries in the East Mediterranean zone. This is a retrospective study in which the histopathology database was searched for the diagnosis of KFD. A full review of KFD patients’ medical records was done. Data regarding demographic features, clinical presentation, laboratory findings, comorbidities, and management protocols were obtained. Published KFD cases from east Mediterranean countries were discussed and compared to other parts of the world. Out of 1968 lymph node biopsies studied, 11 (0.6%) cases of KFD were identified. The mean age of patients with KFD was 32 years (4–59). 73% (8/11) were females. The disease was self-limiting in 5 patients (45%); corticosteroid therapy was needed in 4 patients (34%). One patient was treated with methotrexate and one with antibiotics. One patient died as a consequence of lymphoma. Jordanians and Mediterranean populations, especially those of Arab ethnic background, seem to have low rates of KFD. The genetic susceptibility theory may help to explain the significantly higher disease prevalence among East Asians. Early diagnosis of KFD—although challenging—is essential to reduce the morbidity related to this illness.

Pediatric auto-immune encephalitis

Pediatric Auto-Immune Encephalitis (PAE) is a neuro-inflammatory disorder with a varied presentation. The discovery of the Anti NMDA receptor and other antibodies as the causative agents of PAE, has led to an increased need for guidelines for diagnosis and management of these disorders. PAE remains a challenging group of disorders due to their varying presentations and etiology with a prolonged clinical course. The wide spectrum of clinical symptoms involves altered mental status, movement disorders, acute behavioral changes, psychosis, delirium, seizures, and insomnia. This group of disorders was recently recognized in the children. This review provides clinicians with information on the most common PAE disorders, the spectrum of their clinical presentation, diagnostic tests and treatment protocols based on the current literature.

A model six-month workshop for developing systematic review protocols at teaching hospitals: action research and scholarly productivity

BackgroundResearch engagement contributes to the improvement of patient care. A systematic review is a suitable first scholarly activity because it entails summarization of publicly available data and usually requires neither rigorous ethical review nor research funding.MethodsThis study aimed to develop a model workshop for healthcare staff to acquire skills in creating systematic review protocols based on their own clinical questions at teaching hospitals. We used an action research method to create a model workshop at four hospitals in Japan from April 2015 to March 2017. To improve the program, we solicited reflections using participant questionnaires for each lecture and examined the quality of homework submitted by participants after each lecture. We administered a revised final version of the workshop at five hospitals from April 2016 to March 2017. We evaluated the participants’ scholarly productivity related to these workshops. The observation period was a minimum of 2 years following the workshops.ResultsMost participants had never developed a formal clinical research protocol and voluntarily participated in the workshop. The action research was developed and implemented at nine teaching hospitals in Japan, including one university hospital. The study developed a model nine-step workshop curriculum: 1) Research question development, 2) Search strategy development, 3) Search strategy brush-up, 4) Exclusion and inclusion criteria development, 5) Risk of bias assessment planning, 6) Meta-analysis planning, 7) Subgroup and sensitivity analysis planning, 8) Planning the presentation of results, and 9) Presentation protocols. A total of 233 participants, including medical doctors and other health professionals, produced 414 research questions. Seventy-nine participants (34%) completed the workshop, and 47 review teams accomplished systematic review protocols. The participants published 13 peer-reviewed articles as a result of the workshop.ConclusionsWe developed a structured scholarly productive model workshop for healthcare staff working at hospitals. We found healthcare staff with clinical subspecialties were able to develop an unexpectedly high number of research questions through this workshop. Medical teachers at hospitals with prior systematic review experience could teach how to develop systematic review protocols using this model. Further research is needed to increase the academic productivity of such workshops.Trial registrationUMIN (https://www.umin.ac.jp/ctr/), UMIN000017107 (4/15/2015), UMIN000025580 (1/10/2017).

Adverse Childhood Experiences and Trauma-Informed Care.

Adverse childhood experiences (ACEs) refer to the abuse, neglect, and traumatic experiences in childhood that directly affect long-term adolescent and adult health. Understanding the ACE Pyramid and the physiological stress response has guided research toward a better understanding of the long-term mental and physical health consequences from psychological impacts early in life. Trauma-informed care becomes critical for pediatric clinicians to operationalize in practice. The four R's approach-realize, recognize, respond, and resist re-traumatization-can be used by pediatric providers as guidance. The trauma-informed care approach includes the realization of how ACEs affect health, the recognition of pediatric clinical symptom presentation and screening protocols for ACEs, and the health care provider's ability to respond and not re-traumatize patients when delivering evidence-based care. As recent events have triggered worldwide mental and emotional trauma in youth, clinicians must start operationalizing trauma-informed care into practice, as future presentations of trauma are expected.

Neonatal Contrast Sensitivity and Visual Acuity: Basic Psychophysics.

PurposeThis research was prospectively designed to determine whether a 0.083 cycles per degree (cy/deg) (20/7200) square-wave stimulus is a good choice for clinical measurement of newborn infants' contrast sensitivity and whether the contrast sensitivity function (CSF) of the newborn infant is band-pass. The results were retrospectively analyzed to determine whether the method of constant stimuli (MCS) and the descending method of limits (dLIM) yielded similar results.MethodsIn across-subjects experimental designs, a pilot experiment used MCS (N = 47 visual acuity; N = 38 contrast sensitivity at 0.083 cy/deg), and a main experiment used dLIM (N = 22 visual acuity; N = 22 contrast sensitivity at 0.083 cy/deg; N = 21 at 0.301 cy/deg) to measure visual function in healthy newborn infants. Three candidate CSFs estimated maximum neonatal contrast sensitivity. MCS and dLIM psychometric functions were compared while taking the stimulus presentation protocols into account.ResultsThe band-pass CSF fit the data best, with a peak sensitivity near 0.31 at 0.22 cy/deg. However, the 0.083 cy/deg square-wave stimulus underestimated the best performance of newborn infants by less than 0.15 log10 units. MCS and dLIM data agreed well when the stimulus presentation contingencies were taken into account.ConclusionsNewborn contrast sensitivity is well measured using a 0.083 cy/deg square-wave target, regardless of which CSF shape is correct. MCS and dLIM yield wholly comparable results, with no evidence to suggest effects of other factors such as infant inattention or examiner impatience.Translational RelevanceThese measurements open the way for clinical behavioral measurement of infant visual acuity and contrast sensitivity in the neonatal period.

The Use of Frozen Section in the Early Diagnosis of Acute Invasive Fungal Sinusitis

Objectives Acute invasive fungal sinusitis (AIFS) remains a significant cause of morbidity and mortality in the immunocompromised patient population. Early diagnosis is key to improving patient outcomes. Frozen section biopsies have been shown to decrease time to diagnosis when compared with permanent pathology. However, its accuracy has not been adequately described in the literature, specifically in regard to AIFS. The aim of this study is to evaluate the statistical diagnostic accuracy of frozen sections and to review the etiology, clinical presentation, and current diagnostic protocols in management of AIFS. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Retrospective review included 67 pathologic records in Co-Path, with search criteria including invasive fungal, clinical history, frozen section, and final diagnosis between the dates of 2006 and 2015. Results Sixty-seven cases were reviewed per the search criteria in Co-Path. Of these, 31 met further criteria of having had frozen section analysis. Variables such as sensitivity, specificity, positive predictive value, and negative predictive value were assessed. All 21 positive frozen sections correlated with positive permanent pathology, giving a positive predictive value of 100%. Frozen section biopsies were 87.5% sensitive and 100% specific. Conclusion Early diagnosis of AIFS has been shown to decrease morbidity and mortality. Frozen section biopsies remain key in obtaining an early diagnosis among patients with a high clinical suspicion for invasive fungal sinusitis. Frozen section biopsies positive for invasive fungal pathology were universally consistent with definitive diagnosis.

Bisphosphonate-related osteonecrosis of the jaws: our experience in up to 120 cases

Osteonecrosis of the jaw has been related to the use of bisphosphonates for more than a decade, with numerous attempts of different treatments and even the presentation protocols by surgeons associations. We aim to present a series of clinical cases with various complexities, presenting forms of treatment adopted by our service. We collected clinical data from 120 patients, considering the type of bisphosphonate treatment, time of use, location and extent of osteonecrosis and the treatment performed in our hospital. We have adopted the protocol to perform surgical removal of necrosis, associated with pentoxifylline and tocopherol, and hyperbaric chamber therapy for indicated cases. We resumed the treatment of overall shape necrosis in 90% of cases, and significant improvement of signs and symptoms in 10%. We conclude that the combined use of surgery to other therapies may be indicated in all cases of osteonecrosis of the jaw, provided that the systemic condition of the patient permits the surgical approach.

Management and Outcome of Rhinosinusitis in Nigeria.

ObjectiveThe aim of this study is to present the management and outcome of treatment of rhinosinusitis in Nigeria.Study DesignA retrospective review of the case notes of patients with rhinosinusitis between January 2009 and December 2014.SettingStudy at the University of Ilorin Teaching Hospital, Nigeria, using retrieved case notes after ethical approval was received.Subjects and MethodsThe information retrieved included sociodemographic data, clinical presentation, duration, endoscopic examination, and other clinical management protocols with follow-up. All information was entered into SPSS version 20 and analyzed descriptively, and results are presented in tables and figure.ResultsA total of 5618 patients were seen in the ear, nose, and throat clinic over the 6-year period. Of the patients, 445 had rhinosinusitis, and only 410 had complete data for analysis. Patient age ranged from 2 to 75 years (mean ± SD, 31.8 ± 1.2 years). The male to female ratio was 1.2:1. The duration of symptoms varied from 3 days to 10 years, with 78.7% having symptoms between 3 and 120 months. About 82.4% had nasal discharge, 51.3% had sneezing, 78.9% had alternating nasal obstruction, and 49.3% had nasal itch. Of the patients, 61.4% had a predisposition, of which 30.9% were allergic, 23.3% were infective, and 7.2% were vasomotor. Ethmoidal-maxillary sinuses were commonly affected radiologically. About 63% of patients had medical treatment, and only 28.7% had surgical intervention, of which 37% were scheduled for surgical treatment and 7.3% refused. Improved symptoms were noticed in 72.6% of patients, and 1.4% reported no improvement.ConclusionRhinosinusitis is still common, affecting active males economically with more chronic cases and more allergic predisposition. Early medical management is still effective, and endoscopic sinus surgery is now a better surgical option with better outcome in 72.6%.

The Use of Virtual Reality in Psychology: A Case Study in Visual Perception.

Recent proliferation of available virtual reality (VR) tools has seen increased use in psychological research. This is due to a number of advantages afforded over traditional experimental apparatus such as tighter control of the environment and the possibility of creating more ecologically valid stimulus presentation and response protocols. At the same time, higher levels of immersion and visual fidelity afforded by VR do not necessarily evoke presence or elicit a “realistic” psychological response. The current paper reviews some current uses for VR environments in psychological research and discusses some ongoing questions for researchers. Finally, we focus on the area of visual perception, where both the advantages and challenges of VR are particularly salient.

The 9‐point hedonic scale and hedonic ranking in food science: some reappraisals and alternatives

The 9-point hedonic scale has been used routinely in food science, the same way for 60 years. Now, with advances in technology, data from the scale are being used for more and more complex programs for statistical analysis and modeling. Accordingly, it is worth reconsidering the presentation protocols and the analyses associated with the scale, as well as some alternatives. How the brain generates numbers and the types of numbers it generates has relevance for the choice of measurement protocols. There are alternatives to the generally used serial monadic protocol, which can be more suitable. Traditionally, the 'words' on the 9-point hedonic scale are reassigned as 'numbers', while other '9-point hedonic scales' are purely numerical; the two are not interchangeable. Parametric statistical analysis of scaling data is examined critically and alternatives discussed. The potential of a promising alternative to scaling itself, simple ranking with a hedonic R-Index signal detection analysis, is explored in comparison with the 9-point hedonic scale.

Influence of Sample Presentation Protocol on the Results of Consumer Tests

AbstractThe influence of two sample presentation and instruction delivery protocols on the results of consumer‐based sensory evaluations was studied. In two independent experiments, five peach jams and four Colonia‐type cheese (from the Colonia region in Uruguay) were taste‐tested. In the first experiment, one group of 54 consumers used the sequential monadic (SM) and the other group of 54 consumers used the rank‐rating (RR) sample presentation protocols for the jam sample evaluation. In the second experiment, one group of 54 consumers used the SM and the other group of 54 consumers used the RR sample presentation protocols for the cheese sample evaluation. All samples were evaluated using hedonic scales and CATA (check‐all‐that‐apply) questions. Overall liking scores were found not to depend on the sample presentation protocol. Although the protocol was found to affect the choice and number of attributes listed in the CATA question used by respondents to differentiate the samples, the spatial configurations of samples derived by multiple factor analysis showed a high degree of correlation between the two protocols for most of the CATA attributes. Based on these results, the SM and RR protocols were found to be equally sensitive, for the products tested, in the conditions of this study.Practical ApplicationsConsumer testing is mainly used to predict operational preference that would assure success in the market. Side‐by‐side or monadic presentation of samples during traditional hedonic consumer testing would give results with the same degree of accuracy when testing a reduced number of samples (4–5). The use of CATA (check‐all‐that‐apply) questions would provide the attributes of the samples in a similar way in either monadic or side‐by‐side sample presentation during consumer testing.

Breast Emergencies: Types, Imaging Features, and Management

The objective of this article is to describe the types of breast emergencies that can be encountered in a breast imaging practice, discuss the characteristic imaging features of these emergencies, and explain the most common methods and interventions used for the treatment of breast emergencies and complications. Breast emergencies are uncommon but require prompt identification and management when they do occur. Patients with mastitis or a breast abscess may be seen for either diagnosis or treatment. Most complications are the result of interventional procedures. Pseudoaneurysms, postbiopsy hematoma, and localization wire migration are the most common situations encountered. A milk fistula resulting from a core biopsy is uncommon. Fortunately, seat-belt injuries to the breast are rare. Knowledge of these entities--of the usual presentation, management, and appropriate follow-up protocols--is essential for breast imagers.

Using Research on Preservation and Conservation in a Historic House

Historic houses are challenging environments for conservation and preservation of the often vulnerable collection objects contained within. Multidisciplinary scientific and expert research in the Museum Plantin-Moretus, UNESCO World Heritage since 2005, revealed its particular issues regarding airborne pollutants, climate factors (temperature and relative humidity), light, and presentation protocols that were all potentially damaging to the collection. Particular research on the displayed objects illustrated the negative effects of these issues. The combined research effort now serves as a “status of conservation” upon which future policy can be based. As a rational resource, it addresses overseeing governments’ wishes by making it possible to propose measures that are both effective and efficient. It also serves as a convincing justification for procedural and presentational change by museum personnel and management. Overall, it creates valuable goodwill among the various stakeholders of the museum, thereby going beyond the pure practical use.

Update on Pediatric Leukemia and Lymphoma Imaging

Together, leukemia and lymphoma account for half of all childhood malignancies. Leukemia and lymphoma arise from similar cell lines and can have overlapping imaging features; however, the clinical presentation, imaging strategies, and treatment protocols can vary substantially based on the specific subtype. Although imaging does not play a central role in staging or monitoring disease in childhood leukemia, findings on imaging may be the first indication of the diagnosis. Advanced imaging, especially positron emission tomography/computed tomography, has moved to the forefront of staging and treatment response evaluation in Hodgkin's disease and non-Hodgkin's lymphoma. Imaging also plays a key role in evaluating the myriad of treatment complications that are commonly seen with chemotherapy and associated neutropenia. Future efforts will be largely focused on decreasing radiation exposure to these children, utilizing reduced or radiation-free modalities, such as positron emission tomography/magnetic resonance and diffusion-weighted whole-body imaging with background suppression, as well as refining surveillance imaging strategies. The purpose of this article is to briefly review the classification of pediatric leukemia and lymphoma, illustrate common imaging findings at presentation throughout the body, describe staging and therapeutic response evaluation, and show a spectrum of commonly encountered complications of treatment.

Effect of sample presentation protocols on the performance of a margarine expert panel

In the field of product development and quality assurance flavour lexicons are widely used. These systems include the definition of all attributes and the relevant reference materials or reference samples. With the application of these lexicons more reliable results can be acquired and it can be very helpful to the assessors in sensory analysis. The main purpose of our further research was to establish a flavour language for table margarines. A well-trained margarine expert panel was already established and also an appropriate sensory method (QDA) was chosen. However, the applied sample presentation design also has a strong influence on the results. In this study the effect of two types of test protocols were compared on the performance of the expert panel. The results of the sensory panel were monitored using univariate (F-plot, MSE-plot, p*MSE-plot) and multivariate statistical methods (Tucker-1 correlation loading plot) by PanelCheck. With application of the side-by-side protocol (SBS) the panel agreement and the ability to discriminate the samples and the repeatability of the panel were considerably improved against using the sequential monadic presentation protocol (SM). The explained variance of the first occasion was 74.8% and in case of the application of SM was 55% for PC1.

Stereoscopy and the Human Visual System

Stereoscopic displays have become important for many applications, including operation of remote devices, medical imaging, surgery, scientific visualization, and computer-assisted design. But the most significant and exciting development is the incorporation of stereo technology into entertainment: specifically, cinema, television, and video games. In these applications for stereo, three-dimensional (3D) imagery should create a faithful impression of the 3D structure of the scene being portrayed. In addition, the viewer should be comfortable and not leave the experience with eye fatigue or a headache. Finally, the presentation of the stereo images should not create temporal artifacts like flicker or motion judder. This paper reviews current research on stereo human vision and how it informs us about how best to create and present stereo 3D imagery. The paper is divided into four parts: (1) getting the geometry right, (2) depth cue interactions in stereo 3D media, (3) focusing and fixating on stereo images, and (4) how temporal presentation protocols affect flicker, motion artifacts, and depth distortion.

Temporal presentation protocols in stereoscopic displays: Flicker visibility, perceived motion, and perceived depth

Most stereoscopic displays rely on field-sequential presentation to present different images to the left and right eyes. With sequential presentation, images are delivered to each eye in alternation with dark intervals, and each eye receives its images in counter phase with the other eye. This type of presentation can exacerbate image artifacts including flicker, and the appearance of unsmooth motion. To address the flicker problem, some methods repeat images multiple times before updating to new ones. This greatly reduces flicker visibility, but makes motion appear less smooth. This paper describes an investigation of how different presentation methods affect the visibility of flicker, motion artifacts, and distortions in perceived depth. It begins with an examination of these methods in the spatio-temporal frequency domain. From this examination, it describes a series of predictions for how presentation rate, object speed, simultaneity of image delivery to the two eyes, and other properties ought to affect flicker, motion artifacts, and depth distortions, and reports a series of experiments that tested these predictions. The results confirmed essentially all of the predictions. The paper concludes with a summary and series of recommendations for the best approach to minimize these undesirable effects.