Preliminary Evaluation of Biplane Correlation (BCI) Stereographic Imaging for Lung Nodule Detection

A biplane correlation (BCI) imaging system obtains images that can be viewed in stereo, thereby minimizing overlapping structures. This study investigated whether using stereoscopic visualization provides superior lung nodule detection compared to standard postero-anterior (PA) image display. Images were acquired at two oblique views of ±3° as well as at a standard PA position from 60 patients. Images were processed using optimal parameters and displayed on a stereoscopic display. The PA image was viewed in the standard format, while the oblique views were paired to provide a stereoscopic view of the subject. A preliminary observer study was performed with four radiologists who viewed and scored the PA image then viewed and scored the BCI stereoscopic image. The BCI stereoscopic viewing of lung nodules resulted in 71 % sensitivity and 0.31 positive predictive value (PPV) index compared to PA results of 86 % sensitivity and 0.26 PPV index. The sensitivity for lung nodule detection with the BCI stereoscopic system was reduced by 15 %; however, the total number of false positives reported was reduced by 35 % resulting in an improved PPV index of 20 %. The preliminary results indicate observer dependency in terms of relative advantage of either system in the detection of lung nodules, but overall equivalency of the two methods with promising potential for BCI as an adjunct diagnostic technique

Preterm birth: inflammation, fetal injury and treatment strategies

Preterm birth (PTB) is the leading cause of childhood mortality in children under 5 and accounts for approximately 11% of births worldwide. Premature babies are at risk of a number of health complications, notably cerebral palsy, but also respiratory and gastrointestinal disorders. Preterm deliveries can be medically indicated/elective procedures or they can occur spontaneously. Spontaneous PTB is commonly associated with intrauterine infection/inflammation. The presence of inflammatory mediators in utero has been associated with fetal injury, particularly affecting the fetal lungs and brain. This review will outline (i) the role of inflammation in term and PTB, (ii) the effect infection/inflammation has on fetal development and (iii) recent strategies to target PTB. Further research is urgently required to develop effective methods for the prevention and treatment of PTB and above all, to reduce fetal injury

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Psychosocial Factors that Inform the Decision to Have Metabolic and Bariatric Surgery Utilization in Ethnically Diverse Patients

Metabolic and bariatric surgery (MBS) is currently the only clinically proven method of weight loss that is effective in treating severe obesity and its related comorbidities. However, only about 36% of MBS-eligible patients complete MBS. This qualitative study used the psychosocial framework to identify barriers and facilitators to MBS utilization among patients who had been referred to, or were considering MBS, but had not completed it. A combination of focus groups and in-depth interviews were utilized (Spring 2019) among ethnically diverse patients (N = 29, 82% female, 62% non-Hispanic Black, 10% Hispanic) who were considering MBS. All data was audio recorded, transcribed, and coded. Interview questions were grouped by the four psychosocial model domains (intrapersonal, interpersonal, organization/clinical interaction, societal/environmental) within the context of why patients would/would not follow through with MBS. The analysis included a combination of deductive and inductive approaches to generate the final codebook. Then, each code was input into Dedoose to identify overarching themes and sub-themes. A total of 9 themes and 17 subthemes were found. Two major intrapersonal themes and four subthemes were identified as facilitators to MBS utilization and included a desire for improvement in existing comorbidities, mobility, and anticipated changes in physical appearance. Primary barriers to MBS completion included concerns about potential change in dietary behaviors post-MBS and safety of procedure. Providing educational materials to address MBS common fears and misconceptions may increase utilization rates. Providing community-based pre- and post-support groups for this patient population may also increase MBS completion rates

Socioecological factors associated with ethnic disparities in metabolic and bariatric surgery utilization: a qualitative study

Metabolic and bariatric surgery (MBS) is a safe and effective treatment choice for severe obesity. Yet only approximately 50% of those referred to MBS complete the procedure. Studies show that racial minority groups are less likely than non-Hispanic whites to complete MBS despite having higher rates of severe obesity and co-morbidities. To conduct a qualitative study to determine facilitators and challenges to racially diverse patients completing MBS based on the 4 socioecological model domains (intrapersonal, interpersonal, organization/clinical interaction, and societal/environmental). One university-based surgery practice serving a racially diverse patient population. Focus groups and in-depth interviews were conducted (Spring 2019) among patients (n = 24, 70% female, 50% non-Hispanic black, 4% Hispanic) who completed MBS over the past year. Social support members were also included (n = 7). Grand tour questions were organized by the 4 socioecological model domains and within the context of MBS completion. Data were audio-recorded, transcribed, and coded. A thematic analysis combining a deductive and inductive approach was conducted. Codes were analyzed using Dedoose to identify themes/subthemes. Ten themes and 15 subthemes were identified. Key intra- and interpersonal facilitators to MBS completion included social support systems, primary care physician support of MBS, co-morbidity resolution, discrimination experiences, and mobility improvements. Key community and environment themes associated with post-MBS sustained weight loss included community support groups and access to healthy foods and exercise facilities. No themes or subthemes varied by race. Educating primary care physicians and social support networks about the benefits of MBS could improve utilization rates. MBS patients have a desire to have their communities provide resources to support their postoperative success

L'EU appelle à une réduction de 60% des soutiens distorsifs

Suite à la réunion 'mini-ministérielle' de Montréal, le Commissaire européen à l'agriculture, Franz Fischler a affirmé, le 30 juillet 2003, que l'UE était prête à engager une réduction importante de 60% de ses soutiens intérieurs distorsifs', à éliminer 'les subventions à l'exportation pour certains produits' et à les réduire pour les autres. Toutefois ceci est conditionné à la mise en oe uvre de mesures équivalentes pour d'autre formes de soutiens à l'exportation. Le Commissaire Fischler a également réaffirmé la volonté de l'UE de réduire les tarifs douaniers de 36% en moyenne et manifesté la volonté 'd'ouvrir ou d'étendre les quotas pour certains produits sensibles'. Il a aussi plaidé pour une meilleure protection des produits de qualité et pour plus de concession sur les questions non commerciales. Il a enfin réitéré l'appel à tous les pays développés pour qu'ils accordent un accès libre de droits et de quotas aux exportations provenant des pays les moins avancés. Comment: La volonté de l'UE de réduire de 60% les soutiens intérieurs distorsifs est en effet conditionnée par l'acceptation par l'OMC des systèmes de soutien de l'UE pour traiter les questions non commerciale, c'est à dire une acceptation internationale de la définition de l'UE des formes de soutien non distorsives. Une telle approbation conduira bien sur à un retrait de toute sanction pour ce type de soutien, qui se développe actuellement dans le cadre de la réforme de la PAC. Les projections de l'USDA sur l'impact budgétaire des propositions originales de l'UE pour la réforme de la PAC montrent une réduction de 55% des dépenses sur les mesures liées aux marchés. Si on y ajoute les autres réformes en attente, l'UE devrait pouvoir atteindre ses objectifs dans le cadre de la construction actuelle de la réforme de la PAC.Suite à la réunion 'mini-ministérielle' ..

It’s how I am . . . it’s what I am . . . it’s a part of who I am: A narrative exploration of the impact of adolescent-onset chronic illness on identity formation in young people

In Western society, identity formation is argued to be one of the key developmental tasks of adolescence. Despite implications for adolescent development, research into chronic illness (CI) onset during this period has been notably sparse. This study aimed to explore how diagnosis impacts on the developmental tasks of adolescence, what role adolescent-onset CI plays in identity formation, and how adolescents incorporate the diagnosis into their identity using a narrative analysis. Individual semi-structured interviews were carried out with eight young people aged 14 to 19years who lived with a diagnosis of a CI diagnosed between the ages of 12 and 16 years. Five core narrative themes emerged: walking a different path, tolerating contradiction, a changed interface with others, locating power and a fluid relationship. Narratives were considered to have been influenced by factors such as the interview context and dominant social narratives concerning health and illness. Adolescent-onset CI was found to have a significant, though not exclusively negative, impact on developmental tasks. The findings are discussed in relation to existing literature and potential clinical implications

Preliminary Evaluation of Biplane Correlation (BCI) Stereographic Imaging for Lung Nodule Detection

A biplane correlation (BCI) imaging system obtains images that can be viewed in stereo, thereby minimizing overlapping structures. This study investigated whether using stereoscopic visualization provides superior lung nodule detection compared to standard postero-anterior (PA) image display. Images were acquired at two oblique views of ±3° as well as at a standard PA position from 60 patients. Images were processed using optimal parameters and displayed on a stereoscopic display. The PA image was viewed in the standard format, while the oblique views were paired to provide a stereoscopic view of the subject. A preliminary observer study was performed with four radiologists who viewed and scored the PA image then viewed and scored the BCI stereoscopic image. The BCI stereoscopic viewing of lung nodules resulted in 71 % sensitivity and 0.31 positive predictive value (PPV) index compared to PA results of 86 % sensitivity and 0.26 PPV index. The sensitivity for lung nodule detection with the BCI stereoscopic system was reduced by 15 %; however, the total number of false positives reported was reduced by 35 % resulting in an improved PPV index of 20 %. The preliminary results indicate observer dependency in terms of relative advantage of either system in the detection of lung nodules, but overall equivalency of the two methods with promising potential for BCI as an adjunct diagnostic technique