What causes increasing and unnecessary use of radiological investigations? a survey of radiologists' perceptions

<p>Abstract</p> <p>Background</p> <p>Growth in use and overuse of diagnostic imaging significantly impacts the quality and costs of health care services. What are the modifiable factors for increasing and unnecessary use of radiological services? Various factors have been indentified, but little is known about their relative impact. Radiologists hold key positions for providing such knowledge. Therefore the purpose of this study was to obtain radiologists' perspective on the causes of increasing and unnecessary use of radiological investigations.</p> <p>Methods</p> <p>In a mailed questionnaire radiologist members of the Norwegian Medical Association were asked to rate potential causes of increased investigation volume (fifteen items) and unnecessary investigations (six items), using five-point-scales. Responses were analysed by using summary statistics and Factor Analysis. Associations between variables were determined using Students' t-test, Spearman rank correlation and Chi-Square tests.</p> <p>Results</p> <p>The response rate was 70% (374/537). The highest rated causes of increasing use of radiological investigations were: a) new radiological technology, b) peoples' demands, c) clinicians' intolerance for uncertainty, d) expanded clinical indications, and e) availability. 'Over-investigation' and 'insufficient referral information' were reported the most frequent causes of unnecessary investigations. Correlations between causes of increasing and unnecessary radiology use were identified.</p> <p>Conclusion</p> <p>In order to manage the growth in radiological imaging and curtail inappropriate investigations, the study findings point to measures that influence the supply and demand of services, specifically to support the decision-making process of physicians.</p

Pu and U Atom Ratios and Concentration Factors in Reservoir 11 and Asanov Swamp, Mayak PA: An Application of Accelerator Mass Spectrometry

Mayak Production Association, East Ural, Russia, was established to produce weapons-grade plutonium. Routine discharges and accidents at Mayak PA contaminated large areas, including the Techa River. The objectives of the present work were to study atom ratios for plutonium and, for the first time to our knowledge, uranium isotopes in water, soil, grass, and aquatic biota samples from Reservoir 11 and the Asanov Swamp, downstream from Mayak PA. Atom ratios (240Pu/239Pu, 236U/235U, 235U/238U) were determined using accelerator mass spectrometry to confirm radionuclide source characteristics and calculate activities and concentration factors for the studied samples. The lowest 240Pu/239Pu atom ratios were consistently found in Asanov Swamp samples (∼0,019), indicating a major contribution from early discharges of weapons-grade Pu. 240Pu/239Pu atom ratios in Reservoir 11 were higher, indicating influence from more recent civil reprocessing. The presence of 236U is usually indicative of fuel irradiation; 236U/235U ratios increase from weapons to civil sources. Our new data show that Asanov samples had lower 236U/235U ratios than Reservoir 11 samples (0.0005-0.0045 for Asanov compared with 0.0074-0.0153 for Reservoir 11) in agreement with Pu results. Pu and U concentration factors calculated for vegetation and biota samples at Mayak were comparable with corresponding values found in the literature

Rheumatoid factor isotype switch and somatic mutation variants within rheumatoid arthritis synovium

The presence of clonally-related B-lymphocyte aggregates within synovial lining tisue of rheumatoid arthritis (RA) patients suggests a germinal centre-like reaction, which may hold implications for disease pathogenesis and the causes of chronic inflammation. We studied 250 rheumatoid factor (RF) heavy-chain sequences cloned from the synovium of three patients with RA, to determine whether they undergo both somatic mutation and isotype switching consistent with this hypothesis. Size analysis of immunoglobulin heavy-chain cDNAs from synovial RF+ B cells revealed oligoclonal RF+ populations and identically-sized VH-D-JH transcripts of different immunoglobulin isotypes. Sequencing of individual inserts selected from cloned immunoglobulin heavy-chain cDNAs demonstrated a clonal relationship between immunoglobulin M (IgM) RF and IgA RF, suggesting that this isotype switch occurred in synovium. Furthermore, most somatic mutations were found to have occurred after this isotype switch. This finding suggests that the RA synovial microenvironment sustains somatic mutation and isotype switching in RF-specific B lymphocytes akin to secondary lymphoid organs