Optimisation of the digital radiographic imaging of suspected non-accidental injury.

Aim: To optimise the digital (radiographic) imaging of children presenting with suspected non-accidental injury (NAI).;Objectives: (i) To evaluate existing radiographic quality criteria, and to develop a more suitable system if these are found to be inapplicable to skeletal surveys obtained in suspected NAI. (ii) To document differences in image quality between conventional film-screen and the recently installed Fuji5000R computed radiography (CR) system at Great Ormond Street Hospital for Children, (iii) To document the extent of variability in the standard of skeletal surveys obtained in the UK for suspected NAI. (iv) To determine those radiographic parameters which yield the highest diagnostic accuracy, while still maintaining acceptable radiation dose to the child, (v) To determine how varying degrees of edge-enhancement affect diagnostic accuracy. (vi) To establish the accuracy of soft compared to hard copy interpretation of images in suspected NAI.;Materials and Methods: (i) and (ii) Retrospective analysis of 286 paediatric lateral spine radiographs by two observers based on the Commission of European Communities (CEC) quality criteria, (iii) Review of the skeletal surveys of 50 consecutive infants referred from hospitals throughout the United Kingdom (UK) with suspected NAI. (iv) Phantom studies. Leeds TO. 10 and TO. 16 test objects were used to compare the relationship between film density, exposure parameters and visualisation of object details, (iv) Clinical study. Anteroposterior and lateral post mortem skull radiographs of six consecutive infants were obtained at various exposures. Six observers independently scored the images based on visualisation of five criteria, (v) and (vi) A study of diagnostic accuracy in which six observers independently interpreted 50 radiographs from printed copies (with varying degrees of edge-enhancement) and from a monitor.;Results: The CEC criteria are useful for optimisation of imaging parameters and allow the detection of differences in quality of film-screen and digital images. There is much variability in the quality and number of radiographs performed as part of skeletal surveys in the UK for suspected NAI. The Leeds test objects are either not sensitive enough (TO. 10) or perhaps over sensitive (TO. 16) for the purposes of this project. Furthermore, the minimum spatial resolution required for digital imaging in NAI has not been established. Therefore the objective interpretation of phantom studies is difficult. There is scope for reduction of radiation dose to children with no effect on image quality. Diagnostic accuracy (fracture detection) in suspected NAI is generally low, and is not affected by image display modality.;Conclusions: The CEC quality criteria are not applicable to the assessment of clinical image quality. A national protocol for skeletal surveys in NAI is required. Dedicated training, close supervision, collaboration and consistent exposure of radiologists to cases of NAI should improve diagnostic accuracy. The potential exists for dose reduction when performing skeletal surveys in children and infants with suspected NAI. Future studies should address this issue

Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 2: axial skeleton and differential diagnoses

Recognising the skeletal manifestations of inflicted injury (II) in infants and young children is of crucial importance. There are specific fracture patterns which are highly suspicious of II in addition to common differential diagnoses with which radiologists should be familiar. Our objective is to provide a non-exhaustive review of the important factors relevant to the imaging and reporting of II as a platform for further learning. Part 2 encompasses fracture patterns of the axial skeleton and important differential diagnoses

Emotional intelligence assessment in a graduate entry medical school curriculum.

BACKGROUND: The management of emotions in the workplace is a skill related to the ability to demonstrate empathic behaviour towards patients; to manage emotional reactions in oneself and to lead others as part of a team. This ability has been defined as emotional intelligence (EI) and doctor\u27s EI may be related to communication skills and to patient satisfaction levels. This study reports on the use of two assessments of EI as part of a course on Personal and Professional Development (PPD) in a graduate medical school curriculum. METHODS: Fifty one graduate entry medical students completed an eight session course on PPD between December 2005 and January 2006. Students completed two measures of EI: self-report (EQ-i) and ability (MSCEIT V2.0) over a two year study period. The data gathered were used to explore the relationship between self-report and ability EI and between EI and student demographics, academic performance and change over time. RESULTS: Analysis of the EI data demonstrated that self-report EI did not change over time and was not related to ability EI. Females scored higher than males on a number of self-report and ability EI scores. Self-reported self-awareness was found to deteriorate in males and females over time. High self-reported EI was found to be associated with poor performance on clinical competency assessments but with good performance on a number of bio-medical knowledge based assessments. CONCLUSIONS: This report concludes that assessments of EI can be incorporated into a medical school curriculum as part of a PPD programme and that the concept of EI may be associated with performance in medical school

Comparison of Kidney Disease Risks Among African Americans in Maryland and Neighboring Regional States

AbstractChronic kidney disease (CKD) is a recognized global health burden that has affected 10-15% of the general adult population, which is caused by diabetes and has disproportionately affected minority populations such as African Americans. Despite the prevalence of diabetes and hypertension, other variables could predispose this racial group to CKD, hence the need for this study. The purpose of this cross-sectional quantitative study using secondary data analysis methods was to investigate to what extent various factors such as gender, diet, age, exercise, socioeconomic status, diabetes, and hypertension were associated with the prevalence of CKD among African Americans residents in Maryland, compared with their level of association with CKD as found in a combined group of six other Centers for Disease Control and Prevention (CDC) Region B states. The theoretical framework for this study was the social cognitive theory of the health behavior model. The data source was an extracted subset of Region B data from the national-level CDC Behavioral Risk Factors Surveillance System Survey. Using weighted population data, the study showed that statistically significant relationships existed between such predictors as diabetes, hypertension, diet, gender, exercise, socioeconomic status, and occurrence of CKD among the study population (p = 0.001). This study may influence positive social change through social policies that targets the improvement of health literacy and equality among minority populations, especially African Americans, in this case those residing in region B states

Skeletal imaging of child abuse (non-accidental injury)

In recent years there has been a worldwide increased awareness that children are physically abused by their carers. Radiologists play a vital role in the detection of inflicted injuries. This article reviews the skeletal imaging findings seen in child abus

Tight junctions: a barrier to the initiation and progression of breast cancer?

Breast cancer is a complex and heterogeneous disease that arises from epithelial cells lining the breast ducts and lobules. Correct adhesion between adjacent epithelial cells is important in determining the normal structure and function of epithelial tissues, and there is accumulating evidence that dysregulated cell-cell adhesion is associated with many cancers. This review will focus on one cell-cell adhesion complex, the tight junction (TJ), and summarize recent evidence that TJs may participate in breast cancer development or progression. We will first outline the protein composition of TJs and discuss the functions of the TJ complex. Secondly we will examine how alterations in these functions might facilitate breast cancer initiation or progression; by focussing on the regulatory influence of TJs on cell polarity, cell fate and cell migration. Finally we will outline how pharmacological targeting of TJ proteins may be useful in limiting breast cancer progression. Overall we hope to illustrate that the relationship between TJ alterations and breast cancer is a complex one; but that this area offers promise in uncovering fundamental mechanisms linked to breast cancer progression

Modular Principles for Flexibility of Spaces in Skill Acquisition Centres, Benue State

The design of skill centre around the country is such that they are specific to particular skill type and usually the buildings cannot be used for another activity. The need to use spaces for multiple functions has ensured that flexible spaces in skill acquisition centres are designed such that the spaces can easily be varied into smaller discrete and scalable sizes. This paper examined the interior spaces for pedagogical and didactic activities in six selected skills acquisition centres in Benue state. The issue of the rigidity of spaces occurring as product of the building design which is meant to serve a required function usually ensures that spaces are less flexible and in many cases unusable for other functions. The aim of the study is to examine the flexibility nature of skill centres with a view to determining functions that could be combined. A post occupancy evaluation was carried out using a mix method approach through the use of observation checklist and questionnaire. The issues examined include the various sizes of workshop spaces, walling materials used to enclose spaces, the degree of flexibility of both spaces and materials based on modular principles and users' perception of satisfaction of working spaces. A total of 300 copies of questionnaires were administered to staff and students. Based on the total valid responses, 70% were not satisfied with the sizes of the working space. The resultant data obtained was analysed using descriptive statistics from SPSS. It was observed that most spaces though modular were non-flexible. Users' satisfaction with the sizes of working spaces was determined. The paper concluded on the need for the flexibility of spaces in order to accommodate varying utility.Keywords: Flexibility, Interior Spaces, Modular Space, User Satisfaction, Working Spac