Won\u27t You Harmonize With Me?

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Post-mortem perinatal imaging: what is the evidence?

Post-mortem imaging for the investigation of perinatal deaths is an acceptable tool amongst parents and religious groups, enabling a less invasive autopsy examination. Nevertheless, availability is scarce nationwide, and there is some debate amongst radiologists regarding the best practice and optimal protocols for performing such studies. Much of the published literature to date focusses on single centre experiences or interesting case reports. Diagnostic accuracy studies are available for a variety of individual imaging modalities (e.g. post-mortem CT, MRI, ultrasound and micro-CT), however, assimilating this information is important when attempting to start a local service. In this article, we present a comprehensive review summarising the latest research, recently published international guidelines, and describe which imaging modalities are best suited for specific indications. When the antenatal clinical findings are not supported by the post-mortem imaging, we also suggest how and when an invasive autopsy may be considered. In general, a collaborative working relationship within a multidisciplinary team (consisting of radiologists, radiographers, the local pathology department, mortuary staff, foetal medicine specialists, obstetricians and bereave-ment midwives) is vital for a successful service

Improving uptake of perinatal autopsy

PURPOSE OF REVIEW: Uptake of perinatal autopsy has declined in the West over the past 30 years, largely because of reduced parental acceptance of a traditional invasive autopsy. Several studies have recently investigated the decline to identify the key factors and how they may be mitigated. RECENT FINDINGS: Three main themes were identified that have been found to improve uptake of perinatal autopsy: improved communication, in particular ensuring the consent process was conducted as a conversation with time spent talking through the procedure and allowing time for questions; health professional training to ensure staff discussing autopsy with parents have adequate understanding of the procedure and are able to convey confidence and empathy; and availability of less invasive autopsy, including noninvasive as well as minimally invasive options. These should be offered alongside standard autopsy, which some parents may still prefer. SUMMARY: This review highlights that the discussions that take place, and the options that are available to parents, can profoundly impact whether or not they consent to autopsy investigation. Further research should focus on the impact of offering less invasive options as well as evaluating the training and support materials that have recently been developed

Decoherence in a double-slit quantum eraser

We study and experimentally implement a double-slit quantum eraser in the presence of a controlled decoherence mechanism. A two-photon state, produced in a spontaneous parametric down conversion process, is prepared in a maximally entangled polarization state. A birefringent double-slit is illuminated by one of the down-converted photons, and it acts as a single-photon two-qubits controlled not gate that couples the polarization with the transversal momentum of these photons. The other photon, that acts as a which-path marker, is sent through a Mach-Zehnder-like interferometer. When the interferometer is partially unbalanced, it behaves as a controlled source of decoherence for polarization states of down-converted photons. We show the transition from wave-like to particle-like behavior of the signal photons crossing the double-slit as a function of the decoherence parameter, which depends on the length path difference at the interferometer.Comment: Accepted in Physical Review

Commercially available artificial intelligence tools for fracture detection: the evidence

Missed fractures are a costly healthcare issue, not only negatively impacting patient lives, leading to potential long-term disability and time off work, but also responsible for high medicolegal disbursements that could otherwise be used to improve other healthcare services. When fractures are overlooked in children, they are particularly concerning as opportunities for safeguarding may be missed. Assistance from artificial intelligence (AI) in interpreting medical images may offer a possible solution for improving patient care, and several commercial AI tools are now available for radiology workflow implementation. However, information regarding their development, evidence for performance and validation as well as the intended target population is not always clear, but vital when evaluating a potential AI solution for implementation. In this article, we review the range of available products utilizing AI for fracture detection (in both adults and children) and summarize the evidence, or lack thereof, behind their performance. This will allow others to make better informed decisions when deciding which product to procure for their specific clinical requirements

Health professionals’ and coroners’ views on less invasive perinatal and paediatric autopsy: a qualitative study

OBJECTIVE: To assess health professionals’ and coroners’ attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting. METHODS: A qualitative study using semistructured interviews. Data were analysed thematically. RESULTS: Twenty-five health professionals (including perinatal/paediatric pathologists and anatomical pathology technologists, obstetricians, fetal medicine consultants and bereavement midwives, intensive care consultants and family liaison nurses, a consultant neonatologist and a paediatric radiologist) and four coroners participated. Participants viewed less invasive methods of autopsy as a positive development in prenatal and paediatric care that could increase autopsy rates. Several procedural and psychological benefits were highlighted including improved diagnostic accuracy in some circumstances, potential for faster turnaround times, parental familiarity with imaging and laparoscopic approaches, and benefits to parents and faith groups who object to invasive approaches. Concerns around the limitations of the technology such not reaching the same levels of certainty as full autopsy, unsuitability of imaging in certain circumstances, the potential for missing a diagnosis (or misdiagnosis) and de-skilling the workforce were identified. Finally, a number of implementation issues were raised including skills and training requirements for pathologists and radiologists, access to scanning equipment, required computational infrastructure, need for a multidisciplinary approach to interpret results, cost implications, equity of access and acceptance from health professionals and hospital managers. CONCLUSION: Health professionals and coroners viewed less invasive autopsy as a positive development in perinatal and paediatric care. However, to inform implementation a detailed health economic analysis and further exploration of parental views, particularly in different religious groups, are required

HoloLens for medical imaging using post-mortem fetal micro-CT data

AIM AND OBJECTIVES: Demonstrate applicability of HoloLens technology for viewing post-mortem fetal micro-CT imaging data. Develop a pipeline focusing on the required editing of 3D segmentations for rendering in virtual reality (VR), file format and storage needs for medical holographic applications and the necessary functionality of a holographic application interface

Body weight-based iodinated contrast immersion timing for human fetal postmortem microfocus computed tomography

Objectives The aim of this study was to evaluate the length of time required to achieve full iodination using potassium tri-iodide as a contrast agent, prior to human fetal postmortem microfocus computed tomography (micro-CT) imaging. Methods Prospective assessment of optimal contrast iodination was conducted across 157 human fetuses (postmortem weight range 2-298 g; gestational age range 12-37 weeks), following micro-CT imaging. Simple linear regression was conducted to analyse which fetal demographic factors could produce the most accurate estimate for optimal iodination time. Results Postmortem body weight (r2 = 0.6435) was better correlated with iodination time than gestational age (r2 = 0.1384), producing a line of best fit, y = [0.0304 × body weight (g)] − 2.2103. This can be simplified for clinical use whereby immersion time (days) = [0.03 × body weight (g)] − 2.2. Using this formula, for example, a 100-g fetus would take 5.2 days to reach optimal contrast enhancement. Conclusions The simplified equation can now be used to provide estimation times for fetal contrast preparation time prior to micro-CT imaging and can be used to manage service throughput and parental expectation for return of their fetus. Advances in knowledge A simple equation from empirical data can now be used to estimate preparation time for human fetal postmortem micro-CT imaging

Joint measurements of spin, operational locality and uncertainty

Joint, or simultaneous, measurements of non-commuting observables are possible within quantum mechanics, if one accepts an increase in the variances of the jointly measured observables. In this paper, we discuss joint measurements of a spin 1/2 particle along any two directions. Starting from an operational locality principle, it is shown how to obtain a bound on how sharp the joint measurement can be. We give a direct interpretation of this bound in terms of an uncertainty relation.Comment: Accepted for publication in Phys. Rev.