ACR CT Accreditation Program and the Lung Cancer Screening Program Designation

The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer screening should be performed at sites providing high-quality low-dose CT examinations overseen and interpreted by qualified physicians using a structured reporting and management system. The ACR has developed a set of tools necessary for radiologists to take the lead on the front lines of lung cancer screening. The ACR Lung Cancer Screening Center designation is built upon the ACR CT accreditation program and requires use of Lung-RADS or a similar structured reporting and management system. This designation provides patients and referring providers with the assurance that they will receive high-quality screening with appropriate follow-up care.     

Comparison of physical activity assessed using hip- and wrist-worn accelerometers

ObjectivesIt is unclear how physical activity estimates differ when assessed using hip- vs wrist-worn accelerometers. The objective of this study was to compare physical activity assessed by hip- and wrist-worn accelerometers in free-living older women.DesignA cross-sectional study collecting data in free-living environment.MethodsParticipants were from the Women's Health Study, in which an ancillary study is objectively measuring physical activity using accelerometers (ActiGraph GT3X+). We analyzed data from 94 women (mean (SD) age = 71.9 (6.0) years) who wore a hip-worn and wrist-worn accelerometers simultaneously for 7 days.ResultsUsing triaxial data (vector magnitude, VM), total activity volume (counts per day) between the two locations was moderately correlated (Spearman's r = 0.73). Hip and wrist monitors wear locations identically classified 71% individuals who were at the highest 40% or lowest 40% of their respective distributions. Similar patterns and slightly stronger agreements were observed when examining steps instead of VM counts.ConclusionsAccelerometer-assessed physical activity using hip- vs wrist-worn devices was moderately correlated in older, free-living women. However, further research needs to be conducted to examine comparisons of specific activities or physical activity intensity levels.     

Education and the moderating roles of age,sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment

BackgroundWe examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).MethodsParticipants were 30,785 dementia-free individuals aged 55–103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.ResultsCompared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers.ConclusionHigh School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.     

A mosque-based methadone maintenance treatment strategy: Implementation and pilot results

BackgroundThis paper describes the rationale, implementation and operation of a “world first” Islamic inspired methadone maintenance treatment project delivered in a mosque setting and presents the outcome for the first group of participants. The project explored the viability of expanding addiction recovery services through the network of mosques in Muslim communities.MethodsThe project combined methadone maintenance with peer and religious counseling. Participants consisted of 36 male Muslim heroin users who went through the project. Urine tests and self-reported measures on various dimensions relevant to drug use and quality of life were collected at baseline and 12 months.ResultsThe project had a 12 month retention rate of 80%. At 12 months all but one participant tested negative for opioids and other substances. Self-report measures showed significant reductions in the degree and variety of drug use, improvements in general health, and psychological and social functioning of participants. Qualitative data showed that availability of methadone, convenient location and religion were the main reasons drawing participants to the program.ConclusionsMosques are viable venues for offering medication assisted recovery services and offer an alternative approach for managing addiction in Muslim communities. The prospect of mobilizing community resources to offer community-oriented long-term recovery management programs in mosques and other places of worship deserves consideration.     

Quantifying population preferences around vaccination against severe but rare diseases: A conjoint analysis among French university students, 2016

BackgroundSeveral concepts are available to explain vaccine decision making by individual and inter-individual factors, including risk perception, social conformism and altruism. However, only a few studies have quantified the weight of these determinants in vaccine acceptance. Using a conjoint analysis tool, we aimed at eliciting preferences in a student population regarding vaccination against a rare, severe and rapidly evolving hypothetical disease, similar to meningococcal serogroup C meningitis or measles.MethodsDuring March-May 2016, we conducted an emailing survey among university students aged 18–24 years (N = 775) in Rennes, France. Participants were asked to decide for or against immediate vaccination in 24 hypothetical scenarios, containing various levels of four attributes: epidemic situation, adverse events, information on vaccination coverage, and potential for indirect protection. Data were analysed using random effect estimator logit models.ResultsParticipants accepted on average 52% of scenarios and all attributes significantly impacted vaccination acceptance. The highest positive effects were seen with an epidemic situation (OR 3.81, 95%-CI 3.46–4.19), 90% coverage in the community (3.64, 3.15–4.20) and potential for disease elimination from the community (2.87, 2.53–3.26). Information on “insufficient coverage” was dissuasive (vs. none of friends vaccinated: 0.65, 0.56–0.75). Controversy had a significantly greater negative effect than a confirmed risk of severe adverse events (OR 0.05 vs. 0.22). In models including participant characteristics, preference weights were unchanged, while trust in health authorities and vaccination perceptions strongly influenced acceptance themselves. The greatest significant variation of preference weights between subgroups was observed with controversy among students using alternative medicine daily (OR 0.28) and among students relying on scientific vaccine information (OR 0.02).ConclusionsAmong young adults, potential for indirect protection and factual information on coverage in the community and potential side effects positively impact theoretical vaccine acceptance. Conjoint analyses should be conducted to understand vaccine hesitancy in specific vaccination programs.     

Birth preparedness and place of birth in rural Mysore,India: A prospective cohort study

BackgroundIndia accounts for almost a third of the global deaths among newborns on their first day of birth. In spite of making significant progress in increasing institutional births, large numbers of rural Indian women are still electing to give birth at home. The aim of this study was to identify factors associated with place of birth among women who had recently given birth in rural Mysore, India.MethodsBetween January 2009 and 2011, 1675 rural pregnant women enrolled in a prospective cohort study in Mysore District completed interviewer-administered questionnaires on maternity care services. Ethical approval of the original study was obtained from the Institutional Review Boards of Vikram Hospital and Florida International University. Logistic regression analyses were conducted to identify factors associated with place of birth among the 1654 (99%) women that were successfully followed up after childbirth.FindingsThe median age of the women was 20 years; the majority were educated (87%), low-income (52%), and multiparous (56%). The prevalence of home births was low (4%). Half of the women giving birth at home did not adequately plan for transportation (55%), finances (48%), or birthing with a skilled provider (55%). Multiparous women had greater odds of giving birth at home compared to public (adjusted odds ratio [AOR]=7.83, p<0.001) and private institutions (AOR=7.05, p<0.001). Women attending ≥4 antenatal consultations had greater odds of giving birth at public (AOR=2.53, p=0.036) and private institutions (AOR=3.58, p=0.010). Those with higher scores of birth preparedness also had greater odds of giving birth at public (AOR=2.53, p<0.001) and private institutions (AOR=3.00, p<0.001).Conclusions and implicationsAs a means to reduce newborn mortality, maternal health interventions in India and similar populations should focus on increasing birth preparedness and institutional births among rural women, particularly among those from lower socio-economic status.     

An outbreak of swimming-pool related respiratory symptoms: An elusive source of trichloramine in a municipal indoor swimming pool

BackgroundSeveral members of a swimming club complained of respiratory symptoms associated with attending a municipal indoor swimming pool. Trichloramine, a volatile chlorination by-product and a potent respiratory irritant, was the most probable culprit, but the exact cause for its presence in excessive concentrations remained elusive.MethodsTwenty-two competitive swimmers and six coaches were evaluated during the outbreak and nine swimmers and four coaches were re-evaluated one year later. Symptoms were recorded by non-standardized history taking; pulmonary function testing included spirometry, measurement of fraction of exhaled nitric oxide (F_ENO) and histamine provocation. Concentrations of trichloramine in air were measured repeatedly by the method of Héry.ResultsThe most commonly reported symptoms consisted of cough (n = 16), dyspnoea (n = 13), tearing eyes (n = 10) and blocked or runny nose (n = 6). Mean FEV₁% predicted was 109.1%. Mean F_ENO level was 19.7 ppb (higher than 25 ppb in 3 subjects). Airway hyperreactivity to histamine (PC₂₀ ≤ 8 mg/ml) was detected in 22/26 subjects. Measured trichloramine concentrations in air exceeded the maximal concentration (WHO) of 0.5 mg/m³ four times between May and October 2011 and four times between January and March 2012. Polyamine compounds, present in glue used for repairing pipework, were identified as a probable external source of nitrogen resulting in increasing trichloramine concentrations. After the removal of the presumed cause of the excessive trichloramine concentrations, most subjects improved clinically, but several subjects remained symptomatic and had bronchial hyperreactivity.DiscussionA high prevalence of airway hyperreactivity, accompanied by symptoms of upper and lower airways, was detected in swimmers who had been repeatedly exposed to high trichloramine concentrations. A glue containing polyamines, used to repair a pipework, was suspected to be the source of this excessive production of trichloramine.     

贵州省鼠伤寒沙门菌单相变异株的CRISPR基因型和遗传多样性研究北大核心CSCD

目的了解贵州省鼠伤寒沙门菌单相变异株规律的成簇间隔短回文重复序列(CRISPR)的基因型及遗传多样性,为贵州省沙门菌病的预防控制提供依据。方法对分离自2013—2018年贵州省7个市(州)的71株疑似鼠伤寒沙门菌单相变异株进行系统生化鉴定及血清分型,结合双重PCR法确定疑似菌株为鼠伤寒沙门菌单相变异株。提取鼠伤寒沙门菌单相变异株的DNA作为模板,进行CRISPR1和CRISPR2的PCR扩增,将阳性扩增产物进一步测序,获得菌株的CRISPR1和CRISPR2间隔序列,根据间隔序列的组成,确定CRISPR基因型,并使用Bionumerics软件对菌株进行遗传多样性分析。结果71株疑似鼠伤寒沙门菌单相变异菌株经系统生化鉴定、血清分型及双重PCR法鉴定为鼠伤寒沙门菌单相变异株,经CRISPR1和CRISPR2两个位点的PCR扩增和产物测序,71株菌共检测到163个间隔序列,其中CRISPR1有102个,CRISPR2有61个。联合CRISPR1和CRISPR2两个位点的间隔序列进行分析,发现71株菌被分为33个CRISPR基因型(TSTs),其中TST11和TST1为贵州省的优势基因型,分别占总菌株数的25.35%和12.68%。71株菌经Bionumerics软件聚类分析后被分为A、B、C、D 4个簇,A簇包含的菌株最多,B簇包含的基因型最多,不同来源的3株参考株独立成簇,D簇包含7个TSTs基因型。结论贵州省鼠伤寒沙门菌单相变异株具有优势的CRISPR基因型和遗传多样性的特点,可能有其他的感染来源。