A focussed ethnographic study of diagnostic radiographer problem solving in the trauma setting

Aim: when imaging patients for x-ray examinations Diagnostic Radiographers should position the patient so that bones, joints and soft tissues can be clearly visualised. In order to achieve this a widely accepted set of positioning criteria have been developed for each anatomical region. In the trauma setting the radiographer must either move the injured body part sufficiently to meet the criteria or manipulate the imaging equipment to achieve a similar representation of the anatomy. This difference between the presenting position of the patient and the imaging position required presents the radiographer with an ill-defined problem which employs careful management to minimise patient discomfort, avoid risk of injury and optimise image quality for diagnosis. Little is known of radiographer problem solving in the clinical setting. This research uses focussed ethnography to investigate how the radiographer achieves appropriate positioning of the patient through the application of problem solving.Method: a focussed ethnographic study was undertaken in the clinical setting at two hospital sites. Sixty three observations of trauma imaging examinations were undertaken followed by semi structured interviews with the practitioners. The data were analysed thematically following a structure recommended for focussed ethnography.Results: the findings of this unique study demonstrated a multi-stage assessment process used to evaluate the patients’ injury and ability to co-operate with the examination. In light of the assessment the conduct of the examination varied with the degree of complexity of the examination and a measure of this complexity was developed to illustrate this. Findings demonstrated that in agreement with known models of practice the level of cognition required moved from subconscious to conscious as the complexity of the examination increased it was also found that radiographers recognised the importance of experience in managing imaging examinations. Opportunities for re-design of the examination request card were also identified to aid communication between the referrer and the radiographer and assist in the radiographers’ assessment of the patient. Areas for further research are also suggested

Comparison of the Near-Threshold Production of eta- and K-Mesons in Proton-Proton Collisions

The pp -> pp eta and pp -> pLambda K^+ reactions near threshold are dominated by the first and second S_11 resonance respectively. It is shown that a one-pion-exchange model exciting these isobars reproduces well the ratio of the production cross sections. The consequences for this and other channels are discussed.Comment: 10 pages, LaTeX2e, 1 eps-figur

Ovarian Activity and Oestrous Signs among Group-Housed, Lactating Sows: Influence of Behaviour, Environment and Production

Animal welfare concerns require the development of housing systems that allow the animals to express their natural behaviour. One example of this is the group-housing system for lactating sows. The present study aimed at exploring ovarian activity in such a system. Thirty-eight sows farrowing individually outdoors during spring and summer, and indoors during autumn and winter, and group-housed in groups of four during weeks 3–7 of the lactation period, were monitored regarding reproductive functions, behaviour and production during their first to fourth lactation period. Average ovulation frequency during lactation was 47%. Only 50% of these ovulating cases were accompanied by a standing oestrus. Lactational ovulation frequency was higher in later parities (p < 0.001). Ovulation frequency was higher (p < 0.05) during winter (74%) and spring (69%), than during summer (10%) and autumn (23%). Occurrence of lactational ovulation was associated with some aspects of suckling behaviour and also with litter weight gain (p < 0.05). Forty-nine per cent of the lactational ovulations occurred during the seventh week of lactation. Timing of ovulation seemed positively (p = 0.08) associated with weight loss during lactation. Compared with the sows that were anoestrus during lactation, oestradiol-17β values were higher (p < 0.05) only in the week before occurrence of lactational ovulation. Weaning-to-oestrous interval was prolonged (p < 0.05) among the sows that ovulated during lactation. The present study identifies several factors influencing ovarian activity among group-housed sows, thereby providing tools for the control of lactational ovulation in group-housing systems

Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand.

Background: Severe malaria remains a major cause of death and morbidity amongst adults in the Asiatic tropics. Methods: A retrospective analysis of the clinical and laboratory data of 988 adult patients, hospitalized with Plasmodium falciparum malaria and prospectively recruited to malaria studies in western Thailand between 1986 and 2002, was performed to assess the factors associated with a fatal outcome. Different severity scores and classifications for defining severe malaria were compared and, using multiple logistic regression, simple models for predicting mortality developed. Results: The proportion of patients fulfilling the WHO 2000 definition of severe malaria was 78.1%, and their mortality was 10%. Mortality in patients given parenteral artesunate or artemether (16/317, 5%) was lower than in those given parenteral quinine (59/442, 13%) (P < 0.001). Models using parameter sets based on WHO 1990, 2000 and Adapted AQ criteria plus blood smear parasite-stage assessment gave the best mortality prediction. A malaria prognostic index (MPI), derived from the dataset using five clinical or laboratory variables gave similar prognostic accuracy. Conclusions: The mortality of severe malaria in adults has fallen and the switch from quinine to artesunate has probably been an important contributor. Prognostic indices based on WHO 2000 definitions, and other simpler indices based on fewer variables, provide clinically useful predictions of outcome in Asian adults with severe malaria

Environmental differences between sites control the diet and nutrition of the carnivorous plant Drosera rotundifolia

Background and aims: Carnivorous plants are sensitive to small changes in resource availability, but few previous studies have examined how differences in nutrient and prey availability affect investment in and the benefit of carnivory. We studied the impact of site-level differences in resource availability on ecophysiological traits of carnivory for Drosera rotundifolia L. Methods: We measured prey availability, investment in carnivory (leaf stickiness), prey capture and diet of plants growing in two bogs with differences in N deposition and plant available N: Cors Fochno (0.62 g m−2 yr.−1, 353 μg l−1), Whixall Moss (1.37 g m−2 yr.−1, 1505 μg l−1). The total N amount per plant and the contributions of prey/root N to the plants’ N budget were calculated using a single isotope natural abundance method. Results: Plants at Whixall Moss invested less in carnivory, were less likely to capture prey, and were less reliant on prey-derived N (25.5% compared with 49.4%). Actual prey capture did not differ between sites. Diet composition differed – Cors Fochno plants captured 62% greater proportions of Diptera. Conclusions: Our results show site-level differences in plant diet and nutrition consistent with differences in resource availability. Similarity in actual prey capture may be explained by differences in leaf stickiness and prey abundance

An enormous sulfur isotope excursion indicates marine anoxia during the end-Triassic mass extinction

The role of ocean anoxia as a cause of the end-Triassic marine mass extinction is widely debated. Here, we present carbonate-associated sulfate δ³⁴S data from sections spanning the Late Triassic–Early Jurassic transition, which document synchronous large positive excursions on a global scale occurring in ~50 thousand years. Biogeochemical modeling demonstrates that this S isotope perturbation is best explained by a fivefold increase in global pyrite burial, consistent with large-scale development of marine anoxia on the Panthalassa margin and northwest European shelf. This pyrite burial event coincides with the loss of Triassic taxa seen in the studied sections. Modeling results also indicate that the pre-event ocean sulfate concentration was low (<1 millimolar), a common feature of many Phanerozoic deoxygenation events. We propose that sulfate scarcity preconditions oceans for the development of anoxia during rapid warming events by increasing the benthic methane flux and the resulting bottom-water oxygen demand

Anthropogenic-scale CO2 degassing from the Central Atlantic Magmatic Province as a driver of the end-Triassic mass extinction

The climatic and environmental impact of exclusively volcanic CO2 emissions is assessed during the main effusive phase of the Central Atlantic Magmatic Province (CAMP), which is synchronous with the end-Triassic mass extinction. CAMP volcanism occurred in brief and intense eruptive pulses each producing extensive basaltic lava flows. Here, CAMP volcanic CO2 injections into the surface system are modelled using a biogeochemical box model for the carbon cycle. Our modelling shows that, even if positive feedback phenomena may be invoked to explain the carbon isotope excursions preserved in end-Triassic sedimentary records, intense and pulsed volcanic activity alone may have caused repeated temperature increases and pH drops, up to 5 °C and about 0.2 log units respectively. Hence, rapid and massive volcanic CO2 emissions from CAMP, on a similar scale to current anthropogenic emissions, severely impacted on climate and environment at a global scale, leading to catastrophic biotic consequences

QuantiFERON®-TB gold in-tube performance for diagnosing active tuberculosis in children and adults in a high burden setting.

To determine whether QuantiFERON®-TB Gold In-Tube (QFT) can contribute to the diagnosis of active tuberculosis (TB) in children in a high-burden setting and to assess the performance of QFT and tuberculin skin test (TST) in a prospective cohort of TB suspect children compared to adults with confirmed TB in Tanzania. Sensitivity and specificity of QFT and TST for diagnosing active TB as well as indeterminate QFT rates and IFN-γ levels were assessed in 211 TB suspect children in a Tanzanian district hospital and contrasted in 90 adults with confirmed pulmonary TB. Sensitivity of QFT and TST in children with confirmed TB was 19% (5/27) and 6% (2/31) respectively. In adults sensitivity of QFT and TST was 84% (73/87) and 85% (63/74). The QFT indeterminate rate in children and adults was 27% and 3%. Median levels of IFN-γ were lower in children than adults, particularly children <2 years and HIV infected. An indeterminate result was associated with age <2 years but not malnutrition or HIV status. Overall childhood mortality was 19% and associated with an indeterminate QFT result at baseline. QFT and TST showed poor performance and a surprisingly low sensitivity in children. In contrast the performance in Tanzanian adults was good and comparable to performance in high-income countries. Indeterminate results in children were associated with young age and increased mortality. Neither test can be recommended for diagnosing active TB in children with immature or impaired immunity in a high-burden setting

Evaluation of Phage Display Discovered Peptides as Ligands for Prostate-Specific Membrane Antigen (PSMA)

The aim of this study was to identify potential ligands of PSMA suitable for further development as novel PSMA-targeted peptides using phage display technology. The human PSMA protein was immobilized as a target followed by incubation with a 15-mer phage display random peptide library. After one round of prescreening and two rounds of screening, high-stringency screening at the third round of panning was performed to identify the highest affinity binders. Phages which had a specific binding activity to PSMA in human prostate cancer cells were isolated and the DNA corresponding to the 15-mers were sequenced to provide three consensus sequences: GDHSPFT, SHFSVGS and EVPRLSLLAVFL as well as other sequences that did not display consensus. Two of the peptide sequences deduced from DNA sequencing of binding phages, SHSFSVGSGDHSPFT and GRFLTGGTGRLLRIS were labeled with 5-carboxyfluorescein and shown to bind and co-internalize with PSMA on human prostate cancer cells by fluorescence microscopy. The high stringency requirements yielded peptides with affinities KD∼1 μM or greater which are suitable starting points for affinity maturation. While these values were less than anticipated, the high stringency did yield peptide sequences that apparently bound to different surfaces on PSMA. These peptide sequences could be the basis for further development of peptides for prostate cancer tumor imaging and therapy. © 2013 Shen et al