The use and diagnostic yield of radiology in subjects with longstanding musculoskeletal pain – an eight year follow up

BACKGROUND: Longstanding musculoskeletal pain is common in the general population and associated with frequent use of health care. Plain radiography is a common diagnostic approach in these patients despite knowledge that the use in the investigation of musculoskeletal pain is associated with low diagnostic yield, substantial costs and high radiation exposure. The aim of this study was to assess the use of diagnostic imaging and the proportion of pathological findings with regard to duration and distribution of pain in a cohort from the general population. METHODS: An eight-year longitudinal study based on questionnaires at three occasions and medical records on radiological examinations done in medical care. Thirty subjects were selected from an established population based cohort of 2425 subjects that in 1995 answered a postal survey on pain experience. At baseline there were ten subjects from each of three pain groups; No chronic pain, Chronic regional pain, and Chronic widespread pain (CWP). Those who presented with CWP at two or all three occasions were considered to have a longstanding or re-occurring CWP. In total the thirty subjects underwent 102 radiological examinations during the eight year follow up. RESULTS: There was a non-significant (p = 0.10) finding indicating that subjects with chronic pain at baseline (regional or widespread) were examined three times more often than those with no chronic pain. When the indication for the examination was pain, there was a low proportion of positive findings in subjects with longstanding CWP, compared to all others (5.3% vs 28.9%; p = 0.045). On the other hand, in examinations on other indications than pain the proportion of positive findings was high in the CWP group (62.5% vs 14.8%; p = 0.001). CONCLUSION: Radiological examinations had a low diagnostic yield in evaluation of pain in subjects with longstanding/reoccurring CWP. These subjects had on the other hand more often positive findings when examined on other indications than pain. This may indicate that subjects with longstanding/reoccurring CWP are more prone to other diseases. It is a challenge for caregivers, often primary care physicians, to use radiological examinations to the best for their patients

Social accountability of medical education: Aspects on global accreditation.

Medical doctors constitute a profession which embraces trust from and accountability to society. This responsibility extends to all medical educational institutions. Social accountability of medical education means a willingness and ability to adjust to the needs of patients and health care systems both nationally and globally. But it also implies a responsibility to contribute to the development of medicine and society through fostering competence for research and improvement. Accreditation is a process by which a statutory body evaluates and recognises an educational institution and/or its programme with respect to meeting approved criteria. It is a means for quality assurance, but also a strong power to reinforce the need for improvement and reforms. It must be performed through internationally recognised and transparent standards and should foremost promote quality development. The social accountability of medical education must be included in all accreditation processes at all levels. The global standards programme by World Federation for Medical Education (WFME) provides tools for national or regional accreditation but also guidance for reforms and quality improvement. The standards are used worldwide and have been adopted to local needs in most parts of the world. They are framed to specify attainment at two levels: basic standards or minimum requirements and standards for quality development. The concept of social accountability is embedded in all parts of the WFME standards documents. In 2011, a revision of the standards for undergraduate education has been instituted. Strengthening of aspects on social accountability of medical education will be a particular concern

Self-energy correction to the hyperfine structure splitting of hydrogenlike atoms

A first testing ground for QED in the combined presence of a strong Coulomb field and a strong magnetic field is provided by the precise measurement of the hyperfine structure splitting of hydrogenlike 209Bi. We present a complete calculation of the one-loop self-energy correction to the first-order hyperfine interaction for various nuclear charges. In the low-Z regime we almost perfectly agree with the Z alpha expansion, but for medium and high Z there is a substantial deviation

Митолошките елементи во македонската научно-фантастична книжевност за деца и млади

This paper reflects the presence of mythological elements in the Macedonian contemporary science-fiction literature for children and youth. In the first place, there is a cognitive element, care for the collective destiny of the tribe or community, then "technical utilitarism" or means by which the hero uses to facilitate his enterprise, skills that people from Earth concurrence of the aliens (telepathy, levitation, invisibility), then the topic of cyclical destruction and renewal of the Cosmos, aspect of initiation, the fear of the machines, meeting the primitive civilization, the desire to beat the old age and death, and so on

Pelardäck : program för dimensionering av pelardäck enligt Betonghandboken med kontroll enligt BBK-79.

FELARDÄCK är ett program som dimensionerar och kontrollerar pelardäck enligt Betonghandboken respektive BBK-79· Programmet är skrivet i FORTRAN 77 och utfört av Peter Linde och Hans Lindgren på LDC's VAX 11/780. Programmet innehåller separata programdelar för hantering av indata, beräkning och ger möjligheter till editering (vilket ger användaren stora friheter), vidare är det utbyggbart med rutiner för uppritning av diagram, utskrift av skräddarsydda resultat och för rutiner som ändrar i databaser innehållande materialkvaliteter etc

On the role of Zr and B addition on solidification cracking of IN738LC produced by laser powder bed fusion

The demand for manufacturing increasingly complex geometries for high temperature applications drives the increasing interest into additive manufacturing of nickel-based superalloys. Of particular interest are superalloys with high contents of the strengthening phase γ\u27 such as IN738LC. Previous research suggests that especially B and Zr have a detrimental influence on crack formation during the laser powder bed fusion (LPBF) process. The present study investigates solidification cracks in an IN738LC derivative with increased B (0.03 wt.%) and Zr (0.07 wt.%) in more detail using high resolution techniques such as transmission electron microscopy (TEM) and atom probe tomography (APT). Analysis of the bulk material shows a high number of MC carbides containing Ti and Cr. The concentration profiles indicate non-equilibrium carbide compositions by suggesting that Cr is pushed out of these particles. The carbides are surrounded by a thin B-rich layer at the metal/carbide interface. Analysis of the fracture surface shows both Zr and small amounts of B in the formed oxide layer. The presence of these elements together with thermodynamic calculations and previously reported findings of the same material variant support the hypothesis that low-melting phases are likely reasons for cracking of IN738LC

The effect of boron and zirconium on the microcracking susceptibility of IN-738LC derivatives in laser powder bed fusion

The effect of boron (<0.01 to 0.03 wt%) and zirconium (<0.01 to 0.07 wt%) on the microcracking susceptibility of the γ’-strengthened Ni-base superalloy IN-738LC during laser powder bed fusion (LPBF) was studied using custom designed powder grades. It was found that both elements have a strong effect on the microcracking susceptibility, the microcracks are located at high angle grain boundaries based on EBSD measurements and crack density increases with the content of both elements. High crack density in the material with high boron and zirconium content corresponds to a large fraction of intergranular decohesion facets exhibiting a dendritic morphology on the fracture surface, typical for solidification cracking. Investigation of the fracture surface chemistry by X-ray photoelectron spectroscopy (XPS) indicates that considerable amounts of B and Zr are present in oxide state. Auger electron spectroscopy (AES) confirms that both elements are segregated to the intergranular decohesion facets on the fracture surface. Thin layers of B- and Zr-containing oxide on the microcrack surfaces were indicated by atom probe tomography (APT) as well. Hence, it is suggested that the cracking susceptibility of the studied alloying system is caused by formation of B- and Zr-containing oxide at high-angle grain boundaries during solidification

Anti-infectious and anti-inflammatory effects of peptide fragments sequentially derived from the antimicrobial peptide centrocin 1 isolated from the green sea urchin, Strongylocentrotus droebachiensis

Bacterial resistance against antibiotic treatment has become a major threat to public health. Antimicrobial peptides (AMPs) have emerged as promising alternative agents for treatment of infectious diseases. This study characterizes novel synthetic peptides sequentially derived from the AMP centrocin 1, isolated from the green sea urchin, for their applicability as anti-infective agents.The microbicidal effect of centrocin 1 heavy chain (CEN1 HC-Br), its debrominated analogue (CEN1 HC), the C-terminal truncated variants of both peptides, i.e. CEN1 HC-Br (1--20) and CEN1 HC (1--20), as well as the cysteine to serine substituted equivalent CEN1 HC (Ser) was evaluated using minimal microbicidal concentration assay. The anti-inflammatory properties were assessed by measuring the inhibition of secretion of pro-inflammatory cytokines. All the peptides tested exhibited marked microbicidal and anti-inflammatory properties. No difference in efficacy was seen comparing CEN1 HC-Br and CEN1 HC, while the brominated variant had higher cytotoxicity. C-terminal truncation of both peptides reduced salt-tolerability of the microbicidal effect as well as anti-inflammatory actions. Also, serine substitution of cysteine residue decreased the microbicidal effect. Thus, from the peptide variants tested, CEN1 HC showed the best efficacy and safety profile. Further, CEN1 HC significantly reduced bacterial counts in two different animal models of infected wounds, while Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) failed to develop resistance against this peptide under continued selection pressure. In summary, CEN1 HC appears a promising new antimicrobial agent, and clinical studies are warranted to evaluate the applicability of this AMP for local treatment of infections in man