Supplementary Views Research Articles

Science and Religion: Students' Views and Understanding on Evolutionary Concepts

This study was carried out to explore the connection between science and religion especially focused on students' views and understanding of evolutionary concepts of biology at the secondary level. To find out the students' views and understanding of evolutionary concepts in connection with science and religion, a mixed-method design was used consisting of 50 participants of five secondary schools in Kathmandu Metropolitan City. The random sampling method was used for student selection while purposive sampling was used for schools selection. A five-point Liker scale, concept understanding inventory, and interview guideline tools were developed. The tools were validated for the collection of data. Thus, the gathered data were analyzed through descriptive statistics and thematic explanation. From the analysis, it was found that religion and science are continued debatable subjects in philosophy and theology till now. It also provides a philosophical analysis of how they interrelate with each other. The majority understanding of students has been found to be in conflict, science supportive, religion supportive, coalition, contrast, and supplementary views between science and religion towards evolutionary biology. This study concludes that students have common sense, content and nature of science, non-science, and dialect-based misleading as well as corrected understanding about evolutionary biology. Thus, the creationism concept of evolution should be included in the science curriculum to achieve a better understanding of the evolutionary concept.

Accuracy of Mammography in the Diagnosis of Breast Cancer

Background: Breast cancer is one of the leading causes of cancer-related deaths among women worldwide. Mammography was recently introduced at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria for breast cancer screening and diagnosis at the institution. Objective: The objective of this study is to determine the diagnostic accuracy of mammography in the assessment of palpable malignant breast lump among adult females referred from the NAUTH outpatient clinics using histopathology as gold standard. Materials and Methods: This prospective cross sectional study involved recruitment of consenting adult females with palpable breast lump referred for mammography between October 2017 and November 2019 at NAUTH, Nnewi, Nigeria. Two standard views—cranio-caudal (CC) and medio-lateral oblique (MLO)—were done for each patient. Spot magnification or other supplementary views were only done when indicated. Data analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0 for Windows software. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of malignant breast lesions were 41.4%, 98%, 96.7%, 54.4%, and 65%, respectively. The most common features of malignancy were mammographic opacity with an irregular outline (86.7%) and architectural distortion (80%), whereas asymmetric density (10%) was the least common feature. Conclusion: Mammography has a fairly high overall diagnostic accuracy in breast cancer diagnosis. However, an alternative imaging modality is required for dense breasts. This study’s reported specificity (98%) suggests that the test has a very high ability to correctly identify non-cancerous breast lumps. This is particularly relevant in breast cancer screening with an objective to rule out the presence of the disease among adult females in the population.

International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest.

The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol. Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the "4 F" approach: fluid, form, function, filling. An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.

LO045: Sonography in Hypotension and Cardiac Arrest (SHoC) - Cardiac Arrest: A consensus on the integration of point of care ultrasound into advanced cardiac life support during cardiac arrest

Introduction: Point of care ultrasound (PoCUS) provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm. We consider that a consensus-based priority checklist using a “4 F’s” approach (Fluid; Form; Function; Filling), would provide a better algorithm during ACLS. Methods: The ultrasound subcommittee of the Australasian College for Emergency Medicine (ACEM) drafted a checklist incorporating PoCUS into the ACLS algorithm. This was further developed using the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. A modified Delphi tool was developed to reach an international consensus on how to integrate ultrasound into cardiac arrest algorithms for emergency department patients. Results: Consensus was reached following 3 rounds. The agreed protocol focuses on the timing of PoCUS as well as the specific clinical questions. Core cardiac windows performed during the rhythm check pause in chest compressions are the sub-xiphoid and parasternal cardiac views. Either view should be used to detect pericardial fluid, as well as examining ventricular form (e.g. right heart strain) and function, (e.g. asystole versus organized cardiac activity). Supplementary views include lung views (for absent lung sliding in pneumothorax and for pleural fluid), and IVC views for filling. Additional ultrasound applications are for endotracheal tube confirmation, proximal leg veins for DVT, or for sources of blood loss (AAA, peritoneal/pelvic fluid). Conclusion: The authors hope that this process will lead to a consensus-based SHoC-cardiac arrest guideline on incorporating PoCUS into the ACLS algorithm.

British Society of Breast Radiology Annual Scientific Meeting 2015.

Objective: To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. Methods: Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. Results: The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views—the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review—AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. Conclusion: The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. Advances in knowledge: The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities.

Why Pluralism, Relativism, and Panthareism: An Ethical Landscape with Sport in the Background*

Abstract In reference to the monograph entitled “Sports and Ethics: Philosophical Studies”, published in the “Physical Culture and Sport. Studies and Research” quarterly (2014, vol. 62), and in particular in reference to the paper entitled “The Normative Ethics and Sport” (Kosiewicz, 2014, pp. 5-22), the article presents new and at the same time supplementary views on the relationships between sports and normative ethics. The main objective of the paper is to provide a rationale as to why these relationships may be viewed in the context of the assumptions of ethical pluralism, ethical relativism, ethical panthareism, and axionormative negationism. The text is of a strictly cognitive and extra-ideological nature and it attempts to avoid moral valuation, moralism, and moralizing. The view it postulates is also labeled as ethical negationism, which rejects the necessity for external support and enhancement of sports rivalry rules with moral principles. It assumes that regulations, book rules, and game rules as well as the principles of sports rivalry ought to be of an entirely amoral character, independent of ethics. The article suggests minimizing the impact of moral postulates on sport. It postulates a need for widespread propagation of this point of view in competitive, professional, spectator, and Olympic sport disciplines, as well as in top-level sports or elite sports. The views presented in the paper point to the need to separate normative ethics from sports as far as it is at all possible in contemporary sports indoctrinated with obligations or attitudes of a moral tenor. This is because normative ethics – according to the author - is relative ethics, depending on an unlimited number of variables, e.g., various social contexts or individual points of view. The text engages in a polemic with colloquial and evaluative opinions of those sports fans who by all means strive to bolster its formal, functional, and axiological status. A significant part of them erroneously attributes sports to an extraordinary moral mission related to promoting an intuitively understood good with a religious and extra-confessional tenor.

A comparison of the accuracy of digital breast tomosynthesis with supplementary views in the diagnostic workup of mammographic lesions

Supplementary views (SV) are routinely used in the diagnostic workup of mammographic lesions. Previous studies have demonstrated that digital breast tomosynthesis (DBT) increases the accuracy of classification of mammographic lesions [1]. In this study the diagnostic accuracy of SV is compared with DBT.

Preoperative Dual-Phase Parathyroid Imaging With Tc-99m-Sestamibi

Previously, we have found that the additional use of a pinhole collimator in parathyroid scintigraphy resulted in a decrease in the number of incorrect side localizations and an increase in reproducibility compared with that of using a parallel-hole collimator alone. The aim was to investigate whether the addition of anterior oblique views to parathyroid scintigraphy (PS) with a pinhole collimator could further enhance the diagnostic ability and reproducibility. The level of preoperative parathyroid hormone (PTH) as a potential predictor of the usefulness of the supplementary views was also studied. Forty-seven patients with primary hyperparathyroidism (HPT) underwent dual-phase PS using a combined protocol with parallel-hole and pinhole collimators. The pinhole collimator was used in the anterior as well as right and left anterior oblique positions. Thyroid pertechnetate scans were undertaken in the same positions. Two observers assessed the images independently. By adding oblique views, the gain in correct side localization occurred in all cases but one was seen in patients with rapid washout. The level of PTH could not predict these patients. The observer agreement on correct side localizations rose significantly from 81% to 94%. The addition of oblique views to the imaging protocol using the pinhole collimator for parathyroid and thyroid scintigraphy in primary HPT results in an increase in observer agreement and the number of correct side localizations in patients with rapid washout of MIBI. The preoperative level of PTH cannot, however, predict these patients.

An indexed atlas of digital mammograms for computer-aided diagnosis of breast cancer

Screening mammography is used for the early detection of breast cancer in asymptomatic women (between the ages of 50 and 69 in Canada). Screen Test: Alberta Program for the Early Detection of Breast Cancer has been in operation since 1990, and attracts the participation of over 21,000 women per year. Screen Test has offices in Calgary and Edmonton, and offers extended service with three mobile units to more than 100 sites in the province of Alberta. Mammograms are difficult images to interpret, especially in the screening context where the probability of encountering an abnormality is low and patient information is limited. A cost-effective, efficient method needs to be developed in order to achieve high diagnostic accuracy. Diagnostic mammography refers to the radiological examination of symptomatic women who exhibit clinical signs such as a palpable lump, skin puckering, or nipple retraction, or as a result of screening. Mammography is used to detect abnormalities and classify them as benign or malignant. Ambiguous cases with suspicious features detected on mammograms are evaluated further with adjunctive imaging procedures. Depending on the characteristics of the abnormality, these procedures may include supplementary views, ultrasound, magnification mammography, magnetic resonance imaging, computed tomography, and nuclear medicine techniques. Biopsy is indicated if these methods do not lead to a definite diagnosis but indicate a high suspicion for malignancy, and confirmation of malignancy is required. Objective methods for the analysis of mammographic features are needed for the development of computer methods to assist radiologists in the evaluation of ambiguous features; that is, for computer-aided diagnosis (CAD) of breast cancer. Current research is directed toward the development of digital mammographic imaging and image analysis systems that can detect features, classify them, and give visual prompts to the radiologist, such as the Image Checker by R2 Technology, EasyVision RAD used with Philips' Computed Radiography system, and Second Look from iCAD.

Standing Views to Differentiate Gallbladder or Bile Leak from Duodenal Activity on Cholescintigrams

Confusing a gallbladder or bile leak with duodenal activity is a common source of error in the interpretation of cholescintigrams. Techniques such as supplementary oblique views, delayed views, the "water test," dynamic display and combined cholescintigraphy and ultrasound have been used with varying degrees of success. As illustrated in two cases, supplementary standing views provide a simple alternative method to differentiate gallbladder from small bowel activity.

Fat plane radiological signs in wrist and elbow trauma

With most elbow or wrist injuries, if fractures are not evident, they are probably nonexistent. But in a small percentage of cases, these signs serve to lower diagnostic thresholds. Of the four fat plane signs reviewed, the posterior fat pad sign and the navicular fat stripe seem to be more valuable than the supinator and pronator quadratus signs. However, each is useful in its own way. Although the clinical appearance of the extremity may dictate the same initial treatment whether or not a fracture is found, early identification of more subtle fractures will avoid delay of definitive treatment and provide a better estimation of healing time. None of these signs alone is completely reliable; they should be used as adjuncts in fracture diagnosis. Finally, no sign is specific to one type of fracture, although one or two types of occult fractures are most commonly identified on supplementary views when such signs are positive.

Stenosis of the deep femoral artery: an evaluation of the accuracy of single-plane, anteroposterior arteriograms

Pre-operative evaluation of the deep femoral artery is important in determining surgical treatment of aortofemoral disease. We reviewed 16 years' experience in bilateral aorto-femoral by-pass grafting and found that 63.2% of stenoses of the deep femoral arteries seen at surgery had been missed on conventional antero-posterior arteriograms. These findings demonstrate the inadequacy of a single, antero-posterior projection and the need for supplementary views in assessing lesions of the deep femoral artery.

Cerebral angiostratigraphy: first practical results.

The limitations of the standard angio-stratigraphic procedures with the classical projections, and even with supplementary views (oblique and under-the-chin-bregmatic), led us to devise a technic whereby the intracranial vascular system could be demonstrated at various levels simultaneously. This technic, which has been described in an earlier publication (1), permits dissociation of the different components of the intracranial vessels, freed from confusing superimposed shadows. With a single injection of contrast material, not exceeding in amount that used in standard stratigraphy (10 c.c.), projections of several layers of the cerebral circulation are achieved simultaneously. The advantages of such a procedure are apparent, since repeated injections of the medium for demonstration of individual layers, such as would otherwise be required for this purpose, are obviously out of the question. With the new technic, five stratigrams can be obtained, separated from one another by a distance of 1.0 cm., either...

Table for routine angiocardiography; synchronous serial roentgenography in two planes at right angles.

With the technic at present commonly used in angiocardiography there may be difficulty in the localization of the contrast medium in the heart as well as in identification of the various chambers of the heart and estimation of their volume and configuration. To overcome these difficulties specific technical arrangements have been necessary. From the commencement of the injection and until the contrast medium has passed through the heart, a series of roentgenograms must be taken, from which the various cavities of the heart and the vessels can be assessed. The intervals between exposures should be chosen so that the passage of the contrast medium through the different chambers of the heart may be followed. Robb and Steinberg as well as other investigators have worked with roentgenography in one projection only. If the examination demands supplementary views with further projections it is necessary to repeat the entire examination after repeated injection

THE INEFFECTIVENESS OF PRESENT-DAY RADIOLOGY IN DIAGNOSIS OF CARCINOMA OF THE CARDIAC END OF THE STOMACH WITH SUGGESTIONS FOR IMPROVEMENT

The defective use of radiology by clinician and radiologist is prevalent. The causes and consequences are discussed in regard to carcinoma of the cardiac end of the stomach. Present-day results are so poor that a new approach is suggested. A comprehensive setof films should be secured to show adequately all regions of the stomach, each region in two planes, and the gastro-enterologist, as well as the radiologist, should set his mind to the interpretation of these films. Such methods, applied in other branches of surgery and medicine, have led to an increase in diagnostic efficiency. The failure of the cardiac end to balloon when the patient is supine, with the stomach as full as possible, is a sign of advanced carcinoma. Attention is drawn to this, not as a new sign, but as one that is frequently overlooked. A technique has been suggested in the hope of securing the detection of growths when they are as large as a cherry, to supplement the present technique, which often overlooks them even when they are the size of a cricket ball. These supplementary views are like all other methods in medicine. They have their fallacies and their difficulties. But they should not be discarded on this account.