Comparing magnetic resonance liver fat fraction measurements with histology in fibrosis: the difference between proton density fat fraction and tissue mass fat fraction

Magnetic resonance spectroscopy (MRS) provides a powerful method of measuring fat fraction. However, previous studies have shown that MRS results give lower values compared with visual estimates from biopsies in fibrotic livers. This study investigated these discrepancies and considered whether a tissue water content correction, as assessed by MRI relaxometry, could provide better agreement. 110 patients were scanned in a 1.5 T Philips scanner and biopsies were obtained. Multiple echo MRS (30 × 30 ×  30 mm volume) was used to determine Proton Density Fat Fraction (PDFF). Biopsies were assessed by visual assessment for fibrosis and steatosis grading. Digital image analysis (DIA) was also used to quantify fat fraction within tissue samples. T relaxation times were then used to estimate tissue water content to correct PDFF for confounding factors. PDFF values across the four visually assessed steatosis grades were significantly less in the higher fibrosis group (F3-F4) compared to the lower fibrosis group (F0-F2). The slope of the linear regression of PDFF vs DIA fat fraction was ~ 1 in the low fibrosis group and 0.77 in the high fibrosis group. Correcting for water content based on T increased the gradient but it did not reach unity. In fibrotic livers, PDFF underestimated fat fraction compared to DIA methods. Values were improved by applying a water content correction, but fat fractions were still underestimated

Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

Background: Compared to very low gestational age (\u3c32 weeks, VLGA) cohorts, very low birth weight (\u3c1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (\u3c1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and \u3c32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking

Tales of migration from the global south. The civilized and uncivilized migrant in the narratives of La Tercera and El Mercurio

Migration is not a new phenomenon in Chile as the country has long seen migrants coming from Europe, the Middle East and Asia. Colonial views about race and ethnicity adopted by Latin Americans as part of their class structure (Quijano 2000) established an early differentiation between the “civilized migrant” and the “uncivilized migrant” among groups that arrived on Latin America shores. Chilean news media has echoes of this binary vision between the “civilized = good” migrant and the “uncivilized = bad” migrant. The chapter aims to uncover the narratives of the civilized and uncivilized migrant within the printed news media, particularly in the two major newspapers El Mercurio and La Tercera, by focusing on how these ideas frame the way in which they cover migration.Published versio

Information overload within the health care system : a literature review

There is a widespread view held by health clinicians that their work effectiveness is impaired by ‘information overload.’ Building upon a previous work by Wilson, a review of the literature was undertaken to look for the evidence of this. It was found that the literature, particularly in the context of the clinical environment, was limited. This review explores the diverse overarching theories of information overload, effects of the phenomenon that are perceived to occur and proposed solutions to this problem. Many of the papers noted an information explosion but only three authors explicitly attempted to measure both the quantity and the complexity of this information. It was also found that the typology of the information studied was severely limited with most studies exploring information such as guidelines, access to journals, research findings and other knowledge intensive areas. Solutions proposed seem to concentrate on technological means rather than exploring the use of humans either in management of information or as a step in the filtering process