World Federation of Pediatric Imaging (WFPI) volunteer outreach through tele-reading: the pilot project in South Africa

BackgroundShortages in radiology services are estimated to affect 3.5-4.7 billion people worldwide. Teleradiology is a potential means of alleviating this shortage.ObjectiveThis paper examines the practicality and sustainability of a pilot pediatric teleradiology project at the Khayelitsha District Hospital in sub-Saharan Africa. We analyze how this World Federation of Pediatric Imaging (WFPI) program fares against the global challenges described in the current literature facing these practice types.Materials and methodsA teleradiology pilot was developed to provide coverage to the Khayelitsha District Hospital after the district pediatrician requested assistance in interpreting radiographs. This program utilized a network of WFPI volunteer pediatric radiologists, direct JPEG conversion of digital radiographic images, and an e-mail delivery system of images, referral requests and teleradiology opinion. Data were collected retrospectively from referral cards and JPEG images of radiographs, as well as from the volunteer officer database.ResultsA total of 555 referral cards and 1,106 radiographs were submitted for teleradiology opinion during the course of this pilot program; 74.6% of requests for image interpretation were chest radiographs and 14.2% of those were for the evaluation of tuberculosis. There were 40 volunteer teleradiologists from 17 countries; all spoke English, and 14 were bilingual (8 fluent in Spanish, 5 in Portuguese, and 1 in Italian).ConclusionTeleradiology is a viable option to alleviate radiologist shortages in underserved areas, but there are many challenges to designing an adequate teleradiology system. The WFPI pilot teleradiology program can be considered a successful one

A Family of Helminth Molecules that Modulate Innate Cell Responses via Molecular Mimicry of Host Antimicrobial Peptides

Over the last decade a significant number of studies have highlighted the central role of host antimicrobial (or defence) peptides in modulating the response of innate immune cells to pathogen-associated ligands. In humans, the most widely studied antimicrobial peptide is LL-37, a 37-residue peptide containing an amphipathic helix that is released via proteolytic cleavage of the precursor protein CAP18. Owing to its ability to protect against lethal endotoxaemia and clinically-relevant bacterial infections, LL-37 and its derivatives are seen as attractive candidates for anti-sepsis therapies. We have identified a novel family of molecules secreted by parasitic helminths (helminth defence molecules; HDMs) that exhibit similar biochemical and functional characteristics to human defence peptides, particularly CAP18. The HDM secreted by Fasciola hepatica (FhHDM-1) adopts a predominantly α-helical structure in solution. Processing of FhHDM-1 by F. hepatica cathepsin L1 releases a 34-residue C-terminal fragment containing a conserved amphipathic helix. This is analogous to the proteolytic processing of CAP18 to release LL-37, which modulates innate cell activation by classical toll-like receptor (TLR) ligands such as lipopolysaccharide (LPS). We show that full-length recombinant FhHDM-1 and a peptide analogue of the amphipathic C-terminus bind directly to LPS in a concentration-dependent manner, reducing its interaction with both LPS-binding protein (LBP) and the surface of macrophages. Furthermore, FhHDM-1 and the amphipathic C-terminal peptide protect mice against LPS-induced inflammation by significantly reducing the release of inflammatory mediators from macrophages. We propose that HDMs, by mimicking the function of host defence peptides, represent a novel family of innate cell modulators with therapeutic potential in anti-sepsis treatments and prevention of inflammation

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Social Research 1 Maintaining Full Employment: Simulating an Employer of Last Resort Program

In Employer of Last Resort Program (ELR) the government, through some institutional arrangement, offers direct employment to anyone wishing to work. 1 In particular, those unable to find jobs in the private sector are guaranteed an offer of work. This effectively turns employment into an entitlement. In a set of related papers Edward Nell and I have explored the macroeconomics and the institutional features of an ELR designed to create employment directly, while indirectly stabilizing private output and employment, and, at the same time, helping to control inflation. 2 Such a program, we show, could have three mutually supportive components: Job Placement, which combines our current system of unemployment insurance with an expanded career-counseling program, Job Training, which aids mid-career training through job training accounts for workers, and Public Service Employment, which directly provides full or part-time jobs. This is not the only way an ELR can be set up, but these three are complementary and together address both demand-based unemployment and skill-mix issues for U.S. labor markets, issues that are often intertwined. In our proposal, all three components would be funded as entitlements or direct spending

Three dimensional depth visualization using image sensing to detect artefact in space

Thesis submitted in fulfilment of the requirements for the degree Doctor of Technology: Electrical Engineering in the Faculty of Engineering at the Cape Peninsula University of Technology 2014Three-dimensional (3D) artefact detection can provide the conception of vision and real time interaction of electronic products with devices. The orientation and interaction of electrical systems with objects can be obtained. The introduction of electronic vision detection can be used in multiple applications, from industry, in robotics and also to give orientation to humans to their immediate surroundings. An article covering holograms states that these images can provide information about an object that can be examined from different angles. The limitations of a hologram are that there must be absolute immobilization of the object and the image system. Humans are capable of stereoscopic vision where two images are fused together to provide a 3D view of an object. In this research, two digital images are used to determine the artefact position in space. The application of a camera is utilized and the 3D coordinates of the artefact are determined. To obtain the 3D position, the principles of the pinhole camera, a single lens as well as two image visualizations are applied. This study explains the method used to determine the artefact position in space. To obtain the 3D position of an artefact with a single image was derived. The mathematical formulae are derived to determine the 3D position of an artefact in space and these formulae are applied in the pinhole camera setup to determine the 3D position. The application is also applied in the X-ray spectrum, where the length of structures can be obtained using the mathematical principles derived. The XYZ coordinates are determined, a computer simulation as well as the experimental results are explained. With this 3D detection method, devices can be connected to a computer to have real time image updates and interaction of objects in an XYZ coordinate system. Keywords: 3D point, xyz-coordinates, lens, hologra

Design and analysis of a system for 3D fabrication of synthetic anatomical structures

Thesis (MTech (Electrical Engineering))--Cape Peninsula University of Technology, 2005This dissertation is the reading and display ofDICOM medical images (Digital Imaging and Communication in Medicine) and production ofmodel artifacts of anatomical organs using Rapid Prototyping An algorithm to read these DICOM medical images was developed. It also displays pixel information ofthe image. When the DICOM image has been read and displayed, the information required to produce the anatomical artifact is extracted. These 2D slice images, MRI (Magnetic Resonance Imaging) and CT Scan (Computer Tomography) images are written to 3D file in SLC (Slice files) and STL (Stereolithography File Format) format. A 3D softcopy ofthe anatomical structure is created. At this stage, the clinician or surgeon can make any changes or require additional information to be added to the anatomical structure. With the 3D model available in STL format, a physical artifact is produced using Rapid Prototyping. The external edge ofthe anatomical structure can be produced using Rapid Prototyping as well as the outer rim with the internal structures. To produce the external surface ofthe structure, an outer rim edge detection algorithm has been developed. This will only extract the external surface ofthe structure. In addition to the softcopy ofthe structure, multiple organs can be displayed on the same image and this will give a representation ofthe interaction ofneighboring organs and structures. This is useful as both the normal anatomy as well as the infiltration ofthe abnormal pathology can be viewed simultaneously. One of the major limitations ofdisplaying the information in a 3D image is that the files are very large. Since 3D STL files use triangles to display the outer surface ofa structure, a method to reduce the file size and still keep the image information was developed. The triangle reduction method is a method to display the 3D information and to decrease the STL file size depending on the complexity ofthe outer surface ofthe structure. To ensure that the anatomical model s represented as in the DlCOM files, an Interpolation Algorithm was developed to reconstruct the outer ofthe model from 2D MRI or CT-Scan images. A word about computer models: Some of the programs and presentations are based on the real world. They model the real world and anatomical structures. It is very important to note that the models are created with software. Obviously a model is useful if it resembles reality closely, but it is only a prediction about the model itself. Models are useful because they help to explain why certain things happen and how interaction takes place. Models provide suggestions for how structures might look. Computer models provide answers very quickly. These are computer models representing the real structure. (Czes Kosniowski, 1983

Long-term management impacts on soil C, N and physical fertility, Part I: Broadbalk experiment

For many centuries manure application to the soil has been common practice. Organic amendments and fertiliser applications can increase crop yields and soil organic matter (SOM). However, the long-term impacts on soil physical fertility are often neglected. This study was carried out on the Broadbalk Wheat Experiment at Rothamsted, UK, established in 1843 on an Aquic/Typic Paleudalf soil. Application of farmyard manure (FYM), N fertiliser and wheat straw on total organic C (CT), labile C (CL) and non-labile C (CNL), total N (NT), mean weight diameter (MWD) and unsaturated hydraulic conductivity (Kunsat) were studied on wheat ('Triticum aestivum') and adjacent woodland and pasture areas. Manure additions, N fertiliser and straw incorporation increased all C fractions, particularly the CL fraction. The addition of 35 t ha⁻1 year⁻¹ of FYM increased CT to 2.5 times that of the control (no fertiliser) treatment and CL to 5 times that of the control. With highest N application and straw returned, CT increased by 1.3 times and CL by 1.5 times that of the control treatment. There were linear relationships between rate of N fertiliser applied and all C fractions, with the rate of increase almost double with straw than straw removed. Manure application improved MWD, as did high N fertiliser additions with straw returned. Application of N fertiliser only increased MWD and Kunsat (at 10 mm tension) if straw was returned, while the addition of manure resulted in decreased Kunsat. The highest Kunsat rate was on the high N fertiliser, straw returned treatments. The uncropped areas all had high soil structural stability. Similar relationships occurred between all C fractions and NT and MWD for the high C soils, but relationships were much stronger with CL than the other C fractions in the low C soils. These results showed that soils with low C concentration are more reliant on CL for structural stability