Management of recurrent localised bladder amyloid, has methotrexate helped?

Background

Amyloidosis of the bladder is a benign condition which can present with a multitude of symptoms including bladder mass, irritative voiding symptoms and haematuria.

Case presentation

We report on the investigation and management of a patient with recurrent localised amyloidosis of the bladder, which appears to have been managed fortuitously by concurrent methotrexate prescribed for another indication.

Conclusion

We provide further assessment and management with a focus on the possible benefit of methotrexate for management of localised bladder amyloidosis.

User-Intended Doppler Measurement Type Prediction Combining CNNs With Smart Post-Processing

Spectral Doppler measurements are an important part of the standard echocardiographic examination. These measurements give insight into myocardial motion and blood flow, providing clinicians with parameters for diagnostic decision making. Many of these measurements are performed automatically with high accuracy, increasing the efficiency of the diagnostic pipeline. However, full automation is not yet available because the user must manually select which measurement should be performed on each image. In this work, we develop a pipeline based on convolutional neural networks (CNNs) to automatically classify the measurement type from cardiac Doppler scans. We show how the multi-modal information in each spectral Doppler recording can be combined using a meta parameter post-processing mapping scheme and heatmaps to encode coordinate locations. Additionally, we experiment with several architectures to examine the tradeoff between accuracy, speed, and memory usage for resource-constrained environments. Finally, we propose a confidence metric using the values in the last fully connected layer of the network and show that our confidence metric can prevent many misclassifications. Our algorithm enables a fully automatic pipeline from acquisition to Doppler spectrum measurements. We achieve 96% accuracy on a test set drawn from separate clinical sites, indicating that the proposed method is suitable for clinical adoption.

The 'Digital Twin' to enable the vision of precision cardiology

Providing therapies tailored to each patient is the vision of precision medicine, enabled by the increasing ability to capture extensive data about individual patients. In this position paper, we argue that the second enabling pillar towards this vision is the increasing power of computers and algorithms to learn, reason, and build the 'digital twin' of a patient. Computational models are boosting the capacity to draw diagnosis and prognosis, and future treatments will be tailored not only to current health status and data, but also to an accurate projection of the pathways to restore health by model predictions. The early steps of the digital twin in the area of cardiovascular medicine are reviewed in this article, together with a discussion of the challenges and opportunities ahead. We emphasize the synergies between mechanistic and statistical models in accelerating cardiovascular research and enabling the vision of precision medicine.

World Small Animal Veterinary Association Global Dental Guidelines

Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.

Liquid Chromatographic Method for Determination of Diquat and Paraquat Herbicides in Potatoes: Collaborative Study

A liquid chromatographic (LC) method for the determination of diquat and paraquat herbicides/desiccants in potatoes was collaboratively studied in 6 laboratories. Analytes are extracted from 5 g sample with dilute acid by using a microreflux procedure; the hydrolysate is adjusted to pH 9–10 and passed through a disposable silica cartridge for rapid cleanup and preconcentration. Analytes are separated on a reversed-phase LC column and are measured as their heptanesulfonate ion pairs by UV detection. Each collaborator determined diquat and paraquat at 4 levels (0.05,0.1,0.5, and 1.0 ppm) in blind duplicate samples plus 2 blind negative control samples. Potatoes, obtained from each participant’s region, were spiked by the collaborators with unknown aqueous solutions containing no analyte or a mixture of diquat and paraquat standards. Repeatability and reproducibility relative standard deviations (RSDr and RSDR) averaged 17.1 and 29.0%, respectively, for determination of diquat and 10.8 and 29.5%, respectively, for paraquat. For analysis of standard solutions, RSDr and RSDR values were 6.3 and 12.0%, respectively, for diquat and 7.3 and 13.9%, respectively, for paraquat. Accuracy, measured by comparison with true spiking values (absolute recovery) averaged 77.6 and 76.2% for diquat and paraquat, respectively, and ranged from 71.8 to 88.0% for both compounds. The method was adopted first action by AOAC International.

Cardiac Motion Evolution Model for Analysis of Functional Changes Using Tensor Decomposition and Cross-Sectional Data

Cardiac disease can reduce the ability of the ventricles to function well enough to sustain long-term pumping efficiency. Recent advances in cardiac motion tracking have led to improvements in the analysis of cardiac function. We propose a method to study cohort effects related to age with respect to cardiac function. The proposed approach makes use of a recent method for describing cardiac motion of a given subject using a polyaffine model, which gives a compact parameterization that reliably and accurately describes the cardiac motion across populations. Using this method, a data tensor of motion parameters is extracted for a given population. The partial least squares method for higher order arrays is used to build a model to describe the motion parameters with respect to age, from which a model of motion given age is derived. Based on the cross-sectional statistical analysis with the data tensor of each subject treated as an observation along time, the left ventricular motion over time of Tetralogy of Fallot patients is analysed to understand the temporal evolution of functional abnormalities in this population compared to healthy motion dynamics.

Exploring the value of mental health nurses working in primary care in England: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Primary care and, in particular, general practice (GP) are often first point of access to health care. International evidence suggests that healthcare systems oriented towards primary care may produce better outcomes, at lower costs and with higher user satisfaction. Despite this, there are noted deficiencies and variations in the quality of care in primary care for patients with mental health problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emerging models of providing mental health services in primary care are poorly understood. This paper evaluates a mental health nurse-led Primary Care Liaison Service (PCLS), developed in 2011 in inner London. The findings suggest that this type of service can improve the quality of care for people presenting with mental health problems within primary care, specifically due to improved integration, clinical effectiveness, patient-centred care, access and efficiency. The study also highlighted challenges such as staff retention within this new role and setting appropriate referral criteria. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This is a relatively new service, and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area. The extent to which the findings are transferable will depend on service configuration and local demographics which can vary. Further research within this area could give more detail on the impact of such teams on health outcomes, recovery rates, secondary care referrals and accident and emergency attendances, and its cost-effectiveness.

ABSTRACT

Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse (PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area.

Detecting Clinically Meaningful Shape Clusters in Medical Image Data: Metrics Analysis for Hierarchical Clustering Applied to Healthy and Pathological Aortic Arches

OBJECTIVE

Today's growing medical image databases call for novel processing tools to structure the bulk of data and extract clinically relevant information. Unsupervised hierarchical clustering may reveal clusters within anatomical shape data of patient populations as required for modern precision medicine strategies. Few studies have applied hierarchical clustering techniques to three-dimensional patient shape data and results depend heavily on the chosen clustering distance metrics and linkage functions. In this study, we sought to assess clustering classification performance of various distance/linkage combinations and of different types of input data to obtain clinically meaningful shape clusters.

METHODS

We present a processing pipeline combining automatic segmentation, statistical shape modeling, and agglomerative hierarchical clustering to automatically subdivide a set of 60 aortic arch anatomical models into healthy controls, two groups affected by congenital heart disease, and their respective subgroups as defined by clinical diagnosis. Results were compared with traditional morphometrics and principal component analysis of shape features.

RESULTS

Our pipeline achieved automatic division of input shape data according to primary clinical diagnosis with high F-score (0.902 ± 0.042) and Matthews correlation coefficient (0.851 ± 0.064) using the correlation/weighted distance/linkage combination. Meaningful subgroups within the three patient groups were obtained and benchmark scores for automatic segmentation and classification performance are reported.

CONCLUSION

Clustering results vary depending on the distance/linkage combination used to divide the data. Yet, clinically relevant shape clusters and subgroups could be found with high specificity and low misclassification rates.

SIGNIFICANCE

Detecting disease-specific clusters within medical image data could improve image-based risk assessment, treatment planning, and medical device development in complex disease.

Ventricular structure in ARVC: going beyond volumes as a measure of risk

BACKGROUND

Altered right ventricular structure is an important feature of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), but is challenging to quantify objectively. The aim of this study was to go beyond ventricular volumes and diameters and to explore if the shape of the right and left ventricles could be assessed and related to clinical measures. We used quantifiable computational methods to automatically identify and analyse malformations in ARVC patients from Cardiovascular Magnetic Resonance (CMR) images. Furthermore, we investigated how automatically extracted structural features were related to arrhythmic events.

METHODS

A retrospective cross-sectional feasibility study was performed on CMR short axis cine images of 27 ARVC patients and 21 ageing asymptomatic control subjects. All images were segmented at the end-diastolic (ED) and end-systolic (ES) phases of the cardiac cycle to create three-dimensional (3D) bi-ventricle shape models for each subject. The most common components to single- and bi-ventricular shape in the ARVC population were identified and compared to those obtained from the control group. The correlations were calculated between identified ARVC shapes and parameters from the 2010 Task Force Criteria, in addition to clinical outcomes such as ventricular arrhythmias.

RESULTS

Bi-ventricle shape for the ARVC population showed, as ordered by prevalence with the percent of total variance in the population explained by each shape: global dilation/shrinking of both ventricles (44 %), elongation/shortening at the right ventricle (RV) outflow tract (15 %), tilting at the septum (10 %), shortening/lengthening of both ventricles (7 %), and bulging/shortening at both the RV inflow and outflow (5 %). Bi-ventricle shapes were significantly correlated to several clinical diagnostic parameters and outcomes, including (but not limited to) correlations between global dilation and electrocardiography (ECG) major criteria (p = 0.002), and base-to-apex lengthening and history of arrhythmias (p = 0.003). Classification of ARVC vs. control using shape modes yielded high sensitivity (96 %) and moderate specificity (81 %).

CONCLUSION

We presented for the first time an automatic method for quantifying and analysing ventricular shapes in ARVC patients from CMR images. Specific ventricular shape features were highly correlated with diagnostic indices in ARVC patients and yielded high classification sensitivity. Ventricular shape analysis may be a novel approach to classify ARVC disease, and may be used in diagnosis and in risk stratification for ventricular arrhythmias.

A statistical shape modelling framework to extract 3D shape biomarkers from medical imaging data: assessing arch morphology of repaired coarctation of the aorta

BACKGROUND

Medical image analysis in clinical practice is commonly carried out on 2D image data, without fully exploiting the detailed 3D anatomical information that is provided by modern non-invasive medical imaging techniques. In this paper, a statistical shape analysis method is presented, which enables the extraction of 3D anatomical shape features from cardiovascular magnetic resonance (CMR) image data, with no need for manual landmarking. The method was applied to repaired aortic coarctation arches that present complex shapes, with the aim of capturing shape features as biomarkers of potential functional relevance. The method is presented from the user-perspective and is evaluated by comparing results with traditional morphometric measurements.

METHODS

Steps required to set up the statistical shape modelling analyses, from pre-processing of the CMR images to parameter setting and strategies to account for size differences and outliers, are described in detail. The anatomical mean shape of 20 aortic arches post-aortic coarctation repair (CoA) was computed based on surface models reconstructed from CMR data. By analysing transformations that deform the mean shape towards each of the individual patient's anatomy, shape patterns related to differences in body surface area (BSA) and ejection fraction (EF) were extracted. The resulting shape vectors, describing shape features in 3D, were compared with traditionally measured 2D and 3D morphometric parameters.

RESULTS

The computed 3D mean shape was close to population mean values of geometric shape descriptors and visually integrated characteristic shape features associated with our population of CoA shapes. After removing size effects due to differences in body surface area (BSA) between patients, distinct 3D shape features of the aortic arch correlated significantly with EF (r = 0.521, p = .022) and were well in agreement with trends as shown by traditional shape descriptors.

CONCLUSIONS

The suggested method has the potential to discover previously unknown 3D shape biomarkers from medical imaging data. Thus, it could contribute to improving diagnosis and risk stratification in complex cardiac disease.

Spatio-Temporal Tensor Decomposition of a Polyaffine Motion Model for a Better Analysis of Pathological Left Ventricular Dynamics

Given that heart disease can cause abnormal motion dynamics over the cardiac cycle, understanding and quantifying cardiac motion can provide insight for clinicians to aid with diagnosis, therapy planning, and determining prognosis. The goal of this paper is to extract population-specific motion patterns from 3D displacements in order to identify the mean motion in a population, and to describe pathology-specific motion patterns in terms of the spatial and temporal components. Since there are common motion patterns observed in patients with the same condition, extracting these can lead towards a better understanding of the disease. Quantifying cardiac motion at a population level is not a simple task since images can vary widely in terms of image quality, size, resolution, and pose. To overcome this, we analyze the parameters obtained from a cardiac-specific Polyaffine motion-tracking algorithm, which are aligned both spatially and temporally to a common reference space. Once all parameters are aligned, different subjects can be compared and analyzed in the space of Polyaffine transformations by projecting the transformations to a reduced order subspace in which dominant motion patterns in each population can be extracted. Using tensor decomposition, the spatial and temporal aspects can be decoupled in order to study the components individually. The proposed method was validated on healthy volunteers and Tetralogy of Fallot patients according to known spatial and temporal behavior for each population. A key advantage of this method is the ability to regenerate motion sequences from the models, which can be visualized in terms of the full motion.

Benchmarking framework for myocardial tracking and deformation algorithms: an open access database

In this paper we present a benchmarking framework for the validation of cardiac motion analysis algorithms. The reported methods are the response to an open challenge that was issued to the medical imaging community through a MICCAI workshop. The database included magnetic resonance (MR) and 3D ultrasound (3DUS) datasets from a dynamic phantom and 15 healthy volunteers. Participants processed 3D tagged MR datasets (3DTAG), cine steady state free precession MR datasets (SSFP) and 3DUS datasets, amounting to 1158 image volumes. Ground-truth for motion tracking was based on 12 landmarks (4 walls at 3 ventricular levels). They were manually tracked by two observers in the 3DTAG data over the whole cardiac cycle, using an in-house application with 4D visualization capabilities. The median of the inter-observer variability was computed for the phantom dataset (0.77 mm) and for the volunteer datasets (0.84 mm). The ground-truth was registered to 3DUS coordinates using a point based similarity transform. Four institutions responded to the challenge by providing motion estimates for the data: Fraunhofer MEVIS (MEVIS), Bremen, Germany; Imperial College London - University College London (IUCL), UK; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Inria-Asclepios project (INRIA), France. Details on the implementation and evaluation of the four methodologies are presented in this manuscript. The manually tracked landmarks were used to evaluate tracking accuracy of all methodologies. For 3DTAG, median values were computed over all time frames for the phantom dataset (MEVIS=1.20mm, IUCL=0.73 mm, UPF=1.10mm, INRIA=1.09 mm) and for the volunteer datasets (MEVIS=1.33 mm, IUCL=1.52 mm, UPF=1.09 mm, INRIA=1.32 mm). For 3DUS, median values were computed at end diastole and end systole for the phantom dataset (MEVIS=4.40 mm, UPF=3.48 mm, INRIA=4.78 mm) and for the volunteer datasets (MEVIS=3.51 mm, UPF=3.71 mm, INRIA=4.07 mm). For SSFP, median values were computed at end diastole and end systole for the phantom dataset(UPF=6.18 mm, INRIA=3.93 mm) and for the volunteer datasets (UPF=3.09 mm, INRIA=4.78 mm). Finally, strain curves were generated and qualitatively compared. Good agreement was found between the different modalities and methodologies, except for radial strain that showed a high variability in cases of lower image quality.

Uniqueness of solutions of semilinear Poisson equations

Let R(n) denote n-dimensional Euclidean space, with n > 1. We study the uniqueness of positive solutions u(x), x in R(n), of the semilinear Poisson equation Deltau + f(u) = 0 under the assumption that u(x) --> 0 as x --> infinity. This type of problem arises in phase transition theory, in population genetics, and in the theory of nucleon cores, with various different forms of the driving term f(u). For the important model case f(u) = -u + u(p), where p is a constant greater than 1, our results show (i) that when the dimension n of the underlying space is 2, there is at most one solution (up to translation) for any given p and (ii) that when the dimension n is 3, there is at most one solution when 1 < p </= 3. In both cases, the solution is radially symmetric and monotonically decreasing as one moves outward from the center. For dimensions other than 2 or 3, and indeed for the analogous cases of a real dimensional parameter n > 1, we obtain corresponding results. We note finally, again for the model case, that existence holds for 1 < p < (n + 2)/(n - 2); thus, there remains an interesting difference between the parameter ranges for which existence and uniqueness are established.

Changes in the news representation of smokers and tobacco-related media advocacy from 1995 to 2005 in Australia

BACKGROUND

This study aims to show how smokers were represented in smoking-related news articles, editorials, letters and columns in a major Australian newspaper over an 11-year period from January 1995 to December 2005.

METHODS

Qualitative content analysis was conducted on a sample of 618 articles to identify 21 representational categories (RCs) of the smoker. Articles were also examined for statements that lent organisational support to either tobacco control or the promotion of tobacco.

RESULTS

The construction of the smoker as a "regulated citizen" due to being subjected to tobacco policy was the most prevalent RC, occurring in 43.4% of articles. Of the 13 most prevalent RCs, eight were constructions of the smoker that lent support to tobacco control outcomes, two were supportive of the promotion of tobacco, and three could be used by both parties. 30.6% of articles contained at least one statement from a tobacco control advocacy source, compared with only 13.6% of articles having a statement towards the promotion of tobacco.

CONCLUSION

These results indicate that constructions of the smoker that support tobacco control have dominated smoking-related discourse in this Australian newspaper and that representations favouring a tobacco industry viewpoint appeared less often. However, the pro-tobacco representations of smokers in reports relating to legal issues highlight an area of media discourse in which tobacco control advocates should remain vigilant.

The implantable loop recorder in children

OBJECTIVE

To evaluate use of the implantable loop recorder in children.

SETTING

Royal Hospital for Sick Children, Glasgow, UK.

METHOD

Retrospective study of children who had an implantable loop recorder between September 1998 and October 2005.

RESULTS

38 devices were implanted in 34 children. Median age at implantation 11.3 years (range 1.8-17.6); median follow-up period 15 months (range 2-58). The main presenting complaint was syncope in 26 (76.5%), seizures in 6 (17.6%) and palpitations in 2 (5.9%). After implantation, 19 (55.9%) patients had symptom recurrence. Of these, 11 were shown to have sinus rhythm during symptoms and 8 had an abnormal ECG. Four patients had asystole >3 seconds and were diagnosed with reflex asystolic syncope; 2 had polymorphic ventricular tachycardia. One patient who already had a diagnosis of long QT syndrome was shown to have ventricular ectopy during symptoms and beta-blockers were increased. One patient had transient complete heart block during symptoms but refused a pacemaker. In almost half the patients (44.1%), symptoms resolved after implantation. Complications requiring removal of the device occurred in 6 (15.8%) implants.

CONCLUSIONS

In children with syncope and palpitations, the implantable loop recorder appears to be an excellent method of effecting a "cure" in almost 50% of subjects. For those who remain symptomatic, it is successful in determining cardiac rhythm during symptoms, but the complication rate in children may be higher than that of adults.

Long-term survival of surgically treated hip fracture in an Australian regional hospital

This study was undertaken to identify factors influencing outcome in elderly patients operated for hip fracture. In particular, this study examined factors related to mortality at least 30 months post-fracture. Hospital records and death registrations were analysed for 463 patients aged 60 or more years treated for hip fracture at a Queensland regional hospital between 1997 and 2001. The overall mortality for surgically treated patients was 13.7% at 100 days and 24.9% at one year Patient factors including age, gender, health status and place of residence were the predominant influences on mortality. Non-patient and process factors including delay to surgery, type of operation and type of anaesthetic had minimal impact on mortality. No major determinants of length of hospital stay were identified. Patient health status was the main determinant for surgical delay. Our results confirm the persistently high mortality in this group of patients, and suggest that the main determinants of outcome are patient- rather than process-related.

Inter- and intraobserver variability in LVH and RVH reporting in pediatric ECGs

BACKGROUND

Physicians' diagnoses are often used as the gold standard for evaluating computer electrocardiogram (ECG) interpretation programs. As part of a larger study to evaluate the Glasgow pediatric ECG analysis program, inter- and intraobserver variability in the ECG reporting of two pediatric cardiologists was examined.

METHODS

The ECGs of 984 children were sent for reporting independently by two cardiologists with all identifying information except age and sex removed. Three hundred twenty ECGs had no clinical indication available, and they were thus reported "blind." For 664 ECGs, the clinical indication was known and included with the ECG trace. All ECGs reported as right ventricular hypertrophy (RVH) or left ventricular hypertrophy (LVH) were returned to the cardiologists without their knowledge for reporting a second time "blind" as to the clinical indication.

RESULTS

When the cardiologists' reports were compared with each other, the provision of clinical information led to greater agreement between them for the diagnosis of LVH (kappa increased from 0.44 to 0.52) but did not substantially affect their agreement in diagnosing RVH (kappa fell from 0.66 to 0.63). Intraindividual comparisons in 166 ECGs revealed that one cardiologist was more consistent in diagnosing RVH and the other more consistent in diagnosing LVH.

CONCLUSIONS

This study has demonstrated the difficulties in using cardiologists' diagnoses as the gold standard with which to evaluate pediatric ECGs.

Evaluation of pediatric electrocardiogram diagnosis of ventricular hypertrophy by computer program compared with cardiologists

This study aimed to evaluate the diagnosis of pediatric left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH) by the Glasgow electrocardiogram (ECG) interpretation program compared to interpretations provided by two pediatric cardiologists. ECGs had all identifying information removed and were sent to the cardiologists independently with the patient's age and sex and the clinical indication for the ECG, if known. A total of 984 ECGs were included in the study, of which 664 were reported "with clinical indication" and 320 were reported "blind." With respect to an averaged diagnosis of the two cardiologists, the sensitivity of the program for RVH was better when the cardiologists reported blind (73.3%) than with the clinical indication (53.5%), with the same trend for the program compared with individual cardiologists. The specificity of the program was at least 94.4% in all cases. For LVH, the program had high specificity (=95.8%) for "reported blind" and "with clinical indication" cases but low sensitivities throughout (the highest was 44.4% with respect to an averaged diagnosis of the two cardiologists reporting with the clinical indication). Subsequent discussion revealed that if the cardiologists had disagreed with one another initially, their consensus opinion was twice as likely to be in agreement with the program.

Tobacco in the news: an analysis of newspaper coverage of tobacco issues in Australia, 2001

OBJECTIVE

To assess the extent and nature of newspaper coverage of tobacco related issues in Australia in 2001.

DESIGN

Content analysis of newspaper articles.

SUBJECTS

All articles (n=1188) at least seven lines long and containing at least one paragraph focused on tobacco in all major Australian national and State capital city newspapers (n=12) in 2001.

MAIN OUTCOME MEASURES

Number of articles, month of publication, State in which newspaper published, prominence of article, type of article, article theme, and slant of article relative to tobacco control objectives.

RESULTS

The number of tobacco articles varied considerably in different months over the course of the year, from a low of 51 in December to a peak of 180 in May. The most frequent theme was secondhand smoke issues (30% of articles), with the second most dominant theme related to education, prevention, and cessation programmes and services (20%). Events that were covered were predominantly positive for tobacco control: 62% of articles were related to events that were positive, compared with 21% that were negative for tobacco control objectives. Excluding news articles, the opinions expressed by the authors of articles were also mainly positive (61%) rather than negative (22%) for tobacco control objectives. The amount of coverage of and population exposure to tobacco focused articles showed considerable variation across different Australian States, with Victoria having the highest frequency and rate of articles and the most media impressions per capita throughout 2001.

CONCLUSIONS

: Coverage of events and opinions related to tobacco in Australian newspapers in 2001 was generally positive for tobacco control objectives. Given that over 2 million individuals (out of a population of 19 million) were potentially exposed to tobacco related newspaper articles per day in Australia, this represents good news for tobacco control advocates. The variation in news coverage in different States and at different times in the year, however, illustrates how a combination of local events and advocacy efforts may at times combine to make tobacco more newsworthy. Understanding which tobacco issues are most likely to be covered and the nature of the coverage about them provides valuable feedback for tobacco control advocates and is a useful gauge of actual events as well as the tobacco related agendas promoted by the press.

Use of an implantable loop recorder to investigate syncope in a cat

The Reveal is an implantable loop recorder. It is increasingly being used in humans for the diagnosis of unexplained syncope where it is believed that cardiac arrhythmias may play a role, and may have great potential for investigating syncope in veterinary patients. The purpose of this report is to describe the first use of the device in the diagnosis of unexplained syncope in a cat.

Mechanical strain, induced noninvasively in the high-frequency domain, is anabolic to cancellous bone, but not cortical bone

Departing from the premise that it is the large-amplitude signals inherent to intense functional activity that define bone morphology, we propose that it is the far lower magnitude, high-frequency mechanical signals that continually barrage the skeleton during longer term activities such as standing, which regulate skeletal architecture. To examine this hypothesis, we proposed that brief exposure to slight elevations in these endogenous mechanical signals would suffice to increase bone mass in those bones subject to the stimulus. This was tested by exposing the hind limbs of adult female sheep (n = 9) to 20 min/day of low-level (0.3g), high-frequency (30 Hz) mechanical signals, sufficient to induce a peak of approximately 5 microstrain (micro epsilon) in the tibia. Following euthanasia, peripheral quantitative computed tomography (pQCT) was used to segregate the cortical shell from the trabecular envelope of the proximal femur, revealing a 34.2% increase in bone density in the experimental animals as compared with controls (p = 0.01). Histomorphometric examination of the femur supported these density measurements, with bone volume per total volume increasing by 32% (p = 0.04). This density increase was achieved by two separate strategies: trabecular spacing decreased by 36.1% (p = 0.02), whereas trabecular number increased by 45.6% (p = 0.01), indicating the formation of cancellous bone de novo. There were no significant differences in the radii of animals subject to the stimulus, indicating that the adaptive response was local rather than systemic. The anabolic potential of the signal was evident only in trabecular bone, and there were no differences, as measured by any assay, in the cortical bone. These data suggest that subtle mechanical signals generated during predominant activities such as posture may be potent determinants of skeletal morphology. Given that these strain levels are three orders of magnitude below strains that can damage bone tissue, we believe that a noninvasive stimulus based on this sensitivity has potential for treating skeletal complications such as osteoporosis.

Anabolism. Low mechanical signals strengthen long bones

Although the skeleton's adaptability to load-bearing has been recognized for over a century, the specific mechanical components responsible for strengthening it have not been identified. Here we show that after mechanically stimulating the hindlimbs of adult sheep on a daily basis for a year with 20-minute bursts of very-low-magnitude, high-frequency vibration, the density of the spongy (trabecular) bone in the proximal femur is significantly increased (by 34.2%) compared to controls. As the strain levels generated by this treatment are three orders of magnitude below those that damage bone tissue, this anabolic, non-invasive stimulus may have potential for treating skeletal conditions such as osteoporosis.

Performance and carcass merit of growing beef steers with chlortetracycline-modified sensitivity to pituitary releasing hormones and fed two dietary protein levels

This paper reports the effects of reduced sensitivity to growth hormone-releasing hormone and thyrotropin-releasing hormone through feeding a subtherapeutic level of chlortetracycline (CTC; 350 mg CTC/d) and two levels of dietary CP (10% and 13% of diet DM) on growth performance and carcass merit characteristics. Thirty-two steers (initial average BW, 286 kg) were adapted to a common 13% CP diet consisting primarily of grass hay, corn, and soybean meal fed to gain 1.25 kg/d. The steers were assigned to four treatments (with or without CTC and 10% or 13% dietary CP in a factorial arrangement) and fed ad libitum amounts of diet for 91 d. Feed intake was determined daily and steers were weighed weekly. Steers were killed at the end of the feeding period for carcass merit determinations. Efficiency of BW gain was greater (P < .05) for steers fed the 13% CP diet than for the 10% CP diet and tended to be less for CTC-steers when the 10% CP diet was fed and greater for the CTC-steers when the 13% CP diet was fed (CTC x dietary CP interaction, P < .10). Feeding CTC increased (P < .01) fat over the longissimus muscle and marbling. This study is interpreted to indicate that the sustained effect of subtherapeutic feeding of CTC to cattle appears to increase fat deposition consistent with a reduced growth hormone and thyroid status reported earlier for these same steers. This would tend to increase energy utilization but may not necessarily produce a measurable increase in BW gain.

Globalization and international trade in the twenty-first century: opportunities for and threats to the health sector in the south

Globalization and international trade are important forces at the turn of the century. This article explores how freer international trade will affect developing countries that are net importers of health care goods and services. Four commodities are used as special cases for discussion: pharmaceuticals, health care technologies, pesticides, and tobacco and its related products. The authors discuss the role of international specialized agencies, such as the World Trade Organization, World Health Organization, and World Bank, that are concerned with international trade and its health and health care consequences, and argue that closer collaboration is required among these agencies if the negative effects of trade liberalization on developing countries are to be mitigated. The authors pose a number of research questions that could help in developing proactive policies for the South on the trade of goods and services with harmful effects on health as well as those with potential health and economic benefits.

Assessment of the quality of neonatal echocardiographic images transmitted by ISDN telephone lines

OBJECTIVE

To assess the quality of echocardiographic images from neonates transmitted over Integrated Service Digital Network 2 (ISDN2) channels.

DESIGN

Echocardiographic images were viewed live in real time either by a direct video link or by transmission over the commercial network, using one, two, or three ISDN2 channels. The order of the viewing formats was random and four observers marked each view for potential for provision of complete diagnostic information and quality.

SETTING

Cardiology department of tertiary referral centre for paediatric cardiac services. ISDN lines were positioned in two nearby rooms. Telephone connection was through the commercial network and video connection by a direct video cable.

PATIENTS

10 neonates were studied (weight 2600 to 3900 g). In each, nine echocardiographic studies were undertaken to assess imaging (M mode and cross sectional) and Doppler (spectral and colour) quality.

RESULTS

No significant differences were found in diagnostic ability between the different formats for M mode, colour, or spectral Doppler studies. For cross sectional imaging the diagnostic information and image quality increased with increasing numbers of ISDN channels. With six channels there was little difference from the directly connected images.

CONCLUSIONS

In echocardiographic assessment of the newborn, one or two ISDN2 channels will transmit images of satisfactory quality in many situations but three or more channels are necessary to ensure minimum degradation of the live image.

Effects of oral chlortetracycline and dietary protein level on plasma concentrations of growth hormone and thyroid hormones in beef steers before and after challenge with a combination of thyrotropin-releasing hormone and growth hormone-releasing hormone

The objective of this study was to determine the effect of a subtherapeutic level of chlortetracycline (CTC) fed to growing beef steers under conditions of limited and adequate dietary protein on plasma concentrations of GH, thyroid-stimulating hormone (TSH), and thyroid hormones before and after an injection of thyrotropin-releasing hormone (TRH) + GHRH. Young beef steers (n = 32; average BW = 285 kg) were assigned to a 2x2 factorial arrangement of treatments of either a 10 or 13% crude protein diet (70% concentrate, 15% wheat straw, and 15% cottonseed hulls) and either a corn meal carrier or carrier + 350 mg of CTC daily top dressed on the diet. Steers were fed ad libitum amounts of diet for 56 d, and a jugular catheter was then placed in each steer in four groups (two steers from each treatment combination per group) during four consecutive days (one group per day). Each steer was injected via the jugular catheter with 1.0 microg/kg BW TRH + .1 microg/kg BW GHRH in 10 mL of saline at 0800. Blood samples were collected at -30, -15, 0, 5, 10, 15, 20, 30, 45, 60, 120, 240, and 360 min after releasing hormone injection. Plasma samples were analyzed for GH, TSH, thyroxine (T4), and triiodothyronine (T3). After 84 d on trial, the steers were slaughtered and the pituitary and samples of liver were collected and analyzed for 5'-deiodinase activity. Feeding CTC attenuated the GH response to releasing hormone challenge by 26% for both area under the response curve (P<.03) and peak response (P<.10). Likewise, CTC attenuated the TSH response to releasing hormone challenge for area under the response curve by 16% (P<.10) and peak response by 33% (P<.02), and attenuated the T4 response for area under the curve by 12% (P<.08) and peak response by 14% (P<.04). Type II deiodinase activity in the pituitary was 36% less (P<.02) in CTC-fed steers than in steers not fed CTC. The results of this study are interpreted to suggest that feeding subtherapeutic levels of CTC to young growing beef cattle attenuates the release of GH and TSH in response to pituitary releasing hormones, suggesting a mechanism by which CTC may influence tissue deposition in cattle.

Long-term outcome after selective posterior rhizotomy in children with spastic cerebral palsy

A retrospective analysis of data collected prospectively was performed to determine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population comprised children with spastic CP, who had SPR more than 4 years prior to the time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically, muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the same measures. Hip adductor spasticity, hip abduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entry criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-year values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2.1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and quadriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed to be better at 1 and 5 years compared to baseline, but no statistical analysis was done for this secondary outcome measure. It was concluded that improvements in lower limb motor outcome are present at 1 year after SPR, and that these improvements are generally maintained at 5 years.

Increased expression of matrix metalloproteinase-1 in osteocytes precedes bone resorption as stimulated by disuse: evidence for autoregulation of the cell's mechanical environment?

An in vivo animal model of bone adaptation was used to examine a possible role for matrix metalloproteinase-1 in the local mediation of bone remodeling: to corrode the coupling of osteocytes to the matrix in an attempt to autoregulate the cell's perception of its mechanical environment. Twelve young (12-16 months old) skeletally mature turkeys were separated into groups to be studied for stimulus periods of either 3 or 30 days. In each animal, the left ulna was functionally isolated and subjected to either disuse or 3,000 microstrain at 1 Hz for 10 minutes per day. The right ulna remained intact and served as an intra-animal control. No significant differences in bone area were detected at 3 days; however, ulnae subjected to disuse lost 8 +/- 4% (+/-SD) of bone area by 30 days. Over the same period, ulnae subjected to the mechanical stimulus gained 21 +/- 9% of bone area. With use of in situ reverse transcription-polymerase chain reaction, less than 2% of the osteocytes examined from the intact control ulnae stained positively for matrix metalloproteinase-1 mRNA. An antibody raised against matrix metalloproteinase-1 revealed no positively labeled osteocytes in the intact ulnae. This low percentage of osteocytes expressing matrix metalloproteinase-1 mRNA was similar to that seen in ulnae subjected to the osteogenic mechanical stimuli. In contrast, ulnae subjected to either 3 or 30 days of disuse showed evidence of matrix metalloproteinase-1 mRNA activity in a high percentage of osteocytes (89 +/- 5 and 66 +/- 8%, respectively; each time point significantly different from intact ulnae, as well as from each other, p < 0.05). The percentage of osteocytes labeled with the anti-matrix metalloproteinase-1 antibody was also highly elevated following 3 days of disuse (74 +/- 17%). These data demonstrate that an early response of bone to disuse is the upregulation of matrix metalloproteinase-1 activity in osteocytes. It is proposed that this upregulation of collagenase activity is indicative of the cell's degradation of coupling to the matrix, and it thus reflects the osteocyte's regulation of its own mechanical environment. We believe that such autoregulation of the osteocyte's physical environment will accommodate subtle changes in the bone's functional environment without the need to add or resorb bone tissue.

The New Zealand Socioeconomic Index: developing and validating an occupationally-derived indicator of socio-economic status

OBJECTIVE

Following revision of the international standard classification (ISCO88), to update and validate on health data an occupationally derived indicator of socio-economic status (SES) adapted to changing occupational and demographic conditions.

METHOD

The development of the New Zealand Socioeconomic Index (NZSEI) is based on a 'returns to human capital' model of the stratification process and uses data from the 1991 New Zealand Census (n = 1,051, 926) to generate scores for 97 occupational groups. The construct validation of the scale is carried out on data from the 1992-93 nationwide Household Health Survey (n = 3,000) using three health indicators (self-assessed health, cigarette smoking, general practitioner visits).

RESULTS

In general, the results are consistent with expected socio-economic patterns drawn from the literature for the three indicators.

CONCLUSIONS

While further work is required on a number of methodological and conceptual issues, the NZSEI provides a robust, standardised and internationally comparable occupational scale of SES for both males and females in either full- or part-time employment.

IMPLICATIONS

The NZSEI can be used on routinely collected occupational data. It has a clear conceptual rationale, updates existing SES scales, and provides a link to international standards in SES and occupational classification.

Enhancement of fracture healing by low intensity ultrasound

Fracture healing is a highly complex regenerative process that is essentially a replay of developmental events. These events include the action of many different cell types, a myriad of proteins, and active gene expression that in the majority of cases ultimately will restore the bone's natural integrity. Several biologic and biophysical approaches have been introduced to minimize delayed healing and nonunions, some with promising results. One example of such an approach is low intensity pulsed ultrasound, a noninvasive form of mechanical energy transmitted transcutaneously as high frequency acoustical pressure waves in biologic organisms. Numerous in vivo animal studies and perspective double blind placebo controlled clinical trials have shown that low intensity ultrasound is capable of accelerating and augmenting the healing of fresh fractures. Preliminary evidence suggests efficacy in the treatment of delayed healing and nonunions as well. This article reviews the animal and clinical studies that consider the effects of ultrasound on fracture healing, and the in vivo and in vitro work that strives to identify the biologic mechanism(s) responsible for the ultrasound induced enhancement of osteogenesis and fracture healing.

Role of heat shock proteins in the pathogenesis of cystic fibrosis arthritis

BACKGROUND

Arthritis is a well recognised complication of cystic fibrosis. The cause of this arthritis is not yet clear but it is likely to be an immunological reaction to one of the many bacterial antigens to which the lungs are exposed. One such group, the heat shock proteins, (hsp), was investigated. These are immunodominant antigens of a wide variety of infectious microorganisms and have varying amino acid chain sequences, some of which are similar to those found in human tissues.

METHODS

Antibodies to human hsp 27 and hsp 90 in the serum of patients with cystic fibrosis, with and without arthritis, and in normal age and sex matched healthy controls were measured. The severity of the cystic fibrosis was assessed by lung function tests and chest radiographs. The nature of the organisms colonising the lungs was determined by bacteriological examination of sputum.

RESULTS

Higher mean titres of serum IgG anti-human hsp 27 and hsp 90 antibodies were found in 50 patients with cystic fibrosis than in healthy controls (hsp 27, 0.25 (95% CI 0.19 to 0.33) versus 0.05 (95% CI 0.04 to 0.07); hsp 90, 0.27 (95% CI 0.22 to 0.32) versus 0.11 (95% CI 0.08 to 0.14)). These antibodies were higher in patients in whom the lungs were colonised with Pseudomonas aeruginosa than in those without infection (hsp 27, 0.41 (95% CI 0.17 to 0.63) versus 0.18 (95% CI 0.10 to 0.27); hsp 90, 0.37 (95% CI 0.18 to 0.57) versus 0.22 (95% CI 0.16 to 0.29)). The eight patients with cystic fibrosis with arthritis had higher anti-hsp 27 antibodies (0.48 (95% CI 0.13 to 0.92)) than the 42 patients without arthritis (0.22 (95% CI 0.17 to 0.30)).

CONCLUSIONS

These findings suggest that the arthritis associated with cystic fibrosis, despite being seronegative for rheumatoid factor, was associated with more severe lung disease and with a greater inflammatory response to heat shock proteins.

Pressure regulates osteoclast formation and MCSF expression in marrow culture

One of the forces generated during skeletal loading is hydrostatic pressure. In the work presented here, the ability of increased pressure to influence recruitment of osteoclasts was evaluated. Murine marrow cultures, with pO2 and pCO2 kept constant, were subjected to either control (1.0 atm) or elevated (1.37 or 2.0 atm) hydrostatic pressure. As compared to control, cultures pressurized for 6 days at 1.37 atm formed less osteoclast-like cells (OCLC) (71 +/- 6% of control, P < 0.0001). A similar degree of inhibition occurred in cultures exposed to pressure during days 2-4 only (62 +/- 6%), while treatment during days 5-7 failed to inhibit the OCLC number relative to control (99 +/- 5%). Delivery of 2.0 atm pressure on days 2-4 generated 52 +/- 4% OCLC compared to control. Since macrophage colony stimulating factor (MCSF)-dependent proliferation of osteoclast precursors occurs during the pressure-sensitive period, semiquantitative RT-PCR for MCSF mRNA was performed after 3 days in 1.37 atm (days 2-4). As compared to controls, pressure caused a decrease in mRNA coding for the membrane bound form of MCSF (71.2 +/- 4% (n = 25, P < or = 0.05), while the MCSF RT-PCR product representing the secreted form showed no consistent change. This lack of response of the soluble MCSF RT-PCR product was expected, as levels of bioassayable MCSF were not altered by pressure. Extrapolating these data to in vivo conditions suggests that load-bearing will inhibit the formation of osteoclasts.

Differentiation of the bone-tissue remodeling response to axial and torsional loading in the turkey ulna

The ability of bone tissue to differentiate between axial and torsional loading was determined with use of a functionally isolated turkey-ulna model of bone adaptation. Surface modeling and intracortical remodeling were quantified after four weeks of 5000 cycles per day of axial loading sufficient to cause 1000 microstrain normal to the long axis of the bone (five ulnae), 5000 cycles per day of torsional loading sufficient to cause 1000 microstrain of shear strain (five ulnae), or disuse (six ulnae). Of these three distinct regimens, only disuse caused a significant change in gross areal properties (12 per cent loss of bone; p < 0.05) as compared with those in the contralateral, intact control ulnae (sixteen ulnae). This finding suggested that both axial and torsional loading conditions were suitable substitutes for functional signals normally responsible for bone homeostasis. However, the intracortical response was strongly dependent on the manner in which the bone was loaded. Axial loading increased the number of intracortical pores by a factor of seven as compared with that in the controls (246 +/- 40.5 compared with 36 +/- 8.5 pores); it also increased the area lost because of porosis as compared with that in the controls (1.39 +/- 0.252 compared with 0.202 +/- 0.062 square millimeter); however, the mean size of the individual pores was similar to that in the controls (0.00565 +/- 0.0019 compared with 0.00561 +/- 0.0029 square millimeter). Conversely, torsional loading failed to increase substantially the number of pores (67 +/- 22.6 pores), the area of bone lost because of porosis (0.352 +/- 0.114 square millimeter), or the size of the pores (0.00525 +/- 0.0035 square millimeter) as compared with those in the controls. Although disuse failed to increase substantially the number of intracortical pores (59 +/- 22.4 pores), significant area (1.05 +/- 0.35 square millimeters; p < 0.05) was lost within the cortex because of a threefold increase in the mean size of each pore (0.0178 +/- 0.0126 square millimeter). It appears that bone tissue can readily differentiate between distinct components of the strain environment, with strain per se necessary to retain coupled formation and resorption, shear strain achieving this goal by maintaining the status quo, and axial strain increasing intracortical turnover but retaining coupling. While it is clear that load influences bone mass and morphology, it is also clear that specific parameters within the strain environment have distinct strategic roles in defining this architecture.