A novel approach to 3D modelling ground-penetrating radar (GPR) data - A case study of a cemetery and applications for criminal investigation

Ground-penetrating radar (GPR) is an established geophysical technique used extensively for the accurate reconstruction of the shallow (<10 m) subsurface. Reconstructions have largely been completed and presented as 2D vertical and horizontal planes, leaving limited visualization of subsurface 3D shapes and their spatial relationships. With technological advancements, particularly the availability and integration of various software platforms, 3D modelling of GPR data is now emerging as the new standard. However, despite these developments, there remains an inadequate examination and testing of these techniques, particularly in determining if their application is beneficial and warranted. In this study we conducted a GPR grid survey on a churchyard cemetery to generate and evaluate 2D and 3D-modelled reconstructions of the cemetery burial sites. Data collection and processing was completed using a Sensors and Software Incorporated pulseEKKO™ Pro SmartCart GPR system and EKKO_Project™ software, respectively. The modelling component was achieved using Schlumberger's Petrel™ E & P software platform, which is tailored to the petroleum industry. The subsurface patterns present in the 2D and 3D models closely matched the cemetery plot plan, validating our data collection, processing, and modelling methods. Both models were adequate for 2D horizontal visualization of reflection patterns at any specific depth. The 3D model was used to identify the presence of a companion burial plot (stacked caskets) and possible leachate plumes below and encircling burial sites, both of which were not evident in the 2D model, highlighting the benefits of 3D modelling when discerning subsurface objects. We expect our findings to be of value to similar GPR studies, with particular significance to geoforensic studies and criminal investigations.

Feminisation of UK General Practice: a challenge for the Defence Medical Services?

BACKGROUND

The Defence Medical Services (DMS) primarily recruits its trained General Practitioners (GPs) from the NHS and since 1970, the number of men entering medicine has doubled whereas the number of women has increased 10-fold; female GPs will outnumber their male counterparts by 2017. This study performs a quantitative assessment of the potential impact of feminisation of UK General Practice upon the DMS recruitment and workforce planning.

METHODS

General Medial Council General Practice Certificate of Completion of Training (GMC GP CCT) data were analysed to identify any change in the percentage of male and female GP Specialty Training Registrars successfully completing GP vocational training between 2007 and 2012, thus becoming potentially recruitable into the DMS as independent GPs.

RESULTS

A 3% increase was seen in the number of women achieving GMC GP CCT between 2007 and 2012 (p=0.015). The percentage of DMS GP Specialty Training Registrars (GPStRs) gaining their GMC GP CCT in 2012 who were women (25%) was about half that seen nationally (59%). A lack of 2007 by-sex GMC GP CCT data for DMS GPStRs prevented a comparison with 2012.

CONCLUSIONS

The national increase of only 3% infers feminisation of UK General Practice is not an immediate challenge for the DMS. Nevertheless, as feminisation of the UK GP workforce is expected to continue, the future cohort from whom the DMS will recruit its GPs is likely to contain increasing numbers of women. With the return to contingency, the DMS may wish to consider the implications of increasing numbers of female GPs upon service delivery in the UK and overseas, and explore more flexible medical employment models.

Outpatient myeloablative allo-SCT: a comprehensive approach yields decreased hospital utilization and low TRM

Historically, myeloablative allogeneic hematopoietic SCT (HSCT) has required prolonged in-patient hospitalization due to the effects of mucosal toxicity and prolonged cytopenias. We explored the safety and feasibility of outpatient management of these patients. A total of 100 consecutive patients underwent a matched-related donor myeloablative allogeneic HSCT for a hematologic malignancy at a single institution. Patients were hospitalized briefly for stem-cell infusion and thereafter only for complications more safely managed in the in-patient setting. The median hospital length of stay from the start of the preparative regimen to day +30 and day +100 post-transplant was 12 and 15 days, respectively. Planned hospital discharge occurred in 79 patients after stem cell infusion. Patients were readmitted to hospital at median of day +7 post transplant, with neutropenic fever being the primary cause for readmission. In total, 18 patients required no in-patient care in the first 100 days. Non-relapse mortality at day 100 and 6 months was 10 and 15%, respectively, for all patients, and 0 and 5%, respectively, for standard risk patients. In summary, outpatient myeloablative allogeneic HSCT with expectant in-patient management can be accomplished safely with low treatment-related morbidity and mortality. Clinical outcomes seem comparable to those reported for traditional in-patient management.

Home administration of high-dose oral busulfan in patients undergoing hematopoietic stem cell transplantation

We report our experience with oral busulfan (BU) in 159 consecutive patients to evaluate the safety of home administration. Patients received a myeloablative BU-containing regimen, including oral anticonvulsant and antiemetic prophylaxis, followed by hematopoietic stem cell transplantation. Comprehensive verbal and written education was provided. Pharmacokinetic monitoring was performed and dose adjustments were made to target an area under the plasma concentration-time curve (AUC) of 900-1500 micromol.min/l. Safety was assessed by evaluating therapy-related toxicities, including seizures, venoocclusive disease (VOD) and patient tolerability. The utilization of pharmacokinetic monitoring was reviewed as a secondary end point. Of the 143 patients evaluated for BU-related seizures and VOD, only two (1.4%) experienced a generalized seizure and four patients (3%) were diagnosed with VOD. VOD resolved in three patients and was a contributing cause of death in one patient. Additional BU dosing owing to nausea and/or vomiting occurred in 28 patients (18%) and five patients (3%) were hospitalized. The median measured AUC was 1405 micromol.min/l, 68% of patients required a dose adjustment, and the median total administered BU dose was 13.6 mg/kg. In conclusion, high-dose oral BU can be safely administered on an outpatient basis.

A spiritual well-being model: use with older women who experience depression

Although evidence exists to suggest an integral influence of one's spirit on one's mental health, few nurse theoreticians have attempted to delineate and include the concept of spirituality in their nursing models. In making practice decisions related to spiritual matters, mental health nurses require knowledge about the interface between spirituality and mental health. Many symptoms of depression, the most common mental health problem of older adults, parallel indications of spiritual distress. The author presents a spiritual well-being model that provides a framework to discuss the antecedents, symptoms, spiritual needs, and holistic treatment of depression as it is experienced by older women.

Closed carbon dioxide filtration revisited

There are compelling reasons why the closed carbon dioxide filtration method for inhalation anaesthesia deserves serious reconsideration. Use of the closed absorption system today can provide all the benefits recognised by those who introduced it seventy to eighty years ago. A most important benefit is the increased opportunity of learning afforded the user, which leads either neophyte or senior clinician to improvement of both concept and clinical skills. The current resurgence of interest is fully appropriate for all physicians who aspire to be true specialists in the care of patients during clinical anaesthesia.

Closed system with agent-specific vaporizers and nitrous oxide

Through judicious use of nitrous oxide the closed system can be quite effectively used with currently available equipment including both agent-specific direct-reading percentage vaporizers and suitable devices for the measurement of end-tidal concentrations of oxygen, carbon dioxide and anaesthetic agents. It is only necessary to think in terms of required volumes of fresh gases and vapours added to the system as well as the appropriate concentrations of oxygen and anaesthetic in the respired mixture. When used as described the inspired concentration of nitrous oxide in the closed system should never exceed 50% (usually about 40%). Therefore nitrous oxide will not pose the threat of hypoxaemia unless misused. Experience in teaching this method during the previous decade supports a belief that learning the use of a truly closed circle absorption anaesthesia system is fundamentally important to the development of clinical skills and also facilitates understanding of basic concepts related to respiratory physiology and the uptake and distribution of inhalation anaesthetics. It follows that students and residents should be introduced to this method in the early weeks of their learning experience.

Salvage therapy in epithelial ovarian cancer

Table 1 summarizes studies in which clinical or pathologic response rates can be determined. The majority of patients in these studies had macroscopic drug-resistant tumors, and most had received cisplatin-based chemotherapy. It is noteworthy that the response rate in this group of patients is considerably higher than the 30% to 36% seen with the most active salvage therapies, such as taxol (paclitaxel). Like most trials of salvage chemotherapy for refractory ovarian carcinoma, many responses were short-lived. Toxicity in these studies is comparable to that seen in trials of ASCT in other solid tumors. The promising results observed in these small studies of ASCT in ovarian carcinoma warrant further investigation focused on defining which groups of patients are likely to benefit from this approach. Based on evidence from the lymphohematopoietic malignancies, it would seem reasonable to use ASCT in patients early in the course of their disease before extensive pretreatment and preferably at a time of minimal tumor burden. Some groups have been exploring ASCT as consolidation therapy after surgery and limited debulking chemotherapy. Based on kinetic models of tumor growth, other investigators have suggested that multiple courses of high-dose chemotherapy with ASCT after debulking surgery may result in more cures than a single ASCT after conventional chemotherapy. The feasibility of performing sequential ASCT has been well documented. So far the best drug regimens, the number of cycles that should be used, and the patients who should be candidates for high-dose chemotherapy and ASCT remain undefined. Presently, there is no role for this therapeutic modality outside of well-designed clinical trials.

Prevention and management of graft-versus-host disease. Practical recommendations

Graft-versus-host disease (GVHD) is the leading cause of failure of allogeneic bone marrow transplantation. The disease typically involves the skin, liver and gastrointestinal tract, with death frequently resulting from infectious complications. Cyclosporin-based drug combinations are the mainstay of GVHD prophylaxis. The major toxicity of cyclosporin is renal dysfunction, and optimal strategies of therapeutic drug monitoring to minimise toxicity and maximise clinical efficacy have yet to be devised. Initial treatment of established GVHD usually includes high dose corticosteroids. Patients failing to respond to first line therapy have a poor prognosis. Investigational approaches to decreasing the mortality associated with GVHD include using monoclonal antibodies directed at specific T cell subsets, and T cell depletion of bone marrow grafts.

Autologous graft-versus-host disease: a novel approach for antitumor immunotherapy

Autologous bone marrow transplantation (BMT) is a therapeutic option for the treatment of lymphohematopoietic malignancies and solid tumors. Despite the intensive cytoreductive therapy, however, the rates of tumor recurrence after autologous BMT remain unacceptably high. Current studies suggest that the administration of cyclosporine (CsA) disrupts the reconstitution of self-tolerance following autologous BMT leading to the induction of an autoimmune graft-versus-host disease (GVHD). Studies in a rat tumor model and preliminary clinical trials suggest that this autoimmune or autologous GVHD provides a significant antitumor effect. Moreover, the antitumor effect of autologous GVHD can be enhanced by administration of gamma-interferon, which upregulates the antigen recognized by the autoreactive effector cells of autologous GVHD. These studies indicate that the induction of an autoimmune GVHD after autologous BMT may be a promising immunotherapeutic approach for treatment of certain neoplastic diseases.

Protective value of a liver initiation-promotion regimen against the lethal effect of carbon tetrachloride in rats

This study was designed as one test of the hypothesis that an early sequence of steps in hepatocarcinogenesis in the rat, with the production of hepatocyte nodules, may be a special form of adaptive response that has survival value for the host. Fischer 344 rats were initiated with a single dose of diethylnitrosamine. Hepatocyte nodules were rapidly generated by selecting for resistant hepatocytes by a brief exposure to 2-acetylaminofluorene coupled with partial hepatectomy, a procedure that leads to liver cancer without any further treatment. Most animals with hepatocyte nodules were completely resistant to single doses of CCl4 that induced 100% mortality in control animals. The demonstration of this protective effect is consistent with the proposed hypothesis.

Busulfan-induced hepatitis

A 61-yr-old man with chronic myelocytic leukemia treated continuously for 8 yr with busulfan presented with fever, abdominal pain, and elevated liver enzymes in a cholestatic pattern. Evaluation of his liver and biliary tract with ultrasound and computerized tomography disclosed no structural abnormality. A percutaneous needle liver biopsy revealed cellular cholestasis with focal liver cell necrosis accompanied by a mild inflammatory infiltrate. Busulfan was discontinued, with subsequent normalization of liver enzymes and resolution of fever. These findings are interpreted as being compatible with busulfan-induced hepatitis.

Inspired humidity in anaesthesia breathing circuits: comparison and examination of effect of Revell circulator

Humidity levels of respired gases in spontaneously breathing patients were measured with a quadrupole mass spectrometer (Medishield Model MS-2) and compared between various anaesthetic systems during clinical anaesthesia. In studies of high flow rebreathing non-absorption systems the mean inspired absolute humidity averaged approximately 16 mg X l-1 (range 14.7 to 16.1 mg X l-1) compared to a semiclosed circle absorption system (BOC MK III) in which values for absolute humidity varied from 6.8 +/- 5.1 mg X l-1 for children through 9.5 +/- 3.0 mg X l-1 for adults), and the closed circle absorption system in which values of 20.5 +/- 2.3 mg X l-1 were only gradually reached. Addition of a functioning Revell circulator to the circle absorption system provided immediately markedly higher levels of inspired humidity during clinical use, either semiclosed (15.4 +/- 5.1 mg X l-1 in children to 18.8 +/- 2.4 mg X l-1 in adults), or closed (23.3 +/- 1.8 mg X l-1 in adults). These markedly higher inspired levels of absolute humidity were attained during forced circulation of respired gas provided by the Revell circulator without the concomitant disadvantages of rebreathing or the potential hazards associated with some humidifying devices.

Risk factors for breast cancer in women in northern Alberta, Canada, as related to age at diagnosis

A population-based case-control study involving interviews with 577 female breast cancer patients and 826 controls in northern Alberta. Canada, revealed that some determinants of breast cancer varied according to age. Among women under age 45, risk factors included a younger age at menarche, late age at last birth, high parity, and recent use of oral contraceptives. At older ages risk was related to natural as opposed to surgical menopause, late age at first birth, low parity, late age at natural menopause, and tonsillectomy. At all ages there was an increased risk of breast cancer associated with difficulty in conceiving, benign breast disease, not having breast fed, and a history of breast cancer among mothers or sisters. For some variables the age differences were pronounced; the combination of low parity and late age at first birth was associated with a sevenfold increase in breast cancer risk at risk at ages 55-80 but a slight decrease at ages under 45. The effect of tonsillectomy steadily increased with age and represents a new lead, but certain features of the data suggest that the link to oral contraceptives among among younger women and the inverse relation to breast feeding at all ages may not be causal. Even though design limitations (cases interviewed in a different setting from controls) appeared not to influence conclusions, the results may have been subjected to interview bias and thus should be interpreted cautiously.

Esophageal cancer among black men in Washington, D.C. II. Role of nutrition

A case-control study of esophageal cancer was conducted among the black male residents of Washington, D.C., to find reasons for the exceptionally high risk in this population. The next of kin of 120 esophageal cancer cases who died during 1975-77 and of 250 D.C. black males who died of other causes were interviewed. Five indicators of general nutritional status--fresh or frozen meat and fish consumption, dairy product and egg consumption, fruit and vegetable consumption, relative weight (wt/ht2), and number of meals eaten per day--were each significantly and inversely correlated with the relative risk of esophageal cancer. Associations with other food groups were not apparent. The least nourished third of the study population, defined by any of these five measures, was at twice the risk of the most nourished third. None of these associations was markedly reduced by controlling for ethanol consumption, the other major risk factor in this population; smoking; socioeconomic status; or the other nutrition measures. When the three food group consumption measures were combined into a single overall index of general nutritional status, the relative risk of esophageal cancer between extremes was 14. Estimates of the intake of vitamin A, carotene, vitamin C, thiamin, and riboflavin were inversely associated with relative risk; but each micronutrient index was less strongly associated with risk than were the broad food groups that provide most of the micronutrient. Thus no specific micronutrient deficiency was identified. Instead, generally poor nutrition was the major dietary predictor of risk and may partially explain the susceptibility of urban black men to esophageal cancer.

Esophageal cancer among black men in Washington, D.C. I. Alcohol, tobacco, and other risk factors

A case-control study involving interviews with the next of kin or close friends of 120 black males who recently died of esophageal cancer and 250 similarly aged black males who died of other causes was undertaken to discover reasons for the exceptionally high mortality from this cancer in Washington, D.C. The age-adjusted annual death rate in Washington, D.C., for nonwhite males, 1970-75, was 28.6/100,000, far higher than the national rate of 12.4/100,000 and the rates in other metropolitan areas of the country. The major factor responsible for the excess was alcoholic beverage consumption, with an estimated 81% of the esophageal cancers attributed to its use; high use of alcoholic beverages was also found among the controls. The relative risk (RR) of esophageal cancer associated with use of alcoholic beverages was 6.4 (95% confidence interval=2.5, 16.4). The RR increased with amount of ethanol consumed and was highest among drinkers of hard liquor, although the risk was also elevated among consumers of wine and/or beer only. The RR associated with cigarette smoking was 1.9 (1.0, 3.5) when controls with smoking-related causes of death were excluded but declined to 1.5 (0.7, 3.0) when adjusted for ethanol consumption. Significant differences of approximately twofold were found between low and high levels of a) consumption of fresh or frozen meat and fish, fruits and vegetables, and dairy products and eggs and b) relative weight (wt/ht2). The inverse trends with these general measures of nutritional status were not explained by alcoholic beverage consumption or socioeconomic status as measured by educational level.

Mesothelioma associated with the shipbuilding industry in coastal Virginia

A case-control study was undertaken to clarify reasons for a four-fold increased incidence of mesothelioma discovered among white males in coastal Tidewater, Va., from 1972 to 1978. Sixty-one cases were identified. Interviews with next of kin revealed that the excess was linked to employment in area shipyards. Three-fourths of the cases had been employed in the shipbuilding industry, nearly all beginning employment prior to 1950. Most were career employees, but an increased risk was also found among those who worked only temporarily, mainly during World War II, and were reportedly exposed to asbestos. More of the cases than controls were pipecoverers or pipefitters, but cases were reported to work in a variety of shipyard trades. Few of the mesothelioma cases were heavy smokers, a trend that may be related in part to the competing risks for fatal diseases caused by the interactions of smoking and asbestos exposure. Information obtained by interview for five of the six white females diagnosed with mesothelioma revealed that the husband of four had been employed in the shipbuilding industry.

Can naloxone inhibit the cardiovascular effect of acupuncture?

Forty dogs were studied during MAC-1 halothane anesthesia with a chronically implanted electromagnetic flow probe on the ascending aorta. Cardiac output, stroke volume, heart rate, mean arterial pressure, pulse pressure, central venous pressure and total peripheral resistance were determined in addition to Pao2, pH, Paco2 and base deficit. Acupuncture moxibustion with electrocautery at Jen Chung (Go-26) produced a significant (five per cent level) increase in the cardiac output, stroke volume, heart rate, mean arterial pressure and pulse pressure and a significant decrease in total peripheral resistance during a 120-minute period of observation in dogs under halothane anaesthesia. Acupuncture moxibustion at Go-26 following pretreatment with the narcotic antagonist naloxone (1 mg.kg-1) produced a significant increase in cardiac output, heart rate, mean arterial pressure. It is concluded that naloxone, which inhibits the analgesic effects of acupuncture, does not inhibit the symphathomimetic effect of acupuncture or moxibustion at Jen Chung (Go-26) in dogs under light MAC-1 halothane anaesthesia.

Inhibition of the cardiovascular effects of acupuncture (moxibustion) by propranolol in dogs during halothane anaesthesia

Acupuncture by electrocautery, moxibustion, at Jen Chung (Go-26) acupoint produces a sympathomimetic effect on the cardiovascular system of dogs under halothane anaesthesia (MAC I). This effect is manifest by significant increase in cardiac output, stroke volume, heart rate, mean arterial pressure and pulse pressure while total peripheral resistance is significantly decreased during a two-hour period of observation. Pretreatment with the beta blocker, propranolol, caused a significant decrease in cardiac output, heart rate, mean arterial pressure and pulse pressure while total peripheral resistance is significantly increased. Similar responses were observed when propranolol was administered without moxibustion at Jen Chung (Go-26).

Cardiac output response to altered acid-base status during diethyl ether anaesthesia

The effects of acid-base changes on cardiac output during diethyl ether anaesthesia were studied in 25 mongrel dogs prepared by surgically implanting a plastic encased non-ferrous core electromagnetic probe on the ascending aorta. The findings are: (1) Metabolic acidaemia produced only slight decrease in cardiac output but a more marked fall became evident with decreasing pH(2) Respiratory acidaemia led to a slight rise in cardiac output. (3) Respiratory alkalaemia decreased cardiac output. (4) Metabolic alkalaemia also produced a decline in cardiac output.

Variation in cardiac output with acid-base changes in the anesthetized dog

Studies were performed in dogs anesthetized with pentobarbital, 30 mg/kg, and ventilated mechanically during succinylcholine apnea in order to ascertain the variation in cardiac output under various acid-base conditions. The findings were: 1) metabolic acidosis decreases cardiac output; 2) increasing respiratory acidosis in the absence of severe metabolic acidosis causes increase in cardiac output; 3) increasing respiratory acidosis in the presence of severe metabolic acidosis causes depression of cardiac output. The effect on cardiac output of changing arterial pH at steady PaCOCO2 is shown quantitatively. The relationship of PaCOCO2 to “pH adjusted” cardiac output is determined. From these data a nomogram is presented from which the combined effects of arterial pH and PaCOCO2 on cardiac output can be estimated.

cardiac output and anesthesia; acid-base status and cardiac output; pH and cardiac output; PaCOCO2 and cardiac output

Submitted on June 29, 1964