The Swedish Agency for health technology-report about traumatic shaking: much ado about nothing?

The 2016 Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) systematic review deals with the role of the ‘triad’ (subdural hematoma, retinal hemorrhages, and various forms of brain symptoms) in the medical investigation of suspected traumatic shaking. In this commentary we will not discuss the methodological shortcomings of the SBU-review but will concentrate on the effects of the review on the daily practice of protecting children and families in court procedures. In our opinion the report did not add anything to what was already known in clinical and forensic medicine. The SBU-review confirmed that shaking can cause the ‘triad’ and that there are other explanations for the ‘triad’ and its components. The report however did not provide a realistic list of these other explanations. The review reduced the discussion about inflicted head injury in young children to a discussion about the ‘triad’ and traumatic shaking, ignoring the fact that ‘diagnosing’ inflicted head injury concerns a complete clinical and forensic evaluation of all individual and combined findings, of which for example the presence of bruising or fractures, were excluded by the SBU-panel.     

What is different about a radiologist's brain?

PURPOSE: To investigate neuronal activations during processing of radiologic and nonradiologic images by experienced radiologists and nonradiologist subjects by using event-related functional magnetic resonance (MR) imaging. MATERIALS AND METHODS: Study was approved by local ethics committee, and informed consent was obtained. Radiologic and control images were presented to 12 experienced radiologists (mean age, 35.8 years +/- 3.6 [standard deviation]) and 12 nonradiologist subjects (mean age, 33.0 years +/- 6.9). Half of the images were artificially manipulated-that is, for example, a local shadow was introduced. Subjects had to indicate whether a visually presented image was original or manipulated, while neuronal activity was assessed by using event-related functional MR imaging. Analysis was performed on the basis of fixed-effects general linear models with correction for multiple comparisons (false discovery rate). RESULTS: Radiologic images, when compared with control images, evoked stronger activations exclusively in the group of radiologists, notably in the bilateral middle and inferior temporal gyrus, bilateral medial and middle frontal gyrus, and left superior and inferior frontal gyrus (P < .001, corrected). Additionally, visual processing of control images (ie, nonradiologic images) differed significantly between experienced radiologists and nonradiologist subjects (P < .001, corrected). Radiologists showed strongest activation in the left-dominant more posterior superior and inferior parietal lobule, while nonradiologist subjects showed strongest activation in the right-dominant more anterior superior and inferior parietal lobule and postcentral gyrus. CONCLUSION: With radiologic experience, there is selective enhancement of brain activation with radiologic images, and the visual system is modified in general.     

Giving radioiodine? Think about airport security alarms

An increased sensitivity of airport detectors, a growing number of isotopic tests, and globalization of the society have raised a number of false positive radioactive alarms at airports and public places. This paper presents two new cases of patients who triggered airport security alarms after receiving 740MBq of (131)I for non-toxic goitre and attempts to compare surprisingly limited literature concerning this problem. A 57-year-old man triggered a security alarm at three different airports on the 17th, 28th, and 31st day after radioiodine exposure. Interestingly enough, in the meantime, on the 18th and 22nd day, no radiation was detected in him at the airport where he was twice detained as a source of radiation later on. The second case presents a 45-year-old woman who activated security alarm detectors while crossing a border on her coach trip 28 days after radioiodine administration.     

Spanish radiographers’ concerns about the COVID-19 pandemic

IntroductionThe current outbreak of COVID-19 has caused worldwide healthcare and social emergency in which healthcare professionals were under extreme work conditions while being fearful of becoming infected or spreading the disease to their relatives. The perceived threat of COVID-19 has the potential to cause severe psychological maladjustment. The aim of the study is to explore Spanish radiographers’ concerns about the COVID-19 pandemic.MethodsThis study was quantitative, observational and cross-sectional. The sample was made up of 546 radiographers working in Spain during the outbreak. The instrument used for analysis was an ad hoc questionnaire with socio-demographic questions and the questionnaire on perception of threat from COVID-19 validate to spanish healthcare professionals.ResultsThe sample consisted of 70.1% of female, 29.7% of male and 0.2% undeclare sex participants. The results showed a high level of a perceived threat from COVID-19 (7.57 ± 0.088), furthermore we observed a high level of threat about the possibility of infecting family members (8.49 ± 0.25), patients (8.33 ± 0.086), and coworkers (8.35 ± 0.084). Furthermore, females have a higher level of a perception of threat to spread infection between patients (r = ?0.136; p = 0.001) and coworkers (r = ?0.118; p = 0.006), than males.ConclusionCOVID-19 pandemic is perceived as a serious threat, being especially concerned about the threat of spreading the infection to family, coworkers, and patients. The perception of risk depends partly on professionals’ gender and family responsibilities.Implications for practiceOur findings suggest that it is recommended that healthcare professionals receive formation to reinforce and improve their emotional competencies for coping successfully with potentially stressful situations like COVI19 pandemic.     

What do British service personnel know about malaria?

BACKGROUND: Approximately 2000 cases of malaria are imported into the United Kingdom each year, and 10 to 14 patients die. Evidence has been published suggesting that levels of knowledge about the disease are chronically poor among travelers. Objective: The aim of this study was to describe the levels of knowledge of malaria in a deployable population from all three services of the U.K. armed forces. METHOD: A questionnaire-based survey was undertaken, asking questions regarding core knowledge about malaria and regarding other health issues, beliefs, and experiences that might influence knowledge about malaria. RESULTS: Core knowledge concerning malaria was variable, and questions concerning experiences and beliefs generated from other health issues were generally answered poorly. The Royal Air Force showed the best knowledge and the Army the worst. Those with longer service and higher rank had better knowledge than did junior soldiers with shorter service. Core knowledge about malaria among male subjects was generally good, but overall knowledge appeared to be better among female subjects. CONCLUSIONS: Levels of malaria awareness are variable in the U.K. armed forces and, in general, worse in the Army and among those with less time in the services.     

What do single-fiber studies tell us about exercise training?

Many exercise programs designed by trainers have the specific aim to enhance strength, endurance, or power of certain muscle groups to improve athletic performance. Muscle training is also an important component of rehabilitation to limit atrophy associated with immobilization, aging, or disease. To optimize exercise interventions, a good understanding of the response to various training programs and the identification of the mechanisms that influence muscle function are required. Changes in the performance of muscle contraction are associated, among other things, with muscle fiber-type expression and functional properties of the contractile apparatus. Chemically skinned, single fibers is the only model that allows study of the mechanical properties of human muscle fibers as a function of the expression of myosin heavy-chain isoforms. Recently, this model has been used to explore the functional adaptations after different types of solicitations. The current results of the literature indicate that cross-sectional area and force of a specific fiber type are enhanced after resistance training, whereas maximal unloaded shortening velocity is increased by endurance training. Plyometric training improves both fiber force and shortening velocity. Fiber peak power is increased after resistance or plyometric training, and on a long-term basis it is decreased after endurance training. Studies on elderly individuals indicate that this population may react differently with respect to some single-fiber adaptations after training. Generally, training regimens tend to decrease the proportion of type IIx fibers. The available data in the literature make it possible to formulate recommendations applicable to sport science and rehabilitation.     

Singlet oxygen in vivo – it is all about intensity

Recently we could establish detection of singlet oxygen phosphorescence in sarcoma mouse models in vivo. Modern NIR-PMTs in combination with Time-Correlated Multi Photon Counting allow for direct supervision of photosensitizer activity, even from outside the animal [1]. Positioning of the tip of an optical multi-mode fiber bundle directly above the skin combines site-selective pulsed excitation and detection.The presented work addresses the influence of illumination intensity on the amount and locations of singlet oxygen generation in tumor tissue. We use time-resolved optical detection at the typical emission wavelength around 1270 nm and close to it at 1200 nm to determine the phosphorescence kinetics. The discussed data comprise in vivo measurements in tumor-laden HET-CAM [2] and mice. The results show that too intense illumination is a major issue, affecting many PDT treatments and all singlet oxygen measurements in vivo reported so far. Outside of the blood vessels, oxygen consumption due to chemical quenching of the vast majority of generated singlet oxygen may exceed the diffusion-limited supply. Whether or not this results in local anoxia depends on the local drug concentration and the illumination intensity [3].In most cases, singlet oxygen generation is limited to the blood vessels and walls, while photosensitizers in the surrounding tissue will likely not partake.Being a limitation for the treatment on one hand, on the other this finding offers a new method for tumor diagnosis when using photosensitizers exploiting the EPR effect. Using a new method that we call “robust data analysis” on the phosphorescence kinetics measured for our polymer-bound photosensitizers, which circulate in the blood stream for a long time and extravasate mainly in the tumor, yielded convincing results to support its applicability for tumor diagnostics.In contrast to high intensity PDT, some papers reported successful treatment with nanoparticular drugs using much lower illumination intensity [4]. The question of whether with such illumination singlet oxygen is indeed generated in areas outside of vessels and walls is addressed by numerical analysis. Based on the assumption that all detected luminescence kinetics at around 1270 nm comprise mainly two components, singlet oxygen phosphorescence from photosensitizers and phosphorescence from the photosensitizer triplet state, we may simulate expected kinetics for lower illumination intensities. In addition, we discuss how to perform measurements at such low intensities.     

What do patients know about ultrasound,CT and MRI?

OBJECTIVES: To establish the level of patient knowledge of ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI); to describe patient information-seeking behaviour before attendance; and to assess patients' understanding of the main aspects of scanning examinations. DESIGN: Survey of people attending for ultrasound, CT and MRI using a questionnaire, including 12 statements on simple aspects of procedures, to be indicated as true or false. SETTING: Radiology department of an acute teaching hospital NHS Trust in the north-east of Scotland. PARTICIPANTS: A convenience sample of 500 out-patient, non-emergency first time attenders for ultrasound (300), computed tomography (150), and magnetic resonance imaging (50). RESULTS: An 82% response rate to the questionnaire was achieved. Less than half the patients (48.9%, 182/372) indicated they knew the type of investigation they had been referred for. When responses were compared with referral letters, 64% (238/372) were incongruent. Few participants hadsought information (32%, 120/372), but of those who had the main source was family and friends (72%, 86/120). Seven participants searched the Internet. Eighty-two percent (308/372) of participants reported having been given an explanation of why an investigation was necessary. The majority of participants (67.8%, 251/372) expected to receive their results within 2 weeks. The mean score on the 12 true/false knowledge statements was 3.8, and 17% (65/372) answered 'Don't know' to all the statements. One person answered all questions correctly. CONCLUSIONS: Patients were not well informed regarding these investigations. This has significant implications for information-giving strategies and informed consent.     

What can imaging tell us about cognitive impairment and dementia?

Dementia is a contemporary global health issue with far reaching consequences, not only for affected individuals and their families, but for national and global socio-economic conditions. The hallmark feature of dementia is that of irreversible cognitive decline, usually affecting memory, and impaired activities of daily living. Advances in healthcare worldwide have facilitated longer life spans, increasing the risks of developing cognitive decline and dementia in late life. Dementia remains a clinical diagnosis. The role of structural and molecular neuroimaging in patients with dementia is primarily supportive role rather than diagnostic, American and European guidelines recommending imaging to exclude treatable causes of dementia, such as tumor, hydrocephalus or intracranial haemorrhage, but also to distinguish between different dementia subtypes, the commonest of which is Alzheimer’s disease. However, this depends on the availability of these imaging techniques at individual centres. Advanced magnetic resonance imaging (MRI) techniques, such as functional connectivity MRI, diffusion tensor imaging and magnetic resonance spectroscopy, and molecular imaging techniques, such as 18F fluoro-deoxy glucose positron emission tomography (PET), amyloid PET, tau PET, are currently within the realm of dementia research but are available for clinical use. Increasingly the research focus is on earlier identification of at risk preclinical individuals, for example due to family history. Intervention at the preclinical stages before irreversible brain damage occurs is currently the best hope of reducing the impact of dementia.     

Entomotoxicology for the forensic toxicologist: much ado about nothing?

We present a series of 29 necropsies in which organic compounds (including benzodiazepines, barbiturates, antidepressants, phenothiazine, opiates, cannabinoids, meprobamate, digoxin and nefopam) were detected in arthropod larvae sampled on human corpses. No correlation was observed between drug concentrations in the larvae versus human samples. When tested, inter-larvae and inter-site variations of drug concentrations (i.e., within larvae when analyzed separately, and within anatomic sites when larvae were grouped according to their site of sampling) were enormous and not reproducible from one case to another, confirming that arthropod larvae are unreliable for quantitative toxicological analysis. Since drugs identified in maggots are always detectable in the cadaver too, we conclude that larvae analysis is of almost no interest for practical forensic casework.     

What do clinicians understand about deaths reportable to the Coroner?

SettingThe study setting is a tertiary referral hospital of over 980 beds, in Victoria, Australia. The hospital is a long established major academic public health service providing healthcare, health professional education and health research. The hospital has 103,756 in-patient admissions, 190,756 outpatient attendances and over 82,000 presentations to the Emergency Department annually.Participants22 clinicians completed an in-depth, audio-recorded interview: 12 medical and 10 nursing staff, with a variety of clinical experience.Intervention(s)Each audio recorded interview was transcribed verbatim for thematic analysis. The semi structured questions were designed to explore the clinician's understanding of deaths that meet the criteria to be reported to Coroners Court of Victoria (CCOV), and why such reporting was required. There was also the opportunity to identify any barriers or enablers to the reporting process, whether internal or external to the organisation.ResultsTwo main themes emerged from the interviews: 1. lack of awareness of which deaths are reportable to the coroner and 2. the need for educational support. Several subthemes were also identified such as accountability, the need for feedback and blame.DiscussionThe understanding of clinicians as to which deaths meet the reportable criteria in healthcare is quite variable and this indicates that there might be a level of under reporting. Apart from the potential of not meeting legal obligations, there may also be the loss of a valuable opportunity for lessons to inform clinical practice and enhance the delivery of safe patient care.     

Science to practice: what is new about detecting emphysema?

Through the use of diffusion-weighted 3He MR imaging, Fain et al in this issue of Radiology demonstrated the potential for detection of early emphysema in the lungs of healthy smokers. The technique possibly could become an important tool for understanding the pulmonary processes that occur with emphysema, for implementing treatment before clinical symptoms occur, and for monitoring the effect of treatment.     

Acute exercise and subsequent nutritional adaptations: what about obese youths?

The imbalance between energy expenditure and energy intake is the main factor accounting for the progression of obesity. For many years, physical activity has been part of weight-loss programmes to increase energy expenditure. It is now recognized that exercise can also affect appetite and energy consumption. In the context of seeking new obesity treatments, it is of major interest to clarify the impact of physical exercise on energy intake. Many reviews on this topic have been published regarding both lean and overweight adults, and this review focuses on the relationships between acute exercise and the short-term regulation of energy intake in lean and overweight or obese youths. The current literature provides very few data regarding the impact of exercise on subsequent energy intake and perceived and measured appetite in children and adolescents, mainly because of methodological difficulties in the assessment of both energy intake and expenditure. It has been long suggested that energy intake was regulated after exercise in order to compensate for the exercise-induced energy expenditure and then preserve energy balance. This overview underlines that the energy expended during exercise is not the main parameter that influences subsequent energy intake in both lean and overweight/obese children and adolescents, and that factors such as the duration or intensity of exercise may have larger impact. The effects of acute exercise on the following nutritional adaptations (energy intake and appetite feelings) remain inconclusive in lean youths, mainly due to the lack of data and the disparity of the methodologies used. Studies in overweight or obese children and adolescents are confronted with the same difficulties, and the few available data suggest that intensive exercise (>70% maximal oxygen consumption) can induce a reduction in daily energy balance, as a result of its anorexigenic effect in obese adolescents. However, further studies are needed to clarify the impact of acute exercise on subsequent nutritional adaptations and appetite-related hormones in children and adolescents, and to investigate the effect of chronic exercise programmes.