Diagnostic yield of CT thorax angiography in patients suspected of pulmonary embolism: independent predictors and protocol adherence

OBJECTIVES: To determine the diagnostic yield of computed tomography scanning of the pulmonary arteries (CTPA) in our centre and factors associated with it. Differences between specialties as well as adherence to protocol were investigated. METHODS: All patients receiving a first CTPA for pulmonary embolism (PE) in 2010 were included. Data about relevant clinical information and the requesting specialty were retrospectively obtained. Differences in diagnostic yield were tested using a chi-squared test. Independent predictors were identified with multivariate logistic regression. RESULTS: PE on CTPA was found in 224 of the 974 patients (23 %). Between specialties, diagnostic yield varied from 19.5 to 23.9 % (p = 0.20). Independent predictors of diagnostic yield were: age, sex, D-dimer, cough, dyspnea, cardiac history, chronic obstructive pulmonary disease (COPD), atelectasis/consolidation, intrapulmonary mass and/or interstitial pulmonary disease on CT. Wells scores were poorly documented (n = 127, 13.0 %). Poor adherence to protocol was also shown by a high amount of unnecessary D-dimer values with a high Wells-score (35 of 58; 58.6 %). CONCLUSIONS: The diagnostic yield of CTPA in this study was relatively high in comparison with other studies (6.7–31 %). Better adherence to protocol might improve the diagnostic yield further. A prospective study could confirm the independent predictors found in this study. TEACHING POINTS: • Pulmonary embolism is potentially life-threatening and requires quick and reliable diagnosis. • Computed tomography of the pulmonary arteries (CTPA) provides this reliable diagnosis. • Several independent predictors of diagnostic yield of CTPA for pulmonary embolism were identified. • Diagnostic yield of CTPA did not differ between requesting specialties in our Hospital. • Better protocol adherence could improve the diagnostic yield of CTPA for pulmonary embolism

Associations between Socio-Economic Status and Unfavorable Social Indicators of Child Wellbeing; a Neighbourhood Level Data Design

Background: Living in deprivation is related to ill health. Differences in health outcomes between neighbourhoods may be attributed to neighbourhood socio-economic status (SES). Additional to differences in health, neighbourhood differences in child wellbeing could also be attributed to neighbourhood SES. Therefore, we aimed to investigate the association between neighbourhood deprivation, and social indicators of child wellbeing. Methods: Aggregated data from 3565 neighbourhoods in 390 municipalities in the Netherlands were eligible for analysis. Neighbourhood SES scores and neighbourhood data on social indicators of child wellbeing were used to perform repeated measurements, with one year measurement intervals, over a period of 11 years. Linear mixed models were used to estimate the associations between SES score and the proportion of unfavorable social indicators of child wellbeing. Results: After adjustment for year, population size, and clustering within neighbourhoods and within a municipality, neighbourhood SES was inversely associated with the proportion of ‘children living in families on welfare’ (estimates with two cubic splines: −3.59 [CI: −3.99; −3.19], and −3.00 [CI: −3.33; −2.67]), ‘delinquent youth’ (estimate −0.26 [CI: −0.30; −0.23]) and ‘unemployed youth’ (estimates with four cubic splines: −0.41 [CI: −0.57; −0.25], −0.58 [CI: −0.73; −0.43], −1.35 [−1.70; −1.01], and −0.96 [1.24; −0.70]). Conclusions: In this study using repeated measurements, a lower neighbourhood SES was significantly associated with a higher prevalence of unfavorable social indicators of child wellbeing. This contributes to the body of evidence that neighbourhood SES is strongly related to child health and a child’s ability to reach its full potential in later life. Future studies should consist of larger longitudinal datasets, potentially across countries, and should attempt to take the interpersonal variation into account with more individual-level data on SES and outcomes

Numerical investigation of the in-plane seismic performance of unstrengthened and TRM-strengthened rammed earth walls

The large availability of raw earth around the World led to its extensive use as a building material through history. Thus, earthen materials integrate several historical monuments, but their main use was to build living and working environments for billions of people. On the other hand, past earthquakes revealed their inadequate seismic behavior, which is a matter of concern as a significant percentage of earthen buildings are located in regions with medium to high seismic hazard. Nevertheless, their seismic behavior and the development of efficient strengthening solutions are topics that are not yet sufficiently investigated in the literature. In this context, this study investigates numerically the in-plane seismic behavior of a rammed earth component by means of advanced nonlinear finite element modeling, which included performing nonlinear static (pushover) and nonlinear dynamic analyses. Moreover, the strengthening effectiveness of a low-cost textile-reinforced mortar on such component was also evaluated. The strengthening was observed to increase the load and displacement capacities, to preserve the integrity for higher lateral load levels and to postpone failure without adding significant mass to the system. Furthermore, the pushover analysis was shown to predict reliably the capacities of the models with respect to the incremental dynamic analysis.This work was financed by FEDER funds through the Competitively Factors Operational Programme (COMPETE) and by national funds through the Foundation for Science and Technology (FCT) within the scope of projects POCI-01-0145-FEDER-016737 (PTDC/ECM-EST/2777/2014) and POCI-01-0145-FEDER-007633. The support from grant SFRH/BPD/97082/2013 is also acknowledged

Integrating interconception care in preventive child health care services:The Healthy Pregnancy 4 All program

BackgroundMost parents with young children pay routine visits to Well-Baby Clinics, or so-called Preventive Child Health Care (PCHC) services. This offers a unique opportunity to promote and deliver interconception care. This study aimed to integrate such care and perform an implementation evaluation.MethodsIn seven Dutch municipalities, PCHC professionals were instructed to discuss the possibility of an interconception care consultation during each routine six-months well-baby visit. The primary outcome of this study was coverage of the intervention, quantified as the proportion of visits during which women were informed about interconception care. Secondary outcomes included adoption, fidelity, feasibility, appropriateness, acceptability and effectiveness of the intervention, studied by surveying PCHC professionals and women considering becoming pregnant.ResultsThe possibility of interconception care was discussed during 29% (n = 1,849) of all visits, and 60% of the PCHC physicians adopted the promotion of interconception care by regularly informing women. About half of the PCHC professionals and most women judged integration of interconception care in PCHC appropriate and acceptable. Estimated feasibility was poor, since 13% of the professionals judged future integration in daily practice as probable. The uptake of interconception care consultations was low (n = 4 consultations).ConclusionsPromotion of interconception care was achieved in approximately one-third of the routine PCHC consultations and appeared promising with regards to adoption, appropriateness and acceptability. However, concerns on feasibility and uptake of interconception care consultations in daily practice remain. Suggestions for improvement may include further integration of interconception care health promotion in routine PCHC consultations, while allocating sufficient resources

Geographical differences in perinatal health and child welfare in the Netherlands: Rationale for the healthy pregnancy 4 all-2 program

Background: Geographical inequalities in perinatal health and child welfare require attention. To improve the identification, and care, of mothers and young children at risk of adverse health outcomes, the HP4All-2 program was developed. The program consists of three studies, focusing on creating a continuum for risk selection and tailored care pathways from preconception and antenatal care towards 1) postpart

On visual pigment templates and the spectral shape of invertebrate rhodopsins and metarhodopsins

The absorbance spectra of visual pigments can be approximated with mathematical expressions using as single parameter the absorbance peak wavelength. A comparison of the formulae of Stavenga et al. in Vision Res 33:1011–1017 (1993) and Govardovskii et al. in Vis Neurosci 17:509–528 (2000) applied to a number of invertebrate rhodopsins reveals that both templates well describe the normalized α-band of rhodopsins with peak wavelength > 400 nm; the template spectra are virtually indistinguishable in an absorbance range of about three log units. The template formulae of Govardovskii et al. in Vis Neurosci 17:509–528 (2000) describe the rhodopsin spectra better for absorbances below 10−3. The template predicted spectra deviate in the ultraviolet wavelength range from each other as well as from measured spectra, preventing a definite conclusion about the spectral shape in the wavelength range <400 nm. The metarhodopsin spectra of blowfly and fruitfly R1-6 photoreceptors derived from measured data appear to be virtually identical. The established templates describe the spectral shape of fly metarhodopsin reasonably well. However, the best fitting template spectrum slightly deviates from the experimental spectra near the peak and in the long-wavelength tail. Improved formulae for fitting the fly metarhodopsin spectra are proposed

Earth blocks stabilized by cow-dung

WOS:000379589500010International audienceIn developing countries, most of the population cannot afford conventional building blocks made with the sand-cement mixture. In addition, these blocks do not provide thermal comfort and have a high embodied energy compared to vernacular materials. The main objective of this work was to produce low cost, resistant and durable (good resistance to water) blocks with a thermal behaviour enabling quality comfort indoor. For that purpose, the effects of cow-dung on microstructural changes in earth blocks (adobes) are investigated by means of X-ray diffraction, thermal gravimetric analyses, scanning electronic microscopy coupled with energy dispersive spectrometry, and video microscopy. The effects of these changes on the physical properties (water absorption and linear shrinkage) and mechanical properties (flexural and compressive strengths) of adobe blocks are evaluated. It is shown that cow-dung reacts with kaolinite and fine quartz to produce insoluble silicate amine, which glues the isolated soil particles together. Moreover, the significant presence of fibres in cow-dung prevents the propagation of cracks in the adobes and thus reinforces the material. The above phenomena make the adobe microstructure homogeneous with an apparent reduction of the porosity. The major effect of cow-dung additions is a significant improvement in the water resistance of adobe, which leads to the conclusion that adobes stabilized by cow-dung are suitable as building materials in wet climates

Maslow in the Mud: Contrast between qualitative and quantitative assessment of thermal performance in historic buildings.

This paper argues that the notion of comfort is first and foremost re-lated to subjective choices and individual value systems. The article presents re-sults from research on the perception and measurements of the thermal qualities of heritage buildings in Lincolnshire, UK. The qualitative and quantitative re-sults identified a strong contrast between different methodologies. Inhabitants describe as comfortable houses which would not be considered comfortable if a standard positivist approach was used. The conflict presented will be dis-cussed in the context of sustainable strategies in architecture

β-Catenin Signaling Increases during Melanoma Progression and Promotes Tumor Cell Survival and Chemoresistance

Beta-catenin plays an important role in embryogenesis and carcinogenesis by controlling either cadherin-mediated cell adhesion or transcriptional activation of target gene expression. In many types of cancers nuclear translocation of beta-catenin has been observed. Our data indicate that during melanoma progression an increased dependency on the transcriptional function of beta-catenin takes place. Blockade of beta-catenin in metastatic melanoma cell lines efficiently induces apoptosis, inhibits proliferation, migration and invasion in monolayer and 3-dimensional skin reconstructs and decreases chemoresistance. In addition, subcutaneous melanoma growth in SCID mice was almost completely inhibited by an inducible beta-catenin knockdown. In contrast, the survival of benign melanocytes and primary melanoma cell lines was less affected by beta-catenin depletion. However, enhanced expression of beta-catenin in primary melanoma cell lines increased invasive capacity in vitro and tumor growth in the SCID mouse model. These data suggest that beta-catenin is an essential survival factor for metastatic melanoma cells, whereas it is dispensable for the survival of benign melanocytes and primary, non-invasive melanoma cells. Furthermore, beta-catenin increases tumorigenicity of primary melanoma cell lines. The differential requirements for beta-catenin signaling in aggressive melanoma versus benign melanocytic cells make beta-catenin a possible new target in melanoma therapy