A multicentre study of computer aided diagnosis for patients with acute abdominal pain was performed in eight centres with over 250 participating doctors and 16737 patients. Performance in diagnosis and decision making was compared over two periods: a test period (when a small computer system was provided to aid diagnosis) and a baseline period (before the system was installed). The two periods were well matched for type of case and rate of accrual.The system proved reliable and was used in 75-1% of possible cases. User reaction was broadly favourable. During the test period improvements were noted in diagnosis, decision making, and patient outcome. Initial diagnostic accuracy rose from 45-6% to 65 3%. The negative laparotomy rate fell by almost half, as did the perforation rate among patients with appendicitis (from 23.7% to 11-5%). The bad management error rate fell from 0-9% to 0-2%, and the observed mortality fell by 22-0%. The savings made were estimated as amounting to 278 laparotomies and 8516 bed nights during the trial period-equivalent throughout the National Health Service to annual savings in resources worth over £20m and direct cost savings of over £5m.Computer aided diagnosis is a useful system for improving diagnosis and encouraging better clinical practice.

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Context Female patients with anterior cruciate ligament reconstruction (ACLR) are less likely to return to sport than males. Psychological readiness predicts successful return to sport, but it is unclear if psychological experiences differ between males and females during recovery. Objective To explore gender differences in psychological readiness factors of return to sport after ACLR. Design Qualitative study. Setting Laboratory. Patients or Other Participants A total of 12 male (months since surgery = 6.2 ± 1.2) and 13 female (months since surgery = 6.4 ± 1.3) high school athletes with a history of ACLR. Data Collection and Analysis Participants were interviewed before physician clearance to return to activity. Transcribed interviews were analyzed using deductive thematic coding of 5 themes identified from previous research (psychological distress, self-efficacy, locus of control, athletic identity, and fear of reinjury) and inductive secondary subthematic coding. Gender comparisons were generated within primary themes and secondary subthemes. Results All deductive themes were consistently reinforced. Male and female participants reported fear of movement, loss of athletic identity, and motivational mindsets for return to sport and self-improvement. Males reported a stronger sense of internal locus of control using positive internal reinforcement, whereas females described balancing internal and external control and valuing external support systems. Male participants described mood changes influenced by physical and social limitations. Female participants closely monitored their emotions throughout recovery and were influenced by rehabilitation fluctuations. Conclusions Male and female high school athletes described different psychological factors related to return to sport and locus of control as well as psychological distress. Gender-specific psychological interventions may be warranted to overcome psychological barriers after ACLR.

Cardiotoxicity is a dose-limiting and potentially lethal complication of anthracycline administration. Previous studies failed to determine definitive toxic doses or cardioprotective factors. Current dosing strategies may utilize unnecessarily high anthracycline doses, such that survival benefit may not outweigh increased toxicity rates. A systematic review of randomized controlled trials and prospective/retrospective studies investigating anthracycline treatment in pediatric solid tumors was performed from PubMed/MEDLINE and Cochrane databases. Generalized linear models mapping survival, cardiotoxicity, and cardiotoxicity-free survival adjusted for male-to-female ratio, follow-up time, and concomitant chemotherapeutic drugs or cardioprotective agents (dexrazoxane) were generated using R. Survival rose linearly with increasing cumulative anthracycline dose whereas cardiotoxicity demonstrated exponential increases both without (dose, >200 mg/m) and with (dose, >400 mg/m) dexrazoxane. Maximum cardiotoxicity-free survival was 268.2 mg/m without and 431.8 mg/m with dexrazoxane. Despite increasing cardiotoxicity-free dose by >150 mg/m, dexrazoxane minimally improved projected survival (71.9% vs. 75.4%). Cardiotoxicity increased linearly as a function of follow-up time with rates doubling from 5 to 20 years, without evidence of plateau. On the basis of our model, current dosing regimens-doxorubicin doses >375 mg/m without dexrazoxane-overvalue increased anthracycline administration and may contribute to devastating cardiotoxicity. The linear increase of cardiotoxicity without evidence of plateau confirms the necessity for lifelong cardiac monitoring.

A data collection exercise is presented that was conducted by the Department of Transport of the Metropolitan Assembly of Accra, Ghana, to further its knowledge of transportation services placed under its jurisdiction. In order to map the city’s transportation network, a partnership was developed between local authorities and a Canadian university with the support of the French bilateral development agency. An innovative methodology based on the use of smartphones and digital technologies allowed the project team to collect and map 315 jitney routes in less than 2 months. Collectors equipped with GPS-enabled smartphones surveyed Accra’s formal jitney network in its entirety and transmitted data daily to a team overseas in charge of mapping and analysis. The first map of the city’s transportation network is presented here and preliminary conclusions are drawn from it. By mapping passengers’ boarding and alighting, this study also offers unique insights into the spatial distribution of the demand for transportation in Accra. This research opens both methodological and operational perspectives. It contributes to a growing body of literature on jitneys and transportation planning in developing countries. It also demonstrates that transportation data can be collected with limited time and resources through the use of mobile technologies. From a practical point of view, these data will assist the authorities in regulating, planning, and developing Accra’s transportation network.