Experience in Imaging Medullary Thyroid Carcinoma Using 99mTc (V) Dimercaptosuccinic Acid (DMSA)

99mTc (V) dimercaptosuccinic acid (DMSA) is a new tumor imaging agent that has been successfully used to image patients with medullary thyroid carcinoma (MTC). Since 1986, studies have been performed in 32 patients with histologically proven MTC at Guy\u27s Hospital, London, England. Five patients with primary tumor were studied prior lo surgery, four patients were studied after successful removal of the primary tumor, and 26 patients with biochemical evidence of recurrence were studied. Eight patients were studied serially to assess progression of disease, and four patients were studied before and after surgery. Twenty-one of the 26 patients with disease had positive scans with four false negative scans and three true negative scans. One patient had a false-positive scan (sensitivity 80%, specificity 75%). Two of the false-negative scans were obtained in patients with moderate but stable elevations of calcitonin but no other evidence of recurrence. One false-negative scan was obtained in a patient who was discovered on screening to have an abnormal pentagastrin response, and a small 1 cm tumor was subsequently removed. Uptake in local neck recurrence was frequently intense, but uptake at sites of bone metastases was less marked. 99mTc (V) DMSA is an inexpensive radiopharmaceutical which produces good quality images and has been shown to have an acceptable sensitivity and specificity in the follow-up of patients with MTC and thereby contributes significantly to the management of these patients

Comparison of aircraft-derived observations with in situ research aircraft measurements

Mode Selective Enhanced Surveillance (Mode-S EHS) reports are aircraft-based observations that have value in numerical weather prediction (NWP). These reports contain the aircraft's state vector in terms of its speed, direction, altitude and Mach number. Using the state vector, meteorological observations of temperature and horizontal wind can be derived. However, Mode-S EHS processing reduces the precision of the state vector from 16-bit to 10-bit binary representation. We use full precision data from research grade instruments, on-board the United Kingdom's Facility for Atmospheric Airborne Measurements, to emulate Mode-S EHS reports and to compare with derived observations. We aim to understand the observation errors due to the reduced precision of Mode-S EHS reports. We derive error models to estimate these observation errors. The temperature error increases from 1.25 K to 2.5 K between an altitude of 10 km and the surface due to its dependency on Mach number and also Mode-S EHS precision. For the cases studied, the zonal wind error is around 0.50 ms− 1 and the meridional wind error is 0.25 ms− 1. The wind is also subject to systematic errors that are directionally dependent. We conclude that Mode-S EHS derived horizontal winds are suitable for data assimilation in high-resolution NWP. Temperature reports may be usable when aggregated from multiple aircraft. While these reduced precision, high frequency data provide useful, albeit noisy, observations; direct reports of the higher precision data would be preferable

Estimating the prevalence of forced marriage in England

A forced marriage (FM) has been defined in the UK as "a marriage conducted without the valid consent of both parties, wheree duress is a factor" (Home Office, 2000, p.4). The Court of Appeal clarified that duress is: "whether the mind of the applicant has been overborne, howsoever that was caused" (Magill and Lee, 2008, p.8). FM is therefore a marriage in which one or both spouses do not (or, in the case of some vulnerable adults, cannot) consent to the marriage and duress is involved. Duress can include physical, psychological, financial, sexual and emotional pressure. FM is therefore distinct from arranged marriage, as in an arranged marriage the family will take the lead in arranging the match but the couples have a choice as to whether to proceed

The Evaluation of the ‘Teens and Toddlers’ Youth Programme: A Randomised Controlled Trial

In 2009, the government's Department for Education commissioned a team of researchers at NatCen Social Research to evaluate the effectiveness of the youth development/teenage pregnancy prevention programme ‘Teens and Toddlers’. Previous studies had positive findings but had not been very rigorous in terms of methodology and methods used. We evaluated the programme through a randomised controlled trial, in collaboration with the London School of Hygiene & Tropical Medicine and Bryson Purdon Social Research. This case study provides an account of the stages in conducting a randomised controlled trial, from the initial scoping out of what exactly we were going to measure, coming up with the randomised controlled trial design, to reflecting on the possible methodological limitations of our research. It gives a narrative of the whole ‘RCT journey’ – how we determined the outcomes to be measured, the factors that enabled and limited us in designing the randomised controlled trial and the methodological and practical challenges the research team encountered along the way and how we dealt with those

Recorded quality of primary care for osteoarthritis: an observational study

INTRODUCTION Osteoarthritis causes substantial morbidity in developed countries. In the UK it is the most prevalent chronic disease among adults aged 65 years and over, affecting 32% of men and 47% of women.1 It is also the most common cause of disability.2 Osteoarthritis is an age-related condition,3 and there is a greater level of need among women and those from more deprived backgrounds.4 Those in poorer socioeconomic groups and women have higher levels of need for hip and knee replacement but receive relatively fewer joint replacements.4–6 Many individuals are living for prolonged periods with severe osteoarthritis. High-quality primary care is of clear importance for such a prevalent condition that has both major personal and social impact. This has been recognised by the National Institute for Health and Clinical Excellence (NICE), which has recently published guidelines for the care and management of osteoarthritis in adults.7 However, there is little published information on the quality of primary care for osteoarthritis in the UK. US studies have found the quality of osteoarthritis primary care to be suboptimal, with achievement of quality measures ranging from 31% to 64%.8 This study assessed the overall quality of recorded osteoarthritis treatment in primary care in an English county. It also assessed whether the recorded ABSTRACT Background Osteoarthritis is the most common chronic disease in the UK, with greater prevalence in women, older people, and those with poorer socioeconomic status. Effective treatments are available, yet little is known about the quality of primary care for this disabling condition. Aim To measure the recorded quality of primary care for osteoarthritis, and assess variations by patient and/or practice characteristics. Design of study Retrospective observational study. Setting Eighteen general practices in England. Method Records of 320/393 randomly selected patients with osteoarthritis (response rate 81%) were reviewed. High-quality health care was specified by nine quality indicators. Logistic regression modelling assessed variations in quality by age, sex, deprivation, severity, time since diagnosis, and practice size. Results There was substantial variation in the recorded achievement of individual indicators (range 5% to 90%). The percentage of eligible patients whose records show that they received care in the form of information provision ranged from 17% to 30%. For regular assessment indicators the range was 27% to 43%, and for treatment indicators the range was 5% to 90%. Recorded achievement of quality indicators was higher in those with more severe osteoarthritis (odds ratio [OR] 1.38, 95% CI = 1.13 to 1.69) and in older patients (OR 1.14, 95% CI = 1.02 to 1.28). There were no significant variations by deprivation score. Conclusion This study has demonstrated the feasibility of using existing robust quality indicators to measure the quality of primary care for osteoarthritis, and has found considerable scope for improvement in the recording of high-quality care. The lack of variation between practices suggests that system-level initiatives may be needed to achieve improvement. One challenge will be to improve care for all, withou

Spines of the stem chondrichthyan Doliodus latispinosus (Whiteaves) comb. nov. from the Lower Devonian of eastern Canada

The higher taxonomic affinities of fin spines from the Lower Devonian (Emsian) Atholville beds near Campbellton, New Brunswick, Canada, originally identified as Ctenacanthus latispinosus, have been uncertain since they were first described by Whiteaves in the late Nineteenth Century. Woodward subsequently referred the species to Climatius, because the isolated Canadian fin spines were similar to those preserved in articulated specimens of Climatius reticulatus from the Lower Old Red Sandstone (Lochkovian) of Scotland. Spines of the same form as the 'Atholville beds' specimens are also found in Emsian mudstones on the Gaspé Peninsula, Quebec. One of the fin spine forms appears identical to the pectoral fin spines on an articulated specimen from Atholville that has been assigned to the stem chondrichthyan Doliodus problematicus, a taxon erected for isolated diplodont teeth. By comparison with median and paired fin spine morphology on the climatiiform Climatius reticulatus from the Scottish Lower Old Red Sandstone and the spines preserved on the articulated Doliodus, isolated fin spines from Campbellton and several localities on the Gaspé Peninsula are now identified as belonging to Doliodus latispinosus comb. nov. The variety of spine morphotypes recognized – pectoral, prepelvic, prepectoral, and median – support a phylogenetic position within the "acanthodians" rather than "conventionally defined chondrichthyans".The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author