Disclosing incidental findings in brain research: The rights of minors in decision‐making

MRI is used routinely in research with children to generate new knowledge about brain development. The detection of unexpected brain abnormalities (incidental findings; IFs) in these studies presents unique challenges. While key issues surrounding incidence and significance, duty of care, and burden of disclosure have been addressed substantially for adults, less empirical data and normative analyses exist for minors who participate in minimal risk research. To identify ethical concerns and fill existing gaps, we conducted a comprehensive review of papers that focused explicitly on the discovery of IFs in minors. The discourse in the 21 papers retrieved for this analysis amply covered practical issues such as informed consent and screening, difficulties in ascertaining clinical significance, the economic costs and burden of responsibility on researchers, and risks (physical or psychological). However, we found little discussion about the involvement of minors in decisions about disclosure of IFs in the brain, especially for IFs of low clinical significance. In response, we propose a framework for managing IFs that integrates practical considerations with explicit appreciation of rights along the continuum of maturity. This capacity‐adjusted framework emphasizes the importance of involving competent minors and respecting their right to make decisions about disclosure. J. Magn. Reson. Imaging 2013;38:1009–1013. © 2013 Wiley Periodicals, Inc.     

An Experimental Model of Heat Storage in Working Firefighters

Objective. Develop experimental models to study uncompensable heat stress (UCHS) in working firefighters (FFs). Methods. FFs ingested core temperature (Tc) capsules prior to performing sequential tasks in 40°C andpersonal protective ensemble (PPE), or 18°C andno PPE. Both trials were conducted in an environmental chamber with FFs using self-contained breathing apparatus (SCBA). Results. FFs exercising in heat andPPE reproduced UCHS conditions. For every FF in both trials for whom the capsules worked, Tc was elevated, andTc_max occurred after completion of study protocol. Trials with PPE resulted in a mean maximum temperature of 38.94°C (± 0.37°C); Tc_max reached 40.4°C. Without PPE, maximum Tc averaged 37.79°C (± 0.07°C). Heat storage values ranged from 131 to 1205 kJ, averaging 578 kJ (± 151.47kJ) with PPE and210.83 kJ (± 21.77kJ) without PPE. Conclusions. An experimental model has been developed that simulates the initial phases of an interior fire attack to study the physiology of UCHS in FF. The hot environment andPPE increase maximum Tc andheat storage over that due to the exertion required to perform the tasks andmay decrease time to volitional fatigue. This model will permit controlled studies to optimize work-rest cycles, rehab conditions, andphysical conditioning of FFs.     

Fear of aids: An assessment of knowledge and attitudes of medical,nursing, and medical technology students

The reluctance of students in health professions to care for AIDS patients is partially based on the perceived risk of transmission of HIV from patient contact. We hypothesize that fear of contagion is due to lack of knowledge and deep‐rooted attitudes and emotions existing even in areas of low HIV seroprevalence. We tested this hypothesis on medical, nursing, and medical technology students. Using a questionnaire that yielded four scales, results showed only 58% of students were knowledgeable, 81% were fearful of contagion, 57% were homophobic, and 8% had death anxiety. Lack of knowledge was correlated with fear of contagion (p < .05), whereas homophobia was weakly associated (p = .08). We conclude that this perceived risk of infection is a result of lack of knowledge, disbelief of the facts, and the interplay of personal values and emotions. Alternative educational methods are needed to increase students’ knowledge and to encourage students to examine their personal feelings and attitudes.     

IGF—1对ISP损伤大鼠心肌CA变化影响的研究

目的：研究胰岛素样生长因子１（ＩＧＦ－１）对异丙基肾上腺素（ＩＳＰ）损伤大鼠心肌儿茶酚胺（ＩＣＡ）的变化影响。方法：采用改变的荧光分光光度法测定ＣＡ的含量。结果ＩＧＦ－１可抑制内源性ＣＡ的产生。结论：作者认为ＩＧＦ－１对ＩＳＰ损伤大鼠心肌具有保护作用。     

A systematic concept analysis of mental health promotion

This study explored and clarified the nature and characteristics of the concept of mental health promotion. The study also investigated how these characteristics appear in current policies and strategies. A total of 30 scientific articles and policy documents were identified and analysed using Rodgers’s systematic evolutionary concept analysis method. The analysis provided valuable information on the attributes, related concepts, antecedents, consequences and references of mental health promotion, indicating that the concept is a distinct concept comprising a unique set of attributes and characteristics. A concept mapping of mental health promotion was subsequently developed. The analysis and the concept mapping provide health professionals, policy-makers and researchers with a framework, upon which well-grounded mental health promotion practice and evaluation research can be based.     

Ten-year risk of second hip fracture. A NOREPOS study

BackgroundSecond hip fracture risk is elevated after the first, however whether risk differs with age, by sex or over time is not well known.ObjectiveTo examine the risk of second hip fracture by sex, age and time after first hip fracture.DesignData on all hip fractures in subjects 50 years and older and treated in Norwegian hospitals during 1999–2008 were retrieved. Surgical procedure codes and additional diagnosis codes were used to define incident fractures. Survival analyses with and without adjustment for competing risk of death were used to estimate the risk of second hip fracture.ResultsAmong the 81,867 persons who sustained a first hip fracture, 6161 women and 1782 men suffered a second hip fracture during follow-up. The overall age-adjusted hazard ratio (HR) of a second hip fracture did not differ between the sexes (women versus men, HR = 1.03; 95% confidence interval (CI): 0.98–1.09). Taking competing risk of death into account, the corresponding age-adjusted HR of a second hip fracture was 1.40 (95% CI: 1.33–1.47) in women compared to men. The greater risk in women was due to a higher mortality in men. Based on competing risk analyses, we estimate that 15% of women and 11% of men will have suffered a second hip fracture within 10 years after the first hip fracture. The ten-year cumulative incidence was above 10% in all age-groups, except in men 90 years and older.ConclusionFracture preventive strategies have a large potential in both women and men who suffer their first hip fracture due to the high risk of another hip fracture.     

18F-FDG PET/CT纹理分析在肺癌与肺结核的高代谢孤立性肺结节鉴别诊断中的增益价值

目的 探讨18F-氟脱氧葡萄糖（FDG） PET/CT纹理分析在肺癌与肺结核的高代谢孤立性肺结节（SPN）鉴别诊断中的增益价值。 方法 回顾性分析2017年1月至2020年6月在内蒙古赤峰市医院和北京大学肿瘤医院行18F-FDG PET/CT检查且结果表现为高代谢[最大标准化摄取值（SUV_max）≥2.5]的108例SPN患者的临床资料,其中男性68例、女性40例,年龄35~72岁,中位年龄50岁;肺结核患者45例（肺结核组）、肺癌患者63例（肺癌组）。所有患者均经组织病理学检查结果确诊。分析所有患者18F-FDG PET/CT图像SPN的良恶性（主观定性诊断）,并计算错判率、灵敏度和特异度。采用MaZda纹理分析软件分别对CT和PET图像中的SPN横断面最大层面及相邻上下两层图像手动勾画ROI并提取纹理特征参数。分别采用Fisher系数、分类错误概率+平均相关系数、交互信息以及三者联合的方法（FPM）筛选具有鉴别意义的纹理特征。对筛选出的纹理特征进行原始数据、主成分、线性分类和非线性分类的分析,对SPN的良恶性进行鉴别,以错判率评价其鉴别效能。计量资料的组间比较采用独立样本t检验;计数资料的组间比较采用χ2检验。对错判率最低的各纹理特征参数分别进行受试者工作特征（ROC）曲线分析,筛选最具鉴别意义的前3位纹理特征。 结果 肺癌组与肺结核组患者在年龄[54（42~72）岁对47（35~64）岁]、SUV_max[（9.51±4.65）对（5.35±2.89）]间的差异均有统计学意义（t=2.180、2.520,均P<0.05）;在性别、SPN长径间的差异均无统计学意义（χ2=0.070,t=0.675,均P>0.05）。主观定性诊断高代谢SPN良恶性的错判率为26.9%（29/108）、灵敏度为93.7%(59/63)、特异度为35.9%（14/39）。基于SUV_max的ROC曲线分析,SUV_max临界值为5.3时错判率为25.0%（27/108）,其与主观定性诊断的错判率差异无统计学意义（χ2=0.096,P>0.05）。CT和PET图像基于FPM联合非线性分类分析诊断的错判率最低,分别为8.33%和1.85%,两者间的差异有统计学意义（χ2=4.694,P<0.05）;其与主观定性诊断和基于SUV_max的ROC曲线分析比较,错判率的差异均有统计学意义（χ2=10.800、27.457,均P<0.05）。最具鉴别意义的前3位纹理特征分别为灰度游程矩阵中的垂直方向长行程补偿、灰度游程矩阵中的135°方向长行程补偿和灰度共生矩阵中的逆差距。 结论 MaZda纹理分析鉴别高代谢SPN良恶性的诊断效能较主观诊断高,在肺癌与肺结核的高代谢SPN的鉴别诊断中具有增益价值。