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Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) Head computed tomographic (CT) decision instrument for selective imaging of blunt head injury patients: An observational study
Gregory W. Hendey,Malkeet Gupta,Robert Rodriguez,William R. Mower
- , 2017, DOI: 10.1371/journal.pmed.1002313
Abstract:
Nonconcordance between Clinical and Head CT Findings: The Specter of Overdiagnosis
Kelli N. O'Laughlin,Jerome R. Hoffman,Steven Go,Gelareh Z. Gabayan,Erum Iqbal,Guy Merchant,Roberto A. Lopez-Freeman,Michael I. Zucker,William R. Mower
Emergency Medicine International , 2013, DOI: 10.1155/2013/314948
Abstract: Background. It is unclear whether history and physical examination findings can predict abnormalities on head computed tomography (CT) believed to indicate increased risk of lumbar-puncture- (LP-) induced brain herniation. The objectives of this study were to (1) identify head CT findings felt to be associated with increased risk of brain herniation and (2) to assess the ability of history and physical examination to predict those findings. Methods. Using a modified Delphi survey technique, an expert panel defined CT abnormalities felt to predict increased risk of LP-induced brain herniation. Presence of such findings on CT was compared with history and physical examination (H&P) variables in 47 patients. Results. No H&P variable predicted “high-risk” CT; combining H&P variables to improve sensitivity led to extremely low specificity and still failed to identify all patients with high-risk CT. Conclusions. “High-risk” CT is not uncommon in patients with clinical characteristics known to predict an absence of actual risk from LP, and thus it may not be clinically relevant. “Overdiagnosis” will be increasingly problematic as technological advances identify increasingly subtle deviations from “normal.” 1. Introduction There is substantial evidence in the medical literature that lumbar puncture (LP) is extremely safe [1–3], particularly in the setting of patients who are immunologically normal and who do not manifest abnormal mental status, papilledema, or focal neurological deficit [3–5]. Nevertheless, many clinicians are concerned that LP could lead to tonsillar herniation [6–11] in patients with increased intracranial pressure (ICP), by decreasing cerebrospinal fluid pressure in the subarachnoid space, and thus creating a pressure gradient that could displace cerebral and brainstem structures [7, 12]. There are only a small number of reports, however, suggesting catastrophic deterioration related to LP [9, 13, 14], and even the validity of these observations has been questioned [15–17]. Nevertheless, despite the substantial evidence that few, if any patients, are at risk from LP, many clinicians worry about potential harm, and it has been suggested that head computed tomography (CT) be obtained prior to LP, in the hope that it might be able to identify the few patients in whom the procedure would purportedly be dangerous [5, 18]. There are no studies, however, which define what if any findings on head CT actually do predict increased risk of tonsillar herniation following LP [3, 4, 19]. We designed this study to assess the prevalence of “high-risk” CT
Derivation and Validation of Two Decision Instruments for Selective Chest CT in Blunt Trauma: A Multicenter Prospective Observational Study (NEXUS Chest CT)
Robert M. Rodriguez？,Mark I. Langdorf？,Daniel Nishijima？,Brigitte M. Baumann？,Gregory W. Hendey？,Anthony J. Medak？,Ali S. Raja？,Isabel E. Allen？,William R. Mower
PLOS Medicine , 2015, DOI: 10.1371/journal.pmed.1001883
Abstract: Background Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs) for selective chest computed tomography (CT) in adult blunt trauma patients. Methods and Findings From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity). In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients—6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1) abnormal chest X-ray, (2) rapid deceleration mechanism, (3) distracting injury, (4) chest wall tenderness, (5) sternal tenderness, (6) thoracic spine tenderness, and (7) scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%–100%), a specificity of 20.8% (95% CI 19.2%–22.4%), and a negative predictive value (NPV) of 99.8% (95% CI 98.9%–100%) for major injury, and a sensitivity of 95.4% (95% CI 93.6%–96.9%), a specificity of 25.5% (95% CI 23.5%–27.5%), and a NPV of 93.9% (95% CI 91.5%–95.8%) for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%–100%), a specificity of 31.7% (95% CI 29.9%–33.5%), and a NPV of 99.9% (95% CI 99.3%–100%) for major injury and a sensitivity of 90.7% (95% CI 88.3%–92.8%), a specificity of 37.9% (95% CI 35.8%–40.1%), and a NPV of 91.8% (95% CI 89.7%–93.6%) for either major or minor injury. Regarding the limitations of our work, some clinicians may disagree with our injury classification and sensitivity thresholds for injury detection. Conclusions We prospectively derived and validated two DIs (Chest CT-All and Chest CT-Major) that identify blunt trauma patients with clinically significant thoracic
Developing an Institutional Repository: an insider’s look at the University of Utah IR
Mower, Allyson
Library Student Journal , 2006,
Abstract: The University of Utah libraries (J. Willard Marriott Library, S.J. Quinney Law Library and Spencer S. Eccles Health Sciences Library) have embarked on a campus-wide project to develop an institutional repository. In response to widespread use of the Web and readily available—albeit somewhat new and untested—digital technologies, librarians determined that the University of Utah needed a digital collection to truly represent the scholarly creations of its faculty, researchers and students. This essay focuses on the initial stage of the project and also offers reflections on its current status as well as possibilities for the future.
The Librarian's Copyright Companion, 2nd Edition, by James S. Heller, Paul Hellyer, & Benjamin J. Keele [Review]
Allyson Mower
Journal of Librarianship and Scholarly Communication , 2013,
Abstract:
SCIWORA is Not Just Child’s Play: Analysis of the NEXUS Data
Hendey, G. W,Wolfson, A. B,Mower, W. R,Hoffman, J. R
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2002,
Abstract:
Occupational Wages and Globalization  [PDF]
William R. DiPietro
iBusiness (IB) , 2011, DOI: 10.4236/ib.2011.32023
Abstract: Using a country’s trade share as a measure of globalization, this paper employs cross country regression analysis on 161 occupations for the year 2000 to assess whether globalization has a negative effect on occupational wages. The results are consistent with the notion that greater integration of national economies with the rest of the world adversely affects occupational wages in many occupations within countries.
PREP-Mt: predictive RNA editor for plant mitochondrial genes
Jeffrey P Mower
BMC Bioinformatics , 2005, DOI: 10.1186/1471-2105-6-96
Abstract: To test the general applicability of the PREP-Mt methodology, RNA editing sites were predicted for 370 full-length or nearly full-length DNA sequences and then compared to the known sites of RNA editing for these sequences. Of 60,263 cytidines in this test set, PREP-Mt correctly classified 58,994 as either an edited or unedited site (accuracy = 97.9%). PREP-Mt properly identified 3,038 of the 3,698 known sites of RNA editing (sensitivity = 82.2%) and 55,956 of the 56,565 known unedited sites (specificity = 98.9%). Accuracy and sensitivity increased to 98.7% and 94.7%, respectively, after excluding the 489 silent editing sites (which have no effect on protein sequence or function) from the test set.These results indicate that PREP-Mt is effective at identifying C to U RNA editing sites in plant mitochondrial protein-coding genes. Thus, PREP-Mt should be useful in predicting protein sequences for use in molecular, biochemical, and phylogenetic analyses. In addition, PREP-Mt could be used to determine functionality of a mitochondrial gene or to identify particular sequences with unusual editing properties. The PREP-Mt methodology should be applicable to any system where RNA editing increases protein conservation across species.RNA editing is a type of RNA processing (such as polyadenylation, intron splicing, and 5' end-capping) that inserts, deletes, or modifies nucleotides in an RNA transcript, thereby changing the information encoded by the genome. First discovered in trypanosome mitochondria [1], RNA editing has since been observed in a range of eukaryotes, including slime molds, amoeboid protozoans, plants, animals, and fungi, and also in viruses [2,3]. In plants, RNA editing converts cytidines to uridines and uridines to cytidines in mitochondrial and plastid, but not nuclear, transcripts. The frequency and type of conversion in each organelle is highly lineage-specific [4-7]. In angiosperms, for example, approximately 400 editing sites (all C to U) have been foun
Deliberate ante-mortem dental modification and its implications in archaeology, ethnography and anthropology
Jim P. Mower
Papers from the Institute of Archaeology , 1999, DOI: 10.5334/pia.137
Abstract: This paper will focus on the variation in deliberate ante-mortem tooth modification through archaeological, anthropological and ethnographic examples. Non-deliberate dental alteration will be discussed as a means of differentiating deliberate, culturally driven modifications, from accidental or occupationally related change. Teeth will often survive better than bone in archaeological contexts. With this in mind, this work will consider the classification and appearance of dental modification and the motivations for such practices. This study will also attempt to highlight the potential in dental anthropology for the identification of status indicators, cultural markers and other indications of past human behaviour in archaeological dental remains. Suggestions will be made for the possibilities of future studies in this area.
Trench Warfare? Archaeologists battle it out
James P. Mower
Papers from the Institute of Archaeology , 2000, DOI: 10.5334/pia.152
Abstract:
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