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We investigated the role of previous experience when providing summary judgments of mammography narratives. A total of 807 women who either did or did not have previous experience of a mammogram were presented with a written description of a mammography visit. We manipulated the presentation position of a negative element within the narrative to alter its accessibility in memory and determine whether the latter impacted equally on two types of summary judgments. After the narrative presentation, participants were asked to provide both retrospective and prospective evaluations, that is, summary judgments about the described event and an appraisal of the likelihood of participating in future instances of such event, respectively. A recency effect was observed only for retrospective but not for prospective evaluations. When examined only for the subset of women who had undergone a mammography visit themselves, prospective evaluations were shown to be predicted by the reported quality of the mammography participants experienced themselves. The findings support and extend the accessibility model of emotional self-report and suggest that own experience leaks into evaluations of hypothetical scenarios by selectively impacting on prospective evaluations.

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BACKGROUND: Evaluating the development phase of a complex intervention programme can be challenging. A prospective evaluation approach is presented based on the example of the new complex psycho-oncological care programme isPO (integrated, cross-sectoral Psycho-Oncology). Prior to programme implementation, we examined (1) if isPO was developed as intended, and (2) if it was relevant and transferable into the newly developed psycho-oncological care networks in North-Rhine Westphalia, Germany. Further, we investigated which implementation facilitators and barriers were anticipated and which implementation strategies were planned by the programme designers (multidisciplinary professionals and cancer supporting organizations who developed the isPO programme components and the networks). METHODS: A mixed-methods approach was applied. Qualitative data were collected by quarterly progress reports, interviews and a focus group with the programme designers. Evaluation criteria for document analyses of the quarterly progress reports were developed and applied. Content analysis was applied for analysing interviews and focus group. Quantitative data were gained from evaluating the programme training for the isPO service providers by short written questionnaires that were analysed descriptively. RESULTS: An implementable prototype of the isPO programme has been developed within 15 months, however no piloting was conducted. The programme's complexity proved to be challenging with regard to coordination and communication of the numerous programme designers. This was intensified by existing interdependencies between the designers. Further, there was little communication and participation between the programme designers and the prospective users (patients and service providers). Due to these challenges, only context-unspecific implementation strategies were planned. CONCLUSION: The required resources for developing a new complex care programme and the need of a mature implementation strategy should be sufficiently addressed. Programmes may benefit from prospective evaluation by gaining insightful knowledge concerning the programme's maturity and anticipating implementation facilitators and barriers. A mixed-methods evaluation design was crucial for achieving profound insight into the development process. TRIAL REGISTRATION: The study has been registered in the German Clinical Trials Register (No. DRKS00015326 ) on 30.10.2018.

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BACKGROUND AND AIMS: We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates. METHODS: We performed a post-hoc pooled analysis of data from seven prospective, randomized trials involving serial coronary intravascular ultrasonography (IVUS). The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque. Using multivariable mixed modeling, we determined the association of on-treatment HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE. RESULTS: Among 3,312 patients (mean age 58.6±9years, 28.4%women) average on-treatment HbA1c was 6.2±1.1%. Overall, there was no net significant annualized change in PAV (0.12±0.19%, p = 0.52). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index, systolic blood pressure, smoking, low- and high-density lipoprotein cholesterol, triglyceride levels, peripheral vascular disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13(0.08, 0.19), p < 0.001]. On-treatment HbA1c levels were independently associated with MACE [hazard ratio (95% confidence interval): 1.13(1.04, 1.23), p = 0.005]. CONCLUSIONS: Independent of achieved cardiovascular risk factor control, greater HbA1c levels significantly associate with coronary atheroma progression rates and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.

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Musculoskeletal disorders (MSDs) frequently occur among dental practitioners and present a significant occupational burden with an early onset in the dentists' career. This study aimed to analyze the five-year development of self-reported overall MSDs among the dentistry students during the course of their studies and to assess the possible influence of the risk as well as protective factors. The questionnaire inquiry was performed among the first-year dentistry students, regarding the occurrence of MSDs and the presence of potential risk and protective factors. The same students were followed, and they filled in the same questionnaire in the middle and at the end of their studies. A total of 73 dentistry students and 28 general medicine students participated. The occurrence of the overall MSDs statistically significantly increased from 30.1% at the beginning of the first year to 45.2% at the end of the fifth year among the dentistry students. The top-level sport was statistically significantly associated with the higher occurrence of MSDs in the fifth year and with the development of new MSDs between the first and the fifth year. This longitudinal prospective evaluation showed a significant increase in the MSDs occurrence among the dentistry students during their studies.

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Artificial intelligence (AI) is undergoing a revolution thanks to the breakthroughs of machine learning algorithms in computer vision, speech recognition, natural language processing and generative modelling. Recent works on publicly available pharmaceutical data showed that AI methods are highly promising for Drug Target prediction. However, the quality of public data might be different than that of industry data due to different labs reporting measurements, different measurement techniques, fewer samples and less diverse and specialized assays. As part of a European funded project (ExCAPE), that brought together expertise from pharmaceutical industry, machine learning, and high-performance computing, we investigated how well machine learning models obtained from public data can be transferred to internal pharmaceutical industry data. Our results show that machine learning models trained on public data can indeed maintain their predictive power to a large degree when applied to industry data. Moreover, we observed that deep learning derived machine learning models outperformed comparable models, which were trained by other machine learning algorithms, when applied to internal pharmaceutical company datasets. To our knowledge, this is the first large-scale study evaluating the potential of machine learning and especially deep learning directly at the level of industry-scale settings and moreover investigating the transferability of publicly learned target prediction models towards industrial bioactivity prediction pipelines.

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AIM: The aim of the present study was to create a tool to evaluate the risk of peri-implantitis according its severity. METHODS: After ethics committee approval, 43 patients provided signed consent and were included prospectively. Forty-five observations were recorded. The following criteria were recorded: number of implant faces showing bleeding and/or suppuration, pocket depth on at least two faces of the implant, bone loss as a function of the length of the implant evaluated on X-rays, number of implant faces with bacterial plaque, the parameters required for determination of excess cement (screwed or sealed prosthesis, burying of sealed prostheses), periodontal status, glycemia, and annual consumption of tobacco. Each of these parameters was plotted on a chart using Microsoft Excel. RESULTS: Seventeen of 45 (37.8%) cases were identified as having high peri-implantitis risk, two of 45 (4.4%) had low risk, and 11 of 45 (24.4%) had moderate risk; 33.3% patients did not have peri-implantitis and were considered at very low risk. CONCLUSION: The observed results applied to the evaluation model are an effective diagnostic tool in assessing the risk of peri-implantitis. The tool takes into account parameters, which have not been taken into account until now. The information is automatically processed and allows early management of peri-implantitis.

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BACKGROUND: Clinicians sometimes use decompression for secondary, low-risk cyst enucleation. The authors explored whether the decompression of dentigerous cysts associated with third molars is a reliable, long-term, definitive treatment option. METHODS: The authors monitored 25 mandibular cysts associated with impacted third molars in adults after surgical decompression without the extraction of the related tooth for a mean (standard deviation) time of 37 (15) months (range, 12-71 months). The authors carefully evaluated the postoperative clinical situation and the extent of radiographic shrinkage. RESULTS: A minimal epithelial slit remained patent in all patients. All lacked clinical problems, had no need for further intervention, and exhibited persistent impaction of the teeth. The cyst reduction rate calculated on panoramic radiographs ranged from 63.4% to 98.8% (mean [standard deviation] 87.5% [10.6%]) and was statistically significant (P < .05). In 13 patients, the reduction rate was greater than 90%. CONCLUSIONS: Decompression triggered marked radiographic reductions of cysts when epithelial communication persisted. The situation stabilized after the first 6 through 8 months, and no further intervention was required. PRACTICAL IMPLICATIONS: It is risky to enucleate cysts associated with impacted third molars and extract the molars. Clinicians can solve the problem in dental practice by using surgical decompression.

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We prospectively investigated in adults the decompression of dentigerous cysts associated with impacted third molars at high risk of iatrogenic damage during extraction. The computerised calculated volumetric postoperative reductions measured by cone-beam computed tomography at four and eight months were correlated with the duration of treatment, initial volume, and patient's age. We prospectively monitored 14 adult patients with 14 dentigerous cysts that were associated with impacted third molars, for eight months after decompression. The mean (SD) reduction in volume during the first eight months was 71 (14) % (51% after the first four months and 20% after the second four months), with a monthly reduction rate of 9%. Both the total decrease in volume (a) and the monthly rate of reduction (b) were significantly associated (p<0.01) and linearly correlated with the duration of decompression [r (a)=-0.89, r (b)=-0.61] and initial volume [r (a)=r (b)=0.92], but not with the patient's age (p=0.49) [r (a)=r (b)=0.04]. The trend towards reduction in volume within a period of eight months of treatment allowed us to better understand the duration of decompression required.

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BACKGROUND: Low health literacy increases the risk for hospital readmissions. Despite this, the measurement and use of health literacy to guide discharge counseling and planning in heart failure patients is not commonly performed. A short 3-Question Brief Health Literacy Screen (BHLS) is available and takes less than three minutes to complete, but has never been evaluated to help determine whether health literacy affects healthcare use after discharge in patients with heart failure. OBJECTIVE: The purpose of this study was to assess 30-day readmissions and emergency department visits based on health literacy evaluated by the BHLS in an acute care heart failure population. METHODS: This was a prospective observational cohort study conducted at a large quaternary health system. Hospitalized patients with a diagnosis of heart failure were assessed for health literacy using the BHLS. Unplanned healthcare use after discharge including 30-day, all-cause ED visits and hospital readmissions was assessed using univariate and logistic regression models. RESULTS: Two hundred and sixty four patients aged 66.6 ± 14.3 (mean ± SD) years met inclusion/exclusion criteria of whom 175 (66.3%) had a BHLS score >9 (adequate health literacy) and 89 (33.7%) had a BHLS score ≤9 (low health literacy). Predictors of low health literacy included older age (p = 0.019), lower education level (p < 0.001) and unemployed (p = 0.048). After controlling for potential confounders, low health literacy was independently associated with 30-day healthcare use after hospital discharge (OR:1.80; 95% CI: 1.04-3.11; p = 0.035). CONCLUSION: Using a short, 3-question validated survey instrument, it was demonstrated that low health literacy was associated with increased 30-day unplanned healthcare use after discharge in this heart failure population. These results provide a clinically useful, easily incorporated tool that could identify high-risk patients at need for clinical interventions.

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The rapid and accurate detection of influenza virus in respiratory specimens is required for optimal management of patients with acute respiratory infections. Because of the variability of the symptoms and the numerous other causes of influenza-like illness, the diagnosis of influenza cannot be made on the basis of clinical criteria alone. Thus, rapid influenza diagnostic tests have been developed such as the Alere i Influenza A&B isothermal nucleic acid assay. We prospectively evaluated the performance of the Alere i Influenza A&B assay in comparison with our routine Xpert Flu/RSV assay. Positive samples were subtyped according to the protocol from the National Influenza Center (Paris, France). A total of 96 respiratory nasal swab samples were analyzed: with both methods, 38 were positive and 56 were negative. Samples were prospectively collected from January 20 to April 8, 2015, from patient (86 adult and 10 pediatric patients) presenting with an influenza-like illness through the French influenza season. In comparison with the Xpert Flu/RSV assay, the overall sensitivity and specificity of the Alere i Influenza A&B assay were 95% and 100%, respectively. Our results indicate that the Alere i Influenza A&B assay has a good overall analytical performance and a high degree of concordance with the PCR-based Xpert Flu/RSV assay. The Alere i Influenza A&B isothermal nucleic acid amplification test is a powerful tool for influenza detection due to its high sensitivity and specificity as well as its ability to generate results within 15min.

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PURPOSE: In mid-2007, we introduced a new risk-stratified follow-up programme (FUP) for surgically treated localized renal cell carcinoma. After inclusion, the patients have been followed prospectively. In this study, we present the results in regard to stratification, completeness of the FUP and recurrences. METHODS: The FUP consists of three risk groups: low risk (LR), intermediate risk (IR) and high risk (HR), based on the risk stratification model introduced by Leibovich et al. (Cancer 97(7):1663-1671, 2003). In all risk groups, the patients are scheduled for ten follow-up visits (FUV) over 5 years, but seven, five and three FUVs, respectively, are outsourced to the patient's general practitioner (GP). Chest X-ray and abdomen CT are the imaging modalities used in the FUP. RESULTS: Of 312 included patients, 195 (62.5 %) had a complete FUP. However, in 86 patients the scheduled FUP had to be reduced, leaving 86.3 % of the remaining patients with a complete FUP. By including GPs, the number of FUVs at the hospital was reduced by ~60 %. The 5-year probability for freedom of recurrence is 0.98, 0.84 and 0.52 for the LR, IR and HR groups, respectively. Of 31 recurrences, 20 patients (65 %) were diagnosed within the FUP. Eleven patients (35 %) were diagnosed due to symptoms, and five of these had recurrences in locations not covered by standard imaging. Patients diagnosed within the FUP showed a better prognosis for survival and could in greater part receive tumour-directed treatment. CONCLUSIONS: After 8 years of clinical use, the outcome measures of the FUP seem to be within acceptable ranges.

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PURPOSE: A residential rehabilitation program of the Bethel Institute in Germany for approximately three years is offered to young adults with epilepsy and mild intellectual disabilities. Participants aim at epilepsy improvements and want to gain more independence. The purpose of this study was to investigate effects of the program and their stability over the course of time. METHOD: Ninety-seven clients completed the program between 1999 and 2011. Data with repeated measurements (T1=four weeks after admission, T2=discharge, T3=at least two years after discharge) were only available for 51 of them. Outcome variables were seizure frequency, carer-ratings on their clients' success, assistance needs after the program (supported housing vs. long-term residential care) and client-ratings on activities of daily living, problems at work, on health-related and on global quality of life (QOL), on life satisfaction and on depression and psychological distress. RESULTS: Seizure frequency was significantly reduced, more than half of the clients moved to supported housing. Clients reported improvements in activities of daily living and some aspects of their QOL. These improvements remained constant over at least two years. Baseline data scarcely correlated with outcome measures. Analyses of subgroups demonstrated that changes of client-ratings correspond to changes of external parameters such as seizure frequency and professional assistance. CONCLUSION: Improvements with regard to more independent living, a better seizure control and more favorable self-ratings remained stable over the following years. From a social-welfare point of view, it is especially important that about half of the clients moved to supported housing after the program.

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BACKGROUND: Circular excision by secondary-intention healing is useful for small skin defects (diameter <10 mm). But the injection pain as the local anesthesia is administered one of the patients' biggest concerns. Buffered lidocaine can effectively relieve the injection pain, but it might increase the potential complications. This study examined the effect of buffered lidocaine on wound healing. METHODS: Patients undergoing circular excision by secondary-intention healing were divided into 2 groups and were administered buffered or unbuffered lidocaine as the local anesthesia. Comparative parameters included injection pain, postoperative pain, complication rate, scar width, and scar quality at 6 months. Statistical differences between the 2 agents were assessed. RESULTS: The patients in the buffered group experienced 0.9 fewer scaled injection pain units than did the patients in the unbuffered group (p = 0.009). Complication rates and scar appearance did not show any statistical difference between the 2 groups. CONCLUSION: Buffered lidocaine is useful to relieve the injection pain during the secondary-intention healing, and it is safe to use if it is applied properly.

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KIE: A lawsuit filed in federal court in Atlanta, Georgia, in February 1982 by two private ophthalmologists and seven prospective patients charges a group of academic physicians with attempting to monopolize radial keratotomy, a surgical procedure for correcting myopia, by labeling it experimental and urging restraint in its use. The parties have agreed to a settlement involving a payment of $250,000 by the defendants and a statement that the procedure is effective in qualified patients and should no longer be considered experimental. A second suit, brought by nine physicians in federal court in Chicago in June 1984, accuses the American Academy of Ophthamology of attempting to control the procedure. The broader issue at stake is how new surgical prdocedures should be evaluated before they are brought into widespread use. In the case of radial kerototomy, a large-scale clinical trial funded by the National Eye Institute is proceeding as planned despite the legal controversy.^ieng

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