Evolution of cooperation in an epithelium

Cooperation is prevalent in nature, not only in the context of social interactions within the animal kingdom but also on the cellular level. In cancer, for example, tumour cells can cooperate by producing growth factors. The evolution of cooperation has traditionally been studied for well-mixed populations under the framework of evolutionary game theory, and more recently for structured populations using evolutionary graph theory (EGT). The population structures arising due to cellular arrangement in tissues, however, are dynamic and thus cannot be accurately represented by either of these frameworks. In this work, we compare the conditions for cooperative success in an epithelium modelled using EGT, to those in a mechanical model of an epithelium—the Voronoi tessellation (VT) model. Crucially, in this latter model, cells are able to move, and birth and death are not spatially coupled. We calculate fixation probabilities in the VT model through simulation and an approximate analytic technique and show that this leads to stronger promotion of cooperation in comparison with the EGT model.

Should helical CT scanning of the thoracic cavity replace the conventional chest x-ray as a primary assessment tool in pediatric trauma? An efficacy and cost analysis

BACKGROUND/PURPOSE

Findings from studies in the trauma literature suggest that thoracic computed tomography (TCT) scanning should replace conventional radiographs as an initial imaging modality. Limited data exist on the clinical utility and cost of TCT scans in pediatric trauma. Our current practice is to obtain TCT scans in those children at risk for thoracic injures. The purpose of this study is to examine what additional information TCT provides, how frequently it results in a change in clinical management, and a cost/benefit analysis.

METHODS

Children 18 years old and younger that had both a Chest x-ray (CXR) and TCT scan in their initial workup were included. Indications for TCT scan were (1) any sign of thoracic injury on CXR, (2) pathologic findings on physical examination of the chest, and (3) high impact force to chest wall. A child may have had one or more indications for a TCT scan.

RESULTS

Between 1996 and 2000, 45 of 1,638 trauma patients met study criteria. Indications for TCT included thoracic injury on CXR (n = 27), findings on physical examination (n = 8) and high-impact force (n = 33). In 18 of the 45 (40%), injuries were detected with TCT imaging but not on CXR. These included contusions (n = 12), hemothorax (n = 6), pneumothorax (n = 5), widened mediastinum (n = 4), rib fractures (n = 2), diaphragmatic rupture (n = 1), and aortic injury (n = 1). In 8 patients (17.7%) TCT imaging resulted in a change in clinical management. These included insertion of a chest tube (n = 5) aortography (n = 2) and operation (n = 1). Age, sex, injury severity score, mechanism, and indication for TCT could not predict differences between TCT and CXR (P >.05). In our institution, the cost of a TCT is $200, and the patient charge is $906 ($94 per CXR). Based on our study data 200 TCTs would need to be done for each clinically significant change, increasing patient ($180,000) and hospital ($39,600) costs.

CONCLUSIONS

Helical TCT is a highly sensitive imaging modality for the thoracic cavity; however, routine CXR still provides clinically valuable information for the initial trauma evaluation at minimal cost. TCT should be reserved for selected cases and not as a primary imaging tool.

General nurses' attitudes to patients who self-harm

This article describes the prevalence of suicidal behaviour, both nationally and in relation to one inner city district general hospital. The authors discuss what is currently known about risk assessment for identifying those patients likely to repeat the act in the near future. They also examine the findings of a recent survey about nurses' perceptions and attitudes to patients who take deliberate drug overdoses. The survey found that nurses possessed some of the facts about risk factors relating to future parasuicidal intent and displayed generally professional attitudes to the treatment of these patients in general medical wards and A&E, but they appeared to show negative personal reactions after caring for patients who self-harm.