Evaluation of the region-specific risks of accidental radioactive releases from the European Spallation Source

The European Spallation Source (ESS) is a neutron research facility under construction in southern Sweden. The facility will produce a wide range ofradionuclides that could be released into the environment. Some radionuclides are of particular concern such as the rare earth gadolinium-148. In this article, the local environment was investigated in terms of food production and rare earth element concentration in soil. The collected data will later be used to model thetransfer of radioactive contaminations from the ESS

Blood

This book examines both the fluid and cellular components of blood. After the introductory section, the second section presents updates on various topics in hemodynamics. Chapters in this section discuss anemia, 4D flow MRI in cardiology, cardiovascular complications of robot-assisted laparoscopic pelvic surgery, altered perfusion in multiple sclerosis, and hemodynamic laminar shear stress in oxidative homeostasis. The third section focuses on thalassemia with chapters on diagnosis and screening for thalassemia, high blood pressure in beta-thalassemia, and hepatitis C infection in thalassemia patients

Altered cord blood biomarkers in neonatal brain injury

Introduction: Alterations in RNA and proteins observed at birth may have long-term effects on early life. Perinatal asphyxia (PA) accounts for a quarter of all global neonatal deaths. Early intervention is critical for developing strategies to improve long-term outcome. Early identifiers for infants at risk of HIE is prone to subjective-bias or poorly objective biochemical measurements. The umbilical cord blood (UCB) can give a snapshot of both the newborn and the in-utero environment. It is non-invasive to both mother and infant and contains microRNA (miRNA), messenger RNA (mRNA) and circulating proteins that can exist stably in the circulation. This thesis aims to progress further the knowledge of UCB biomarkers using low-throughput techniques in both RNA and protein analyses, and to explore and validate proposed and potential biomarkers in HIE. Methods: This thesis utilised three distinct, well-defined cohorts throughout, the BiHIVE1 cohort (2009- 2011), the BiHiVE2 cohort (2012-1015), and the BASELINE longitudinal birth cohort (2008- 2016). The BiHIVE1 cohort was recruited in Cork, Ireland (7500 live births per annum), this study included full-term infants with PA enrolled at birth. This cohort recruited 112 cases (40 developed HIE - 24 mild, 6 moderate and 10 severe), of these 52 had neurodevelopmental follow-up, and 7 died in infancy. For this cohort, healthy controls were recruited from the BASELINE cohort. The BiHiVE2 validation cohort was recruited in Cork, Ireland and Karolinska Huddinge, Sweden (4400 live births per annum), this study included infants with PA along with healthy control infants. This cohort recruited 353 cases (48 developed HIE - 32 mild, 14 moderate and 2 severe) and 289 controls, 449 had neurodevelopmental follow-up, and no deaths occurred in infancy. Infants with perinatal asphyxia had matched inclusion criteria across both BiHiVE1 and BiHiVE2. Infants were assigned a modified Sarnat score at 24 hours and were followed-up with neurological assessment and neurodevelopmental outcome at 18-36 months of age. Umbilical cord serum, plasma and whole blood were processed and biobanked across all cohorts at delivery and stored at -80°C. Techniques employed throughout the thesis include blood processing, RNA isolations of whole blood miRNA and mRNA, and subsequent cDNA synthesis and quantitative real-time polymerase chain reaction (qPCR). Protein expression measurements were conducted with sandwich enzyme-linked immunosorbent assays (ELISA) on cord serum samples. All statistical analyses were conducted using IBM SPSS Statistics 24, graphical representation of data was generated using GraphPad Prism 8. Results: miRNA Panel: One-hundred and sixty infants had miRNA qPCR analyses across both BiHiVE1 and BiHiVE2. In BiHIVE1, 12 candidate miRNAs were identified, and 7 of these miRNAs were chosen for validation in BiHIVE2. The BiHIVE2 cohort showed consistent alteration of 3 miRNAs; miR-374a-5p was decreased in infants diagnosed as having HIE compared with healthy control infants (P = 0.009), miR-376c-3p was decreased in infants with PA compared with healthy control infants (P = 0.004), and miR-181b-5p was decreased in infants eligible for therapeutic hypothermia (TH) (P = 0.02). Predicted mRNA Targets: One-hundred and twenty-six infants had mRNA analyses. In the grade of HIE severity, the level of mFZD4 was increased in severe HIE vs mild HIE (P = 0.004), and severe HIE vs moderate HIE (P = 0.003). Fifty-six infants were included in the neurodevelopmental outcome analysis; Levels of mNFAT5 were increased in severely abnormal vs normal outcome (P = 0.036), and in severely abnormal vs mildly abnormal outcome (P = 0.013). Levels of mFZD4 were increased in severely abnormal vs normal outcome (P = 0.004), and in severely abnormal vs mildly abnormal outcome (P = 0.026). Interleukin-16: One-hundred and thirteen infants were included in the final analyses. Cord blood-based IL-16 was increased in infants with perinatal asphyxia and HIE relative to controls (P = 0.025). IL-16 was also increased in the HIE group relative to controls (P = 0.042). There was no significant difference in IL-16 across grades of HIE or in those with abnormal outcomes at 2-years of age. Activin A and mACVR2B: Serum activin A analyses included 101 infants. No differences were observed across the groups (P = 0.693). The HIE group included 23 infants; a combination of mild and moderate HIE, without infants with a severe grade. No differences were observed across the grades of HIE (P = 0.115). Whole blood mACVR2B analyses included 68 infants, and no differences were observed across the groups (P = 0.746). The HIE group included 22 infants, and no differences were observed across the grades of HIE (mild and moderate only) (P = 0.468). No differences were observed in infants followed up to 18-36 months in serum activin A or in whole blood mACVR2B, (P = 0.550) and (P = 0.881) respectively. Conclusions: This thesis has identified and validated the decreased expression of UCB miRNA (miR-181b, 374a and miR-376c), increased expression of UCB mRNA (mNFAT5 and mFZD4) and increased UCB cytokine expression (IL-16) across two cohorts in HIE. It validates previous miRNA whole blood biomarkers of PA (miR-376c) and HIE (miR-374a) and proposes novel whole blood mRNA biomarkers as assessors for both HIE severity (mFZD4) and long-term neurodevelopmental outcome (mNFAT5 and mFZD4), which can outperform current measurements. These miRNA and mRNA could aid current measures as objective diagnostic and prognostic markers of HIE. It has further explored the strengths of cytokines and proteins and confirmed their inability as biomarkers across HIE groups and grades. This work has an important role in further developing UCB-based biomarkers in early life

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society

The Catalan Health Care System in a process of change: review of the 2011-2015 Health Plan for Catalonia at the halfway point

Planificació sanitària; Sistema sanitari; Línies estratègiquesPlanificación sanitaria; Sistema sanitario; Líneas estratégicasHealth planning; Health system; Strategic linesAquest document de balanç a meitat del període del Pla de salut 2011-2015 parteix de l‘orientació dels objectius de salut i se centra en aquelles línies d‘actuació que tenen major significat quant a la transformació del model assistencial (orientació a la cronicitat, major resolució i accessibilitat, qualitat en l‘alta especialització, enfocament cap a les persones, salut pública amb perspectiva interdepartamental).Este documento de balance a mitad del período del Plan de Salud 2011-2015 parte de la orientación de los objetivos de salud y se centra en aquellas líneas de actuación que tienen mayor significado en cuanto a la transformación del modelo asistencial (orientación a la cronicidad, mayor resolución y accesibilidad, calidad en la alta especialización, enfoque hacia las personas, salud pública con perspectiva interdepartamental).This review at the halfway point of the of the 2011-2015 health plan is based on the orientation of the health care objectives and focuses on those lines of action that are of greater significance in terms of transforming the model of care (orientation toward chronicity, greater resolution and accessibility, quality in high specialization, focus on people, public health from an interdepartmental perspective)

12 Chapters on Nuclear Medicine

The development of nuclear medicine as a medical specialty has resulted in the large-scale application of its effective imaging methods in everyday practice as a primary method of diagnosis. The introduction of positron-emitting tracers (PET) has represented another fundamental leap forward in the ability of nuclear medicine to exert a profound impact on patient management, while the ability to produce radioisotopes of different elements initiated a variety of tracer studies in biology and medicine, facilitating enhanced interactions of nuclear medicine specialists and specialists in other disciplines. At present, nuclear medicine is an essential part of diagnosis of many diseases, particularly in cardiologic, nephrologic and oncologic applications and it is well-established in its therapeutic approaches, notably in the treatment of thyroid cancers. Data from official sources of different countries confirm that more than 10-15 percent of expenditures on clinical imaging studies are spent on nuclear medicine procedures

Automated deep phenotyping of the cardiovascular system using magnetic resonance imaging

Across a lifetime, the cardiovascular system must adapt to a great range of demands from the body. The individual changes in the cardiovascular system that occur in response to loading conditions are influenced by genetic susceptibility, and the pattern and extent of these changes have prognostic value. Brachial blood pressure (BP) and left ventricular ejection fraction (LVEF) are important biomarkers that capture this response, and their measurements are made at high resolution. Relatively, clinical analysis is crude, and may result in lost information and the introduction of noise. Digital information storage enables efficient extraction of information from a dataset, and this strategy may provide more precise and deeper measures to breakdown current phenotypes into their component parts. The aim of this thesis was to develop automated analysis of cardiovascular magnetic resonance (CMR) imaging for more detailed phenotyping, and apply these techniques for new biological insights into the cardiovascular response to different loading conditions. I therefore tested the feasibility and clinical utility of computational approaches for image and waveform analysis, recruiting and acquiring additional patient cohorts where necessary, and then applied these approaches prospectively to participants before and after six-months of exercise training for a first-time marathon. First, a multi-centre, multi-vendor, multi-field strength, multi-disease CMR resource of 110 patients undergoing repeat imaging in a short time-frame was assembled. The resource was used to assess whether automated analysis of LV structure and function is feasible on real-world data, and if it can improve upon human precision. This showed that clinicians can be confident in detecting a 9% change in EF or a 20g change in LV mass. This will be difficult to improve by clinicians because the greatest source of human error was attributable to the observer rather than modifiable factors. Having understood these errors, a convolutional neural network was trained on separate multi-centre data for automated analysis and was successfully generalizable to the real-world CMR data. Precision was similar to human analysis, and performance was 186 times faster. This real-world benchmarking resource has been made freely available (thevolumesresource.com). Precise automated segmentations were then used as a platform to delve further into the LV phenotype. Global LVEFs measured from CMR imaging in 116 patients with severe aortic stenosis were broken down into ~10 million regional measurements of structure and function, represented by computational three-dimensional LV models for each individual. A cardiac atlas approach was used to compile, label, segment and represent these data. Models were compared with healthy matched controls, and co-registered with follow-up one year after aortic valve replacement (AVR). This showed that there is a tendency to asymmetric septal hypertrophy in all patients with severe aortic stenosis (AS), rather than a characteristic specific to predisposed patients. This response to AS was more unfavourable in males than females (associated with higher NT-proBNP, and lower blood pressure), but was more modifiable with AVR. This was not detected using conventional analysis. Because cardiac function is coupled with the vasculature, a novel integrated assessment of the cardiovascular system was developed. Wave intensity theory was used to combine central blood pressure and CMR aortic blood flow-velocity waveforms to represent the interaction of the heart with the vessels in terms of traveling energy waves. This was performed and then validated in 206 individuals (the largest cohort to date), demonstrating inefficient ventriculo-arterial coupling in female sex and healthy ageing. CMR imaging was performed in 236 individuals before training for a first-time marathon and 138 individuals were followed-up after marathon completion. After training, systolic/diastolic blood pressure reduced by 4/3mmHg, descending aortic stiffness decreased by 16%, and ventriculo-arterial coupling improved by 14%. LV mass increased slightly, with a tendency to more symmetrical hypertrophy. The reduction in aortic stiffness was equivalent to a 4-year reduction in estimated biological aortic age, and the benefit was greater in older, male, and slower individuals. In conclusion, this thesis demonstrates that automating analysis of clinical cardiovascular phenotypes is precise with significant time-saving. Complex data that is usually discarded can be used efficiently to identify new biology. Deeper phenotypes developed in this work inform risk reduction behaviour in healthy individuals, and demonstrably deliver a more sensitive marker of LV remodelling, potentially enhancing risk prediction in severe aortic stenosis

Innovative ICT solutions in telemedicine to support clinical practice and research in hospitals

2010/2011The scope of this study was to examine ICT telemedicine innovations and potentialities in web-portals, intranet services and tele-radiology topics respectively, in order to design, develop and, possibly, realize apposite telemedicine systems and solutions for healthcare and in particular for the hospitals. ICT techniques and technologies are nowadays applied in every area of our common living from work places to our homes, our free-time, schools, universities and so on. The healthcare services offered by hospitals are heavily supported by technologies and, behind them, by a wide research both in ICT and biomedical sciences. Thanks to these advances telemedicine is now becoming a fundamental part of services offered by hospitals and healthcare structures. The healthcare management, the doctors and the common people are now experimenting how telemedicine is an added value to all the services offered in terms of the quality of care, the patient follow up, the early diagnose and treatment of pathologies and diseases. In this research is presented an all-inclusive approach to telemedicine problems and challenges in particular studying, developing and proposing ICT methods and technologies in the above mentioned three areas of interest: •innovative healthcare and telemedicine-ready hospital website or portal design and development; •analysis and study of models for the realization of intranet healthcare services to enhance both quality of care and the management of healthcare personnel evaluation; •tele-radiology and some of its actual new perspectives as the study and the evaluation of the “mobile” tele-radiology approach using commercial tablets (and what it could mean).For the first topic the results may be summarized in the development of a more interactive and “social” hospital web-portal offering original solutions and services to all the categories of users (audience, professionals, researchers), allowing them – through the use of advanced tools - to configure and select their own pages and interests. The originality of this approach consists in a good cost/effective result in the respect of the last and worldwide accepted Internet regulations and policies too. A similar approach regarded the intranet services and the design of web interfaces for the clinical practice and the executive evaluation. These kind of innovative systems regard a limited and selected number of more skilled users, typically belonging to a corporation or to specific offices. As above the approach is important: interactive services, innovative tools and affordable instruments are the keywords of the systems designed or proposed to solve specific problems or needs. The last research topic concerned the proposal of a protocol for the assessment of medical images on commercial displays, interesting the stakeholders and the groups involved in medical images treatment, visualization and communication. The potentialities of the mobile tablet devices improve day after day and new devices are marketed every week and the innovation is round the corner. These potentialities must encounter the medical diagnostics world and meet the standards and the regulations the international community established. It will be difficult for a commercial tablet to obtain the medical device CE mark not only for commercial reasons, but the technical limits may be reached and even surpassed adopting objective measures and evaluations. This study demonstrates that commercial tablets may be used in clinical practice for the correct visualization and diagnose of medical images. The measures of some display characteristics may be considered acceptable for mobile interpretation (even report?) of medical images, but if and only if the ambient lighting conditions are under objective control and integrated automated systems in tablets warns physicians about bad or borderline technical and ambient restrictions or bonds.XXIII Ciclo197

Textbook of Patient Safety and Clinical Risk Management

Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems. The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties