Ultra-high-pressure liquid chromatography–solid-phase clean-up for determining aflatoxins in Egyptian food commodities

In this work, we determined the content of regulated aflatoxins (ATs) B1, B2, G1, and G2 in food commodities using solid-phase extraction (SPE) and ultra-high-pressure liquid chromatography with fluorescence detection without derivatization. We extracted ATs from the ground samples by mixing in NaCl and 80% (v/v) methanol. The sample was enriched and cleaned up by SPE technique using Bakerbond^® C18 cartridges. The extract that we obtained was immediately analyzed using isocratic elution with a mobile phase consisting of acetonitrile, methanol and deionized water in a ratio of 64:18:18. Method validation was carried out by determining these ATs in a quality control material consisting of almond T02445QC and with the add-found test. The results provided satisfactory recovery within the range of 89.6–103.3%. Repeatability and intermediate precisions were assessed as RSD (%) which were found in the range of 1.1–11.3% and 1.5–12.0%, respectively. The limit of detection (S/N = 3) was 0.03, 0.02, 0.04, and 0.02 μg kg⁻¹ for B1, B2, G1 and G2, respectively. Finally, the method was successfully applied to determine ATs in raw Egyptian food commodities, namely maize, popcorn, pistachio, corn, peanuts, chilli, wheat, green coffee and almond, and the corresponding RSD did not exceed 11%.     

Diversity and education of the nursing workforce 2006–2016

Background

The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor’s degree, and inter-professional education.

Trends in Outpatient MRI Seem to Reflect Recent Reimbursement Cuts

PurposeTo determine whether recent reimbursement cuts have resulted in a shift of outpatient MRI from private offices to hospital outpatient departments (HOPDs); and to study office MRI utilization trends among radiologists and other specialists.MethodsThe Medicare Part B Physician/Supplier Procedure Summary Master Files were used. MRI codes were aggregated, and total MRI volumes from 2002 to 2012 were studied. Medicare place-of-service codes were used to identify studies performed in private offices and HOPDs and create trend lines. Specialty codes were used to categorize private office MRI users as radiologists, orthopedic surgeons, other physicians, and independent diagnostic testing facilities.ResultsMedicare office and HOPD utilization of MRI (all specialties) rose rapidly from 2002 to 2006, reaching 2,727,807 in offices and 2,355,641 in HOPDs. Thereafter, office volume steadily declined, whereas HOPD volume steadily increased. By 2012, more studies were done in HOPDs than in offices. Over the entire period from 2002 and 2012, office MRI volume among radiologists increased 27%, compared with 216% among orthopedic surgeons and 124% among other physicians.ConclusionsAlthough the majority of Medicare outpatient MRI studies had previously been performed in private offices, recent years brought a shift, with more now being performed in HOPDs. This change will increase costs to payers, because reimbursements to HOPDs are generally higher than those to offices. Although radiologists perform the majority of MRI exams that are conducted in private offices, the rate of growth for such exams from 2002 to 2012 was considerably higher among orthopedic surgeons and other physicians than among radiologists.     

Comparison of European (ESR) and American (ACR) White Papers on Teleradiology: Patient Primacy Is Paramount

The ACR and European Society of Radiology white papers on teleradiology propose best practice guidelines for teleradiology, with each body focusing on its respective local situation, market, and legal regulations. The organizations have common viewpoints, the most important being patient primacy, maintenance of quality, and the “supplementary” position of teleradiology to local services. The major differences between the white papers are related mainly to the market situation, the use of teleradiology, teleradiologist credentialing and certification, the principles of “international” teleradiology, and the need to obtain “informed consent” from patients. The authors describe these similarities and differences by highlighting the background and context of teleradiology in Europe and the United States.     

The Shift in Outpatient Advanced Imaging From Private Offices to Hospital Facilities

PurposeTo study recent outpatient imaging trends in private offices and hospital outpatient departments (HOPDs), to determine if shifting between the two has occurred. Concern is currently focused on whether reduced reimbursements and other factors might lead to a shift to higher-cost HOPDs.MethodsThe nationwide Medicare Physician/Supplier Procedure Summary Master Files for 2001 to 2013 were studied. All Current Procedural Terminology codes for MRI, echocardiography, nuclear medicine, ultrasound, and CT were selected, and procedure utilization rates per 1,000 Medicare beneficiaries were determined for each year. Medicare location codes identified the settings where the scans were performed.ResultsTotal utilization rates, per 1,000 beneficiaries, of all these examination types in private offices, grew from 478 in 2001, to 874 in 2008 (+83%), and then declined to 503 in 2011 (–42%), primarily as a result of code bundling. No further bundling occurred in 2012 or 2013, but the decline continued in those years, to 462. In HOPDs, the total rate rose from 416 in 2001, to 523 in 2008 (+26%), followed by similar bundling-related declines, to 418 (–20%) in 2011. But in 2012 and 2013, in contrast to private office trends, the HOPD rate increased to 447. The ratio of private office to HOPD advanced imaging was 1.67 in 2008, declining to 1.03 in 2013. In addition, individual modality shifts away from offices and into HOPDs were quite apparent.ConclusionsIn recent years, a shift has occurred in utilization of all advanced imaging modalities, from private offices to HOPDs. This change could portend a loss of access for patients and an increase in costs.     

Proteus syndrome review: molecular,clinical, and pathologic features

Proteus syndrome is caused by an activating AKT1 mutation (c.49G>A, p.Glu17Lys). Many variable features are possible in this mosaic disorder, including: (i) disproportionate, asymmetric, and distorting overgrowth; (ii) bone abnormalities different from those observed in other disorders; (iii) a characteristic cerebriform connective tissue nevus made up of highly collagenized connective tissue; (iv) epidermal nevi in early life, consisting of acanthosis and hyperkeratosis; (v) vascular malformations of the capillary, venous, or lymphatic types; (vi) dysregulated adipose tissue including lipomas, lipohypoplasia, fatty overgrowth, and localized fat deposits; (vii) other unusual features, including bullous lung alterations; specific neoplasms; a facial phenotype associated with intellectual disability and/or seizures, and/or brain malformations; and (viii) deep vein thrombosis, resulting in premature death. Concluding remarks address diagnostic criteria, natural history, management, psychosocial issues, and differential diagnosis.     

Current status of ambulatory blood pressure monitoring in Asian countries: A report from the HOPE Asia Network

Ambulatory blood pressure monitoring (ABPM) can measure 24‐hour blood pressure (BP), including nocturnal BP and diurnal variations. This feature of ABPM could be of value in Asian populations for preventing cardiovascular events. However, no study has yet investigated regarding the use of ABPM in actual clinical settings in Asian countries/regions. In this study, 11 experts from 11 countries/regions were asked to answer questionnaires regarding the use of ABPM. We found that its use was very limited in primary care settings and almost exclusively available in referral settings. The indications of ABPM in actual clinical settings were largely similar to those of home BP monitoring (HBPM), that is, diagnosis of white‐coat or masked hypertension and more accurate BP measurement for borderline clinic BP. Other interesting indications, such as nighttime BP patterns, including non‐dipper BP, morning BP surge, and BP variability, were hardly adopted in daily clinical practice. The use of ABPM as treatment guidance for detecting treated but uncontrolled hypertension in the Asian countries/regions didn't seem to be common. The barrier to the use of ABPM was primarily its availability; in referral centers, patient reluctance owing to discomfort or sleep disturbance was the most frequent barrier. ABPM use was significantly more economical when it was reimbursed by public insurance. To facilitate ABPM use, more simplified indications and protocols to minimize discomfort should be sought. For the time being, HBPM could be a reasonable alternative.     

Throwing Away the Key: The Ethics of Risk Assessment for Preventive Detention Schemes

Preventive detention schemes that aim to protect the community from certain ‘dangerous’ individuals have long existed. While risk assessment is now pervasive in the management and treatment of many individuals, it raises particular issues when a person's liberty is at stake on the basis of what that person might do. This R.G. Myers Memorial Lecture addresses the ethical issues raised by mental health practitioners providing risk assessments for legislative schemes that involve the deprivation of liberty. It will focus in particular on Australian post-sentence preventive detention schemes for sex offenders that have been held by the United Nations Human Rights Committee to breach fundamental human rights. However, the ethical issues discussed also have repercussions for civil commitment laws that enable the detention of those with severe mental or intellectual impairments.     

Mental health issues for lesbian,gay, bisexual and transgender people: a qualitative study

International research clearly demonstrates that lesbian, gay, bisexual men and women and transgender (LGBT) people experience poorer mental health than heterosexual people. Despite this robust evidence, one important gap in New Zealand is an understanding of the mental health issues of this group. A qualitative research project was commissioned to address this. Data from interviews with 17 key informants and a qualitative online survey completed by 124 LGBT people were thematically analysed. An overarching theme of macro-social environment was identified, along with two other themes: social acceptance and connection experienced by LGBT individuals and the provision of mental health services and other support. These themes were pertinent across the LGBT groupings, but at times in uneven and different ways. In order to develop useful mental health policy and service provision for LGBT people, greater account of social explanations for poor mental health is indicated, along with appropriate mental health service provision.