A multitransmit external body array combined with a (1) H and (31) P endorectal coil to enable a multiparametric and multimetabolic MRI examination of the prostate at 7T

Item does not contain fulltextPURPOSE: In vivo (1) H and (31) P magnetic resonance spectroscopic imaging (MRSI) provide complementary information on the biology of prostate cancer. In this work we demonstrate the feasibility of performing multiparametric imaging (mpMRI) and (1) H and (31) P spectroscopic imaging of the prostate using a (31) P and (1) H endorectal radiofrequency coil (ERC) in combination with a multitransmit body array at 7 Tesla (T). METHODS: An ERC with a (31) P transceiver loop coil and (1) H receive (Rx) asymmetric microstrip ((31) P/(1) H ERC) was designed, constructed and tested in combination with an external 8-channel (1) H transceiver body array coil (8CH). Electromagnetic field simulations and measurements and in vivo temperature measurements of the ERC were performed for safety validation. In addition, the signal-to-noise (SNR) benefit of the (1) H microstrip with respect to the 8CH was evaluated. Finally, the feasibility of the setup was tested in one volunteer and three patients with prostate cancer by performing T2 -weighted and diffusion-weighted imaging in combination with (1) H and (31) P spectroscopic imaging. RESULTS: Electromagnetic field simulations of the (31) P loop coil showed no differences in the E- and B-fields of the (31) P/(1) H ERC compared with a previously safety validated ERC without (1) H microstrip. The hotspot of the specific absorption rate (SAR) at the feed point of the (31) P/(1) H ERC loop coil was 9.42 W/kg when transmitting on (31) P at 1 W. Additional in vivo measurements showed a maximum temperature increase at the SAR hotspot of 0.7 degrees C over 6 min on (31) P at 1.9 W transmit (Tx) power, indicating safe maximum power levels. When transmitting with the external (1) H body array at 40W for 2:30 min, the temperature increase around the ERC was < 0.3 degrees C. Up to 3.5 cm into the prostate the (1) H microstrip of the ERC provided higher SNR than the 8CH. The total coil combination allowed acquisition of an mpMRI protocol and the assessment of (31) P and (1) H metabolites of the prostate in all test subjects. CONCLUSION: We developed a setup with a (31) P transceiver and (1) H Rx endorectal coil in combination with an 8-channel transceiver external body array coil and demonstrated its safety and feasibility for obtaining multiparametric imaging and (1) H and (31) P MRSI at 7T in patients with prostate cancer within one MR examination

Supporting future scholars of engaged research

Researchers in the UK are taking on new roles and responsibilities to meet the requirements of an expanded agenda for generating and evidencing social and economic impacts from research. Within this wider context, culture change programmes have identified learning as an important driver of change. Here we outline a professional development programme designed to train postgraduate researchers studying environmental sciences in core engagement, influence and impact, governance and organization skills for research. We argue that training is an important step in further catalysing progressive culture change. However, our research- and experience-informed critical reflections in supporting researchers suggest that there is still significant work to be done: (1) to offer consistent messages to researchers at all grades about social impacts from research and (2) to ensure that engagement is seen as an aspirational activity, embedded within research

Regeneration of the intervertebral disc

Degeneration of intervertebral disc (IVD) seems to be one of the main causes associated to lower back pain (LBP), one of the most common painful conditions that lead to work absenteeism, medical visits, and hospitalization in actual society [1,2]. This complex fibro-cartilaginous structure is composed by two structures, an outer multilayer fiber structure (annulus fibrosus, AF) and a gel-like inner core (nucleus pulposus, NP), which are sandwiched in part between two cartilage endplates (CEP) [1]. Existing conservative and surgical treatments for LBP are directed to pain relief and do not adequately restore disc structure and mechanical function [2]. In the last years, several studies have been focusing on the development of tissue engineering (TE) approaches aiming to substitute/regenerate the AF or NP, or both by developing an artificial disc that could be implanted in the body thus replacing the damaged disc [3]. TE strategies aiming to regenerate NP tissue often rely on the use of natural hydrogels, due to the number of advantages that these highly hydrated networks can offer. Nevertheless, several of the hydrogel systems developed still present numerous problems, such as variability of production, and inappropriate mechanical and degradation behaviour. Recently, our group has proposed the use of gellan gum (GG) and its derivatives, namely the ionic- and photo-crosslinked methacrylated gellan gum (GG-MA) hydrogels, as potential injectable scaffolds for IVD regeneration [4,5]. Work has been conducted regarding the improvement of GG mechanical properties either by chemically modifying the polymer (allowing to better control in situ gelation and hydrogel stability) [4] or by reinforcing it with biocompatible and biodegradable GG microparticles (enabling the control of degradation rate and cell distribution) [5]. Another strategy currently under investigation relies on the development of a biphasic scaffold that mimics the total disc by using a reverse engineering approach

Quantifying spatial resilience

1. Anthropogenic stressors affect the ecosystems upon which humanity relies. In some cases when resilience is exceeded, relatively small linear changes in stressors can cause relatively abrupt and nonlinear changes in ecosystems. 2. Ecological regime shifts occur when resilience is exceeded and ecosystems enter a new local equilibrium that differs in its structure and function from the previous state. Ecological resilience, the amount of disturbance that a system can withstand before it shifts into an alternative stability domain, is an important framework for understanding and managing ecological systems subject to collapse and reorganization. 3. Recently, interest in the influence of spatial characteristics of landscapes on resilience has increased. Understanding how spatial structure and variation in relevant variables in landscapes affects resilience to disturbance will assist with resilience quantification, and with local and regional management. 4. Synthesis and applications. We review the history and current status of spatial resilience in the research literature, expand upon existing literature to develop a more operational definition of spatial resilience, introduce additional elements of a spatial analytical approach to understanding resilience, present a framework for resilience operationalization and provide an overview of critical knowledge and technology gaps that should be addressed for the advancement of spatial resilience theory and its applications to management and conservation

A study of National Health Service management of chronic osteoarthritis and low back pain

AIM: To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective. BACKGROUND: Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care. METHOD: Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients’ records for three years from diagnosis (‘newly diagnosed’ patients) or for the most recent three years (‘established’ patients). FINDINGS: Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and ‘newly diagnosed’ patients were significantly more likely to visit their GP for pain management than ‘established’ patients. Although ‘newly diagnosed’ patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups. CONCLUSION: This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use

What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care

<p>Abstract</p> <p>Background</p> <p>Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice.</p> <p>Methods</p> <p>We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.</p> <p>Results</p> <p>One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).</p> <p>Conclusions</p> <p>One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.</p

Experiences and attitudes of Dutch rheumatologists and oncologists with regard to their patients’ health-related Internet use

The objective of this study is to explore the experiences and attitudes of rheumatologists and oncologists with regard to their patients’ health-related Internet use. In addition, we explored how often physicians referred their patients to health-related Internet sites. We sent a questionnaire to all the rheumatologists and oncologists in the Netherlands. The questionnaire included questions concerning demographics, experiences with patients’ health-related Internet use, referral behavior, and attitudes to the consequences of patients’ health-related Internet use (for patients themselves, the physician-patient relationship and the health care). The response rate was 46% (N = 238). Of these respondents, 134 practiced as a rheumatologist and 104 as an oncologist. Almost all physicians encountered their patients raising information from the Internet during a consultation. They were not, however, confronted with their patients’ health-related Internet use on a daily basis. Physicians had a moderately positive attitude towards the consequences of patients’ health-related Internet use, the physician-patient relationship and the health care. Oncologists were significantly less positive than rheumatologists about the consequences of health-related Internet use. Most of the physicians had never (32%) or only sometimes (42%) referred a patient to a health-related Internet site. Most physicians (53%) found it difficult to stay up-to-date with reliable Internet sites for patients. Physicians are moderately positive about their patients’ health-related Internet use but only seldom refer them to relevant sites. Offering an up-to-date site with accredited websites for patients might help physicians refer their patients

Computerised speechreading training for deaf children: A randomised controlled trial

Purpose: We developed and evaluated in a randomised controlled triala computerised speechreading training programme to determine a) whether it is possible to train speechreading in deaf children and b) whether speechreading training results in improvements in phonological and reading skills.Previous studies indicate a relationship between speechreading and reading skill and further suggest this relationshipmay be mediated by improved phonological representations. This is important since many deaf children find learning to read to be very challenging. Method: Sixty-six deaf 5-7 year olds were randomised into speechreading and maths training arms. Each training programme was comprised of10 minutesessionsa day, 4 days a week for 12 weeks. Children were assessed on a battery of language and literacy measures before training, immediately after training, 3 months and 10 months after training. Results: We found no significant benefits for participants who completed the speechreading training, compared to those who completed the maths training, on the speechreading primary outcome measure. However, significantly greater gains were observed in the speechreading training group on one of the secondary measures of speechreading. There was also some evidence of beneficial effects of the speechreading training on phonological representations, however these effects were weaker. No benefits were seen toword reading. Conclusions: Speechreading skill is trainable in deaf children. However, to support early reading, training may need to be longer or embedded in a broader literacy programme. Nevertheless, a training tool that can improve speechreading is likely to be of great interest to professionals working with deaf children

Occurrence and population densities of yeast species in a fresh-water lake

Quantitative studies of yeasts present in surface and deep water samples from a fresh water body (Douglas Lake, Michigan) revealed 12 species ( Candida parapsilosis, C. pulcherrima, Cryptococcus albidus, Cr. diffluens, Cr. gastricus, Cr. laurentii, Rhodotorula glutinis, R. pilimanae, R. rubra, Trichosporon cutaneum, Debaryomyces sp., “black yeasts”). In two regions of surface sampling the population densities averaged 39.6 and 5.5 cells per 100 ml respectively, whereas the average deep water count was 40.3 cells per 100 ml. Yeasts of the genus Rhodotorula predominated.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41778/1/10482_2005_Article_BF02046074.pd