Health and Safety in a Family Child Care Network: An Analysis of Violation Data of Routine,Full Unannounced Inspections

Maternal and Child Health Journal - To analyze how engagement with a staffed family child network is associated with compliance on health and safety regulations among family day care (FDC) homes....     

Can We Perform CT of the Appendix with Less Than 1 mSv? A De-escalating Dose-simulation Study

Objectives

To systematically explore the lowest reasonably achievable radiation dose for appendiceal CT using an iterative reconstruction (IR) in young adults.

Methods

We prospectively included 30 patients who underwent 2.0-mSv CT for suspected appendicitis. From the helical projection data, 1.5-, 1.0- and 0.5-mSv CTs were generated using a low-dose simulation tool and the knowledge-based IR. We performed step-wise non-inferiority tests sequentially comparing 2.0-mSv CT with each of 1.5-, 1.0- and 0.5-mSv CT, with a predetermined non-inferiority margin of 0.06. The primary end point was the pooled area under the receiver-operating-characteristic curve (AUC) for three abdominal and three non-abdominal radiologists.

Results

For the abdominal radiologists, the non-inferiorities of 1.5-, 1.0- and 0.5-mSv CT to 2.0-mSv CT were sequentially accepted [pooled AUC difference: 2.0 vs. 0.5 mSv, 0.017 (95% CI: -0.016, 0.050)]. For the non-abdominal radiologists, the non-inferiorities of 1.5- and 1.0-mSv CT were accepted; however, the non-inferiority of 0.5-mSv CT could not be proved [pooled AUC difference: 2.0 vs. 1.0 mSv, -0.017 (-0.070, 0.035) and 2.0 vs. 0.5 mSv, 0.045 (-0.071, 0.161)].

Conclusion

The 1.0-mSv appendiceal CT was non-inferior to 2.0-mSv CT in terms of diagnostic performance for both abdominal and non-abdominal radiologists; 0.5-mSv appendiceal CT was non-inferior only for abdominal radiologists.

Key points

? For both abdominal and non-abdominal radiologists, 1.0-mSv appendiceal CT could be feasible. ? The 0.5-mSv CT was non-inferior to 2.0-mSv CT only for expert abdominal radiologists. ? Reader experience is an important factor affecting diagnostic impairment by low-dose CT.

     

Associations between physical activity and comorbidities in Korean cancer survivors

Purpose

To examine the associations between physical activity, metabolic risk factors, and comorbidities in Korean cancer survivors.

Methods

We used multiple cross-sectional data sets from the 2007–2013 Korean National Health and Nutrition Examination Surveys (KNHANES) that included 1225 cancer survivors. Physical activity and comorbidities were self-reported. Metabolic risk factors were measured via blood analyses and included fasting glucose, insulin, total cholesterol, triglycerides, and blood pressure.

Results

The sample was 38.4% male with a mean age of 59.9?±?12.4 years. The most common cancers were stomach (22.5%), cervical (14.6%), breast (14.4%), and colorectal (11.8%). Cancer survivors meeting aerobic physical activity guidelines, compared to those completely inactive, had significantly lower fasting glucose (p?=?.001), HbA1c (p?=?.006), and systolic blood pressure (p?=?.001), and significantly lower risks of hypertension (odds ratio [OR]?=?0.55, 95% confidential interval [CI]?=?0.32 to 0.93), diabetes (OR?=?0.64, 95% CI?=?0.43 to 0.95), and arthritis (OR?=?0.64, 95% CI?=?0.41 to 0.99). Moreover, cancer survivors meeting strength exercise guidelines, compared to those not meeting guidelines, had significantly lower levels of fasting glucose (p?=?.001), HbA1c (p?<?.001), and total cholesterol (p?=?.031), and significantly lower risks of arthritis (OR?=?0.42, 95% CI?=?0.25 to 0.85) and back pain (OR?=?0.50, 95% CI?=?0.30 to 0.83).

Conclusion

Aerobic physical activity and strength exercise were significantly associated with lower risks of metabolic disturbances and comorbidities in Korean cancer survivors.

Implications for Cancer Survivors

Cancer survivors should engage in at least 150 min/week of aerobic exercise and at least 2 days/week of strength exercise to lower their risk of metabolic disturbances and comorbidities.

     

Using additional pressure control lines when connecting a continuous renal replacement therapy device to an extracorporeal membrane oxygenation circuit

Background

The introduction of a continuous renal replacement therapy (CRRT) device into the extracorporeal membrane oxygenation (ECMO) circuit is widely used. However, excessive pressure transmitted to the CRRT device is a major disadvantage. We investigated the effects of using additional pressure control lines on the pressure and the lifespan of the CRRT circuit connected to the ECMO.

Methods

This is an observational study using prospectively collected data from consecutive patients receiving CRRT connected into the ECMO circuit at a university-affiliated, tertiary hospital from January 2013 to December 2016. The CRRT circuit was connected into the ECMO circuit through the Luer Lock connection without an additional pressure control line in 16 patients (9%, no line group), an additional pressure control line on the inlet line in 36 patients (23%, single line group), and additional pressure control lines on both the inlet and outlet lines in 118 patients (77%, double line group). The outcome measures of interest were compared among the three groups.

Results

The median access pressure was higher in the no line group compared to the groups. However, median filter pressure, effluent pressure, and return pressure were higher in the double line group compared to the other groups. There were no significant differences in platelets, lactate dehydrogenase, and plasma hemoglobin among the 3 groups over the time period studied. Median lifespan of the CRRT circuits in the double line group was 45.0 (29.0–63.7) hours, which was higher compared to 21.8 (11.6–31.8) hours in the no line group and 23.0 (15.0–34.6) hours in the single line group, respectively. In addition, in-hospital mortality was lower in the double line group (48.3%) compared to the no line group (68.8%) and the single line group (75.0%).

Conclusions

Additional tubing can be considered a simple and safe method for pressure control and lengthening circuit survival when connecting the CRRT device to the ECMO circuit.

     

Bio-artificial skin composed of gelatin and (1-->3), (1-->6)-beta-glucan

Porous scaffolds composed of gelatin and beta-glucan were prepared using the freeze-drying method. The scaffold had an inter-connected pore structure with average pore size of 90-150 microm. Results for the contact angle and cell attachment revealed that a high gelatin content was suitable for cellular attachment and distribution in two- or three-dimensional fibroblast cultures, because the gelatin had acidic residues, and arginine-glycine-aspartic acid groups. To prepare a stratified wound dressing to mimic the normal human skin, fibroblasts and keratinocyte cells were isolated from a child's foreskin, and were co-cultured in gelatin/beta-glucan scaffolds were cross-linked using 1-ethyl-(3-3-dimethylaminopropyl) carbodiimide hydrochloride. An in vivo study showed that after 1 week, the artificial dermis containing the fibroblasts enhanced the re-epithelialization of a full-thickness skin defect rather than the acellular scaffold.     

Poly(lactic-co-glycolic acid) microspheres as an injectable scaffold for cartilage tissue engineering

Injectable scaffold has raised great interest for tissue regeneration in vivo, because it allows easy filling of irregularly shaped defects and the implantation of cells through minimally invasive surgical procedures. In this study, we evaluated poly(lactic-co-glycolic acid) (PLGA) microsphere as an injectable scaffold for in vivo cartilage tissue engineering. PLGA microspheres (30-80 microm in diameter) were injectable through various gauges of needles, as the microspheres did not obstruct the needles and microsphere size exclusion was not observed at injection. The culture of chondrocytes on PLGA microspheres in vitro showed that the microspheres were permissive for chondrocyte adhesion to the microsphere surface. Rabbit chondrocytes were mixed with PLGA microspheres and injected immediately into athymic mouse subcutaneous sites. Chondrocyte transplantation without PLGA microspheres and PLGA microsphere implantation without chondrocytes served as controls. Four and 9 weeks after implantation, chondrocytes implanted with PLGA microspheres formed solid, white cartilaginous tissues, whereas no gross evidence of cartilage tissue formation was noted in the control groups. Histological analysis of the implants by hematoxylin and eosin staining showed mature and well-formed cartilage. Alcian blue/safranin O staining and Masson's trichrome staining indicated the presence of highly sulfated glycosaminoglycans and collagen, respectively, both of which are the major extracellular matrices of cartilage. Immunohistochemical analysis showed that the collagen was mainly type II, the major collagen type in cartilage. This study demonstrates the feasibility of using PLGA microspheres as an injectable scaffold for in vivo cartilage tissue engineering. This scaffold may be useful to regenerate cartilaginous tissues through minimally invasive surgical procedures in orthopedic, maxillofacial, and urologic applications.     

Vitamin D(3) up-regulating protein 1 (VDUP1) antisense DNA regulates tumorigenicity and melanogenesis of murine melanoma cells via regulating the expression of fas ligand and reactive oxygen species

The expression of vitamin D(3) up-regulating protein-1 (VDUP1) was up-regulated by 1alpha,25-dihydroxyvitamin D(3) (VD3) treatment in B16 mouse melanoma cells. The functional effect of VDUP1 on B16F10 melanoma cells was demonstrated by reduction of Fas ligand and CD44 expression in cells transfected with VDUP1 antisense cDNA. Furthermore, intracellular reactive oxygen species level and cell proliferation were decreased in antisense transfectants compared with those in vector controls. However, melanin synthesis was up-regulated in antisense transfectants. In addition, VDUP1 antisense transfectants showed an increased susceptibility to natural killer (NK) cells in vitro. When VDUP1 antisense transfectants were implanted into syngeneic mice, significant reduction of tumor cell growth was observed with the infiltrate of T cells and NK cells in tumor area. Taken together, these results demonstrate that VDUP1 has critical physiological roles and can be a novel therapeutic target for melanoma.     

Identification of signatures in biomedical spectra using domain knowledge

OBJECTIVE: Demonstrate that incorporating domain knowledge into feature selection methods helps identify interpretable features with predictive capability comparable to a state-of-the-art classifier. METHODS: Two feature selection methods, one using a genetic algorithm (GA) the other a L(1)-norm support vector machine (SVM), were investigated on three real-world biomedical magnetic resonance (MR) spectral datasets of increasing difficulty. Consensus sets of the feature sets obtained by the two methods were also assessed. RESULTS AND CONCLUSIONS: Features identified independently by the two methods and by their consensus, determine class-discriminatory groups or individual features, whose predictive power compares favorably with that of a state-of-the-art classifier. Furthermore, the identified feature signatures form stable groupings at definite spectral positions, hence are readily interpretable. This is a useful and important practical result for generating hypothesis for the domain expert.