Credentialing for radiology

Patients expect to receive safe, predictable and high-quality care delivered by competent professionals. Thus, it has become important to provide specific training in existing and new modalities and prove on-going clinical expertise. Hospital credentialing is the process by which the competence of a doctor is determined by the hospital management. In Australia, radiologists participate in a mandatory program of continuing professional development and are also required to maintain a logbook of procedures. The Conjoint Committee for the Recognition of Training in Peripheral Endovascular Therapy has been established to advise the respective subspecialty groups on the requirements for accreditation. This article examines some of the issues the committee has considered in preparing the criteria to assist institutions for the purposes of credentialing and gives an Australian perspective on future trends

Progressive multifocal leucoencephalopathy in an immunocompetent patient with favourable outcome. A case report

To report the clinical course of PML in an apparently immunocompetent patient treated with cidofovir

The holistic phase model of early adult crisis

The objective of the current study was to explore the structural, temporal and experiential manifestations of crisis episodes in early adulthood, using a holistic-systemic theoretical framework. Based on an analysis of 50 interviews with individuals about a crisis episode between the ages of 25 and 35, a holistic model was developed. The model comprises four phases: (1) Locked-in, (2) Separation/Time-out, (3) Exploration and (4) Rebuilding, which in turn have characteristic features at four levels—person-in-environment, identity, motivation and affect-cognition. A crisis starts out with a commitment at work or home that has been made but is no longer desired, and this is followed by an emotionally volatile period of change as that commitment is terminated. The positive trajectory of crisis involves movement through an exploratory period towards active rebuilding of a new commitment, but ‘fast-forward’ and ‘relapse’ loops can interrupt Phases 3 and 4 and make a positive resolution of the episode less likely. The model shows conceptual links with life stage theories of emerging adulthood and early adulthood, and it extends current understandings of the transitional developmental challenges that young adults encounter

Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver interaction, self-care and metabolic transmission were reported for some communication technologies. Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals

Rawls and Political Realism: Realistic Utopianism or Judgement in Bad Faith?

Political realism criticises the putative abstraction, foundationalism and neglect of the agonistic dimension of political practice in the work of John Rawls. This paper argues that had Rawls not fully specified the implementation of his theory of justice in one particular form of political economy then he would be vulnerable to a realist critique. But he did present such an implementation: a property-owning democracy. An appreciation of Rawls s specificationist method undercuts the realist critique of his conception of justice as fairness

Hostility, Physical Aggression and Trait Anger as Predictors for Suicidal Behavior in Chinese Adolescents: A School-Based Study

Purpose: This study explored the extent to which trait aggression is associated with suicidal behavior in a nationwide school-based sample of adolescents. Methods: A nationwide sample of 14,537 high school students in urban areas of China was recruited. Information concerning suicide ideation, plans, attempts, trait aggression and other risk factors was collected by a self-reported questionnaire. Multivariate regression analyses were employed to predict suicidal behavior. Results: Approximately 18.5 % of students reported suicide ideation, 8.7 % reported suicide plans, and 4.1 % reported attempts during the past one year. Hostility and trait anger had a significant positive association with suicidal ideation. Hostility and physical aggression were positively related to suicide plans. Hostility had a positive correlation with suicide attempts, while trait anger was inversely associated with suicide attempts. Conclusions: This study suggests that hostility, physical aggression and trait anger may be able to be used to predict suicidal behavior among adolescents. Suicide prevention programs should target at attenuating the severity of hostility, anger and physical aggression. But teachers and parents should also give close attention to students with low trait anger

Photonic multilayer structure of Begonia chloroplasts enhances photosynthetic efficiency

Enhanced light harvesting is an area of interest for optimizing both natural photosynthesis and artificial solar energy capture1,2. Iridescence has been shown to exist widely and in diverse forms in plants and other photosynthetic organisms and symbioses3,4, but there has yet to be any direct link demonstrated between iridescence and photosynthesis. Here we show that epidermal chloroplasts, also known as iridoplasts, in shade-dwelling species of Begonia5, notable for their brilliant blue iridescence, have a photonic crystal structure formed from a periodic arrangement of the light-absorbing thylakoid tissue itself. This structure enhances photosynthesis in two ways: by increasing light capture at the predominantly green wavelengths available in shade conditions, and by directly enhancing quantum yield by 5-10% under low-light conditions. These findings together imply that the iridoplast is a highly modified chloroplast structure adapted to make best use of the extremely low-light conditions in the tropical forest understorey in which it is found5,6. A phylogenetically diverse range of shade-dwelling plant species has been found to produce similarly structured chloroplasts7-9, suggesting that the ability to produce chloroplasts whose membranes are organized as a multilayer with photonic properties may be widespread. In fact, given the well-established diversity and plasticity of chloroplasts10,11, our results imply that photonic effects may be important even in plants that do not show any obvious signs of iridescence to the naked eye but where a highly ordered chloroplast structure may present a clear blue reflectance at the microscale. Chloroplasts are generally thought of as purely photochemical; we suggest that one should also think of them as a photonic structure with a complex interplay between control of light propagation, light capture and photochemistry

GSK-3 Activity Is Critical for the Orientation of the Cortical Microtubules and the Dorsoventral Axis Determination in Zebrafish Embryos

The formation of dorsal-ventral (D–V) axis is the earliest event that breaks the radial symmetry and determines the bilateral body plan of a vertebrate embryo, however, the maternal control of this process is not fully understood. Here, we discovered a new dorsalizing window of acute lithium treatment, which covers only less than 10 minutes after fertilization. Lithium treatment in this window was not able to reverse the ventralized phenotype in tokkeabi (tkk) mutant embryos, and its dorsalizing activity on wild-type embryos was inhibited by nocodazole co-treatment. These evidences indicate that the underlying mechanism is independent of a direct activation of Wnt/β-catenin signaling, but depends on the upstream level of the microtubule mediated dorsal determinant transport. In order to identify the target of lithium in this newly discovered sensitive window, GSK-3 inhibitor IX as well as the IMPase inhibitor L690, 330 treatments were performed. We found that only GSK-3 inhibitor IX treatment mimicked the lithium treatment in the dorsalizing activity. Further study showed that the parallel pattern of cortical microtubules in the vegetal pole region and the directed migration of the Wnt8a mRNA were randomized by either lithium or GSK-3 inhibitor IX treatment. These results thus revealed an early and critical role of GSK-3 activity that regulates the orientation of the cortical microtubules and the directed transport of the dorsal determinants in zebrafish embryos

Adolescents' reactions to participating in ethically sensitive research: A prospective self-report study

Background: Conducting psychological research with adolescents is imperative for better understanding, prevention and treatment of mental illness. However there is concern that research addressing topics such as mental illness, substance use and suicidality has potential to distress participants, particularly youth. Method: We administered a questionnaire to 1973 adolescents (13-18 years) at two time points, one year apart. Participants responded to items regarding nonsuicidal self-injury, psychological distress, history of physical and/or sexual abuse, adverse life events, alcohol use, suicidal behaviour, self-efficacy, and coping skills as well as two open-ended questions regarding whether they enjoyed participating in the research and whether participation worried or upset them. Results: Most youth (74 %) enjoyed participation and cited altruistic reasons and a greater self-awareness as reasons. Those reporting being upset by the questionnaire (15 %) reported poorer psychological functioning than their peers. Youth who were upset by their participation at baseline, but who reported enjoying the questionnaire at follow-up reported improved psychosocial functioning over time, while the reverse was true for those who initially enjoyed participation but later reported the questionnaire upset them. Conclusions: Results suggest researchers acknowledge benefits for young people who participate in research, but also be mindful of the potential for distress among the most at risk youth