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Background: Proper diagnosis in primary care is crucial due to the large number of skin cancer diagnoses each year and its associated growing economic burden. Understanding how primary care providers can be best trained in dermoscopy is instrumental in helping primary care providers differentiate benign and malignant cutaneous lesions so that appropriate action can be taken (eg, biopsy/referral to dermatology or reassurance). Objective: To assess the success of concise dermoscopy training among primary care providers. Design: A cohort study was conducted in primary care at Mayo Clinic, Rochester, including primary care physicians, nurse practitioners, and physician assistants in internal medicine and family medicine. Diagnostic accuracy was measured on standardized testing through image-based recognition and in clinical practice through observation of referral and biopsy patterns both before and after dermoscopy education, focused on the TADA plus method. Results: Forty-three primary care providers completed the image-based recognition tests, with significant improvement in mean score measured after dermoscopy training workshop (20%). Among the thirteen primary care providers who continued to use dermoscopy in clinical practice, a significant improvement (31%) in mean clinical diagnostic accuracy was observed comparing 1 year of practice data before versus after dermoscopy training. Conclusion: Improvement in diagnostic accuracy with utilization of the TADA plus method translates into clinical practice. Therefore, training primary care providers in dermoscopy may improve the dermatologic care patients receive in primary care, especially in rural or medically underserved areas where access to dermatology is limited.

BackgroundDermoscopy is commonly used for the evaluation of pigmented lesions, but agreement between experts for identification of dermoscopic structures is known to be relatively poor. Expert labeling of medical data is a bottleneck in the development of machine learning (ML) tools, and crowdsourcing has been demonstrated as a cost- and time-efficient method for the annotation of medical images. ObjectiveThe aim of this study is to demonstrate that crowdsourcing can be used to label basic dermoscopic structures from images of pigmented lesions with similar reliability to a group of experts. MethodsFirst, we obtained labels of 248 images of melanocytic lesions with 31 dermoscopic “subfeatures” labeled by 20 dermoscopy experts. These were then collapsed into 6 dermoscopic “superfeatures” based on structural similarity, due to low interrater reliability (IRR): dots, globules, lines, network structures, regression structures, and vessels. These images were then used as the gold standard for the crowd study. The commercial platform DiagnosUs was used to obtain annotations from a nonexpert crowd for the presence or absence of the 6 superfeatures in each of the 248 images. We replicated this methodology with a group of 7 dermatologists to allow direct comparison with the nonexpert crowd. The Cohen κ value was used to measure agreement across raters. ResultsIn total, we obtained 139,731 ratings of the 6 dermoscopic superfeatures from the crowd. There was relatively lower agreement for the identification of dots and globules (the median κ values were 0.526 and 0.395, respectively), whereas network structures and vessels showed the highest agreement (the median κ values were 0.581 and 0.798, respectively). This pattern was also seen among the expert raters, who had median κ values of 0.483 and 0.517 for dots and globules, respectively, and 0.758 and 0.790 for network structures and vessels. The median κ values between nonexperts and thresholded average–expert readers were 0.709 for dots, 0.719 for globules, 0.714 for lines, 0.838 for network structures, 0.818 for regression structures, and 0.728 for vessels. ConclusionsThis study confirmed that IRR for different dermoscopic features varied among a group of experts; a similar pattern was observed in a nonexpert crowd. There was good or excellent agreement for each of the 6 superfeatures between the crowd and the experts, highlighting the similar reliability of the crowd for labeling dermoscopic images. This confirms the feasibility and dependability of using crowdsourcing as a scalable solution to annotate large sets of dermoscopic images, with several potential clinical and educational applications, including the development of novel, explainable ML tools.

This review article describes the patterns and trends of early rehabilitation (ER), occupational therapy (OT) and physical therapy (PT), and the specific roles of rehabilitation therapists, particularly occupational therapists (OTs) and physical therapists (PTs) in acute care hospitals in the United States (U. S.). First, a broad overview of the research literature related to the consequences of bed rest and immobility is presented along with the techniques used by OTs and PTs to minimize negative outcomes and optimize function through ER. Occupation-based and mobility-focused practices are then outlined to describe rehabilitation therapy's role in decreasing readmissions and improving patient and family satisfaction. Finally, traditional OT and PT practices in acute care settings in China, including the challenges of implementing ER and the implications for contemporary practice, are discussed. ER refers to the initiation of therapy services in an expedited manner for patients who have rehabilitative, safety, or community support needs in the acute care hospital. That is, after experiencing an injury, illness, or disease, patients'occupational performance and ability to participate in activities and mobility can be improved, or prevented from worsening, with ER. The goals of OT and PT in an accelerated and fast-past hospital environment are to facilitate a patient's functional performance and outcomes to improve function recovery and to prevent further disability and loss of function. Currently in U. S., federal regulations, health care policies, financial constraints, and the demanded shortened hospital stays require therapists to be both comprehensive and efficient and to continue advancing ER practices. Early rehabilitation must be well-timed and intensive enough to bring about positive changes. Additionally, ensuring patients'active engagement and addressing therapy goals that patients and families identified as essential are imperative to achieve patients'successful transition to home or to another setting. Through ER, not only can a patient's functional abilities improve, but ER reduces the risk of undesirable and unintended health consequences. Such hospital-acquired conditions (HAC) are conditions which occur during a patient's hospitalization and are not present at admission. The risk of developing HAC increases if the patient is limited from active engagement in activity and mobility as a result of bed rest, immobility, or deconditioning. Systemic deconditioning, which can result from a prolonged critical illness, a trauma, or a surgery, reduces the patient's functional capacity, impairs cognitive abilities, diminishes psychological coping, and increases rates of depression and anxiety. With ER, the specific OT and PT rehabilitative interventions minimize the risk for negative health conditions, impairments, and disability while simultaneously promoting functional recovery. Specific to each rehabilitation profession's roles and responsibilities in the U. S., OTs promote the patients'occupational performance and participation in daily occupations, roles, habits, and routines. Through facilitating the patient's engagement in typical activities of daily living, OT improves patient's overall health, well-being, and independence at home and in the community. In addition to direct therapy service to patients, OTs also assess and recommend specific task and environmental modifications. Occupational therapists'intervention may focus on compensatory (i.e., facilitating occupation through modifying the task or environment) or remediation (i.e., rehabilitative) techniques for patients to achieve a greater level of independence. In PT, the emphasis is on promoting and progressing patients'mobility and movement to increase performance and to enhance function, well-being, overall health and quality of life. PTs promote optimal mobility to enable patients to achieve a greater level of independence, autonomy, and to return to previous or enhanced level of function. Any patient who has or may develop impairments, activity limitations, and participation restrictions related to musculoskeletal, neuromuscular, cardiovascular, pulmonary, and integumentary systems can be treated by PT. Therefore, PTs are well-suited to promote early rehabilitation (ER) in the acute care setting. In the U. S., currently, however, acute care hospitals are not often designed to support patients and meet their intensive rehabilitation needs. Consequently, patients who require assistance with daily occupations or mobility or who have ongoing rehabilitation needs often result in relocating, or transferring to another health care facility, i.e., post-acute care, for continued recovery of medical issues and rehabilitative deficits. Multiple levels of post-acute care are available in the U. S.including skilled nursing facilities, rehabilitation hospitals, long-term acute care hospitals, nursing homes, outpatient clinics, home health, and private caregiver services. Currently, in the Chinese acute care hospital, patients have the option to stay for an extended period of time which provides the opportunity for OTs and PTs to provide multiple rehabilitation visits. Typically, the outcomes of OT and PT services are to restore physical mobility, increase active range of motion, and improve function in order for the patient to return home with family. It seems, due to the Chinese culture, tradition and custom, less emphasis is on improving independence with self-care activities. It is expected that family members take on the responsibilities to provide care to a family member who is ill or has disabilities. As such, in China there is typically a supportive family dynamic, meaning the family is present daily during rehabilitative intervention, helping provide therapeutic exercises and physical agent modalities for their loved ones. The burden of care on the family members worsens at discharge, especially if the patient and family have not received therapy or patient education to improve the patient's function and independence. Currently, the profession of rehabilitation including occupational therapy and physical therapy in China is in an excellent position of growth and advancement. Understanding the unique roles of OT and PT in acute care from an international perspective will improve global health not only through rehabilitative services, but also through focusing on health and wellness for the patient, family, and community. Early rehabilitation in the acute care setting is an effective way to improve the health and well-being of patients and enable them to return to their home and community in a timely manner. OTs and PTs play instrumental roles in early rehabilitation in the acute care settings.

Identification and development of sustainable land management is urgently required because of widespread resource degradation from poor land use practices. In addition, the world will need to increase food production to meet the nutritional needs of a growing global population without major environmental degradation. Ongoing climate change and its impacts on the environment is an additional factor to consider in identifying and developing sustainable land use practices. The objectives of this paper are to: (1) provide a background to the need for sustainable land management, (2) identify some of its major components, and (3) discuss some examples of sustainable land management systems that are being practiced around the world. Some common components of this type of management are: (1) understanding the ecology of land management, (2) maintenance or enhancement of land productivity, (3) maintenance of soil quality, (4) increased diversity for higher stability and resilience, (5) provision of economic and ecosystem service benefits for communities, and (6) social acceptability. Several examples of sustainable land management systems are discussed to illustrate the wide range of systems that have been developed around the world including agroforestry, conservation agriculture, and precision agricultural systems. Improved technology, allowing for geater environmental measurement and for improved access and sharing of information, provides opportunities to identify and develop more sustainable land management practices and systems for the future.

The Affymetrix Drug Metabolism Enzymes and Transporters (DMET) microarray is the first assay to offer a large representation of SNPs conferring genetic diversity across known pharmacokinetic markers. As a convenient and painless alternative to blood, saliva samples have been reported to work well for genotyping on the high density SNP arrays, but no reports to date have examined this application for saliva-derived DNA on the DMET platform. Genomic DNA extractions from saliva samples produced an ample quantity of genomic DNA for DMET arrays, however when human amplifiable DNA was measured, it was determined that a large percentage of this DNA was from bacteria or fungi. A mean of 37.3% human amplifiable DNA was determined for saliva-derived DNAs, which results in a significant decrease in the genotyping call rate (88.8%) when compared with blood-derived DNAs (99.1%). More interestingly, the percentage of human amplifiable DNA correlated with a higher genotyping call rate, and almost all samples with more than 31.3% human DNA produced a genotyping call rate of at least 96%. SNP genotyping results for saliva derived DNA (n = 39) illustrated a 98.7% concordance when compared with blood DNA. In conclusion, when compared with blood DNA and tested on the DMET array, saliva-derived DNA provided adequate genotyping quality with a significant lower number of SNP calls. Saliva-derived DNA does perform very well if it contains greater than 31.3% human amplifiable DNA.

ABSTRACT We determined the usefulness of tapered element oscillating microbalances (TEOMs) for researchers and engineers involved with measuring diesel particulate mass. Two different test facilities were used for generating diesel [...]