Faster magnetic resonance imaging in emergency room patients with right lower quadrant pain and suspected acute appendicitis

Purpose: Emergency Departments (ED) are becoming busier, with a resultant increase in the number of imaging referrals. The purpose of this study was to assess the diagnostic accuracy of an abbreviated two sequence magnetic resonance (MR) protocol for evaluating ED patients with right lower quadrant pain and suspected acute appendicitis, with a view to expediting patient turnaround times and imaging costs. Material and methods: Fifty patients (49 females, one male; mean age 25.4 ± 5.2 years) who underwent ED MR imaging from July 2014 to March 2015 for right lower quadrant pain were retrospectively reviewed. MR abdomen/pelvis was performed on 1.5 T MR obtaining axial T1 gradient echo in/out of phase, transverse fast spin echo T2 with fat sat/motion correction, axial/coronal T2 HASTE (half-Fourier acquisition single-shot turbo spin-echo), and axial DWI (diffusion-weighted imaging) sequences. Images were reviewed by two fellowship-trained radiologists on a five-point confidence scale. Mean acquisition/interpretation times for the standard departmental protocol and the proposed abbreviated MR protocol (comprising T2 HASTE and DWI images) were calculated. Sensitivity, specificity, and diagnostic accuracy for the abbreviated protocol against the full protocol were also calculated. Results: Mean scanning time for abbreviated protocol and standard protocol was calculated to be 21.1 minutes and 40.5 minutes, respectively. Mean interpretation time for abbreviated protocol for reader one and two was 4.1 ± 1.5 minutes and 4.5 ± 1.4 minutes, respectively, and for standard protocol was 8.1 ± 1.8 minutes and 7.1 ± 1.4 minutes, respectively. Sensitivity, specificity, and accuracy for the FAST protocol were calculated to be 100% each for reader one and 75%, 100%, and 94%, respectively, for reader two. Conclusions: The proposed abbreviated MR protocol has comparable diagnostic accuracy in diagnosing ED patients with right lower quadrant pain, with significant reduction in imaging/interpretation times. It thus has the potential to be implemented in ED imaging with significant reduction in patient turnaround times and costs

Gravitational lensing as folds in the sky

We revisit the gravitational lensing phenomenon using a new visualization technique. It consists in projecting the observers sky into the source plane, what gives rise to a folded and stretched surface. This provides a clear graphical tool to visualize some interesting well-known effects, such as the development of multiple images of a source, the structure of the caustic curves, the parity of the images and their magnification as a function of the source position.Comment: 11 pages, 8 figure

CFTR Gating II: Effects of Nucleotide Binding on the Stability of Open States

Previously, we demonstrated that ADP inhibits cystic fibrosis transmembrane conductance regulator (CFTR) opening by competing with ATP for a binding site presumably in the COOH-terminal nucleotide binding domain (NBD2). We also found that the open time of the channel is shortened in the presence of ADP. To further study this effect of ADP on the open state, we have used two CFTR mutants (D1370N and E1371S); both have longer open times because of impaired ATP hydrolysis at NBD2. Single-channel kinetic analysis of ΔR/D1370N-CFTR shows unequivocally that the open time of this mutant channel is decreased by ADP. ΔR/E1371S-CFTR channels can be locked open by millimolar ATP with a time constant of ∼100 s, estimated from current relaxation upon nucleotide removal. ADP induces a shorter locked-open state, suggesting that binding of ADP at a second site decreases the locked-open time. To test the functional consequence of the occupancy of this second nucleotide binding site, we changed the [ATP] and performed similar relaxation analysis for E1371S-CFTR channels. Two locked-open time constants can be discerned and the relative distribution of each component is altered by changing [ATP] so that increasing [ATP] shifts the relative distribution to the longer locked-open state. Single-channel kinetic analysis for ΔR/E1371S-CFTR confirms an [ATP]-dependent shift of the distribution of two locked-open time constants. These results support the idea that occupancy of a second ATP binding site stabilizes the locked-open state. This binding site likely resides in the NH(2)-terminal nucleotide binding domain (NBD1) because introducing the K464A mutation, which decreases ATP binding affinity at NBD1, into E1371S-CFTR shortens the relaxation time constant. These results suggest that the binding energy of nucleotide at NBD1 contributes to the overall energetics of the open channel conformation

Krylov Methods for Low-Rank Regularization

This paper introduces new solvers for the computation of low-rank approximate solutions to large-scale linear problems, with a particular focus on the regularization of linear inverse problems. Although Krylov methods incorporating explicit projections onto low-rank subspaces are already used for well-posed systems that arise from discretizing stochastic or time-dependent PDEs, we are mainly concerned with algorithms that solve the so-called nuclear norm regularized problem, where a suitable nuclear norm penalization on the solution is imposed alongside a fit-to-data term expressed in the 2-norm: this has the effect of implicitly enforcing low-rank solutions. By adopting an iteratively reweighted norm approach, the nuclear norm regularized problem is reformulated as a sequence of quadratic problems, which can then be efficiently solved using Krylov methods, giving rise to an inner-outer iteration scheme. Our approach differs from the other solvers available in the literature in that: (a) Kronecker product properties are exploited to define the reweighted 2-norm penalization terms; (b) efficient preconditioned Krylov methods replace gradient (projection) methods; (c) the regularization parameter can be efficiently and adaptively set along the iterations. Furthermore, we reformulate within the framework of flexible Krylov methods both the new inner-outer methods for nuclear norm regularization and some of the existing Krylov methods incorporating low-rank projections. This results in an even more computationally efficient (but heuristic) strategy, that does not rely on an inner-outer iteration scheme. Numerical experiments show that our new solvers are competitive with other state-of-the-art solvers for low-rank problems, and deliver reconstructions of increased quality with respect to other classical Krylov methods

Estimation of latent variable models for ordinal data via fully exponential Laplace approximation

Latent variable models for ordinal data represent a useful tool in different fields of research in which the constructs of interest are not directly observable. In such models, problems related to the integration of the likelihood function can arise since analytical solutions do not exist. Numerical approximations, like the widely used Gauss Hermite (GH) quadrature, are generally applied to solve these problems. However, GH becomes unfeasible as the number of latent variables increases. Thus, alternative solutions have to be found. In this paper, we propose an extended version of the Laplace method for approximating the integrals, known as fully exponential Laplace approximation. It is computational feasible also in presence of many latent variables, and it is more accurate than the classical Laplace method

Implementasi Animasi Pada Multimedia Interaktif

Most people do reading activities to gain knowledge, as entertainment or a hobby for people to read. From generation to generation, reading begins to decreases. Reading becomes obsolete. Nowadays, reading a book filled with writing would be boring. Books preferably instant and interesting than a book filled with long writing and tedious. While in general almost all history books are full of writing. So this time i will make an interactive multimedia that interesting and not boring about the history of the kingdom of Majapahit.In the manufacture of interactive multimedia about the history of Majapahit i implemented several important elements in interactive multimedia ie text, images, sounds, and animations are placed and adjusted the alignment between text, images, sound, and animation. The menu also made efficiently so that it can move from one topic to another topic. The addition of some visual effects that make interactive multimedia applications about the history of Majapahit becoming more.The apllication was tested to some people to see if the interactive multimedia about the history of Majapahit interesting or not. Amounting to 75,52% people said that the interactive multimedia about the history of Majapahit is more interesting rather than the book full of writing

Quema de caña de azúcar en Laredo-Trujillo: Transgresión de derechos ambientales y el deber estatal ante impactos ambientales negativos

La investigación “Quema de caña de azúcar en Laredo–Trujillo: Transgresión de derechos ambientales y el deber estatal ante impactos ambientales negativos” tuvo como objetivo determinar la correlación entre la transgresión de los derechos ambientales y el deber del Estado ante impactos ambientales negativos existentes por la quema de caña de azúcar en Laredo, 2022. La investigación es cuantitativa, básica y descriptiva; de diseño correlacional transversal. La población fue de 80 expertos, y la muestra se conformó por 50; se empleó la encuesta para recolectar datos con dos cuestionarios, validados por el juicio de expertos y con confiabilidad de 0,845 según Alfa de Crombach. Los resultados obtenidos en Transgresión de los derechos ambientales, destaca el nivel “Demasiado” con 50%; en cambio, en el Deber del Estado ante los impactos ambientales por la quema de caña de azúcar, destaca el nivel “Nada” con 50%; asimismo, la prueba Rho de Spearman = 0, 429 y significancia = 0,217. Estos resultados permitieron arribar a la conclusión que, entre ambas variables existe una correlación baja y no significativa; por lo que urge una propuesta de salud ambiental para disminuir el daño que causa la quema de caña en Lared

Senior medical students’ awareness of radiation risks from common diagnostic imaging examinations

Background: Senior medical students represent future physicians who commonly refer patients for diagnostic imaging studies that may involve ionizing radiation. The radiology curriculum at the University of British Columbia provides students with broad-based knowledge about common imaging examinations. The purpose of this study was to investigate students’ awareness of radiation exposures and risks.Methods: An anonymous multiple-choice cross-sectional questionnaire was distributed to final year medical students to assess knowledge of radiation from common diagnostic examinations and radiation-related risks following completion of the longitudinal radiology curriculum, carried out over the four years of medical training.Results: Sixty-three of 192 eligible students participated (33% response rate). The majority felt that knowledge of radiation doses of common imaging examinations is somewhat or very important; however, only 12% (N = 8) routinely discuss radiation-related risks with patients. While all respondents recognized children as most sensitive to the effects of radiation, only 24% (N = 15) correctly identified gonads as the most radiation-sensitive tissue. Almost all respondents recognized ultrasound and MRI as radiation free modalities. Respondents who correctly identified the relative dose of common imaging examinations in chest x-ray equivalents varied from 3-77% (N = 2 – 49); the remaining responses were largely underestimates. Finally, 44% (N = 28) correctly identified the excess risk of a fatal cancer from an abdominal CT in an adult, while the remainder underestimated this risk.Conclusion: Medical students acknowledge the importance of radiation-related issues to patient care. While almost all students are familiar with radiation-free modalities, many are not familiar with, and commonly underestimate, the relative doses and risks of common imaging studies. This may expose patients to increasing imaging investigations and exposure to radiation hazards

Cyclic fatigue resistance, torsional resistance, and metallurgical characteristics of M3 Rotary and M3 Pro Gold NiTi files

Objectives: To evaluate the mechanical properties and metallurgical characteristics of the M3 Rotary and M3 Pro Gold files (United Dental). Materials and Methods: One hundred and sixty new M3 Rotary and M3 Pro Gold files (sizes 20/0.04 and 25/0.04) were used. Torque and angle of rotation at failure (n = 20) were measured according to ISO 3630-1. Cyclic fatigue resistance was tested by measuring the number of cycles to failure in an artificial stainless steel canal (60° angle of curvature and a 5-mm radius). The metallurgical characteristics were investigated by differential scanning calorimetry. Data were analyzed using analysis of variance and the Student-Newman-Keuls test. Results: Comparing the same size of the 2 different instruments, cyclic fatigue resistance was significantly higher in the M3 Pro Gold files than in the M3 Rotary files (p < 0.001). No significant difference was observed between the files in the maximum torque load, while a significantly higher angular rotation to fracture was observed for M3 Pro Gold (p < 0.05). In the DSC analysis, the M3 Pro Gold files showed one prominent peak on the heating curve and 2 prominent peaks on the cooling curve. In contrast, the M3 Rotary files showed 1 small peak on the heating curve and 1 small peak on the cooling curve. Conclusions: The M3 Pro Gold files showed greater flexibility and angular rotation than the M3 Rotary files, without decrement of their torque resistance. The superior flexibility of M3 Pro Gold files can be attributed to their martensite phase

“To Become Successful”: Impacts of Parent Migration on Youth’s Educational Opportunities and Aspirations in Ponorogo, Indonesia

Migration happens on a large scale in Indonesia. While migrants often say supporting their children’s education is a key motivation for migration, they face tremendous difficulties in saving up for the long-term due to debt, unforeseen financial difficulties, and the lack of investment opportunities in Ponorogo. Consequently, the use of remittances for education is of an ad-hoc nature, and it does not take much to shock the household budget leading to the disruption of educational aspirations. To address these challenges, this policy brief recommends that the state provides favourable structural conditions to support young people’ access to education and occupational opportunities.DFIDMigrating out of Povert