Can Image Enhancement Allow Radiation Dose to Be Reduced Whilst Maintaining the Perceived Diagnostic Image Quality Required for Coronary Angiography?

Objectives: The aim of this research was to quantify the reduction in radiation dose facilitated by image processing alone for percutaneous coronary intervention (PCI) patient angiograms, without reducing the perceived image quality required to confidently make a diagnosis. Methods: Incremental amounts of image noise were added to five PCI angiograms, simulating the angiogram as having been acquired at corresponding lower dose levels (10-89% dose reduction). Sixteen observers with relevant experience scored the image quality of these angiograms in three states - with no image processing and with two different modern image processing algorithms applied. These algorithms are used on state-of-the-art and previous generation cardiac interventional X-ray systems. Ordinal regression allowing for random effects and the delta method were used to quantify the dose reduction possible by the processing algorithms, for equivalent image quality scores. Results: Observers rated the quality of the images processed with the state-of-the-art and previous generation image processing with a 24.9% and 15.6% dose reduction respectively as equivalent in quality to the unenhanced images. The dose reduction facilitated by the state-of-the-art image processing relative to previous generation processing was 10.3%. Conclusions: Results demonstrate that statistically significant dose reduction can be facilitated with no loss in perceived image quality using modern image enhancement; the most recent processing algorithm was more effective in preserving image quality at lower doses. Advances in knowledge: Image enhancement was shown to maintain perceived image quality in coronary angiography at a reduced level of radiation dose using computer software to produce synthetic images from real angiograms simulating a reduction in dose

The time-dependent expression of keratins 5 and 13 during the reepithelialization of human skin wounds

The time-dependent reepithelialization of 55 human surgical skin wounds with a wound age between 8h and more than 2 months was investigated by the immunohistochemical localization of cytokeratins 5 and 13. A complete, rebuilt epidermal layer over the wound area was first detectable in a 5-day-old wound, while all wounds of more than 18 days duration contained a completely reepithelialized wound area. Between 5 and 18 days the basal layer of keratinocytes showed — in contrast to normal skin — only some cells positive for cytokeratin 5. In some, but not all lesions with a wound age of 13 days or more, a basal cell layer completely staining for cytokeratin 5 was demonstrable. This staining pattern was found in all skin wounds with a wound age of more than 23 days. The immunohistochemical detection of cytokeratin 13 which can be observed regularly in non-cornifying squamous epithelia provides no information for the time-estimation of human skin wounds, since no significant temporary expression of this polypeptide seems to occur during the healing of human skin wounds

Modern carbonate ooids preserve ambient aqueous REE signatures

Skeletal and non-skeletal components of marine sedimentary rocks have been analyzed for the purpose of reconstructing the rare earth element (REE) and yttrium (Y) compositions of paleo-seawater, but skeletal carbonates frequently have proven to be unreliable recorders of seawater chemistry. Here, we present a systematic multi-technique assessment of rare earth and other trace elements in ooid sands from the modern Great Bahama Bank (GBB–marine) and Great Salt Lake (GSL–continental) based on strong-acid (hydrofluoric and nitric) and weak-acid (acetic) digestions, as well as laser ablation (LA) of ooid cortices and nuclei. The results show that Bahamian ooid cortices possess shale-normalized REE + Y features nearly identical to those of shallow seawater, including limited contamination from siliciclastic REEs. An admixture of even 0.2% of detritally sourced material can modify the primary marine REE + Y patterns by, for example, increasing the light REE (LREE) content. Mean values of LA data for Bahamian ooid cortices exhibit similar REE + Y signatures to those produced by acetic acid digestion, but LA data are generally noisier, primarily as a result of low REE concentrations and the small volume of carbonate ablated in analysis. Screening out samples with ΣREE  0.9 ppm) returns a flat pattern, suggesting similar degrees of LREE depletion controlled by carbonate complexation under similar aqueous alkalinity conditions in Great Salt Lake and Bahamian waters. In summary, ooids can be a reliable proxy for REE + Y characteristics of ambient surficial waters when adopting suitable analytical methods, including laser ablation, that allow the identification and isolation of a contamination signal from siliciclastic detritus

Temporal and Individual Variation in Offspring Provisioning by Tree Swallows: A New Method of Automated Nest Attendance Monitoring

Studies of the ecology and evolution of avian nesting behavior have been limited by the difficulty and expense of sampling nest attendance behavior across entire days or throughout a substantial portion of the nestling period. Direct observation of nesting birds using human observers and most automated devices requires sub-sampling of the nestling period, which does not allow for the quantification of the duration of chick-feeding by parents within a day, and may also inadequately capture temporal variation in the rate at which chicks are fed. Here I describe an inexpensive device, the Automated Perch Recorder (APR) system, which collects accurate, long-term data on hourly rates of nest visitation, the duration of a pair's workday, and the total number of visits the pair makes to their nest across the entire period for which it is deployed. I also describe methods for verifying the accuracy of the system in the field, and several examples of how these data can be used to explore the causes of variation in and tradeoffs between the rate at which birds feed their chicks and the total length of time birds spend feeding chicks in a day

Foot and ankle injuries during the Athens 2004 Olympic Games

<p>Abstract</p> <p>Background</p> <p>Major, rare and complex incidents can occur at any mass-gathering sporting event and team medical staff should be appropriately prepared for these. One such event, the Athens Olympic Games in 2004, presented a significant sporting and medical challenge. This study concerns an epidemiological analysis of foot and ankle injuries during the Games.</p> <p>Methods</p> <p>An observational, epidemiological survey was used to analyse injuries in all sport tournaments (men's and women's) over the period of the Games.</p> <p>Results</p> <p>A total of 624 injuries (525 soft tissue injuries and 99 bony injuries) were reported. The most frequent diagnoses were contusions, sprains, fractures, dislocations and lacerations. Significantly more injuries in male (58%) versus female athletes (42%) were recorded. The incidence, diagnosis and cause of injuries differed substantially between the team sports.</p> <p>Conclusion</p> <p>Our experience from the Athens Olympic Games will inform the development of public health surveillance systems for future Olympic Games, as well as other similar mass events.</p

Differing Burden and Epidemiology of Non-Typhi Salmonella Bacteremia in Rural and Urban Kenya, 2006–2009

BACKGROUND: The epidemiology of non-Typhi Salmonella (NTS) bacteremia in Africa will likely evolve as potential co-factors, such as HIV, malaria, and urbanization, also change. METHODS: As part of population-based surveillance among 55,000 persons in malaria-endemic, rural and malaria-nonendemic, urban Kenya from 2006-2009, blood cultures were obtained from patients presenting to referral clinics with fever ≥38.0°C or severe acute respiratory infection. Incidence rates were adjusted based on persons with compatible illnesses, but whose blood was not cultured. RESULTS: NTS accounted for 60/155 (39%) of blood culture isolates in the rural and 7/230 (3%) in the urban sites. The adjusted incidence in the rural site was 568/100,000 person-years, and the urban site was 51/100,000 person-years. In both sites, the incidence was highest in children <5 years old. The NTS-to-typhoid bacteremia ratio in the rural site was 4.6 and in the urban site was 0.05. S. Typhimurium represented >85% of blood NTS isolates in both sites, but only 21% (urban) and 64% (rural) of stool NTS isolates. Overall, 76% of S. Typhimurium blood isolates were multi-drug resistant, most of which had an identical profile in Pulse Field Gel Electrophoresis. In the rural site, the incidence of NTS bacteremia increased during the study period, concomitant with rising malaria prevalence (monthly correlation of malaria positive blood smears and NTS bacteremia cases, Spearman's correlation, p = 0.018 for children, p = 0.16 adults). In the rural site, 80% of adults with NTS bacteremia were HIV-infected. Six of 7 deaths within 90 days of NTS bacteremia had HIV/AIDS as the primary cause of death assigned on verbal autopsy. CONCLUSIONS: NTS caused the majority of bacteremias in rural Kenya, but typhoid predominated in urban Kenya, which most likely reflects differences in malaria endemicity. Control measures for malaria, as well as HIV, will likely decrease the burden of NTS bacteremia in Africa

Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007

<p>Abstract</p> <p>Background</p> <p>Since 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund.</p> <p>Methods</p> <p>Global Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models.</p> <p>Results</p> <p>By end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic <it>falciparum </it>malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented.</p> <p>Conclusions</p> <p>These results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems.</p