CT evaluation of the equivocal pulmonary nodule

In the setting of a questionable pulmonary nodule demonstrated by conventional radiographs, the place of CT in the diagnostic algorithm is not well established. We reviewed our experience in 50 consecutive patients referred to CT for a "possible pulmonary nodule." From the chest radiographs we noted nodule location, maximum dimension, presence on one or both views, and presence on a previous radiograph (> 1 year old), and nodules were categorized as "likely" or "unlikely" to be real parenchymal lesions based on radiographic appearance. Of a total of 56 questionable nodules, CT demonstrated no abnormality in 21 cases, parenchymal nodules in 16, scarring, atelectasis, or infiltrate in 11, and normal structural variants in 8. True pulmonary nodules were statistically significantly more frequently categorized as "likely" lesions than normal variants or no disease, but this was not of a magnitude to be clinically useful. Based on analysis of various radiographic features of equivocal nodules and their subsequent outcomes, we suggest a radiologic approach to the equivocal pulmonary nodule.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26780/1/0000336.pd

What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK?

Background: The UK has poor lung cancer survival rates and high early mortality, compared to other countries. We aimed to identify factors associated with early death, and features of primary care that might contribute to late diagnosis. Methods: All cases of lung cancer diagnosed between 2000 and 2013 were extracted from The Health Improvement Network database. Patients who died within 90 days of diagnosis were compared with those who survived longer. Standardised chest X-ray (CXR) and lung cancer rates were calculated for each practice. Results: Of 20 142 people with lung cancer, those who died early consulted with primary care more frequently prediagnosis. Individual factors associated with early death were male sex (OR 1.17; 95% CI 1.10 to 1.24), current smoking (OR 1.43; 95% CI 1.28 to 1.61), increasing age (OR 1.80; 95% CI 1.62 to 1.99 for age ≥80 years compared to 65–69 years), social deprivation (OR 1.16; 95% CI 1.04 to 1.30 for Townsend quintile 5 vs 1) and rural versus urban residence (OR 1.22; 95% CI 1.06 to 1.41). CXR rates varied widely, and the odds of early death were highest in the practices which requested more CXRs. Lung cancer incidence at practice level did not affect early deaths. Conclusions: Patients who die early from lung cancer are interacting with primary care prediagnosis, suggesting potentially missed opportunities to identify them earlier. A general increase in CXR requests may not improve survival; rather, a more timely and appropriate targeting of this investigation using risk assessment tools needs further assessment

Annihilation range and final-state interaction in the antiproton-proton annihilation into pi-pi+

The large set of accurate data on differential cross section and analyzing power from the CERN LEAR experiment on $\bar pp \to \pi^+\pi^-$ in the range from 360 to 1550 MeV/c is well reproduced within a distorted wave approximation approach. The initial $\bar pp$ scattering wave functions originate from a recent $\bar N N$ model. The transition operator is obtained from a combination of the $^3P_0$ and $^3S_1$ quark-antiquark annihilation mechanisms. A good fit to the data, in particular the reproduction of the double dip structure observed in the analyzing powers, requires quark wave functions for proton, antiproton, and pions with radii slightly larger than the respective measured charge radii. This corresponds to an increase in range of the annihilation mechanisms and consequently the amplitudes for total angular momentum J=2 and higher are much larger than in previous approaches. The final state $\pi\pi$ wave functions, parameterized in terms of $\pi\pi$ phase shifts and inelasticities, are also a very important ingredient for the fine tuning of the fit to the observables.Comment: 11 pages, 11 figures (Revtex 4), revised version with one additional figure. Accepted for publication in PR

Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields

Breckenkamp J, Berg-Beckhoff G, Muenster E, et al. Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields. Environmental Health. 2009;8(1):23.Background: The aim of this study was to examine the feasibility of performing a cohort study on health risks from occupational exposure to radiofrequency electromagnetic fields (RF-EMF) in Germany. Methods: A set of criteria was developed to evaluate the feasibility of such a cohort study. The criteria aimed at conditions of exposure and exposure assessment (level, duration, preferably on an individual basis), the possibility to assemble a cohort and the feasibility of ascertaining various disease endpoints. Results: Twenty occupational settings with workers potentially exposed to RF-EMF and, in addition, a cohort of amateur radio operators were considered. Based on expert ratings, literature reviews and our set of predefined criteria, three of the cohorts were identified as promising for further evaluation: the personnel (technicians) of medium/short wave broadcasting stations, amateur radio operators, and workers on dielectric heat sealers. After further analyses, the cohort of workers on dielectric heat sealers seems not to be feasible due to the small number of exposed workers available and to the difficulty of assessing exposure (exposure depends heavily on the respective working process and mixture of exposures, e.g. plastic vapours), although exposure was highest in this occupational setting. The advantage of the cohort of amateur radio operators was the large number of persons it includes, while the advantage of the cohort of personnel working at broadcasting stations was the quality of retrospective exposure assessment. However, in the cohort of amateur radio operators the exposure assessment was limited, and the cohort of technicians was hampered by the small number of persons working in this profession. Conclusion: The majority of occupational groups exposed to RF-EMF are not practicable for setting up an occupational cohort study due to the small numbers of exposed subjects or due to exposure levels being only marginally higher than those of the general public

The kick with the kite: an analysis of kite surfing related off shore rescue missions in Cape Town, South Africa

Methods: The observation period for this study started on October 1, 2003 and ended on May 1, 2004 and included 30 air rescue missions. Data and information were collected prospectively. Results: The Air Mercy Service in Cape Town Province responded to 30 requests for help. Twenty five accidents were attributed to inability to detach the kite from the harness. Injuries occurred in five incidents and included fractures of the upper arm, ribs and ankle, and lacerations and contusions to the head and neck. Two patients suffered from hypothermia and one experienced severe exhaustion. All surfers were rescued successfully and there were no fatal accidents. Discussion: The risk potential of this new sport is unclear. Dangerous situations can occur despite proper training and safety precautions due to unpredictable conditions and difficulties with equipment. Safety should be stressed. Surfers should sailing with a fellow kiter and should wear a life vest. More efforts must be taken to make this booming new water sport safer