Clonality Testing in Veterinary Medicine: A Review With Diagnostic Guidelines.

PubMed

Keller, S M; Vernau, W; Moore, P F

2016-07-01

The accurate distinction of reactive and neoplastic lymphoid proliferations can present challenges. Given the different prognoses and treatment strategies, a correct diagnosis is crucial. Molecular clonality assays assess rearranged lymphocyte antigen receptor gene diversity and can help differentiate reactive from neoplastic lymphoid proliferations. Molecular clonality assays are commonly used to assess atypical, mixed, or mature lymphoid proliferations; small tissue fragments that lack architecture; and fluid samples. In addition, clonality testing can be utilized to track neoplastic clones over time or across anatomic sites. Molecular clonality assays are not stand-alone tests but useful adjuncts that follow clinical, morphologic, and immunophenotypic assessment. Even though clonality testing provides valuable information in a variety of situations, the complexities and pitfalls of this method, as well as its dependency on the experience of the interpreter, are often understated. In addition, a lack of standardized terminology, laboratory practices, and interpretational guidelines hinders the reproducibility of clonality testing across laboratories in veterinary medicine. The objectives of this review are twofold. First, the review is intended to familiarize the diagnostic pathologist or interested clinician with the concepts, potential pitfalls, and limitations of clonality testing. Second, the review strives to provide a basis for future harmonization of clonality testing in veterinary medicine by providing diagnostic guidelines. © The Author(s) 2016.

Telangiectatic osteosarcoma of the rib: a rare entity and a potential diagnostic pitfall.

PubMed

Saguem, I; Ayadi, L; Kallel, R; Charfi, S; Bahri, I; Gouiaa, N; Sellami-Boudawara, T

2016-12-01

Osteosarcoma (OS) is a common primary malignant tumor of bones that produces osteoid matrix. Telangiectatic osteosarcoma (TOS) is a rare variant of OS. It affects the long bones especially the lower end of femur and the upper ends of tibia and humerus, a distribution similar to the conventional osteosarcoma. The rib involvement is very infrequent. We present a case of TOS of the rib that posed a diagnostic difficulty owing to its unusual location and to its resemblance to giant cell tumor and aneurysmal bone cyst. Correspondence. © Copyright Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology.

Soft Tissue Tumor Immunohistochemistry Update: Illustrative Examples of Diagnostic Pearls to Avoid Pitfalls.

PubMed

Wei, Shi; Henderson-Jackson, Evita; Qian, Xiaohua; Bui, Marilyn M

2017-08-01

- Current 2013 World Health Organization classification of tumors of soft tissue arranges these tumors into 12 groups according to their histogenesis. Tumor behavior is classified as benign, intermediate (locally aggressive), intermediate (rarely metastasizing), and malignant. In our practice, a general approach to reaching a definitive diagnosis of soft tissue tumors is to first evaluate clinicoradiologic, histomorphologic, and cytomorphologic features of the tumor to generate some pertinent differential diagnoses. These include the potential line of histogenesis and whether the tumor is benign or malignant, and low or high grade. Although molecular/genetic testing is increasingly finding its applications in characterizing soft tissue tumors, currently immunohistochemistry still not only plays an indispensable role in defining tumor histogenesis, but also serves as a surrogate for underlining molecular/genetic alterations. Objective- To provide an overview focusing on the current concepts in the classification and diagnosis of soft tissue tumors, incorporating immunohistochemistry. This article uses examples to discuss how to use the traditional and new immunohistochemical markers for the diagnosis of soft tissue tumors. Practical diagnostic pearls, summary tables, and figures are used to show how to avoid diagnostic pitfalls. - Data were obtained from pertinent peer-reviewed English-language literature and the authors' first-hand experience as bone and soft tissue pathologists. - -The ultimate goal for a pathologist is to render a specific diagnosis that provides diagnostic, prognostic, and therapeutic information to guide patient care. Immunohistochemistry is integral to the diagnosis and management of soft tissue tumors.

Primary progressive aphasia: a clinical approach.

PubMed

Marshall, Charles R; Hardy, Chris J D; Volkmer, Anna; Russell, Lucy L; Bond, Rebecca L; Fletcher, Phillip D; Clark, Camilla N; Mummery, Catherine J; Schott, Jonathan M; Rossor, Martin N; Fox, Nick C; Crutch, Sebastian J; Rohrer, Jonathan D; Warren, Jason D

2018-06-01

The primary progressive aphasias are a heterogeneous group of focal 'language-led' dementias that pose substantial challenges for diagnosis and management. Here we present a clinical approach to the progressive aphasias, based on our experience of these disorders and directed at non-specialists. We first outline a framework for assessing language, tailored to the common presentations of progressive aphasia. We then consider the defining features of the canonical progressive nonfluent, semantic and logopenic aphasic syndromes, including 'clinical pearls' that we have found diagnostically useful and neuroanatomical and other key associations of each syndrome. We review potential diagnostic pitfalls and problematic presentations not well captured by conventional classifications and propose a diagnostic 'roadmap'. After outlining principles of management, we conclude with a prospect for future progress in these diseases, emphasising generic information processing deficits and novel pathophysiological biomarkers.

Reduction of bias and variance for evaluation of computer-aided diagnostic schemes.

PubMed

Li, Qiang; Doi, Kunio

2006-04-01

Computer-aided diagnostic (CAD) schemes have been developed to assist radiologists in detecting various lesions in medical images. In addition to the development, an equally important problem is the reliable evaluation of the performance levels of various CAD schemes. It is good to see that more and more investigators are employing more reliable evaluation methods such as leave-one-out and cross validation, instead of less reliable methods such as resubstitution, for assessing their CAD schemes. However, the common applications of leave-one-out and cross-validation evaluation methods do not necessarily imply that the estimated performance levels are accurate and precise. Pitfalls often occur in the use of leave-one-out and cross-validation evaluation methods, and they lead to unreliable estimation of performance levels. In this study, we first identified a number of typical pitfalls for the evaluation of CAD schemes, and conducted a Monte Carlo simulation experiment for each of the pitfalls to demonstrate quantitatively the extent of bias and/or variance caused by the pitfall. Our experimental results indicate that considerable bias and variance may exist in the estimated performance levels of CAD schemes if one employs various flawed leave-one-out and cross-validation evaluation methods. In addition, for promoting and utilizing a high standard for reliable evaluation of CAD schemes, we attempt to make recommendations, whenever possible, for overcoming these pitfalls. We believe that, with the recommended evaluation methods, we can considerably reduce the bias and variance in the estimated performance levels of CAD schemes.

Creatine transporter deficiency: prevalence among patients with mental retardation and pitfalls in metabolite screening.

PubMed

Arias, Angela; Corbella, Marc; Fons, Carmen; Sempere, Angela; García-Villoria, Judit; Ormazabal, Aida; Poo, Pilar; Pineda, Mercé; Vilaseca, María Antonia; Campistol, Jaume; Briones, Paz; Pàmpols, Teresa; Salomons, Gajja S; Ribes, Antonia; Artuch, Rafael

2007-11-01

To report the prevalence of creatine transporter deficiency in males with mental retardation and to study whether a protein-rich food intake might be a potential diagnostic pitfall. We determined creatine/creatinine ratio in urine samples from 1600 unrelated male patients with mental retardation and/or autism. Urine creatine was analyzed by HPLC-MS/MS. Thirty-three of 1600 cases showed increased urine creatine/creatinine ratio. Four out of these thirty-three cases were definitively diagnosed with creatine transporter deficiency, while the other 29 were false positive results. Significantly higher values were observed for urine Cr/Crn ratio in healthy volunteers after a meal based on beef or oily fish as compared to eggs, pasta or salad (Wilcoxon test: p<0.005). False positive results may be observed in biochemical screening for creatine transporter deficiency, and they may be due to intake of meals rich in creatine prior to urine samples analysis.

Practical use and pitfalls of hepatocyte-specific contrast agents (HSCAs) for pediatric hepatic and biliary magnetic resonance imaging.

PubMed

Ayyala, Rama S; Anupindi, Sudha A; Callahan, Michael J

2017-02-01

Magnetic resonance imaging is commonly used to evaluate for hepatic and biliary pathology in the pediatric population. Recently, there has been increased use of hepatocyte-specific contrast agents (HSCAs), such as Gadoxetate disodium in children. Traditionally, HSCAs have been used to characterize focal liver lesions. However, these agents can also be used to problem solve specific hepatic or biliary diagnostic dilemmas. The purpose of this manuscript is to review the practical uses of HSCA in children with both hepatic and biliary indications, and review the corresponding imaging findings. We will highlight the diagnostic uses of HSCA in children, as well as pitfalls encountered.

Spinal meningioma, aortic aneurysms and the missing link of observation: the anchoring heuristic approach.

PubMed

Floros, Nikolaos; Papadakis, Marios; Schelzig, Hubert; Oberhuber, Alexander

2018-03-10

Over the last three decades, the development of systematic and protocol-based algorithms, and advances in available diagnostic tests have become the indispensable parts of practising medicine. Naturally, despite the implementation of meticulous protocols involving diagnostic tests or even trials of empirical therapies, the cause of one's symptoms may still not be obvious. We herein report a case of chronic back pain, which took about 5 years to get accurately diagnosed. The case challenges the diagnostic assumptions and sets ground of discussion for the diagnostic reasoning pitfalls and heuristic biases that mislead the caring physicians and cost years of low quality of life to our patient. This case serves as an example of how anchoring heuristics can interfere in the diagnostic process of a complex and rare entity when combined with a concurrent potentially life-threatening condition. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Massive ovarian edema, due to adjacent appendicitis.

PubMed

Callen, Andrew L; Illangasekare, Tushani; Poder, Liina

2017-04-01

Massive ovarian edema is a benign clinical entity, the imaging findings of which can mimic an adnexal mass or ovarian torsion. In the setting of acute abdominal pain, identifying massive ovarian edema is a key in avoiding potential fertility-threatening surgery in young women. In addition, it is important to consider other contributing pathology when ovarian edema is secondary to another process. We present a case of a young woman presenting with subacute abdominal pain, whose initial workup revealed marked enlarged right ovary. Further imaging, diagnostic tests, and eventually diagnostic laparoscopy revealed that the ovarian enlargement was secondary to subacute appendicitis, rather than a primary adnexal process. We review the classic ultrasound and MRI imaging findings and pitfalls that relate to this diagnosis.

Machine learning, medical diagnosis, and biomedical engineering research - commentary.

PubMed

Foster, Kenneth R; Koprowski, Robert; Skufca, Joseph D

2014-07-05

A large number of papers are appearing in the biomedical engineering literature that describe the use of machine learning techniques to develop classifiers for detection or diagnosis of disease. However, the usefulness of this approach in developing clinically validated diagnostic techniques so far has been limited and the methods are prone to overfitting and other problems which may not be immediately apparent to the investigators. This commentary is intended to help sensitize investigators as well as readers and reviewers of papers to some potential pitfalls in the development of classifiers, and suggests steps that researchers can take to help avoid these problems. Building classifiers should be viewed not simply as an add-on statistical analysis, but as part and parcel of the experimental process. Validation of classifiers for diagnostic applications should be considered as part of a much larger process of establishing the clinical validity of the diagnostic technique.

Pitfalls Associated With the Use of Molecular Diagnostic Panels in the Diagnosis of Cryptococcal Meningitis.

PubMed

O'Halloran, Jane A; Franklin, Alexander; Lainhart, William; Burnham, Carey-Ann; Powderly, William; Dubberke, Erik

2017-01-01

We report the case of a kidney transplantation patient on chronic immunosuppressive therapy presenting with subacute meningitis. The final diagnosis of cryptococcal meningitis was delayed due to 2 false-negative cryptococcal results on a molecular diagnostic panel. Caution with such platforms in suspected cryptococcal meningitis is needed.

Promises, pitfalls and practicalities of prenatal whole exome sequencing.

PubMed

Best, Sunayna; Wou, Karen; Vora, Neeta; Van der Veyver, Ignatia B; Wapner, Ronald; Chitty, Lyn S

2018-01-01

Prenatal genetic diagnosis provides information for pregnancy and perinatal decision-making and management. In several small series, prenatal whole exome sequencing (WES) approaches have identified genetic diagnoses when conventional tests (karyotype and microarray) were not diagnostic. Here, we review published prenatal WES studies and recent conference abstracts. Thirty-one studies were identified, with diagnostic rates in series of five or more fetuses varying between 6.2% and 80%. Differences in inclusion criteria and trio versus singleton approaches to sequencing largely account for the wide range of diagnostic rates. The data suggest that diagnostic yields will be greater in fetuses with multiple anomalies or in cases preselected following genetic review. Beyond its ability to improve diagnostic rates, we explore the potential of WES to improve understanding of prenatal presentations of genetic disorders and lethal fetal syndromes. We discuss prenatal phenotyping limitations, counselling challenges regarding variants of uncertain significance, incidental and secondary findings, and technical problems in WES. We review the practical, ethical, social and economic issues that must be considered before prenatal WES could become part of routine testing. Finally, we reflect upon the potential future of prenatal genetic diagnosis, including a move towards whole genome sequencing and non-invasive whole exome and whole genome testing. © 2017 John Wiley & Sons, Ltd. © 2017 John Wiley & Sons, Ltd.

Inverted papilloma-like sinonasal epithelial hyperplasia, overshadowing underlying sinonasal fibrosarcoma: a diagnostic pitfall.

PubMed

Maly, Alexander; Maly, Bella; Eliashar, Ron; Doviner, Victoria

2006-01-01

Proliferating invaginations of the sinonasal epithelium, simulating inverted papillomas, have been mentioned once in the literature as a reactive phenomenon overlying sinonasal fibrosarcomas. These proliferations may be so marked as to make the distinction from inverted papilloma virtually impossible. The possible result is that the examining pathologist's attention might be drawn exclusively to the epithelial component, thus causing him to overlook, especially in a small biopsy, a rather bland but distinctive sarcomatoid component which is located underneath. We report such a case of marked endophytic proliferation of sinonasal epithelium which was interpreted, in the preoperative biopsy, as an inverted papilloma with dense fibrous stroma which later, in the surgical specimen, was found to be a part of a submucosal fibrosarcoma. The diagnostic pitfall is discussed.

Myofibroblastoma Breast with Unusual Morphological Features. Cytohistopathogical Diagnostic Pitfalls and Role of Immunohistochemistry-Review of Literature

PubMed Central

Shivali, B.; S., Kataria; Chandramouleeswari, K.; Anita, S.

2013-01-01

Myofibroblastoma (MFB) is a rare mesenchymal tumour, derived from mammary stromal fibro-myofibroblasts, with diverse biological and morphological behaviour. Large and cellular myofibroblastomas, especially those with epitheliod like cells, can mimic various spindle cell lesions and metaplastic carcinomas, thus posing diagnostic challenge. A 50–year woman presented with slow growing, painless lump in the left breast. Fine Needle Aspiration (FNA) smears showed predominant atypical spindle cell population, pleomorphic epithelial like cells and giant cells. Cytodiagnosis of atypical spindle cell lesion with the possibility of metaplastic carcinoma was suggested. Histopathological examination showed fascicles of spindle cell population admixed with epithelial like cells, atypical cells and tumour giant cells, thus raising differential diagnosis of metaplastic carcinoma, low grade spindle cell sarcoma and myofibroblastic tumour. Lymph nodes were negative for metastatic deposits. Immunohistochemistry revealed variable coexpression of markers for vimentin, fibronectin, CD34, SMA (smooth muscle actin), but negative expression for , S-100, CD99, CK7 (cytokeratin 7), HMWK (high molecular weight keratin), ER (oestrogen receptor) and PR(progesterone receptors). Diagnosis of cellular myofibroblastoma with mixed unusual morphological features was defined, based on both histological and immunohistochemical features. MFB may cause a potential diagnostic pitfall while interpreting FNA and histopathological sections due to its wide differential diagnosis. The distinction of MFB from its cytohistological mimics of malignancy is crucial to avoid unnecessary extensive procedures. The case report emphasizes the role of immunohistochemistry as gold standard in diagnosis of MFB. The case is also being presented because of its large size and rare mixed unusual morphological features. PMID:24298520

PathEdEx – Uncovering High-explanatory Visual Diagnostics Heuristics Using Digital Pathology and Multiscale Gaze Data

PubMed Central

Shin, Dmitriy; Kovalenko, Mikhail; Ersoy, Ilker; Li, Yu; Doll, Donald; Shyu, Chi-Ren; Hammer, Richard

2017-01-01

Background: Visual heuristics of pathology diagnosis is a largely unexplored area where reported studies only provided a qualitative insight into the subject. Uncovering and quantifying pathology visual and nonvisual diagnostic patterns have great potential to improve clinical outcomes and avoid diagnostic pitfalls. Methods: Here, we present PathEdEx, an informatics computational framework that incorporates whole-slide digital pathology imaging with multiscale gaze-tracking technology to create web-based interactive pathology educational atlases and to datamine visual and nonvisual diagnostic heuristics. Results: We demonstrate the capabilities of PathEdEx for mining visual and nonvisual diagnostic heuristics using the first PathEdEx volume of a hematopathology atlas. We conducted a quantitative study on the time dynamics of zooming and panning operations utilized by experts and novices to come to the correct diagnosis. We then performed association rule mining to determine sets of diagnostic factors that consistently result in a correct diagnosis, and studied differences in diagnostic strategies across different levels of pathology expertise using Markov chain (MC) modeling and MC Monte Carlo simulations. To perform these studies, we translated raw gaze points to high-explanatory semantic labels that represent pathology diagnostic clues. Therefore, the outcome of these studies is readily transformed into narrative descriptors for direct use in pathology education and practice. Conclusion: PathEdEx framework can be used to capture best practices of pathology visual and nonvisual diagnostic heuristics that can be passed over to the next generation of pathologists and have potential to streamline implementation of precision diagnostics in precision medicine settings. PMID:28828200

PathEdEx - Uncovering High-explanatory Visual Diagnostics Heuristics Using Digital Pathology and Multiscale Gaze Data.

PubMed

Shin, Dmitriy; Kovalenko, Mikhail; Ersoy, Ilker; Li, Yu; Doll, Donald; Shyu, Chi-Ren; Hammer, Richard

2017-01-01

Visual heuristics of pathology diagnosis is a largely unexplored area where reported studies only provided a qualitative insight into the subject. Uncovering and quantifying pathology visual and nonvisual diagnostic patterns have great potential to improve clinical outcomes and avoid diagnostic pitfalls. Here, we present PathEdEx, an informatics computational framework that incorporates whole-slide digital pathology imaging with multiscale gaze-tracking technology to create web-based interactive pathology educational atlases and to datamine visual and nonvisual diagnostic heuristics. We demonstrate the capabilities of PathEdEx for mining visual and nonvisual diagnostic heuristics using the first PathEdEx volume of a hematopathology atlas. We conducted a quantitative study on the time dynamics of zooming and panning operations utilized by experts and novices to come to the correct diagnosis. We then performed association rule mining to determine sets of diagnostic factors that consistently result in a correct diagnosis, and studied differences in diagnostic strategies across different levels of pathology expertise using Markov chain (MC) modeling and MC Monte Carlo simulations. To perform these studies, we translated raw gaze points to high-explanatory semantic labels that represent pathology diagnostic clues. Therefore, the outcome of these studies is readily transformed into narrative descriptors for direct use in pathology education and practice. PathEdEx framework can be used to capture best practices of pathology visual and nonvisual diagnostic heuristics that can be passed over to the next generation of pathologists and have potential to streamline implementation of precision diagnostics in precision medicine settings.

Rhinitis Overview

MedlinePlus

... triggers. Videos: Choosing Wisely » Rhinitis (Hay Fever) Treatment & Management Once specific allergens are diagnosed, your allergist / immunologist ... Pitfalls of Diagnostic Allergy Testing » The Diagnosis and Management of Rhinitis: An Updated Practice Parameter » Allergen Immunotherapy: ...

[Pitfalls in the histopathological diagnostics of endometrial carcinoma and its precursors : Clinically relevant differential diagnoses, avoidance of false positive diagnoses].

PubMed

Kommoss, F; Lax, S F

2016-11-01

Making an incorrect histopathological diagnosis of an endometrial lesion may lead to unwanted loss of fertility and therapy-associated morbidity; therefore, endometrial carcinomas need to be correctly typed and differentiated from hyperplastic precursors, benign lesions and artifacts. Typical diagnostic pitfalls are described in this article. Misdiagnosing endometrial lesions can be avoided by paying thorough attention to gross as well as microscopic features and by taking crucial differential diagnoses into consideration. These are, in particular, well-differentiated endometrioid adenocarcinoma of the endometrium versus atypical endometrial hyperplasia, myoinvasive endometrioid adenocarcinoma versus atypical polypoid adenomyoma and endometrioid carcinoma versus serous carcinoma of the endometrium with a predominantly glandular pattern. It is also important to consider the possibility of a false positive diagnosis of atypical endometrial hyperplasia or carcinoma in cases of biopsy-induced artifacts.

Rib fracture following stereotactic body radiotherapy: a potential pitfall.

PubMed

Stanic, Sinisa; Boike, Thomas P; Rule, William G; Timmerman, Robert D

2011-11-01

Although the incidence of rib fractures after conventional radiotherapy is generally low (<2%), rib fractures are a relatively common complication of stereotactic body radiotherapy. For malignancy adjacent to the chest wall, the incidence of rib fractures after stereotactic body radiotherapy is as high as 10%. Unrecognized bone fractures can mimic bone metastases on bone scintigraphy, can lead to extensive workup, and can even lead to consideration of unnecessary systemic chemotherapy, as treatment decisions can be based on imaging findings alone. Nuclear medicine physicians and diagnostic radiologists should always consider rib fracture in the differential diagnosis.

Ethical principles and pitfalls of genetic testing for dementia.

PubMed

Hedera, P

2001-01-01

Progress in the genetics of dementing disorders and the availability of clinical tests for practicing physicians increase the need for a better understanding of multifaceted issues associated with genetic testing. The genetics of dementia is complex, and genetic testing is fraught with many ethical concerns. Genetic testing can be considered for patients with a family history suggestive of a single gene disorder as a cause of dementia. Testing of affected patients should be accompanied by competent genetic counseling that focuses on probabilistic implications for at-risk first-degree relatives. Predictive testing of at-risk asymptomatic patients should be modeled after presymptomatic testing for Huntington's disease. Testing using susceptibility genes has only a limited diagnostic value at present because potential improvement in diagnostic accuracy does not justify potentially negative consequences for first-degree relatives. Predictive testing of unaffected subjects using susceptibility genes is currently not recommended because individual risk cannot be quantified and there are no therapeutic interventions for dementia in presymptomatic patients.

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

PubMed Central

Bohlender, Jörg

2013-01-01

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis. PMID:24403969

Adenomyosis: from the sign to the diagnosis. Imaging, diagnostic pitfalls and differential diagnosis: a pictorial review.

PubMed

Valentini, A L; Speca, S; Gui, B; Soglia, G; Soglia, B G; Miccò, M; Bonomo, L

2011-12-01

Adenomyosis is a pathological gynaecological condition characterised by benign invasion of the endometrium into the myometrium. It is often misdiagnosed, or is not easily recognised, although it is responsible for disabling symptoms such as menorrhagia, abnormal uterine bleeding, dysmenorrhoea and infertility in premenopausal women. The aim of this pictorial review is to analyse the features of adenomyosis by illustrating the most usual and typical imaging patterns, along with the unusual appearances, seen in a vast array of gynaecological imaging modalities. The different findings of focal and diffuse adenomyosis along with the diagnostic limitations of ultrasound, hysterosalpingography and magnetic resonance imaging are described, as are the pitfalls and differential diagnosis with other pathological conditions that are often misdiagnosed as adenomyosis. The role of the different imaging modalities in planning appropriate treatment and their usefulness in monitoring therapy are also discussed.

Protein and genetic diagnosis of limb girdle muscular dystrophy type 2A: The yield and the pitfalls.

PubMed

Fanin, Marina; Angelini, Corrado

2015-08-01

Limb girdle muscular dystrophy type 2A (LGMD2A) is the most frequent form of LGMD worldwide. Comprehensive clinical assessment and laboratory testing is essential for diagnosis of LGMD2A. Muscle immunoblot analysis of calpain-3 is the most useful tool to direct genetic testing, as detection of calpain-3 deficiency has high diagnostic value. However, calpain-3 immunoblot testing lacks sensitivity in about 30% of cases due to gene mutations that inactivate the enzyme. The best diagnostic strategy should be determined on a case-by-case basis, depending on which tissues are available, and which molecular and/or genetic methods are adopted. In this work we survey the current knowledge, advantages, limitations, and pitfalls of protein testing and mutation detection in LGMD2A and provide an update of genetic epidemiology. © 2015 Wiley Periodicals, Inc.

Intracranial Arterial Dissection Mimicking a Saccular Aneurysm: Clinical Image.

PubMed

Rodríguez-Hernández, Ana; Torné, Ramon; Arikan, Fuat

2017-02-01

This report portrays our pitfall in the initial diagnosis of an intracranial arterial dissection that we misinterpreted as a saccular aneurysm. Intracranial arterial dissections presenting with convexity subarachnoid hemorrhage are rare, thus being easily mistaken with mild traumatic head injuries and therefore preventing transfer to a tertiary hospital. Even in those cases where the dissection is suspected and the patient is transferred to the appropriate facility for a diagnostic angiogram, misdiagnosis is not infrequent. The typical radiographic signs such as the double lumen or "pearl and string" are scarcely present in the diagnostic angiogram. Thrombus within the dissected segment can be mistaken by vasospasm and may even reveal fake images of saccular aneurysms, thus prompting inadequate endovascular or surgical treatment. The case reported here illustrates all these likely pitfalls in the diagnosis and management of intracranial arterial dissections. Copyright © 2016 Elsevier Inc. All rights reserved.

Skin prick tests and allergy diagnosis.

PubMed

Antunes, João; Borrego, Luís; Romeira, Ana; Pinto, Paula

2009-01-01

Skin testing remains an essential diagnostic tool in modern allergy practice. A significant variability has been reported regarding technical procedures, interpretation of results and documentation. This review has the aim of consolidating methodological recommendations through a critical analysis on past and recent data. This will allow a better understanding on skin prick test (SPT) history; technique; (contra-) indications; interpretation of results; diagnostic pitfalls; adverse reactions; and variability factors.

Potential Pitfalls Related to Space-Based Lidar Remote Sensing of the Earth With an Emphasis on Wind Measurement

NASA Technical Reports Server (NTRS)

Kavaya, Michael J.; Spiers, Gary D.; Frehlich, Rod G.

2000-01-01

A collection of issues is discussed that are potential pitfalls, if handled incorrectly, for earth-orbiting lidar remote sensing instruments. These issues arise due to the long target ranges, high lidar-to-target relative velocities, low signal levels, use of laser scanners, and other unique aspects of using lasers in earth orbit. Consequences of misunderstanding these topics range from minor inconvenience to improper calibration to total failure. We will focus on wind measurement using coherent detection Doppler lidar, but many of the potential pitfalls apply also to noncoherent lidar wind measurement, and to measurement of parameters other than wind.

Diagnosis of hepatic iron overload: a family study illustrating pitfalls in diagnosing hemochromatosis.

PubMed

Schranz, Melanie; Talasz, Heribert; Graziadei, Ivo; Winder, Thomas; Sergi, Consolato; Bogner, Klaus; Vogel, Wolfgang; Zoller, Heinz

2009-03-01

Recent identification of genetic variants in iron storage disease has changed the classification system and diagnostic algorithms for hemochromatosis. Clinical diagnosis of the disease requires phenotypic evidence of iron overload because the commonly disease-associated HFE genotypes have an incomplete penetrance. Furthermore, approximately 20% of patients with a clinical diagnosis of hemochromatosis have no disease-associated genotype, which underlines the importance of clear phenotypic criteria of hemochromatosis. A diagnosis of hemochromatosis cannot be made even in patients with liver cirrhosis simply on the basis of genetic testing that indicates that iron overload is the cause of the disease and not its consequence. Proper diagnosis requires integration of clinical presentation, family history, and the results of biochemical and histopathologic tests. Here we propose a rational diagnostic algorithm for hepatic iron overload syndromes and illustrate potential pitfalls by presenting a family study in a pedigree with rare HFE variants (H63D and E168Q), in cis on the same chromosome. Although the clinical suspicion of hemochromatosis was confirmed by histology, chemical analysis of liver tissue revealed a normal hepatic iron concentration, which is compatible with the genetic finding of 1 normal and 1 doubly mutated allele. In conclusion, clinical suspicion of hemochromatosis and elevated serum iron parameters should prompt HFE genotyping for C282Y and H63D. Should they be uninformative, further genetic tests should be recommended only if iron overload in liver tissue has been confirmed chemically.

Big data in sleep medicine: prospects and pitfalls in phenotyping

PubMed Central

Bianchi, Matt T; Russo, Kathryn; Gabbidon, Harriett; Smith, Tiaundra; Goparaju, Balaji; Westover, M Brandon

2017-01-01

Clinical polysomnography (PSG) databases are a rich resource in the era of “big data” analytics. We explore the uses and potential pitfalls of clinical data mining of PSG using statistical principles and analysis of clinical data from our sleep center. We performed retrospective analysis of self-reported and objective PSG data from adults who underwent overnight PSG (diagnostic tests, n=1835). Self-reported symptoms overlapped markedly between the two most common categories, insomnia and sleep apnea, with the majority reporting symptoms of both disorders. Standard clinical metrics routinely reported on objective data were analyzed for basic properties (missing values, distributions), pairwise correlations, and descriptive phenotyping. Of 41 continuous variables, including clinical and PSG derived, none passed testing for normality. Objective findings of sleep apnea and periodic limb movements were common, with 51% having an apnea–hypopnea index (AHI) >5 per hour and 25% having a leg movement index >15 per hour. Different visualization methods are shown for common variables to explore population distributions. Phenotyping methods based on clinical databases are discussed for sleep architecture, sleep apnea, and insomnia. Inferential pitfalls are discussed using the current dataset and case examples from the literature. The increasing availability of clinical databases for large-scale analytics holds important promise in sleep medicine, especially as it becomes increasingly important to demonstrate the utility of clinical testing methods in management of sleep disorders. Awareness of the strengths, as well as caution regarding the limitations, will maximize the productive use of big data analytics in sleep medicine. PMID:28243157

Challenges in pediatric chronic inflammatory demyelinating polyneuropathy.

PubMed

Haliloğlu, Göknur; Yüksel, Deniz; Temoçin, Cağri Mesut; Topaloğlu, Haluk

2016-12-01

Chronic inflammatory demyelinating neuropathy, a treatable immune-mediated disease of the peripheral nervous system is less common in childhood compared to adults. Despite different sets of diagnostic criteria, lack of a reliable biologic marker leads to challenges in diagnosis, follow-up and treatment. Our first aim was to review clinical presentation, course, response to treatment, and prognosis in our childhood patients. We also aimed to document diagnostic and therapeutic pitfalls and challenges at the bedside. Our original cohort consisted of 23 pediatric patients who were referred to us with a clinical diagnosis of chronic inflammatory demyelinating neuropathy. Seven patients reaching to an alternative diagnosis were excluded. In the remaining patients, diagnostic, treatment and follow-up data were compared in typical patients who satisfied both clinical and electrodiagnostic criteria and atypical patients who failed to meet minimal research chronic inflammatory demyelinating neuropathy electrodiagnostic requirements. Eight of 16 patients (50%) met the minimal chronic inflammatory demyelinating neuropathy research diagnostic requirements. There was only a statistically significant difference (p = 0.010) in terms of European Neuromuscular Centre childhood chronic inflammatory diagnostic mandatory clinical criteria between the two groups. Misdiagnosis due to errors in electrophysiological interpretation (100%, n = 8), cerebrospinal fluid cytoalbuminologic dissociation (100%, n = 4 and/or subjective improvement on any immunotherapy modality (80 ± 19.27%)) was frequent. Pediatric CIDP is challenging in terms of diagnostic and therapeutic pitfalls at the bedside. Diagnostic errors due to electrophysiological interpretation, cerebrospinal fluid cytoalbuminologic dissociation, and/or subjective improvement on immunotherapy should be considered. Copyright © 2016 Elsevier B.V. All rights reserved.

Chronic thromboembolic pulmonary hypertension

PubMed Central

Reesink, H.J.; Kloek, J.J.; Bresser, P.

2006-01-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rapidly progressive and deadly disease, resulting from incomplete resolution of acute pulmonary embolism. Historically, the incidence of CTEPH was significantly underestimated but it may be as high as 3.8% following acute pulmonary embolism. Although the medical management of CTEPH may be supportive, the only curative treatment is pulmonary endarterectomy (PEA). However, a careful screening programme is mandatory to select CTEPH patients who are likely to benefit from PEA. In this review we discuss the pathophysiology, clinical and diagnostic pitfalls, surgical treatment, outcome after surgery, and the potential benefit of medical treatment in inoperable CTEPH patients. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696637

Development of Pediatric Sleep Questionnaires as Diagnostic or Epidemiological Tools: A Brief Review of Do's and Don'ts

PubMed Central

Spruyt, Karen; Gozal, David

2010-01-01

Questionnaires are a useful and extensively used tool in clinical sleep medicine and in sleep research. The number of sleep questionnaires targeting the pediatric age range has tremendously increased in recent years, and with such explosion in the number of instruments, their heterogeneity has become all the more apparent. Here, we explore the theoretical and pragmatic processes required for instrument design and development, i.e., how any questionnaire, inventory, log, or diary should be created and evaluated, and also provide illustrative examples to further underline the potential pitfalls that are inherently embedded in every step of tool development. PMID:20952230

Circulating microRNAs in breast cancer: novel diagnostic and prognostic biomarkers

PubMed Central

Hamam, Rimi; Hamam, Dana; Alsaleh, Khalid A; Kassem, Moustapha; Zaher, Waleed; Alfayez, Musaad; Aldahmash, Abdullah; Alajez, Nehad M

2017-01-01

Effective management of breast cancer depends on early diagnosis and proper monitoring of patients’ response to therapy. However, these goals are difficult to achieve because of the lack of sensitive and specific biomarkers for early detection and for disease monitoring. Accumulating evidence in the past several years has highlighted the potential use of peripheral blood circulating nucleic acids such as DNA, mRNA and micro (mi)RNA in breast cancer diagnosis, prognosis and for monitoring response to anticancer therapy. Among these, circulating miRNA is increasingly recognized as a promising biomarker, given the ease with which miRNAs can be isolated and their structural stability under different conditions of sample processing and isolation. In this review, we provide current state-of-the-art of miRNA biogenesis, function and discuss the advantages, limitations, as well as pitfalls of using circulating miRNAs as diagnostic, prognostic or predictive biomarkers in breast cancer management. PMID:28880270

Circulating microRNAs in breast cancer: novel diagnostic and prognostic biomarkers.

PubMed

Hamam, Rimi; Hamam, Dana; Alsaleh, Khalid A; Kassem, Moustapha; Zaher, Waleed; Alfayez, Musaad; Aldahmash, Abdullah; Alajez, Nehad M

2017-09-07

Effective management of breast cancer depends on early diagnosis and proper monitoring of patients' response to therapy. However, these goals are difficult to achieve because of the lack of sensitive and specific biomarkers for early detection and for disease monitoring. Accumulating evidence in the past several years has highlighted the potential use of peripheral blood circulating nucleic acids such as DNA, mRNA and micro (mi)RNA in breast cancer diagnosis, prognosis and for monitoring response to anticancer therapy. Among these, circulating miRNA is increasingly recognized as a promising biomarker, given the ease with which miRNAs can be isolated and their structural stability under different conditions of sample processing and isolation. In this review, we provide current state-of-the-art of miRNA biogenesis, function and discuss the advantages, limitations, as well as pitfalls of using circulating miRNAs as diagnostic, prognostic or predictive biomarkers in breast cancer management.

Advancing the research agenda for diagnostic error reduction.

PubMed

Zwaan, Laura; Schiff, Gordon D; Singh, Hardeep

2013-10-01

Diagnostic errors remain an underemphasised and understudied area of patient safety research. We briefly summarise the methods that have been used to conduct research on epidemiology, contributing factors and interventions related to diagnostic error and outline directions for future research. Research methods that have studied epidemiology of diagnostic error provide some estimate on diagnostic error rates. However, there appears to be a large variability in the reported rates due to the heterogeneity of definitions and study methods used. Thus, future methods should focus on obtaining more precise estimates in different settings of care. This would lay the foundation for measuring error rates over time to evaluate improvements. Research methods have studied contributing factors for diagnostic error in both naturalistic and experimental settings. Both approaches have revealed important and complementary information. Newer conceptual models from outside healthcare are needed to advance the depth and rigour of analysis of systems and cognitive insights of causes of error. While the literature has suggested many potentially fruitful interventions for reducing diagnostic errors, most have not been systematically evaluated and/or widely implemented in practice. Research is needed to study promising intervention areas such as enhanced patient involvement in diagnosis, improving diagnosis through the use of electronic tools and identification and reduction of specific diagnostic process 'pitfalls' (eg, failure to conduct appropriate diagnostic evaluation of a breast lump after a 'normal' mammogram). The last decade of research on diagnostic error has made promising steps and laid a foundation for more rigorous methods to advance the field.

Potential Pitfalls Related to Space-Based Lidar Remote Sensing of the Earth with an Emphasis on Wind Measurement

NASA Technical Reports Server (NTRS)

Kavaya, Michael J.; Spiers, Gary D.; Frehlich, Rod G.; Arnold, James E. (Technical Monitor)

2000-01-01

A collection of issues is discussed that are potential pitfalls, if handled incorrectly, for earth-orbiting lidar remote sensing instruments. These issues arise due to the long target ranges, high lidar-to-target relative velocities, low signal levels, use of laser scanners, and other unique aspects of using lasers in earth orbit. Consequences of misunderstanding these topics range from minor inconvenience to improper calibration to total failure. We will focus on wind measurement using coherent detection Doppler lidar, but many of the potential pitfalls apply also to noncoherent lidar wind measurement, and to measurement of parameters other than wind. Each area will be identified as to its applicability.

Pitfalls in colour photography of choroidal tumours

PubMed Central

Schalenbourg, A; Zografos, L

2013-01-01

Colour imaging of fundus tumours has been transformed by the development of digital and confocal scanning laser photography. These advances provide numerous benefits, such as panoramic images, increased contrast, non-contact wide-angle imaging, non-mydriatic photography, and simultaneous angiography. False tumour colour representation can, however, cause serious diagnostic errors. Large choroidal tumours can be totally invisible on angiography. Pseudogrowth can occur because of artefacts caused by different methods of fundus illumination, movement of reference blood vessels, and flattening of Bruch's membrane and sclera when tumour regression occurs. Awareness of these pitfalls should prevent the clinician from misdiagnosing tumours and wrongfully concluding that a tumour has grown. PMID:23238442

Pitfalls in colour photography of choroidal tumours.

PubMed

Schalenbourg, A; Zografos, L

2013-02-01

Colour imaging of fundus tumours has been transformed by the development of digital and confocal scanning laser photography. These advances provide numerous benefits, such as panoramic images, increased contrast, non-contact wide-angle imaging, non-mydriatic photography, and simultaneous angiography. False tumour colour representation can, however, cause serious diagnostic errors. Large choroidal tumours can be totally invisible on angiography. Pseudogrowth can occur because of artefacts caused by different methods of fundus illumination, movement of reference blood vessels, and flattening of Bruch's membrane and sclera when tumour regression occurs. Awareness of these pitfalls should prevent the clinician from misdiagnosing tumours and wrongfully concluding that a tumour has grown.

Critical Pitfalls in the use of BRAF Mutation as a Diagnostic Tool in Thyroid Nodules: a Case Report.

PubMed

Kuhn, Elisabetta; Ragazzi, Moira; Zini, Michele; Giordano, Davide; Nicoli, Davide; Piana, Simonetta

2016-09-01

Thyroid fine-needle aspiration (FNA) cytology is the primary tool for the diagnostic evaluation of thyroid nodules. BRAF mutation analysis is employed as an ancillary tool in indeterminate cases, as recommended by the American Thyroid Association management guidelines. Hereby, we report the case of a 73-year-old woman who presented an 8-mm-size, ill-defined, left thyroid nodule. FNA resulted "suspicious for papillary thyroid carcinoma". BRAF mutation status was analyzed, and somatic BRAF (V600E) mutation identified. The patient underwent a total thyroidectomy. At histological examination, the nodule was composed of Langerhans cells, admixed with many eosinophils. A final diagnosis of Langerhans cell histiocytosis of the thyroid was made. Our case emphasizes the critical diagnostic pitfalls due to the use of BRAF (V600E) mutation analysis in thyroid FNA. Notably, BRAF (V600E) mutation is common in melanoma, colorectal carcinoma, lung carcinoma, ovarian carcinoma, brain tumors, hairy cell leukemia, multiple myeloma, and histiocytoses. Therefore, in cases of indeterminate FNA with unclassifiable atypical cells BRAF (V600E) mutated, the possibility of a localization of hystiocytosis or a secondary thyroid malignancy should be taken into account.

The bedside diagnostic accuracy of a novice reflectance confocal microscopy reader for skin cancer detection in vivo in real-time: understanding challenges and potential pitfalls

NASA Astrophysics Data System (ADS)

Jain, Manu; Pulijal, Sri Varsha; Rajadhyaksha, Milind

2017-02-01

Reflectance confocal microscopy (RCM) is a non-invasive device that images skin lesions in vivo at a cellular resolution to guide management of patient care. While previous studies have demonstrated high accuracy of RCM in diagnosing skin cancers, most of these studies were performed by experts as a blinded analysis off-site and does not reflect true clinical scenario. We assessed the diagnostic potential of a novice RCM reader, in clinical settings, at the bedside. Over a period of 15 months (August 2015- November 2016), 168 lesions (from 128 cases) were imaged with RCM to determine BCC and or melanoma in dermoscopically equivocal lesions. To evaluate the learning curve of the novice reader, diagnostic accuracy was evaluated at the end of 15 months, as well as during the first half (8 months) and latter half (seven months) of the study. Histopathological diagnosis was available in 95/168 lesions, including 38 melanocytic lesions (ML: 13 melanomas and 25 nevi) and 57 non-melanocytic lesions (NML: 26 BCCs, 4 SCCs and 27 benign). The remaining 73/168 lesions (43.45%) were not biopsied (received topical treatment, monitoring). On RCM, 22/26 (84.61%) BCCs and 11/13 (84.61%) melanomas were correctly diagnosed. BCC was missed in 3/26 (11.53%) lesions and melanoma in 2/13 (15.38%) lesions; these lesions were diagnosed mostly as superficial BCCs and focal epidermal changes overlying deeply situated melanoma nodule on histopathology, respectively. False positive diagnosis of BCC was obtained in 7/23 (30.4%) lesions and of melanoma in 2/22 (4.5%) lesions; these were diagnosed mostly as benign inflamed keratosis and moderately atypical dysplastic nevus on histopathology, respectively. In 7 lesions BCC or melanoma could not be ruled out. A marked increase in the sensitivity and specificity was noticed between the two halves of the study. An overall high diagnostic accuracy of 80.28% with high sensitivity and specificity of 80.68% and 80.8%, respectively in diagnosing skin cancers was obtained. Based on this study, we identified some current limitations and potential pitfalls of RCM. The fact that the diagnostic accuracy of the novice reader increased with time, indicates a learning curve reading RCM images. Additionally, current technical limitations of RCM such as inability to differentiate various cell types, sampling error, and, shallow depth of imaging also lead to false diagnosis. Efforts are ongoing to overcome these challenges by building US based teaching-training program and through a multimodal imaging approach for better diagnosis and patient care.

Integration of Gamification into Course Design: A Noble Endeavor with Potential Pitfalls

ERIC Educational Resources Information Center

Moore-Russo, Deborah; Wiss, Andrew; Grabowski, Jeremiah

2018-01-01

In this article, we provide a commentary on the current state of gamification in higher education by reviewing the research literature, noting a lack of research focused on the design of gamified postsecondary courses. To address this issue, we discuss four potential pitfalls instructors may encounter when designing gamified learning activities.…

Advances in nuclear medicine.

PubMed

Selberg, Kurt; Ross, Michael

2012-12-01

Nuclear scintigraphy is a mainstay of diagnostic imaging and has preserved its relevance in the imaging of acute and chronic trauma. It is particularly useful in the evaluation of athletic injuries. Pitfalls of interpretation, false negatives and false positives exist as with many imaging modalities. Synthesis of physical exam findings, lameness evaluation and, when possible, diagnostic analgesia in combination with nuclear scintigraphy imaging findings, will allow for the most information to be applied to the patient's clinical problem. Published by Elsevier Inc.

From the RSNA refresher courses: US of the rotator cuff: pitfalls, limitations, and artifacts.

PubMed

Rutten, Matthieu J C M; Jager, Gerrit J; Blickman, Johan G

2006-01-01

High-resolution ultrasonography (US) has gained increasing popularity as a diagnostic tool for assessment of the soft tissues in shoulder impingement syndrome. US is a powerful and accurate method for diagnosis of rotator cuff tears and other rotator cuff abnormalities, provided the examiner has a detailed knowledge of shoulder anatomy, uses a standardized examination technique, and has a thorough understanding of the potential pitfalls, limitations, and artifacts. False-positive sonographic findings of rotator cuff tears can be caused by the technique (anisotropy, transducer positioning, acoustic shadowing by the deltoid septum), by the anatomy (rotator cuff interval, supraspinatus-infraspinatus interface, musculotendinous junction, fibrocartilaginous insertion), or by disease (criteria for diagnosis of rotator cuff tears, tendon inhomogeneity, acoustic shadowing by scar tissue or calcification, rotator cuff thinning). False-negative sonographic findings of rotator cuff tears can be caused by the technique (transducer frequency, suboptimal focusing, imaging protocol, transducer handling), by the anatomy (nondiastasis of the ruptured tendon fibers, posttraumatic obscuration of landmarks), by disease (tendinosis, calcifications, synovial proliferation, granulation or scar tissue, bursal thickening, massive rotator cuff tears), or by patient factors (obesity, muscularity, limited shoulder motion). (c) RSNA, 2006.

Whole-body scintigraphy with radioiodine-131. A comprehensive list of false-positives with some examples.

PubMed

McDougall, I R

1995-10-01

Whole-body scintigraphy with radioiodine-131 is an important diagnostic test in the management of patients with differentiated thyroid cancer who have undergone surgical treatment. The scan can demonstrate the presence of residual thyroid or functioning metastases in lymph nodes or distant sites. However, there are a number of potential pitfalls in the interpretation of this scan that could lead to a false-positive diagnosis of cancer. The scintiscans are presented for five patients in whom uptake outside of the thyroid was not due to functioning metastases. Some of these abnormalities are physiologic, such as uptake of iodine in the gastrointestinal tract. A comprehensive list of false-positive results are tabulated.

[Genetic diagnostics of pathogenic splicing abnormalities in the clinical laboratory--pitfalls and screening approaches].

PubMed

Niimi, Hideki; Ogawa, Tomomi; Note, Rhougou; Hayashi, Shirou; Ueno, Tomohiro; Harada, Kenu; Uji, Yoshinori; Kitajima, Isao

2010-12-01

In recent years, genetic diagnostics of pathogenic splicing abnormalities are increasingly recognized as critically important in the clinical genetic diagnostics. It is reported that approximately 10% of pathogenic mutations causing human inherited diseases are splicing mutations. Nonetheless, it is still difficult to identify splicing abnormalities in routine genetic diagnostic settings. Here, we studied two different kinds of cases with splicing abnormalities. The first case is a protein S deficiency. Nucleotide analyses revealed that the proband had a previously reported G to C substitution in the invariant AG dinucleotide at the splicing acceptor site of intronl/exon2, which produces multiple splicing abnormalities resulting in protein S deficiency. The second case is an antithrombin (AT) deficiency. This proband had a previously reported G to A substitution, at nucleotide position 9788 in intron 4, 14 bp in front of exon 5, which created a de novo exon 5 splice site and resulted in AT deficiency. From a practical standpoint, we discussed the pitfalls, attentions, and screening approaches in genetic diagnostics of pathogenic splicing abnormalities. Due to the difficulty with full-length sequence analysis of introns, and the lack of RNA samples, splicing mutations may escape identification. Although current genetic testing remains to be improved, to screen for splicing abnormalities more efficiently, it is significant to use an appropriate combination of various approaches such as DNA and/or RNA samples, splicing mutation databases, bioinformatic tools to detect splice sites and cis-regulatory elements, and in vitro and/or in vivo experimentally methods as needed.

Cytopathologist-performed and ultrasound-guided fine needle aspiration cytology enhances diagnostic accuracy and avoids pitfalls: An overview of 20 years of personal experience with a selection of didactic cases.

PubMed

Paksoy, Nadir; Ozbek, Busra

2018-01-01

Over the last few decades, fine needle aspiration cytology (FNA) has emerged as a SAFE (Simple, Accurate, Fast, Economical) diagnostic tool based on the morphologic evaluation of cells. The first and most important step in obtaining accurate results from FNA is to procure sufficient and representative material from the lesion and to appropriately transfer this material to the laboratory. Unfortunately, the most important aspect of this task occurs beyond the control of the cytopathologist, a key reason for obtaining unsatisfactory results with FNA. There is growing interest in the field of cytology in "cytopathologist-performed ultrasound (US)-guided FNA," which has been reported to yield accurate results. The first author has been applying FNA in his own private cytopathology practice with a radiologist and under the guidance of US for more than 20 years. This study retrospectively reviews the utility of this practice. We present a selection of didactic examples under different headings that highlight the application of FNA by a cytopathologist, accompanied by US, under the guidance of a radiologist, in the form of an "outpatient FNA clinic." The use of this technique enhances diagnostic accuracy and prevents pitfalls. The highlights of each case are also outlined as "take-home messages."

Hb lepore/β0-thalassaemia with α+-thalassaemia interactions, a potential diagnostic pitfall.

PubMed

Alauddin, Hafiza; Mohamad Nasir, Suziana; Ahadon, Madzlifah; Raja Sabudin, Raja Zahratul Azma; Ithnin, Azlin; Hussin, Noor Hamidah; Alias, Hamidah; Loh, C-Khai; Abdul Latiff, Zarina; Abdul Murad, Nor Azian; Othman, Ainoon

2015-12-01

Haemoglobin (Hb) Lepore is a variant Hb consisting of two α-globin and two δβ-globin chains. In a heterozygote, it is associated with clinical findings of thalassaemia minor, but interactions with other haemoglobinopathies can lead to various clinical phenotypes and pose diagnostic challenges. We reported a pair of siblings from a Malay family, who presented with pallor and hepatosplenomegaly at the ages of 21 months and 14 months old. The red cell indices and peripheral blood smears of both patients showed features of thalassaemia intermedia. Other laboratory investigations of the patients showed conflicting results. However, laboratory investigation results of the parents had led to a presumptive diagnosis of compound heterozygote Hb Lepore/β-thalassaemia and co-inheritance α+-thalassaemia (-α3.7). Hb Lepore has rarely been detected in Southeast Asian countries, particularly in Malaysia. These two cases highlight the importance of family studies for accurate diagnosis, hence appropriate clinical management and genetic counseling.

Where Lies the Fault in Diagnosing Dhat Syndrome among Females? Understanding through a Case Study.

PubMed

Kar, Sujita Kumar; Singh, Amit

2017-01-01

Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-centered management gets weakened, affecting the clinical outcome. This case study focuses on the diagnostic dilemmas related to Dhat syndrome in females and pitfalls in the current diagnostic system.

Clinical Problem Analysis (CPA): A Systematic Approach To Teaching Complex Medical Problem Solving.

ERIC Educational Resources Information Center

Custers, Eugene J. F. M.; Robbe, Peter F. De Vries; Stuyt, Paul M. J.

2000-01-01

Discusses clinical problem analysis (CPA) in medical education, an approach to solving complex clinical problems. Outlines the five step CPA model and examines the value of CPA's content-independent (methodical) approach. Argues that teaching students to use CPA will enable them to avoid common diagnostic reasoning errors and pitfalls. Compares…

CD-ROM: Potential and Pitfalls.

ERIC Educational Resources Information Center

Dreiss, L. Jack; Bashir, Shahzad

1990-01-01

Examines issues surrounding CD-ROM as an organizational information management tool: (1) the CD-ROM market; (2) pitfalls, including compatibility, effect on existing information systems, fear of obsolescence, protection of sensitive information, and lack of successful role models; and (3) factors that will fuel growth, including greater…

A Rare Case of Chronic Active Epstein-Barr Virus (EBV) Infection Accompanied by the Infiltration of EBV-infected CD8+ T Cells into the Muscle.

PubMed

Kobayashi, Nobuhiko; Mitsui, Takeki; Ogawa, Yoshiyuki; Iriuchishima, Hirono; Takizawa, Makiko; Yokohama, Akihiko; Saitoh, Takayuki; Koiso, Hiromi; Tsukamoto, Norifumi; Murakami, Hirokazu; Nojima, Yoshihisa; Handa, Hiroshi

2018-04-01

We describe a rare case of chronic active Epstein-Barr virus (CAEBV) infection, with infiltration of the skeletal muscle. A 19-year-old woman with swollen cervical lymph nodes and a fever was referred to our hospital. Swelling of the trapezium muscle and elevation of creatinine kinase level were observed. Biopsy results of the brachialis muscle revealed infiltration of Epstein-Barr virus (EBV)-encoded RNA-positive CD8 T lymphocytes. The EBV virus load in the peripheral blood was high, and EBV monoclonality was determined by Southern blot analysis. Owing to the rarity of CAEBV with skeletal muscle infiltration, this case alerts physicians to the potential diagnostic pitfalls of CAEBV.

T1 pseudohyperintensity on fat-suppressed MRI: A potential diagnostic pitfall

PubMed Central

Huynh, Tuan N.; Johnson, D. Thor; Poder, Liina; Joe, Bonnie N.; Webb, Emily M.; Coakley, Fergus V.

2011-01-01

MRI findings in two patients with misleading T1 hyperintensity seen only on fat-suppressed images are presented, one with a renal cell carcinoma that was misinterpreted as a hemorrhagic cyst and the other with an ovarian serous cystadenocarcinoma that was misinterpreted as a complicated endometrioma. The apparent T1 hyperintensity on fat suppressed images in these cases was likely due to varying perception of image signal dependent on local contrast, an optical effect known as the checker-shadow illusion. T1 pseudohyperintensity should be considered when apparently high T1 signal intensity is seen only on fat-suppressed images; review of non fat-suppressed images may help prevent an erroneous diagnoses of blood-containing lesions. PMID:21765301

Extraventricular neurocytoma in a child mimicking oligodendroglioma: a diagnostic pitfall.

PubMed

Limaiem, F; Bellil, S; Chelly, I; Mekni, A; Bellil, K; Jemel, H; Haouet, S; Zitouna, M; Kchir, N

2009-04-01

Extraventricular neurocytomas are rare neuronal tumours that have been included in the 2007 WHO classification as a variant of central neurocytoma. They arise outside the ventricles, usually within the cerebral hemisphere,s but also in other regions throughout the neuraxis. The morphological overlap of these tumours with oligodendroglioma often poses diagnostic difficulty. Herein, a case of extraventricular neurocytoma in a 4-year-old girl is reported that mimicked histologically oligodendroglioma. The authors describe the clinicopathological features of this rare entity with special emphasis on differential diagnosis.

Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation.

PubMed

Duigenan, Shauna; Oliva, Esther; Lee, Susanna I

2012-02-01

The CT and MRI features of ovarian torsion are illustrated with gross pathologic correlation. Ovarian enlargement with or without an underlying mass is the finding most frequently associated with torsion, but it is nonspecific. A twisted pedicle, although not often detected on imaging, is pathognomonic when seen. Subacute ovarian hemorrhage and abnormal enhancement is usually seen, and both features show characteristic patterns on CT and MRI. Ipsilateral uterine deviation can also be seen. Diagnostic pitfalls that may mimic ovarian torsion and observations for discriminating them are discussed.

Pitfalls in PCR troubleshooting: Expect the unexpected?

PubMed Central

Schrick, Livia; Nitsche, Andreas

2015-01-01

PCR is a well-understood and established laboratory technique often used in molecular diagnostics. Huge experience has been accumulated over the last years regarding the design of PCR assays and their set-up, including in-depth troubleshooting to obtain the optimal PCR assay for each purpose. Here we report a PCR troubleshooting that came up with a surprising result never observed before. With this report we hope to sensitize the reader to this peculiar problem and to save troubleshooting efforts in similar situations, especially in time-critical and ambitious diagnostic settings. PMID:27077041

Chordoma of the Head and Neck: A Review.

PubMed

Wasserman, Jason K; Gravel, Denis; Purgina, Bibianna

2018-06-01

Chordoma is a rare malignant bone tumor that can arise anywhere along the central neural axis and many involve head and neck sites, most commonly the skull base. The relative rarity of these tumors, combined with the complex anatomy of the head and neck, pose diagnostic challenges to pathologists. This article describes the pertinent clinical, pathologic, and molecular features of chordomas and describes how these features can be used to aid in formulating a differential diagnosis. Emphasis is placed on key diagnostic pitfalls and the importance of incorporating immunohistochemical information into the diagnosis.

Pitfalls

NASA Technical Reports Server (NTRS)

Triffet, Terry

1990-01-01

Though potentially of great benefit to the nation, the experience of the workshop participants and their discussions with Sea Grant and Land Grant officials make it clear that the Space Grant Program must avoid certain pitfalls of the past and present if it is to be successful. The most important of these are listed and briefly discussed.

[Thalassaemia diagnostics].

PubMed

Kusters, Elske; Kerkhoffs, Jean-Louis H; van Rossum, André P

2014-01-01

The thalassaemias are characterised by quantitative aberrations in the production of the globin chains that make up haemoglobin, and are a subgroup of the haemoglobinopathies. In this LabQuiz we show how thalassaemia carrier status can be indicated in the results of regular laboratory tests, and discuss the laboratory diagnostics that can confirm or rule out thalassaemia. In these two cases we will present a man of Moroccan descent, and two brothers of Filipino descent, all with anaemia and microcytosis. We show it is possible to differentiate between iron-deficiency anaemia and thalassaemia carrier status on the basis of a complete blood count and measurement of ferritin levels, and which laboratory diagnostics can be subsequently performed in order to confirm a suspicion of thalassaemia. The background section discusses the properties and pitfalls of routine laboratory diagnostics for the thalassaemias, and thalassaemia diagnostics in the Dutch newborn screening programme.

Flow Cytometry of Extracellular Vesicles: Potential, Pitfalls, and Prospects.

PubMed

Nolan, John P

2015-07-01

Evidence suggests that extracellular vesicles (EVs) can play roles in physiology and pathology, providing impetus to explore their use as diagnostic and therapeutic targets. However, EVs are also small, heterogeneous, and difficult to measure, and so this potential has not yet been realized. The development of improved approaches to EV detection and characterization will be critical to further understanding their roles in physiology and disease. Flow cytometry has been a popular tool for measuring cell-derived EVs, but has often been used in an uncritical manner in which fundamental principles and limitations of the instrument are ignored. Recent efforts to standardize procedures and document the effects of different methodologies have helped to address this shortcoming, but much work remains. In this paper, I address some of the instrument, reagent, and analysis considerations relevant to measurement of individual EVs in flow, with the aim of clarifying a path to quantitative and standardized measurement of these interesting and potentially important biological nanoparticles. Copyright © 2015 John Wiley & Sons, Inc.

Hip Arthroscopy: Common Problems and Solutions.

PubMed

Casp, Aaron; Gwathmey, Frank Winston

2018-04-01

The use of hip arthroscopy continues to expand. Understanding potential pitfalls and complications associated with hip arthroscopy is paramount to optimizing clinical outcomes and minimizing unfavorable results. Potential pitfalls and complications are associated with preoperative factors such as patient selection, intraoperative factors such as iatrogenic damage, traction-related complications, inadequate correction of deformity, and nerve injury, or postoperative factors such as poor rehabilitation. This article outlines common factors that contribute to less-than-favorable outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization

PubMed Central

Chang, Michael C.; Shim, John J.

2012-01-01

Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs. PMID:23378884

Diagnostic utility of alpha-methylacyl CoA racemase (P504S) on prostate needle biopsy.

PubMed

Jiang, Zhong; Woda, Bruce A

2004-11-01

Alpha-methylacyl CoA racemase (AMACR), also known as P504S, was identified by the analysis of cDNA library subtraction in conjunction with high throughput microarray screening from prostate tissue and has been proven to be one of the very few biomarkers that can distinguish cancer from benign cells with high sensitivity and specificity for prostate carcinoma. It is a successful example of the translation of molecular findings into clinical practice. This review focuses on the study of AMACR (P504S) expression in small focal prostate cancer and atypical small acinar proliferation (ASAP) on needle biopsies and emphasizes the utility of AMACR (P504S) in routine surgical pathology practice. We also discuss the potential pitfalls and caveats in the interpretation of immunostaining results.

Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation.

PubMed

Chang, James D; Manning, Warren J; Ebrille, Elisa; Zimetbaum, Peter J

2017-05-09

The potential for cardiac implantable electronic device leads to interfere with tricuspid valve (TV) function has gained increasing recognition as having hemodynamic and clinical consequences associated with incremental morbidity and death. The diagnosis and treatment of lead-related (as distinct from functional) tricuspid regurgitation pose unique challenges. Because of pitfalls in routine diagnostic imaging, a high level of clinical suspicion must be maintained to avoid overlooking the possibility that worsening heart failure is a consequence of mechanical interference with TV leaflet mobility or coaptation and is amenable to lead extraction or valve repair or replacement. The future of cardiac implantable electronic devices includes pacing and perhaps defibrillation without a lead traversing the TV. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Acute gall bladder perforation--a dilemma in early diagnosis.

PubMed Central

Ong, C L; Wong, T H; Rauff, A

1991-01-01

Gall bladder perforation is a rare complication of cholecystitis. A definitive diagnosis is uncommon before surgery and the morbidity and mortality associated with this condition are high. We report six patients with gall bladder perforation to show the difficulty of making an early diagnosis. The history and the clinical findings of these patients are reviewed to highlight diagnostic pitfalls. PMID:1885081

Myasthenia Gravis: Unusual Presentations and Diagnostic Pitfalls.

PubMed

Rodolico, Carmelo; Parisi, Daniela; Portaro, Simona; Biasini, Fiammetta; Sinicropi, Stefano; Ciranni, Annamaria; Toscano, Antonio; Messina, Sonia; Musumeci, Olimpia; Vita, Giuseppe; Girlanda, Paolo

2016-08-30

Myasthenia gravis (MG) is an autoimmune disorder presenting with fluctuating, fatigable muscle weakness. Initial symptoms classically involve ocular and proximal limb muscles. Rarely, MG may onset with unusual features, so it can be misdiagnosed with other neuromuscular diseases. To describe unusual and atypical presentations of MG in a large cohort of patients, considering and discussing diagnostic difficulties and pitfalls. We report on 21 out of 508 MG patients, coming to our department in the last 27 years and presenting with atypical or unusual features. The diagnosis was achieved performing a careful clinical examination, a proper neurophysiological assessment, the neostigmine test, the AChR and MuSK antibodies assay and chest CT-scan. Patients with atypical/unusual MG onset were the 4.4% of all MG patients population. We describe seven different clinical categories: asymmetric distal upper limbs weakness, foot drop, isolated triceps brachii weakness and foot drop, post exertional axial weakness with dropped head, acute facial dyplegia, limb-girdle MG and MG with sudden lower limbs weakness and recurrent falls. Atypical and unusual presentations may increase the risk to misdiagnose or delay MG diagnosis. Isolated limb-girdle presentation is the most frequent atypical form in our series.

Diagnostic Approach to Pediatric Spine Disorders.

PubMed

Rossi, Andrea; Martinetti, Carola; Morana, Giovanni; Severino, Mariasavina; Tortora, Domenico

2016-08-01

Understanding the developmental features of the pediatric spine and spinal cord, including embryologic steps and subsequent growth of the osteocartilaginous spine and contents is necessary for interpretation of the pathologic events that may affect the pediatric spine. MR imaging plays a crucial role in the diagnostic evaluation of patients suspected of harboring spinal abnormalities, whereas computed tomography and ultrasonography play a more limited, complementary role. This article discusses the embryologic and developmental anatomy features of the spine and spinal cord, together with some technical points and pitfalls, and the most common indications for pediatric spinal MR imaging. Copyright © 2016 Elsevier Inc. All rights reserved.

Exploitation of microbial forensics and nanotechnology for the monitoring of emerging pathogens.

PubMed

Bokhari, Habib

2018-03-07

Emerging infectious diseases remain among the leading causes of global mortality. Traditional laboratory diagnostic approaches designed to detect and track infectious disease agents provide a framework for surveillance of bio threats. However, surveillance and outbreak investigations using such time-consuming approaches for early detection of pathogens remain the major pitfall. Hence, reasonable real-time surveillance systems to anticipate threats to public health and environment are critical for identifying specific aetiologies and preventing the global spread of infectious disease. The current review discusses the growing need for monitoring and surveillance of pathogens with the same zeal and approach as adopted by microbial forensics laboratories, and further strengthening it by integrating with the innovative nanotechnology for rapid detection of microbial pathogens. Such innovative diagnostics platforms will help to track pathogens from high risk areas and environment by pre-emptive approach that will minimize damages. The various scenarios with the examples are discussed where the high risk associated human pathogens in particular were successfully detected using various nanotechnology approaches with potential future prospects in the field of microbial forensics.

MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls.

PubMed

Tamai, Ken; Togashi, Kaori; Ito, Tsuyoshi; Morisawa, Nobuko; Fujiwara, Toshitaka; Koyama, Takashi

2005-01-01

Adenomyosis is a nonneoplastic condition, characterized by benign invasion of ectopic endometrium into the myometrium with hyperplasia of adjacent smooth muscle. The common symptoms include dysmenorrhea, menorrhagia, and abnormal uterine bleeding, but these do not allow diagnosis. Therefore, imaging plays an important role because establishment of the correct preoperative diagnosis is critical to avoid unnecessary intervention. Magnetic resonance (MR) imaging is a highly accurate noninvasive modality for diagnosis of adenomyosis, differentiation of adenomyosis from other gynecologic disorders, and planning of appropriate treatment. Although the typical MR imaging findings are well established, adenomyosis actually varies widely in terms of histopathologic features (adenomyosis with sparse glands), growth patterns (polypoid adenomyoma, adenomyotic cyst, and miniature uterus), responses to hormonal activity (tamoxifen, decidual changes), and responses to treatment (gonadotropin-releasing hormone agonist). The MR imaging findings of adenomyosis occasionally mimic those of uterine malignancy or ovarian cancer. Furthermore, malignancy occasionally develops in otherwise benign adenomyosis. Pitfalls in diagnosis of adenomyosis include myometrial contractions, leiomyoma, adenomatoid tumor, metastases, endometrial carcinoma, and endometrial stromal sarcoma. Knowledge of the various appearances of adenomyosis and the possible pitfalls in differential diagnosis help guide the determination of appropriate treatment options. (c) RSNA, 2005.

Diagnosis of B-Cell Non-Hodgkin Lymphomas with Small-/Intermediate-Sized Cells in Cytopathology

PubMed Central

Schwock, Joerg; Geddie, William R.

2012-01-01

Fine needle sampling is a fast, safe, and potentially cost-effective method of obtaining tissue for cytomorphologic assessment aimed at both initial triage and, in some cases, complete diagnosis of patients that present clinically with lymphadenopathy. The cytologic diagnosis of B-cell non-Hodgkin lymphomas composed of small-/intermediate-sized cells, however, has been seen as an area of great difficulty even for experienced observers due to the morphologic overlap between lymphoma and reactive lymphadenopathies as well as between the lymphoma entities themselves. Although ancillary testing has improved diagnostic accuracy, the results from these tests must be interpreted within the morphological and clinical context to avoid misinterpretation. Importantly, the recognition of specific cytologic features is crucial in guiding the appropriate selection of ancillary tests which will either confirm or refute a tentative diagnosis. For these reasons, we here review the cytologic characteristics particular to five common B-cell non-Hodgkin lymphomas which typically cause the most diagnostic confusion based on cytological assessment alone: marginal zone lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, and lymphoplasmacytic lymphoma. We summarize the most pertinent cytomorphologic features for each entity as well as for reactive lymphoid hyperplasia, contrast them with each other to facilitate their recognition, and highlight common diagnostic pitfalls. PMID:22693682

Disseminated Acanthamoeba Infection Presenting With Cutaneous Lesions in an Immunocompromised Patient: A Case Report, Review of Histomorphologic Findings, and Potential Diagnostic Pitfalls.

PubMed

Morrison, Annie O; Morris, Robert; Shannon, Amie; Lauer, Scott R; Guarner, Jeannette; Kraft, Colleen S

2016-02-01

Free-living amoebas are exceedingly rare causes of cutaneous infections and present unique diagnostic and therapeutic challenges. We describe a case of disseminated acanthamoebiasis with cutaneous manifestations and summarize additional diagnostic, prognostic, and therapeutic highlights. A 58-year-old man with relapsed chronic lymphocytic leukemia had several weeks of progressive, painful ulcerations on the forehead, arms, abdomen, and thighs. A biopsy was performed for histopathologic evaluation. The biopsy specimen showed inflammatory infiltrate with abscess formation involving the epidermis, dermis, and subcutis. Scattered cells showed nuclei with a prominent central karyosome, dispersed chromatin, and either abundant foamy basophilic cytoplasm or two well-demarcated cytoplasmic walls. Acanthamoeba species was confirmed by polymerase chain reaction from the formalin-fixed, paraffin-embedded tissue. Cutaneous lesions from acanthamoebiasis are exceptionally rare but should be included in the differential diagnosis of necrotic cutaneous lesions in immunocompromised patients. Although infrequently encountered, pathologists need to be aware of the morphologic features of free-living amoebas. Immunohistochemical and molecular studies can confirm the diagnosis. Multiagent treatment regimens, when initiated empirically, have been more successful than single-agent regimens, but infections involving the central nervous system are almost universally fatal. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Avoiding pitfalls in estimating heritability with the common options approach

PubMed Central

Danchin, Etienne; Wajnberg, Eric; Wagner, Richard H.

2014-01-01

In many circumstances, heritability estimates are subject to two potentially interacting pitfalls: the spatial and the regression to the mean (RTM) fallacies. The spatial fallacy occurs when the set of potential movement options differs among individuals according to where individuals depart. The RTM fallacy occurs when extreme measurements are followed by measurements that are closer to the mean. We simulated data from the largest published heritability study of a behavioural trait, colony size choice, to examine the operation of the two fallacies. We found that spurious heritabilities are generated under a wide range of conditions both in experimental and correlative estimates of heritability. Classically designed cross-foster experiments can actually increase the frequency of spurious heritabilities. Simulations showed that experiments providing all individuals with the identical set of options, such as by fostering all offspring in the same breeding location, are immune to the two pitfalls. PMID:24865284

Immobilized liquid layers: A new approach to anti-adhesion surfaces for medical applications

PubMed Central

Sotiri, Irini; Overton, Jonathan C; Waterhouse, Anna

2016-01-01

Surface fouling and undesired adhesion are nearly ubiquitous problems in the medical field, complicating everything from surgeries to routine daily care of patients. Recently, the concept of immobilized liquid (IL) interfaces has been gaining attention as a highly versatile new approach to antifouling, with a wide variety of promising applications in medicine. Here, we review the general concepts behind IL layers and discuss the fabrication strategies on medically relevant materials developed so far. We also summarize the most important findings to date on applications of potential interest to the medical community, including the use of these surfaces as anti-thrombogenic and anti-bacterial materials, anti-adhesive textiles, high-performance coatings for optics, and as unique platforms for diagnostics. Although the full potential and pitfalls of IL layers in medicine are just beginning to be explored, we believe that this approach to anti-adhesive surfaces will prove broadly useful for medical applications in the future. PMID:27022136

Current and potential imaging applications of ferumoxytol for magnetic resonance imaging.

PubMed

Toth, Gerda B; Varallyay, Csanad G; Horvath, Andrea; Bashir, Mustafa R; Choyke, Peter L; Daldrup-Link, Heike E; Dosa, Edit; Finn, John Paul; Gahramanov, Seymur; Harisinghani, Mukesh; Macdougall, Iain; Neuwelt, Alexander; Vasanawala, Shreyas S; Ambady, Prakash; Barajas, Ramon; Cetas, Justin S; Ciporen, Jeremy; DeLoughery, Thomas J; Doolittle, Nancy D; Fu, Rongwei; Grinstead, John; Guimaraes, Alexander R; Hamilton, Bronwyn E; Li, Xin; McConnell, Heather L; Muldoon, Leslie L; Nesbit, Gary; Netto, Joao P; Petterson, David; Rooney, William D; Schwartz, Daniel; Szidonya, Laszlo; Neuwelt, Edward A

2017-07-01

Contrast-enhanced magnetic resonance imaging is a commonly used diagnostic tool. Compared with standard gadolinium-based contrast agents, ferumoxytol (Feraheme, AMAG Pharmaceuticals, Waltham, MA), used as an alternative contrast medium, is feasible in patients with impaired renal function. Other attractive imaging features of i.v. ferumoxytol include a prolonged blood pool phase and delayed intracellular uptake. With its unique pharmacologic, metabolic, and imaging properties, ferumoxytol may play a crucial role in future magnetic resonance imaging of the central nervous system, various organs outside the central nervous system, and the cardiovascular system. Preclinical and clinical studies have demonstrated the overall safety and effectiveness of this novel contrast agent, with rarely occurring anaphylactoid reactions. The purpose of this review is to describe the general and organ-specific properties of ferumoxytol, as well as the advantages and potential pitfalls associated with its use in magnetic resonance imaging. To more fully demonstrate the applications of ferumoxytol throughout the body, an imaging atlas was created and is available online as supplementary material. Published by Elsevier Inc.

In Vitro Evaluation of Molecular Tumor Targets in Nuclear Medicine: Immunohistochemistry Is One Option, but Under Which Conditions?

PubMed

Reubi, Jean Claude

2017-12-01

The identification of new molecular targets for diagnostic and therapeutic applications using in vitro methods is an important challenge in nuclear medicine. One such method is immunohistochemistry, increasingly popular because it is easy to perform. This review presents the case for conducting receptor immunohistochemistry to evaluate potential molecular targets in human tumor tissue sections. The focus is on the immunohistochemistry of G-protein-coupled receptors, one of the largest families of cell surface proteins, representing a major class of drug targets and thus playing an important role in nuclear medicine. This review identifies common pitfalls and challenges and provides guidelines on performing such immunohistochemical studies. An appropriate validation of the target is a prerequisite for developing robust and informative new molecular probes. © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

DSM-5 and neurodevelopmental and other disorders of childhood and adolescence.

PubMed

Wills, Cheryl D

2014-01-01

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the classification of mental disorders for children and adolescents has been revised. Although some changes are welcome and needed, others have been controversial. In this article, I examine the diagnostic changes along with some of the associated controversies and resolutions. The implications for the practice of child forensic psychiatry, including problems that may be encountered by forensic psychiatrists who evaluate adults with childhood-onset mental disorders, are examined. The pitfalls associated with improper use of The Manual by legal professionals are also reviewed. © 2014 American Academy of Psychiatry and the Law.

Hotspot mutations in cancer genes may be missed in routine diagnostics due to neighbouring sequence variants.

PubMed

Bartels, Stephan; Schipper, Elisa; Hasemeier, Britta; Kreipe, Hans; Lehmann, Ulrich

2018-05-27

The detection of hotspot mutations in key cancer genes is now an essential part of the diagnostic work-up in molecular pathology. Nearly all assays for mutation detection involve an amplification step. A second single nucleotide variant (SNV) on the same allele adjacent to a mutational hotspot can interfere with primer binding, leading to unnoticed allele-specific amplification of the wild type allele and thereby false-negative mutation testing. We present two diagnostic cases with false negative sequence results for JAK2 and SRSF2. In both cases mutations would have escaped detection if only one strand of DNA had been analysed. Because many commercially available diagnostic kits rely on the analysis of only one DNA strand they are prone to fail in cases like these. Detailed protocols and quality control measures to prevent corresponding pitfalls are presented. Copyright © 2017. Published by Elsevier Inc.

Social media and professional identity: Pitfalls and potential.

PubMed

O'Regan, Andrew; Smithson, William Henry; Spain, Eimear

2018-02-01

Social media developments have completely changed how information is accessed and communicated. While great potential exists with these platforms, recent reports of online unprofessional behavior by doctors has threatened the medical professional identity; a matter of critical importance for clinicians and medical educators. This paper outlines a role for social media in facilitating support for clinicians and medical teachers; it will raise awareness of pitfalls and explain ethical and legal guidelines. An analysis of inappropriate behaviors and conflicting attitudes regarding what is acceptable in online posts, including the inter-generational contrast in online presence and perceptions of where the boundaries lie. Guidance documents are analyzed and potentially confusing and conflicting statements are identified and clarified. The authors believe that clinicians and medical students must follow ethical imperatives in both personal and professional spheres. It is essential that medical educational and professional bodies encourage clinicians to support one another and share information online while providing clear legal and ethical advice on maintaining standards and avoiding common pitfalls. Education on the responsible use of social media and associated risk awareness should be a priority for medical school curricula.

WE-AB-206-02: ACR Ultrasound Accreditation: Requirements and Pitfalls

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walter, J.

The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. The goal of this ultrasound hands-on workshop is to demonstrate quality control (QC) testing in diagnostic ultrasound and to provide updates in ACR ultrasound accreditation requirements. The first half of this workshop will include two presentations reviewing diagnostic ultrasound QA/QC and ACR ultrasound accreditation requirements. The second half of the workshop will include live demonstrations of basic QC tests. An array of ultrasound testing phantoms and ultrasound scanners will be available for attendees to learn diagnostic ultrasound QC in a hands-on environmentmore » with live demonstrations and on-site instructors. The targeted attendees are medical physicists in diagnostic imaging. Learning Objectives: Gain familiarity with common elements of a QA/QC program for diagnostic ultrasound imaging dentify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools Learn ACR ultrasound accreditation requirements Jennifer Walter is an employee of American College of Radiology on Ultrasound Accreditation.« less

Pearls and pitfalls of allergy diagnostic testing: report from the American College of Allergy, Asthma and Immunology/American Academy of Allergy, Asthma and Immunology Specific IgE Test Task Force.

PubMed

Cox, Linda; Williams, Brock; Sicherer, Scott; Oppenheimer, John; Sher, Larry; Hamilton, Robert; Golden, David

2008-12-01

The intended purpose of this monograph is to provide a general overview of allergy diagnostics for health care professionals who care for patients with allergic disease. For a more comprehensive review of allergy diagnostic testing, readers can refer to the Allergy Diagnostic Practice Parameters. A key message is that a positive allergy test result (skin or blood) indicates only the presence of allergen specific IgE (called sensitization). It does not necessarily mean clinical allergy (ie, allergic symptoms with exposure). It is important for this reason that the allergy evaluation be based on the patient's history and directed by a health care professional with sufficient understanding of allergy diagnostic testing to use the information obtained from his/her evaluation of the patient to determine (1) what allergy diagnostic tests to order, (2) how to interpret the allergy diagnostic test results, and (3) how to use the information obtained from the allergy evaluation to develop an appropriate therapeutic treatment plan.

Diagnostic pitfalls in newborns and babies with blisters and erosions.

PubMed

Nischler, Elke; Klausegger, Alfred; Hüttner, Clemens; Pohla-Gubo, Gabriele; Diem, Anja; Bauer, Johann W; Hintner, Helmut

2009-01-01

Establishing the correct diagnosis in newborns presenting with blisters and erosions is not always a straightforward process. Many different disease entities including acquired (i.e., infectious, immunobullous, traumatic) and inherited disorders have to be taken into consideration. Similarities in clinical appearance, colonization and/or superinfections of preexisting skin lesions, as well as the absence of late changes in the neonate often pose significant diagnostic challenges. In this paper we discuss by giving examples the process of making an accurate diagnosis of blistering skin diseases in the neonatal period on the basis of a diagnostic algorithm. In addition, we provide an overview of the rational use and the limitations of laboratory procedures such as microbial testing, routine light microscopy, immunofluorescence antigen mapping, transmission electron microscopy, and molecular genetic analysis.

Validation of consensus panel diagnosis in dementia.

PubMed

Gabel, Matthew J; Foster, Norman L; Heidebrink, Judith L; Higdon, Roger; Aizenstein, Howard J; Arnold, Steven E; Barbas, Nancy R; Boeve, Bradley F; Burke, James R; Clark, Christopher M; Dekosky, Steven T; Farlow, Martin R; Jagust, William J; Kawas, Claudia H; Koeppe, Robert A; Leverenz, James B; Lipton, Anne M; Peskind, Elaine R; Turner, R Scott; Womack, Kyle B; Zamrini, Edward Y

2010-12-01

The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance. To determine conditions that improve consensus panel diagnosis. Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images. Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography. Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia. Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations. The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules. Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.

Peroneal tendon pathology: Pre- and post-operative high resolution US and MR imaging.

PubMed

Kumar, Yogesh; Alian, Ali; Ahlawat, Shivani; Wukich, Dane K; Chhabra, Avneesh

2017-07-01

Peroneal tendon pathology is an important cause of lateral ankle pain and instability. Typical peroneal tendon disorders include tendinitis, tenosynovitis, partial and full thickness tendon tears, peroneal retinacular injuries, and tendon subluxations and dislocations. Surgery is usually indicated when conservative treatment fails. Familiarity with the peroneal tendon surgeries and expected postoperative imaging findings is essential for accurate assessment and to avoid diagnostic pitfalls. Cross-sectional imaging, especially ultrasound and MRI provide accurate pre-operative and post-operative evaluation of the peroneal tendon pathology. In this review article, the normal anatomy, clinical presentation, imaging features, pitfalls and commonly performed surgical treatments for peroneal tendon abnormalities will be reviewed. The role of dynamic ultrasound and kinematic MRI for the evaluation of peroneal tendons will be discussed. Normal and abnormal postsurgical imaging appearances will be illustrated. Copyright © 2017 Elsevier B.V. All rights reserved.

Gynecologic imaging: current and emerging applications.

PubMed

Iyer, V R; Lee, S I

2010-01-01

Common diagnostic challenges in gynecology and the role of imaging in their evaluation are reviewed. Etiologies of abnormal uterine bleeding identified on pelvic sonography and sonohysterography are presented. An algorithmic approach for characterizing an incidentally detected adnexal mass and use of magnetic resonance imaging for definitive diagnosis are discussed. Finally, the role of F18-fluorodeoxyglucose positron emission tomography in the management of gynecological malignancies, and pitfalls associated with their use are examined.

Magnetic resonance imaging in local staging of endometrial carcinoma: diagnostic performance, pitfalls, and literature review.

PubMed

Zandrino, Franco; La Paglia, Ernesto; Musante, Francesco

2010-01-01

To assess the diagnostic accuracy of magnetic resonance imaging in local staging of endometrial carcinoma, and to review the results and pitfalls described in the literature. Thirty women with a histological diagnosis of endometrial carcinoma underwent magnetic resonance imaging. Unenhanced T2-weighted and dynamic contrast-enhanced Ti-weighted sequences were obtained. Hysterectomy and salpingo-oophorectomy was performed in all patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for the detection of deep myometrial and cervical infiltration. For deep myometrial infiltration T2-weighted sequences reached a sensitivity of 85%, specificity of 76%, PPV of 73%, NVP of 87%, and accuracy of 80%, while contrast-enhanced scans reached a sensitivity of 90%, specificity of 80%, PPV of 82%, NPV of 89%, and accuracy of 85%. For cervical infiltration T2-weighted sequences reached a sensitivity of 75%, specificity of 88%, PPV of 50%, NPV of 96%, and accuracy of 87%, while contrast-enhanced scans reached a sensitivity of 100%, specificity of 94%, PPV of 75%, NPV of 100%, and accuracy of 95%. Unenhanced and dynamic gadolinium-enhanced magnetic resonance allows accurate assessment of myometrial and cervical infiltration. Information provided by magnetic resonance imaging can define prognosis and management.

Pitfalls and Potentials of Crowd Science: a Meta-Analysis of Contextual Influences

NASA Astrophysics Data System (ADS)

Klippel, A.; Sparks, K.; Wallgrün, J. O.

2015-08-01

Crowd science is becoming an integral part of research in many disciplines. The research discussed in this paper lies at the intersection of spatial and behavioral sciences, two of the greatest beneficiaries of crowd science. As a young methodological development, crowd science needs attention from the perspective of a rigorous evaluation of the data collected to explore potentials as well as limitations (pitfalls). Our research has addressed a variety of contextual effects on the validity of crowdsourced data such as cultural, linguistic, regional, as well as methodological differences that we will discuss here in light of semantics.

Whole-body FDG PET-MR oncologic imaging: pitfalls in clinical interpretation related to inaccurate MR-based attenuation correction.

PubMed

Attenberger, Ulrike; Catana, Ciprian; Chandarana, Hersh; Catalano, Onofrio A; Friedman, Kent; Schonberg, Stefan A; Thrall, James; Salvatore, Marco; Rosen, Bruce R; Guimaraes, Alexander R

2015-08-01

Simultaneous data collection for positron emission tomography and magnetic resonance imaging (PET/MR) is now a reality. While the full benefits of concurrently acquiring PET and MR data and the potential added clinical value are still being evaluated, initial studies have identified several important potential pitfalls in the interpretation of fluorodeoxyglucose (FDG) PET/MRI in oncologic whole-body imaging, the majority of which being related to the errors in the attenuation maps created from the MR data. The purpose of this article was to present such pitfalls and artifacts using case examples, describe their etiology, and discuss strategies to overcome them. Using a case-based approach, we will illustrate artifacts related to (1) Inaccurate bone tissue segmentation; (2) Inaccurate air cavities segmentation; (3) Motion-induced misregistration; (4) RF coils in the PET field of view; (5) B0 field inhomogeneity; (6) B1 field inhomogeneity; (7) Metallic implants; (8) MR contrast agents.

Web based collaborative decision making in flood risk management

NASA Astrophysics Data System (ADS)

Evers, Mariele; Almoradie, Adrian; Jonoski, Andreja

2014-05-01

Stakeholder participation in the development of flood risk management (FRM) plans is essential since stakeholders often have a better understanding or knowledge of the potentials and limitation of their local area. Moreover, a participatory approach also creates trust amongst stakeholders, leading to a successful implementation of measures. Stakeholder participation however has its challenges and potential pitfalls that could lead to its premature termination. Such challenges and pitfalls are the limitation of financial resources, stakeholders' spatial distribution and their interest to participate. Different type of participation in FRM may encounter diverse challenges. These types of participation in FRM can be classified into (1) Information and knowledge sharing (IKS), (2) Consultative participation (CP) or (3) Collaborative decision making (CDM)- the most challenging type of participation. An innovative approach to address these challenges and potential pitfalls is a web-based mobile or computer-aided environment for stakeholder participation. This enhances the remote interaction between participating entities such as stakeholders. This paper presents a developed framework and an implementation of CDM web based environment for the Alster catchment (Hamburg, Germany) and Cranbrook catchment (London, UK). The CDM framework consists of two main stages: (1) Collaborative modelling and (2) Participatory decision making. This paper also highlights the stakeholder analyses, modelling approach and application of General Public License (GPL) technologies in developing the web-based environments. Actual test and evaluation of the environments was through series of stakeholders workshops. The overall results based from stakeholders' evaluation shows that web-based environments can address the challenges and potential pitfalls in stakeholder participation and it enhances participation in flood risk management. The web-based environment was developed within the DIANE-CM project (Decentralised Integrated Analysis and Enhancement of Awareness through Collaborative Modelling and Management of Flood Risk) of the 2nd ERANET CRUE funding initiative.

Lymphomatoid hypersensitivity reaction to levofloxacin during autologous stem cell transplantation: a potential diagnostic pitfall in patients treated for lymphoma or leukemia.

PubMed

Esparza, Edward M; Takeshita, Junko; George, Evan

2011-01-01

Drug-associated cutaneous lymphomatoid hypersensitivity reactions are rare eruptions that can clinically and microscopically mimic a bona fide lymphomatous process. Clinically, the appearance ranges from papulosquamous to purpuric. Histopathologically, these reactions simulate a wide variety of lymphoma subtypes; the most frequently reported examples resemble mycosis fungoides. We report a 61-year-old female who developed a purpuric eruption prior to engraftment of an autologous hematopoietic stem cell transplant for stage IV mantle cell lymphoma. Skin biopsies showed a superficial perivascular and interstitial infiltrate of large, immature-appearing mononuclear cells associated with spongiosis, papillary dermal edema and erythrocyte extravasation. The cells were immunoreactive for T-cell markers and lacked B-cell marker expression, excluding recurrence of the underlying mantle cell lymphoma as a diagnostic possibility. The cutaneous eruption was temporally linked to levofloxacin administration and resolved after discontinuation of this medication. This is the first report of a lymphomatoid hypersensitivity reaction associated with fluoroquinolone use. The histopathologic features presented in this paper underscore the potential for misdiagnosis of such lesions as lymphoma or acute myeloid leukemia, particularly in the setting of hematopoietic stem cell transplantation for underlying lymphoma or leukemia. Clinical correlation, morphologic comparison to the original malignancy and immunohistochemical studies aid the dermatopathologist in rendering the correct diagnosis. Copyright © 2010 John Wiley & Sons A/S.

Philosophy of science and the diagnostic process.

PubMed

Willis, Brian H; Beebee, Helen; Lasserson, Daniel S

2013-10-01

This is an overview of the principles that underpin philosophy of science and how they may provide a framework for the diagnostic process. Although philosophy dates back to antiquity, it is only more recently that philosophers have begun to enunciate the scientific method. Since Aristotle formulated deduction, other modes of reasoning including induction, inference to best explanation, falsificationism, theory-laden observations and Bayesian inference have emerged. Thus, rather than representing a single overriding dogma, the scientific method is a toolkit of ideas and principles of reasoning. Here we demonstrate that the diagnostic process is an example of science in action and is therefore subject to the principles encompassed by the scientific method. Although a number of the different forms of reasoning are used readily by clinicians in practice, without a clear understanding of their pitfalls and the assumptions on which they are based, it leaves doctors open to diagnostic error. We conclude by providing a case example from the medico-legal literature in which diagnostic errors were made, to illustrate how applying the scientific method may mitigate the chance for diagnostic error.

Delineating Extramammary Findings at Breast MR Imaging.

PubMed

Gao, Yiming; Ibidapo, Opeyemi; Toth, Hildegard K; Moy, Linda

2017-01-01

Breast magnetic resonance (MR) imaging is the only breast imaging modality that consistently encompasses extramammary structures in the thorax and upper abdomen. Incidental extramammary findings on breast MR images of patients with a history of breast cancer or other malignancies are significantly more likely to be malignant and may affect staging and treatment. An understanding of the frequency, distribution, and context of extramammary findings on breast MR images and a familiarity with common and uncommon sites of breast cancer metastasis inform the differential diagnosis and prompt the appropriate diagnostic next step, to differentiate benign from malignant findings. High-yield organ systems on breast MR images, as reflected by a high positive predictive value for malignancy, are correlated with known distant sites of breast cancer metastasis in the bone, lung, liver, and lymph nodes. Staging is considered when disease involves the skin and chest wall. Unusual sites of breast cancer metastasis from invasive lobular carcinoma are discussed, including the gastrointestinal tract, peritoneum, and adrenal glands. Nonmalignant clinically important findings involving the cardiovascular and gastrointestinal systems are reviewed, and potential pitfalls in diagnosis and interpretation are highlighted. A consistently systematic diagnostic approach is emphasized for identifying extramammary abnormalities on breast MR images. All things considered, the radiologist should be able to improve diagnostic sensitivity and specificity while interpreting extramammary findings on breast MR images. © RSNA, 2017.

Concomitant occurrence of macroprolactin, exercise-induced amenorrhea, and a pituitary lesion: a diagnostic pitfall. Case report.

PubMed

Cattaneo, F A; Fahie-Wilson, M N

2001-08-01

The authors report the case of a 37-year-old woman who presented with amenorrhea and an increased level of serum prolactin. Magnetic resonance images of the pituitary revealed a lesion with characteristics consistent with those of a microadenoma. Transsphenoidal exploration was performed, but a prolactinoma was not found. After endocrinological review, the patient's hyperprolactinemia was found to be caused by the presence of macroprolactin and her amenorrhea was due to intense exercise and low body weight. Macroprolactin is an isoform of prolactin that is variably reactive in assays for prolactin, but displays minimum bioactivity in vivo. Patients with macroprolactin are mostly asymptomatic. This phenomenon may cause elevated prolactin values, which the authors view as apparent hyperprolactinemia. The presence of macroprolactin is an underrecognized problem, occurring in as many as 15 to 20% of patients with elevated prolactin values and often leading to unnecessary, expensive diagnostic procedures and inappropriate treatment. The presence of macroprolactin should always be suspected when the patient's clinical history or clinical or radiological data are incompatible with the prolactin value. Physicians dealing with diagnosis and treatment of hyperprolactinemia (general practitioners, gynecologists, neurosurgeons, endocrinologists, and biochemists) should be aware of the potentially misleading nature of macroprolactin.

Issues and challenges associated with classifying neoplasms in percutaneous needle biopsies of incidentally found small renal masses.

PubMed

Evans, Andrew J; Delahunt, Brett; Srigley, John R

2015-03-01

Percutaneous needle core biopsy has become acceptable for classifying renal tumours and guiding patient management in the setting of an incidentally-detected small renal mass (SRM), defined as an asymptomatic, non-palpable mass <4cm in maximum dimension. Long-held concerns preventing the incorporation of biopsies into routine patient care, including the perception of poor diagnostic yield and risks of complications such as bleeding or biopsy tract seeding, have largely been disproven. While needle biopsies for SRMs have traditionally been performed in academic centres, pathologists based in non-academic centres can expect to encounter these specimens as urologists and/or interventional radiologist trainees complete their training programs and begin work in non-academic centres. This review covers the rationale for performing these biopsies, the expected diagnostic yield, relevant differential diagnoses and an approach to classifying SRMs based on limited samples as well as the use of immunohistochemical (IHC) staining panels to aid in this process. There is also an undeniable learning curve for pathologists faced with reporting these biopsies and a number of issues and potential pitfalls attributable to sampling must be kept in mind by pathologists and clinicians alike. Copyright © 2015 Elsevier Inc. All rights reserved.

Diagnostic imaging of infertility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Winfield, A.C.; Wentz, A.C.

1987-01-01

This text presents a review of all the imaging modalities available in the diagnosis of infertility. This book integrates the perspectives of experts in ob/gyn, radiology, reproductive endocrinology, and urology. It's a one-of-a-kind ''how to'' guide to hysterosalpinography and infertility evaluation, providing complete clinical information on the techniques, pitfalls, problems encountered and differential diagnosis. Detailed descriptions accompany numerous high-quality illustrations to help correlate findings and give meaning to the radiographic and ultrasound images.

A Precious Diagnostic "Pearl": The Necklace Pattern in Germ Cell Tumors of the Testis.

PubMed

Snow, Justin; Mosquera, Juan Miguel; Scognamiglio, Theresa; Robinson, Brian D; Khani, Francesca

2018-04-01

Diffuse embryoma is a rare pattern of nonseminomatous germ cell tumor of the testis originally described in 1983. We report a case with this predominant pattern in an 18-year-old male with a painless palpable testicular mass. Although it is relatively common to see a diffuse embryoma pattern focally in mixed nonseminomatous germ cell tumors of the testis, it is rarely the predominant pattern and can represent a diagnostic pitfall on routine hematoxylin and eosin stain. We emphasize the importance of recognizing the individual components within the diffuse embryoma pattern, review the literature, and briefly discuss the ancillary immunohistochemical stains that may be utilized to help support the diagnosis.

Promise and pitfalls of molecular markers of thyroid nodules

PubMed Central

Jadhav, S.; Lila, Anurag; Bandgar, Tushar; Shah, Nalini

2012-01-01

Thyroid nodules are common in the general population with a prevalence of 5-7% The initial evaluation of thyroid nodules commonly involves thyroid function tests, an ultrasound (USG) and fine needle aspiration biopsy (FNAB). The optimal management of patients with thyroid nodules with indeterminate cytology is plagued by the lack of highly sensitive and specific diagnostic modalities In this article we attempt to review the available literature on the molecular markers which are increasingly being studied for their diagnostic utility in assessing thyroid nodules. The various molecular markers consist of gene mutations, gene re arrangements, RNA based assays and immunohistochemical markers. The molecular markers definitely would help to optimise the management of such patients. PMID:23565369

Potential pitfalls of strain rate imaging: angle dependency

NASA Technical Reports Server (NTRS)

Castro, P. L.; Greenberg, N. L.; Drinko, J.; Garcia, M. J.; Thomas, J. D.

2000-01-01

Strain Rate Imaging (SRI) is a new echocardiographic technique that allows for the real-time determination of myocardial SR, which may be used for the early and accurate detection of coronary artery disease. We sought to study whether SR is affected by scan line alignment in a computer simulation and an in vivo experiment. Through the computer simulation and the in vivo experiment we generated and validated safe scanning sectors within the ultrasound scan sector and showed that while SRI will be an extremely valuable tool in detecting coronary artery disease there are potential pitfalls for the unwary clinician. Only after accounting for these affects due to angle dependency, can clinicians utilize SRI's potential as a valuable tool in detecting coronary artery disease.

Extraosseous Extension of Aggressive Vertebral Hemangioma as a Potential Pitfall on 68Ga-PSMA PET/CT.

PubMed

Probst, Stephan; Bladou, Franck; Abikhzer, Gad

2017-08-01

A 74-year-old man with newly diagnosed prostate cancer underwent Ga-PSMA PET/CT, which demonstrated intense uptake in and adjacent the L2 vertebral body. Subsequent MRI of the lumbar spine showed an aggressive L2 hemangioma with adjacent soft tissue extension. There was congruence of the intraosseous and extraosseous components of the hemangioma and the PSMA PET uptake. This is a rare but important potential pitfall in Ga-PSMA PET/CT-a soft tissue lesion with intense tracer uptake related not to a nodal metastasis of prostate cancer but to extraosseous extension of an aggressive vertebral body hemangioma.

Pitfalls and Limitations in the Interpretation of Geophysical Images for Hydrologic Properties and Processes

NASA Astrophysics Data System (ADS)

Day-Lewis, F. D.

2014-12-01

Geophysical imaging (e.g., electrical, radar, seismic) can provide valuable information for the characterization of hydrologic properties and monitoring of hydrologic processes, as evidenced in the rapid growth of literature on the subject. Geophysical imaging has been used for monitoring tracer migration and infiltration, mapping zones of focused groundwater/surface-water exchange, and verifying emplacement of amendments for bioremediation. Despite the enormous potential for extraction of hydrologic information from geophysical images, there also is potential for misinterpretation and over-interpretation. These concerns are particularly relevant when geophysical results are used within quantitative frameworks, e.g., conversion to hydrologic properties through petrophysical relations, geostatistical estimation and simulation conditioned to geophysical inversions, and joint inversion. We review pitfalls to interpretation associated with limited image resolution, spatially variable image resolution, incorrect data weighting, errors in the timing of measurements, temporal smearing resulting from changes during data acquisition, support-volume/scale effects, and incorrect assumptions or approximations involved in modeling geophysical or other jointly inverted data. A series of numerical and field-based examples illustrate these potential problems. Our goal in this talk is to raise awareness of common pitfalls and present strategies for recognizing and avoiding them.

Imaging of rare appendicular non-acral soft-tissue chondromas in adults with histopathologic correlation.

PubMed

Nouh, Mohamed Ragab; Amr, Hanan Abd El-Aziz; Ali, Rola H

2018-06-01

Background Soft-tissue chondroma (STC) is a rare benign soft tissue tumor that arises primarily in acral extra-skeletal locations. Occasionally, STCs may arise in more proximal non-acral locations, accompanied by non-classic features that label them as indeterminate lesions and pose diagnostic challenge for both radiologists and pathologists alike. Purpose To explicate the potential of diagnostic imaging in the identification and characterization of appendicular non-acral STCs with emphasis on their morphologic magnetic resonance imaging (MRI) enhancement. Material and Methods Our clinical database records were searched for patients with histologically proven primary soft-tissue chondroid lesions over a five-year period. Two musculoskeletal (MSK) trained radiologists evaluated the imaging studies and an MSK pathologist revised the pathological findings. Results The study included six cases of appendicular non-acral STCs (mean age = 40.5 years). The mean size of the tumors was 5.6 cm, with four localized to the knee region, one in the thigh, and one in the sternoclavicular region. All cases showed high signal intensity matrix with low-signal intensity septa on T2-weighted MRI and post-contrast marginal/septal enhancement. The lesions were lobulated and lacked host tissue reaction except for one showing subjacent mild soft-tissue edema. Histologically, the cases lacked overt features of malignancy although one was originally misdiagnosed as chondrosarcoma. Conclusion Non-acral STCs are benign cartilaginous tumors that may pose a diagnostic challenge, both radiologically and pathologically. Collaborative imaging and pathologic workup is needed for better characterization of non-aggression of these lesions, and to avoid diagnostic pitfalls and unnecessary radical resections.

Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion: cytohistologic correlation study with diagnostic pitfalls.

PubMed

Mokhtar, Ghadeer A; Delatour, Nicolas L D Roustan; Assiri, Ali H; Gilliatt, M Angela; Senterman, Mary; Islam, Shahidul

2008-01-01

In the current study, we explore the diagnostic parameters and pitfalls in the follow-up of 123 cases of Pap smears diagnosed as high-grade atypical squamous cells (ASC-H) at our institution. A computer database search was performed from the archives of the Ottawa Hospital Cytopathology Service for cases diagnosed with ASC-H between January 2003 and July 2005. Follow-up of the 123 cases of ASC-H showed high grade squamous intraepithelial lesion (HSIL) in 73 patients (59.4%), low grade squamous intraepithelial lesion (LSIL) in 11 (8.9%), immature squamous metaplasia in 23 (18.7%), reactive squamous cell changes in 12 (9.8%), benign glandular lesions (endocervical atypia, degenerated glandular cells) in 2 (1.6%) and atrophy in 2 (1.6%). In our study, 83 patients were younger than 40 years (67.4%), with biopsy-proven HSIL found in 54 patients (65.1%). The remaining 40 patients (32.6%) were older than 40 years of age, and follow-up biopsies showed HSIL in 19 patients (47.5%). In our study, 59.4% of the cases that were diagnosed cytologically as ASC-H were found to have HSIL on subsequent biopsies. This correlation was stronger in patients below the age of 40 years (65.1% vs. 47.5%). The cytopathologic feature most strongly associated with HSIL was the presence of coarse nuclear chromatin (84%).

Fine needle aspiration cytology of oral and oropharyngeal lesions with an emphasis on the diagnostic utility and pitfalls.

PubMed

Gupta, Nalini; Banik, Tarak; Rajwanshi, Arvind; Radotra, Bishan D; Panda, Naresh; Dey, Pranab; Srinivasan, Radhika; Nijhawan, Raje

2012-01-01

This study was undertaken to evaluate the diagnostic utility and pitfalls of fine needle aspiration cytology (FNAC) in oral and oropharyngeal lesions. This was a retrospective audit of oral and oropharyngeal lesions diagnosed with FNAC over a period of six years (2005-2010). Oral/oropharyngeal lesions [n=157] comprised 0.35% of the total FNAC load. The age ranged 1-80 years with the male: female ratio being 1.4:1. Aspirates were inadequate in 7% cases. Histopathology was available in 73/157 (46.5%) cases. Palate was the most common site of involvement [n=66] followed by tongue [n=35], buccal mucosa [n=18], floor of the mouth [n=17], tonsil [n=10], alveolus [n=5], retromolar trigone [n=3], and posterior pharyngeal wall [n=3]. Cytodiagnoses were categorized into infective/inflammatory lesions and benign cysts, and benign and malignant tumours. Uncommon lesions included ectopic lingual thyroid and adult rhabdomyoma of tongue, and solitary fibrous tumor (SFT), and leiomyosarcoma in buccal mucosa. A single false-positive case was dense inflammation with squamous cells misinterpreted as squamous cell carcinoma (SCC) on cytology. There were eight false-negative cases mainly due to sampling error. One false-negative case due to interpretation error was in a salivary gland tumor. The sensitivity of FNAC in diagnosing oral/oropharyngeal lesions was 71.4%; specificity was 97.8% with diagnostic accuracy of 87.7%. Salivary gland tumors and squamous cell carcinoma (SCC) are the most common lesions seen in the oral cavity. FNAC proves to be highly effective in diagnosing the spectrum of different lesions in this region. Sampling error is the main cause of false-negative cases in this region.

Human genetic resistance to malaria.

PubMed

Williams, Thomas N

2009-01-01

This brief chapter highlights the need for caution when designing and interpreting studies aimed at seeking new genes that may be associated with malaria protection, or investigating the potential mechanisms for protection in promising candidates. Judging genetic effects on the basis of the wrong clinical phenotype and missing true protective genes because their protective effects are masked by unpredictable epistatic effects are major potential pitfalls. These issues are by no means unique to malaria: in recent years, the importance of larger sample sizes and careful phenotypic definitions have become appreciated increasingly, particularly for genome-wide studies of complex diseases (Cordell and Clayton, 2005; Burton, Tobin and Hopper, 2005). Until recently, research in the field of malaria genetics has not enjoyed the sort of funding afforded to similar work investigating diseases of importance to the developed world. However, in the last few years, coupled with advances in genetic diagnostics that have led to massive automation and falling costs per gene explored, momentum has grown towards more generous funding that brings with it the opportunity for much larger, multisite cohesive studies. The stage is set for a giant leap forward in the coming years.

Pitfalls in genetic testing: the story of missed SCN1A mutations.

PubMed

Djémié, Tania; Weckhuysen, Sarah; von Spiczak, Sarah; Carvill, Gemma L; Jaehn, Johanna; Anttonen, Anna-Kaisa; Brilstra, Eva; Caglayan, Hande S; de Kovel, Carolien G; Depienne, Christel; Gaily, Eija; Gennaro, Elena; Giraldez, Beatriz G; Gormley, Padhraig; Guerrero-López, Rosa; Guerrini, Renzo; Hämäläinen, Eija; Hartmann, Corinna; Hernandez-Hernandez, Laura; Hjalgrim, Helle; Koeleman, Bobby P C; Leguern, Eric; Lehesjoki, Anna-Elina; Lemke, Johannes R; Leu, Costin; Marini, Carla; McMahon, Jacinta M; Mei, Davide; Møller, Rikke S; Muhle, Hiltrud; Myers, Candace T; Nava, Caroline; Serratosa, Jose M; Sisodiya, Sanjay M; Stephani, Ulrich; Striano, Pasquale; van Kempen, Marjan J A; Verbeek, Nienke E; Usluer, Sunay; Zara, Federico; Palotie, Aarno; Mefford, Heather C; Scheffer, Ingrid E; De Jonghe, Peter; Helbig, Ingo; Suls, Arvid

2016-07-01

Sanger sequencing, still the standard technique for genetic testing in most diagnostic laboratories and until recently widely used in research, is gradually being complemented by next-generation sequencing (NGS). No single mutation detection technique is however perfect in identifying all mutations. Therefore, we wondered to what extent inconsistencies between Sanger sequencing and NGS affect the molecular diagnosis of patients. Since mutations in SCN1A, the major gene implicated in epilepsy, are found in the majority of Dravet syndrome (DS) patients, we focused on missed SCN1A mutations. We sent out a survey to 16 genetic centers performing SCN1A testing. We collected data on 28 mutations initially missed using Sanger sequencing. All patients were falsely reported as SCN1A mutation-negative, both due to technical limitations and human errors. We illustrate the pitfalls of Sanger sequencing and most importantly provide evidence that SCN1A mutations are an even more frequent cause of DS than already anticipated.

Model-based analyses: Promises, pitfalls, and example applications to the study of cognitive control

PubMed Central

Mars, Rogier B.; Shea, Nicholas J.; Kolling, Nils; Rushworth, Matthew F. S.

2011-01-01

We discuss a recent approach to investigating cognitive control, which has the potential to deal with some of the challenges inherent in this endeavour. In a model-based approach, the researcher defines a formal, computational model that performs the task at hand and whose performance matches that of a research participant. The internal variables in such a model might then be taken as proxies for latent variables computed in the brain. We discuss the potential advantages of such an approach for the study of the neural underpinnings of cognitive control and its pitfalls, and we make explicit the assumptions underlying the interpretation of data obtained using this approach. PMID:20437297

Use of frozen section in genitourinary pathology.

PubMed

Shen, Steven S; Truong, Luan D; Ro, Jae Y; Ayala, Alberto G

2012-08-01

Frozen section diagnosis provides critical information for immediate surgical management decision making. Over the last several years, there have been some significant advances in treatment of genitourinary cancer, particularly with regard to surgical techniques. These changes in turn impact the type and frequency of intraoperative frozen section requests. In this review, we describe the main indications and diagnostic challenges of frozen section diagnosis during surgeries of each genitourinary organ system including prostate, kidney, bladder, testis, and penis. The pitfalls and approaches to different diagnostic situations are discussed. It is also stressed that pathologists must not only be familiar with the histological diagnosis, but also understand the limitations of frozen section diagnosis and communicate with urologists during the intraoperative treatment decision making process.

Broadsheet number 57: problems in fine needle biopsy of the thyroid.

PubMed

Orell, S R; Philips, J

2000-08-01

The role of fine needle biopsy and cytological diagnosis in the preoperative evaluation of thyroid nodules is reviewed on the basis of the current literature as well as the authors' personal experience. Technical aspects and guidelines for reporting thyroid samples are discussed in some detail. The main emphasis is on diagnostic pitfalls, those which may lead to a false-negative diagnosis, to a false-positive diagnosis or to an erroneous typing of the lesion, and their cytological patterns are described.

An unexpected cause of vaginal bleeding: the role of pelvic radiography.

PubMed

Kyrgios, Ioannis; Emmanouilidou, Eleftheria; Theodoridis, Theodoros; Galli-Tsinopoulou, Assimina

2014-02-14

Vaginal bleeding and/or discharge in young girls may result from infection, urological problems, endocrine causes, bleeding disorders, dermatological conditions, trauma, sexual abuse, masses or foreign bodies. We report a case of excessive vaginal bleeding caused by a foreign body in a prepubertal girl with emphasis on the diagnostic challenges and pitfalls regarding imaging techniques. In our patient, although invasive and expensive investigations had been initially made, the foreign body was last detected only when a plain pelvic radiography was performed.

Traumatic aortic injury: CT findings, mimics, and therapeutic options

PubMed Central

Lantz, Eric J.; Johnson, C. Michael; Young, Philip M.

2014-01-01

Objective Traumatic aortic injury (TAI) is rare, but frequently lethal. However, with prompt diagnosis, patients can undergo life-saving open or endovascular repair. Unfortunately, because these injuries are relatively rare, subtle forms of these injuries may be missed, and normal variants may mimic TAI leading to misdiagnosis. Conclusions We will discuss computed tomography findings of typical injury patterns of traumatic aortic injuries as well as treatment options, diagnostic pitfalls and injury mimics. These are highlighted with clinical case examples. PMID:25009793

Research methodology in recurrent pregnancy loss.

PubMed

Christiansen, Ole B

2014-03-01

The aim of this article is to highlight pitfalls in research methodology that may explain why studies in recurrent pregnancy loss (RPL) often provide very divergent results. It is hoped that insight into this issue may help clinicians decide which published studies are the most valid. It may help researchers to eliminate methodological flaws in future studies, which may hopefully come to some kind of agreement about the usefulness of diagnostic tests and treatments in RPL. Copyright © 2014 Elsevier Inc. All rights reserved.

Necrotizing Fasciitis Versus Pyoderma Gangrenosum: Securing the Correct Diagnosis! A Case Report and Literature Review

PubMed Central

Bisarya, Kamal; Azzopardi, Silvan; Lye, George; Drew, Peter James

2011-01-01

Objective: To highlight the key differences in history, examination, and management of pyoderma gangrenosum and necrotizing fasciitis and to outline the importance of distinguishing these 2 conditions. Method: We present a case report of a gentleman with a background of ulcerative colitis having a 1-week history of an erythematous wound and localized abscess to the right leg that failed to respond to antibiotic treatment and later on to surgical debridement of a presumed necrotizing fasciitis. Following referral to our plastic surgery unit, a diagnosis of pyoderma gangrenosum was made and this was confirmed following a response to steroid therapy within 48 hours. A literature review of pyoderma gangrenosum cases misdiagnosed for necrotizing fasciitis was carried out to compare and contrast pitfalls in misdiagnosing these 2 conditions. Results: Literature review of 10 cases confirmed the association of pyoderma gangrenosum with inflammatory bowel disease, hematological disease, and surgical trauma. The presence of necrotic tissue in a pyoderma gangrenosum lesion can be a diagnostic pitfall; although blood and tissue culture investigations are usually negative in pyoderma gangrenosum, this may not always be the case. Inflammatory markers can be significantly high in pyoderma gangrenosum and pyrexia is not a feature limited to necrotizing fasciitis. Conclusions: Inappropriate surgical debridement of pyoderma gangrenosum can cause rapid extension of the lesion by enhancing the posttraumatic response and lead to potential reconstructive challenges with psychological repercussions. On the contrary, treating necrotizing fasciitis with immunosuppressive therapy may worsen the condition. The importance of understanding the pathogenesis, clinical features, and management of both conditions cannot be overemphasized. PMID:21625613

Infantile botulism: pitfalls in electrodiagnosis.

PubMed

Sheth, R D; Lotz, B P; Hecox, K E; Waclawik, A J

1999-03-01

Botulism in infants, unless recognized early, is associated with high mortality and morbidity. The diagnosis is suspected when infants present with sudden onset of weakness, respiratory failure, and constipation and is confirmed by demonstration of botulinum toxin in stool several weeks later. Electrodiagnosis allows quick and reliable confirmation of botulism. Low-amplitude compound muscle action potentials, tetanic or post-tetanic facilitation, and the absence of post-tetanic exhaustion support the diagnosis. Two infants with confirmed botulism did not exhibit the characteristic electrodiagnostic features, demonstrating the pitfalls in electrodiagnosis of infantile botulism.

Technical Pitfall in 68Ga-Prostate Specific Membrane Antigen Imaging: Altered Biodistribution Caused by Free 68Ga-Citrate Due to Radiolysis Showing Increased Vascular Activity.

PubMed

Hod, Nir; Anconina, Reut; Levin, Daniel; Ezroh Kazap, Dina; Lantsberg, Sophie

2018-06-01

As with any new molecular imaging modality, accurate characterization of abnormalities on Ga-PSMA PET/CT imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants, and potential sources of false imaging findings. Altered biodistribution can have a significant impact on scan interpretation. Presented here is a rare case in which radiopharmaceutical radiolysis occurred causing excessive free Ga-citrate showing as an increased vascular activity. As Ga-PSMA PET/CT imaging is a relatively new imaging technique, it is important to be aware of such a potential technical pitfall in clinical practice in order to prevent scan misinterpretation.

Complexities and potential pitfalls of clinical study design and data analysis in assisted reproduction.

PubMed

Patounakis, George; Hill, Micah J

2018-06-01

The purpose of the current review is to describe the common pitfalls in design and statistical analysis of reproductive medicine studies. It serves to guide both authors and reviewers toward reducing the incidence of spurious statistical results and erroneous conclusions. The large amount of data gathered in IVF cycles leads to problems with multiplicity, multicollinearity, and over fitting of regression models. Furthermore, the use of the word 'trend' to describe nonsignificant results has increased in recent years. Finally, methods to accurately account for female age in infertility research models are becoming more common and necessary. The pitfalls of study design and analysis reviewed provide a framework for authors and reviewers to approach clinical research in the field of reproductive medicine. By providing a more rigorous approach to study design and analysis, the literature in reproductive medicine will have more reliable conclusions that can stand the test of time.

Bell's Palsy.

PubMed

Reich, Stephen G

2017-04-01

Bell's palsy is a common outpatient problem, and while the diagnosis is usually straightforward, a number of diagnostic pitfalls can occur, and a lengthy differential diagnosis exists. Recognition and management of Bell's palsy relies on knowledge of the anatomy and function of the various motor and nonmotor components of the facial nerve. Avoiding diagnostic pitfalls relies on recognizing red flags or features atypical for Bell's palsy, suggesting an alternative cause of peripheral facial palsy. The first American Academy of Neurology (AAN) evidence-based review on the treatment of Bell's palsy in 2001 concluded that corticosteroids were probably effective and that the antiviral acyclovir was possibly effective in increasing the likelihood of a complete recovery from Bell's palsy. Subsequent studies led to a revision of these recommendations in the 2012 evidence-based review, concluding that corticosteroids, when used shortly after the onset of Bell's palsy, were "highly likely" to increase the probability of recovery of facial weakness and should be offered; the addition of an antiviral to steroids may increase the likelihood of recovery but, if so, only by a very modest effect. Bell's palsy is characterized by the spontaneous acute onset of unilateral peripheral facial paresis or palsy in isolation, meaning that no features from the history, neurologic examination, or head and neck examination suggest a specific or alternative cause. In this setting, no further testing is necessary. Even without treatment, the outcome of Bell's palsy is favorable, but treatment with corticosteroids significantly increases the likelihood of improvement.

Case Report of Myeloid Sarcoma Masquerading as In-Transit Metastasis at a Previous Melanoma Site: Avoiding a Diagnostic Pitfall.

PubMed

Curry, Jonathan L; Tetzlaff, Michael T; Wang, Sa A; Landon, Gene; Alouch, Nail; Patel, Sapna P; Nagarajan, Priyadharsini; Gupta, Shiva; Aung, Phyu P; Devine, Catherine E; Khoury, Joseph D; Loghavi, Sanam; Prieto, Victor G; DiNardo, Courtney D; Gershenwald, Jeffrey E

2018-06-01

Myeloid sarcoma is a rare extramedullary hematologic malignancy. Accurate and timely diagnosis may be challenging because myeloid sarcoma is known to mimic solid tumors, including hepatobiliary, nasopharyngeal, and breast carcinomas. We report a case of myeloid sarcoma that developed in the primary tumor lymphatic drainage field of a previously treated intermediate-thickness cutaneous melanoma, clinically and radiographically mimicking an in-transit metastasis, in a patient with myelodysplastic syndrome. The diagnosis of myeloid sarcoma was achieved after surgical excision of the mass and pathological examination that included extensive immunohistochemical studies. Awareness of such an unusual clinical presentation can help reduce diagnostic delay and ensure that adequate tissue is obtained for pathological examination and ancillary studies that are critical for accurate diagnosis and appropriate patient management.

Acquired myospherulosis secondary to gluteal augmentation on fine needle aspiration cytology: A diagnostic challenge.

PubMed

Alperstein, Susan; Dilcher, Thomas; Viswanathan, Kartik; Rao, Rema A; Siddiqui, Momin T; Giorgadze, Tamara

2018-05-01

A 30-year-old female presented with a three-month history of a multilocular cystic lesion over the lumbosacral spine. Fine-needle aspiration biopsy (FNA) of the lesion was performed at an outside institution, and a cytologic diagnosis, suspicious for chordoma, was rendered. The patient presented for surgical consultation at our institution. Repeat FNA demonstrated an unusual fat-like material. Upon further inquiry, the patient provided a recent history of gluteal contour improvement with fibroadipose tissue implants. A diagnosis of myospherulosis was made with a concurrent surgical pathology correlation. No evidence of chordoma was identified. To date, this is the first reported case of acquired myospherulosis in the context of gluteal contour enhancement and represents an important diagnostic pitfall to consider on cytology preparations. © 2017 Wiley Periodicals, Inc.

Postgastric bypass hypoglycaemia in a patient with end-stage renal disease: a diagnostic and management pitfall.

PubMed

Khalid, Sameen; Bilal, Anika; Asad-Ur-Rahman, F N U; Pratley, Richard

2017-06-15

Roux-en-Y gastric bypass (RYGB) surgery is currently one of the most popular procedures to aid weight loss. Hypoglycaemia associated with gastric bypass surgery is an underdiagnosed but life-threatening potential consequence of the surgical procedure. We present a case of a 44-year-old woman with end-stage renal disease presenting with refractory hypoglycaemia after 10 years of RYGB. Extensive history and work-up excluded medications, renal disease, insulinoma and dumping syndrome as the cause of hypoglycaemia. Dietary modifications or pharmacological trial of drugs did not ameliorate her symptoms with progressive worsening of hypoglycaemia leading to continuous dextrose infusion. Distal pancreatectomy was performed with subsequent resolution of hypoglycaemia. Surgical pathology results showed diffuse hyperplastic islet cells, confirming the diagnosis of postgastric bypass hypoglycaemia. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Differential diagnosis of granulomatous lung disease: clues and pitfalls: Number 4 in the Series "Pathology for the clinician" Edited by Peter Dorfmüller and Alberto Cavazza.

PubMed

Ohshimo, Shinichiro; Guzman, Josune; Costabel, Ulrich; Bonella, Francesco

2017-09-30

Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi) and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis). Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis. Copyright ©ERS 2017.

Standard intelligence tests are valid instruments for measuring the intellectual potential of urban children: comments on pitfalls in the measurement of intelligence.

PubMed

Sattler, J M

1979-05-01

Hardy, Welcher, Mellitis, and Kagan altered standard WISC administrative and scoring procedures and, from the resulting higher subtest scores, concluded that IQs based on standardized tests are inappropriate measures for inner-city children. Careful examination of their study reveals many methodological inadequacies and problematic interpretations. Three of these are as follows: (a) failure to use any external criterion to evaluate the validity of their testing-of-limits procedures; (b) the possibility of examiner and investigator bias; and (c) lack of any comparison group that might demonstrate that poor children would be helped more than others by the probes recommended. Their report creates misleading doubts about existing intelligence tests and does a disservice to inner-city children who need the benefits of the judicious use of diagnostic procedures, which include standardized intelligence tests. Consequently, their assertion concerning the inappropriateness of standardized test results for inner-city children is not only premature and misleading, but it is unwarranted as well.

Gastric Glomus Tumour Misdiagnosed as Gastric Carcinoid: An Unfamiliar Entity with Aids to Diagnosis and Review of Literature.

PubMed

Vig, Tanush; Bindra, Mandeep Singh; Kumar, Ramani Manoj; Alexander, Suceena

2017-05-01

Glomus tumour (GT) is a rare mesenchymal tumour of the stomach with Gastrointestinal Stromal Tumour (GIST), leiomyoma and schwannoma being far more common and comprising more than 90% of all gastric mesenchymal tumours. As glomus bodies are located in the peripheral parts of the human body, these tumours are peripherally located, classically the subungual region, hands, feet and trunk. While being evaluated for renal problems, a middle aged lady was incidentally found to have a gastric tumour. This was submucosal in location and was excised by a wedge resection and reported elsewhere as carcinoid tumour. The patient came to our hospital for further management. The biopsy was reviewed here and the modified diagnosis given was GT, confirmed by panel of immunohistochemistry. Two years after regular clinical follow up the patient is free of disease or any distant metastasis. In this paper the authors discuss the potential pitfalls, differential diagnoses and diagnostic clues that help in diagnosing this gastric tumour.

Gastric Glomus Tumour Misdiagnosed as Gastric Carcinoid: An Unfamiliar Entity with Aids to Diagnosis and Review of Literature

PubMed Central

Bindra, Mandeep Singh; Kumar, Ramani Manoj; Alexander, Suceena

2017-01-01

Glomus tumour (GT) is a rare mesenchymal tumour of the stomach with Gastrointestinal Stromal Tumour (GIST), leiomyoma and schwannoma being far more common and comprising more than 90% of all gastric mesenchymal tumours. As glomus bodies are located in the peripheral parts of the human body, these tumours are peripherally located, classically the subungual region, hands, feet and trunk. While being evaluated for renal problems, a middle aged lady was incidentally found to have a gastric tumour. This was submucosal in location and was excised by a wedge resection and reported elsewhere as carcinoid tumour. The patient came to our hospital for further management. The biopsy was reviewed here and the modified diagnosis given was GT, confirmed by panel of immunohistochemistry. Two years after regular clinical follow up the patient is free of disease or any distant metastasis. In this paper the authors discuss the potential pitfalls, differential diagnoses and diagnostic clues that help in diagnosing this gastric tumour. PMID:28658787

Insights on Parenting.

ERIC Educational Resources Information Center

Barnes, Natalie

1993-01-01

The mother of an extremely gifted boy relates her emotional response upon learning of his giftedness, especially her excitement at his potential and her fear that his uniqueness harbors hidden pitfalls. (JDD)

Quantitation of heteroplasmy of mtDNA sequence variants identified in a population of AD patients and controls by array-based resequencing.

PubMed

Coon, Keith D; Valla, Jon; Szelinger, Szabolics; Schneider, Lonnie E; Niedzielko, Tracy L; Brown, Kevin M; Pearson, John V; Halperin, Rebecca; Dunckley, Travis; Papassotiropoulos, Andreas; Caselli, Richard J; Reiman, Eric M; Stephan, Dietrich A

2006-08-01

The role of mitochondrial dysfunction in the pathogenesis of Alzheimer's disease (AD) has been well documented. Though evidence for the role of mitochondria in AD seems incontrovertible, the impact of mitochondrial DNA (mtDNA) mutations in AD etiology remains controversial. Though mutations in mitochondrially encoded genes have repeatedly been implicated in the pathogenesis of AD, many of these studies have been plagued by lack of replication as well as potential contamination of nuclear-encoded mitochondrial pseudogenes. To assess the role of mtDNA mutations in the pathogenesis of AD, while avoiding the pitfalls of nuclear-encoded mitochondrial pseudogenes encountered in previous investigations and showcasing the benefits of a novel resequencing technology, we sequenced the entire coding region (15,452 bp) of mtDNA from 19 extremely well-characterized AD patients and 18 age-matched, unaffected controls utilizing a new, reliable, high-throughput array-based resequencing technique, the Human MitoChip. High-throughput, array-based DNA resequencing of the entire mtDNA coding region from platelets of 37 subjects revealed the presence of 208 loci displaying a total of 917 sequence variants. There were no statistically significant differences in overall mutational burden between cases and controls, however, 265 independent sites of statistically significant change between cases and controls were identified. Changed sites were found in genes associated with complexes I (30.2%), III (3.0%), IV (33.2%), and V (9.1%) as well as tRNA (10.6%) and rRNA (14.0%). Despite their statistical significance, the subtle nature of the observed changes makes it difficult to determine whether they represent true functional variants involved in AD etiology or merely naturally occurring dissimilarity. Regardless, this study demonstrates the tremendous value of this novel mtDNA resequencing platform, which avoids the pitfalls of erroneously amplifying nuclear-encoded mtDNA pseudogenes, and our proposed analysis paradigm, which utilizes the availability of raw signal intensity values for each of the four potential alleles to facilitate quantitative estimates of mtDNA heteroplasmy. This information provides a potential new target for burgeoning diagnostics and therapeutics that could truly assist those suffering from this devastating disorder.

YouTube: Educational Potentials and Pitfalls

ERIC Educational Resources Information Center

Jones, Troy; Cuthrell, Kristen

2011-01-01

The instructional potential of video technology in the classroom is promising, especially in light of the 21st Century Learning Framework (Siegle, 2009). Studies show positive gains in student outcomes as a result of the integration of video technology in instruction. This article explores potential uses of YouTube as an instructional aid in…

[Persistence of the 5th aortic arch associated with interruption of the aortic arch].

PubMed

Houssa, Mahdi Ait; Atmani, Noureddine; Bamous, Mehdi; Abdou, Abdessamad; Nya, Fouad; Seghrouchni, Anis; Amahzoune, Brahim; El Bekkali, Youssef; Drissi, Mohamed; Boulahya, Abdelatif

2017-01-01

We report a case of persistence of the 5th aortic arch associated with total interruption of the aortic arch. This clinical case shows the diagnostic pitfall of the persistence of the 5th aortic arch and its beneficial hemodynamic effect. Preoperative clinical picture was misleading, due to the persistence of femoral pulses and clinical signs of left-to-right shunt via a wide ductus arteriosus. The diagnosis was intraoperatively adjusted on the basis of blood pressure monitoring using catheter placed into the femoral artery.

OVERVIEW, PRACTICAL TIPS AND POTENTIAL PITFALLS OF USING AUTOMATIC EXPOSURE CONTROL IN CT: SIEMENS CARE DOSE 4D.

PubMed

Söderberg, Marcus

2016-06-01

Today, computed tomography (CT) systems routinely use automatic exposure control (AEC), which modulates the tube current. However, for optimal use, there are several aspects of an AEC system that need to be considered. The purpose of this study was to provide an overview of the Siemens CARE Dose 4D AEC system, discuss practical tips and demonstrate potential pitfalls. Two adult anthropomorphic phantoms were examined using two different Siemens CT systems. When optimising the CT radiation dose and image quality, the projection angle of the localiser, patient centring, protocol selection, scanning direction and the use of protective devices requires special attention. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Mainstreaming: The Promise and the Pitfalls.

ERIC Educational Resources Information Center

Longo, Paul

1982-01-01

Hails the potential that mainstreaming of the handicapped holds for developing individual potential and enhancing equal educational opportunity, but cautions that extensive retraining of staff and diversification of teaching strategies will be necessary if adequate implementation of Public Law 94-142 is to be achieved. (GC)

Warthin tumor with signet-ring cell features as a pitfall in salivary gland cytopathology.

PubMed

Bellevicine, Claudio; Iaccarino, Antonino; Malapelle, Umberto; Troncone, Giancarlo

2013-01-01

Warthin tumor (WT) is a common parotid lesion reliably diagnosed by fine-needle aspiration (FNA). Worrisome metaplastic changes may occur in WT. Their interpretation as mucoepidermoid carcinoma represents a diagnostic pitfall. Moreover, WT and mucoepidermoid carcinoma may coexist, making this distinction difficult. So it is worthwhile to report unusual WT features. We describe a WT with signet-ring cells (SRCs). A 61-year-old male presenting with a 3.6-cm right parotid gland mass underwent FNA with rapid on-site evaluation. DiffQuik-stained smears showed groups of oncocytic cells with abundant granular cytoplasm in a background rich with debris, foamy macrophages and lymphoid cells. SRCs were observed on Papanicolaou-stained smears prepared from a second pass. A WT with SRC features was diagnosed. Histology revealed a WT with post-FNA infarctual changes. To avoid false-positive diagnoses, the cytopathologist should be aware that SRC features may occur in WT. The concomitant presence of oncocytes and SRCs is useful to correctly diagnose this unusual WT variant. Copyright © 2013 S. Karger AG, Basel.

Going single but not solo with podocytes: potentials, limitations, and pitfalls of single-cell analysis.

PubMed

Schiffer, Mario

2017-11-01

Single-cell RNA-sequence (RNA-seq) is a widely used tool to study biological questions in single cells. The discussed study identified 92 genes being predominantly expressed in podocytes based on a 5-fold higher expression compared with endothelial and mesangial cells. In addition to technical pitfalls, the question that is discussed in this commentary is whether results of a single-cell RNAseq study are able to deliver expression data that truly characterize a podocyte. Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

A practical guide to epidemiological practice and standards in the identification and validation of diagnostic markers using a bladder cancer example.

PubMed

Behrens, T; Bonberg, N; Casjens, S; Pesch, B; Brüning, T

2014-01-01

Technical advances to analyze biological markers have generated a plethora of promising new marker candidates for early detection of cancer. However, in subsequent analyses only few could be successfully validated as being predictive, clinically useful, or effective. This failure is partially due to rapid publication of results that were detected in early stages of biomarker research. Methodological considerations are a major concern when carrying out molecular epidemiological studies of diagnostic markers to avoid errors that increase the potential for bias. Although guidelines for conducting studies and reporting of results have been published to improve the quality of marker studies, their planning and execution still need to be improved. We will discuss different sources of bias in study design, handling of specimens, and statistical analysis to illustrate possible pitfalls associated with marker research, and present legal, ethical, and technical considerations associated with storage and handling of specimens. This article presents a guide to epidemiological standards in marker research using bladder cancer as an example. Because of the possibility to detect early cancer stages due to leakage of molecular markers from the target organ or exfoliation of tumor cells into the urine, bladder cancer is particularly useful to study diagnostic markers. To improve the overall quality of marker research, future developments should focus on networks of studies and tissue banks according to uniform legal, ethical, methodological, and technical standards. This article is part of a Special Issue entitled: Computational Proteomics in the Post-Identification Era. Guest Editors: Martin Eisenacher and Christian Stephan. © 2013.

Common System and Software Testing Pitfalls

DTIC Science & Technology

2014-11-03

GEN- TTE -1) Target Platform Difficult to Access (GEN- TTE -2) → Inadequate Test Environments (GEN- TTE -3) Poor Fidelity of Test Environments (GEN- TTE -4...Inadequate Test Environment Quality (GEN- TTE -5) Test Environments Inadequately Tested (GEN- TTE -6) [new pitfall] Inadequate Test Configuration...Management (GEN- TTE -7) 29Common System/SW Testing PitfallsDonald G. Firesmith, 3 November 2014 General Pitfalls – Automated Testing [new pitfall category

Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization.

PubMed

Lenoir, Laurence; Edeline, Julien; Rolland, Yann; Pracht, Marc; Raoul, Jean-Luc; Ardisson, Valérie; Bourguet, Patrick; Clément, Bruno; Boucher, Eveline; Garin, Etienne

2012-05-01

Identifying gastroduodenal uptake of (99m)Tc-macroaggregated albumin (MAA), which is associated with an increased risk of ulcer disease, is a crucial part of the therapeutic management of patients undergoing radioembolization for liver tumours. Given this context, the use of MAA single photon emission computed tomography (SPECT)/CT may be essential, but the procedure has still not been thoroughly evaluated. The aim of this retrospective study was to determine the effectiveness of MAA SPECT/CT in identifying digestive extrahepatic uptake, while determining potential diagnostic pitfalls. Overall, 139 MAA SPECT/CT scans were performed on 103 patients with different hepatic tumour types. Patients were followed up for at least 6 months according to standard requirements. Digestive, or digestive-like, uptake other than free pertechnetate was identified in 5.7% of cases using planar imaging and in 36.6% of cases using SPECT/CT. Uptake sites identified by SPECT/CT included the gastroduodenal region (3.6%), gall bladder (12.2%), portal vein thrombosis (6.5%), hepatic artery (6.5%), coil embolization site (2.1%) as well as falciform artery (5.0%). For 2.1% of explorations, a coregistration error between SPECT and CT imaging could have led to a false diagnosis by erroneously attributing an uptake site to the stomach or gall bladder, when the uptake actually occurred in the liver. SPECT/CT is more efficacious than planar imaging in identifying digestive extrahepatic uptake sites, with extrahepatic uptake observed in one third of scans using the former procedure. However, more than half of the uptake sites in our study were vascular in nature, without therapeutic implications. The risk of coregistration errors must also be kept in mind.

'Medusa head ataxia': the expanding spectrum of Purkinje cell antibodies in autoimmune cerebellar ataxia. Part 3: Anti-Yo/CDR2, anti-Nb/AP3B2, PCA-2, anti-Tr/DNER, other antibodies, diagnostic pitfalls, summary and outlook.

PubMed

Jarius, S; Wildemann, B

2015-09-17

Serological testing for anti-neural autoantibodies is important in patients presenting with idiopathic cerebellar ataxia, since these autoantibodies may indicate cancer, determine treatment and predict prognosis. While some of them target nuclear antigens present in all or most CNS neurons (e.g. anti-Hu, anti-Ri), others more specifically target antigens present in the cytoplasm or plasma membrane of Purkinje cells (PC). In this series of articles, we provide a detailed review of the clinical and paraclinical features, oncological, therapeutic and prognostic implications, pathogenetic relevance, and differential laboratory diagnosis of the 12 most common PC autoantibodies (often referred to as 'Medusa head antibodies' due to their characteristic somatodendritic binding pattern when tested by immunohistochemistry). To assist immunologists and neurologists in diagnosing these disorders, typical high-resolution immunohistochemical images of all 12 reactivities are presented, diagnostic pitfalls discussed and all currently available assays reviewed. Of note, most of these antibodies target antigens involved in the mGluR1/calcium pathway essential for PC function and survival. Many of the antigens also play a role in spinocerebellar ataxia. Part 1 focuses on anti-metabotropic glutamate receptor 1-, anti-Homer protein homolog 3-, anti-Sj/inositol 1,4,5-trisphosphate receptor- and anti-carbonic anhydrase-related protein VIII-associated autoimmune cerebellar ataxia (ACA); part 2 covers anti-protein kinase C gamma-, anti-glutamate receptor delta-2-, anti-Ca/RhoGTPase-activating protein 26- and anti-voltage-gated calcium channel-associated ACA; and part 3 reviews the current knowledge on anti-Tr/delta notch-like epidermal growth factor-related receptor-, anti-Nb/AP3B2-, anti-Yo/cerebellar degeneration-related protein 2- and Purkinje cell antibody 2-associated ACA, discusses differential diagnostic aspects and provides a summary and outlook.

Detection of paroxysmal nocturnal hemoglobinuria clones in patients with myelodysplastic syndromes and related bone marrow diseases, with emphasis on diagnostic pitfalls and caveats

PubMed Central

Wang, Sa A.; Pozdnyakova, Olga; Jorgensen, Jeffrey L.; Medeiros, L. Jeffrey; Stachurski, Dariusz; Anderson, Mary; Raza, Azra; Woda, Bruce A.

2009-01-01

Background The presence of paroxysmal nocturnal hemoglobinuria clones in the setting of aplastic anemia or myelodysplastic syndrome has been shown to have prognostic and therapeutic implications. However, the status of paroxysmal nocturnal hemoglobinuria clones in various categories of myelodysplastic syndrome and in other bone marrow disorders is not well-studied. Design and Methods By using multiparameter flow cytometry immunophenotypic analysis with antibodies specific for four glycosylphosphatidylinositol-anchored proteins (CD55, CD59, CD16, CD66b) and performing an aerolysin lysis confirmatory test in representative cases, we assessed the paroxysmal nocturnal hemoglobinuria-phenotype granulocytes in 110 patients with myelodysplastic syndrome, 15 with myelodysplastic/myeloproliferative disease, 5 with idiopathic myelofibrosis and 6 with acute myeloid leukemia. Results Paroxysmal nocturnal hemoglobinuria-phenotype granulocytes were detected in nine patients with low grade myelodysplastic syndrome who showed clinicopathological features of bone marrow failure, similar to aplastic anemia. All paroxysmal nocturnal hemoglobinuria-positive cases demonstrated loss of the four glycosylphosphatidylinositol-anchored proteins, with CD16−CD66b− clones being larger than those of CD55−CD59− (p<0.05). Altered glycosylphosphatidylinositol-anchored protein expression secondary to granulocytic hypogranulation, immaturity, and/or immunophenotypic abnormalities was present in a substantial number of cases and diagnostically challenging. Conclusions These results show that routine screening for paroxysmal nocturnal hemoglobinuria clones in patients with an intrinsic bone marrow disease who show no clinical evidence of hemolysis has an appreciable yield in patients with low grade myelodysplastic syndromes. The recognition of diagnostic caveats and pitfalls associated with the underlying intrinsic bone marrow disease is essential in interpreting paroxysmal nocturnal hemoglobinuria testing correctly. In our experience, the CD16/CD66b antibody combination is superior to CD55/CD59 in screening for subclinical paroxysmal nocturnal hemoglobinuria because it detects a large clone size and is less subject to analytical interference. PMID:19001281

Detection of paroxysmal nocturnal hemoglobinuria clones in patients with myelodysplastic syndromes and related bone marrow diseases, with emphasis on diagnostic pitfalls and caveats.

PubMed

Wang, Sa A; Pozdnyakova, Olga; Jorgensen, Jeffrey L; Medeiros, L Jeffrey; Stachurski, Dariusz; Anderson, Mary; Raza, Azra; Woda, Bruce A

2009-01-01

The presence of paroxysmal nocturnal hemoglobinuria clones in the setting of aplastic anemia or myelodysplastic syndrome has been shown to have prognostic and therapeutic implications. However, the status of paroxysmal nocturnal hemoglobinuria clones in various categories of myelodysplastic syndrome and in other bone marrow disorders is not well-studied. By using multiparameter flow cytometry immunophenotypic analysis with antibodies specific for four glycosylphosphatidylinositol-anchored proteins (CD55, CD59, CD16, CD66b) and performing an aerolysin lysis confirmatory test in representative cases, we assessed the paroxysmal nocturnal hemoglobinuria-phenotype granulocytes in 110 patients with myelodysplastic syndrome, 15 with myelodysplastic/myeloproliferative disease, 5 with idiopathic myelofibrosis and 6 with acute myeloid leukemia. Paroxysmal nocturnal hemoglobinuria-phenotype granulocytes were detected in nine patients with low grade myelodysplastic syndrome who showed clinicopathological features of bone marrow failure, similar to aplastic anemia. All paroxysmal nocturnal hemoglobinuria-positive cases demonstrated loss of the four glycosylphosphatidylinositol-anchored proteins, with CD16(-)CD66b(-) clones being larger than those of CD55(-)CD59(-) (p<0.05). Altered glycosylphosphatidylinositol-anchored protein expression secondary to granulocytic hypogranulation, immaturity, and/or immunophenotypic abnormalities was present in a substantial number of cases and diagnostically challenging. These results show that routine screening for paroxysmal nocturnal hemoglobinuria clones in patients with an intrinsic bone marrow disease who show no clinical evidence of hemolysis has an appreciable yield in patients with low grade myelodysplastic syndromes. The recognition of diagnostic caveats and pitfalls associated with the underlying intrinsic bone marrow disease is essential in interpreting paroxysmal nocturnal hemoglobinuria testing correctly. In our experience, the CD16/CD66b antibody combination is superior to CD55/CD59 in screening for subclinical paroxysmal nocturnal hemoglobinuria because it detects a large clone size and is less subject to analytical interference.

Complex clinical reasoning in the critical care unit - difficulties, pitfalls and adaptive strategies.

PubMed

Shaw, M; Singh, S

2015-04-01

Diagnostic error has implications for both clinical outcome and resource utilisation, and may often be traced to impaired data gathering, processing or synthesis because of the influence of cognitive bias. Factors inherent to the intensive/acute care environment afford multiple additional opportunities for such errors to occur. This article illustrates many of these with reference to a case encountered on our intensive care unit. Strategies to improve completeness of data gathering, processing and synthesis in the acute care environment are critically appraised in the context of early detection and amelioration of cognitive bias. These include reflection, targeted simulation training and the integration of social media and IT based aids in complex diagnostic processes. A framework which can be quickly and easily employed in a variety of clinical environments is then presented. © 2015 John Wiley & Sons Ltd.

The importance and pitfalls of correlational science in palliative care research.

PubMed

Klepstad, Pål; Kaasa, Stein

2012-12-01

Correlational science discovers associations between patient characteristics, symptoms and biomarkers. Correlational science using data from cross-sectional studies is the most frequently applied study design in palliative care research. The purpose of this review is to address the importance and potential pitfalls in correlational science. Associations observed in correlational science studies can be the basis for generating hypotheses that can be tested in experimental studies and are the basic data needed to develop classification systems that can predict patient outcomes. Major pitfalls in correlational science are that associations do not equate with causality and that statistical significance does not necessarily equal a correlation that is of clinical interest. Researchers should be aware of the end-points that are clinically relevant, that end-points should be defined before the start of the analyses, and that studies with several end-points should account for multiplicity. Correlational science in palliative care research can identify related clinical factors and biomarkers. Interpretation of identified associations should be done with careful consideration of the limitations underlying correlational analyses.

Advantages and pitfalls in the application of mixed-model association methods.

PubMed

Yang, Jian; Zaitlen, Noah A; Goddard, Michael E; Visscher, Peter M; Price, Alkes L

2014-02-01

Mixed linear models are emerging as a method of choice for conducting genetic association studies in humans and other organisms. The advantages of the mixed-linear-model association (MLMA) method include the prevention of false positive associations due to population or relatedness structure and an increase in power obtained through the application of a correction that is specific to this structure. An underappreciated point is that MLMA can also increase power in studies without sample structure by implicitly conditioning on associated loci other than the candidate locus. Numerous variations on the standard MLMA approach have recently been published, with a focus on reducing computational cost. These advances provide researchers applying MLMA methods with many options to choose from, but we caution that MLMA methods are still subject to potential pitfalls. Here we describe and quantify the advantages and pitfalls of MLMA methods as a function of study design and provide recommendations for the application of these methods in practical settings.

Germanium soup

NASA Astrophysics Data System (ADS)

Palmer, Troy A.; Alexay, Christopher C.

2006-05-01

This paper addresses the variety and impact of dispersive model variations for infrared materials and, in particular, the level to which certain optical designs are affected by this potential variation in germanium. This work offers a method for anticipating and/or minimizing the pitfalls such potential model variations may have on a candidate optical design.

Perspective: Whither the problem list? Organ-based documentation and deficient synthesis by medical trainees.

PubMed

Kaplan, Daniel M

2010-10-01

The author argues that the well-formulated problem list is essential for both organizing and evaluating diagnostic thinking. He considers evidence of deficiencies in problem lists in the medical record. He observes a trend among medical trainees toward organizing notes in the medical record according to lists of organ systems or medical subspecialties and hypothesizes that system-based documentation may undermine the art of problem formulation and diagnostic synthesis. Citing research linking more sophisticated problem representation with diagnostic success, he suggests that documentation style and clinical reasoning are closely connected and that organ-based documentation may predispose trainees to several varieties of cognitive diagnostic error and deficient synthesis. These include framing error, premature or absent closure, failure to integrate related findings, and failure to recognize the level of diagnostic resolution attained for a given problem. He acknowledges the pitfalls of higher-order diagnostic resolution, including the application of labels unsupported by firm evidence, while maintaining that diagnostic resolution as far as evidence permits is essential to both rational care of patients and rigorous education of learners. He proposes further research, including comparison of diagnostic efficiency between organ- and problem-oriented thinkers. He hypothesizes that the subspecialty-based structure of academic medical services helps perpetuate organ-system-based thinking, and calls on clinical educators to renew their emphasis on the formulation and documentation of complete and precise problem lists and progressively refined diagnoses by trainees.

Small renal mass biopsy--how, what and when: report from an international consensus panel.

PubMed

Tsivian, Matvey; Rampersaud, Edward N; del Pilar Laguna Pes, Maria; Joniau, Steven; Leveillee, Raymond J; Shingleton, William B; Aron, Monish; Kim, Charles Y; DeMarzo, Angelo M; Desai, Mihir M; Meler, James D; Donovan, James F; Klingler, Hans Christoph; Sopko, David R; Madden, John F; Marberger, Michael; Ferrandino, Michael N; Polascik, Thomas J

2014-06-01

To discuss the use of renal mass biopsy (RMB) for small renal masses (SRMs), formulate technical aspects, outline potential pitfalls and provide recommendations for the practicing clinician. The meeting was conducted as an informal consensus process and no scoring system was used to measure the levels of agreement on the different topics. A moderated general discussion was used as the basis for consensus and arising issues were resolved at this point. A consensus was established and lack of agreement to topics or specific items was noted at this point. Recommended biopsy technique: at least two cores, sampling different tumour regions with ultrasonography being the preferred method of image guidance. Pathological interpretation: 'non-diagnostic samples' should refer to insufficient material, inconclusive and normal renal parenchyma. For non-diagnostic samples, a repeat biopsy is recommended. Fine-needle aspiration may provide additional information but cannot substitute for core biopsy. Indications for RMB: biopsy is recommended in most cases except in patients with imaging or clinical characteristics indicative of pathology (syndromes, imaging characteristics) and cases whereby conservative management is not contemplated. RMB is recommended for active surveillance but not for watchful-waiting candidates. We report the results of an international consensus meeting on the use of RMB for SRMs, defining the technique, pathological interpretation and indications. © 2013 The Authors. BJU International © 2013 BJU International.

Looking beyond the exome: a phenotype-first approach to molecular diagnostic resolution in rare and undiagnosed diseases.

PubMed

Pena, Loren D M; Jiang, Yong-Hui; Schoch, Kelly; Spillmann, Rebecca C; Walley, Nicole; Stong, Nicholas; Rapisardo Horn, Sarah; Sullivan, Jennifer A; McConkie-Rosell, Allyn; Kansagra, Sujay; Smith, Edward C; El-Dairi, Mays; Bellet, Jane; Keels, Martha Ann; Jasien, Joan; Kranz, Peter G; Noel, Richard; Nagaraj, Shashi K; Lark, Robert K; Wechsler, Daniel S G; Del Gaudio, Daniela; Leung, Marco L; Hendon, Laura G; Parker, Collette C; Jones, Kelly L; Goldstein, David B; Shashi, Vandana

2018-04-01

PurposeTo describe examples of missed pathogenic variants on whole-exome sequencing (WES) and the importance of deep phenotyping for further diagnostic testing.MethodsGuided by phenotypic information, three children with negative WES underwent targeted single-gene testing.ResultsIndividual 1 had a clinical diagnosis consistent with infantile systemic hyalinosis, although WES and a next-generation sequencing (NGS)-based ANTXR2 test were negative. Sanger sequencing of ANTXR2 revealed a homozygous single base pair insertion, previously missed by the WES variant caller software. Individual 2 had neurodevelopmental regression and cerebellar atrophy, with no diagnosis on WES. New clinical findings prompted Sanger sequencing and copy number testing of PLA2G6. A novel homozygous deletion of the noncoding exon 1 (not included in the WES capture kit) was detected, with extension into the promoter, confirming the clinical suspicion of infantile neuroaxonal dystrophy. Individual 3 had progressive ataxia, spasticity, and magnetic resonance image changes of vanishing white matter leukoencephalopathy. An NGS leukodystrophy gene panel and WES showed a heterozygous pathogenic variant in EIF2B5; no deletions/duplications were detected. Sanger sequencing of EIF2B5 showed a frameshift indel, probably missed owing to failure of alignment.ConclusionThese cases illustrate potential pitfalls of WES/NGS testing and the importance of phenotype-guided molecular testing in yielding diagnoses.

Looking beyond the exome: a phenotype-first approach to molecular diagnostic resolution in rare and undiagnosed diseases

PubMed Central

Pena, Loren DM; Jiang, Yong-Hui; Schoch, Kelly; Spillmann, Rebecca C.; Walley, Nicole; Stong, Nicholas; Horn, Sarah Rapisardo; Sullivan, Jennifer A.; McConkie-Rosell, Allyn; Kansagra, Sujay; Smith, Edward C.; El-Dairi, Mays; Bellet, Jane; Ann Keels, Martha; Jasien, Joan; Kranz, Peter G.; Noel, Richard; Nagaraj, Shashi K.; Lark, Robert K.; Wechsler, Daniel SG; del Gaudio, Daniela; Leung, Marco L.; Hendon, Laura G.; Parker, Collette C.; Jones, Kelly L.; Goldstein, David B.; Shashi, Vandana

2017-01-01

Purpose To describe examples of missed pathogenic variants on whole exome sequencing (WES) and the importance of deep phenotyping for further diagnostic testing. Methods Guided by phenotypic information, three children with negative WES underwent targeted single gene testing. Results Individual 1 had a clinical diagnosis consistent with infantile systemic hyalinosis, although WES and an NGS-based ANTXR2 test were negative. Sanger sequencing of ANTXR2 revealed a homozygous single base pair insertion, previously missed by the WES variant caller software. Individual 2 had neurodevelopmental regression and cerebellar atrophy, with no diagnosis on WES. New clinical findings prompted Sanger sequencing and copy number testing of PLA2G6. A novel homozygous deletion of the non-coding exon 1 (not included in the WES capture kit) was detected, with extension into the promoter, confirming the clinical suspicion of infantile neuroaxonal dystrophy. Individual 3 had progressive ataxia, spasticity and MRI changes of vanishing white matter leukoencephalopathy. An NGS leukodystrophy gene panel and WES showed a heterozygous pathogenic variant in EIF2B5; no deletions/duplications were detected. Sanger sequencing of EIF2B5 showed a frameshift indel, likely missed due to failure of alignment. Conclusions These cases illustrate potential pitfalls of WES/NGS testing, and the importance of phenotype-guided molecular testing in yielding diagnoses. PMID:28914269

MRI Measurements of Iron Load in Transfusion‐Dependent Patients: Implementation, Challenges, and Pitfalls

PubMed Central

St Pierre, Tim G.

2015-01-01

Magnetic resonance imaging (MRI) has played a key role in studies of iron overload in transfusion‐dependent patients, providing insights into the relations among liver and cardiac iron loading, iron chelator dose, and morbidity. Currently, there is rapid uptake of these methods into routine clinical practice as part of the management strategy for iron overload in regularly transfused patients. Given the manifold methods of data acquisition and analysis, there are several potential pitfalls that may result in inappropriate decision making. Herein, we review the challenges of establishing suitable MRI techniques for tissue iron measurement in regularly transfused patients. PMID:26713769

Cat-Scratch Disease: A Pitfall for Lymphoma Evaluation by FDG-PET/CT.

PubMed

Dubreuil, Julien; Dony, Arthur; Salles, Gilles; Traverse-Glehen, Alexandra; Giammarile, Francesco; Skanjeti, Andrea

2017-02-01

FDG-PET/CT is a standard of care in staging and response assessment of Hodgkin lymphoma. Hence, it is important to recognize pitfalls owing to the potential therapeutic impact. We report a case of a 29-year-old woman affected by stage III bulky Hodgkin lymphoma. The interim FDG-PET/CT showed a complete metabolic response. After three new cycles of chemotherapy, the patient showed fever and lymphadenopathy at clinic examination, PET/CT revealed several FDG uptakes at lymph nodes in inguinal and iliac region. Pathologic analyses, after biopsy and serologic examinations, led to the diagnosis of cat-scratch disease.

A systematic, multimodality approach to emergency elbow imaging.

PubMed

Singer, Adam D; Hanna, Tarek; Jose, Jean; Datir, Abhijit

2016-01-01

The elbow is a complex synovial hinge joint that is frequently involved in both athletic and nonathletic injuries. A thorough understanding of the normal anatomy and various injury patterns is essential when utilizing diagnostic imaging to identify damaged structures and to assist in surgical planning. In this review, the elbow anatomy will be scrutinized in a systematic approach. This will be followed by a comprehensive presentation of elbow injuries that are commonly seen in the emergency department accompanied by multimodality imaging findings. A short discussion regarding pitfalls in elbow imaging is also included. Copyright © 2015 Elsevier Inc. All rights reserved.

Merkel Cell Carcinoma.

PubMed

Pulitzer, Melissa

2017-06-01

Merkel cell carcinoma (MCC) encompasses neuroendocrine carcinomas primary to skin and occurs most commonly in association with clonally integrated Merkel cell polyomavirus with related retinoblastoma protein sequestration or in association with UV radiation-induced alterations involving the TP53 gene and mutations, heterozygous deletion, and hypermethylation of the Retinoblastoma gene. Molecular genetic signatures may provide therapeutic guidance. Morphologic features, although patterned, are associated with predictable diagnostic pitfalls, usually resolvable by immunohistochemistry. Therapeutic options for MCC, traditionally limited to surgical intervention and later chemotherapy and radiation, are growing, given promising early results of immunotherapeutic regimens. Copyright © 2017 Elsevier Inc. All rights reserved.

Telangiectatic osteosarcoma of the spine: a case report.

PubMed

Amritanand, R; Venkatesh, K; Cherian, R; Shah, A; Sundararaj, G D

2008-09-01

Telangiectatic osteosarcoma (TOS) of the spine is rare accounting for only 0.08% of all primary osteosarcomas. Though a well described radio-pathological entity it is not often thought of as a cause of paraplegia. We describe the clinical, radiological and pathological features and discuss the treatment options of telangiectatic osteosarcoma of the dorsal spine presenting in a young man. The diagnostic pitfalls are discussed emphasising the fact that the diagnosis of TOS of the spine requires not only a multi modal approach of appropriate radiological and pathological tests but also an awareness of this condition.

Telangiectatic osteosarcoma of the spine: a case report

PubMed Central

Venkatesh, K.; Cherian, R.; Shah, A.; Sundararaj, G. D.

2008-01-01

Telangiectatic osteosarcoma (TOS) of the spine is rare accounting for only 0.08% of all primary osteosarcomas. Though a well described radio-pathological entity it is not often thought of as a cause of paraplegia. We describe the clinical, radiological and pathological features and discuss the treatment options of telangiectatic osteosarcoma of the dorsal spine presenting in a young man. The diagnostic pitfalls are discussed emphasising the fact that the diagnosis of TOS of the spine requires not only a multi modal approach of appropriate radiological and pathological tests but also an awareness of this condition. PMID:18421481

Odontogenic Cysts and Neoplasms.

PubMed

Bilodeau, Elizabeth Ann; Collins, Bobby M

2017-03-01

This article reviews a myriad of common and uncommon odontogenic cysts and tumors. The clinical presentation, gross and microscopic features, differential diagnosis, prognosis, and diagnostic pitfalls are addressed for inflammatory cysts (periapical cyst, mandibular infected buccal cyst/paradental cyst), developmental cysts (dentigerous, lateral periodontal, glandular odontogenic, orthokeratinized odontogenic cyst), benign tumors (keratocystic odontogenic tumor, ameloblastoma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, ameloblastic fibroma and fibroodontoma, odontoma, squamous odontogenic tumor, calcifying cystic odontogenic tumor, primordial odontogenic tumor, central odontogenic fibroma, and odontogenic myxomas), and malignant tumors (clear cell odontogenic carcinoma, ameloblastic carcinoma, ameloblastic fibrosarcoma). Copyright © 2016 Elsevier Inc. All rights reserved.

Common Postmortem Computed Tomography Findings Following Atraumatic Death: Differentiation between Normal Postmortem Changes and Pathologic Lesions

PubMed Central

Gonoi, Wataru; Okuma, Hidemi; Shirota, Go; Shintani, Yukako; Abe, Hiroyuki; Takazawa, Yutaka; Fukayama, Masashi; Ohtomo, Kuni

2015-01-01

Computed tomography (CT) is widely used in postmortem investigations as an adjunct to the traditional autopsy in forensic medicine. To date, several studies have described postmortem CT findings as being caused by normal postmortem changes. However, on interpretation, postmortem CT findings that are seemingly due to normal postmortem changes initially, may not have been mere postmortem artifacts. In this pictorial essay, we describe the common postmortem CT findings in cases of atraumatic in-hospital death and describe the diagnostic pitfalls of normal postmortem changes that can mimic real pathologic lesions. PMID:26175579

GIS applications to wilderness management: potential uses and limitations

Treesearch

Peter Landres; David R. Spildie; Lloyd P. Queen

2001-01-01

Geographic Information Systems (GIS) are increasingly being used in all areas of natural resource management. This paper first presents a brief primer on GIS, and then discusses potential applications of GIS to wilderness management in the areas of inventorying, monitoring, analysis, planning, and communication. Outlined are the limitations and pitfalls that could...

Treatment of Child Victims of Incest.

ERIC Educational Resources Information Center

Boatman, Bonny; And Others

1981-01-01

Reviews three treatment methods (individual, group, and family therapy) used over a five-year period for child incest victims. Presents common themes, issues, and pitfalls that arose during therapy. Stresses potential benefits of psychotherapy to this population. (Author)

Chief Knowledge Officers? Perceptions, Pitfalls, & Potential.

ERIC Educational Resources Information Center

Corcoran, Mary; Jones, Rebecca

1997-01-01

Argues that few librarians possess the needed competencies to fill the role of "chief knowledge officer" or "knowledge executive." Outlines executive competencies required: communications, leadership, experience, financial management, customer focus, entrepreneurial insight, and information technology grounding; examines gaps…

Measuring the sustainability of a natural system by using multi-criteria distance function methods: Some critical issues.

PubMed

Diaz-Balteiro, L; Belavenutti, P; Ezquerro, M; González-Pachón, J; Ribeiro Nobre, S; Romero, C

2018-05-15

There is an important body of literature using multi-criteria distance function methods for the aggregation of a battery of sustainability indicators in order to obtain a composite index. This index is considered to be a proxy of the sustainability goodness of a natural system. Although this approach has been profusely used in the literature, it is not exempt from difficulties and potential pitfalls. Thus, in this paper, a significant number of critical issues have been identified showing different procedures capable of avoiding, or at least of mitigating, the inherent potential pitfalls associated with each one. The recommendations made in the paper could increase the theoretical soundness of the multi-criteria distance function methods when this type of approach is applied in the sustainability field, thus increasing the accuracy and realism of the sustainability measurements obtained. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cytomorphology of unusual infectious entities in the Pap test

PubMed Central

Khalbuss, Walid E.; Michelow, Pam; Benedict, Cynthia; Monaco, Sara E.; Pantanowitz, Liron

2012-01-01

Rare entities in the Pap test, including neoplastic and non-neoplastic conditions, pose challenges due to their infrequent occurrence in the daily practice of cytology. Furthermore, these conditions give rise to important diagnostic pitfalls. Infections such as tuberculosis cervicitis may be erroneously diagnosed as carcinoma, whereas others, such as schistosomiasis, are associated with squamous cell carcinoma. These cases include granuloma inguinale (donovanosis), tuberculosis, coccidioidomycosis, schistosomiasis, taeniasis, and molluscum contagiosum diagnosed in Pap tests. Granuloma inguinale shows histiocytes that contain intracytoplasmic bacteria (Donovan bodies). Tuberculosis is characterized by necrotizing granulomatous inflammation with Langhans-multinucleated giant cells. Coccidioidomycosis may show large intact or ruptured fungal spherules associated with endospores. Schistosoma haematobium is diagnosed by finding characteristic ova with a terminal spine. Molluscum contagiosum is characterized by the appearance of squamous cells with molluscum bodies. This article reviews the cytomorphology of selected rare infections and focuses on their cytomorphology, differential diagnosis, and role of ancillary diagnostic studies. PMID:22919422

Thyroid lymphoma: diagnostic pitfalls on pre-operative ago-biopsy.

PubMed

Antonino, Antonio; Rosato, Andrea; Barbato, Filomena; De Dominicis, Gianfranco; De Palma, Maurizio

2013-01-01

Thyroid cancer has the highest prevalence of all endocrine malignancies. Malignancy can be of thyroid or non-thyroid origin. Sarcomas and primary thyroid lymphomas (PTL) are rare and surgery is treatment of choice in the former but not in latter. To describe thyroid lymphomas histological types of thyroid cancer found in a reference center. Medical chart review from admitted patients diagnosed with thyroid cancer in the period from january 2007 to june 2012. Demographic, diagnostic, therapeutic and histopathological information were collected. 1604 records of patients admitted with thyroid disease were reviewed. Among 307 thyroid cancer, the cases diagnosed with rare tumors were: 10 cases of anaplastic carcinoma (3.5%), followed by 4 cases of medullary carcinoma (1.3%), 1 cases of teratoma (0.03%), 2 cases of lymphoma (0.06%). The most frequent clinical presentation was a palpable thyroid nodule. All patients with lymphoma died. Thyroid lymphomas are uncommon and tend to worse outcomes.

Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States.

PubMed

Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul; Schriefer, Martin

2016-07-01

In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%-40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%-100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics.

Pitfalls in the psychoeducational assessment of adolescents with learning and school adjustment problems.

PubMed

Pollak, J M

1985-01-01

Over the past decade there has been a growing interest on the part of educators, medical specialists, mental health personnel, and the lay public in the diagnosis, evaluation, and remediation of specific learning disabilities in the school-age child. This paper attempts to show through case illustrations of five high school-age adolescents how parents can seek from clinical evaluators a diagnostic impression of primary learning disability for their nonlearning disabled children; how this otherwise legitimate diagnostic category can be inappropriately used in the service of denying the salient individual, emotional, and family system factors at work in the school-related difficulties; and how the label of learning disability can work as a formidable resistance on the part of the family when, following comprehensive, in-depth assessment, professional recommendations focus less on specific educational remediation and more on the need for individual or family psychotherapy. Suggestions are made for dealing with this clinical issue.

Transitional lumbosacral vertebrae and low back pain: diagnostic pitfalls and management of Bertolotti's syndrome.

PubMed

Almeida, Daniel Benzecry de; Mattei, Tobias Alécio; Sória, Marília Grando; Prandini, Mirto Nelso; Leal, André Giacomelli; Milano, Jerônimo Buzzeti; Ramina, Ricardo

2009-06-01

Bertolotti's syndrome is a spine disorder characterized by the occurrence of a congenital lumbar transverse mega-apophysis in a transitional vertebral body that usually articulates with the sacrum or the iliac bone. It has been considered a possible cause of low back pain. We analyzed the cases of Bertolotti's syndrome that failed clinical treatment and reviewed the literature concerning this subject. Five patients in our series had severe low back pain due to the neo-articulation and two of them were successfully submitted to surgical resection of the transverse mega-apophysis. Taking into account the clinical and surgical experience acquired with these cases, we propose a diagnostic-therapeutic algorithm. There is still no consensus about the most appropriate therapy for Bertolotti's syndrome. In patients in whom the mega-apophysis itself may be the source of back pain, surgical resection may be a safe and effective procedure.

Pink-pigmented non-fermentative gram-negative rods associated with human infections: a clinical and diagnostic challenge.

PubMed

Hogue, R; Graves, M; Moler, S; Janda, J M

2007-06-01

Over the past several decades, the appearance of pink-pigmented bacteria in clinical specimens has gone from being a microbiologic curiosity in the clinical laboratory to the recognition of these aerobic microorganisms as etiologic agents of human disease, most notably bloodstream infections. Advances in the fields of molecular taxonomy and phylogenetics indicate that at least four distinct genera and eight different species are associated with clinical infections in susceptible patient populations. However, these bacteria are slow growing and present multiple diagnostic challenges to the microbiology laboratory including culture, isolation, and identification to species rank. This article provides a current review of these unusual non-fermentative chromogenic bacteria including their disease spectrum, taxonomy, and laboratory identification. The review also highlights the pitfalls or shortcomings we currently have in our knowledge of these microbes and their disease-producing capabilities.

[A boy with a painful knee: bone tumour or stress fracture?].

PubMed

Robben, Bart J; Jutte, Paul C

2012-01-01

The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with the use of various imaging techniques, it can be difficult to establish the correct diagnosis. Although a primary bone tumour requires early treatment to improve its prognosis, the discriminative factor in the diagnosis of a stress fracture is its clinical development over time. A 10-year-old boy was referred to our outpatient clinic on the suspicion of a primary bone tumour in his right tibia. A case was once described in this journal in which a stress fracture had eventually led to an amputation. The suspicion of primary bone tumour often marks the start of a long and intense diagnostic course. A stress fracture is the major diagnostic pitfall when there is a suspicion of such a tumour. If doubts persist after a diagnostic work-up by imaging, consultation with the Bone Tumour Committee is indicated. The patient can also be quickly referred to a centre specialised in treating bone tumours, as was the case in this article.

[New ASAS criteria for the diagnosis of spondyloarthritis: diagnosing sacroiliitis by magnetic resonance imaging].

PubMed

Banegas Illescas, M E; López Menéndez, C; Rozas Rodríguez, M L; Fernández Quintero, R M

2014-01-01

Radiographic sacroiliitis has been included in the diagnostic criteria for spondyloarthropathies since the Rome criteria were defined in 1961. However, in the last ten years, magnetic resonance imaging (MRI) has proven more sensitive in the evaluation of the sacroiliac joints in patients with suspected spondyloarthritis and symptoms of sacroiliitis; MRI has proven its usefulness not only for diagnosis of this disease, but also for the follow-up of the disease and response to treatment in these patients. In 2009, The Assessment of SpondyloArthritis international Society (ASAS) developed a new set of criteria for classifying and diagnosing patients with spondyloarthritis; one important development with respect to previous classifications is the inclusion of MRI positive for sacroiliitis as a major diagnostic criterion. This article focuses on the radiologic part of the new classification. We describe and illustrate the different alterations that can be seen on MRI in patients with sacroiliitis, pointing out the limitations of the technique and diagnostic pitfalls. Copyright © 2013 SERAM. Published by Elsevier Espana. All rights reserved.

Recommendations on nuclear and multimodality imaging in IE and CIED infections.

PubMed

Erba, Paola Anna; Lancellotti, Patrizio; Vilacosta, Isidre; Gaemperli, Oliver; Rouzet, Francois; Hacker, Marcus; Signore, Alberto; Slart, Riemer H J A; Habib, Gilbert

2018-05-24

In the latest update of the European Society of Cardiology (ESC) guidelines for the management of infective endocarditis (IE), imaging is positioned at the centre of the diagnostic work-up so that an early and accurate diagnosis can be reached. Besides echocardiography, contrast-enhanced CT (ce-CT), radiolabelled leucocyte (white blood cell, WBC) SPECT/CT and [ 18 F]FDG PET/CT are included as diagnostic tools in the diagnostic flow chart for IE. Following the clinical guidelines that provided a straightforward message on the role of multimodality imaging, we believe that it is highly relevant to produce specific recommendations on nuclear multimodality imaging in IE and cardiac implantable electronic device infections. In these procedural recommendations we therefore describe in detail the technical and practical aspects of WBC SPECT/CT and [ 18 F]FDG PET/CT, including ce-CT acquisition protocols. We also discuss the advantages and limitations of each procedure, specific pitfalls when interpreting images, and the most important results from the literature, and also provide recommendations on the appropriate use of multimodality imaging.

Climate change mitigation: potential benefits and pitfalls of enhanced rock weathering in tropical agriculture

PubMed Central

Lim, Felix; James, Rachael H.; Pearce, Christopher R.; Scholes, Julie; Freckleton, Robert P.; Beerling, David J.

2017-01-01

Restricting future global temperature increase to 2°C or less requires the adoption of negative emissions technologies for carbon capture and storage. We review the potential for deployment of enhanced weathering (EW), via the application of crushed reactive silicate rocks (such as basalt), on over 680 million hectares of tropical agricultural and tree plantations to offset fossil fuel CO2 emissions. Warm tropical climates and productive crops will substantially enhance weathering rates, with potential co-benefits including decreased soil acidification and increased phosphorus supply promoting higher crop yields sparing forest for conservation, and reduced cultural eutrophication. Potential pitfalls include the impacts of mining operations on deforestation, producing the energy to crush and transport silicates and the erosion of silicates into rivers and coral reefs that increases inorganic turbidity, sedimentation and pH, with unknown impacts for biodiversity. We identify nine priority research areas for untapping the potential of EW in the tropics, including effectiveness of tropical agriculture at EW for major crops in relation to particle sizes and soil types, impacts on human health, and effects on farmland, adjacent forest and stream-water biodiversity. PMID:28381631

Climate change mitigation: potential benefits and pitfalls of enhanced rock weathering in tropical agriculture.

PubMed

Edwards, David P; Lim, Felix; James, Rachael H; Pearce, Christopher R; Scholes, Julie; Freckleton, Robert P; Beerling, David J

2017-04-01

Restricting future global temperature increase to 2°C or less requires the adoption of negative emissions technologies for carbon capture and storage. We review the potential for deployment of enhanced weathering (EW), via the application of crushed reactive silicate rocks (such as basalt), on over 680 million hectares of tropical agricultural and tree plantations to offset fossil fuel CO 2 emissions. Warm tropical climates and productive crops will substantially enhance weathering rates, with potential co-benefits including decreased soil acidification and increased phosphorus supply promoting higher crop yields sparing forest for conservation, and reduced cultural eutrophication. Potential pitfalls include the impacts of mining operations on deforestation, producing the energy to crush and transport silicates and the erosion of silicates into rivers and coral reefs that increases inorganic turbidity, sedimentation and pH, with unknown impacts for biodiversity. We identify nine priority research areas for untapping the potential of EW in the tropics, including effectiveness of tropical agriculture at EW for major crops in relation to particle sizes and soil types, impacts on human health, and effects on farmland, adjacent forest and stream-water biodiversity. © 2017 The Author(s).

Tuberculosis screening in high human immunodeficiency virus prevalence settings: turning promise into reality

PubMed Central

Corbett, E. L.; MacPherson, P.

2014-01-01

SUMMARY Twenty years of sky-high tuberculosis (TB) incidence rates and high TB mortality in high human immunodeficiency virus (HIV) prevalence countries have so far not been matched by the same magnitude or breadth of responses as seen in malaria or HIV programmes. Instead, recommendations have been narrowly focused on people presenting to health facilities for investigation of TB symptoms, or for HIV testing and care. However, despite the recent major investment and scale-up of TB and HIV services, undiagnosed TB remains highly prevalent at community level, implying that diagnosis of TB remains slow and incomplete. This maintains high transmission rates and exposes people living with HIV to high rates of morbidity and mortality. More intensive use of TB screening, with broader definitions of target populations, expanded indications for screening both inside and outside of health facilities, and appropriate selection of new diagnostic tools, offers the prospect of rapidly improving population-level control of TB. Diagnostic accuracy of suitable (high throughput) algorithms remains the major barrier to realising this goal. In the present study, we review the evidence available to guide expanded TB screening in HIV-prevalent settings, ideally through combined TB-HIV interventions that provide screening for both TB and HIV, and maximise entry to HIV and TB care and prevention. Ideally, we would systematically test, treat and prevent TB and HIV comprehensively, offering both TB and HIV screening to all health facility attendees, TB households and all adults in the highest risk communities. However, we are still held back by inadequate diagnostics, financing and paucity of population-impact data. Relevant contemporary research showing the high need for potential gains, and pitfalls from expanded and intensified TB screening in high HIV prevalence settings are discussed in this review. PMID:23928165

[Medicolegal aspects in neuroradiologic emergencies].

PubMed

Picard, L

2004-09-01

Naturally, neuroimaging emergencies are a component of the global subject of emergencies that have for several years been a frequent subject in the press. The current situation is the consequence of the evolution of ideas from contractual liability to the frequently discussed principle of precaution. Examples offered by the daily practice allow to emphasize the main difficulties: diagnosis of headaches, seizure episode on public roads, head trauma, stroke... The medical liability of the neuroradiologist is not the same for diagnostic or interventional neuroradiology; it can sometimes be shared with other physicians. This liability includes the indication, the quality of the diagnosis, the information of the patient and relatives, the communication of results with other physicians, the maintenance of the equipment... Knowledge of potential pitfalls allows preventive measures including competence of the neuroradiologist, informed patient consent, and written precise protocols are the most important. However, according to the evolution of our societies, it is likely that it will become increasingly difficult to achieve a professional neuroradiology career without being questioned; it is thus advisable to be prepared for such eventuality.

Autoimmune lymphoproliferative syndrome mimicking chronic active Epstein-Barr virus infection.

PubMed

Nomura, Keiko; Kanegane, Hirokazu; Otsubo, Keisuke; Wakiguchi, Hiroshi; Noda, Yukihiro; Kasahara, Yoshihito; Miyawaki, Toshio

2011-06-01

Chronic active Epstein-Barr virus infection (CAEBV) is defined as a systemic EBV-associated lymphoproliferative disease characterized by fever, lymphadenopathy, and splenomegaly in apparently immunocompetent persons. Recent studies have revealed that EBV infects T or natural killer cells in most patients with CAEBV; the etiology of CAEBV, however, remains unknown. Autoimmune lymphoproliferative disorder (ALPS) is an inherited disorder associated with defects in apoptosis, and clinically characterized by lymphadenopathy, splenomegaly, hypergammaglobulinemia, and autoimmune disease. ALPS is most often associated with mutations in the FAS gene, which is an apoptosis-signaling receptor important for homeostasis of the immune system. Based on the clinical similarity between ALPS and CAEBV with respect to lymphoproliferation, we have examined the possibility of the co-occurrence of ALPS in patients with a diagnosis of CAEBV. In this study, we have identified FAS gene mutations in three Japanese patients with lymphadenopathy, hepatosplenomegaly, and unusual EBV infection, who were diagnosed with CAEBV. These observations, which indicate that the clinical development of ALPS may be associated with EBV infection, alert us to a potential diagnostic pitfall of CAEBV.

Prostate-Specific Membrane Antigen-Negative Metastases-A Potential Pitfall in Prostate-Specific Membrane Antigen PET.

PubMed

Noto, Benjamin; Auf der Springe, Katharina; Huss, Sebastian; Allkemper, Thomas; Stegger, Lars

2018-06-01

Ga-PSMA-11 PET/CT was performed in a 74-year-old man because of biochemical recurrence of prostate cancer following radiation therapy of the prostate gland 24 months earlier. Besides focal nuclide accumulation in the prostate gland suggestive of local recurrence, PET scan revealed no further pathologic uptake. However, CT showed multiple pulmonic nodules suggestive of metastases. Thoracotomy and pathologic examination revealed the nodules to be prostate cancer metastasis. Furthermore, immunohistochemical staining with PSMA antibodies demonstrated a virtual lack of PSMA expression. This case demonstrates the possibility of PSMA-negative metastases of prostate cancer an important pitfall that should be known to physicians interpreting PSMA PET.

The promise and pitfalls of community resilience.

PubMed

Uscher-Pines, Lori; Chandra, Anita; Acosta, Joie

2013-12-01

An important shift in terminology has occurred in emergency preparedness, and the concept of community resilience has become ubiquitous. Although enhancing community resilience is broader than preparedness, and emphasizes a distinct set of activities and participants, the terms are often used interchangeably. The implications of this shift have not been fully explored. This commentary describes the potential promise and pitfalls of the concept of community resilience and recommends strategies to overcome its limitations. We believe that resilience has the power to dramatically change this field in immense, positive ways, but some important challenges such as confusion about definitions and lack of accountability must first be overcome. (Disaster Med Public Health Preparedness. 2013;7:603-606).

Job Sharing in Geography.

ERIC Educational Resources Information Center

Kay, Jeanne

1982-01-01

Job sharing is an employment alternative in which two qualified individuals manage the responsibilities of a single position. Discusses the barriers to and the potential, advantages, disadvantages, pitfalls, and challenges of job sharing. Focuses on job sharing in the geography profession. (Author/JN)

SLIDE PRESENTATION: LIMITATIONS OF USE OF GEOSYNTHETIC CLAY LINERS (GCLS)

EPA Science Inventory

This presentation describes the design and construction issues pertaining to the use of geosynthetic clay liners (GCLSs) in waste containment. The presentation covers new materials, potential design and construction pitfalls and a summary of ongoing research.

Cognitive neuropsychology and its vicissitudes: The fate of Caramazza's axioms.

PubMed

Shallice, Tim

2015-01-01

Cognitive neuropsychology is characterized as the discipline in which one draws conclusions about the organization of the normal cognitive systems from the behaviour of brain-damaged individuals. In a series of papers, Caramazza, later in collaboration with McCloskey, put forward four assumptions as the bridge principles for making such inferences. Four potential pitfalls, one for each axiom, are discussed with respect to the use of single-case methods. Two of the pitfalls also apply to case series and group study procedures, and the other two are held to be indirectly testable or avoidable. Moreover, four other pitfalls are held to apply to case series or group study methods. It is held that inferences from single-case procedures may profitably be supported or rejected using case series/group study methods, but also that analogous support needs to be given in the other direction for functionally based case series or group studies. It is argued that at least six types of neuropsychological method are valuable for extrapolation to theories of the normal cognitive system but that the single- or multiple-case study remains a critical part of cognitive neuropsychology's methods.

"But Why Then?" Chronological Context and Historical Interpretations

ERIC Educational Resources Information Center

Fordham, Michael

2014-01-01

When Michael Fordham was introduced to Dr Seuss's "Butter Battle Book" he immediately recognised its potential value in the classroom as a popular interpretation of the Cold War. Wanting his Year 9 pupils to explain how and why the past has been interpreted in different ways he shows the potential pitfalls inherent in asking pupils to…

The application of genetic indicators in wild populations: Potential and pitfalls for genetic monitoring [Chapter 15

Treesearch

Jennifer Pierson; Gordon Luikart; Michael Schwartz

2015-01-01

The genetic aspects of biodiversity and conservation have been long recognised as important to the viability of populations and evolutionary potential of species (Lande 1988). Yet incorporating genetic considerations into conservation, management, and decision making has lagged behind this recognition (Mace et al. 2003; Laikre et al. 2010). Gene-level (genetic...

A Comparison of Herpetofaunal Sampling Effectiveness of Pitfall, Single-ended, and Double-ended Funnel Traps Used with Drift Fences

Treesearch

Cathryn H. Greenberg; Daniel G. Neary; Larry D. Harris

1994-01-01

We assessed the relative effectiveness of pitfalls, single-ended, and double-ended funnel traps at 12 replicate sites in sand pine scrub using drift fence arrays. Pitfalls captured fewer species but yielded more individuals of many species and higher average species richness than funnel traps. Pitfalls and funnel traps exhibited differential capture bias probably due...

A perspective on microarrays: current applications, pitfalls, and potential uses

PubMed Central

Jaluria, Pratik; Konstantopoulos, Konstantinos; Betenbaugh, Michael; Shiloach, Joseph

2007-01-01

With advances in robotics, computational capabilities, and the fabrication of high quality glass slides coinciding with increased genomic information being available on public databases, microarray technology is increasingly being used in laboratories around the world. In fact, fields as varied as: toxicology, evolutionary biology, drug development and production, disease characterization, diagnostics development, cellular physiology and stress responses, and forensics have benefiting from its use. However, for many researchers not familiar with microarrays, current articles and reviews often address neither the fundamental principles behind the technology nor the proper designing of experiments. Although, microarray technology is relatively simple, conceptually, its practice does require careful planning and detailed understanding of the limitations inherently present. Without these considerations, it can be exceedingly difficult to ascertain valuable information from microarray data. Therefore, this text aims to outline key features in microarray technology, paying particular attention to current applications as outlined in recent publications, experimental design, statistical methods, and potential uses. Furthermore, this review is not meant to be comprehensive, but rather substantive; highlighting important concepts and detailing steps necessary to conduct and interpret microarray experiments. Collectively, the information included in this text will highlight the versatility of microarray technology and provide a glimpse of what the future may hold. PMID:17254338

Methods for Evaluating Wetland Condition #12: Using Amphibians in Bioassessments of Wetlands

USGS Publications Warehouse

Sparling, D.W.; Richter, K.O.; Calhoun, A.; Micacchion, M.

2001-01-01

Because amphibians have both aquatic and terrestrial life stages they can serve in a unique way among vertebrates as sources of information for bioassessments of both wetlands and surrounding habitats. Although there are many data gaps in our knowledge about the habitat requirements and ecology of many amphibian species, it is apparent that community composition, presence and frequency of abnormalities, various mensural characteristics (e.g. snout vent length divided by body weight) and laboratory diagnostics (e.g. cholinesterase activity, blood chemistry) can be used in developing metrics for an index of biotic integrity. In addition, potential metrics can be derived from the various life stages that most amphibians experience such as egg clusters; embryonic development and hatching rates; tadpole growth, development, and survival; progress and success of metamorphosis; and breeding behavior and presence of adults. It is important, however, to focus on regional biodiversity and species assemblages of amphibians in the development of metrics rather than to strive for broadscale application of common metrics. This report discusses the procedures of developing an index of biotic integrity based on amphibians, explains potential pitfalls in using amphibians in bioassessments, and demonstrates where more research is needed to enhance the use of amphibians in evaluating wetland conditions.

Bioremediation of treated wood with bacteria

Treesearch

Carol A. Clausen

2006-01-01

This chapter reviews prior research in the field of bacterial bioremediation for wood treated with oilborne and inorganic preservatives. Current state of the art is summarized along with potential benefits and pitfalls of a pilot-scale bioremediation process for CCA-treated waste wood.

Nuclear Forensics and Radiochemistry: Radiation Detection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rundberg, Robert S.

Radiation detection is necessary for isotope identification and assay in nuclear forensic applications. The principles of operation of gas proportional counters, scintillation counters, germanium and silicon semiconductor counters will be presented. Methods for calibration and potential pitfalls in isotope quantification will be described.

Herbicide-resistant crop biotechnology: potential and pitfalls

USDA-ARS?s Scientific Manuscript database

Herbicide-resistant crops are an important agricultural biotechnology that can enable farmers to effectively control weeds without harming their crops. Glyphosate-resistant (i.e. Roundup Ready) crops have been the most commercially successful varieties of herbicide-resistant crops and have been plan...

A manifesto for cardiovascular imaging: addressing the human factor†

PubMed Central

Fraser, Alan G

2017-01-01

Abstract Our use of modern cardiovascular imaging tools has not kept pace with their technological development. Diagnostic errors are common but seldom investigated systematically. Rather than more impressive pictures, our main goal should be more precise tests of function which we select because their appropriate use has therapeutic implications which in turn have a beneficial impact on morbidity or mortality. We should practise analytical thinking, use checklists to avoid diagnostic pitfalls, and apply strategies that will reduce biases and avoid overdiagnosis. We should develop normative databases, so that we can apply diagnostic algorithms that take account of variations with age and risk factors and that allow us to calculate pre-test probability and report the post-test probability of disease. We should report the imprecision of a test, or its confidence limits, so that reference change values can be considered in daily clinical practice. We should develop decision support tools to improve the quality and interpretation of diagnostic imaging, so that we choose the single best test irrespective of modality. New imaging tools should be evaluated rigorously, so that their diagnostic performance is established before they are widely disseminated; this should be a shared responsibility of manufacturers with clinicians, leading to cost-effective implementation. Trials should evaluate diagnostic strategies against independent reference criteria. We should exploit advances in machine learning to analyse digital data sets and identify those features that best predict prognosis or responses to treatment. Addressing these human factors will reap benefit for patients, while technological advances continue unpredictably. PMID:29029029

Principles and Pitfalls in the Differential Diagnosis and Management of Childhood Obesities123

PubMed Central

Martos-Moreno, Gabriel Á.; Barrios, Vicente; Muñoz-Calvo, María T.; Pozo, Jesús; Chowen, Julie A.; Argente, Jesús

2014-01-01

Obesity is currently the most prevalent chronic childhood disease in Western countries. It is one of the most frequent consultations in general pediatrics and is even more common in pediatric endocrinology. As might be predicted, the prevalence of obesity-associated comorbidities is also increasing in children and adolescents. It is widely accepted that this increase in obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being closely associated with the current lifestyle in Western countries. However, there is increasing evidence indicating that an individual’s genetic background is important in determining obesity risk. The physiologic mechanisms controlling appetite and energy expenditure are being revealed in part because of the identification of new causes of human monogenic, syndromic, and endocrine-related obesity. Thus, it is no longer appropriate to talk about obesity, but rather about “obesities” or “different diseases causing obesity,” because their pathophysiologic bases differ. Moreover, these obesities require different diagnostic and management approaches. The pediatrician must be aware of this issue and focus the clinical history and physical examination toward specific clinical signs and symptoms to better exploit the available diagnostic and therapeutic resources when facing a child with obesity. Genetic, genomic, and metabolomic studies are often necessary to obtain a more appropriate diagnosis. Cognitive behavioral therapy is fundamental in obese children. The identification of potential targets will hopefully result in new pharmacologic approaches for translational and personalized medicine for obesity in the near future. PMID:24829481

Principles and pitfalls in the differential diagnosis and management of childhood obesities.

PubMed

Martos-Moreno, Gabriel Á; Barrios, Vicente; Muñoz-Calvo, María T; Pozo, Jesús; Chowen, Julie A; Argente, Jesús

2014-05-01

Obesity is currently the most prevalent chronic childhood disease in Western countries. It is one of the most frequent consultations in general pediatrics and is even more common in pediatric endocrinology. As might be predicted, the prevalence of obesity-associated comorbidities is also increasing in children and adolescents. It is widely accepted that this increase in obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being closely associated with the current lifestyle in Western countries. However, there is increasing evidence indicating that an individual's genetic background is important in determining obesity risk. The physiologic mechanisms controlling appetite and energy expenditure are being revealed in part because of the identification of new causes of human monogenic, syndromic, and endocrine-related obesity. Thus, it is no longer appropriate to talk about obesity, but rather about "obesities" or "different diseases causing obesity," because their pathophysiologic bases differ. Moreover, these obesities require different diagnostic and management approaches. The pediatrician must be aware of this issue and focus the clinical history and physical examination toward specific clinical signs and symptoms to better exploit the available diagnostic and therapeutic resources when facing a child with obesity. Genetic, genomic, and metabolomic studies are often necessary to obtain a more appropriate diagnosis. Cognitive behavioral therapy is fundamental in obese children. The identification of potential targets will hopefully result in new pharmacologic approaches for translational and personalized medicine for obesity in the near future. © 2014 American Society for Nutrition.

An unusual cause of ischemia after coronary bypass grafting!!

PubMed

Hammami, Rania; Charfeddine, Salma; Elleuch, Nizar; Fourati, Hela; Abid, Leila; Kammoun, Samir

2018-01-01

Coronary subclavian steal syndrome is an uncommon cause of ischemia recurrence after coronary artery bypass grafting. Endovascular treatment of subclavian artery stenosis or occlusion is increasingly common and appears to offer a safe and effective alternative to surgical revascularization. We report a case of recurrent angina after coronary artery bypass grafting for critical subclavian artery stenosis. The anomalous origin of the vertebral artery from the aortic arch was an indication for endovascular treatment. We discuss the diagnostic difficulties and the management pitfalls of subclavian artery angioplasty in this syndrome. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Strategies for basic laboratory diagnostics of the hemoglobinopathies in multi-ethnic societies: interpretation of results and pitfalls.

PubMed

Giordano, P C

2013-10-01

The consistent multi-ethnic migrations of the last decades have considerably changed the epidemiology of the hemoglobinopathies. Healthy carriers of these conditions are present today in many nonendemic parts of the world, and severely affected children are now born where these diseases were previously rare or unknown. Improving the competence in carrier diagnostics at the laboratory level is one of the first concerns when introducing management and primary prevention of the severe conditions in nonendemic areas. This review describes how and when carriers should be correctly diagnosed and informed. The essential technologies needed for basic carrier diagnostics in different situations are summarized in some detail, and interpretation of the results and a number of related problems are discussed. The role of the hematology laboratory is essential, particularly in nonendemic areas where the first line of health care is often insufficiently aware of hemoglobinopathy management. Carriers living in nonendemic areas can be appropriately diagnosed and informed regarding genetic risk and prevention by well-organized laboratories. Both basic and specialized diagnostics are needed for the correct treatment for the anemic carriers, for primary prevention in couples at risk and for state-of-the art care of severely affected patients. © 2012 John Wiley & Sons Ltd.

Future of diagnostic microbiology.

PubMed

Khardori, N

2014-01-01

Diagnostic Microbiology is the tool that makes it possible to identify the exact etiology of infectious diseases and the most optimal therapy at the level of individual patients as well as communities. Conventional methods require time to grow the microbes in vitro under specific conditions and not all microbes are easily cultivable. This is followed by biochemical methods for identification which also require hours and sometimes days. Transport of the specimens under less than ideal conditions, prior use of antibiotics and small number of organisms are among the factors that render culture-based methods less reliable. Newer methods depend on amplification of nucleic acids followed by use of probes for identification. This mitigates the need for higher microbial load, presence of metabolically active viable organisms and shortens the time to reporting. These methods can be used to detect antibiotic resistance genes directly from the specimen and help direct targeted therapy. Since these methods will not fulfill all the diagnostic needs, a second approach is being used to shorten the time to identification after the organism has already grown. Mass spectrometry and bioinformatics are the tools making this possible. This review gives a historical perspective on diagnostic microbiology, discusses the pitfalls of current methodology and provides an overview of newer and future methods.

Regional anaesthesia in obstetrics.

PubMed

Pedersen, H; Finster, M

1984-01-01

This review includes a brief discussion of the indications and pitfalls of regional anaesthetic techniques commonly used during parturition. Emphasis is given to the physiological changes of pregnancy and the potential effects on the fetus. The criteria for the choice of local anaesthetic are also presented.

Integrated corridor management initiative : demonstration phase evaluation, San Diego decision support system analysis test plan.

DOT National Transportation Integrated Search

2000-01-01

This report demonstrates the benefits and potential pitfalls of deploying and operating an integrated freeway and arterial management system. In particular, it discusses the lessons learned about the Medical Center Corridor (MCC) Project deployed in ...

Is NF-kappaB a good target for cancer therapy? Hopes and pitfalls.

PubMed

Baud, Véronique; Karin, Michael

2009-01-01

Nuclear factor kappaB (NF-kappaB) transcription factors have a key role in many physiological processes such as innate and adaptive immune responses, cell proliferation, cell death, and inflammation. It has become clear that aberrant regulation of NF-kappaB and the signalling pathways that control its activity are involved in cancer development and progression, as well as in resistance to chemotherapy and radiotherapy. This article discusses recent evidence from cancer genetics and cancer genome studies that support the involvement of NF-kappaB in human cancer, particularly in multiple myeloma. The therapeutic potential and benefit of targeting NF-kappaB in cancer, and the possible complications and pitfalls of such an approach, are explored.

Frequent Pitfalls in the Characterization of Electrodes Designed for Electrochemical Energy Conversion and Storage.

PubMed

Zeradjanin, Aleksandar R

2018-04-25

Focus on the importance of energy conversion and storage boosted research interest in various electrocatalytic materials. Characterization of solid-liquid interfaces during faradaic and non-faradaic processes is routinely conducted in many laboratories worldwide on a daily basis. This can be deemed as a very positive tendency. However, careful insight into modern literature suggests frequent misuse of electroanalytical tools. This can have very negative implications and postpone overall development of electrocatalytic materials with the desired properties. This work points out some of the frequent pitfalls in electrochemical characterization, suggests potential solutions, and above all encourages comprehensive analysis and in-depth thinking about electrochemical phenomena. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Using demographic data to better interpret pitfall trap catches

PubMed Central

Matalin, Andrey V.; Makarov, Kirill V.

2011-01-01

Abstract The results of pitfall trapping are often interpreted as abundance in a particular habitat. At the same time, there are numerous cases of almost unrealistically high catches of ground beetles in seemingly unsuitable sites. The correlation of catches by pitfall trapping with the true distribution and abundance of Carabidae needs corroboration. During a full year survey in 2006/07 in the Lake Elton region (Volgograd Area, Russia), 175 species of ground beetles were trapped. Considering the differences in demographic structure of the local populations, and not their abundances, three groups of species were recognized: residents, migrants and sporadic. In residents, the demographic structure of local populations is complete, and their habitats can be considered “residential”. In migrants and sporadic species, the demographic structure of the local populations is incomplete, and their habitats can be considered “transit”. Residents interact both with their prey and with each other in a particular habitat. Sporadic species are hardly important to a carabid community because of their low abundances. The contribution of migrants to the structure of carabid communities is not apparent and requires additional research. Migrants and sporadic species represent a “labile” component in ground beetles communities, as opposed to a “stable” component, represented by residents. The variability of the labile component substantially limits our interpretation of species diversity in carabid communities. Thus, the criteria for determining the most abundant, or dominant species inevitably vary because the abundance of migrants in some cases can be one order of magnitude higher than that of residents. The results of pitfall trapping adequately reflect the state of carabid communities only in zonal habitats, while azonal and disturbed habitats are merely transit ones for many species of ground beetles. A study of the demographic structure of local populations and assessment of the migratory/residential status of particular carabid species are potential ways of increasing the reliability of pitfall trap information. PMID:21738415

Pitfalls, Caveats and Concerns: "What could possibly go wrong?"

EPA Science Inventory

This presentation is part of a panel to discuss recently revised regulations for human subjects research. In particular, a new category of exempt research that involves "Limited IRB Review." The objectives for my component are to (1) highlight some of the potential pitf...

Probable Diagnosis of a Patient with Niemann-Pick Disease Type C: Managing Pitfalls of Exome Sequencing.

PubMed

Zeiger, William A; Jamal, Nasheed I; Scheuner, Maren T; Pittman, Patricia; Raymond, Kimiyo M; Morra, Massimo; Mishra, Shri K

2018-02-17

Here, we present a case of a 31-year-old man with progressive cognitive decline, ataxia, and dystonia. Extensive laboratory, radiographic, and targeted genetic studies over the course of several years failed to yield a diagnosis. Initial whole exome sequencing through a commercial laboratory identified several variants of uncertain significance; however, follow-up clinical examination and testing ruled each of these out. Eventually, repeat whole exome sequencing identified a known pathogenic intronic variant in the NPC1 gene (NM_000271.4, c.1554-1009G>A) and an additional heterozygous exonic variant of uncertain significance in the NPC1 gene (NM_000271.4, c.2524T>C). Follow-up biochemical testing was consistent with a diagnosis of probable Niemann-Pick disease Type C (NP-C). This case illustrates the potential of whole exome sequencing for diagnosing rare complex neurologic diseases. It also identifies several potential common pitfalls that must be navigated by clinicians when interpreting commercial whole exome sequencing results.

2-[18 F]fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) findings of chronic expanding intrapericardial hematoma: a potential interpretive pitfall that mimics a malignant tumor

PubMed Central

2013-01-01

A 77-year-old man who had undergone mitral valve replacement 5 years previously presented with an intrapericardial mass. Computed tomography and magnetic resonance imaging showed that the mass lesion contained hematoma components. Positron-emission tomography (PET) with 2-[18 F] fluoro-2-deoxy-d-glucose (FDG) revealed uptake in the peripheral rim of the mass. These findings suggested the presence of hematoma associated with a malignant lesion. Surgical resection was performed, and the histological diagnosis was chronic expanding intrapericardial hematoma without neoplastic changes. Chronic expanding intrapericardial hematoma is a rare disease but should be considered when an expanding mass is found in a patient after cardiac surgery. The FDG-PET findings of chronic expanding hematomas, including FDG uptake in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall that mimics a malignant tumor. PMID:23324446

Positive Pitfalls

ERIC Educational Resources Information Center

Schneider, Michael

2004-01-01

This article describes how Cahokia middle and high school students conduct inquiry-based science through a pitfall trap experiment. In a collaborative effort, students designed and conducted pitfall trap investigations that combined their interest in the natural world with their love of technology. The students set up their own experiments to…

Human Rhabdomyosarcoma Cell Lines for Rhabdomyosarcoma Research: Utility and Pitfalls

PubMed Central

Hinson, Ashley R. P.; Jones, Rosanne; Crose, Lisa E. S.; Belyea, Brian C.; Barr, Frederic G.; Linardic, Corinne M.

2013-01-01

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of childhood and adolescence. Despite intergroup clinical trials conducted in Europe and North America, outcomes for high risk patients with this disease have not significantly improved in the last several decades, and survival of metastatic or relapsed disease remains extremely poor. Accrual into new clinical trials is slow and difficult, so in vitro cell-line research and in vivo xenograft models present an attractive alternative for preclinical research for this cancer type. Currently, 30 commonly used human RMS cell lines exist, with differing origins, karyotypes, histologies, and methods of validation. Selecting an appropriate cell line for RMS research has important implications for outcomes. There are also potential pitfalls in using certain cell lines including contamination with murine stromal cells, cross-contamination between cell lines, discordance between the cell line and its associated original tumor, imposter cell lines, and nomenclature errors that result in the circulation of two or more presumed unique cell lines that are actually from the same origin. These pitfalls can be avoided by testing for species-specific isoenzymes, microarray analysis, assays for subtype-specific fusion products, and short tandem repeat analysis. PMID:23882450

Penile Analogue of Stratified Mucin-Producing Intraepithelial Lesion of the Cervix: The First Described Case. A Diagnostic Pitfall.

PubMed

Michal, Michael; Michal, Michal; Miesbauerova, Marketa; Hercogova, Jana; Skopalikova, Barbora; Kazakov, Dmitry V

2016-05-01

The authors report a case where undifferentiated (classic) penile intraepithelial neoplasia was associated with the presence of goblet cells throughout the full epithelial thickness and which later progressed into an invasive carcinoma. The lesion evolved in three consecutive biopsies from only surface epithelium occupying numerous goblet cells in the first to variably sized solid nodules in the dermis composed of atypical squamous and/or basaloid cells intermixed with numerous goblet cells in the third biopsy. Both cellular components expressed CK7 and p16 protein. Human Papillomavirus (HPV) genotyping revealed high risk HPV type 16. To the best of our knowledge, this is the first description of such a lesion occurring on the penis, which can be considered the penile analogue of cervical stratified mucin-producing intraepithelial lesion (SMILE). The correct diagnosis was rendered retrospectively, after recognition of the existence of a vulvar lesion resembling cervical SMILE. The initial biopsy was misinterpreted as extramammary Paget disease, which also constitutes the main pitfall in the differential diagnosis. Another important differential diagnosis is penile/vulvar mucinous metaplasia. The finding of atypical squamous epithelial cells positive for p16 associated with mucinous cells present throughout the full epithelial thickness is a clue to the diagnosis of penile SMILE.

Plasmodium vivax molecular diagnostics in community surveys: pitfalls and solutions.

PubMed

Gruenberg, Maria; Moniz, Clara Antunes; Hofmann, Natalie Ellen; Wampfler, Rahel; Koepfli, Cristian; Mueller, Ivo; Monteiro, Wuelton Marcelo; Lacerda, Marcus; de Melo, Gisely Cardoso; Kuehn, Andrea; Siqueira, Andre M; Felger, Ingrid

2018-01-30

A distinctive feature of Plasmodium vivax infections is the overall low parasite density in peripheral blood. Thus, identifying asymptomatic infected individuals in endemic communities requires diagnostic tests with high sensitivity. The detection limits of molecular diagnostic tests are primarily defined by the volume of blood analysed and by the copy number of the amplified molecular marker serving as the template for amplification. By using mitochondrial DNA as the multi-copy template, the detection limit can be improved more than tenfold, compared to standard 18S rRNA targets, thereby allowing detection of lower parasite densities. In a very low transmission area in Brazil, application of a mitochondrial DNA-based assay increased prevalence from 4.9 to 6.5%. The usefulness of molecular tests in malaria epidemiological studies is widely recognized, especially when precise prevalence rates are desired. Of concern, however, is the challenge of demonstrating test accuracy and quality control for samples with very low parasite densities. In this case, chance effects in template distribution around the detection limit constrain reproducibility. Rigorous assessment of false positive and false negative test results is, therefore, required to prevent over- or under-estimation of parasite prevalence in epidemiological studies or when monitoring interventions.

Is MBO Appropriate in the Academic Setting?

ERIC Educational Resources Information Center

Lasher, Harry J.

1978-01-01

A model for implementing a Management by Objectives (MBO) system in the academic environment is presented and potential problems are explored. Some of the pitfalls discussed include: organizational climate, clarity of objectives, assumption that MBO concepts are readily understood, instant success syndrome, and economic reward myopia. (JMD)

Integrating Neuropsychology and School Psychology: Potential and Pitfalls

ERIC Educational Resources Information Center

Jantz, Paul B.; Plotts, Cynthia A.

2014-01-01

The neurological basis of learning disabilities (LD), and other handicapping conditions commonly found in school-age children, makes the integration of neuropsychology and school psychology plausible. However, there has been longstanding debate over the required level of education, training, supervision, and credentialing needed for the practice…

San Antonio's Medical Center Corridor: Lessons Learned From The Metropolitan Model Deployment Initiative: Reducing Delay Through Integrated Freeway & Arterial Management

DOT National Transportation Integrated Search

2000-10-01

This report demonstrates the benefits and potential pitfalls of deploying and operating an integrated freeway and arterial management system. In particular, it discusses the lessons learned about the Medical Center Corridor (MCC) Project deployed in ...

Modeling: The Right Tool for the Job.

ERIC Educational Resources Information Center

Gavanasen, Varut; Hussain, S. Tariq

1993-01-01

Reviews the different types of models that can be used in groundwater modeling. Discusses the flow and contaminant transport models in the saturated zone, flow and contaminant transport in variably saturated flow regime, vapor transport, biotransformation models, multiphase models, optimization algorithms, and potentials pitfalls of using these…

Practical Paediatric Psychopharmacological Prescribing in Autism: The Potential and the Pitfalls.

ERIC Educational Resources Information Center

Gringras, Paul

2000-01-01

This article discusses the evidence behind two approaches to psychopharmacological management in children with autism: selecting and treating target symptoms or treatment or curing the primary social impairment underlying autism. The effectiveness of stimulants, antidepressants, melatonin, naltrexone, fenfluramine, and secretin is appraised. The…

Building Organizational Capacity: Strategic Management in Higher Education

ERIC Educational Resources Information Center

Toma, J. Douglas

2010-01-01

Every university or college president envisions bold initiatives--big projects intended to change the nature of an institution with significant implications across all sectors. How can leaders and senior managers charged with implementing reforms effectively frame their work and anticipate potential pitfalls? No organization can maximize its…

Designing and Implementing Performance-Based Career Ladder Plans.

ERIC Educational Resources Information Center

Hawley, Willis D.

1985-01-01

Reviews the factors that any teacher motivation plan must incorporate to be effective and outlines 11 principles that should be followed in designing career ladder plans to meet teacher needs, increase teacher competence, and facilitate effective instruction. Warns against potential pitfalls in career ladder plans. (PGD)

Application of basic principles of physics to head and neck MR angiography: troubleshooting for artifacts.

PubMed

Pandey, Shilpa; Hakky, Michael; Kwak, Ellie; Jara, Hernan; Geyer, Carl A; Erbay, Sami H

2013-05-01

Neurovascular imaging studies are routinely used for the assessment of headaches and changes in mental status, stroke workup, and evaluation of the arteriovenous structures of the head and neck. These imaging studies are being performed with greater frequency as the aging population continues to increase. Magnetic resonance (MR) angiographic imaging techniques are helpful in this setting. However, mastering these techniques requires an in-depth understanding of the basic principles of physics, complex flow patterns, and the correlation of MR angiographic findings with conventional MR imaging findings. More than one imaging technique may be used to solve difficult cases, with each technique contributing unique information. Unfortunately, incorporating findings obtained with multiple imaging modalities may add to the diagnostic challenge. To ensure diagnostic accuracy, it is essential that the radiologist carefully evaluate the details provided by these modalities in light of basic physics principles, the fundamentals of various imaging techniques, and common neurovascular imaging pitfalls. ©RSNA, 2013.

Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States

PubMed Central

Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul

2016-01-01

In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%–40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%–100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics. PMID:27314832

Applied statistics in ecology: common pitfalls and simple solutions

Treesearch

E. Ashley Steel; Maureen C. Kennedy; Patrick G. Cunningham; John S. Stanovick

2013-01-01

The most common statistical pitfalls in ecological research are those associated with data exploration, the logic of sampling and design, and the interpretation of statistical results. Although one can find published errors in calculations, the majority of statistical pitfalls result from incorrect logic or interpretation despite correct numerical calculations. There...

Avoiding common pitfalls in qualitative data collection and transcription.

PubMed

Easton, K L; McComish, J F; Greenberg, R

2000-09-01

The subjective nature of qualitative research necessitates scrupulous scientific methods to ensure valid results. Although qualitative methods such as grounded theory, phenomenology, and ethnography yield rich data, consumers of research need to be able to trust the findings reported in such studies. Researchers are responsible for establishing the trustworthiness of qualitative research through a variety of ways. Specific challenges faced in the field can seriously threaten the dependability of the data. However, by minimizing potential errors that can occur when doing fieldwork, researchers can increase the trustworthiness of the study. The purpose of this article is to present three of the pitfalls that can occur in qualitative research during data collection and transcription: equipment failure, environmental hazards, and transcription errors. Specific strategies to minimize the risk for avoidable errors will be discussed.

Ground-foraging ants (Hymenoptera: Formicidae) and rainfall effect on pitfall trapping in a deciduous thorn woodland (caatinga), Northeastern Brazil.

PubMed

Nunes, Francyregis A; Segundo, Glauco B Martins; Vasconcelos, Yuri B; Azevedo, Raul; Quinet, Yves

2011-12-01

The semi-arid Caatinga is the fourth largest biome of Brazil, which biota still remains one of the most poorly known, especially with regard to invertebrate groups. In this study, a ground-foraging ant assemblage was surveyed during one year and the effect of rainfall on pitfall trapping was assessed. The study was performed in an area located in the municipality of Pentecoste (3 degrees 48' S - 39 degrees 20' W), in the State of Ceará. A 200m transect with 20 equidistant sampling points was established. Transect sampling was performed once a month during 12 months, over the period August 2008-August 2009. At each sampling point, a pitfall trap partially filled with a mixture of ethanol and monoethylene glycol was placed at the beginning of each month and remained in the field for seven days. 39 species belonging to six subfamilies and 19 genera, plus two unidentified species, were collected, with Pheidole (10 spp.) and Camponotus (8 spp.) being the taxa with the most species. 23 species were frequent, being found in more than 50% of the 12 transect samplings. Five species had an intermediate frequency (25 to 50%), while 13 were relatively infrequent (less than 25%). Most of the species (22) showed low occurrence, being found in less than 10% of the 240 samples (20 samples each month, during 12 months). Only five species were collected in more than 50% of the samples, those species being also responsible for most of the total abundance (number of captured individuals of all species) observed each month. The species-accumulation curves (observed and estimated) indicated that sampling sufficiency was attained, and that about 92% of the estimated ground-foraging ant fauna had been collected. 40 and 29 species were collected in the dry and rainy season, respectively, with monthly species richness ranging from 13 to 28. The total ant abundance showed a drastic decrease during the rainy season, and a negative linear correlation was found between rainfall and total ant abundance (R2 = 0.68). A similar negative linear correlation was found for species occurrences against rainfall (R2 = 0.71), and for mean number of species per pitfall trap against rainfall (R2 = 0.71). However, some species showed equal abundance, occurrence and mean number of individuals per pitfall trap in both seasons, while others showed a much higher abundance and occurrence during the rainy season. Pitfall trapping as a method to sample ground-foraging ant assemblage of the Caatinga biome and potential factors responsible for lower pitfall trap performance during rainy season are discussed.

Cardiac Autonomic Regulation in Autism and Fragile X Syndrome: A Review

PubMed Central

Klusek, Jessica; Roberts, Jane E.; Losh, Molly

2014-01-01

Despite the significance of efforts to understand the biological basis of autism, progress in this area has been hindered, in part, by the considerable heterogeneity in the disorder. Fragile X syndrome (FXS), a monogenic condition associated with high risk for autism, may pave the way for the dissection of biological heterogeneity within idiopathic autism. This paper adopts a cross-syndrome biomarker approach to evaluate potentially overlapping profiles of cardiac arousal dysregulation (and broader autonomic dysfunction) in autism and FXS. Approaches such as this, aimed at delineating shared mechanisms across genetic syndromes, hold great potential for improving diagnostic precision, promoting earlier identification, and uncovering key systems that can be targeted in pharmaceutical/behavioral interventions. Biomarker approaches may be vital to deconstructing complex psychiatric disorders, and are currently promoted as such by major research initiatives such as the NIMH Research Domain Criteria (RDoC). Evidence reviewed here supports physiological dysregulation in a subset of individuals with autism, as evidenced by patterns of hyperarousal and dampened parasympathetic vagal tone, which overlap with the well-documented physiological profile of FXS. Moreover, there is growing support for a link between aberrant cardiac activity and core deficits associated with autism, such as communication and social impairment. The delineation of physiological mechanisms common to autism and FXS could lend insight into relationships between genetic etiology and behavioral endstates, highlighting FMR1 as a potential candidate gene. Research gaps and potential pitfalls are discussed to inform timely, well-controlled biomarker research that will ultimately promote better diagnosis and treatment of autism and associated conditions. PMID:25420222

Digital Development in Rural Areas: Potentials and Pitfalls.

ERIC Educational Resources Information Center

Malecki, Edward J.

2003-01-01

Data on rural-urban differences in access to telecommunications technology suggest that the U.S. "digital divide" is diminishing. However, major shortcomings in telecommunications infrastructure persist in rural America, and more serious barriers to rural development are related to human capital shortages. These may be resolved in some…

Schools Where Parents Make A Difference.

ERIC Educational Resources Information Center

Davies, Don, Ed.

This book presents 11 case studies that demonstrate successful efforts to improve education through building new relationships between schools and communities. In addition to presenting the case studies, the book also contains an introductory chapter that discusses the potentials and pitfalls of local efforts at participatory democracy, as well as…

Land-Grant Extension: Defining Public Good and Identifying Pitfalls in Evaluation

ERIC Educational Resources Information Center

Collins, Christopher S.

2015-01-01

Land-grant extension is an ongoing example of higher education outreach and community engagement. Population, food, climate, and geographic isolation all factor into the importance of producing and facilitating agricultural knowledge. This qualitative study took place in a geographically isolated region with potential food security issues to…

Automated Structure Annotation and Curation for MassBank: Potential and Pitfalls

EPA Science Inventory

The European MassBank server (www.massbank.eu) was founded in 2012 by the NORMAN Network (www.norman-network.net) to provide open access to mass spectra of substances of environmental interest contributed by NORMAN members. The automated workflow RMassBank was developed as a part...

Functional Magnetic Resonance Imaging in Alzheimer' Disease Drug Development.

PubMed

Holiga, Stefan; Abdulkadir, Ahmed; Klöppel, Stefan; Dukart, Juergen

2018-01-01

While now commonly applied for studying human brain function the value of functional magnetic resonance imaging in drug development has only recently been recognized. Here we describe the different functional magnetic resonance imaging techniques applied in Alzheimer's disease drug development with their applications, implementation guidelines, and potential pitfalls.

Diversity Training: Does It Make a Positive Impact?

ERIC Educational Resources Information Center

Deardorff, Karen Sickels; Heyman, Marjorie

1999-01-01

Examines the importance of diversity training for employees in all work environments and presents a case study of one training program delivered to facility management personnel at Ohio University. The diversity program components are described as are its positive results and potential pitfalls when presented at an institution. Concluding comments…

Feminist Identity Development: Implications for Feminist Therapy with Women.

ERIC Educational Resources Information Center

McNamara, Kathleen; Rickard, Kathryn M.

1989-01-01

Discusses implications of the Downing and Roush (1985) feminist identity development model for feminist therapy with women. Describes potential pitfalls of feminist therapy and emergent issues at subsequent stages of client's identity development. Proposes research agenda for hypothesis testing of model when applied to therapy with women clients.…

An indication for "granny glasses".

PubMed

Brodie, S E

1995-01-01

A young woman with a large astigmatic refractive error obtained no visual improvement with glasses. Repeated manifest refractions revealed persistent variations in the apparent cylinder axis. A suitable choice of spectacle frames facilitated a satisfactory outcome. The pitfalls inherent in the clinical specification of cylinder axis, and the potential visual consequences, are discussed.

Science, Technology, Society: Opportunities.

ERIC Educational Resources Information Center

Lux, Donald G., Ed.

1992-01-01

Recognizing the potential pitfalls resulting from a lack of human foresight lies at the heart of the science-technology-society (STS) movement. This issue of "Theory Into Practice" is the second part of a two-part series that examines the educational opportunities arising as educators attempt to develop student understanding of STS. In the first…

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

PubMed Central

Miranda Rius, Jaume; Nadal, Alfons; Lahor, Eduard; Mtui, Beatus; Brunet, Lluís

2013-01-01

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported. The patient was a 55-year-old black male, whose chief complaint was a progressive gingival overgrowth for more than ten years, in the buccal area of the anterior left mandible. According to the clinical features and the radiological diagnosis of odontogenic keratocyst, a conservative surgery with enucleation and curettage was performed. Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma. After 12-month of follow-up, no evidence of recurrence was found. Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment. PMID:23722914

[Fulminant isolated necrotizing fasciitis of the chest wall, complicating thoracic empyema].

PubMed

Kovács, Ottó; Szántó, Zoltán; Krasznai, Géza

2016-03-01

Authors introduce the case of a 64-year-old male patient with fulminant isolated necrotizing fasciitis of the chest wall, complicating empyema thoracis of unknown origin. The patient's co-morbidities were hypertension, ischaemic heart disease, atrial fibrillation with oral anticoagulation. The real etiology was revealed post mortem, due to the rapid progression. The autopsy demonstrated that the fasciitis was caused by a small blunt thoracic trauma (haematoma), not emerged from patient's history and was not visible during physical examination. Authors review diagnostic pitfalls, leading to delayed recognition in addition to this very case. After quick diagnosis surgical debridement, targeted wide spectrum antibiotics and maximal intensive care are the basic pillars of the management of necrotizing fasciitis.

Oral biopsy: oral pathologist's perspective.

PubMed

Kumaraswamy, K L; Vidhya, M; Rao, Prasanna Kumar; Mukunda, Archana

2012-01-01

Many oral lesions may need to be diagnosed by removing a sample of tissue from the oral cavity. Biopsy is widely used in the medical field, but the practice is not quite widespread in dental practice. As oral pathologists, we have found many artifacts in the tissue specimen because of poor biopsy technique or handling, which has led to diagnostic pitfalls and misery to both the patient and the clinician. This article aims at alerting the clinicians about the clinical faults arising preoperatively, intraoperatively and postoperatively while dealing with oral biopsy that may affect the histological assessment of the tissue and, therefore, the diagnosis. It also reviews the different techniques, precautions and special considerations necessary for specific lesions.

Tachycardia detection in ICDs by Boston Scientific : Algorithms, pearls, and pitfalls.

PubMed

Zanker, Norbert; Schuster, Diane; Gilkerson, James; Stein, Kenneth

2016-09-01

The aim of this study was to summarize how implantable cardioverter defibrillators (ICDs) by Boston Scientific sense, detect, discriminate rhythms, and classify episodes. Modern devices include multiple programming selections, diagnostic features, therapy options, memory functions, and device-related history features. Device operation includes logical steps from sensing, detection, discrimination, therapy delivery to history recording. The program is designed to facilitate the application of the device algorithms to the individual patient's clinical needs. Features and functions described in this article represent a selective excerpt by the authors from Boston Scientific publicly available product resources. Programming of ICDs may affect patient outcomes. Patient-adapted and optimized programming requires understanding of device operation and concepts.

Pitfalls of Personal Development Plans--The User Perspective

ERIC Educational Resources Information Center

Grohnert, Therese; Beausaert, Simon; Segers, Mien

2014-01-01

This study was conducted to investigate which pitfalls users of personal development plans (PDPs) perceive in business and governmental organisations with mandatory PDP use. Hundred and thirty-one written statements of PDP users across three Dutch organisations were analysed and categorised into nine pitfalls. Next to an overall lack of use and…

Intravesicular taxane-induced dermatotoxicity in a 78-year-old man with urothelial carcinoma and primary cutaneous anaplastic large cell lymphoma.

PubMed

J Pelletier, Daniel; O'Donnell, Michael; Stone, Mary Seabury; Liu, Vincent

2018-06-01

Patients treated with intravesical bacillus Calmette-Guérin therapy for urothelial carcinoma often become refractory and experience recurrent disease, thus necessitating alternative intravesical treatment modalities if the patient is to be spared the morbidities associated with radical cystectomy. Intravesical treatment with taxane-based chemotherapy, such as docetaxel, has gained traction in urologic oncology, proving to be an effective salvage therapy in such patients. Systemic taxane-based chemotherapeutic regimens have long been used in several advanced malignancies, and their systemic side-effects and associated histologic correlates have been extensively documented. In contrast to adverse effects associated with systemic administration, intravesical taxane administration has thus far proven to be well-tolerated, with little to no systemic absorption. To our knowledge, features of taxane-induced systemic effects have not been reported in this setting. Herein, we report a case of a patient with recurrent urothelial carcinoma treated with intravesical docetaxel, along with primary cutaneous anaplastic large cell lymphoma, who developed characteristic dermatotoxic histologic findings associated with intravenous taxane administration. As such histopathologic findings often represent close mimickers of neoplastic and infectious etiologies, knowledge of the potential for systemic manifestations of taxane therapy in patients treated topically may prevent potentially costly diagnostic pitfalls. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The mandate for a proper preservation in histopathological tissues.

PubMed

Comănescu, Maria; Arsene, D; Ardeleanu, Carmen; Bussolati, G

2012-01-01

A sequence of technically reproducible procedures is mandatory to guarantee a proper preservation of tissues and to build up the basis for sound diagnoses. However, while the goal of these procedures was, until recently, to assure only structural (histological and cytological) preservation, an appropriate preservation of antigenic properties and of nucleic acid integrity is now additionally requested, in order to permit pathologists to provide the biological information necessary for the adoption of personalized therapies. The present review analyses the sequence of technical steps open to critical variations. Passages such as dehydration, paraffin embedding, sectioning and staining are relatively well standardized and allow adoption of dedicated (automatic) apparatuses, while other pre-analytical steps, i.e. time and modalities of transfer of surgical specimens from the surgical theatre to the pathology laboratory (s.c. "ischemia time") and the type and length of fixation are not standardized and are a potential cause of discrepancies in diagnostic results. Our group is involved in European-funded projects tackling these problems with the concrete objective of implementing a model of effective tumors investigations by high performance genetic and molecular methodologies. The problem of the discrepant quality level of histopathological and cytological preparations involved five European countries and exploiting the potential of "virtual slide technology". Concrete issues, techniques and pitfalls, as well as proposed guidelines for processing the tissues are shown in this presentation.

Designing sensory-substitution devices: Principles, pitfalls and potential1

PubMed Central

Kristjánsson, Árni; Moldoveanu, Alin; Jóhannesson, Ómar I.; Balan, Oana; Spagnol, Simone; Valgeirsdóttir, Vigdís Vala; Unnthorsson, Rúnar

2016-01-01

An exciting possibility for compensating for loss of sensory function is to augment deficient senses by conveying missing information through an intact sense. Here we present an overview of techniques that have been developed for sensory substitution (SS) for the blind, through both touch and audition, with special emphasis on the importance of training for the use of such devices, while highlighting potential pitfalls in their design. One example of a pitfall is how conveying extra information about the environment risks sensory overload. Related to this, the limits of attentional capacity make it important to focus on key information and avoid redundancies. Also, differences in processing characteristics and bandwidth between sensory systems severely constrain the information that can be conveyed. Furthermore, perception is a continuous process and does not involve a snapshot of the environment. Design of sensory substitution devices therefore requires assessment of the nature of spatiotemporal continuity for the different senses. Basic psychophysical and neuroscientific research into representations of the environment and the most effective ways of conveying information should lead to better design of sensory substitution systems. Sensory substitution devices should emphasize usability, and should not interfere with other inter- or intramodal perceptual function. Devices should be task-focused since in many cases it may be impractical to convey too many aspects of the environment. Evidence for multisensory integration in the representation of the environment suggests that researchers should not limit themselves to a single modality in their design. Finally, we recommend active training on devices, especially since it allows for externalization, where proximal sensory stimulation is attributed to a distinct exterior object. PMID:27567755

Designing sensory-substitution devices: Principles, pitfalls and potential1.

PubMed

Kristjánsson, Árni; Moldoveanu, Alin; Jóhannesson, Ómar I; Balan, Oana; Spagnol, Simone; Valgeirsdóttir, Vigdís Vala; Unnthorsson, Rúnar

2016-09-21

An exciting possibility for compensating for loss of sensory function is to augment deficient senses by conveying missing information through an intact sense. Here we present an overview of techniques that have been developed for sensory substitution (SS) for the blind, through both touch and audition, with special emphasis on the importance of training for the use of such devices, while highlighting potential pitfalls in their design. One example of a pitfall is how conveying extra information about the environment risks sensory overload. Related to this, the limits of attentional capacity make it important to focus on key information and avoid redundancies. Also, differences in processing characteristics and bandwidth between sensory systems severely constrain the information that can be conveyed. Furthermore, perception is a continuous process and does not involve a snapshot of the environment. Design of sensory substitution devices therefore requires assessment of the nature of spatiotemporal continuity for the different senses. Basic psychophysical and neuroscientific research into representations of the environment and the most effective ways of conveying information should lead to better design of sensory substitution systems. Sensory substitution devices should emphasize usability, and should not interfere with other inter- or intramodal perceptual function. Devices should be task-focused since in many cases it may be impractical to convey too many aspects of the environment. Evidence for multisensory integration in the representation of the environment suggests that researchers should not limit themselves to a single modality in their design. Finally, we recommend active training on devices, especially since it allows for externalization, where proximal sensory stimulation is attributed to a distinct exterior object.

Commercial Opportunities and Ethical Pitfalls in Personalized Medicine: A Myriad of Reasons to Revisit the Myriad Genetics Saga.

PubMed

So, Derek; Joly, Yann

2013-06-01

In 1996, the US-based biotechnology company Myriad Genetics began offering genetic diagnostic tests for mutations in the genes BRCA1 and BRCA2 , which are linked to hereditary breast and ovarian cancer. Since that time, Myriad has been a forerunner in the field of personalized medicine through the use of effective commercialization strategies which have been emulated by other commercial biotechnology companies. Myriad's strategies include patent acquisition and active enforcement, direct-to-consumer advertising, diversification, and trade secrets. These business models have raised substantial ethical controversy and criticism, often related to the company's focus on market dominance and the potential conflict between private sector profitability and the promotion of public health. However, these strategies have enabled Myriad to survive the economic challenges that have affected the biotechnology sector and to become financially successful in the field of personalized medicine. Our critical assessment of the legal, economic and ethical aspects of Myriad's practices over this period allows the identification of the company's more effective business models. It also discusses of the consequences of implementing economically viable models without first carrying out broader reflection on the socio-cultural, ethical and political contexts in which they would apply.

Prognostic relevance of motor talent predictors in early adolescence: A group- and individual-based evaluation considering different levels of achievement in youth football.

PubMed

Höner, Oliver; Votteler, Andreas

2016-12-01

In the debate about the usefulness of motor diagnostics in the talent identification process, the prognostic validity for tests conducted in early adolescence is of critical interest. Using a group- and individual-based statistical approach, this prospective cohort study evaluated a nationwide assessment of speed abilities and technical skills regarding its relevance for future achievement levels. The sample consisted of 22,843 U12-players belonging to the top 4% in German football. The U12-results in five tests served as predictors for players' selection levels in U16-U19 (youth national team, regional association, youth academy, not selected). Group-mean differences proved the prognostic relevance for all predictors. Low individual selection probabilities demonstrated limited predictive values, while excellent test results proved their particular prognostic relevance. Players scoring percentile ranks (PRs) ≥ 99 had a 12 times higher chance to become youth national team players than players scoring PR < 99. Simulating increasing score cut-off values not only enhanced specificity (correctly identified non-talents) but also led to lower sensitivity (loss of talents). Extending the current research, these different approaches revealed the ambiguity of the diagnostics' prognostic relevance, representing both the usefulness and several pitfalls of nationwide diagnostics. Therefore, the present diagnostics can support but not substitute for coaches' subjective decisions for talent identification, and multidisciplinary designs are required.

The touro 12-step: a systematic guide to optimizing survey research with online discussion boards.

PubMed

Ip, Eric J; Barnett, Mitchell J; Tenerowicz, Michael J; Perry, Paul J

2010-05-27

The Internet, in particular discussion boards, can provide a unique opportunity for recruiting participants in online research surveys. Despite its outreach potential, there are significant barriers which can limit its success. Trust, participation, and visibility issues can all hinder the recruitment process; the Touro 12-Step was developed to address these potential hurdles. By following this step-by-step approach, researchers will be able to minimize these pitfalls and maximize their recruitment potential via online discussion boards.

Tips for Teachers of Evidence-based Medicine: Clinical Prediction Rules (CPRs) and Estimating Pretest Probability

PubMed Central

McGinn, Thomas; Jervis, Ramiro; Wisnivesky, Juan; Keitz, Sheri

2008-01-01

Background Clinical prediction rules (CPR) are tools that clinicians can use to predict the most likely diagnosis, prognosis, or response to treatment in a patient based on individual characteristics. CPRs attempt to standardize, simplify, and increase the accuracy of clinicians’ diagnostic and prognostic assessments. The teaching tips series is designed to give teachers advice and materials they can use to attain specific educational objectives. Educational Objectives In this article, we present 3 teaching tips aimed at helping clinical learners use clinical prediction rules and to more accurately assess pretest probability in every day practice. The first tip is designed to demonstrate variability in physician estimation of pretest probability. The second tip demonstrates how the estimate of pretest probability influences the interpretation of diagnostic tests and patient management. The third tip exposes learners to various examples and different types of Clinical Prediction Rules (CPR) and how to apply them in practice. Pilot Testing We field tested all 3 tips with 16 learners, a mix of interns and senior residents. Teacher preparatory time was approximately 2 hours. The field test utilized a board and a data projector; 3 handouts were prepared. The tips were felt to be clear and the educational objectives reached. Potential teaching pitfalls were identified. Conclusion Teaching with these tips will help physicians appreciate the importance of applying evidence to their every day decisions. In 2 or 3 short teaching sessions, clinicians can also become familiar with the use of CPRs in applying evidence consistently in everyday practice. PMID:18491194

How do doctors in training react to seizures?

PubMed

Seneviratne, Udaya; Ma, Henry; Phan, Thanh G

2016-01-01

There are scant data on how doctors approach seizures in the acute setting. We sought to study (a) exposure to seizure disorders as well as relevant training and (b) reactions to seizures in the acute setting, among medical residents undergoing physician training. The exposure to and training on seizure disorders were assessed using a structured questionnaire first. Then, they were tested with 20 videos consisting of 10 epileptic seizures (ESs) and 10 psychogenic nonepileptic seizures (PNESs). After each video, we asked three questions to test (a) the diagnosis and the practice of administration of benzodiazepines to terminate the seizure, (b) the estimation of seizure duration, and (c) the practice of intubation. The accuracy of diagnosis was measured by the area under the summary receiver operating characteristics curve (AUC). The difference between true seizure duration and estimated duration was evaluated using paired-sample t-test. A total of 48 trainees participated in the study. The majority witnessed seizures in movies (37, 77.1%) and television (35, 72.9%). Only 12 (25%) received bedside teaching on seizure disorders. Their diagnostic accuracy of seizures was very poor (AUC=0.54). Participants significantly underestimated the duration of seizures. Thirty-five doctors made an illogical decision to intubate but not to terminate the seizure with intravenous benzodiazepine. The diagnostic accuracy of seizures is poor among trainees, and their estimates of seizure duration are unreliable. Our study highlights potential pitfalls in the acute management of seizures and the need for more training on seizure disorders. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Artificial Intelligence and Machine Learning in Radiology: Opportunities, Challenges, Pitfalls, and Criteria for Success.

PubMed

Thrall, James H; Li, Xiang; Li, Quanzheng; Cruz, Cinthia; Do, Synho; Dreyer, Keith; Brink, James

2018-03-01

Worldwide interest in artificial intelligence (AI) applications, including imaging, is high and growing rapidly, fueled by availability of large datasets ("big data"), substantial advances in computing power, and new deep-learning algorithms. Apart from developing new AI methods per se, there are many opportunities and challenges for the imaging community, including the development of a common nomenclature, better ways to share image data, and standards for validating AI program use across different imaging platforms and patient populations. AI surveillance programs may help radiologists prioritize work lists by identifying suspicious or positive cases for early review. AI programs can be used to extract "radiomic" information from images not discernible by visual inspection, potentially increasing the diagnostic and prognostic value derived from image datasets. Predictions have been made that suggest AI will put radiologists out of business. This issue has been overstated, and it is much more likely that radiologists will beneficially incorporate AI methods into their practices. Current limitations in availability of technical expertise and even computing power will be resolved over time and can also be addressed by remote access solutions. Success for AI in imaging will be measured by value created: increased diagnostic certainty, faster turnaround, better outcomes for patients, and better quality of work life for radiologists. AI offers a new and promising set of methods for analyzing image data. Radiologists will explore these new pathways and are likely to play a leading role in medical applications of AI. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Pitfalls in Persuasion: How Do Users Experience Persuasive Techniques in a Web Service?

NASA Astrophysics Data System (ADS)

Segerståhl, Katarina; Kotro, Tanja; Väänänen-Vainio-Mattila, Kaisa

Persuasive technologies are designed by utilizing a variety of interactive techniques that are believed to promote target behaviors. This paper describes a field study in which the aim was to discover possible pitfalls of persuasion, i.e., situations in which persuasive techniques do not function as expected. The study investigated persuasive functionality of a web service targeting weight loss. A qualitative online questionnaire was distributed through the web service and a total of 291 responses were extracted for interpretative analysis. The Persuasive Systems Design model (PSD) was used for supporting systematic analysis of persuasive functionality. Pitfalls were identified through situations that evoked negative user experiences. The primary pitfalls discovered were associated with manual logging of eating and exercise behaviors, appropriateness of suggestions and source credibility issues related to social facilitation. These pitfalls, when recognized, can be addressed in design by applying functional and facilitative persuasive techniques in meaningful combinations.

Pitfalls and major issues in the histologic diagnosis of peripheral T-cell lymphomas: results of the central review of 573 cases from the T-Cell Project, an international, cooperative study.

PubMed

Bellei, Monica; Sabattini, Elena; Pesce, Emanuela Anna; Ko, Young-Hyeh; Kim, Won Seog; Cabrera, Maria Elena; Martinez, Virginia; Dlouhy, Ivan; Paes, Roberto Pinto; Barrese, Tomas; Vassallo, Josè; Tarantino, Vittoria; Vose, Julie; Weisenburger, Dennis; Rüdiger, Thomas; Federico, Massimo; Pileri, Stefano

2017-12-01

Peripheral T-cell lymphomas (PTCLs) comprise a heterogeneous group of neoplasms that are derived from post-thymic lymphoid cells at different stages of differentiation with different morphological patterns, phenotypes and clinical presentations. PTCLs are highly diverse, reflecting the diverse cells from which they can originate and are currently sub-classified using World Health Organization (WHO) 2008 criteria. In 2006 the International T-Cell Lymphoma Project launched the T-Cell Project, building on the retrospective study previously carried on by the network, with the aim to prospectively collect accurate data to improve knowledge on this group of lymphomas. Based on previously published reports from International Study Groups it emerged that rendering a correct classification of PTCLs is quite difficult because the relatively low prevalence of these diseases results in a lack of confidence by most pathologists. This is the reason why the T-Cell Project requested the availability of diagnostic material from the initial biopsy of each patient registered in the study in order to have the initial diagnosis centrally reviewed by expert hematopathologists. In the present report the results of the review process performed on 573 cases are presented. Overall, an incorrect diagnosis was centrally recorded in 13.1% cases, including 8.5% cases centrally reclassified with a subtype eligible for the project and 4.6% cases misclassified and found to be disorders other than T-cell lymphomas; 2.1% cases were centrally classified as T-Cell disorders not included in the study population. Thus, the T-Cell Project confirmed the difficulties in providing an accurate classification when a diagnosis of PTCLs is suspected, singled out the major pitfalls that can bias a correct histologic categorization and confirmed that a centralized expert review with the application of adequate diagnostic algorithms is mandatory when dealing with these tumours. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Reproducibility Issues: Avoiding Pitfalls in Animal Inflammation Models.

PubMed

Laman, Jon D; Kooistra, Susanne M; Clausen, Björn E

2017-01-01

In light of an enhanced awareness of ethical questions and ever increasing costs when working with animals in biomedical research, there is a dedicated and sometimes fierce debate concerning the (lack of) reproducibility of animal models and their relevance for human inflammatory diseases. Despite evident advancements in searching for alternatives, that is, replacing, reducing, and refining animal experiments-the three R's of Russel and Burch (1959)-understanding the complex interactions of the cells of the immune system, the nervous system and the affected tissue/organ during inflammation critically relies on in vivo models. Consequently, scientific advancement and ultimately novel therapeutic interventions depend on improving the reproducibility of animal inflammation models. As a prelude to the remaining hands-on protocols described in this volume, here, we summarize potential pitfalls of preclinical animal research and provide resources and background reading on how to avoid them.

Pitfalls of diffusion-weighted imaging of the female pelvis

PubMed Central

Duarte, Ana Luisa; Dias, João Lopes; Cunha, Teresa Margarida

2018-01-01

Diffusion-weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. High signal intensity on DWI with simultaneous low signal intensity on apparent diffusion coefficient maps is usually associated with malignancy. However, that pattern can also be seen in many benign lesions, a fact that should be recognized by radiologists. Correlating DWI findings with those of conventional (T1- and T2-weighted) MRI sequences and those of contrast-enhanced MRI sequences is mandatory in order to avoid potential pitfalls. The aim of this review article is the description of the most relevant physiological and benign pathological conditions of the female pelvis that can show restricted diffusion on DWI. PMID:29559764

Patient-specific instruments: advantages and pitfalls

PubMed Central

Hafez, Mahmoud A.; Moholkar, Kirti

2017-01-01

Patient-specific instruments (PSI) aim to improve the accuracy of total knee replacement (TKR) based on computer-assisted preoperative planning. In this work, the authors describe the advantages and pitfalls of PSI based on their clinical experience. The main conclusion of this work is that PSI has direct impact on the logistical and technical features of TKR with some advantages and pitfalls. PMID:29227785

Pitfall Traps and Mini-Winkler Extractor as Complementary Methods to Sample Soil Coleoptera.

PubMed

Carneiro, A C; Batistella, D A; Battirola, L D; Marques, M I

2016-02-01

We compared abundance, species richness, and capture efficiency with pitfall traps and mini-Winkler extractors to examine their use as complementary methods for sampling soil Coleoptera during dry (2010) and high water seasons (2011) in three areas, including inundated and non-inundated regions, in the Pantanal of Poconé, Mato Grosso, Brazil. We paired treatments with two 10 × 10 m plots in inundated and non-inundated locations that were repeated three times in each location for a total of 18 plots. In each plot, we used nine pitfall traps and collected 2 m(2) of leaf litter and surface soil samples with mini-Winkler extractors. We collected a total of 4260 adult beetles comprising 36 families, 113 genera, and 505 species. Most were caught in pitfalls (69%) and the remainder in the mini-Winkler extractors (31%). Each method provided distinct information about the beetle community: 252 species were captured only in pitfall traps, 147 using only the mini-Winkler extractors, and these methods shared another 106 species. Pitfall and mini-Winkler contribute in different ways for the sampling of the soil beetle community, and so they should be considered complementary for a more thorough assessment of community diversity.

Role of online journals and peer-reviewed research

Treesearch

Robert L. Deal

2014-01-01

The recent explosion of online journals has lead some researchers, scientist and academics to reconsider their traditional venues for publishing research. These on-line journals have the potential for quickly disseminating research, but they also present lots of uncertainty, confusion, and pitfalls for researchers. Many academics search out journals with the high...

Possibilities and pitfalls of outsourcing.

PubMed

Hazelwood, Sarah E; Hazelwood, Anita C; Cook, Ellen D

2005-10-01

Outsourcing can save healthcare organizations costs related to staffing and training. Organizations should ensure that a vendor's staff is credentialed, knowledgeable, and properly trained. Outsourcing firms should ensure the confidentiality and security of the information they will handle. Outsourcing carries risks for providers, including potentially negative impact on tax-exempt status and loss of control over business processes.

Memory colours affect colour appearance.

PubMed

Witzel, Christoph; Olkkonen, Maria; Gegenfurtner, Karl R

2016-01-01

Memory colour effects show that colour perception is affected by memory and prior knowledge and hence by cognition. None of Firestone & Scholl's (F&S's) potential pitfalls apply to our work on memory colours. We present a Bayesian model of colour appearance to illustrate that an interaction between perception and memory is plausible from the perspective of vision science.

Promises and Pitfalls of Online Education. Evidence Speaks Reports, Vol 2, #15

ERIC Educational Resources Information Center

Bettinger, Eric; Loeb, Susanna

2017-01-01

Online courses have expanded rapidly and have the potential to extend further the educational opportunities of many students, particularly those least well-served by traditional educational institutions. However, in their current design, online courses are difficult, especially for the students who are least prepared. These students' learning and…

Teaching Children with Language Delays to Say or Sign "More": Promises and Potential Pitfalls

ERIC Educational Resources Information Center

Lederer, Susan Hendler

2018-01-01

Teaching young children with language delays to say or sign the word "more" has had strong support from the literature since the 1970s (Bloom & Lahey, 1978; Holland, 1975; Lahey & Bloom, 1977; Lederer, 2002). Semantically, teaching children the word/sign "more" is supported by research on early vocabulary development…

Network-Based Professional Development: A Comparison of Statewide Initiatives.

ERIC Educational Resources Information Center

Shotsberger, Paul G.; Stammen, Ronald; Vetter, Ronald; Blue, Gloria; Greer, Edrie

This paper addresses opportunities and issues related to the use of the World Wide Web and high-speed networks as a delivery vehicle for training educators who are geographically dispersed. The benefits and potential pitfalls of using networks as educational platforms are explored from the perspective of various systems specifically being…

Multi-Point E-Conferencing with Initial Teacher Training Students in England: Pitfalls and Potential

ERIC Educational Resources Information Center

Pratt, Nick

2008-01-01

This article reports on attempts to initiate multi-point e-conferencing between English teacher education students on school placements, their host teachers and their university tutors. A sociocultural perspective is adopted in analysing the project, using the metaphor of a "professional knowledge landscape" [Clandinin, D. J., &…

Considering Layoffs? Tips for Avoiding Legal Problems

ERIC Educational Resources Information Center

Kelderman, Eric

2009-01-01

The fiscal year that begins on July 1 for most colleges is expected to bring a wave of layoffs, as institutions grapple with declining state contributions, a falloff in donations, and other budget pressures. Eliminating jobs can create a number of legal pitfalls, including potential lawsuits for breach of contract or discrimination. If handled…

Activism or Slacktivism? The Potential and Pitfalls of Social Media in Contemporary Student Activism

ERIC Educational Resources Information Center

Cabrera, Nolan L.; Matias, Cheryl E.; Montoya, Roberto

2017-01-01

The emergence of social media has greatly influenced 21st-century student activism. It has also given rise to the birth of "slacktivism," an online form of self-aggrandizing, politically ineffective activism. This theoretical article delves into the conceptualizations of what constitutes student activism versus slacktivism in a digital…

The Cable Fable.

ERIC Educational Resources Information Center

Kalba, Kas, Ed.

1972-01-01

An entire issue of the "Yale Review of Law and Social Action" has been devoted to 12 articles providing views on potential benefits and pitfalls of cable television in contrast to the picture provided by the Sloan Commission Report. The goal further unifying these articles is that of waging the argument for an expanded cable television policy.…

School Social Work Services and Their Regulation in Michigan.

ERIC Educational Resources Information Center

Pryor, Carolyn B; Secor, Donna

1998-01-01

Clarifies the process through which people can obtain approval as school social workers by the State of Michigan Department of Education. Describes the history of school social work in Michigan and illustrates the potential and pitfalls of statewide efforts to promote and regulate schools social work. Explains recent efforts to establish…

The Writing on the Wall: Activist Rhetorics, Public Writing, and Responsible Pedagogy

ERIC Educational Resources Information Center

Sundvall, Scott; Fredlund, Katherine

2017-01-01

Drawing from their experiences teaching two different activism-focused writing courses, the authors consider the benefits, pitfalls, and potential dangers of activist writing pedagogy. Scott provides a retrospective on a rhetoric and writing course focused on the employment of digital rhetoric, while Katherine reflects on an activist-rhetoric…

Practice nursing: the pitfalls and the potential.

PubMed

Pearce, Lynne

2016-03-16

A survey by the Queen's Nursing Institute has confirmed that practice nursing is facing major pressures, with one third of practice nurses due to retire by 2020, patchy access to training and widespread discrepancies in pay. But there is also cause for optimism, as new initiatives aim to ensure practice nurses are better supported and rewarded.

Democratising Turkey through Student-Centred Pedagogy: Opportunities and Pitfalls

ERIC Educational Resources Information Center

Altinyelken, Hülya Kosar

2015-01-01

Global reform talk on pedagogy has been converging around student-centred pedagogy (SCP) in recent decades. One of the significant appeals of this pedagogical model is its democratisation potentials. This article seeks to empirically study SCP's role in democratising learning and promoting social democratisation by taking the case of Turkey, a…

Engaging First-Year University Students in Research: Promise, Potentials, and Pitfalls

ERIC Educational Resources Information Center

Sangster, Sarah L.; Loy, Kara L.; Mills, Sheryl D.; Lawson, Karen L.

2016-01-01

In 2014, the Undergraduate Research Initiative at the University of Saskatchewan implemented a pilot project to organize, support, and promote curriculum-based research experience as an integral aspect of participating first-year courses. The framework for the course-based initiative was the research arc; usually in groups, students in these…

Beyond GDP: Classifying Alternative Measures for Progress

ERIC Educational Resources Information Center

Bleys, Brent

2012-01-01

Both the potential pitfalls of macro-economic policies focused on stimulating economic growth and the problems involved in using GDP as a measure of well-being or economic welfare have long been recognized by economists and researchers from other social sciences. Therefore, it is no surprise that alternative measures for policy-making have been…

Straight-line drift fences and pitfall traps

USGS Publications Warehouse

Corn, Paul Stephen

1994-01-01

Straight-line drift fences typically are short barriers (5-15 m) that direct animals traveling on the substrate surface into traps places at the ends of or beside the barriers. Traps (described below) can be pitfalls, funnel traps, or a combination of the two. Drift fences with pitfall or funnel traps and pitfall traps without fences are used commonly to inventory and monitor populations of amphibians and reptiles. For example, 9 of 17 field studies reported for management of terrestrial vertebrates (Sarzo et al. 1988) used these techniques to sample amphibians. Drift fences with pitfall traps can be used to determine species richness at a site and to detect the presence of rare species. They also can yield data on relative abundances and habitat use of selected species. Pitfall traps arrayed in a grid without fences can also be used to study the population ecology and habitat use of selected species. Population density can be estimated with this latter technique if used in conjunction with mark-recapture techniques (see Chapter 8). Drift fence arrays or pitfall grids can be left in place for long-term monitoring. In this section, I discuss the use of this technique to obtain data on amphibians away from breeding ponds. Use of drift fences and traps to monitory amphibian activity at breeding ponds is discussed in the section "Drift Fences Encircling Breeding Sits", below (technique 9). Some materials and procedures are common to both techniques. Investigators contemplating the use of drift fences and traps in any context should read both accounts.

Diffusion MRI: Pitfalls, literature review and future directions of research in mild traumatic brain injury.

PubMed

Delouche, Aurélie; Attyé, Arnaud; Heck, Olivier; Grand, Sylvie; Kastler, Adrian; Lamalle, Laurent; Renard, Felix; Krainik, Alexandre

2016-01-01

Mild traumatic brain injury (mTBI) is a leading cause of disability in adults, many of whom report a distressing combination of physical, emotional and cognitive symptoms, collectively known as post-concussion syndrome, that persist after the injury. Significant developments in magnetic resonance diffusion imaging, involving voxel-based quantitative analysis through the measurement of fractional anisotropy or mean diffusivity, have enhanced our knowledge on the different stages of mTBI pathophysiology. Other diffusion imaging-derived techniques, including diffusion kurtosis imaging with multi-shell diffusion and high-order tractography models, have recently demonstrated their usefulness in mTBI. Our review starts by briefly outlining the physical basis of diffusion tensor imaging including the pitfalls for use in brain trauma, before discussing findings from diagnostic trials testing its usefulness in assessing brain structural changes in patients with mTBI. Use of different post-processing techniques for the diffusion imaging data, identified the corpus callosum as the most frequently injured structure in mTBI, particularly at sub-acute and chronic stages, and a crucial location for evaluating functional outcome. However, structural changes appear too subtle for identification using traditional diffusion biomarkers, thus disallowing expansion of these techniques into clinical practice. In this regard, more advanced diffusion techniques are promising in the assessment of this complex disease. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Role of Molecular Biology in Diagnosis and Characterization of Vulvo-Vaginitis in Clinical Practice.

PubMed

Donders, Gilbert G G; Ravel, Jacques; Vitali, Beatrice; Netea, Mihai G; Salumets, Andres; Unemo, Magnus

2017-01-01

The diagnosis of vulvo-vaginal complaints has always been enigmatic in obstetrics and gynecology. Patients with clear, pathognomonic symptoms end up with a proper diagnosis and treatment most of the time, but unfortunately we are now living in a world where women reach out to the Internet and readily get all information as to which disease their symptoms correspond to and also find the appropriate treatment "over-the-counter." Because of this trend, we as specialists are increasingly confronted with patients with complex and combined conditions. At the same time, extremely sensitive and accurate diagnostic tools are now being developed at a rapid pace, allowing the physicians to diagnose vulvo-vaginal disease with a substantially increased precision. Moreover, many of these molecular biology (MB)-based tests have become so common and affordable that self-sampling and self-testing are no longer utopia. On the other hand, too much information that is too readily available and that is too affordable also encompasses pitfalls, leading to gross overtreatment and psychological burden. As experienced caregivers, we should supervise these evolutions, define their place and proper use as diagnostic tools, utilize their potential as ad hoc tools to follow-up treatment efficacy and guide how such tools can be used for responsible self-testing. In the present paper, responding to the need for appropriate, quality assured and accessible tests for vulvo-vaginitis and the huge potential delivered by the rapidly developing MB methods, we recommend the need for a broad and regular discussion forum, composed of both clinical and technical experts and opinion makers, in order to match the needs with the huge opportunities and ideally combine the initiatives and forces into the same direction. This forum should then translate conceived strategies into regularly updated, evidence-based national and international guidelines. © 2017 S. Karger AG, Basel.

Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy: Progress and Pitfalls.

PubMed

Oomen, Ad W G J; Semsarian, Christopher; Puranik, Rajesh; Sy, Raymond W

2018-04-04

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy that predominantly affects the right ventricle. With a prevalence in the range of 1:5000 to 1:2000 persons, ARVC is one of the leading causes of sudden cardiac death in young people and in athletes. Although early detection and treatment is important, the diagnosis of ARVC remains challenging. There is no single pathognomonic diagnostic finding in ARVC; rather, current international task force criteria specify diagnostic major and minor criteria in six categories: right ventricular imaging (including echocardiography and cardiac magnetic resonance imaging (MRI)), histology, repolarisation abnormalities, depolarisation and conduction abnormalities, arrhythmias and family history (including genetic testing). Combining findings from differing diagnostic modalities can establish a "definite", "borderline" or "possible" diagnosis of ARVC. However, there are limitations inherent in the current task force criteria, including the lack of specificity for ARVC; future iterations may be improved, for example, by enhanced imaging protocols able to detect subtle changes in the structure and function of the right ventricle, incorporation of electro-anatomical data, response to adrenergic challenge, and validated criteria for interpreting genetic variants. Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Exfoliative cytologic findings of primary pulmonary adenoid cystic carcinom: a report of 2 cases with a review of the cytologic features.

PubMed

Daneshbod, Yahya; Modjtahedi, Ebrahim; Atefi, Sohrab; Bedayat, Gholam Reza; Daneshbod, Khosrow

2007-01-01

Adenoid cystic carcinoma is a very rare primary pulmonary neoplasm. Cytologic findings of pulmonary washing and brushing in 2 cases of primary bronchial adenoid cystic carcinoma with special histologic features are described, with an emphasis on some points that have not been reported previously, together with the diagnostic pitfalls. Two cases of primary adenoid cystic carcinoma of the lung were diagnosed on exfoliative cytology. The patients' ages were 55 and 65 years old. Cytologic findings included large and small clusters of small cells in both 2 and 3 dimensions with occasional cystlike spaces containing mucoid material. The cells were arranged in spherical, cylindrical, basaloid and rosettelike arrangements. There were also abundant small and large mucoid globules, cylinders of homogeneous, acellular, mucous material and "cannon balls." Cytoplasmic and intranuclear round inclusions were noted in case 1. Rare findings of nuclear molding were noted. In case 2, chondromyxoid material and a bimorphic population of tumor cells caused diagnostic confusion with other salivary gland-type tumors of the lung. These cases showed characteristic cytologic findings of adenoid cystic carcinoma together with rare findings of intracellular and extracellular inclusionlike bodies, myxochondroid material, bimorphic populations and nuclear molding, which can cause diagnostic confusion with other lung tumors.

PNET-like features of synovial sarcoma of the lung: a pitfall in the cytologic diagnosis of soft-tissue tumors.

PubMed

Hummel, P; Yang, G C; Kumar, A; Cohen, J M; Winkler, B; Melamed, J; Scholes, J V; Jagirdar, J

2001-04-01

Fine-needle aspiration (FNA) cytology of soft-tissue tumors is evolving. As more experience is gained, we are becoming aware of potential pitfalls. We describe 2 cases of synovial sarcoma of the lung, primary and metastatic, in patients who had FNA biopsy performed on a lung mass. The cytologic smears showed extremely cellular groups of malignant small round cells, intersected by small blood vessels, with numerous loose single cells, in a background of macrophages and mature lymphocytes. The tumors displayed monomorphic cells forming rosettes and displaying occasional mitoses. A diagnosis of neuroendocrine tumor/primitive neuroepithelial tumor (PNET) was suspected. Furthermore, this suspicion was supported by immunohistochemical stains, which showed positivity for a neuroendocrine marker, Leu 7 (case 1), and for a neural marker, CD 99 (O 13 or HBA 71) (both cases); and negativity for cytokeratins (case 1). The resection specimen of case 1 had mostly tightly packed small round cells, with occasional rosettes, similar to the FNA biopsy, and focal areas composed of spindle cells, organized in a focal fibrosarcoma-like and hemangiopericytoma-like pattern. A balanced translocation between chromosomes X and 18, demonstrated by both karyotyping and fluorescent in situ hybridization (FISH), enabled us to make a diagnosis of synovial sarcoma, which was histologically classified as poorly differentiated. Case 2 was a metastatic biphasic synovial sarcoma of the arm, with a prominent epithelial component. Synovial sarcoma, when composed mainly of small round cells on cytologic smears, is a great mimicker of neuroendocrine/PNET tumors, with light microscopic and immunohistochemical overlap. Awareness of this potential pitfall may aid in preventing a misdiagnosis. Its recognition is of major concern, especially for the poorly differentiated variant, because it is associated with a worse prognosis. Copyright 2001 Wiley-Liss, Inc.

Assessing Brain–Muscle Connectivity in Human Locomotion through Mobile Brain/Body Imaging: Opportunities, Pitfalls, and Future Directions

PubMed Central

Gennaro, Federico; de Bruin, Eling D.

2018-01-01

Assessment of the cortical role during bipedalism has been a methodological challenge. While surface electroencephalography (EEG) is capable of non-invasively measuring cortical activity during human locomotion, it is associated with movement artifacts obscuring cerebral sources of activity. Recently, statistical methods based on blind source separation revealed potential for resolving this issue, by segregating non-cerebral/artifactual from cerebral sources of activity. This step marked a new opportunity for the investigation of the brains’ role while moving and was tagged mobile brain/body imaging (MoBI). This methodology involves simultaneous mobile recording of brain activity with several other body behavioral variables (e.g., muscle activity and kinematics), through wireless recording wearable devices/sensors. Notably, several MoBI studies using EEG–EMG approaches recently showed that the brain is functionally connected to the muscles and active throughout the whole gait cycle and, thus, rejecting the long-lasting idea of a solely spinal-driven bipedalism. However, MoBI and brain/muscle connectivity assessments during human locomotion are still in their fledgling state of investigation. Mobile brain/body imaging approaches hint toward promising opportunities; however, there are some remaining pitfalls that need to be resolved before considering their routine clinical use. This article discusses several of these pitfalls and proposes research to address them. Examples relate to the validity, reliability, and reproducibility of this method in ecologically valid scenarios and in different populations. Furthermore, whether brain/muscle connectivity within the MoBI framework represents a potential biomarker in neuromuscular syndromes where gait disturbances are evident (e.g., age-related sarcopenia) remains to be determined. PMID:29535995

Payoffs and Pitfalls of a Minority Outreach Program: An Alaskan Example

NASA Astrophysics Data System (ADS)

Hanks, C. L.; Fowell, S. J.; Wartes, D.; Owens, G.

2004-12-01

The Rural Alaska Honors Institute (RAHI) is a summer bridging program for college-bound high school students from remote Alaskan communities. In the 20+ years since its initiation, more than 50% of RAHI graduates eventually obtained post-secondary degrees. The success of the RAHI program provides insights into how an outreach program can achieve its goals and avoid potential pitfalls. Instrumental to the success of the RAHI program are: longevity; small size (40-45 students per summer); support from the Alaska Native community; academic rigor; aggressive recruiting; establishment of a sense of community amongst participants; and individual mentoring and support. Potential pitfalls include: overextending the program to include too many students; failure to maintain academic rigor in all courses; recruitment of students and staff who do not embrace the program's methods and goals; and attempts to evaluate the program on the basis of short-term results. Alaska Natives in Geosciences introduces college-bound Alaska Native students to the geosciences by teaching a college-level introductory geoscience class as a RAHI elective. By collaborating with RAHI, Alaska Natives in Geosciences takes advantage of RAHI's effective recruitment efforts and proven mentoring program. However, maintaining scientific rigor has been difficult due to large differences in the students' scientific backgrounds, the demands of other courses in the RAHI program and the brevity of the summer session. Immediate post-course survey responses suggest that many RAHI students thought the geoscience class was interesting but too difficult and much too time-consuming. However, surveys of RAHI geoscience students a year later suggest that many found the course a very positive experience. An unanticipated result was that RAHI students who did not take the class also gained some insight into the geosciences.

Molecular testing for clinical diagnosis and epidemiological investigations of intestinal parasitic infections.

PubMed

Verweij, Jaco J; Stensvold, C Rune

2014-04-01

Over the past few decades, nucleic acid-based methods have been developed for the diagnosis of intestinal parasitic infections. Advantages of nucleic acid-based methods are numerous; typically, these include increased sensitivity and specificity and simpler standardization of diagnostic procedures. DNA samples can also be stored and used for genetic characterization and molecular typing, providing a valuable tool for surveys and surveillance studies. A variety of technologies have been applied, and some specific and general pitfalls and limitations have been identified. This review provides an overview of the multitude of methods that have been reported for the detection of intestinal parasites and offers some guidance in applying these methods in the clinical laboratory and in epidemiological studies.

Molecular Testing for Clinical Diagnosis and Epidemiological Investigations of Intestinal Parasitic Infections

PubMed Central

Stensvold, C. Rune

2014-01-01

SUMMARY Over the past few decades, nucleic acid-based methods have been developed for the diagnosis of intestinal parasitic infections. Advantages of nucleic acid-based methods are numerous; typically, these include increased sensitivity and specificity and simpler standardization of diagnostic procedures. DNA samples can also be stored and used for genetic characterization and molecular typing, providing a valuable tool for surveys and surveillance studies. A variety of technologies have been applied, and some specific and general pitfalls and limitations have been identified. This review provides an overview of the multitude of methods that have been reported for the detection of intestinal parasites and offers some guidance in applying these methods in the clinical laboratory and in epidemiological studies. PMID:24696439

A pitfall during endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes.

PubMed

Krenke, Rafal; Korczynski, Piotr; Gorska, Katarzyna; Chazan, Ryszarda

2014-03-01

The high diagnostic yield and favorable safety profile of endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes have been recently demonstrated. We report an unusual technical problem during endobronchial ultrasound-guided transbronchial forceps biopsy that could be a prerequisite for severe complications. A rupture of the steering band precluded closure of the forceps jaws opened in the subcarinal lymph node. A solution to the problem is presented, together with other procedure-related complications reported in the literature. The report emphasizes that a dysfunction of the forceps steering band can result in severe complications when it occurs during transbronchial sampling of mediastinal lesions. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Diagnostic classification of cancer using DNA microarrays and artificial intelligence.

PubMed

Greer, Braden T; Khan, Javed

2004-05-01

The application of artificial intelligence (AI) to microarray data has been receiving much attention in recent years because of the possibility of automated diagnosis in the near future. Studies have been published predicting tumor type, estrogen receptor status, and prognosis using a variety of AI algorithms. The performance of intelligent computing decisions based on gene expression signatures is in some cases comparable to or better than the current clinical decision schemas. The goal of these tools is not to make clinicians obsolete, but rather to give clinicians one more tool in their armamentarium to accurately diagnose and hence better treat cancer patients. Several such applications are summarized in this chapter, and some of the common pitfalls are noted.

PCR Amplification Strategies towards full-length HIV-1 Genome sequencing.

PubMed

Liu, Chao Chun; Ji, Hezhao

2018-06-26

The advent of next generation sequencing has enabled greater resolution of viral diversity and improved feasibility of full viral genome sequencing allowing routine HIV-1 full genome sequencing in both research and diagnostic settings. Regardless of the sequencing platform selected, successful PCR amplification of the HIV-1 genome is essential for sequencing template preparation. As such, full HIV-1 genome amplification is a crucial step in dictating the successful and reliable sequencing downstream. Here we reviewed existing PCR protocols leading to HIV-1 full genome sequencing. In addition to the discussion on basic considerations on relevant PCR design, the advantages as well as the pitfalls of published protocols were reviewed. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

"Hidden" bone metastasis from thyroid carcinoma: a clinical note.

PubMed

Sioka, C; Skarulis, M C; Tulloch-Reid, M K; Heiss, J D; Reynolds, J C

2014-01-01

The (131)I-iodide ((131)I) whole-body scan, for thyroid carcinoma is at times difficult to interpret. In a diagnostic whole body (131)I scan of a patient with follicular carcinoma, a posterior skull lesion was partially hidden by overlapping facial structures. On lateral head view, the abnormality was clearly evident. SPECT/CT and MRI showed the lesion originated in the occipital bone and had enlarged into the posterior fossa. The mass was surgically removed and the patient received (131)I therapy for residual tissue. The study demonstrates a pitfall in the reading of two dimensional radioiodine images which can be overcome by SPECT or lateral imaging. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

Planning Strabismus Surgery: How to Avoid Pitfalls and Complications.

PubMed

Aroichane, Maryam

2016-01-01

Good surgical results following strabismus surgery depend on several factors. In this article, detailed steps for planning strabismus surgery will be reviewed for basic horizontal strabismus surgery, vertical, and oblique muscle surgeries. The thought process behind each case will be presented to help in selecting the best surgical approach to optimize postoperative results. The surgical planning for strabismus will be developed with clinical examples from easy cases to more complex ones. Preoperative pictures of the ocular alignment are an integral part of planning surgery and help in documenting the strabismus before and after surgery. Three cases of strabismus cases will be reviewed with several key factors for planning surgery, including visual acuity, refractive error, potential for stereovision, and risk of postoperative diplopia. The most important factor is accurate orthoptic measurements. The surgical planning for each patient is detailed along with preoperative pictures. Strabismus surgery results can be improved by careful preoperative planning. The surgeon has the ability to discern potential pitfalls that can alter the surgical outcome. Surgical planning allows a dedicated time of reflection before surgery, foreseeing potential problems, and avoiding them during the surgery. © 2016 Board of regents of the University of Wisconsin System, American Orthoptic Journal, Volume 66, 2016, ISSN 0065-955X, E-ISSN 1553-4448.

Potential and pitfalls of researching ethnic communities in recreation: a Puerto Rican case study

Treesearch

Edwin G& #243; mez; Edwin mez

2003-01-01

Although the empirical literature on ethnic/racial groups and recreation has been growing, there have been request by researchers for approaches on procuring information from hard-to-reach populations. The purpose of this report is to provide prospective researchers with "lessons learned" in the field when researching ethnic group members. This study observes...

Falling in Love

ERIC Educational Resources Information Center

Drew, Philip

2007-01-01

Occasionally, the search committee for a tenure-track position will decide on a candidate who is A.B.D., all but dissertation, and decide to hire him or her with the understanding that the Ph.D. will be completed by a given deadline. In the the form of an anecdote, the author discusses the potential pitfalls--for both the university, the…

Social Media Use and Social Connectedness in Adolescents: The Positives and the Potential Pitfalls

ERIC Educational Resources Information Center

Allen, Kelly A.; Ryan, Tracii; Gray, DeLeon L.; McInerney, Dennis M.; Waters, Lea

2014-01-01

As social media use is rising among adolescents, the issue of whether this use leads to positive or negative outcomes warrants greater understanding. This article critically reviews the literature related to this important topic. Specifically, we examine how social media use affects social connectedness in terms of three elements of adolescent…

Reptile and amphibian response to season of burn in an upland hardwood forest

Treesearch

Cathryn H. Greenberg; Tyler Seiboldt; Tara L. Keyser; W. Henry McNab; Patrick Scott; Janis Bush; Christopher E. Moorman

2018-01-01

Growing-season burns are increasingly used in upland hardwood forest for multiple forest management goals. Many species of reptiles and amphibians are ground-dwelling, potentially increasing their vulnerability to prescribed fire, especially during the growing-season when they are most active. We used drift fences with pitfall traps to experimentally assess how...

Lost in a Giant Database: The Potentials and Pitfalls of Secondary Analysis for Deaf Education

ERIC Educational Resources Information Center

Kluwin, T. N.; Morris, C. S.

2006-01-01

Secondary research or archival research is the analysis of data collected by another person or agency. It offers several advantages, including reduced cost, a less time-consuming research process, and access to larger populations and thus greater generalizability. At the same time, it offers several limitations, including the fact that the…

Planning and Implementing Social Service Information Systems: A Guide for Management and Users. Human Services Monograph Series Number 25. Project Share.

ERIC Educational Resources Information Center

Cotter, Barbara

Intended to aid administrators and users of social services in establishing information systems, this comprehensive guide to the design of such systems identifies the elements, effective strategies, and potential pitfalls involved in their planning, implementation, and utilization. Detailed discussions of management strategies for system…

Legal Challenges to Teacher Evaluation: Pitfalls and Possibilities in the States

ERIC Educational Resources Information Center

Hazi, Helen M.

2014-01-01

This article forecasts potential legal problems emerging from the use of new teacher evaluation systems in the states. This research was a policy analysis that combined three types of data to forecast the states and the legal challenges they might encounter: state policy data, selected case law, and problems from the literature of teacher…

A New Landscape: Opportunities and Pitfalls for Universities Expanding in the Persian Gulf

ERIC Educational Resources Information Center

DiConsiglio, John

2009-01-01

Dozens of universities--primarily from the United States, United Kingdom, and Australia--are eyeing the Gulf region as a largely untapped reservoir of academic potential and economic opportunity. During the last few years, UAE states like Dubai, Abu Dhabi, Qatar, and Ras al Khaymah have spent billions to entice top universities. And many colleges…

From the Games Industry: Ten Lessons for Game-Based Learning

ERIC Educational Resources Information Center

Hollins, Paul; Whitton, Nicola

2011-01-01

This paper draws on lessons learned from the development process of the entertainment games industry and discusses how they can be applied to the field of game-based learning. This paper examines policy makers and those wishing to commission or develop games for learning and highlights potential opportunities as well as pitfalls. The paper focuses…

Honoring the Past, Changing the Future: Bringing Native American Voices into Dance Theory Courses

ERIC Educational Resources Information Center

Prichard, Robin

2016-01-01

The inclusion of Native American perspectives adds an important voice in honoring the multiplicities of histories and cultures inherent in American society. And yet, teachers run the risk of committing unknown offenses if they are not familiar with the potential pitfalls that longstanding asymmetrical power relations between cultures can produce.…

Becoming a Principal in Indonesia: Possibility, Pitfalls and Potential

ERIC Educational Resources Information Center

Sumintono, Bambang; Sheyoputri, Elslee Y. A.; Jiang, Na; Misbach, Ifa H.; Jumintono

2015-01-01

The preparation and development of school leaders is now considered to be fundamental to school and system improvement. In the pursuit of educational change and reform, the leadership of the principal is deemed to be of critical importance. This qualitative study is part of a large scale research project that is exploring principal preparation and…

Can Critical Management Education Be Critical in a Formal Higher Educational Setting?

ERIC Educational Resources Information Center

Choo, Kok Leong

2007-01-01

This article attempts to establish the scope of critical management education in a formal educational setting. It is based on an empirical study of 24 academic staffs' experience of engaging critical management education in four UK University Business Schools. The study seems to show that there are significant barriers to and potential pitfalls in…

Language in Action: From Webquests to Virtual Realities

ERIC Educational Resources Information Center

Godwin-Jones, Robert

2004-01-01

English is the lingua franca of the Internet and as a consequence the World Wide Web offers a rich bounty for ESL and EFL teachers and learners. It also represents a vast repository of misinformation, poor language use, and potentially offensive material. There are any number of possible approaches to avoiding the pitfalls of the Internet while…

Emotion and emotion regulation: from another perspective.

PubMed

Langlois, Judith H

2004-01-01

An overview of the content of the From Another Perspective collection on emotion and emotion regulation is provided. The lead article identifies fundamental issues of definition and the commentaries represent varying theoretical and methodological perspectives on emotion and emotion regulation. Together, the articles discuss the promises and pitfalls of emotion research and its potential for understanding child development.

Observing System Simulation Experiments: An Overview

NASA Technical Reports Server (NTRS)

Prive, Nikki C.; Errico, Ronald M.

2016-01-01

An overview of Observing System Simulation Experiments (OSSEs) will be given, with focus on calibration and validation of OSSE frameworks. Pitfalls and practice will be discussed, including observation error characteristics, incestuousness, and experimental design. The potential use of OSSEs for investigation of the behaviour of data assimilation systems will be explored, including some results from experiments using the NASAGMAO OSSE.

Risky communication: pitfalls in counseling about risk, and how to avoid them.

PubMed

O'Doherty, K; Suthers, G K

2007-08-01

A genetic counselor is often faced with the difficult task of conveying a set of complex and highly abstract factors associated with the client's risk of developing a familial disorder. The client is faced with the even more difficult task of making significant health-related decisions about an event which may or may not eventuate. Although there is a large corpus of research on this topic, much of the knowledge on risk communication is difficult to apply in a practical context. In this paper we draw together some insights on risk communication and decision-making under conditions of uncertainty, and apply them directly to the problem of communicating familial cancer risk. In particular, we focus on the distinction between individual risk and observed frequencies of adverse events, various framing effects, and contextualizing risk communication. We draw attention to some of the potential pitfalls in counseling about risk and offer avenues for circumventing them.

The commercial marketing of healthy lifestyles to address the global child and adolescent obesity pandemic: prospects, pitfalls and priorities.

PubMed

Kraak, Vivica I; Kumanyika, Shiriki K; Story, Mary

2009-11-01

Public- and private-sector initiatives to promote healthy eating and physical activity, called 'healthy lifestyles', are a relatively recent response to the global obesity pandemic. The present paper explores different views about marketing healthy lifestyles with a special emphasis on private-sector initiatives and public-private partnerships designed to reach young people. We discuss aspects of these initiatives and partnerships from three perspectives: (i) the potential for commercial marketing practices to have a favourable influence on reversing global obesity trends (termed prospects); (ii) unresolved dilemmas and challenges that may hinder progress (termed pitfalls); and (iii) the implementation and evaluation of coordinated and systematic actions (termed priorities) that may increase the likelihood that commercially marketed healthy-lifestyle initiatives and public-private partnerships can make a positive contribution to reverse the rise in overweight and obesity among young people globally.

Essential pitfalls in "essential” tremor

PubMed Central

Espay, AJ; Lang, AE; Erro, R; Merola, A; Fasano, A; Berardelli, A; Bhatia, KP

2016-01-01

While essential tremor has been considered the most common movement disorder, it has largely remained a diagnosis of exclusion: many tremor and non-tremor features must be absent for the clinical diagnosis to stand. The clinical features of “essential tremor” overlap with or may be part of other tremor disorders and, not surprisingly, this prevalent familial disorder has remained without a gene identified, without a consistent natural history, and without an acceptable pathology or pathophysiologic underpinning. The collective evidence suggests that under the rubric of essential tremor there exists multiple unique diseases, some of which represent cerebellar dysfunction, but for which there is no intrinsic “essence” other than a common oscillatory behavior on posture and action. One approach may be to use the term “essential tremor” only as a transitional node in the deep phenotyping of tremor disorders based on historical, phenomenological, and neurophysiological features, to facilitate its etiologic diagnosis or serve for future gene- and biomarker-discovery efforts. This approach deemphasizes essential tremor as a diagnostic entity and facilitates the understanding of the underlying disorders in order to develop biologically tailored diagnostic and therapeutic strategies. PMID:28116753

Use of machine learning to improve autism screening and diagnostic instruments: effectiveness, efficiency, and multi-instrument fusion

PubMed Central

Bone, Daniel; Bishop, Somer; Black, Matthew P.; Goodwin, Matthew S.; Lord, Catherine; Narayanan, Shrikanth S.

2016-01-01

Background Machine learning (ML) provides novel opportunities for human behavior research and clinical translation, yet its application can have noted pitfalls (Bone et al., 2015). In this work, we fastidiously utilize ML to derive autism spectrum disorder (ASD) instrument algorithms in an attempt to improve upon widely-used ASD screening and diagnostic tools. Methods The data consisted of Autism Diagnostic Interview-Revised (ADI-R) and Social Responsiveness Scale (SRS) scores for 1,264 verbal individuals with ASD and 462 verbal individuals with non-ASD developmental or psychiatric disorders (DD), split at age 10. Algorithms were created via a robust ML classifier, support vector machine (SVM), while targeting best-estimate clinical diagnosis of ASD vs. non-ASD. Parameter settings were tuned in multiple levels of cross-validation. Results The created algorithms were more effective (higher performing) than current algorithms, were tunable (sensitivity and specificity can be differentially weighted), and were more efficient (achieving near-peak performance with five or fewer codes). Results from ML-based fusion of ADI-R and SRS are reported. We present a screener algorithm for below (above) age 10 that reached 89.2% (86.7%) sensitivity and 59.0% (53.4%) specificity with only five behavioral codes. Conclusions ML is useful for creating robust, customizable instrument algorithms. In a unique dataset comprised of controls with other difficulties, our findings highlight limitations of current caregiver-report instruments and indicate possible avenues for improving ASD screening and diagnostic tools. PMID:27090613

Use of machine learning to improve autism screening and diagnostic instruments: effectiveness, efficiency, and multi-instrument fusion.

PubMed

Bone, Daniel; Bishop, Somer L; Black, Matthew P; Goodwin, Matthew S; Lord, Catherine; Narayanan, Shrikanth S

2016-08-01

Machine learning (ML) provides novel opportunities for human behavior research and clinical translation, yet its application can have noted pitfalls (Bone et al., 2015). In this work, we fastidiously utilize ML to derive autism spectrum disorder (ASD) instrument algorithms in an attempt to improve upon widely used ASD screening and diagnostic tools. The data consisted of Autism Diagnostic Interview-Revised (ADI-R) and Social Responsiveness Scale (SRS) scores for 1,264 verbal individuals with ASD and 462 verbal individuals with non-ASD developmental or psychiatric disorders, split at age 10. Algorithms were created via a robust ML classifier, support vector machine, while targeting best-estimate clinical diagnosis of ASD versus non-ASD. Parameter settings were tuned in multiple levels of cross-validation. The created algorithms were more effective (higher performing) than the current algorithms, were tunable (sensitivity and specificity can be differentially weighted), and were more efficient (achieving near-peak performance with five or fewer codes). Results from ML-based fusion of ADI-R and SRS are reported. We present a screener algorithm for below (above) age 10 that reached 89.2% (86.7%) sensitivity and 59.0% (53.4%) specificity with only five behavioral codes. ML is useful for creating robust, customizable instrument algorithms. In a unique dataset comprised of controls with other difficulties, our findings highlight the limitations of current caregiver-report instruments and indicate possible avenues for improving ASD screening and diagnostic tools. © 2016 Association for Child and Adolescent Mental Health.

Teaching DSM-III to clinicians. Some problems of the DSM-III system reducing reliability, using the diagnosis and classification of depressive disorders as an example.

PubMed

Malt, U F

1986-01-01

Experiences from teaching DSM-III to more than three hundred Norwegian psychiatrists and clinical psychologists suggest that reliable DSM-III diagnoses can be achieved within a few hours training with reference to the decision trees and the diagnostic criteria only. The diagnoses provided are more reliable than the corresponding ICD diagnoses which the participants were more familiar with. The three main sources of reduced reliability of the DSM-III diagnoses are related to: poor knowledge of the criteria which often is connected with failure of obtaining diagnostic key information during the clinical interview; unfamiliar concepts and vague or ambiguous criteria. The two first issues are related to the quality of the teaching of DSM-III. The third source of reduced reliability reflects unsolved validity issues. By using the classification of five affective case stories as examples, these sources of diagnostic pitfalls, reducing reliability and ways to overcome these problems when teaching the DSM-III system, are discussed. It is concluded that the DSM-III system of classification is easy to teach and that the system is superior to other classification systems available from a reliability point of view. The current version of the DSM-III system, however, partly owes a high degree of reliability to broad and heterogeneous diagnostic categories like the concept major depression, which may have questionable validity. Thus, the future revisions of the DSM-III system should, above all, address the issue of validity.

Antibiotics in frozen bone grafts can cause allergic reactions in recipient patients.

PubMed

Crnogaca, Kresimir; Bicanic, Goran; Delimar, Domagoj

2015-02-01

Antibiotic prophylaxis is a routine procedure during total hip arthroplasty (THA), and the vast majority of cadavers within the multitissue procurement receive one or more antibiotics. Upon harvesting, bone grafts are stored in the bone banks on the temperature as low as -80°C for up to 5 years. It is shown in the literature that the antibiotics remain active and viable in the bone grafts even after being exposed to extremely low temperatures in the prolonged periods. Possibility of remnant antibiotic concentrations in the bone grafts and the fact that these antibiotic remnants maintain active even after being exposed to extremely low temperatures create the environment in which the possibility for the allergic reaction in sensitive patient receiving bone graft exists. We hypothesize that harvested bone grafts containing active antibiotic substance have the potential for local and systemic allergic reaction in sensitive recipient patients thus increasing morbidity and the costs of the treatment. Allergic reactions can mimic surgical site infections as well with the consequent substantial pitfalls in the treatment. Following that, in the setting of an assumed but not confirmed surgical site infection, the immunological evaluation on antibiotics for recipients of bone grafts could be added to the standard diagnostic algorithms. In addition, bone banks should be obliged to provide information of all potential drugs that can be found in every specific bone graft to the end users. Copyright © 2014 Elsevier Ltd. All rights reserved.

Use of contrast media in diagnostic imaging: medico-legal considerations.

PubMed

Pomara, C; Pascale, N; Maglietta, F; Neri, M; Riezzo, I; Turillazzi, E

2015-09-01

Contrast media (CM) are used in imaging techniques to enhance the differences between body tissues on images. The ideal contrast medium should achieve very high concentration in the tissues without producing any adverse effects. Unfortunately, this has not been possible so far and all CM have adverse effects. The increasing use of CM is likely to give rise to a wide range of pitfalls, including compliance with and appropriateness of indications for the use of CM themselves, the choice of the 'best' contrast agent, off-label use, evaluation of special populations of patients, and competence to tackle emergency scenarios following the administration of CM. Even more prominent, and potentially more important, is the issue of informed consent which brings with it a duty to inform patients awaiting the administration of CM with regard to the nature of the procedure, the existence of alternative procedures, the extent of the risks relating to the use of CM and, finally, the risks relating to refusal of the procedure. All these issues may give rise to concerns about liability for failure to offer adequate information to patients or to carefully evaluate and balance the potential risks and benefits of the procedure or, finally, for being unprepared in the event of adverse reactions to CM, especially when these are severe and life-threatening. Educational and training programmes for radiologists are likely to shape change in the medical liability environment in the coming years.

Neonatal thyrotoxicosis caused by maternal autoimmune hyperthyroidism.

PubMed

Correia, Miguel Fragata; Maria, Ana Teresa; Prado, Sara; Limbert, Catarina

2015-03-06

Neonatal immune hyperthyroidism is a rare but potentially fatal condition. It occurs in 1-5% of infants born to women with Graves' disease (GD). In most of the cases it is due to maternal antibodies transferred from the mother into the fetal compartment, stimulating the fetal thyroid by binding thyrotropin (thyroid-stimulating hormone, TSH) receptor. We present a case of neonatal thyrotoxicosis due to maternal GD detected at 25 days of age and discuss the potential pitfalls in the diagnosis. 2015 BMJ Publishing Group Ltd.

Neonatal thyrotoxicosis caused by maternal autoimmune hyperthyroidism

PubMed Central

Correia, Miguel Fragata; Maria, Ana Teresa; Prado, Sara; Limbert, Catarina

2015-01-01

Neonatal immune hyperthyroidism is a rare but potentially fatal condition. It occurs in 1–5% of infants born to women with Graves’ disease (GD). In most of the cases it is due to maternal antibodies transferred from the mother into the fetal compartment, stimulating the fetal thyroid by binding thyrotropin (thyroid-stimulating hormone, TSH) receptor. We present a case of neonatal thyrotoxicosis due to maternal GD detected at 25 days of age and discuss the potential pitfalls in the diagnosis. PMID:25750228

Molecular diagnosis of skin infections using paraffin-embedded tissue - review and interdisciplinary consensus.

PubMed

Sunderkötter, Cord; Becker, Karsten; Kutzner, Heinz; Meyer, Thomas; Blödorn-Schlicht, Norbert; Reischl, Udo; Nenoff, Pietro; Geißdörfer, Walter; Gräser, Yvonne; Herrmann, Mathias; Kühn, Joachim; Bogdan, Christian

2018-02-01

Nucleic acid amplification techniques (NATs), such as PCR, are highly sensitive and specific methods that have become valuable supplements to culture and serology in the diagnosis of infectious disorders. However, especially when using formalin-fixed and paraffin-embedded tissue, these techniques are associated with both false-negative and false-positive results, a pitfall that is frequently misjudged. Representatives of the German Society of Hygiene and Microbiology (DGHM) and the German Society of Dermatology (DDG) therefore set out to develop a consensus - in the form of a review article - on the appropriate indications for NATs using paraffin-embedded tissue, its contraindications, and the key points to be considered in the pre- and post-analytical phase. Given that fresh, naive tissue is preferably to be used in the workup of a suspected infection, PCR analysis on paraffin sections represents an exception. The latter may be considered if an infection is suspected at a later point in time and fresh tissue has not been preserved or can no longer be obtained. Potential indications include confirmation of histologically suspected infections with Leishmania spp., Bartonella spp., Rickettsia spp., or in case of ecthyma contagiosum. Infections with, for example, mycobacteria or RNA viruses, on the other hand, are not considered useful indications for NATs using paraffin sections. In order to avoid misinterpretation of test results, it is essential that laboratory reports on NATs using paraffin-embedded tissue contain information on the indication/diagnostic circumstances, the required and chosen pre-analytical steps, the limitations of the method, and on diagnostic alternatives. © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Multicore Considerations for Legacy Flight Software Migration

NASA Technical Reports Server (NTRS)

Vines, Kenneth; Day, Len

2013-01-01

In this paper we will discuss potential benefits and pitfalls when considering a migration from an existing single core code base to a multicore processor implementation. The results of this study present options that should be considered before migrating fault managers, device handlers and tasks with time-constrained requirements to a multicore flight software environment. Possible future multicore test bed demonstrations are also discussed.

Designing a Feasibility Study: A Starting Point for Considering New Management Initiatives for Working Parents.

ERIC Educational Resources Information Center

Friedman, Dana E.

This brief paper was prepared as a starting point for employers considering the adoption of a new management initiative for working parents. It is not an exhaustive outline of all considerations in the decision-making process, nor does it provide solutions to all the known pitfalls. It does, however, suggest the potential scope and complexity of…

Chapter 10. Developing a habitat monitoring program: three examples from national forest planning

Treesearch

Michael I. Goldstein; Lowell H. Suring; Christina D. Vojta; Mary M. Rowland; Clinton. McCarthy

2013-01-01

This chapter reviews the process steps of wildlife habitat monitoring described in chapters 2 through 9 and provides three case examples that illustrate how the process steps apply to specific situations. It provides the reader an opportunity to synthesize the material while also revealing the potential knowledge gaps and pitfalls that may complicate completion of a...

Quality Assurance and Evaluation through Brazilian Lenses: An Exploration into the Validity of Umbrella Concepts

ERIC Educational Resources Information Center

Centeno, Vera G.; Kauko, Jaakko; Candido, Helena H. D.

2018-01-01

In our present research we address the question of whether it is valid to apply the Quality Assurance and Evaluation (QAE) umbrella concept, which was formulated to explain new phenomena in European educational governance, to similar developments in Brazilian basic education. This led us to reflect on the possible pitfalls and potential strengths…

Using existing growth models to predict RCW habitat development following site preparation: pitfalls of the process and potential growth response

Treesearch

Benjamin O. Knapp; Joan L. Walker

2013-01-01

Land managers throughout the Southeast are interested in restoring the longleaf pine (Pinus palustris Mill.) ecosystem, due in part to its value as habitat for the endangered red-cockaded woodpecker (Picoides borealis). In 2003, we established a study at Camp Lejeune, NC, to determine the effects of common site preparation...

Benefits and Pitfalls of Using HTML as a CD-ROM Development Tool.

ERIC Educational Resources Information Center

Misanchuk, Earl R.; Schwier, Richard A.

The hypertext markup language (HTML) used to develop pages for the world wide web also has potential for use in creating some types of multimedia instruction destined for CD-ROMs. After providing a brief overview of HTML, this document presents pros and cons relevant to CD-ROM production. HTML can offer compatibility to both Windows and Macintosh…

Anarchist Epistemologies and the Separation of Science and State: The Critique and Relevance of Paul Feyerabend to Educational Foundations

ERIC Educational Resources Information Center

Wolfmeyer, Mark

2017-01-01

This article synthesizes Paul Feyerabend's controversial contributions to 20th-century philosophy of science through the synthesis of his works and the secondary literature, with specific foci on current trends in educational foundations and the potentials and pitfalls for applying Feyerabendian logics to our work. First, I situate his strains of…

Computers in the English Program: Promises and Pitfalls. New York State English Council Monograph.

ERIC Educational Resources Information Center

Chew, Charles R., Ed.

Since an increasing number of English teachers are being asked to find a place for computers in the English program, this monograph focuses on issues connected to this technology. The first article sets the stage with a discussion of the power and potential of the computer. Other articles focus on the following topics: (1) promises and…

The Potential, Pitfalls and Promise of Computerized Testing

ERIC Educational Resources Information Center

McHenry, Bill; Griffith, Leonard; McHenry, Jim

2004-01-01

Imagine administering an online standardized test to an entire class of 11th-grade students when, halfway through the exam, the server holding the test hits a snag and throws everyone offline. Imagine another scenario in which an elementary school has very few computers so teachers must bus their students to the local high school for a timed test.…

From the outside Looking in: The Praxis Dilemma of Linking Psychopolitical Validity with Community Policing

ERIC Educational Resources Information Center

Williams, Brian N.

2008-01-01

The author applies the concept of psychopolitical validity beyond the confines of the academy to the contemporary practice of American community policing. As such, it presents the promise and pitfalls of this potential union by highlighting points of linkage and places of conflict and tension and provides a commentary on the praxis dilemma of…

Are You Ready for E-Readers in Your Library?

ERIC Educational Resources Information Center

Gustafson, Chris

2012-01-01

This article discusses some things to consider when thinking about adding e-readers to one's collection. These include: (1) What is the purpose?; (2) Which device?; (3) How will one keep track of his or her e-readers and their contents?; (4) What are some potential pitfalls?; (5) Is there a positive impact on student learning?; and (6) Are…

Avoiding legal pitfalls in surrogacy arrangements.

PubMed

James, Summer; Chilvers, Rebecca; Havemann, Dara; Phelps, John Y

2010-12-01

The goal of this article is to discuss the legal pitfalls that reproductive endocrinologists face when participating in gestational surrogacy contracts. This paper was composed using Westlaw and LexisNexis commercial legal search engines to perform a review of statutes and cases pertaining to gestational surrogacy. The search results demonstrated that in the absence of suitable preparation, there is significant potential for litigation while participating in gestational agreements. Providers caring for gestational carriers have been named as parties in lawsuits for failure to provide psychological screening, failure to screen for infectious disease and participation in gestational contracts that are not compliant with state law. There is great disparity in state laws and court rulings pertaining to gestational agreements. When legal disputes arise, individual state laws and court rulings are controlling over the Uniform Parentage Act. Likewise, recommendations by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine do not supersede state laws. The failure to abide by individual state laws unnecessarily exposes reproductive endocrinologists and their IVF facilities to potential litigation. In order to lessen exposure to litigation, an understanding of individual state legislation or historical court rulings is advised. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Why epilepsy challenges social life.

PubMed

Steiger, Bettina K; Jokeit, Hennric

2017-01-01

Social bonds are at the center of our daily living and are an essential determinant of our quality of life. In people with epilepsy, numerous factors can impede cognitive and affective functions necessary for smooth social interactions. Psychological and psychiatric complications are common in epilepsy and may hinder the processing of social information. In addition, neuropsychological deficits such as slowed processing speed, memory loss or attentional difficulties may interfere with enjoyable reciprocity of social interactions. We consider societal, psychological, and neuropsychological aspects of social life with particular emphasis on socio-cognitive functions in temporal lobe epilepsy. Deficits in emotion recognition and theory of mind, two main aspects of social cognition, are frequently observed in individuals with mesial temporal lobe epilepsy. Results from behavioural studies targeting these functions will be presented with a focus on their relevance for patients' daily life. Furthermore, we will broach the issue of pitfalls in current diagnostic tools and potential directions for future research. By giving a broad overview of individual and interpersonal determinants of social functioning in epilepsy, we hope to provide a basis for future research to establish social cognition as a key component in the comprehensive assessment and care of those with epilepsy. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Do clinicians decide relying primarily on Bayesians principles or on Gestalt perception? Some pearls and pitfalls of Gestalt perception in medicine.

PubMed

Cervellin, Gianfranco; Borghi, Loris; Lippi, Giuseppe

2014-08-01

Clinical judgment is a foundation of medical practice and lies at the heart of a physician's knowledge, expertise and skill. Although clinical judgment is an active part of all medical fields, thus including diagnosis and therapy, communication and decision making, it is still poorly defined. It can be considered a synthesis of intuition (mainly based on Gestalt principles) and an analytical approach. Gestalt perception finds its rationale in the evidence that perception of any given object or experience exhibits intrinsic qualities that cannot be completely reduced to visual, auditory, tactile, olfactory, or gustatory components. Thus, perceptions are not constructed in a "bottom-up" fashion from such elements, but are instead globally perceived, in a more "top-down" fashion. Gestalt perception, if cautiously and carefully combined with structured (techno)logical tools, would permit one to defoliate the often too-many-branches built diagnostic trees, and help physicians to better develop their competency. On the other hand, the practice of evidence-based medicine lies in the integration of individual clinical expertise and judgment with the best available external clinical evidence from systematic research. This article is aimed at providing some general concepts about Gestalt perception, and to discuss some aspects of clinical practice potentially influenced by this approach.

Commercial Opportunities and Ethical Pitfalls in Personalized Medicine: A Myriad of Reasons to Revisit the Myriad Genetics Saga

PubMed Central

So, Derek; Joly, Yann

2013-01-01

In 1996, the US-based biotechnology company Myriad Genetics began offering genetic diagnostic tests for mutations in the genes BRCA1 and BRCA2, which are linked to hereditary breast and ovarian cancer. Since that time, Myriad has been a forerunner in the field of personalized medicine through the use of effective commercialization strategies which have been emulated by other commercial biotechnology companies. Myriad’s strategies include patent acquisition and active enforcement, direct-to-consumer advertising, diversification, and trade secrets. These business models have raised substantial ethical controversy and criticism, often related to the company’s focus on market dominance and the potential conflict between private sector profitability and the promotion of public health. However, these strategies have enabled Myriad to survive the economic challenges that have affected the biotechnology sector and to become financially successful in the field of personalized medicine. Our critical assessment of the legal, economic and ethical aspects of Myriad’s practices over this period allows the identification of the company’s more effective business models. It also discusses of the consequences of implementing economically viable models without first carrying out broader reflection on the socio-cultural, ethical and political contexts in which they would apply. PMID:23885284

RBM10-TFE3 Renal Cell Carcinoma: A Potential Diagnostic Pitfall Due to Cryptic Intrachromosomal Xp11.2 Inversion Resulting in False-negative TFE3 FISH.

PubMed

Argani, Pedram; Zhang, Lei; Reuter, Victor E; Tickoo, Satish K; Antonescu, Cristina R

2017-05-01

Xp11 translocation renal cell carcinoma (RCC) are defined by chromosome translocations involving the Xp11 breakpoint which results in one of a variety of TFE3 gene fusions. TFE3 break-apart florescence in situ hybridization (FISH) assays are generally preferred to TFE3 immunohistochemistry (IHC) as a means of confirming the diagnosis in archival material, as FISH is less sensitive to the variable fixation which can result in false positive or false negative IHC. Prompted by a case report in the cytogenetics literature, we identify 3 cases of Xp11 translocation RCC characterized by a subtle chromosomal inversion involving the short arm of the X chromosome, resulting in an RBM10-TFE3 gene fusion. TFE3 rearrangement was not detected by conventional TFE3 break-apart FISH, but was suggested by strong diffuse TFE3 immunoreactivity in a clean background. We then developed novel fosmid probes to detect the RBM10-TFE3 gene fusion in archival material. These cases validate RBM10-TFE3 as a recurrent gene fusion in Xp11 translocation RCC, illustrate a source of false-negative TFE3 break-apart FISH, and highlight the complementary role of TFE3 IHC and TFE3 FISH.

Rare phenotypes in the understanding of autoimmunity

PubMed Central

Zeissig, Yvonne; Petersen, Britt-Sabina; Franke, Andre; Blumberg, Richard S; Zeissig, Sebastian

2017-01-01

The study of rare phenotypes has a long history in the description of autoimmune disorders. First Mendelian syndromes of idiopathic tissue destruction were defined more than 100 years ago and were later revealed to result from immune-mediated reactivity against self. In the past two decades, continuous advances in sequencing technology and particularly the advent of next-generation sequencing have allowed to define the genetic basis of an ever-growing number of Mendelian forms of autoimmunity. This has provided unique insight into the molecular pathways that govern immunological homeostasis and that are indispensable for the prevention of self-reactive immune-mediated tissue damage and ‘horror autotoxicus’. Here we will discuss selected examples of past and recent investigations into rare phenotypes of autoimmunity that have delineated pathways critical for central and peripheral control of the adaptive immune system. We will outline the implications of these findings for rare and common forms of autoimmunity and will discuss the benefits and potential pitfalls of the integration of next-generation sequencing into algorithms for clinical diagnostics. Because of the concise nature of this review, we will focus on syndromes caused by defects in the control of adaptive immunity as innate immune-mediated autoinflammatory disorders have been covered in excellent recent reviews on Mendelian and polygenic forms of autoimmunity. PMID:27562064

How to avoid the ten most frequent EMS pitfalls

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andrews, W.

1982-04-19

It pays to do your homework before investing in an energy management system if you want to avoid the 10 most common pitfalls listed by users, consultants, and manufacturers as: oversimplification, improper maintenance, failure to involve operating personnel, inaccurate savings estimates, failure to include monitoring capability, incompetent or fradulent firms, improper load control, not allowing for a de-bugging period, failure to include manual override, and software problems. The article describes how each of these pitfalls can lead to poor decisions and poor results. (DCK)

Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters

DTIC Science & Technology

2015-12-01

1 AD_________________ AWARD NUMBER: W81XWH-08-2-0162 TITLE: Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War...Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters 5a. CONTRACT NUMBER 5b. GRANT NUMBER: W81XWH-08-2-0162 5c...Purpose: To demonstrate that 1) ultrasound guided foreign body removal (USFBR) is superior to conventional surgery in the cadaver model, 2) USFBR can be

Gabor Deconvolution as Preliminary Method to Reduce Pitfall in Deeper Target Seismic Data

NASA Astrophysics Data System (ADS)

Oktariena, M.; Triyoso, W.

2018-03-01

Anelastic attenuation process during seismic wave propagation is the trigger of seismic non-stationary characteristic. An absorption and a scattering of energy are causing the seismic energy loss as the depth increasing. A series of thin reservoir layers found in the study area is located within Talang Akar Fm. Level, showing an indication of interpretation pitfall due to attenuation effect commonly occurred in deeper level seismic data. Attenuation effect greatly influences the seismic images of deeper target level, creating pitfalls in several aspect. Seismic amplitude in deeper target level often could not represent its real subsurface character due to a low amplitude value or a chaotic event nearing the Basement. Frequency wise, the decaying could be seen as the frequency content diminishing in deeper target. Meanwhile, seismic amplitude is the simple tool to point out Direct Hydrocarbon Indicator (DHI) in preliminary Geophysical study before a further advanced interpretation method applied. A quick-look of Post-Stack Seismic Data shows the reservoir associated with a bright spot DHI while another bigger bright spot body detected in the North East area near the field edge. A horizon slice confirms a possibility that the other bright spot zone has smaller delineation; an interpretation pitfall commonly occurs in deeper level of seismic. We evaluates this pitfall by applying Gabor Deconvolution to address the attenuation problem. Gabor Deconvolution forms a Partition of Unity to factorize the trace into smaller convolution window that could be processed as stationary packets. Gabor Deconvolution estimates both the magnitudes of source signature alongside its attenuation function. The enhanced seismic shows a better imaging in the pitfall area that previously detected as a vast bright spot zone. When the enhanced seismic is used for further advanced reprocessing process, the Seismic Impedance and Vp/Vs Ratio slices show a better reservoir delineation, in which the pitfall area is reduced and some morphed as background lithology. Gabor Deconvolution removes the attenuation by performing Gabor Domain spectral division, which in extension also reduces interpretation pitfall in deeper target seismic.

Introduction to the Special Issue on Neuropsychology Practices in Integrated Care Teams.

PubMed

Festa, Joanne R

2018-05-01

This special issue on neuropsychology practices in integrated healthcare teams demonstrates how neuropsychologists have transformed their practices in an evolving healthcare landscape. These contributions are an overview of the many ways in which neuropsychologists function in integrated care teams. The experiences of integrated neuropsychologists serve as a model for those seeking new practice opportunities by providing highly practical, clinically relevant information. Included in this volume are articles on education and reimbursement issues, information about clinical practices that address diagnostic issues, prognostics and clinical management, as well as surgical treatment planning and outcome prediction. Authors highlight the value of their services, their contribution to improving team and patient communication, as well as the biopsychosocial understanding of the patient. Several unexpected challenges are detailed among the pearls and pitfalls of these practices.

Pleomorphic lipoma: A gentle giant of pathology

PubMed Central

Sakhadeo, Uma; Mundhe, Rajesh; DeSouza, Maria A; Chinoy, Roshan F

2015-01-01

Pleomorphic lipoma is a relatively rare adipocytic neoplasm, occurring predominantly in elderly males in the subcutaneous tissues of the neck or shoulder. To the best of our knowledge, only five cases have been reported in which the lesion was intramuscular. We hereby report a case of a 60-year-old female patient, presenting with an intramuscular, posterior shoulder mass. The aspirate showed a giant cell-rich lesion, admixed with short, plump-looking, spindly cells. There was no overt evidence of malignancy; however, the cell cytology was sufficiently atypical to warrant concern. Subsequent excision revealed a classical pleomorphic lipoma on histology with no evidence of malignancy. CD34 staining by immunohistochemistry further supported the diagnosis. Differential diagnosis and the cytological diagnostic pitfalls of pleomorphic lipomas have been discussed with a review of the literature. PMID:26729985

Pleomorphic lipoma: A gentle giant of pathology.

PubMed

Sakhadeo, Uma; Mundhe, Rajesh; DeSouza, Maria A; Chinoy, Roshan F

2015-01-01

Pleomorphic lipoma is a relatively rare adipocytic neoplasm, occurring predominantly in elderly males in the subcutaneous tissues of the neck or shoulder. To the best of our knowledge, only five cases have been reported in which the lesion was intramuscular. We hereby report a case of a 60-year-old female patient, presenting with an intramuscular, posterior shoulder mass. The aspirate showed a giant cell-rich lesion, admixed with short, plump-looking, spindly cells. There was no overt evidence of malignancy; however, the cell cytology was sufficiently atypical to warrant concern. Subsequent excision revealed a classical pleomorphic lipoma on histology with no evidence of malignancy. CD34 staining by immunohistochemistry further supported the diagnosis. Differential diagnosis and the cytological diagnostic pitfalls of pleomorphic lipomas have been discussed with a review of the literature.

Beta-lactam resistance in the gram negatives: increasing complexity of conditional, composite and multiply resistant phenotypes.

PubMed

Iredell, Jon; Thomas, Lee; Espedido, Björn

2006-12-01

The greatest impact of microbiology data on clinical care is in the critically ill. Unfortunately, this is also the area in which microbiology laboratories are most often non-contributive. Attempts to move to rapid, culture-independent diagnostics are driven by the need to expedite urgent results. This is difficult in Gram-negative infection because of the complexity of the antibiotic resistance phenotype. Here, we discuss resistance to modern beta-lactams as a case in point. Recent outbreaks of transmissible carbapenem resistance among Gram-negative enteric pathogens in Sydney and Melbourne serve to illustrate the pitfalls of traditional phenotypical approaches. A better understanding of the epidemiology and mosaic nature of antibiotic resistance elements in the microflora is needed for us to move forward.

Gastrointestinal tract spindle cell lesions--just like real estate, it's all about location.

PubMed

Voltaggio, Lysandra; Montgomery, Elizabeth A

2015-01-01

Interpretation of gastrointestinal tract mesenchymal lesions is simplified merely by knowing in which anatomic layer they are usually found. For example, Kaposi sarcoma is detected on mucosal biopsies, whereas inflammatory fibroid polyp is nearly always in the submucosa. Gastrointestinal stromal tumors (GISTs) are generally centered in the muscularis propria. Schwannomas are essentially always in the muscularis propria. Mesenteric lesions are usually found in the small bowel mesentery. Knowledge of the favored layer is even most important in interpreting colon biopsies, as many mesenschymal polyps are encountered in the colon. Although GISTs are among the most common mesenchymal lesions, we will concentrate our discussion on other mesenchymal lesions, some of which are in the differential diagnosis of GIST, and point out some diagnostic pitfalls, particularly in immunolabeling.

Advanced imaging techniques in brain tumors

PubMed Central

2009-01-01

Abstract Perfusion, permeability and magnetic resonance spectroscopy (MRS) are now widely used in the research and clinical settings. In the clinical setting, qualitative, semi-quantitative and quantitative approaches such as review of color-coded maps to region of interest analysis and analysis of signal intensity curves are being applied in practice. There are several pitfalls with all of these approaches. Some of these shortcomings are reviewed, such as the relative low sensitivity of metabolite ratios from MRS and the effect of leakage on the appearance of color-coded maps from dynamic susceptibility contrast (DSC) magnetic resonance (MR) perfusion imaging and what correction and normalization methods can be applied. Combining and applying these different imaging techniques in a multi-parametric algorithmic fashion in the clinical setting can be shown to increase diagnostic specificity and confidence. PMID:19965287

Common Pitfalls in Exposure and Response Prevention (EX/RP) for OCD

PubMed Central

Gillihan, Seth J.; Williams, Monnica T.; Malcoun, Emily; Yadin, Elna; Foa, Edna B.

2012-01-01

Obsessive-compulsive disorder (OCD) is a highly debilitating disorder. Fortunately there are treatments that help the majority of OCD sufferers. The behavioral treatment with the most empirical support for its efficacy is exposure and response prevention (EX/RP). Over the years in our supervision meetings and in our clinical practice we have noted a number of relatively common therapist pitfalls that decrease the effectiveness of EX/RP. These pitfalls include not encouraging patients to approach the most distressing situations, doing imaginal exposure when in vivo is called for (and vice versa), encouraging distraction during exposure, providing reassurance, failing to address the core fear, ineffective handling of mental compulsions, and difficulty working with close others in the patient’s life. In the current article we describe these common pitfalls and how to avoid them. PMID:22924159

Efficacy of Pitfall Trapping, Winkler and Berlese Extraction Methods for Measuring Ground-Dwelling Arthropods in Moist-Deciduous Forests in the Western Ghats

PubMed Central

Sabu, Thomas K.; Shiju, Raj T.

2010-01-01

The present study provides data to decide on the most appropriate method for sampling of ground-dwelling arthropods measured in a moist-deciduous forest in the Western Ghats in South India. The abundance of ground-dwelling arthropods was compared among large numbers of samples obtained using pitfall trapping, Berlese and Winkler extraction methods. Highest abundance and frequency of most of the represented taxa indicated pitfall trapping as the ideal method for sampling of ground-dwelling arthropods. However, with possible bias towards surface-active taxa, pitfall-trapping data is inappropriate for quantitative studies, and Berlese extraction is the better alternative. Berlese extraction is the better method for quantitative measurements than the other two methods, whereas pitfall trapping would be appropriate for qualitative measurements. A comparison of the Berlese and Winkler extraction data shows that in a quantitative multigroup approach, Winkler extraction was inferior to Berlese extraction because the total number of arthropods caught was the lowest; and many of the taxa that were caught from an identical sample via Berlese extraction method were not caught. Significantly a greater frequency and higher abundance of arthropods belonging to Orthoptera, Blattaria, and Diptera occurred in pitfall-trapped samples and Psocoptera and Acariformes in Berlese-extracted samples than that were obtained in the other two methods, indicating that both methods are useful, one complementing the other, eliminating a chance for possible under-representation of taxa in quantitative studies. PMID:20673122

General practice ethics: text messages and boundaries in the GP-patient relationship.

PubMed

Mintzker, Yishai; Rogers, Wendy

2015-08-01

Virtual forms of communication (eg texting) can support patients and may contribute to better care. However, these informal communication methods may intrude on the doctor’s leisure time and undermine standards of care if they replace face-to-face consultations.Texting may cross boundaries in potentially unprofessional ways, especially when particular patients are favoured with this privilege. It may disadvantage patients who are not favoured or who are not comfortable using mobile technology. We also note that GPs cannot control the distribution of their number or recall it without the inconvenience of changing the number once it has been disclosed.Virtual communication is an integral part of the way we live, despite the potential pitfalls. Each form (social media, electronic messaging systems, video consultations, mobile phones, etc) has its advantages and disadvantages. This makes it important for practices to develop policies supporting the responsible use of virtual communication. Such policies should:clarify (for patients and GPs) when its use is appropriate accommodate doctors’ individual preferences regarding technology provide guidance regarding GPs’ duties, especially for interactions that do not allow full evaluation of patients.GPs may wish to have specific criteria for providing patients with this degree of access, set very clear indications and contraindications to its use, explain the potential pitfalls, and ensure that text messages augment good care rather than replace it.

Public-Private Partnerships in Development: Three Applications in Timor Leste. Working Paper No. 221 (Formerly Webdoc No. 9)

ERIC Educational Resources Information Center

Braz, Jose

2003-01-01

Timor Leste, the first new nation of the twenty-first century, is a young country facing many of the most challenging problems of underdevelopment: illiteracy, malnutrition, low skills base and high unemployment. It also is on the threshold of facing the potential pitfalls of being a relatively large-scale exporter of oil and gas. Finally…

Why Isn't Creativity More Important to Educational Psychologists? Potentials, Pitfalls, and Future Directions in Creativity Research

ERIC Educational Resources Information Center

Plucker, Jonathan A.; Beghetto, Ronald A.; Dow, Gayle T.

2004-01-01

The construct of creativity has a great deal to offer educational psychology. Creativity appears to be an important component of problem-solving and other cognitive abilities, healthy social and emotional well-being, and scholastic and adult success. Yet the study of creativity is not nearly as robust as one would expect, due in part to the…

Keep Taking the Tablets? Assessing the Use of Tablet Devices in Learning and Teaching Activities in the Further Education Sector

ERIC Educational Resources Information Center

Fabian, Khristin; MacLean, Donald

2014-01-01

This article summarises the methodology and outcomes of an interventionist/action research project to assess the benefits, and potential pitfalls, of the use of mobile devices in learning and teaching activities in a Further Education environment. A bank of 15 tablet devices were purchased and prepared for classroom use. Staff members were…

Communication errors in radiology - Pitfalls and how to avoid them.

PubMed

Waite, Stephen; Scott, Jinel Moore; Drexler, Ian; Martino, Jennifer; Legasto, Alan; Gale, Brian; Kolla, Srinivas

2018-06-07

Communication failures are a common cause of patient harm and malpractice claims against radiologists. In addition to overt communication breakdowns among providers, it is also important to address the quality of communication to optimize patient outcomes. In this review, we describe common communication failures and potential solutions providing a framework for radiologists to improve health care delivery. Copyright © 2018. Published by Elsevier Inc.

Why revisit your cost-accounting strategy.

PubMed

Arredondo, Ricky

2014-07-01

Healthcare entities seeking to develop effective cost-accounting systems should take six steps to avoid potential pitfalls: Secure broad executive-level support for the effort. Ensure systems are in place to analyze the disparate data. Define measurable objectives to ensure that implementation achieves desired results. Give due consideration to implementation planning. Train support staff sufficiently to avoid underutilization. Develop a sufficiently broad base of staff support for the system.

Common problems and pitfalls in gear design

NASA Technical Reports Server (NTRS)

Townsend, Dennis P.

1986-01-01

There are several pitfalls and problems associated with the successful design of a new gear transmission. A new design will require the knowledge and experience of several technical areas of engineering. Most of the pitfalls and problems associated with a new design are related to an inadequate evaluation of several areas, such as, the lubrication and cooling requirements, complete static and dynamic load analysis, evaluation of materials and heat treatment and the latest manufacturing technology. Some of the common problems of the gear design process are discussed with recommendations made for avoiding these conditions.

Corticosteroids in brain cancer patients: benefits and pitfalls

PubMed Central

Dietrich, Jörg; Rao, Krithika; Pastorino, Sandra; Kesari, Santosh

2011-01-01

Glucocorticoids have been used for decades in the treatment of brain tumor patients and belong to the most powerful class of agents in reducing tumor-associated edema and minimizing side effects and the risk of encephalopathy in patients undergoing radiation therapy. Unfortunately, corticosteroids are associated with numerous and well-characterized adverse effects, constituting a major challenge in patients requiring long-term application of corticosteroids. Novel anti-angiogenic agents, such as bevacizumab (Avastin®), which have been increasingly used in cancer patients, are associated with significant steroid-sparing effects, allowing neuro-oncologists to reduce the overall use of corticosteroids in patients with progressive malignant brain tumors. Recent experimental studies have revealed novel insights into the mechanisms and effects of corticosteroids in cancer patients, including modulation of tumor biology, angiogenesis and steroid-associated neurotoxicity. This article summarizes current concepts of using corticosteroids in brain cancer patients and highlights potential pitfalls in their effects on both tumor and neural progenitor cells. PMID:21666852

Common pitfalls in preclinical cancer target validation.

PubMed

Kaelin, William G

2017-07-01

An alarming number of papers from laboratories nominating new cancer drug targets contain findings that cannot be reproduced by others or are simply not robust enough to justify drug discovery efforts. This problem probably has many causes, including an underappreciation of the danger of being misled by off-target effects when using pharmacological or genetic perturbants in complex biological assays. This danger is particularly acute when, as is often the case in cancer pharmacology, the biological phenotype being measured is a 'down' readout (such as decreased proliferation, decreased viability or decreased tumour growth) that could simply reflect a nonspecific loss of cellular fitness. These problems are compounded by multiple hypothesis testing, such as when candidate targets emerge from high-throughput screens that interrogate multiple targets in parallel, and by a publication and promotion system that preferentially rewards positive findings. In this Perspective, I outline some of the common pitfalls in preclinical cancer target identification and some potential approaches to mitigate them.

Late-Stage Erythema Elevatum Diutinum Mimicking a Fibroblastic Tumor: A Potential Pitfall.

PubMed

Llamas-Velasco, Mar; Stengel, Berhard; Pérez-González, Yosmar Carolina; Mentzel, Thomas

2018-06-01

Erythema elevatum diutinum (EED) is a rare dermatosis with evolving histopathological features that vary according to the age of the lesions, with a variable fibrosis and a fascicled proliferation of spindle cells in late phases. The authors present an otherwise healthy 57-year-old woman with multiple indurated nodules on the inner aspect of both feet. Skin biopsy showed storiform interlacing bundles of spindled cells with plump nuclei and some areas with neutrophils and leukocytoclasia. CD34 and S100 were negative. This case is noteworthy clinically due to its location and its histopathological presentation that comprises a wide differential diagnosis, including inflammatory pseudotumor, dermatofibrosarcoma protuberans, superficial nodular fasciitis, hyalinized leiomyoma, sclerosing spindle cell perineuroma, and sclerotic fibroma. The authors have reviewed the main histopathological and immunohistochemical features that help in the differential diagnosis of this rare variant of EED. A careful search for leukocytoclasia and neutrophilic vasculitis is mandatory to establish the right diagnosis of nodular or late-stage EED and avoid the pitfall of considering this a neoplastic process.

The Promise (and Pitfalls) of Public Health Policy Surveillance.

PubMed

Hodge, James G

2016-12-01

Though public health policy surveillance is an integral tool in correlating the law to scientifically based public health law studies, drawing accurate legal conclusions from collected data can be challenging. Data may be of poor quality, inaccessible to law and policy makers, or inapplicable to other jurisdictions over time and place. As Burris et al. (2016) advocate, modern, sophisticated, and interactive data collection systems would render more precise legal analysis tied to public health improvements. Although policy surveillance is promising, public health officials, health care providers, attorneys, and researchers must be skilled and prepared to successfully navigate and resolve potential pitfalls for its benefits to be fully realized. Among the significant challenges related to policy surveillance are: (1) timing; (2) agenda setting; (3) predictable misuse; and (4) politics inherent in a federalist public health legal infrastructure. As public health data infrastructure is developed, better legal approaches must be simultaneously crafted to achieve optimal public health outcomes. Copyright © 2016 by Duke University Press.

Retroperitoneal Pseudoaneurysm Mimicking Ureteral Calculus: Pitfalls in Diagnosis.

PubMed

Kalabin, Aleksandr; Mani, Vishnu R; Dinesh, Anant; Landa, Marina; Davis-Joseph, Brian

2017-10-08

Arterial aneurysms (AA) can be classified as true aneurysms, characterized by the persistence of all three layers of the arterial wall with progressive dilation and wall thinning; arterial pseudoaneurysms (APAs) are characterized by a tear in the vessel wall and a periarterial hematoma formation. They could occur due to a visceral, retroperitoneal, or peripheral origin. Most AA/APA are usually found incidentally, and it is imperative to be vigilant in order to diagnose and manage them due to their potentially life-threatening complications. We present a case of a 35-year-old woman presenting with right-sided abdominal pain mimicking renal colic with an initial misdiagnosis of ureteral calculus. Post-cystoscopy, a misdiagnosis was confirmed, and subsequently, the patient had a right retroperitoneal mass excision. The histopathology report concluded the calcified retroperitoneal mass to be pseudoaneurysm. Such pitfalls in diagnosis are essential to be shared with the larger medical community for increased vigilance and optimal management of pseudoaneurysms.

Retroperitoneal Pseudoaneurysm Mimicking Ureteral Calculus: Pitfalls in Diagnosis

PubMed Central

Kalabin, Aleksandr; Dinesh, Anant; Landa, Marina; Davis-Joseph, Brian

2017-01-01

Arterial aneurysms (AA) can be classified as true aneurysms, characterized by the persistence of all three layers of the arterial wall with progressive dilation and wall thinning; arterial pseudoaneurysms (APAs) are characterized by a tear in the vessel wall and a periarterial hematoma formation. They could occur due to a visceral, retroperitoneal, or peripheral origin. Most AA/APA are usually found incidentally, and it is imperative to be vigilant in order to diagnose and manage them due to their potentially life-threatening complications. We present a case of a 35-year-old woman presenting with right-sided abdominal pain mimicking renal colic with an initial misdiagnosis of ureteral calculus. Post-cystoscopy, a misdiagnosis was confirmed, and subsequently, the patient had a right retroperitoneal mass excision. The histopathology report concluded the calcified retroperitoneal mass to be pseudoaneurysm. Such pitfalls in diagnosis are essential to be shared with the larger medical community for increased vigilance and optimal management of pseudoaneurysms. PMID:29226048

Ratio index variables or ANCOVA? Fisher's cats revisited.

PubMed

Tu, Yu-Kang; Law, Graham R; Ellison, George T H; Gilthorpe, Mark S

2010-01-01

Over 60 years ago Ronald Fisher demonstrated a number of potential pitfalls with statistical analyses using ratio variables. Nonetheless, these pitfalls are largely overlooked in contemporary clinical and epidemiological research, which routinely uses ratio variables in statistical analyses. This article aims to demonstrate how very different findings can be generated as a result of less than perfect correlations among the data used to generate ratio variables. These imperfect correlations result from measurement error and random biological variation. While the former can often be reduced by improvements in measurement, random biological variation is difficult to estimate and eliminate in observational studies. Moreover, wherever the underlying biological relationships among epidemiological variables are unclear, and hence the choice of statistical model is also unclear, the different findings generated by different analytical strategies can lead to contradictory conclusions. Caution is therefore required when interpreting analyses of ratio variables whenever the underlying biological relationships among the variables involved are unspecified or unclear. (c) 2009 John Wiley & Sons, Ltd.

High-resolution shear-wave reflection profiling to image offset in unconsolidated near-surface sediments

NASA Astrophysics Data System (ADS)

Bailey, Bevin L.

S-wave reflection profiling has many theoretical advantages, when compared to P-wave profiling, such as high-resolution potential, greater sensitivities to lithologic changes and insensitivity to the water table and pore fluids, and could be particularly useful in near-surface settings. However, S-wave surveys can be plagued by processing pitfalls unique to near-surface studies such as interference of Love waves with reflections, and the stacking of Love waves as coherent noise, leading to possible misinterpretations of the subsurface. Two lines of S-wave data are processed and used to locate previously unknown faults in Quaternary sediments in a region where earthquake activity poses a threat to surface structures. This study provides clear examples of processing pitfalls such as Love waves with hyperbolic appearances on shot gathers, and a CMP section with coherent noise that is easily misinterpreted as reflections. This study demonstrates pros and cons of using SH reflection data in the near surface.

Pitfalls in the consultant's path.

PubMed

Short, D

If the consultant is to retain his skill and reputation, he must be constantly aware of the pitfalls that lie in his path. This article discusses the temptations of greed, dishonesty, arrogance, alcohol and drug abuse, and neglect of family and recreation.

Mask_explorer: A tool for exploring brain masks in fMRI group analysis.

PubMed

Gajdoš, Martin; Mikl, Michal; Mareček, Radek

2016-10-01

Functional magnetic resonance imaging (fMRI) studies of the human brain are appearing in increasing numbers, providing interesting information about this complex system. Unique information about healthy and diseased brains is inferred using many types of experiments and analyses. In order to obtain reliable information, it is necessary to conduct consistent experiments with large samples of subjects and to involve statistical methods to confirm or reject any tested hypotheses. Group analysis is performed for all voxels within a group mask, i.e. a common space where all of the involved subjects contribute information. To our knowledge, a user-friendly interface with the ability to visualize subject-specific details in a common analysis space did not yet exist. The purpose of our work is to develop and present such interface. Several pitfalls have to be avoided while preparing fMRI data for group analysis. One such pitfall is spurious non-detection, caused by inferring conclusions in the volume of a group mask that has been corrupted due to a preprocessing failure. We describe a MATLAB toolbox, called the mask_explorer, designed for prevention of this pitfall. The mask_explorer uses a graphical user interface, enables a user-friendly exploration of subject masks and is freely available. It is able to compute subject masks from raw data and create lists of subjects with potentially problematic data. It runs under MATLAB with the widely used SPM toolbox. Moreover, we present several practical examples where the mask_explorer is usefully applied. The mask_explorer is designed to quickly control the quality of the group fMRI analysis volume and to identify specific failures related to preprocessing steps and acquisition. It helps researchers detect subjects with potentially problematic data and consequently enables inspection of the data. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Genetic testing for patients with renal disease: procedures, pitfalls, and ethical considerations.

PubMed

Korf, B R

1999-07-01

The Human Genome Project is rapidly producing insights into the molecular basis of human genetic disorders. The most immediate clinical benefit is the advent of new diagnostic methods. Molecular diagnostic tools are available for several genetic renal disorders and are in development for many more. Two general approaches to molecular diagnosis are linkage-based testing and direct mutation detection. The former is used when the gene has not been cloned but has been mapped in relation to polymorphic loci. Linkage-based testing is also helpful when a large diversity of mutations makes direct detection difficult. Limitations include the need to study multiple family members, the need for informative polymorphisms, and genetic heterogeneity. Direct mutation detection is limited by genetic heterogeneity and the need to distinguish nonpathogenic allelic variants from pathogenic mutations. Molecular testing raises a number of complex ethical issues, including those associated with prenatal or presymptomatic diagnosis. In addition, there are concerns about informed consent, privacy, genetic discrimination, and technology transfer for newly developed tests. Health professionals need to be aware of the technical and ethical implications of these new methods of testing, as well as the complexities in test interpretation, as molecular approaches are increasingly integrated into medical practice.

Neonatal screening for glutaric aciduria type I: strategies to proceed.

PubMed

Lindner, M; Ho, S; Fang-Hoffmann, J; Hoffmann, G F; Kölker, S

2006-01-01

Acute encephalopathic crisis in glutaric aciduria type I results in an unfavourable disease course and poor outcome, dominated by dystonia, feeding problems, seizures and reduced life expectancy. A conditio sine qua non for the prevention of irreversible brain damage is timely diagnosis and start of therapy, i.e. before the onset of neurological disease. As there are no specific clinical signs or symptoms that allow a reliable detection of these patients before the manifestation of encephalopathic crises, neonatal screening programmes for glutaric aciduria type I have been established in some countries using analysis of glutarylcarnitine in dried blood spots by tandem mass spectrometry. This article summarizes recent strategies, pitfalls and shortcomings of mass screening for glutaric aciduria type I, focusing on the relevant risk of missing patients with a mild biochemical phenotype (i.e. low excretors). Furthermore, it evaluates a binary strategy--using glutarylcarnitine as primary variable and glutarylcarnitine/acylcarnitine ratios as secondary variable--to improve the diagnostic sensitivity and specificity of neonatal screening for glutaric aciduria type I. An optimization of diagnostic as well as therapeutic procedures must be achieved before screening for glutaric aciduria type I can be regarded as reliable and beneficial for all patients.

An approach to the diagnosis of flat intraepithelial lesions of the urinary bladder using the World Health Organization/ International Society of Urological Pathology consensus classification system.

PubMed

Amin, Mahul B; McKenney, Jesse K

2002-07-01

The classification of flat urothelial (transitional cell) lesions with atypia has historically varied in its application from institution to institution with no fewer than six major nomenclature systems proposed in the past 25 years. In 1998, the World Health Organization/ International Society of Urological Pathology (WHO/ISUP) published a consensus classification that included the following categories for flat urinary bladder lesions: reactive atypia, atypia of unknown significance, dysplasia (low-grade intraepithelial neoplasia), and carcinoma in situ (high-grade intraepithelial neoplasia). This classification expands the definition traditionally used for urothelial carcinoma in situ, basing its diagnosis primarily on the severity of cytologic changes. In proposing the classification system for flat lesions of the bladder with atypia, it was hoped that consistent use of uniform diagnostic terminology would ultimately aid in a better understanding of the biology of these lesions. In this review, the authors discuss the history of the concept of flat urothelial neoplasia, the rationale and histologic criteria for the WHO/ISUP diagnostic categories, an approach to the diagnosis of flat lesions, and problems and pitfalls associated with their recognition in routine surgical pathology specimens.

Molecular classification of gastric cancer.

PubMed

Röcken, Christoph

2017-03-01

Gastric cancer is among the most common cancers worldwide. Despite declining incidences, the prognosis remains dismal in Western countries and is better in Asian countries with national cancer screening programs. Complete endoscopic or surgical resection of the primary tumor with or without lymphadenectomy offers the only chance of cure in the early stage of the disease. Survival of more locally advanced gastric cancers was improved by the introduction of perioperative, adjuvant and palliative chemotherapy. However, the identification and usage of novel predictive and diagnostic targets is urgently needed. Areas covered: Recent comprehensive molecular profiling of gastric cancer proposed four molecular subtypes, i.e. Epstein-Barr virus-associated, microsatellite instable, chromosomal instable and genomically stable carcinomas. The new molecular classification will spur clinical trials exploring novel targeted therapeutics. This review summarizes recent advancements of the molecular classification, and based on that, putative pitfalls for the development of tissue-based companion diagnostics, i.e. prevalence of actionable targets and therapeutic efficacy, tumor heterogeneity and tumor evolution, impact of ethnicity on gastric cancer biology, and standards of care in the East and West. Expert commentary: The overall low prevalence of actionable targets and tumor heterogeneity are the two main obstacles of precision medicine for gastric cancer.

The implementation of liquid-based cytology for lung and pleural-based diseases.

PubMed

Michael, Claire W; Bedrossian, Carlos C W M

2014-01-01

First introduced for the processing of cervico-vaginal samples, liquid-based cytology (LBC) soon found application in nongynecological specimens, including bronchoscopic brushings, washings and transcutaneous and transbronchial aspiration biopsy of the lung as well as pleural effusions. This article reviews the existing literature related to these specimens along with the authors' own experience. A literature review was conducted through Ovid MEDLINE and PubMed search engines using several key words. Most of the literature is based on data collected through the use of split samples. The data confirms that the use of LBC is an acceptable, and sometimes superior, alternative to the conventional preparations (CP). LBC offers several advantages, including the ability to transport in a stable collecting media, elimination of obscuring elements, ease of screening, excellent preservation, random representative sample, and application of ancillary techniques on additional preparations. Some diagnostic pitfalls related to the introduced artifacts were reported. The utilization of LBC offers many advantages over CP and has a diagnostic accuracy that is equal to or surpasses that of CP. LBC affords a bridge to the future application of molecular and other ancillary techniques to cytology. Knowledge of the morphological artifacts is useful at the early stages of implementation.

Diagnostic Pitfalls of Discriminating Lymphoma-Associated Effusions

PubMed Central

Chen, Hung-Jen; Huang, Kuo-Yang; Tseng, Guan-Chin; Chen, Li-Hsiou; Bai, Li-Yuan; Liang, Shinn-Jye; Tu, Chih-Yen; Light, Richard W.

2015-01-01

Abstract High serum lactate dehydrogenase (LDH) level, immunologic defects, enlarged mediastinal lymph nodes, and frequent hydration and diuresis in lymphoma patients may affect the development of pleural effusion (PE). The study was to assess the clinical utility of “Light criteria” and the “recommended algorithm for investigating PEs” in patients with lymphoma. The characteristics of 126 PEs of lymphoma patients who underwent diagnostic thoracentesis between January 1, 2003, and April 30, 2012, were reviewed. Using Light criteria, 29 (23%) PEs were incorrectly classified. The sensitivity for exudates in Light criteria was 88% and the specificity was only 44%. In 32 transudates, PE LDH correlated with blood LDH concentration (P < 0.001, r = 0.66). Nine transudates were misclassified as exudates (50%; 9/18) just due to PE LDH more than two-thirds the upper limits. Among the 56 bilateral PEs, 33 (59%) were exudates. Ten (63%) polymorphonuclear (PMN)-predominant exudative PEs were malignant. Infective PEs were often mononuclear (67%) rather than PMN predominant. When a patient has lymphoma with either unilateral or bilateral PE, thoracentesis for microbiological testing and cytology is imperative. Carefully clinical correlation in addition to the result from Light criteria and differential cell count is essential for prompt management. PMID:25929933

Tissue tropism, pathology and pathogenesis of enterovirus infection.

PubMed

Muehlenbachs, Atis; Bhatnagar, Julu; Zaki, Sherif R

2015-01-01

Enteroviruses are very common and cause infections with a diverse array of clinical features. Enteroviruses are most frequently considered by practising pathologists in cases of aseptic meningitis, encephalitis, myocarditis and disseminated infections in neonates and infants. Congenital infections have been reported and transplacental transmission is thought to occur. Although skin biopsies during hand, foot and mouth disease are infrequently obtained, characteristic dermatopathological findings can be seen. Enteroviruses have been implicated in lower respiratory tract infections. This review highlights histopathological features of enterovirus infection and discusses diagnostic modalities for formalin-fixed paraffin-embedded tissues and their associated pitfalls. Immunohistochemistry can detect enterovirus antigen within cells of affected tissues; however, assays can be non-specific and detect other viruses. Molecular methods are increasingly relied upon but, due to the high frequency of asymptomatic enteroviral infections, clinical-pathological correlation is needed to determine significance. Of note, diagnostic assays on central nervous system or cardiac tissues from immunocompetent patients with prolonged disease courses are most often negative. Histopathological, immunohistochemical and molecular studies performed on clinical specimens also provide insight into enteroviral tissue tropism and pathogenesis. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Quantitative assessment of heteroplasmy of mitochondrial genome: perspectives in diagnostics and methodological pitfalls.

PubMed

Sobenin, Igor A; Mitrofanov, Konstantin Y; Zhelankin, Andrey V; Sazonova, Margarita A; Postnov, Anton Y; Revin, Victor V; Bobryshev, Yuri V; Orekhov, Alexander N

2014-01-01

The role of alterations of mitochondrial DNA (mtDNA) in the development of human pathologies is not understood well. Most of mitochondrial mutations are characterized by the phenomenon of heteroplasmy which is defined as the presence of a mixture of more than one type of an organellar genome within a cell or tissue. The level of heteroplasmy varies in wide range, and the expression of disease is dependent on the percent of alleles bearing mutations, thus allowing consumption that an upper threshold level may exist beyond which the mitochondrial function collapses. Recent findings have demonstrated that some mtDNA heteroplasmic mutations are associated with widely spread chronic diseases, including atherosclerosis and cancer. Actually, each etiological mtDNA mutation has its own heteroplasmy threshold that needs to be measured. Therefore, quantitative evaluation of a mutant allele of mitochondrial genome is an obvious methodological challenge, since it may be a keystone for diagnostics of individual genetic predisposition to the disease. This review provides a comprehensive comparison of methods applicable to the measurement of heteroplasmy level of mitochondrial mutations associated with the development of pathology, in particular, in atherosclerosis and its clinical manifestations.

Diagnostic performance and reproducibility of T2w based and diffusion weighted imaging (DWI) based PI-RADSv2 lexicon descriptors for prostate MRI.

PubMed

Benndorf, Matthias; Hahn, Felix; Krönig, Malte; Jilg, Cordula Annette; Krauss, Tobias; Langer, Mathias; Dovi-Akué, Philippe

2017-08-01

To examine the diagnostic performance of PI-RADSv2 T2w and diffusion weighted imaging (DWI) based lexicon descriptors, inter-observer agreement for descriptor assignment and diagnostic accuracy of the PI-RADSv2 assessment categories for multiparametric prostate MRI. 176 lesions in 79 consecutive patients are analyzed, lesions are histopathologically verified by MRI-ultrasound fusion biopsy. All lesions are rated according to the PI-RADSv2 lexicon, descriptors for T2w and DWI sequences and resulting assessment categories are assigned by two independent blinded radiologists. We perform receiver-operating-characteristic analysis using the assessment categories. To analyze inter-observer agreement, we calculate weighted kappa values for assessment category assignment and unweighted kappa values for descriptor assignment. PI-RADSv2 assessment categories yield an area under the curve of 0.76/0.74 (radiologist 1/radiologist 2), P >0.05. Weighted kappa for agreement is 0.601 in the peripheral zone and 0.580 in the transition zone. We detect a difference in the cancer rate for PI-RADSv2 category 3 between peripheral zone (32%) and transition zone (12%), P <0.05. We obtain moderate agreement at most for descriptor assignment with kappa values ranging from 0.082 (T2w shape in the transition zone) to 0.407 (T2w signal intensity in the peripheral zone) and 0.493 (ADC pattern in the peripheral zone). Our analysis corroborates typical descriptors for benign/malignant lesions, but also reveals insights into potential pitfalls - T2w wedge shaped lesions in the peripheral zone have a considerable cancer rate, despite being labelled category 2 in the lexicon. Agreement for descriptor assignment in the PI-RADSv2 lexicon is at most moderate in our study. Typical descriptors for benign and malignant lesions are validated, whereas the discriminatory power of some descriptors is challenged. The difference in the cancer rate for PI-RADSv2 category 3 between peripheral zone and transition zone should be considered when management recommendations are linked to assessment categories in the future. Copyright © 2017 Elsevier B.V. All rights reserved.

Automated response matching for organic scintillation detector arrays

NASA Astrophysics Data System (ADS)

Aspinall, M. D.; Joyce, M. J.; Cave, F. D.; Plenteda, R.; Tomanin, A.

2017-07-01

This paper identifies a digitizer technology with unique features that facilitates feedback control for the realization of a software-based technique for automatically calibrating detector responses. Three such auto-calibration techniques have been developed and are described along with an explanation of the main configuration settings and potential pitfalls. Automating this process increases repeatability, simplifies user operation, enables remote and periodic system calibration where consistency across detectors' responses are critical.

Gamification of Nursing Education With Digital Badges.

PubMed

White, Meagan; Shellenbarger, Teresa

Digital badges (DBs) serve as an innovative approach to gamifying nursing education by engaging socially connected, technologically savvy nursing students in learning. Because assessment and credentialing mechanisms are housed and managed online, DBs are designed as visible indicators of accomplishment and skill. This article describes important considerations for faculty when incorporating game-based pedagogies such as DB into nursing education and identifies potential pitfalls with DB use that faculty should consider.

Protecting retinal ganglion cells.

PubMed

Khatib, T Z; Martin, K R

2017-02-01

Retinal ganglion cell degeneration underlies several conditions which give rise to significant visual compromise, including glaucoma, hereditary optic neuropathies, ischaemic optic neuropathies, and demyelinating disease. In this review, we discuss the emerging strategies for neuroprotection specifically in the context of glaucoma, including pharmacological neuroprotection, mesenchymal stem cells, and gene therapy approaches. We highlight potential pitfalls that need to be considered when developing these strategies and outline future directions, including the prospects for clinical trials.

Venous ulcer review

PubMed Central

Bevis, Paul; Earnshaw, Jonothan

2011-01-01

Clinical question: What is the best treatment for venous ulcers? Results: Compression aids ulcer healing. Pentoxifylline can aid ulcer healing. Artificial skin grafts are more effective than other skin grafts in helping ulcer healing. Correction of underlying venous incompetence reduces ulcer recurrence. Implementation: Potential pitfalls to avoid are: Failure to exclude underlying arterial disease before application of compression.Unusual-looking ulcers or those slow to heal should be biopsied to exclude malignant transformation. PMID:21673869

Green gold: The potential and pitfalls for North American medicinal plants in the US botanical supplements industry

Treesearch

Aswini Pai; Matthew Skeels

2010-01-01

Complementary and alternative medicine (CAM) has become an implicit part of a lifestyle industry in the United States. The World Health Organization (WHO) reports that at least 41% of the population in the US has used CAM at least once in their lives (WHO 2002). Globalization, an influx of various immigrant cultures, and growing wariness of western allopathic medicine...

Avoiding the Potential Pitfalls of Using Negative Priming Tasks in Developmental Studies: Assessing Inhibitory Control in Children, Adolescents, and Adults

ERIC Educational Resources Information Center

Pritchard, Verena E.; Neumann, Ewald

2009-01-01

Despite being ignored, visual distractors often produce traceable negative priming (NP) effects that can be used to investigate inhibitory processes. Robust NP effects are typically found with young adults, but not with children. Using 2 different NP tasks, the authors compared NP in 5 different age groups spanning 5 to 25 years of age. The 1st…

Induced Insecurity: Understanding the Potential Pitfalls in Developing Theater Campaign Plans

DTIC Science & Technology

2015-06-11

effective partnerships that meet outlined in higher- level strategic guidance . 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. UMITATION OF... effective partnerships that meet the desired end states outlined in higher-level strategic guidance. DEDICATION To the millions of men and women who...and draw conclusions, it does not always prove to be an effective means of predicting the outcome of current or future events. In addition, the

The Use of Self-scanned Silicon Photodiode Arrays for Astronomical Spectrophotometry

NASA Technical Reports Server (NTRS)

Cochran, A. L.

1984-01-01

The use of a Reticon self scanned silicon photodiode array for precision spectrophotometry is discussed. It is shown that internal errors are + or - 0.003 mag. Observations obtained with a photodiode array are compared with observations obtained with other types of detectors with agreement, from 3500 A to 10500 A, of 1%. The photometric properties of self scanned photodiode arrays are discussed. Potential pitfalls are given.

The Acquisition Strategy: A Roadmap to Program Management Success

DTIC Science & Technology

2012-06-01

of the positions taken in the AS. Remember , the PM is the spokesperson and storyteller for his/her program. Potential Pitfalls There are just as...them clearly and precisely • Gathers and assesses relevant information , using abstract ideas to interpret it effectively • Comes to well...incen- tive structure informs the contractor what is important and where to focus. The incentive structure can emphasize performance, cost, or

Severe subarachnoid hemorrhage associated with cerebral venous thrombosis in early pregnancy: a case report.

PubMed

Yamamoto, Junkoh; Kakeda, Shingo; Takahashi, Mayu; Idei, Masaru; Nakano, Yoshiteru; Soejima, Yoshiteru; Saito, Takeshi; Akiba, Daisuke; Shibata, Eiji; Korogi, Yukunori; Nishizawa, Shigeru

2013-12-01

Cerebral venous thrombosis (CVT) rarely induces subarachnoid hemorrhage (SAH). During late pregnancy and puerperium, CVT is an uncommon but important cause of stroke. However, severe SAH resulting from CVT is extremely rare during early pregnancy. We report on a rare case of severe SAH due to CVT, and discuss the potential pitfalls of CVT diagnosis in early pregnancy. A 32-year-old pregnant woman (9th week of pregnancy) presented with slight head dullness. Initial magnetic resonance imaging (MRI) revealed focal, abnormal signal intensity in the left thalamus. Nine days later, the patient developed a generalized seizure and severe SAH was detected with computed tomography (CT) scan. MRI and cerebral angiography revealed a completely thrombosed superior sagittal sinus, vein of Galen, straight sinus, and right transverse sinus. Transvaginal sonography indicated a missed abortion. The day after admission, the patient presented again with a progressive loss of consciousness and signs of herniation. The patient underwent emergency decompressive craniotomy, followed by intrauterine curettage. Two months later, she made an excellent recovery except for a slight visual field defect. A rare case of severe SAH due to CVT is reported, with emphasis on the potential pitfalls of CVT diagnosis in early pregnancy. Copyright © 2013 Elsevier Inc. All rights reserved.

Abdomen after a Puestow procedure: postoperative CT appearance, complications, and potential pitfalls.

PubMed

Freed, K S; Paulson, E K; Frederick, M G; Keogan, M T; Pappas, T N

1997-06-01

To evaluate the postoperative computed tomographic (CT) appearance, complications, and potential pitfalls after a Puestow procedure (lateral side-to-side pancreaticojejunostomy). Forty CT examinations were performed after the Puestow procedure in 20 patients. Images were retrospectively reviewed by three radiologists. The pancreaticojejunal anastomosis was identified at 30 examinations and was immediately anterior to the pancreatic body or tail. The anastomosis contained fluid or gas on 11 scans and oral contrast material on four scans. On 15 scans, the anastomosis appeared as collapsed bowel without gas, fluid, or oral contrast material. The Roux-en-Y loop was identified on 28 (70%) scans and contained fluid or gas on 16 scans and oral contrast material on six scans. The Roux-en-Y loop appeared as collapsed bowel on six scans. When the anastomosis or Roux-en-Y loop contained fluid and gas, the appearance mimicked that of a pancreatic or parapancreatic abscess. Peripancreatic stranding was present on 28 scans and was due to either ongoing pancreatitis or postoperative change. Complications included 15 transient fluid collections, three abscesses, four pseudocysts, one hematoma, and one small-bowel and Roux-en-Y obstruction. Knowledge of the anatomy after a Puestow procedure is essential for accurate interpretation of CT scans.

Pre- and Postoperative Imaging of the Aortic Root

PubMed Central

Chan, Frandics P.; Mitchell, R. Scott; Miller, D. Craig; Fleischmann, Dominik

2016-01-01

Three-dimensional datasets acquired using computed tomography and magnetic resonance imaging are ideally suited for characterization of the aortic root. These modalities offer different advantages and limitations, which must be weighed according to the clinical context. This article provides an overview of current aortic root imaging, highlighting normal anatomy, pathologic conditions, imaging techniques, measurement thresholds, relevant surgical procedures, postoperative complications and potential imaging pitfalls. Patients with a range of clinical conditions are predisposed to aortic root disease, including Marfan syndrome, bicuspid aortic valve, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Various surgical techniques may be used to repair the aortic root, including placement of a composite valve graft, such as the Bentall and Cabrol procedures; placement of an aortic root graft with preservation of the native valve, such as the Yacoub and David techniques; and implantation of a biologic graft, such as a homograft, autograft, or xenograft. Potential imaging pitfalls in the postoperative period include mimickers of pathologic processes such as felt pledgets, graft folds, and nonabsorbable hemostatic agents. Postoperative complications that may be encountered include pseudoaneurysms, infection, and dehiscence. Radiologists should be familiar with normal aortic root anatomy, surgical procedures, and postoperative complications, to accurately interpret pre- and postoperative imaging performed for evaluation of the aortic root. Online supplemental material is available for this article. ©RSNA, 2015 PMID:26761529

Drug detection in breath: non-invasive assessment of illicit or pharmaceutical drugs.

PubMed

Trefz, Phillip; Kamysek, Svend; Fuchs, Patricia; Sukul, Pritam; Schubert, Jochen K; Miekisch, Wolfram

2017-03-20

Breath analysis not only holds great potential for the development of new non-invasive diagnostic methods, but also for the identification and follow up of drug levels in breath. This is of interest for both, forensic and medical science. On the one hand, the detection of drugs of abuse in exhaled breath-similar to the well-known breath alcohol tests-would be highly desirable as an alternative to blood or urine analysis in situations such as police controls for drugged driving. The non-invasive detection of drugs and their metabolites is thus of great interest in forensic science, especially since marijuana is becoming legalized in certain parts of the US and the EU. The detection and monitoring of medical drugs in exhaled breath without the need of drawing blood samples on the other hand, is of high relevance in the clinical environment. This could facilitate a more precise medication and enable therapy control without any burden to the patient. Furthermore, it could be a step towards personalized medicine. This review gives an overview of the current state of drug detection in breath, including both volatile and non-volatile substances. The review is divided into two sections. The first section deals with qualitative detection of drugs (drugs of abuse), while the second is related to quantitative drug detection (medical drugs). Chances and limitations are discussed for both aspects. The detection of the intravenous anesthetic propofol is presented as a detailed example that demonstrates the potential, requirements, pitfalls and limitations of therapeutic drug monitoring by means of breath analysis.

Verification of Functional Fault Models and the Use of Resource Efficient Verification Tools

NASA Technical Reports Server (NTRS)

Bis, Rachael; Maul, William A.

2015-01-01

Functional fault models (FFMs) are a directed graph representation of the failure effect propagation paths within a system's physical architecture and are used to support development and real-time diagnostics of complex systems. Verification of these models is required to confirm that the FFMs are correctly built and accurately represent the underlying physical system. However, a manual, comprehensive verification process applied to the FFMs was found to be error prone due to the intensive and customized process necessary to verify each individual component model and to require a burdensome level of resources. To address this problem, automated verification tools have been developed and utilized to mitigate these key pitfalls. This paper discusses the verification of the FFMs and presents the tools that were developed to make the verification process more efficient and effective.

Animal models of protein allergenicity: potential benefits, pitfalls and challenges.

PubMed

Dearman, R J; Kimber, I

2009-04-01

Food allergy is an important health issue. With an increasing interest in novel foods derived from transgenic crop plants, there is a growing need for the development of approaches suitable for the characterization of the allergenic potential of proteins. There are methods available currently (such as homology searches and serological testing) that are very effective at identifying proteins that are likely to cross-react with known allergens. However, animal models may play a role in the identification of truly novel proteins, such as bacterial or fungal proteins, that have not been experienced previously in the diet. We consider here the potential benefits, pitfalls and challenges of the selection of various animal models, including the mouse, the rat, the dog and the neonatal swine. The advantages and disadvantages of various experimental end-points are discussed, including the measurement of specific IgE by ELISA, Western blotting or functional tests such as the passive cutaneous anaphylaxis assay, and the assessment of challenge-induced clinical symptoms in previously sensitized animals. The experimental variables of route of exposure to test proteins and the incorporation of adjuvant to increase the sensitivity of the responses are considered also. It is important to emphasize that currently none of these approaches has been validated for the purposes of hazard identification in the context of a safety assessment. However, the available evidence suggests that the judicious use of an accurate and robust animal model could provide important additional data that would contribute significantly to the assessment of the potential allergenicity of novel proteins.

The pitfalls of container production

Treesearch

Wayne Bell

2013-01-01

This paper summarizes ten of the biggest “pitfalls” or challenges I have encountered in my experience growing southern pine seedlings in containers over the past 30 years. Learning from challenges is an important part of growing successful nursery operations.

Pitfalls in molecular analysis for mismatch repair deficiency in a family with biallelic pms2 germline mutations.

PubMed

Leenen, C H M; Geurts-Giele, W R R; Dubbink, H J; Reddingius, R; van den Ouweland, A M; Tops, C M J; van de Klift, H M; Kuipers, E J; van Leerdam, M E; Dinjens, W N M; Wagner, A

2011-12-01

Heterozygous germline mutations in the mismatch repair (MMR) genes MLH1, MSH2, MSH6 and PMS2 cause Lynch syndrome. Biallelic mutations in the MMR genes are associated with a childhood cancer syndrome [constitutional mismatch repair deficiency (CMMR-D)]. This is predominantly characterized by hematological malignancies and tumors of the bowel and brain, often associated with signs of neurofibromatosis type 1 (NF1). Diagnostic strategies for selection of patients for MMR gene analysis include analysis of microsatellite instability (MSI) and immunohistochemical (IHC) analysis of MMR proteins in tumor tissue. We report the clinical characterization and molecular analyses of tumor specimens from a family with biallelic PMS2 germline mutations. This illustrates the pitfalls of present molecular screening strategies. Tumor tissues of five family members were analyzed for MSI and IHC. MSI was observed in only one of the analyzed tissues. However, IHC analysis of brain tumor tissue of the index patient and his sister showed absence of PMS2 expression, and germline mutation analyses showed biallelic mutations in PMS2: p.Ser46IIe and p.Pro246fs. The same heterozygous mutations were confirmed in the father and mother, respectively. These data support the conclusion that in case of a clinical phenotype of CMMR-D, it is advisable to routinely combine MSI analysis with IHC analysis for the expression of MMR proteins. With inconclusive or conflicting results, germline mutation analysis of the MMR genes should be considered after thorough counselling of the patients and/or their relatives. © 2011 John Wiley & Sons A/S.

Seven PC Purchasing Pitfalls.

ERIC Educational Resources Information Center

Wodarz, Nan

1997-01-01

Explores how to avoid common pitfalls when schools purchase computer equipment. Purchasing tips are provided in the areas of choosing multiple platforms, buying the cheapest model available, choosing a proprietary design, falling for untested technology, purchasing systems that are not upgradable, ignoring extended warranties, and failing to plan…

Bone morphogenetic protein-2 and bone therapy: successes and pitfalls.

PubMed

Poon, Bonnie; Kha, Tram; Tran, Sally; Dass, Crispin R

2016-02-01

Bone morphogenetic proteins (BMPs), more specifically BMP-2, are being increasingly used in orthopaedic surgery due to advanced research into osteoinductive factors that may enhance and improve bone therapy. There are many areas in therapy that BMP-2 is being applied to, including dental treatment, open tibial fractures, cancer and spinal surgery. Within these areas of treatment, there are many reports of successes and pitfalls. This review explores the use of BMP-2 and its successes, pitfalls and future prospects in bone therapy. The PubMed database was consulted to compile this review. With successes in therapy, there were descriptions of a more rapid healing time with no signs of rejection or infection attributed to BMP-2 treatment. Pitfalls included BMP-2 'off-label' use, which lead to various adverse effects. Our search highlighted that optimising treatment with BMP-2 is a direction that many researchers are exploring, with areas of current research interest including concentration and dose of BMP-2, carrier type and delivery. © 2015 Royal Pharmaceutical Society.

Implementation of personalized medicine in Central-Eastern Europe: pitfalls and potentials based on citizen's attitude.

PubMed

Balicza, Peter; Terebessy, Andras; Grosz, Zoltan; Varga, Noemi Agnes; Gal, Aniko; Fekete, Balint Andras; Molnar, Maria Judit

2018-03-01

Next-generation sequencing is increasingly utilized worldwide as a research and diagnostic tool and is anticipated to be implemented into everyday clinical practice. Since Central-Eastern European attitude toward genetic testing, especially broad genetic testing, is not well known, we performed a survey on this issue among Hungarian participants. A self-administered questionnaire was distributed among patients and patient relatives at our neurogenetic outpatient clinic. Members of the general population were also recruited via public media. We used chi-square testing and binary logistic regression to examine factors influencing attitude. We identified a mixed attitude toward genetic testing. Access to physician consultation positively influenced attitude. A higher self-determined genetic familiarity score associated with higher perceived genetic influence score, which in turn associated with greater willingness to participate in genetic testing. Medical professionals constituted a skeptical group. We think that given the controversies and complexities of the next-generation sequencing field, the optimal clinical translation of NGS data should be performed in institutions which have the unique capability to provide interprofessional health education, transformative biomedical research, and crucial patient care. With optimization of the clinical translational process, improvement of genetic literacy may increase patient engagement and empowerment. The paper highlights that in countries with relatively low-genetic literacy, a special strategy is needed to enhance the implementation of personalized medicine.

Usefulness of axial planes of helical computed tomography for diagnosis of pancreaticobiliary maljunction in early infants with negative findings on magnetic resonance cholangiopancreatography.

PubMed

Okada, Tadao; Sasaki, Fumiaki; Honda, Shouhei; Naitou, Satsuki; Onodera, Yuya; Todo, Satoru

2008-03-01

Magnetic resonance cholangiopancreatography (MRCP) is not sufficient to detect pancreaticobiliary maljunction (PBM) in young infants because the main pancreatic duct is not visualized and respiratory artifacts occur. To our knowledge, there are no reports highlighting the diagnostic accuracy of evaluation using the axial planes of helical computed tomographic (CT) scanning with contrast medium instead of 3-dimensional (3D) reconstruction. The aim of this study was to describe our experience and the characteristics of 3 children with PBM diagnosed using the axial planes of helical CT with contrast medium, although they showed negative findings of PBM by MRCP, instead of 3D reconstruction. Three patients aged from 1 month to 3 years were diagnosed with PBM using the axial planes of helical CT with contrast medium though MRCP could not show the common channel and/or the entrance of the common channel into the duodenum. In all 3 patients, PBM of the common channel was not revealed by MRCP. On the other hand, axial planes of contrast-enhanced helical CT scans showed PBM clearly. Our experience suggests that axial planes of the contrast-enhanced helical CT scan comprise an accurate tool for the diagnosis of fusiform-type PBM and could replace MRCP in younger children. Further studies are necessary for better assessment of the potential advantages and pitfalls of this modality.

Molecular confocal laser endomicroscopy: a novel technique for in vivo cellular characterization of gastrointestinal lesions.

PubMed

Karstensen, John Gásdal; Klausen, Pia Helene; Saftoiu, Adrian; Vilmann, Peter

2014-06-28

While flexible endoscopy is essential for macroscopic evaluation, confocal laser endomicroscopy (CLE) has recently emerged as an endoscopic method enabling visualization at a cellular level. Two systems are currently available, one based on miniprobes that can be inserted via a conventional endoscope or via a needle guided by endoscopic ultrasound. The second system has a confocal microscope integrated into the distal part of an endoscope. By adding molecular probes like fluorescein conjugated antibodies or fluorescent peptides to this procedure (either topically or systemically administered during on-going endoscopy), a novel world of molecular evaluation opens up. The method of molecular CLE could potentially be used for estimating the expression of important receptors in carcinomas, subsequently resulting in immediate individualization of treatment regimens, but also for improving the diagnostic accuracy of endoscopic procedures by identifying otherwise invisible mucosal lesions. Furthermore, studies have shown that fluorescein labelled drugs can be used to estimate the affinity of the drug to a target organ, which probably can be correlated to the efficacy of the drug. However, several of the studies in this research field have been conducted in animal facilities or in vitro, while only a limited number of trials have actually been carried out in vivo. Therefore, safety issues still needs further evaluations. This review will present an overview of the implications and pitfalls, as well as future challenges of molecular CLE in gastrointestinal diseases.

Dealing with the incidental finding of secondary variants by the example of SRNS patients undergoing targeted next-generation sequencing.

PubMed

Weber, Stefanie; Büscher, Anja K; Hagmann, Henning; Liebau, Max C; Heberle, Christian; Ludwig, Michael; Rath, Sabine; Alberer, Martin; Beissert, Antje; Zenker, Martin; Hoyer, Peter F; Konrad, Martin; Klein, Hanns-Georg; Hoefele, Julia

2016-01-01

Steroid-resistant nephrotic syndrome (SRNS) is a severe cause of progressive renal disease. Genetic forms of SRNS can present with autosomal recessive or autosomal dominant inheritance. Recent studies have identified mutations in multiple podocyte genes responsible for SRNS. Improved sequencing methods (next-generation sequencing, NGS) now promise rapid mutational testing of SRNS genes. In the present study, a simultaneous screening of ten SRNS genes in 37 SRNS patients was performed by NGS. In 38 % of the patients, causative mutations in one SRNS gene were found. In 22 % of the patients, in addition to these mutations, a secondary variant in a different gene was identified. This high incidence of accumulating sequence variants was unexpected but, although they might have modifier effects, the pathogenic potential of these additional sequence variants seems unclear so far. The example of molecular diagnostics by NGS in SRNS patients shows that these new sequencing technologies might provide further insight into molecular pathogenicity in genetic disorders but will also generate results, which will be difficult to interpret and complicate genetic counseling. Although NGS promises more frequent identification of disease-causing mutations, the identification of causative mutations, the interpretation of incidental findings and possible pitfalls might pose problems, which hopefully will decrease by further experience and elucidation of molecular interactions.

Fundamentals of liver surgery for the practicing general surgeon.

PubMed

Cofer, Joseph B; Adams, Reid B

2010-05-01

This review focuses on the common general surgical referral problem of an undefined liver lesion. Understanding the clinical context in which the patient presents allows one to narrow the differential diagnosis and develop a focused evaluation plan. Most often, MRI is the most helpful initial study to define the likely diagnosis. If the appropriate radiologic expertise exists locally, most of the diagnostic evaluation, if not all, is feasible by a practicing general surgeon. Likewise, understanding the fundamentals of liver anatomy and physiology will facilitate the general surgeons' ability to evaluate the patient's imaging and liver reserve to decide whether local surgical care can be done safely. If local care is not available or safe, referral to a hepatobiliary specialist is appropriate. Ultimately, it is most important for the general surgeon contemplating surgery on the liver to understand his or her own limitations and the limits of their institutions' capabilities in providing pre- and postoperative care. It is particularly important to understand the pitfalls associated with decision-making for complex hepatobiliary problems and when considering an operation on anybody with significant intrinsic liver disease. When faced with these scenarios, the practicing general surgeon should always raise the question: "Is this patient better served at a hepatobiliary center or one that offers liver transplant?" If yes, a phone call, if not a referral, to a tertiary center to discuss the case is reasonable before embarking on a potentially hazardous operation.

Advantages and pitfalls of an extended gene panel for investigating complex neurometabolic phenotypes.

PubMed

Reid, Emma S; Papandreou, Apostolos; Drury, Suzanne; Boustred, Christopher; Yue, Wyatt W; Wedatilake, Yehani; Beesley, Clare; Jacques, Thomas S; Anderson, Glenn; Abulhoul, Lara; Broomfield, Alex; Cleary, Maureen; Grunewald, Stephanie; Varadkar, Sophia M; Lench, Nick; Rahman, Shamima; Gissen, Paul; Clayton, Peter T; Mills, Philippa B

2016-11-01

Neurometabolic disorders are markedly heterogeneous, both clinically and genetically, and are characterized by variable neurological dysfunction accompanied by suggestive neuroimaging or biochemical abnormalities. Despite early specialist input, delays in diagnosis and appropriate treatment initiation are common. Next-generation sequencing approaches still have limitations but are already enabling earlier and more efficient diagnoses in these patients. We designed a gene panel targeting 614 genes causing inborn errors of metabolism and tested its diagnostic efficacy in a paediatric cohort of 30 undiagnosed patients presenting with variable neurometabolic phenotypes. Genetic defects that could, at least partially, explain observed phenotypes were identified in 53% of cases. Where biochemical abnormalities pointing towards a particular gene defect were present, our panel identified diagnoses in 89% of patients. Phenotypes attributable to defects in more than one gene were seen in 13% of cases. The ability of in silico tools, including structure-guided prediction programmes to characterize novel missense variants were also interrogated. Our study expands the genetic, clinical and biochemical phenotypes of well-characterized (POMGNT1, TPP1) and recently identified disorders (PGAP2, ACSF3, SERAC1, AFG3L2, DPYS). Overall, our panel was accurate and efficient, demonstrating good potential for applying similar approaches to clinically and biochemically diverse neurometabolic disease cohorts. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain.

Idioms and Back Translation

ERIC Educational Resources Information Center

Griffin, Frank

2004-01-01

The challenges of intercultural communication are an integral part of many undergraduate business communication courses. Marketing gaffes clearly illustrate the pitfalls of translation and underscore the importance of a knowledge of the culture with which one is attempting to communicate. A good way to approach the topic of translation pitfalls in…

Diagnostic pitfalls of infarcted Warthin tumor in frozen section evaluation.

PubMed

Tan, Yaohong; Kryvenko, Oleksandr N; Kerr, Darcy A; Chapman, Jennifer R; Kovacs, Christina; Arnold, David J; Rosenberg, Andrew E; Gomez-Fernandez, Carmen R

2016-12-01

Warthin tumor (WT) is the second most common benign salivary gland neoplasm and has characteristic cytologic and histologic findings. Fine-needle aspiration is a common and useful preoperative diagnostic technique, which sometimes leads to ischemic injury resulting in the infarction of these lesions. Infarcted WT may demonstrate variable gross and histologic alterations that may render the diagnosis challenging, particularly during intraoperative frozen section evaluation. In this study, we collected 11 resection specimens from 9 patients with infarcted WT. Seven patients were men and 2 were women, ranging from 49 to 85 years (mean, 69). All the patients had fine-needle aspiration before the resection. Macroscopically, the tumors were tan-white and contained soft, yellow, exudative material. The histologic findings were variable and included necrosis, ghosts of papillae, squamous metaplasia, cholesterol clefts, foamy macrophages, multinucleated giant cell reaction, necrotizing granulomas, and fibrosis. Each case predominantly demonstrated 1 or 2 of these histomorphologic features. In the permanent sections, additional sampling revealed foci of residual viable WT in 8 cases. Three cases were completely infarcted; however, they all had ghost-like papillae in which the architecture of WT was evident. Infarcted WT may present a diagnostic challenge during intraoperative frozen section evaluation. Associated morphologic alterations may preclude a definitive diagnosis of WT and may mimic malignancy. Awareness of the gross and microscopic features associated with infarcted WT is important, particularly for accurate frozen section evaluation of these salivary gland tumors. Copyright © 2016 Elsevier Inc. All rights reserved.

Advances in the diagnosis of bovine besnoitiosis: current options and applications for control.

PubMed

Gutiérrez-Expósito, Daniel; Ferre, Ignacio; Ortega-Mora, Luis M; Álvarez-García, Gema

2017-10-01

Bovine besnoitiosis, which is caused by the tissue cyst-forming intracellular parasite Besnoitia besnoiti, is a chronic and debilitating disease that is responsible for severe economic losses in the cattle raised under extensive husbandry systems. The absence of vaccines, treatments or a health scheme at local, national and international levels has led to a rapid spread of bovine besnoitiosis from western Europe towards eastern countries and northwards. Moreover, this parasitic disease is widely present in many sub-Saharan countries. Thus, bovine besnoitiosis should be included in the animal health scheme of beef cattle herds. Accurate diagnostic tools and common diagnostic procedures are mandatory in any control programme. Relevant advances have been made in this field during the last decade. Succeeding with accurate diagnosis relies on the technique employed and the antibody and parasite kinetics of the infection stage, which may notably influence control programmes and surveillance. Moreover, control programmes should be adapted to the epidemiological status of the disease, as the disease presentation in a herd has important implications for prospective control. Herein, we review the clinical disease presentation of bovine besnoitiosis and the correlation between its clinical course and laboratory parameters. We also provide an update on the available diagnostic tools, discuss their strengths and pitfalls, and provide guidelines for their use in control, surveillance and epidemiological studies. A rational control strategy is also recommended. Copyright © 2017 Australian Society for Parasitology. Published by Elsevier Ltd. All rights reserved.

Navigating the complexities of qualitative comparative analysis: case numbers, necessity relations, and model ambiguities.

PubMed

Thiem, Alrik

2014-12-01

In recent years, the method of Qualitative Comparative Analysis (QCA) has been enjoying increasing levels of popularity in evaluation and directly neighboring fields. Its holistic approach to causal data analysis resonates with researchers whose theories posit complex conjunctions of conditions and events. However, due to QCA's relative immaturity, some of its technicalities and objectives have not yet been well understood. In this article, I seek to raise awareness of six pitfalls of employing QCA with regard to the following three central aspects: case numbers, necessity relations, and model ambiguities. Most importantly, I argue that case numbers are irrelevant to the methodological choice of QCA or any of its variants, that necessity is not as simple a concept as it has been suggested by many methodologists, and that doubt must be cast on the determinacy of virtually all results presented in past QCA research. By means of empirical examples from published articles, I explain the background of these pitfalls and introduce appropriate procedures, partly with reference to current software, that help avoid them. QCA carries great potential for scholars in evaluation and directly neighboring areas interested in the analysis of complex dependencies in configurational data. If users beware of the pitfalls introduced in this article, and if they avoid mechanistic adherence to doubtful "standards of good practice" at this stage of development, then research with QCA will gain in quality, as a result of which a more solid foundation for cumulative knowledge generation and well-informed policy decisions will also be created. © The Author(s) 2014.

The value and pitfalls of speculation about science and technology in bioethics: the case of cognitive enhancement.

PubMed

Racine, Eric; Martin Rubio, Tristana; Chandler, Jennifer; Forlini, Cynthia; Lucke, Jayne

2014-08-01

In the debate on the ethics of the non-medical use of pharmaceuticals for cognitive performance enhancement in healthy individuals there is a clear division between those who view "cognitive enhancement" as ethically unproblematic and those who see such practices as fraught with ethical problems. Yet another, more subtle issue, relates to the relevance and quality of the contribution of scholarly bioethics to this debate. More specifically, how have various forms of speculation, anticipatory ethics, and methods to predict scientific trends and societal responses augmented or diminished this contribution? In this paper, we use the discussion of the ethics of cognitive enhancement to explore the positive and negative contribution of speculation in bioethics scholarship. First, we review and discuss how speculation has relied on different sets of assumptions regarding the non-medical use of stimulants, namely: (1) terminology and framing; (2) scientific aspects such as efficacy and safety; (3) estimates of prevalence and consequent normalization; and (4) the need for normative reflection and regulatory guidelines. Second, three methodological guideposts are proposed to alleviate some of the pitfalls of speculation: (1) acknowledge assumptions more explicitly and identify the value attributed to assumptions; (2) validate assumptions with interdisciplinary literature; and (3) adopt a broad perspective to promote more comprehensive reflection. We conclude that, through the examination of the controversy about cognitive enhancement, we can employ these methodological guideposts to enhance the value of contributions from bioethics and minimize potential epistemic and practical pitfalls in this case and perhaps in other areas of bioethical debate.

Brain banks as key part of biochemical and molecular studies on cerebral cortex involvement in Parkinson's disease.

PubMed

Ravid, Rivka; Ferrer, Isidro

2012-04-01

Exciting developments in basic and clinical neuroscience and recent progress in the field of Parkinson's disease (PD) are partly a result of the availability of human specimens obtained through brain banks. These banks have optimized the methodological, managerial and organizational procedures; standard operating procedures; and ethical, legal and social issues, including the code of conduct for 21st Century brain banking and novel protocols. The present minireview focuses on current brain banking organization and management, as well as the likely future direction of the brain banking field. We emphasize the potentials and pitfalls when using high-quality specimens of the human central nervous system for advancing PD research. PD is a generalized disease in which α-synuclein is not a unique component but, instead, is only one of the players accounting for the complex impairment of biochemical/molecular processes involved in metabolic pathways. This is particularly important in the cerebral cortex, where altered cognition has a complex neurochemical substrate. Mitochondria and energy metabolism impairment, abnormal RNA, microRNA, protein synthesis, post-translational protein modifications and alterations in the lipid composition of membranes and lipid rafts are part of these complementary factors. We have to be alert to the possible pitfalls of each specimen and its suitability for a particular study. Not all samples qualify for the study of DNA, RNA, proteins, post-translational modifications, lipids and metabolomes, although the use of carefully selected samples and appropriate methods minimizes pitfalls and errors and guarantees high-quality reserach. © 2012 The Authors Journal compilation © 2012 FEBS.

The Comparison of Matching Methods Using Different Measures of Balance: Benefits and Risks Exemplified within a Study to Evaluate the Effects of German Disease Management Programs on Long-Term Outcomes of Patients with Type 2 Diabetes.

PubMed

Fullerton, Birgit; Pöhlmann, Boris; Krohn, Robert; Adams, John L; Gerlach, Ferdinand M; Erler, Antje

2016-10-01

To present a case study on how to compare various matching methods applying different measures of balance and to point out some pitfalls involved in relying on such measures. Administrative claims data from a German statutory health insurance fund covering the years 2004-2008. We applied three different covariance balance diagnostics to a choice of 12 different matching methods used to evaluate the effectiveness of the German disease management program for type 2 diabetes (DMPDM2). We further compared the effect estimates resulting from applying these different matching techniques in the evaluation of the DMPDM2. The choice of balance measure leads to different results on the performance of the applied matching methods. Exact matching methods performed well across all measures of balance, but resulted in the exclusion of many observations, leading to a change of the baseline characteristics of the study sample and also the effect estimate of the DMPDM2. All PS-based methods showed similar effect estimates. Applying a higher matching ratio and using a larger variable set generally resulted in better balance. Using a generalized boosted instead of a logistic regression model showed slightly better performance for balance diagnostics taking into account imbalances at higher moments. Best practice should include the application of several matching methods and thorough balance diagnostics. Applying matching techniques can provide a useful preprocessing step to reveal areas of the data that lack common support. The use of different balance diagnostics can be helpful for the interpretation of different effect estimates found with different matching methods. © Health Research and Educational Trust.

Diagnosis and Management of Patients with Paroxysmal Sympathetic Hyperactivity following Acute Brain Injuries Using a Consensus-Based Diagnostic Tool: A Single Institutional Case Series.

PubMed

Godo, Shigeo; Irino, Shigemi; Nakagawa, Atsuhiro; Kawazoe, Yu; Fujita, Motoo; Kudo, Daisuke; Nomura, Ryosuke; Shimokawa, Hiroaki; Kushimoto, Shigeki

2017-09-01

Paroxysmal sympathetic hyperactivity (PSH) is a distinct syndrome of episodic sympathetic hyperactivities following severe acquired brain injury, characterized by paroxysmal transient fever, tachycardia, hypertension, tachypnea, excessive diaphoresis and specific posturing. PSH remains to be an under-recognized condition with a diagnostic pitfall especially in the intensive care unit (ICU) settings due to the high prevalence of concomitant diseases that mimic PSH. A consensus set of diagnostic criteria named PSH-Assessment Measure (PSH-AM) has been developed recently, which is consisted of two components: a diagnosis likelihood tool derived from clinical characteristics of PSH, and a clinical feature scale assigned to the severity of each sympathetic hyperactivity. We herein present a case series of patients with PSH who were diagnosed and followed by using PSH-AM in our tertiary institutional medical and surgical ICU between April 2015 and March 2017 in order to evaluate the clinical efficacy of PSH-AM. Among 394 survivors of 521 patients admitted with acquired brain injury defined as acute brain injury at all levels of severity regardless of the presence of altered consciousness, including traumatic brain injury, stroke, infectious disease, and encephalopathy, 6 patients (1.5%) were diagnosed as PSH by using PSH-AM. PSH-AM served as a useful scoring system for early objective diagnosis, assessment of severity, and serial evaluation of treatment efficacy in the management of PSH in the ICU settings. In conclusion, critical care clinicians should consider the possibility of PSH and can use PSH-AM as a useful diagnostic and guiding tool in the management of PSH.

Protecting retinal ganglion cells

PubMed Central

Khatib, T Z; Martin, K R

2017-01-01

Retinal ganglion cell degeneration underlies several conditions which give rise to significant visual compromise, including glaucoma, hereditary optic neuropathies, ischaemic optic neuropathies, and demyelinating disease. In this review, we discuss the emerging strategies for neuroprotection specifically in the context of glaucoma, including pharmacological neuroprotection, mesenchymal stem cells, and gene therapy approaches. We highlight potential pitfalls that need to be considered when developing these strategies and outline future directions, including the prospects for clinical trials. PMID:28085136

Moral Courage or Heresy: The Benefits and Pitfalls of Military Leaders Speaking Out

DTIC Science & Technology

2008-01-01

available, the threat of judicial intelference with the Executive Branch would violate separation of powers . Held: l.This Court need not address two...claim in this case. (b) The separation - of - powers doctrine does not require federal courts to stay all private actions against the President until he...scheduling orders, potential contempt citations, and sanctions would violate separation of powers principles. Judge Bowman suggested that "judicial case

Tattoos and Piercings: A Review for the Emergency Physician

PubMed Central

Urdang, Michael; Mallek, Jennifer T; Mallon, William K

2011-01-01

Tattoos and piercings are increasingly part of everyday life for large sections of the population, and more emergency physicians are seeing these body modifications (BM) adorn their patients. In this review we elucidate the most common forms of these BMs, we describe how they may affect both the physical and psychological health of the patient undergoing treatment, and also try to educate around any potential pitfalls in treating associated complications. PMID:22224126

Myxoid malignant fibrous histiocytoma presenting as a midline nasal mass.

PubMed

DeRosa, Jaimie; Smit, Jeffrey R

2012-04-01

Myxoid malignant fibrous histiocytoma is a rare type of pediatric non-rhabdomyosarcoma soft-tissue sarcoma. The case of a 5-year-old girl is presented, highlighting the potential for multiple pitfalls and aberrant differential diagnoses that need to be identified for successful treatment of pediatric myxofibrosarcomas. An awareness of these tumors and a call for standardized postsurgical treatment protocols is necessary in order to successfully treat children with this disease.

Annual Progress Report Fiscal Year 1990

DTIC Science & Technology

1991-03-25

87/25 (C) Axillary Venous Sickling in Individuals with Sickle Cell Trait During Upper Extremity Exercise in a Ilypoxic Environment (Monitor: Dr. Ortiz...I ’d Dire, Daniel J.: K8/77 (0) Use of Venous pH in the Initial Evaluation of Pediatric Patients with Diabetic Kcioacidosis...top oercjilu this potential pitfall. At the time of peak. antibody synthesis, rabbits will be bled sia the marginal ear %vim-o central artery in the

The Promise and Potential Pitfalls of a "Learning-Centered" Approach to Creative Social Inquiry: Lessons Learned from an Undergraduate Seminar on Authoritarianism through Literature and Film

ERIC Educational Resources Information Center

Junisbai, Barbara

2014-01-01

Political science faculty have access to a wealth of innovative pedagogies thanks to a comprehensive literature on teaching and learning in the discipline and related fields. Yet, from among the hundreds of documented possibilities, how does one go about deciding which to incorporate into a given course? Few articles have much to say in response…

Neurophysiology of the esophagus.

PubMed

Brock, Christina; Brokjaer, Anne; Drewes, Asbjørn Mohr; Farmer, Adam D; Frøkjaer, Jens Brøndum; Gregersen, Hans; Lottrup, Christian

2014-09-01

The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the methods and characteristics of esophageal afferents in humans; the pitfalls in characterization of mechanosensitive afferents; the sensitization of esophageal afferents in human studies; the brain source modeling in the understanding of the esophagus-brain axis; the use of evoked brain potentials in the esophagus; and measuring descending inhibition in animal and human studies. © 2014 New York Academy of Sciences.

Gold nanoparticles in breast cancer treatment: Promise and potential pitfalls

PubMed Central

Lee, Jihyoun; Chatterjee, Dev Kumar; Lee, Min Hyuk; Krishnan, Sunil

2014-01-01

Despite remarkable achievements in the treatment of breast cancer, some obstacles still remain. Gold nanoparticles may prove valuable in addressing these problems owing to their unique characteristics, including their enhanced permeability and retention in tumor tissue, their light absorbance and surface plasmon resonance in near-infrared light, their interaction with radiation to generate secondary electrons, and their ability to be conjugated with drugs or other agents. Herein, we discuss some basic concepts of gold nanoparticles, and early results from studies regarding their use in breast cancer, including toxicity and side effects. We also discuss these particles’ potential clinical applications. PMID:24556077

Empathy and Social-Emotional Learning: Pitfalls and Touchstones for School-Based Programs

ERIC Educational Resources Information Center

Maxwell, Bruce; DesRoches, Sarah

2010-01-01

This chapter identifies three common pitfalls in the use of the concept of empathy in formal social-emotional learning interventions: (1) not distinguishing between affective and cognitive empathy ("equivocation"); (2) overestimating the role of the imagination in empathizing ("Piaget's fallacy"); and (3) not accommodating the developmental and…

Encounter Co-Training: Benefits and Pitfalls

ERIC Educational Resources Information Center

Lundberg, Joan, Lundberg, Craig

1974-01-01

The authors promote the position that the benefits tend to exceed the pitfalls of dual facilitation of intense small group experience and should become a more standard feature of laboratory training, for reasons of new trainer development, better learning experience for participants, and continuing skill development of experienced trainers. (AJ)

Twitter as a tool for communication and knowledge exchange in academic medicine: A guide for skeptics and novices.

PubMed

Choo, Esther K; Ranney, Megan L; Chan, Teresa M; Trueger, N Seth; Walsh, Amy E; Tegtmeyer, Ken; McNamara, Shannon O; Choi, Ricky Y; Carroll, Christopher L

2015-05-01

Twitter is a tool for physicians to increase engagement of learners and the public, share scientific information, crowdsource new ideas, conduct, discuss and challenge emerging research, pursue professional development and continuing medical education, expand networks around specialized topics and provide moral support to colleagues. However, new users or skeptics may well be wary of its potential pitfalls. The aims of this commentary are to discuss the potential advantages of the Twitter platform for dialogue among physicians, to explore the barriers to accurate and high-quality healthcare discourse and, finally, to recommend potential safeguards physicians may employ against these threats in order to participate productively.

Parenteral nutrition.

PubMed

Inayet, N; Neild, P

2015-03-01

Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of patients with intestinal failure or inaccessibility; however, it may also be associated with a number of potentially life-threatening complications. A recent NCEPOD report (2010) identified a number of inadequacies in the overall provision and management of parenteral nutrition and recommendations were made with the aim of improving clinical practice in the future. This paper focuses on the practical aspects relating to parenteral nutrition for adults, including important concepts, such as patient selection, as well as general management. We also explore the various pitfalls and potential complications and how these may be minimised.

Comparative Effectiveness Research in Pediatric Respiratory Disease: Promise and Pitfalls.

PubMed

Ramos, Kathleen J; Somayaji, Ranjani; Nichols, David P; Goss, Christopher H

2018-02-01

Comparative effectiveness research (CER) has become increasing central to clinical research in medicine. CER seeks to conduct clinical trials that compare different commonly used interventions in real-world settings (pragmatic clinical trials) and use a multitude of sources of evidence (including registries and cohort studies) to inform clinical decision making. CER also ensures that stakeholders (patients, families, care providers, insurers) have a voice in the research process by integrating formal stakeholder engagement as part of the research. This innovative approach to clinical research has distinct benefits and pitfalls. This review first defines what CER is and then describes some of its benefits and then pitfalls. The focus is on the role of CER in pediatrics.

Herpetological Monitoring Using a Pitfall Trapping Design in Southern California

USGS Publications Warehouse

Fisher, Robert; Stokes, Drew; Rochester, Carlton; Brehme, Cheryl; Hathaway, Stacie; Case, Ted

2008-01-01

The steps necessary to conduct a pitfall trapping survey for small terrestrial vertebrates are presented. Descriptions of the materials needed and the methods to build trapping equipment from raw materials are discussed. Recommended data collection techniques are given along with suggested data fields. Animal specimen processing procedures, including toe- and scale-clipping, are described for lizards, snakes, frogs, and salamanders. Methods are presented for conducting vegetation surveys that can be used to classify the environment associated with each pitfall trap array. Techniques for data storage and presentation are given based on commonly use computer applications. As with any study, much consideration should be given to the study design and methods before beginning any data collection effort.

Twinkling artifact on color Doppler ultrasound: an advantage or a pitfall?

PubMed

Ozan, Ebru; Atac, Gokce Kaan; Gundogdu, Sadi

2016-07-01

The twinkling artifact (TA) or color comet-tail artifact is characterized by a rapidly changing mixture of red and blue color Doppler signals. Even though many diseases and clinical conditions have been shown to produce this artifact, its source is not clearly understood yet. The TA may provide additional information to gray-scale ultrasound findings in several clinical situations. However, there may be pitfalls to keep in mind. We must first be aware of the TA to benefit from the advantages and avoid the pitfalls. In this review, we aim to give practicing radiologists an overview of the mechanisms and clinical applications of the TA by illustrating sample cases we have encountered.

[Acute skin infections and their imitators in children : A photo quiz].

PubMed

Theiler, M; Schwieger-Briel, A; Weibel, L

2017-10-01

Skin infections account for 40% of emergency visits in pediatric dermatology. It is important to promptly recognize skin infections with potential complications and initiate treatment. However some characteristic skin findings may imitate skin infections and are often misdiagnosed. To illustrate frequent pediatric skin infections and pitfalls in view of imitators and differential diagnoses. A photo quiz is presented with the discussion of a selection of acute pediatric skin infections in comparison to their infectious or noninfectious differential diagnoses. The following infectious skin conditions and imitators are described and clinical clues for differentiation highlighted: eczema herpeticum and bacterial superinfection of atopic dermatitis; exanthematous hand, foot and mouth disease and varicella infection; erythema chronicum multilocularis and anular urticaria; Gianotti-Crosti syndrome and Gianotti-Crosti-like reaction; bacterial folliculitis of the scalp and kerion celsi and eosinophilic pustular folliculitis of the scalp; cutaneous Leishmaniasis and idiopathic facial aseptic granuloma; allergic and bacterial lymphangitis; bullous impetigo contagiosa and nonaccidental scalding. Careful anamnesis and skin examination with attention to the here illustrated differential diagnoses are essential to avoid pitfalls in the evaluation of acute pediatric skin infections.

Comparative studies of social buffering: A consideration of approaches, terminology, and pitfalls.

PubMed

Kiyokawa, Yasushi; Hennessy, Michael B

2018-03-01

KIYOKAWA, Y. and HENNESSY, M.B. Comparative studies of social buffering: A consideration of approaches, terminology, and pitfalls…NEUROSCI BIOBEHAV REV XXX-XXX, .- Over the past decades, there has been an increasing number of investigations of the impact of social variables on neural, endocrine, and immune outcomes. Among these are studies of "social buffering"-or the phenomenon by which affiliative social partners mitigate the response to stressors. Yet, as social buffering studies have become more commonplace, the variety of approaches taken, definitions employed, and divergent results obtained in different species can lead to confusion and miscommunication. The aim of the present paper, therefore, is to address terminology and approaches and to highlight potential pitfalls to the study of social buffering across nonhuman species. We review and categorize variables currently being employed in social buffering studies and provide an overview of responses measured, mediating sensory modalities and underlying mechanisms. It is our hope that the paper will be useful to those contemplating examination of social buffering in the context of their own research. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessing health impact assessment: multidisciplinary and international perspectives

PubMed Central

Krieger, N; Northridge, M; Gruskin, S; Quinn, M; Kriebel, D; Davey, S; Bassett, M; Rehkopf, D; Miller, C

2003-01-01

Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public's health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion—increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)—that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world. PMID:12933768

Perils, pitfalls, and benefits of a surgeon as a health system employee: the contracting process.

PubMed

Graebner, Nancy K

2011-06-01

One would be hard pressed today to find a general surgeon or subspecialty-trained general surgeon who has not been approached by a health system to discuss employment. The majority of physicians find these initial discussions with a hospital administrator daunting at best regardless of whether they are just finishing residency or fellowship training or have had many successful years of private practice under their belt. Just as real estate has the mantra of "location, location, location," I would suggest that physician employment by a health system should have the mantra of "relationship, relationship, relationship." The following tips provide guidance on how to better understand the potential perils, pitfalls, and benefits of specific content sections of a standard template employment agreement between a health system and a physician. Physicians should review, understand, and be ready to engage in dialogue with the hospital administrator before involving attorneys. My experience is that if the dialogue begins with the attorneys representing each party, the opportunity to fully develop a partnership relationship between the parties is either lost or at minimum severely delayed in its development.

Cytometric methods for measuring bacteria in water: advantages, pitfalls and applications.

PubMed

Hammes, Frederik; Egli, Thomas

2010-06-01

Rapid detection of microbial cells is a challenge in microbiology, particularly when complex indigenous communities or subpopulations varying in viability, activity and physiological state are investigated. Flow cytometry (FCM) has developed during the last 30 years into a multidisciplinary technique for analysing bacteria. When used correctly, FCM can provide a broad range of information at the single-cell level, including (but not limited to) total counts, size measurements, nucleic acid content, cell viability and activity, and detection of specific bacterial groups or species. The main advantage of FCM is that it is fast and easy to perform. It is a robust technique, which is adaptable to different types of samples and methods, and has much potential for automation. Hence, numerous FCM applications have emerged in industrial biotechnology, food and pharmaceutical quality control, routine monitoring of drinking water and wastewater systems, and microbial ecological research in soils and natural aquatic habitats. This review focuses on the information that can be gained from the analysis of bacteria in water, highlighting some of the main advantages, pitfalls and applications.

Current challenges and pitfalls in the pharmacological treatment of depression

PubMed Central

Popa-Velea, O; Gheorghe, IR; Truţescu, CI; Purcărea, VL

2015-01-01

The multifactorial etiology of depression obliges needs an individual assessment, the psychopharmacological approach involving a biopsychosocial analysis for each individual case. The rebalancing of the depressive patient, seen as a return to a normal level of psychosocial functioning and reduced risk of relapse is achieved with a prompt and constant support of specialized teams. Treatment should include psychopharmacological and psychosocial approaches, the results being interrelated and contributing to the prognosis of the disorder. Progress in clinical and pharmacological research, vivid dynamics of socio-economic environment, the complexity of diagnostic evaluation and the need for an interdisciplinary approach may cause difficulties in addressing the depressive patient and the ethical controversies. The aim of this paper is to present a brief analysis of challenges encountered in the present psychiatric practice, starting from the heterogeneity of depressive manifestations and finishing with the prioritization of interventional forms. PMID:25866576

Three-day clotrimazole treatment in candidal vulvovaginitis.

PubMed Central

Masterton, G; Napier, I R; Henderson, J N; Roberts, J E

1977-01-01

The accepted modern practice is to treat each sexually transmitted disease with the shortest possible course of treatment consistent with success. In candidal vulvovaginitis, six days is the minimum period that has so far been found to be successful, but we report here a further reduction to three days. Patients were given two clotrimazole pessaries nightly for three consecutive nights; the overall success rate was 89-4% one month after treatment. This compares favourably with the 93% cure rate reported with the six-day course of clotrimazole. With both the long and short courses, patients having their first attack of genital candidosis responded better than those with a history of previous infection. Short courses of clotrimazole treatment are particularly valuable in dealing with uncooperative women who stop treatment at the earliest possible moment. Clinical and laboratory diagnostic pitfalls and their possible influence upon the therapeutic outcome are also discussed. PMID:870143

Giant submental lipoma: Case report and review of the literature

PubMed Central

Medina, Carlos R; Schneider, S; Mitra, A; Spears, J; Mitra, A

2007-01-01

Lipomas may be located in all parts of the body and may be confused clinically with other soft tissue masses. They infrequently occur in the head and neck. A large neck mass (greater than 10 cm) with a rapid growth rate should raise concerns about a possible malignancy. Failure to distinguish a liposarcoma from a lipoma may represent a medicolegal pitfall. Surgical excision of a lipoma is often used as the definitive treatment modality, and alternative treatments described for lipomas range from liposuction to steroid injections. In the present study, a 60-year-old man who presented with a rapidly enlarging submental mass is described. A 15 cm × 12 cm mass was successfully removed. The surgery produced excellent cosmetic results and no functional impairment. An integrated review of the literature regarding etiology, epidemiology, diagnostic and treatment modalities of submental lipomas follows. PMID:19554181

Gastric heterotopia in rectum: A literature review and its diagnostic pitfall.

PubMed

Dinarvand, Peyman; Vareedayah, Ashley A; Phillips, Nancy J; Hachem, Christine; Lai, Jinping

2017-01-01

The term heterotopia, in pathology, refers to the presence of normal tissues at foreign sites. Gastric heterotopia has been reported anywhere in the gastrointestinal tract. However, the presence of gastric heterotopia in the rectum is very rare. We, here, report a rare case of a localized 2-cm area of cratered mucosa with heaped-up borders in the rectum of a 51-year-old, asymptomatic woman who underwent screening colonoscopy. Histologic examination of the biopsy from the lesional tissue in rectum demonstrated fragments of rectal mucosa co-mingling with oxyntic- and antral-type gastric mucosa. No intestinal metaplasia or Helicobacter pylori is identified. Patients with gastric heterotopia in rectum usually present with bleeding and/or abdominal pain. Definite treatment of choice is surgical or endoscopic resection, although the lesions also respond to histamine-2 receptor blockers. In this article, most recent literature about gastric heterotopia in rectum is reviewed, following a case presentation about it.

Knowledge-base for interpretation of cerebrospinal fluid data patterns. Essentials in neurology and psychiatry.

PubMed

Reiber, Hansotto

2016-06-01

The physiological and biophysical knowledge base for interpretations of cerebrospinal fluid (CSF) data and reference ranges are essential for the clinical pathologist and neurochemist. With the popular description of the CSF flow dependent barrier function, the dynamics and concentration gradients of blood-derived, brain-derived and leptomeningeal proteins in CSF or the specificity-independent functions of B-lymphocytes in brain also the neurologist, psychiatrist, neurosurgeon as well as the neuropharmacologist may find essentials for diagnosis, research or development of therapies. This review may help to replace the outdated ideas like "leakage" models of the barriers, linear immunoglobulin Index Interpretations or CSF electrophoresis. Calculations, Interpretations and analytical pitfalls are described for albumin quotients, quantitation of immunoglobulin synthesis in Reibergrams, oligoclonal IgG, IgM analysis, the polyspecific ( MRZ- ) antibody reaction, the statistical treatment of CSF data and general quality assessment in the CSF laboratory. The diagnostic relevance is documented in an accompaning review.

Neuropsychological testing.

PubMed

Zucchella, Chiara; Federico, Angela; Martini, Alice; Tinazzi, Michele; Bartolo, Michelangelo; Tamburin, Stefano

2018-06-01

Neuropsychological testing is a key diagnostic tool for assessing people with dementia and mild cognitive impairment, but can also help in other neurological conditions such as Parkinson's disease, stroke, multiple sclerosis, traumatic brain injury and epilepsy. While cognitive screening tests offer gross information, detailed neuropsychological evaluation can provide data on different cognitive domains (visuospatial function, memory, attention, executive function, language and praxis) as well as neuropsychiatric and behavioural features. We should regard neuropsychological testing as an extension of the neurological examination applied to higher order cortical function, since each cognitive domain has an anatomical substrate. Ideally, neurologists should discuss the indications and results of neuropsychological assessment with a clinical neuropsychologist. This paper summarises the rationale, indications, main features, most common tests and pitfalls in neuropsychological evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Predicting sudden cardiac death from T wave alternans of the surface electrocardiogram: promise and pitfalls

NASA Technical Reports Server (NTRS)

Rosenbaum, D. S.; Albrecht, P.; Cohen, R. J.

1996-01-01

Sudden cardiac death remains a preeminent public health problem. Despite advances in preventative treatment for patients known to be at risk, to date we have been able to identify, and thus treat, only a small minority of these patients. Therefore, there is a major need to develop noninvasive diagnostic technologies to identify patients at risk. Recent studies have demonstrated that measurement of microvolt-level T wave alternans is a promising technique for the accurate identification of patients at risk for ventricular arrhythmias and sudden cardiac death. In this article, we review the clinical data establishing the relationship between microvolt T wave alternans and susceptibility to ventricular arrhythmias. We also review the methods and technology that have been developed to measure microvolt levels of T wave alternans noninvasively in broad populations of ambulatory patients. In particular, we examine techniques that permit the accurate measurement of T wave alternans during exercise stress testing.

Glenohumeral instability: evaluation with MR arthrography.

PubMed

Beltran, J; Rosenberg, Z S; Chandnani, V P; Cuomo, F; Beltran, S; Rokito, A

1997-01-01

Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement.

Neonatal CNS infection and inflammation caused by Ureaplasma species: rare or relevant?

PubMed

Glaser, Kirsten; Speer, Christian P

2015-02-01

Colonization with Ureaplasma species has been associated with adverse pregnancy outcome, and perinatal transmission has been implicated in the development of bronchopulmonary dysplasia in preterm neonates. Little is known about Ureaplasma-mediated infection and inflammation of the CNS in neonates. Controversy remains concerning its incidence and implication in the pathogenesis of neonatal brain injury. In vivo and in vitro data are limited. Despite improving care options for extremely immature preterm infants, relevant complications remain. Systematic knowledge of ureaplasmal infection may be of great benefit. This review aims to summarize pathogenic mechanisms, clinical data and diagnostic pitfalls. Studies in preterm and term neonates are critically discussed with regard to their limitations. Clinical questions concerning therapy or prophylaxis are posed. We conclude that ureaplasmas may be true pathogens, especially in preterm neonates, and may cause CNS inflammation in a complex interplay of host susceptibility, serovar pathogenicity and gestational age-dependent CNS vulnerability.

Determination of the Critical Micelle Concentration of Neutral and Ionic Surfactants with Fluorometry, Conductometry, and Surface Tension-A Method Comparison.

PubMed

Scholz, Norman; Behnke, Thomas; Resch-Genger, Ute

2018-01-01

Micelles are of increasing importance as versatile carriers for hydrophobic substances and nanoprobes for a wide range of pharmaceutical, diagnostic, medical, and therapeutic applications. A key parameter indicating the formation and stability of micelles is the critical micelle concentration (CMC). In this respect, we determined the CMC of common anionic, cationic, and non-ionic surfactants fluorometrically using different fluorescent probes and fluorescence parameters for signal detection and compared the results with conductometric and surface tension measurements. Based upon these results, requirements, advantages, and pitfalls of each method are discussed. Our study underlines the versatility of fluorometric methods that do not impose specific requirements on surfactants and are especially suited for the quantification of very low CMC values. Conductivity and surface tension measurements yield smaller uncertainties particularly for high CMC values, yet are more time- and substance consuming and not suitable for every surfactant.

Image is everything: pearls and pitfalls of digital photography and PowerPoint presentations for the cosmetic surgeon.

PubMed

Niamtu, Joseph

2004-01-01

Cosmetic surgery and photography are inseparable. Clinical photographs serve as diagnostic aids, medical records, legal protection, and marketing tools. In the past, taking high-quality, standardized images and maintaining and using them for presentations were tasks of significant proportion when done correctly. Although the cosmetic literature is replete with articles on standardized photography, this has eluded many practitioners in part to the complexity. A paradigm shift has occurred in the past decade, and digital technology has revolutionized clinical photography and presentations. Digital technology has made it easier than ever to take high-quality, standardized images and to use them in a multitude of ways to enhance the practice of cosmetic surgery. PowerPoint presentations have become the standard for academic presentations, but many pitfalls exist, especially when taking a backup disc to play on an alternate computer at a lecture venue. Embracing digital technology has a mild to moderate learning curve but is complicated by old habits and holdovers from the days of slide photography, macro lenses, and specialized flashes. Discussion is presented to circumvent common problems involving computer glitches with PowerPoint presentations. In the past, high-quality clinical photography was complex and sometimes beyond the confines of a busy clinical practice. The digital revolution of the past decade has removed many of these associated barriers, and it has never been easier or more affordable to take images and use them in a multitude of ways for learning, judging surgical outcomes, teaching and lecturing, and marketing. Even though this technology has existed for years, many practitioners have failed to embrace it for various reasons or fears. By following a few simple techniques, even the most novice practitioner can be on the forefront of digital imaging technology. By observing a number of modified techniques with digital cameras, any practitioner can take high-quality, standardized clinical photographs and can make and use these images to enhance his or her practice. This article deals with common pitfalls of digital photography and PowerPoint presentations and presents multiple pearls to achieve proficiency quickly with digital photography and imaging as well as avoid malfunction of PowerPoint presentations in an academic lecture venue.

European Earwig, Forficula auricularia L. (Dermaptera: Forficulidae) at the Hanford Reach National Monument, Washington State

USDA-ARS?s Scientific Manuscript database

The European earwig, Forficula auricularia L., was surveyed using pitfall traps at three sites at the Hanford Reach National Monument in south central Washington state. Pitfall traps were collected weekly from April 2002 through April 2003. The earwig was consistently taken during all months of the...

An Ethnographic Eye on Religion in Everyday Life

ERIC Educational Resources Information Center

Berglund, Jenny

2014-01-01

There are many pitfalls associated with teaching about religions. One such pitfall entails the risk of presenting religions as stereotypical monolithic systems; that is, all who belong to a particular religious tradition think and act in the same way. I like to call this sort of stereotyping the "robotic tendency" because it has a habit…

Waiver Applicants Steer Wary Course

ERIC Educational Resources Information Center

McNeil, Michele

2012-01-01

The latest batch of states seeking relief under the No Child Left Behind Act dodge pitfalls that tripped up the first round of applicants. In the latest round of applications for waivers under the No Child Left Behind Act, states have learned lessons from their predecessors and dodged pitfalls that triggered some big revisions from first-round…

Cases on Global E-Learning Practices: Successes and Pitfalls

ERIC Educational Resources Information Center

Sharma, Ramesh C., Ed.; Mishra, Sanjaya, Ed.

2007-01-01

"Cases on Global E-Learning Practices: Successes and Pitfalls" looks into global practices of e-learning, examining the successes and failures of e-learning professionals. It provides a judicious mix of practical experiences and research in the form of case studies. Written by experts from all over the globe, this book shows how to…

Common pitfalls in statistical analysis: Linear regression analysis

PubMed Central

Aggarwal, Rakesh; Ranganathan, Priya

2017-01-01

In a previous article in this series, we explained correlation analysis which describes the strength of relationship between two continuous variables. In this article, we deal with linear regression analysis which predicts the value of one continuous variable from another. We also discuss the assumptions and pitfalls associated with this analysis. PMID:28447022

A Comparison of the Pitfall Trap, Winkler Extractor and Berlese Funnel for Sampling Ground-Dwelling Arthropods in Tropical Montane Cloud Forests

PubMed Central

Sabu, Thomas K.; Shiju, Raj T.; Vinod, KV.; Nithya, S.

2011-01-01

Little is known about the ground-dwelling arthropod diversity in tropical montane cloud forests (TMCF). Due to unique habitat conditions in TMCFs with continuously wet substrates and a waterlogged forest floor along with the innate biases of the pitfall trap, Berlese funnel and Winkler extractor are certain to make it difficult to choose the most appropriate method to sample the ground-dwelling arthropods in TMCFs. Among the three methods, the Winkler extractor was the most efficient method for quantitative data and pitfall trapping for qualitative data for most groups. Inclusion of floatation method as a complementary method along with the Winkler extractor would enable a comprehensive quantitative survey of ground-dwelling arthropods. Pitfall trapping is essential for both quantitative and qualitative sampling of Diplopoda, Opiliones, Orthoptera, and Diptera. The Winkler extractor was the best quantitative method for Psocoptera, Araneae, Isopoda, and Formicidae; and the Berlese funnel was best for Collembola and Chilopoda. For larval forms of different insect orders and the Acari, all the three methods were equally effective. PMID:21529148

Evaluating and interpreting cross-taxon congruence: Potential pitfalls and solutions

NASA Astrophysics Data System (ADS)

Gioria, Margherita; Bacaro, Giovanni; Feehan, John

2011-05-01

Characterizing the relationship between different taxonomic groups is critical to identify potential surrogates for biodiversity. Previous studies have shown that cross-taxa relationships are generally weak and/or inconsistent. The difficulties in finding predictive patterns have often been attributed to the spatial and temporal scales of these studies and on the differences in the measure used to evaluate such relationships (species richness versus composition). However, the choice of the analytical approach used to evaluate cross-taxon congruence inevitably represents a major source of variation. Here, we described the use of a range of methods that can be used to comprehensively assess cross-taxa relationships. To do so, we used data for two taxonomic groups, wetland plants and water beetles, collected from 54 farmland ponds in Ireland. Specifically, we used the Pearson correlation and rarefaction curves to analyse patterns in species richness, while Mantel tests, Procrustes analysis, and co-correspondence analysis were used to evaluate congruence in species composition. We compared the results of these analyses and we described some of the potential pitfalls associated with the use of each of these statistical approaches. Cross-taxon congruence was moderate to strong, depending on the choice of the analytical approach, on the nature of the response variable, and on local and environmental conditions. Our findings indicate that multiple approaches and measures of community structure are required for a comprehensive assessment of cross-taxa relationships. In particular, we showed that selection of surrogate taxa in conservation planning should not be based on a single statistic expressing the degree of correlation in species richness or composition. Potential solutions to the analytical issues associated with the assessment of cross-taxon congruence are provided and the implications of our findings in the selection of surrogates for biodiversity are discussed.

Avoiding Title V permitting pitfalls

DOE Office of Scientific and Technical Information (OSTI.GOV)

Laswell, D.L.

1993-04-01

Title V of the 1990 Clean Air Act Amendments requires states to implement new air operating permit programs. States have a great deal of flexibility in developing their permit programs. Industry should work now to ensure that state programs contain the favorable aspects of the federal regulations and do not contain more stringent requirements that are not required under the Clean Air Act. This article outlines areas of the permit program that have the potential to handicap industry`s ability to expand.

Gene Therapy for Skin Diseases

PubMed Central

Gorell, Emily; Nguyen, Ngon; Lane, Alfred; Siprashvili, Zurab

2014-01-01

The skin possesses qualities that make it desirable for gene therapy, and studies have focused on gene therapy for multiple cutaneous diseases. Gene therapy uses a vector to introduce genetic material into cells to alter gene expression, negating a pathological process. This can be accomplished with a variety of viral vectors or nonviral administrations. Although results are promising, there are several potential pitfalls that must be addressed to improve the safety profile to make gene therapy widely available clinically. PMID:24692191

DOE Office of Scientific and Technical Information (OSTI.GOV)

MacAllister, D.J.; Day, R.; McCormack, M.D.

This paper gives an overview of a major integrated oil company`s experience with artificial intelligence (AI) over the last 5 years, with an emphasis on expert systems. The authors chronicle the development of an AI group, including details on development tool selection, project selection strategies, potential pitfalls, and descriptions of several completed expert systems. Small expert systems produced by teams of petroleum technology experts and experienced expert system developers that are focused in well-defined technical areas have produced substantial benefits and accelerated petroleum technology transfer.

Time-Dependent Trapping of Pollinators Driven by the Alignment of Floral Phenology with Insect Circadian Rhythms

PubMed Central

Lau, Jenny Y. Y.; Guo, Xing; Pang, Chun-Chiu; Tang, Chin Cheung; Thomas, Daniel C.; Saunders, Richard M. K.

2017-01-01

Several evolutionary lineages in the early divergent angiosperm family Annonaceae possess flowers with a distinctive pollinator trapping mechanism, in which floral phenological events are very precisely timed in relation with pollinator activity patterns. This contrasts with previously described angiosperm pollinator traps, which predominantly function as pitfall traps. We assess the circadian rhythms of pollinators independently of their interactions with flowers, and correlate these data with detailed assessments of floral phenology. We reveal a close temporal alignment between patterns of pollinator activity and the floral phenology driving the trapping mechanism (termed ‘circadian trapping’ here). Non-trapping species with anthesis of standard duration (c. 48 h) cannot be pollinated effectively by pollinators with a morning-unimodal activity pattern; non-trapping species with abbreviated anthesis (23–27 h) face limitations in utilizing pollinators with a bimodal circadian activity; whereas species that trap pollinators (all with short anthesis) can utilize a broader range of potential pollinators, including those with both unimodal and bimodal circadian rhythms. In addition to broadening the range of potential pollinators based on their activity patterns, circadian trapping endows other selective advantages, including the possibility of an extended staminate phase to promote pollen deposition, and enhanced interfloral movement of pollinators. The relevance of the alignment of floral phenological changes with peaks in pollinator activity is furthermore evaluated for pitfall trap pollination systems. PMID:28713403

Temperature effects on pitfall catches of epigeal arthropods: a model and method for bias correction.

PubMed

Saska, Pavel; van der Werf, Wopke; Hemerik, Lia; Luff, Martin L; Hatten, Timothy D; Honek, Alois; Pocock, Michael

2013-02-01

Carabids and other epigeal arthropods make important contributions to biodiversity, food webs and biocontrol of invertebrate pests and weeds. Pitfall trapping is widely used for sampling carabid populations, but this technique yields biased estimates of abundance ('activity-density') because individual activity - which is affected by climatic factors - affects the rate of catch. To date, the impact of temperature on pitfall catches, while suspected to be large, has not been quantified, and no method is available to account for it. This lack of knowledge and the unavailability of a method for bias correction affect the confidence that can be placed on results of ecological field studies based on pitfall data.Here, we develop a simple model for the effect of temperature, assuming a constant proportional change in the rate of catch per °C change in temperature, r , consistent with an exponential Q 10 response to temperature. We fit this model to 38 time series of pitfall catches and accompanying temperature records from the literature, using first differences and other detrending methods to account for seasonality. We use meta-analysis to assess consistency of the estimated parameter r among studies.The mean rate of increase in total catch across data sets was 0·0863 ± 0·0058 per °C of maximum temperature and 0·0497 ± 0·0107 per °C of minimum temperature. Multiple regression analyses of 19 data sets showed that temperature is the key climatic variable affecting total catch. Relationships between temperature and catch were also identified at species level. Correction for temperature bias had substantial effects on seasonal trends of carabid catches. Synthesis and Applications . The effect of temperature on pitfall catches is shown here to be substantial and worthy of consideration when interpreting results of pitfall trapping. The exponential model can be used both for effect estimation and for bias correction of observed data. Correcting for temperature-related trapping bias is straightforward and enables population estimates to be more comparable. It may thus improve data interpretation in ecological, conservation and monitoring studies, and assist in better management and conservation of habitats and ecosystem services. Nevertheless, field ecologists should remain vigilant for other sources of bias.

Pitfalls in genetic testing: a case of a SNP in primer-annealing region leading to allele dropout in BRCA1.

PubMed

Silva, Felipe Carneiro; Torrezan, Giovana Tardin; Brianese, Rafael Canfield; Stabellini, Raquel; Carraro, Dirce Maria

2017-07-01

Hereditary breast and ovarian cancer is characterized by mutations in BRCA1 or BRCA2 genes and PCR-based screening techniques, such as capillary sequencing and next-generation sequencing (NGS), are considered gold standard methods for detection of pathogenic mutations in these genes. Single-nucleotide polymorphisms (SNPs) constitute a vast source of variation in the human genome and represent a risk for misdiagnosis in genetic testing, since the presence of a SNP in primer-annealing sites may cause false negative results due to allele dropout. However, few reports are available and the frequency of this phenomenon in diagnostic assays remains unknown. In this article, we investigated the causes of a false negative capillary sequencing result in BRCA1 involving a mother-daughter dyad. Using several molecular strategies, including different DNA polymerases, primer redesign, allele-specific PCR and NGS, we established that the initial misdiagnosis was caused by a SNP located in the primer-annealing region, leading to allele dropout of the mutated allele. Assuming that this problem can also occur in any PCR-based method that are widely used in diagnostic settings, the clinical report presented here draws attention for one of the limitations of genetic testing in general, for which medical and laboratory communities need to be aware.

Diagnosing erectile dysfunction: the penile dynamic colour duplex ultrasound revisited.

PubMed

Aversa, A; Bruzziches, R; Spera, G

2005-12-01

A number of disease processes of the penis including Peyronie's disease, priapism, penile fractures and tumors are clearly visualized with ultrasound. Diagnostic evaluation of erectile dysfunction (ED) by penile dynamic colour-duplex Doppler ultrasonography (D-CDDU) is actually considered a second level approach to ED patients because of the fact that intracavernous injections test IV with prostaglandin-E(1) may provide important information about the patients' erectile capacity. However, no direct vascular imaging and a high percentage of false negative diagnoses of vasculogenic ED are its major pitfalls and subsequent treatment decisions remain quite limited. The occurrence of ED and its sentinel relationship to cardiovascular disease has prompted more accurate vascular screening in all patients even in the absence of cardiovascular risk factors. The sonographic evaluation of the intima-media thickness of the carotid arteries may sometimes represent an early manifestation of diffuse atherosclerotic disease and endothelial damage. This latter finding is often the cause of failure to oral agents, i.e. phosphodiesterase inhibitors, because of inability of the dysfunctional endothelium to release nitric oxide. D-CDDU represents an accurate tool to investigate cavernous artery inflow and venous leakage when compared with more invasive diagnostic techniques i.e. selective arteriography and dynamic infusion cavernosometry along with cavernosography.

Blood or spores? A cautionary note on interpreting cellular debris on human skeletal remains.

PubMed

Cappella, A; Stefanelli, S; Caccianiga, M; Rizzi, A; Bertoglio, B; Sforza, C; Cattaneo, C

2015-07-01

The identification of red blood cells on both skeletal human remains and decomposed corpses is of remarkable importance in forensic sciences, irrespective of its diagnostic value; their presence is often perplexing and difficult to interpret especially when in the context of decomposition and taphonomical variables. Some clinical research has focused on the morphological changes of red blood cells over time by scanning electron microscopy (SEM), but no research has investigated whether botanical structures can be confused for red blood cells. Since some literature has recently presumed the detection of erythrocyte-like cells on skeletal remains (even ancient) as surely erythrocytes, and most have never taken into consideration the chance of an origin different from blood, such as botanical, the present study aims at verifying the possibility of confusion between erythrocytes and botanical cells by applying SEM analysis and at highlighting the pitfalls in this particular issue through a test submitted to pathologists and natural scientists asked to discriminate between red blood cells and different vegetal structures (60 images obtained by SEM analysis). The results showed that although there are diagnostic features useful in identifying red blood cells from botanical structures, some spores resulted very similar to decaying red blood cells, which calls for attention and great caution when studying decomposed human remains.

The Global Neurological Burden of Tuberculosis.

PubMed

Thakur, Kiran; Das, Mitashee; Dooley, Kelly E; Gupta, Amita

2018-04-01

Central nervous system (CNS) involvement of tuberculosis (TB) is the most severe manifestation of TB and accounts for approximately 5 to 10% of all extrapulmonary TB (EPTB) cases and approximately 1% of all TB cases. TB meningitis (TBM) is the most common form of CNS TB, though other forms occur, often in conjunction with TBM, including intracranial tuberculomas, tuberculous brain abscesses, and spinal tubercular arachnoiditis. CNS TB often presents with nonspecific clinical features that mimic symptoms of other neurological conditions, often making diagnosis difficult. Defining neuroimaging characteristics of TBM include thick basal meningeal enhancement, hydrocephalus, and parenchymal infarctions most commonly involving the basal ganglia and internal capsule. Traditional cerebrospinal fluid sample analysis frequently requires lengthy times-to-result and have low sensitivity. Given the pitfalls of conventional CNS TB diagnostic methods, various molecular-based methods, including immunoassays and polymerase chain reaction (PCR)-based assays have emerged as alternative diagnostic tools due to their rapidity, sensitivity, and specificity. Expert panels on TBM have recently emphasized the need for standard research procedures with updated case definitions and standardized study methods, which will hopefully pave the way for more robust multicenter international studies. In this article, we review the epidemiology, diagnosis, molecular factors associated with disease presentation and outcome, and treatment of CNS TB. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Pitfalls of Mobile Devices in Learning: A Different View and Implications for Pedagogical Design

ERIC Educational Resources Information Center

Ting, Yu-Liang

2012-01-01

Studies have been devoted to the design, implementation, and evaluation of mobile learning in practice. A common issue among students' responses toward this type of learning concerns the pitfalls of mobile devices, including small screen, limited input options, and low computational power. As a result, mobile devices are not always perceived by…

Using Malaise traps to sample ground beetles (Coleoptera: Carabidae)

Treesearch

Michael D. Ulyshen; James L. Hanula; Scott Horn

2005-01-01

Pitfall traps provide an easy and inexpensive way to sample ground-dwelling arthropods (Spence and Niemela 1994; Spence et al. 1997; Abildsnes and Tommeras 2000) and have been used exclusively in many studies of the abundance and diversity of ground beetles (Coleoptera: Carabidae). Despite the popularity of this trapping technique, pitfall traps have many disadvantages...

Proposal Pitfalls Plaguing Researchers: Can Technical Communicators Make a Difference?

ERIC Educational Resources Information Center

Lemanski, Steve

2014-01-01

The facts bear out that the odds are against most scientific researchers and scholars--especially those just starting out--in their attempts to win funding for their research projects through their grant proposals. In this article, the author takes a close look at some of the proposal-related problems and pitfalls that have historically challenged…

Habitat relationships of amphibians and reptiles in California oak woodlands

Treesearch

William M. Block; Michael L. Morrison

1998-01-01

We used pitfall traps and time-constrained searches to sample amphibians and reptiles and to describe their habitats in oak woodlands at three areas in California. We captured 766 individuals representing 15 species during pitfall trapping and 333 animals representing 15 species during the time-constrained searches. A total of 19 species were sampled. Across all study...

Common pitfalls in statistical analysis: Clinical versus statistical significance

PubMed Central

Ranganathan, Priya; Pramesh, C. S.; Buyse, Marc

2015-01-01

In clinical research, study results, which are statistically significant are often interpreted as being clinically important. While statistical significance indicates the reliability of the study results, clinical significance reflects its impact on clinical practice. The third article in this series exploring pitfalls in statistical analysis clarifies the importance of differentiating between statistical significance and clinical significance. PMID:26229754

Prostate-specific Membrane Antigen PET: Clinical Utility in Prostate Cancer, Normal Patterns, Pearls, and Pitfalls.

PubMed

Hofman, Michael S; Hicks, Rodney J; Maurer, Tobias; Eiber, Matthias

2018-01-01

Prostate-specific membrane antigen (PSMA) is a transmembrane glycoprotein that is overexpressed in prostate cancer. Radiolabeled small molecules that bind with high affinity to its active extracellular center have emerged as a potential new diagnostic standard of reference for prostate cancer, resulting in images with extraordinary tumor-to-background contrast. Currently, gallium 68 ( 68 Ga)-PSMA-11 (or HBED-PSMA) is the most widely used radiotracer for PSMA positron emission tomography (PET)/computed tomography (CT) or PSMA PET/magnetic resonance (MR) imaging. Evolving evidence demonstrates superior sensitivity and specificity of PSMA PET compared to conventional imaging, with frequent identification of subcentimeter prostate cancer lesions. PSMA PET is effective for imaging disease in the prostate, lymph nodes, soft tissue, and bone in a "one-stop-shop" examination. There is emerging evidence for its clinical value in staging of high-risk primary prostate cancer and localization of disease in biochemical recurrence. The high sensitivity provided by PSMA PET, with frequent identification of small-volume disease, is redefining patterns of disease spread compared with those seen at conventional imaging. In metastatic castration-resistant prostate cancer, PSMA PET is frequently used for theranostic selection (eg, lutetium 177-PSMA radionuclide therapy), but its potential use for therapy monitoring is still under debate. However, evidence on its proper use to improve patient-related outcomes, particularly in the setting of early biochemical recurrence and targeted treatment of oligometastatic disease, is still missing. Despite the term prostate specific, PSMA functions as a folate hydrolase and is expressed in a range of normal tissues and in other benign and malignant processes. Knowledge of its physiologic distribution and other causes of uptake is essential to minimize false-positive imaging findings. © RSNA, 2018.

Interobserver variation in CD30 immunohistochemistry interpretation; consequences for patient selection for targeted treatment.

PubMed

Koens, Lianne; van de Ven, Peter M; Hijmering, Nathalie J; Kersten, Marie José; Diepstra, Arjan; Chamuleau, Martine; de Jong, Daphne

2018-05-14

CD30 immunohistochemistry (IHC) in malignant lymphoma is used for selection of patients in clinical trials using brentuximab vedotin, an antibody drug-conjugate targeting the CD30 molecule. For reliable implementation in daily practice and meaningful selection of patients for clinical trials, information on technical variation and interobserver reproducibility of CD30 IHC staining is required. We conducted a 3-round reproducibility assessment of CD30 scoring for categorized frequency and intensity, including a technical validation, a "live polling" pre- and post-instruction scoring round, and a web-based round including individual scoring with additional IHC information to mimic daily diagnostic practice. Agreement in all three scoring rounds was poor to fair (κ=0,12 to 0,35 for CD30 positive tumor cell percentage, and κ=0,16 to 0,41 for staining intensity), even when allowing for one category of freedom in percentage of tumor cell positivity (κ=0,30 to 0,61). The first round with CD30 staining performed in 5 independent laboratories showed objective differences in staining intensity. In the second round, about half of the pathologists changed their opinion on CD30 frequency after a discussion on potential pitfalls, highlighting hesitancy in decision-making. Using fictional cut-off points for percentage of tumor cell positivity, agreement was still suboptimal (κ=0,35 to 0,60). Lack of agreement in cases with heterogeneous expression is shown to influence patient eligibility for treatment with brentuximab vedotin both in clinical practice and within the context of clinical trials, and limits the potential predictive value of the relative frequency of CD30 positive neoplastic cells for clinical response. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Augmented and virtual reality in surgery—the digital surgical environment: applications, limitations and legal pitfalls

PubMed Central

Baker, Benjamin; Amin, Kavit; Chan, Adrian; Patel, Ketan; Wong, Jason

2016-01-01

The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena. PMID:28090510

Augmented and virtual reality in surgery-the digital surgical environment: applications, limitations and legal pitfalls.

PubMed

Khor, Wee Sim; Baker, Benjamin; Amin, Kavit; Chan, Adrian; Patel, Ketan; Wong, Jason

2016-12-01

The continuing enhancement of the surgical environment in the digital age has led to a number of innovations being highlighted as potential disruptive technologies in the surgical workplace. Augmented reality (AR) and virtual reality (VR) are rapidly becoming increasingly available, accessible and importantly affordable, hence their application into healthcare to enhance the medical use of data is certain. Whether it relates to anatomy, intraoperative surgery, or post-operative rehabilitation, applications are already being investigated for their role in the surgeons armamentarium. Here we provide an introduction to the technology and the potential areas of development in the surgical arena.

Quantitative analysis of single-molecule superresolution images

PubMed Central

Coltharp, Carla; Yang, Xinxing; Xiao, Jie

2014-01-01

This review highlights the quantitative capabilities of single-molecule localization-based superresolution imaging methods. In addition to revealing fine structural details, the molecule coordinate lists generated by these methods provide the critical ability to quantify the number, clustering, and colocalization of molecules with 10 – 50 nm resolution. Here we describe typical workflows and precautions for quantitative analysis of single-molecule superresolution images. These guidelines include potential pitfalls and essential control experiments, allowing critical assessment and interpretation of superresolution images. PMID:25179006

Should psychiatrists write fiction?

PubMed

Bladon, Henry

2018-04-01

This paper looks at the relationship between fiction and psychiatry. Specifically, the idea of psychiatrists as fiction writers is explored, and reference is made to various fictional texts to illustrate the problems of stigma and negative imagery. These two main areas of focus are highlighted as ones that the practice of writing fiction might address, and some potential pitfalls are discussed. The paper suggests how psychiatrists might ameliorate the present problems by incorporating their unique clinical skills and knowledge into fictional narratives. Declaration of interest None.

The CRISPR Conundrum: As Millions of Dollars Flow into Developing the Gene-Editing Tool, Scientists Continue to Discover the Technology's Potential and Pitfalls.

PubMed

Bates, Mary

2016-01-01

We are in the midst of a CRISPR craze. The last five years have seen the publication of over 1,000 scientific papers, the allocation of millions of research dollars, and the establishment of four start-up companies in the United States alone. Internationally, the genome-editing market, fueled by CRISPR technology, is expected to be worth more than US$3,000 million by 2019.

The "rising bubble" sign: a new aid in the diagnosis of unicameral bone cysts.

PubMed

Jordanov, Martin I

2009-06-01

The observation of a bubble of gas at the most non-dependent margin of a lytic bone lesion which has sustained a pathologic fracture implies that the lesion is hollow and can assist the radiologist in making the diagnosis of a unicameral bone cyst. The imaging studies of two patients who sustained pathologic fractures through unicameral bone cysts and exhibited the "rising bubble" sign are shown. The sign's basis, proper utilization, and potential pitfalls are discussed.

Incorporating social media into dermatologic education.

PubMed

Ko, Lauren N; Rana, Jasmine; Burgin, Susan

2017-10-15

In the current digital age, medical education has slowly evolved from the largely lecture-based teaching style of the past to incorporate more interactive pedagogical techniques, including use of social media. Already used readily by millennial trainees and clinicians, social media can also be used in innovative ways to teach trainees and facilitate continuing education among practicing clinicians. In this commentary, we discuss many learning benefits of social media and review potential pitfalls of employing social media in both trainee and physician dermatological education.

And then there were 12--distinguishing Van Leeuwenhoek microscopes from old or new copies.

PubMed

Robertson, Lesley A

2015-07-01

In the wake of announcements of the authentications of two previously unknown Van Leeuwenhoek microscopes in one month, this paper reviews the possibilities and potential pitfalls that might be involved in distinguishing 17th/18th century single-lensed microscopes from historical and modern copies. It is clear that a combination of characteristics must be considered, no single parameter will do. © FEMS 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zarkesh, Ryan A.; Foster, Michael E.; Ichimura, Andrew S.

The ability to tune the steric envelope through redox events post-synthetically or in tandem with other chemical processes is a powerful tool that could assist in enabling new catalytic methodologies and understanding potential pitfalls in ligand design. The α-diimine ligand, dmp-BIAN, exhibits the peculiar and previously unreported feature of varying steric profiles depending on oxidation state when paired with a main group element. A study of the factors that give rise to this behaviour as well as its impact on the incorporation of other ligands is performed.

Retrofit implementation of Zernike phase plate imaging for cryo-TEM

PubMed Central

Marko, Michael; Leith, ArDean; Hsieh, Chyongere; Danev, Radostin

2011-01-01

In-focus phase-plate imaging is particularly beneficial for cryo-TEM because it offers a substantial overall increase in image contrast, without an electron dose penalty, and it simplifies image interpretation. We show how phase-plate cryo-TEM can be implemented with an appropriate existing TEM, and provide a basic practical introduction to use of thin-film (carbon) phase plates. We point out potential pitfalls of phase-plate operation, and discuss solutions. We provide information on evaluating a particular TEM for its suitability. PMID:21272647

An Introduction to Observing System Simulation Experiments

NASA Technical Reports Server (NTRS)

Prive, Nikki C.

2017-01-01

Observing System Simulation Experiments (OSSEs) are used to estimate the potential impact of proposed new instruments and data on numerical weather prediction. OSSEs can also be used to help design new observing platforms and to investigate the behavior of data assimilation systems. A basic overview of how to design and perform an OSSE will be given, as well as best practices and pitfalls. Some examples using the OSSE framework developed at the NASA Global Modeling and Assimilation Office will be shown.

Psoas abscess secondary to retroperitoneal distant metastases from squamous cell carcinoma of the cervix with thrombosis of the inferior vena cava and duodenal infiltration treated by Whipple procedure: A case report and review of the literature.

PubMed

Mehdorn, Matthias; Petersen, Tim-Ole; Bartels, Michael; Jansen-Winkeln, Boris; Kassahun, Woubet Tefera

2016-08-11

Psoas abscess is a rare clinical disease of various origins. Most common causes include hematogenous spread of bacteria from a different primary source, spondylodiscitis or perforated intestinal organs. But rarely some abscesses are related to malignant metastatic disease. In this case report we present the case of a patient with known squamous cell carcinoma of the cervix treated with radio-chemotherapy three years prior. She now presented with a psoas abscess and subsequent complete inferior vena cava thrombosis, as well as duodenal and vertebral infiltration. The abscess was drained over a prolonged period of time and later was found to be a complication caused by metastases of the cervical carcinoma. Due to the massive extent of the metastases a Whipple procedure was performed to successfully control the local progress of the metastasis. As psoas abscess is an unspecific disease which presents with non-specific symptoms adequate therapy may be delayed due to lack of early diagnostic results. This case report highlights the difficulties of managing a malignant abscess and demonstrates some diagnostic pitfalls that might be encountered. It stresses the necessity of adequate diagnostics to initiate successful therapy. Reports on psoas abscesses that are related to cervix carcinoma are scarce, probably due to the rarity of this event, and are limited to very few case reports. We are the first to report a case in which an extensive and complex abdominal procedure was needed for local control to improve quality of life.

Stand age and habitat influences on salamanders in Appalachian cove hardwood forests

Treesearch

W. Mark Ford; Brian R. Chapman; Michael A. Menzel; Richard H. Odom

2002-01-01

We surveyed cove hardwood stands aged 15, 25, 50, and ≥85 years following clearcutting in the southern Appalachian Mountains of northern Georgia to assess the effects of stand age and stand habitat characteristics on salamander communities using drift-fence array and pitfall methodologies from May 1994 to April 1995. Over a 60,060 pitfall trapnight effort, we...

Analysis of Factors Enhancing Pitfall in Research and Teaching of the Nigerian University System

ERIC Educational Resources Information Center

Ahmed, Tafida; Umar, Kasim; Paul, Chima

2015-01-01

The paper analyses factors enhancing pitfall in research and teaching in the Nigerian university system. Using data generated from secondary sources, it was found that so many factors are responsible for the constant decay in teaching and research in the Nigerian universities. The paper however found from literature that the high rate of pitfalls…

Executive Programs for Brazilian Mid-Career Public Managers: Pitfalls and Challenges

ERIC Educational Resources Information Center

Pacheco, Regina Silvia; Franzese, Cibele

2017-01-01

This paper discusses the challenges of professional education for mid-career public managers at graduate level, pointing out pitfalls to avoid and obstacles to face. Analyzing the Brazilian case, the goal is to raise issues that may also be present in other cases. The main argument developed here is that the puzzle faced by graduate programs on…

The Pitfalls of Valenced Labels and the Benefits of Properly Calibrated Psychological Flexibility

ERIC Educational Resources Information Center

McNulty, James K.; Fincham, Frank D.

2012-01-01

Replies to comments by Sonja Lyubomirsky (see record 2012-27130-008), Riva Guiseppe (see record 2012-27130-009), and Alan S. Waterman (see record 2012-27130-010) on the original article by McNulty and Fincham (see record 2011-15476-001) regarding the pitfalls of valenced labels and the benefits of properly calibrated psychological flexibility.

How the Irish Became CRT'd? "Greening" Critical Race Theory, and the Pitfalls of a Normative Atlantic State View

ERIC Educational Resources Information Center

Kitching, Karl

2015-01-01

This article considers the transatlantic use of Critical Race Theory (CRT) frameworks to critically interpret racism in education internationally, and the possibilities and pitfalls this has for understanding racism in Ireland. It argues for the importance of CRT's framework on a number of grounds, but echoes cautions against the assumed, or sole…

Common pitfalls in statistical analysis: “P” values, statistical significance and confidence intervals

PubMed Central

Ranganathan, Priya; Pramesh, C. S.; Buyse, Marc

2015-01-01

In the second part of a series on pitfalls in statistical analysis, we look at various ways in which a statistically significant study result can be expressed. We debunk some of the myths regarding the ‘P’ value, explain the importance of ‘confidence intervals’ and clarify the importance of including both values in a paper PMID:25878958

Surgery of the ear and the lateral skull base: pitfalls and complications

PubMed Central

Schick, Bernhard; Dlugaiczyk, Julia

2013-01-01

Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills. Following a summary about general aspects in pre-, intra-and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation and surgery of vestibular schwannomas and jugulotympanal paragangliomas. Based on these exemplary procedures, basic “dos and don’ts” of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed. An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process. PMID:24403973

[Complications and pitfalls in surgery of the ear/lateral skull base].

PubMed

Schick, B; Dlugaiczyk, J

2013-04-01

Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills.Following a summary about general aspects in pre-, intra- and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation, surgery of vestibular schwannomas, and jugulotympanal paragangliomas. Based on these exemplary procedures, basic "do's and don'ts" of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed.An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process. © Georg Thieme Verlag KG Stuttgart · New York.

Segmentation of large periapical lesions toward dental computer-aided diagnosis in cone-beam CT scans

NASA Astrophysics Data System (ADS)

Rysavy, Steven; Flores, Arturo; Enciso, Reyes; Okada, Kazunori

2008-03-01

This paper presents an experimental study for assessing the applicability of general-purpose 3D segmentation algorithms for analyzing dental periapical lesions in cone-beam computed tomography (CBCT) scans. In the field of Endodontics, clinical studies have been unable to determine if a periapical granuloma can heal with non-surgical methods. Addressing this issue, Simon et al. recently proposed a diagnostic technique which non-invasively classifies target lesions using CBCT. Manual segmentation exploited in their study, however, is too time consuming and unreliable for real world adoption. On the other hand, many technically advanced algorithms have been proposed to address segmentation problems in various biomedical and non-biomedical contexts, but they have not yet been applied to the field of dentistry. Presented in this paper is a novel application of such segmentation algorithms to the clinically-significant dental problem. This study evaluates three state-of-the-art graph-based algorithms: a normalized cut algorithm based on a generalized eigen-value problem, a graph cut algorithm implementing energy minimization techniques, and a random walks algorithm derived from discrete electrical potential theory. In this paper, we extend the original 2D formulation of the above algorithms to segment 3D images directly and apply the resulting algorithms to the dental CBCT images. We experimentally evaluate quality of the segmentation results for 3D CBCT images, as well as their 2D cross sections. The benefits and pitfalls of each algorithm are highlighted.

Liquid Based Preparation (LBP) cytology versus Conventional Cytology (CS) in FNA samples from breast, thyroid, salivary glands and soft tissues. Our experience in Crete (Greece).

PubMed

Mygdakos, N; Nikolaidou, Sylvia; Tzilivaki, Anna; Tamiolakis, D

2009-01-01

The improvement in quality of cytological preparations with the use of LBP methodology has been well-documented, but the cytological artifacts resulting from this technique have not been adequately described. This study describes and illustrates the cytological artifacts introduced by LBP technique when used on fine-needle aspirates (FNAs), and evaluates these artifacts as potential diagnostic pitfalls. We reviewed a total of 96 FNAs simultaneously processed by both conventional smears and LBP. FNAs were obtained from the following sites: lymph node (38), breast (28), soft-tissue sites (nine), salivary glands (six), and thyroid gland (15). The LBP smears were consistently devoid of obscuring elements, and the cells were adequately preserved and evenly dispersed. However, we noted some cytomorphological alterations that should be recognized to avoid erroneous diagnoses. The size of cell clusters was decreased, large branching sheets were fragmented, and there were more single cells, resulting in apparent discohesion. Small cells such as lymphocytes tended to aggregate. All cells were generally smaller and occasionally spindled, the chromatin detail was attenuated, and nucleoli were more prominent. Intranuclear inclusions were difficult to visualize. Background matrix was often altered in both quantity and quality. Extracellular particles, small mononuclear cells, red blood cells, and myoepithelial cells were markedly decreased in number. Cytopathologists should be careful in interpreting FNAs prepared using LBP technique if that is the only methodology employed. Familiarity with artifacts is essential to avoid misdiagnoses.

Potential role of photodynamic techniques combined with new generation flexible ureterorenoscopes and molecular markers for the management of urothelial carcinoma of the upper urinary tract.

PubMed

Audenet, François; Traxer, Olivier; Yates, David R; Cussenot, Olivier; Rouprêt, Morgan

2012-02-01

•  To discuss how the development of new generation flexible ureterorenoscopes in combination with photodynamic diagnosis (PDD) improves the assessment of urothelial cell carcinoma of the upper urinary tract (UUT-UCC). •  Ultimately, this may allow accurate tumour classification and the ability to select which patients would benefit from conservative treatment as opposed to radical surgery. •  We conducted an exhaustive Pubmed literature search using a combination of keywords including: ureterorenoscopy, UUT-UCC diagnosis, PDD, narrow band imaging, conservative treatment UUT-UCC and molecular urinalysis. •  We then selected salient high calibre articles relevant to our objective. •  We give specific consideration to anatomical aspects of UUT-UCC investigation, PDD in UCC, aminolevulinic acid and its derivatives, autofluorescence, narrow band imaging, molecular marker analysis and the recent advances in ureterorenoscopic technology. •  The traditional pitfalls of UUT-UCC diagnosis, namely poor visualisation and difficulty in obtaining representative histological samples, are being circumvented by the introduction of modern digital flexible ureteroscopes that can be combined with PDD and molecular analysis to improve tumour classification, deferring to conservative treatment accordingly. •  The accuracy of the diagnostic work-up of UUT-UCC is improving due to advances in technology, pharmaceutical agents and incorporation of molecular markers, all factors allowing us to characterise tumours of the UUT more definitively. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Importance and pitfalls of molecular analysis to parasite epidemiology.

PubMed

Constantine, Clare C

2003-08-01

Molecular tools are increasingly being used to address questions about parasite epidemiology. Parasites represent a diverse group and they might not fit traditional population genetic models. Testing hypotheses depends equally on correct sampling, appropriate tool and/or marker choice, appropriate analysis and careful interpretation. All methods of analysis make assumptions which, if violated, make the results invalid. Some guidelines to avoid common pitfalls are offered here.

Benefits and Pitfalls: Simple Guidelines for the Use of Social Networking Tools in K-12 Education

ERIC Educational Resources Information Center

Huffman, Stephanie

2013-01-01

The article will outline a framework for the use of social networking tools in K-12 education framed around four thought provoking questions: 1) what are the benefits and pitfalls of using social networking tools in P-12 education, 2) how do we plan effectively for the use of social networking tool, 3) what role does professional development play…

Two new planthopper species (Hemiptera, Fulgoroidea, Caliscelidae) collected in pitfall traps in Zambia.

PubMed

Chmurova, Lucia; Webb, Michael D

2016-08-22

Two new species of planthoppers in the family Caliscelidae (Hemiptera: Fulgoroidea) are described from Zambia, i.e., Afronaso spinosa sp. n. and Calampocus zambiaensis sp. n. All specimens are flightless males and nearly all were collected from baited pitfall traps (except for one specimen collected from a yellow pan trap), suggesting that they live near to or on the ground.

Short-term response of shrews to prescribed fire and mechanical fuelr eduction in a Southern Appalachian upland hardwood forest

Treesearch

Cathryn H. Greenberg; Stanlee Miller; Thomas A. Waldrop

2007-01-01

As part of the multidisciplinary National Fire and Fire Surrogate study, we used drift fences with pitfall traps from May to September 2003 and 2004 to determine how three fuel reduction techniques affected shrews in the Southern Appalachian Mountains of North Carolina. Ground dwelling macroarthropods also were collected from a subset of pitfall traps to assess...

Common pitfalls in statistical analysis: Absolute risk reduction, relative risk reduction, and number needed to treat

PubMed Central

Ranganathan, Priya; Pramesh, C. S.; Aggarwal, Rakesh

2016-01-01

In the previous article in this series on common pitfalls in statistical analysis, we looked at the difference between risk and odds. Risk, which refers to the probability of occurrence of an event or outcome, can be defined in absolute or relative terms. Understanding what these measures represent is essential for the accurate interpretation of study results. PMID:26952180

Image fusion pitfalls for cranial radiosurgery.

PubMed

Jonker, Benjamin P

2013-01-01

Stereotactic radiosurgery requires imaging to define both the stereotactic space in which the treatment is delivered and the target itself. Image fusion is the process of using rotation and translation to bring a second image set into alignment with the first image set. This allows the potential concurrent use of multiple image sets to define the target and stereotactic space. While a single magnetic resonance imaging (MRI) sequence alone can be used for delineation of the target and fiducials, there may be significant advantages to using additional imaging sets including other MRI sequences, computed tomography (CT) scans, and advanced imaging sets such as catheter-based angiography, diffusor tension imaging-based fiber tracking and positon emission tomography in order to more accurately define the target and surrounding critical structures. Stereotactic space is usually defined by detection of fiducials on the stereotactic head frame or mask system. Unfortunately MRI sequences are susceptible to geometric distortion, whereas CT scans do not face this problem (although they have poorer resolution of the target in most cases). Thus image fusion can allow the definition of stereotactic space to proceed from the geometrically accurate CT images at the same time as using MRI to define the target. The use of image fusion is associated with risk of error introduced by inaccuracies of the fusion process, as well as workflow changes that if not properly accounted for can mislead the treating clinician. The purpose of this review is to describe the uses of image fusion in stereotactic radiosurgery as well as its potential pitfalls.

Emerging therapies for gait disability and balance impairment: promises and pitfalls.

PubMed

Maetzler, Walter; Nieuwhof, Freek; Hasmann, Sandra E; Bloem, Bastiaan R

2013-09-15

Therapeutic management of gait and balance impairment during aging and neurodegeneration has long been a neglected topic. This has changed considerably during recent years, for several reasons: (1) an increasing recognition that gait and balance deficits are among the most relevant determinants of an impaired quality of life and increased mortality for affected individuals; (2) the arrival of new technology, which has allowed for new insights into the anatomy and functional (dis)integrity of gait and balance circuits; and (3) based in part on these improved insights, the development of new, more specific treatment strategies in the field of pharmacotherapy, deep brain surgery, and physiotherapy. The initial experience with these emerging treatments is encouraging, although much work remains to be done. The objective of this narrative review is to discuss several promising developments in the field of gait and balance treatment. We also address several pitfalls that can potentially hinder a fast and efficient continuation of this vital progress. Important issues that should be considered in future research include a clear differentiation between gait and balance as two distinctive targets for treatment and recognition of compensatory mechanisms as a separate target for therapeutic intervention. © 2013 Movement Disorder Society.

Osteoporotic Animal Models of Bone Healing: Advantages and Pitfalls.

PubMed

Calciolari, Elena; Donos, Nikolaos; Mardas, Nikos

2017-10-01

The aim of this review was to summarize the advantages and pitfalls of the available osteoporotic animal models of bone healing. A thorough literature search was performed in MEDLINE via OVID and EMBASE to identify animal studies investigating the effect of experimental osteoporosis on bone healing and bone regeneration. The osteotomy model in the proximal tibia is the most popular osseous defect model to study the bone healing process in osteoporotic-like conditions, although other well-characterized models, such as the post-extraction model, might be taken into consideration by future studies. The regenerative potential of osteoporotic bone and its response to biomaterials/regenerative techniques has not been clarified yet, and the critical size defect model might be an appropriate tool to serve this purpose. Since an ideal animal model for simulating osteoporosis does not exist, the type of bone remodeling, the animal lifespan, the age of peak bone mass, and the economic and ethical implications should be considered in our selection process. Furthermore, the influence of animal species, sex, age, and strain on the outcome measurement should be taken into account. In order to make future studies meaningful, standardized international guidelines for osteoporotic animal models of bone healing need to be set up.

Effects of pitfall trap preservative on collections of carabid beetles (Coleoptera: Carabidae)

USGS Publications Warehouse

McCravy, K.W.; Willand, J.E.

2007-01-01

Effects of six pitfall trap preservatives (5% acetic acid solution, distilled water, 70% ethanol, 50% ethylene glycol solution, 50% propylene glycol solution, and 10% saline solution) on collections of carabid beetles (Coleoptera: Carabidae) were studied in a west-central Illinois deciduous forest from May to October 2005. A total of 819 carabids, representing 33 species and 19 genera, were collected. Saline produced significantly fewer captures than did acetic acid, ethanol, ethylene glycol, and propylene glycol, while distilled water produced significantly fewer captures than did acetic acid. Significant associations between numbers of captures and treatment were seen in four species: Amphasia interstitialis (Say), Calathus opaculus LeConte, Chlaenius nemoralis Say, and Cyclotrachelus sodalis (LeConte). Results of this study suggest that type of preservative used can have substantial effects on abundance and species composition of carabids collected in pitfall traps.

Common pitfalls in statistical analysis: Odds versus risk

PubMed Central

Ranganathan, Priya; Aggarwal, Rakesh; Pramesh, C. S.

2015-01-01

In biomedical research, we are often interested in quantifying the relationship between an exposure and an outcome. “Odds” and “Risk” are the most common terms which are used as measures of association between variables. In this article, which is the fourth in the series of common pitfalls in statistical analysis, we explain the meaning of risk and odds and the difference between the two. PMID:26623395

Diagnostic pitfalls in sporadic transthyretin familial amyloid polyneuropathy (TTR-FAP).

PubMed

Planté-Bordeneuve, V; Ferreira, A; Lalu, T; Zaros, C; Lacroix, C; Adams, D; Said, G

2007-08-14

Transthyretin familial amyloid polyneuropathies (TTR-FAPs) are autosomal dominant neuropathies of fatal outcome within 10 years after inaugural symptoms. Late diagnosis in patients who present as nonfamilial cases delays adequate management and genetic counseling. Clinical data of the 90 patients who presented as nonfamilial cases of the 300 patients of our cohort of patients with TTR-FAP were reviewed. They were 21 women and 69 men with a mean age at onset of 61 (extremes: 38 to 78 years) and 17 different mutations of the TTR gene including Val30Met (38 cases), Ser77Tyr (16 cases), Ile107Val (15 cases), and Ser77Phe (5 cases). Initial manifestations included mainly limb paresthesias (49 patients) or pain (17 patients). Walking difficulty and weakness (five patients) and cardiac or gastrointestinal manifestations (five patients), were less common at onset. Mean interval to diagnosis was 4 years (range 1 to 10 years); 18 cases were mistaken for chronic inflammatory demyelinating polyneuropathy, which was the most common diagnostic error. At referral a length-dependent sensory loss affected the lower limbs in 2, all four limbs in 20, and four limbs and anterior trunk in 77 patients. All sensations were affected in 60 patients (67%), while small fiber dysfunction predominated in the others. Severe dysautonomia affected 80 patients (90%), with postural hypotension in 52, gastrointestinal dysfunction in 50, impotence in 58 of 69 men, and sphincter disturbance in 31. Twelve patients required a cardiac pacemaker. Nerve biopsy was diagnostic in 54 of 65 patients and salivary gland biopsy in 20 of 30. Decreased nerve conduction velocity, increased CSF protein, negative biopsy findings, and false immunolabeling of amyloid deposits were the main causes of diagnostic errors. We conclude that DNA testing, which is the most reliable test for TTR-FAP, should be performed in patients with a progressive length-dependent small fiber polyneuropathy of unknown origin, especially when associated with autonomic dysfunction.

MDCT evaluation of acute aortic syndrome (AAS)

PubMed Central

Rossi, Giovanni; Lassandro, Francesco; Rea, Gaetano; Marino, Maurizio; Muto, Maurizio; Molino, Antonio; Scaglione, Mariano

2016-01-01

Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes. PMID:27033344

Oligonucleotides as antivirals: dream or realistic perspective?

PubMed

Van Aerschot, Arthur

2006-09-01

Many reports have been published on antiviral activity of synthetic oligonucleotides, targeted to act either by a true antisense effect or via non-sequence specific interactions. This short review will try to evaluate the current status of the field by focusing on the effects as reported for inhibition of either HSV-1, HCMV or HIV-1. Following an introduction with a historical background and a brief discussion on the different types of constructs and mechanisms of action, the therapeutic potential of antisense oligonucleotides as antivirals, as well as possible pitfalls upon their evaluation will be discussed.

When Is Advertising a Plastic Surgeon's Individual "Brand" Unethical?

PubMed

Smith, Carly P; George, Daniel

2018-04-01

Advertising a plastic surgery practice on social media is fraught with both practical and ethical challenges. We use an institutional betrayal framework to explore the range of potential harms to patient well-being while also considering the pitfalls of social media activity, especially marketing, for practitioners. We also give consideration to the relative benefits that such online patient-clinician relationships can provide. In our analysis, we draw on specific examples of plastic surgery procedures prominently featured on social media, including the Vampire Facelift ® . © 2018 American Medical Association. All Rights Reserved.

Observing System Simulation Experiments for Fun and Profit

NASA Technical Reports Server (NTRS)

Prive, Nikki C.

2015-01-01

Observing System Simulation Experiments can be powerful tools for evaluating and exploring both the behavior of data assimilation systems and the potential impacts of future observing systems. With great power comes great responsibility - given a pure modeling framework, how can we be sure our results are meaningful? The challenges and pitfalls of OSSE calibration and validation will be addressed, as well as issues of incestuousness, selection of appropriate metrics, and experiment design. The use of idealized observational networks to investigate theoretical ideas in a fully complex modeling framework will also be discussed

Retrofit implementation of Zernike phase plate imaging for cryo-TEM.

PubMed

Marko, Michael; Leith, Ardean; Hsieh, Chyongere; Danev, Radostin

2011-05-01

In-focus phase-plate imaging is particularly beneficial for cryo-TEM because it offers a substantial overall increase in image contrast, without an electron dose penalty, and it simplifies image interpretation. We show how phase-plate cryo-TEM can be implemented with an appropriate existing TEM, and provide a basic practical introduction to use of thin-film (carbon) phase plates. We point out potential pitfalls of phase-plate operation, and discuss solutions. We provide information on evaluating a particular TEM for its suitability. Copyright © 2011 Elsevier Inc. All rights reserved.

An introduction to best practices in free energy calculations.

PubMed

Shirts, Michael R; Mobley, David L

2013-01-01

Free energy calculations are extremely useful for investigating small-molecule biophysical properties such as protein-ligand binding affinities and partition coefficients. However, these calculations are also notoriously difficult to implement correctly. In this chapter, we review standard methods for computing free energy via simulation, discussing current best practices and examining potential pitfalls for computational researchers performing them for the first time. We include a variety of examples and tips for how to set up and conduct these calculations, including applications to relative binding affinities and small-molecule solvation free energies.