Oh You Blondy

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A training tool for clinicians in segmenting medical images to make 3D models

INTRODUCTION: 3D models produced from medical imaging can be used to plan treatment, design prosthesis, teach, and for communication. Despite the clinical benefit, few clinicians have experience of how 3D models are produced. This is the first study evaluating a training tool to teach clinicians to produce 3D models and reporting the perceived impact on their clinical practice. METHOD: Following ethical approval, 10 clinicians completed a bespoke training tool, comprising written and video material alongside online support. Each clinician and 2 technicians (included as control) were sent 3 CT scans and asked to produce 6 fibula 3D models using open-source software (3Dslicer). The produced models were compared to those produced by the technicians using Hausdorff distance calculation. Thematic analysis was used to study the postintervention questionnaire. RESULTS: The mean Hausdorff distance between the final model produced by the clinicians and technicians was 0.65 mm ± SD 0.54 mm. The first model made by clinicians took a mean time of 1 hour 25 minutes and the final model took 16:04 minutes (5:00–46:00 minutes). 100% of learners reported finding the training tool useful and will employ it in future practice. DISCUSSION: The training tool described in this article is able to successfully train clinicians to produce fibula models from CT scans. Learners were able to produce comparable models to technicians within an acceptable timeframe. This does not replace technicians. However, the learners perceived this training will allow them to use this technology in more cases, with appropriate case selection and they appreciate the limits of this technology

Third Annual Families and Neighborhoods Network Update

Welcome to the Third Annual Families and Neighborhoods Network Update. In this edition, which focuses on Family Development, you'll find plenty of relevant, interesting news, as well as diversity and spirituality in the context of family development.As always, we strive to provide information and resources regarding human service efforts that support families and neighborhoods. The selection of information and articles for this issue of the Network Update was based on issues raised by the seven Comprehensive Community-BasedModels (CCBMs).Among the highlights of this issue is an article by Dr. Susan Stern and Cassandra Clay, professors at Boston University School of Social Work. In their article, titled "Supporting Children and Families in a Caring Community," they challenge our thinking about family development, while guiding practitioners, policymakers, fund providers, and grassroots community-based organizations into the next century.Also in this issue, you'll find two annotated bibliographies that explore community-based, family centered strategies for integrating education and human services. These bibliographies also present practical ways to design policies that reflect the importance of the family in the development of children and society. As an additional resource, you'll also find a directory of federally-funded resource centers and clearinghouses that compile information on child andfamily welfare, health, and education issues.This issue of the Network Update also offers a personal glimpse of the seven W.K. Kellogg Foundation-funded family development sites. Each of the sites was asked to share its definition of family development, and to specify how that definition translates into services or opportunities for families. Staff members at the seven sites also were asked to discuss their philosophies about family development and how that philosophy differs from a mainstream view. Their thought provoking answers are just a few pages away

High Cancer Burden Among Antiretroviral Therapy Users in Malawi: a Record Linkage Study of Observational HIV Cohorts and Cancer Registry Data.

Background With antiretroviral therapy (ART), AIDS-defining cancer incidence has declined and non-AIDS defining cancers are now more frequent among HIV-infected populations in high-income countries. In sub-Saharan Africa, limited epidemiological data describe cancer burden among ART users. Methods We used probabilistic algorithms to link cases from the population-based cancer registry with electronic medical records supporting ART delivery in the Malawi's two largest HIV cohorts, Lighthouse Trust (LT; 2007-2010) and Queen Elizabeth Central Hospital (QECH; 2000-2010). Age-adjusted cancer incidence rates (IR) and 95% confidence intervals were estimated by cancer site, early versus late incidence periods (4 -24 and >24 months after ART start), and WHO stage among naïve ART initiators enrolled for at least 90 days. Results We identified 4,346 cancers among 28,576 persons. Most people initiated ART at advanced WHO stage (LT stage 3/4: 55%; QECH stage 3/4: 66%); 12% of patients had prevalent malignancies at ART initiation, which were predominantly AIDS-defining eligibility criteria for initiating ART. Kaposi sarcoma (KS) had the highest IR (634.7 per 100,000 person-years), followed by cervical cancer (36.6). KS incidence was highest during the early period 4-24 months after ART initiation. Non-AIDS defining cancers (NADC) accounted for 6% of new cancers. Conclusions Under historical ART guidelines, NADC were observed at low rates, and were eclipsed by high KS and cervical cancer burden. Cancer burden among Malawian ART users does not yet mirror high-income countries. Integrated cancer screening and management in HIV clinics, especially for KS and cervical cancer, remain important priorities in the current Malawi context

Predicted impact of climate change on the distribution of the Critically Endangered golden mantella (Mantella aurantiaca) in Madagascar

The impact of climate change on Malagasy amphibians remains poorly understood. Equally, deforestation, fragmentation, and lack of connectivity between forest patches may leave vulnerable species isolated in habitat that no longer suits their environmental or biological requirements. We assess the predicted impact of climate change by 2085 on the potential distribution of a Critically Endangered frog species, the golden mantella (Mantella aurantiaca), that is confined to a small area of the central rainforest of Madagascar. We identify potential population distributions and climatically stable areas. Results suggest a potential south-eastwardly shift away from the current range and a decrease in suitable habitat from 2110 km2 under current climate to between 112 km2 – 138 km2 by the year 2085 – less than 7% of currently available suitable habitat. Results also indicate that the amount of golden mantella habitat falling within protected areas decreases by 86% over the same period. We recommend research to ascertain future viability and the feasibility of expanding protection to newly identified potential sites. This information can then be used in future conservation actions such as habitat restoration, translocations, re-introductions or the siting of further wildlife corridors or protected areas

Microhabitat preference of the critically endangered golden mantella frog in Madagascar

The golden mantella (Mantella aurantiaca) is a critically endangered (CR) frog, endemic to the eastern rainforests of Madagascar. Although the species is very popular in the pet trade and widely bred in captivity, its specific habitat requirements in the wild are poorly understood. Ten forested sites in the Moramanga district of Madagascar were surveyed for microhabitat and environmental variables, and the presence or absence of golden mantellas in quadrats positioned along transects in the vicinity of breeding sites. Mixed models were used to determine which variables best explained microhabitat use by golden mantellas. Sites where golden mantellas were found tended to have surface temperatures of 2023 ˚C, UVI units at about 2.9, about 30 % canopy cover, and around 30 % herbaceous cover. Within sites, golden mantellas preferred microhabitats that had 70 % leaf litter coverage and relatively low numbers of tree roots. This information can be used to improve the identification and management of habitats in the wild, as well as to refine captive husbandry need

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A Multicenter, Randomized, Placebo‐Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods: A randomized, double‐blind, placebo‐controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P 50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results: A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient‐years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low‐density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C‐reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion: Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists’ Collaboration meta‐analysis of statin effects in other populations