Use of quantitative ultrasound scans of the calcaneus to diagnose osteoporosis in patients with rheumatoid arthritis

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis.Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist andCUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosedby the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis.Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of theCUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis.Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have arole in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. <br/

Use of Quantitative Ultrasound Scans of the Calcaneus to Diagnose Osteoporosis in Patients with Rheumatoid Arthritis

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis.Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist andCUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosedby the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis.Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of theCUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis.Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have arole in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. <br/

A self-consistent, multi-variate method for the determination of gas phase rate coefficients, applied to reactions of atmospheric VOCs and the hydroxyl radical

Gas-phase rate coefficients are fundamental to understanding atmospheric chemistry, yet experimental data are not available for the oxidation reactions of many of the thousands of volatile organic compounds (VOCs) observed in the troposphere. Here a new experimental method is reported for the simultaneous study of reactions between multiple different VOCs and OH, the most important daytime atmospheric radical oxidant. This technique is based upon established relative rate concepts but has the advantage of a much higher throughput of target VOCs. By evaluating multiple VOCs in each experiment, and through measurement of the depletion in each VOC after reaction with OH, the OH + VOC reaction rate coefficients can be derived. Results from experiments conducted under controlled laboratory conditions were in good agreement with the available literature for the reaction of nineteen VOCs, prepared in synthetic gas mixtures, with OH. This approach was used to determine a rate coefficient for the reaction of OH with 2,3-dimethylpent-1-ene for the first time; k = 5.7 (±0.3) × 10–11–cm3 molecule−1 s−1. In addition, a further seven VOCs had only two, or fewer, individual OH rate coefficient measurements available in the literature. The results from this work were in good agreement with those measurements. A similar dataset, at an elevated temperature of 323 (±10) K, was used to determine new OH rate coefficients for twelve aromatic, five alkane, five alkene and three monoterpene VOC + OH reactions. In OH relative reactivity experiments that used ambient air at the University of York, a large number of different VOCs were observed, of which 23 were positively identified. 19 OH rate coefficients were derived from these ambient air samples, including ten reactions for which data was previously unavailable at the elevated reaction temperature of T = 323 (±10) K

The quality of different types of child care at 10 and 18 months. A comparison between types and factors related to quality.

The quality of care offered in four different types of non-parental child care to 307 infants at 10 months old and 331 infants at 18 months old was compared and factors associated with higher quality were identified. Observed quality was lowest in nurseries at each age point, except that at 18 months they offered more learning activities. There were few differences in the observed quality of care by child-minders, grandparents and nannies, although grandparents had somewhat lower safety and health scores and offered children fewer activities. Cost was largely unrelated to quality of care except in child-minding, where higher cost was associated with higher quality. Observed ratios of children to adults had a significant impact on quality of nursery care; the more infants or toddlers each adult had to care for, the lower the quality of the care she gave them. Mothers' overall satisfaction with their child's care was positively associated with its quality for home-based care but not for nursery settings

Ozone photochemistry during the UK heat wave of August 2003

A wide range of chemical and physical parameters have been observed over the course of a severe Europe-wide air pollution episode in August 2003. Detailed surface observations made at the rural perimeter edge of London, U.K. indicated significantly elevated levels of primary VOCs, ozone (>110ppb), other photochemical by-products such as PAN, HCHO, and higher oxygenates but not NOx. Reactive organic tracers in combination with surface Doppler wind radar and back trajectory analysis have been used to establish that initial rapid morning rises in O3 during the episode were caused by entrainment of air from aloft, polluted on regional scales from mainland Europe. Total VOC reactivity to OH approximately doubled during this episode, with similar distribution between functional groups, but showing a temperature dependant exponentially increasing contribution from biogenic isoprene (max 1.2 ppbV). In addition to entrainment of regional air pollution, ozone formation rates within the U.K. boundary layer on the day of observation have been determined using measured peroxy radicals in combination with other chemical data. Under episodic conditions total peroxy radicals in excess 120pptV were observed in late afternoon with strong correlation to a later and higher peak in ozone when compared to non-episodic conditions. During the daytime under episodic conditions alkyl peroxy radical formation was dominated by PAN thermolysis, whose afternoon lifetime averaged only 18.3 min, but which was sustained at a concentration greater than 750 pptV. Low episodic wind speeds resulted in a relatively small possible spatial footprint for emissions of reactive precursors to PAN, and a strong correlation between isoprene and PAN production rate suggest this species may have contributed to the later afternoon increases seen in surface O3