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The Validity and Reliability of Patient-provided Photographs for Diagnosing and Assessing the Severity of Hand Eczema
No full textHand eczema (HE) is a common skin disease, diagnosed through clinical evaluation. However, the increasing need to deliver healthcare remotely, along with the demand for valid and reliable evaluations of HE in research, prompts exploration of the potential benefits of remote assessment. This study assessed the criterion validity and inter- and intra-rater reliability of patient-provided photographs to diagnose and assess the severity of HE. The presence and severity of HE were assessed by 1 of the 2 clinical raters. Following instructions, patients took 4 photographs of their hands. All photographs were assessed twice by the clinical raters and 2 additional raters. In total, 98 patients were included. The sensitivity, specificity, positive and negative predictive value were respectively 85.1%, 79.2%, 92.6%, and 63.3%. Kappa values of 0.35 and 0.66 were found for inter- and intra-rater reliability. The intraclass correlation coefficients based on the Hand Eczema Severity Index (HECSI) were > 0.90. Kappa values for the criterion validity and inter- and intra-rater reliability using the photographic guide were respectively 0.71, 0.58-0.77, and 0.77. The findings indicate that patient-provided photographs are valid and reliable for remote assessment of HE and could be of benefit in healthcare and research by reducing in-person visits and enabling continuous monitoring.</p
Accelerating rare disease diagnostics by linking DNA and RNA through an explainable and interactive RNA-guided workflow
No full textChallenges preventing mainstream use of RNA-sequencing (RNA-seq) in genome diagnostics are sources of biological and technical variation, typically caused by intrinsic differences in gene expression between tissue types, cellular conditions, and environmental factors. While machine learning methods may partially correct unwanted variation, interpreting RNA-seq data that are typically generated by different sources over time, which is a realistic scenario in healthcare, remains challenging and complex. We developed a complete RNA-guided workflow that handles such variation and is therefore able to identify gene-disease associations in the context of genomic, phenotypic, and segregation analysis of rare disease patients. The result is a streamlined implementation of OUTRIDER and FRASER, complemented with Borzoi and MOLGENIS VIP. This novel workflow paves the way for pinpointing rare variants affecting gene expression and splicing using self-contained interactive reports visualizing outlier genes and prioritized patient-level variants for immediate clinical interpretation. We analysed 144 cases from different centres, a realistic cohort for centres more likely to be dependent on background cohorts. We demonstrate that RNA outlier analysis enhances variant interpretation and, despite its limitations, is already able to aid clinical variant interpretation. Our workflow accelerates the prioritization of coding and non-coding variants, and the reclassification of clinically relevant variants of unknown significance.</p
Gendered imaginations:Critical prompting and decoding bias in text-to-image generative AI
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AI performance for nodule volume doubling time in the follow-up of the UKLS lung cancer screening study compared to expert consensus and histological validation
No full textAim: To validate an artificial intelligence (AI) software for automated assessment of nodule growth by volume doubling time measurement (VDT) on protocol-mandated follow-up low-dose CT (LDCT) scans from the UK lung cancer screening (UKLS) trial. Methods: This validation study included 710 UKLS participants with 939 LDCT follow-up scans (361 3-month and 578 12-month). Follow-up scans were assessed independently by both AI and human readers. A positive finding warranting referral was defined as the largest nodule with a solid component ≥ 100 mm3 showing VDT ≤ 400 days at follow-up. Performance was benchmarked against the European expert panel (reference standard) and then the histological outcomes (gold standard). Results: Against the expert panel, AI achieved the lowest 3-month negative misclassification (NM) rate (1/11, 9.1 %), versus human readers (range: 18.2–63.6 %). AI’s positive misclassification (PM) rate was initially 7.8 % (28/361) at 3 months but decreased to 0.9 % (5/578) at 12 months. Against histological outcomes of 9 screen-detected lung cancers, AI identified VDT ≤ 400 days in all 4 cancers also deemed positive by the expert panel at the earliest 3-month follow-up, while human readers missed or delayed referrals in 1–3 of these. AI also identified VDT ≤ 400 days in 3 of 5 cancers that the panel classified as negative, primarily due to their sub-threshold volume (<100mm³). Conclusions: The automated AI system showed strong VDT assessment performance in follow-up screening, outperforming human readers in the early identification of rapid growth in histologically-confirmed cancers, thus supporting its potential to enhance risk stratification and facilitate earlier lung cancer detection.</p
Towards Understanding Induction Policies and Practices in French-Speaking Belgium and the Netherlands
No full textInduction and mentoring are nested within municipal, regional, national, and international policies on educational professional development. To deepen our understanding of the conceptualization and enactment of induction across European countries, this chapter describes and compares the macro-, meso- and micro-level factors that influence how induction practices are manifested in two neighboring countries in Europe: Belgium (the French-speaking part) and The Netherlands. While both countries prioritize and acknowledge the importance of induction, the way induction practices are manifested (from the policies to their enactments in schools) differs. The manifestations of induction practices in these two countries’ policy documents and relevant literature were compared using two theoretical lenses: (1) the ecology of practices and (2) the organizational socialization approach. The comparison of these manifestations provides a rich opportunity to reveal resources and the values that underpin different manifestations of induction practices. We highlight notable similarity at the macro-level, as well as fundamental differences in the way these practices are enacted at the meso- and micro-levels
To the Heart of the Mine:Pride, Shame, and the Identity of the Appalachians
No full textPolitieke duiding van populisme begint vaak in de mijnstreek, van Limburg tot in Kentucky. In het boek Gestolen trots onderzoekt Arlie Russell Hochschild hoe en waarom de mijnwerkers van de Appalachen hun hoop op Trump hebben gericht. Amerikanist Maarten Zwiers legt uit dat achter de stereotiepe beelden van de teleurgestelde en achtergestelde arbeiders in Trumpstaten een veel complexere en gelaagde werkelijkheid schuilgaat.Politieke duiding van populisme begint vaak in de mijnstreek, van Limburg tot in Kentucky. In het boek Gestolen trots onderzoekt Arlie Russell Hochschild hoe en waarom de mijnwerkers van de Appalachen hun hoop op Trump hebben gericht. Amerikanist Maarten Zwiers legt uit dat achter de stereotiepe beelden van de teleurgestelde en achtergestelde arbeiders in Trumpstaten een veel complexere en gelaagde werkelijkheid schuilgaat
Lung Volume Reduction Surgery for Cannabis-Associated Emphysema:Expanding Indication with Functional and Quality of Life Improvements
No full textObjectives: Cannabis-associated emphysema (CAE) involves bullous parenchymal destruction, often not considered for surgery due to the severe destruction and fragile tissue. It is affecting younger patients with limited smoking history, compared to typical emphysema. Given the heterogeneous pattern, lung volume reduction surgery (LVRS) may offer therapeutic benefit. This study explores the role of LVRS in patients with CAE. Methods: CAE patients were analyzed from a prospective collected database from August 2019 until December 2024. Chest computed tomography scan, lung function (forced expiratory volume in 1 second [FEV1], residual volume [RV], quality of life [COPD Assessment Test, CAT]) and operative outcomes were measured up to one-year postintervention. Results: Seven patients (median 53 years (range, 40-70), all male) with 14 joint-years (3-168) underwent 11 LVRS procedures. Four patients experienced a previous pneumothorax. The median length of stay was 6.5 days (3-14), with a chest tube duration of 5.5 days (2-14). Air leaks occurred in 7 procedures (58%) for a median of 7 days (1-10), with prolonged air leak in 3 cases (27%). There was no mortality or readmission. Relative improvement at 6 to 12 months regarding FEV1 was +44% (36-108) and RV -43% (11-62). Six-minute walking distance and CAT improved with +72 m (-28 to 152) and 11 (0-17) points, respectively. Conclusions: This preliminary single-center case series suggests that CAE may represent a suitable indication for properly performed LVRS, with favorable results attributable to its heterogeneous morphology.</p
Suspected Rifampicin-Induced Fever During Periprosthetic Joint Infection Treatment:A Report of 2 Cases
No full textCASE: Drug-induced fever is a rare adverse reaction to antibiotics. This case report describes 2 cases of suspected rifampicin-induced fever in patients undergoing periprosthetic joint infection treatment. Both patients experienced fever with the absence of inflammatory symptoms and a discrepancy between clinical improvement and persistent fever. Discontinuation of rifampicin led to rapid symptom resolution. CONCLUSION: Drug-induced fever should be considered when fever persists without infectious symptoms and after excluding other causes. Prompt recognition and discontinuation can lead to rapid resolution and minimize unnecessary interventions.</p
