Impact of Hematopoietic Cell Transplantation on Myocardial Fibrosis in Young Patients with Sickle Cell Disease

Serial cardiovascular magnetic resonance evaluation of children and young adults with sickle cell disease (SCD) who underwent hematopoietic cell transplantation (HCT) showed that the mean ECV, representing diffuse myocardial fibrosis, decreased by 3.4% from the baseline to 12-months post HCT. (NCT04362293).

Current and emerging 3D visualization technologies in radiology

As the field of three-dimensional (3D) visualization rapidly advances, how healthcare professionals perceive and interact with real and virtual objects becomes increasingly complex. Lack of clear vocabulary to navigate the changing landscape of 3D visualization hinders clinical and scientific advancement, particularly within the field of radiology. In this article, we provide foundational definitions and illustrative examples for 3D visualization in clinical care, with a focus on the pediatric patient population. We also describe how understanding 3D visualization tools enables better alignment of hardware and software products with intended use-cases, thereby maximizing impact for patients, families, and healthcare professionals.

Assessment of Fat Fractions in the Tongue, Soft Palate, Pharyngeal Wall, and Parapharyngeal Fat Pad by the GOOSE and DIXON Methods

OBJECTIVE

The 2-point DIXON method is widely used to assess fat fractions (FFs) in magnetic resonance images (MRIs) of the tongue, pharyngeal wall, and surrounding tissues in patients with obstructive sleep apnea (OSA). However, the method is semiquantitative and is susceptible to B0 field inhomogeneities and R2* confounding factors. Using the method, although several studies have shown that patients with OSA have increased fat deposition around the pharyngeal cavity, conflicting findings was also reported in 1 study. This discrepancy necessitates that we examine the FF estimation method used in the earlier studies and seek a more accurate method to measure FFs.

MATERIALS AND METHODS

We examined the advantages of using the GOOSE (globally optimal surface estimation) method to replace the 2-point DIXON method for quantifying fat in the tongue and surrounding tissues on MRIs. We first used phantoms with known FFs (true FFs) to validate the GOOSE method and examine the errors in the DIXON method. Then, we compared the 2 methods in the tongue, soft palate, pharyngeal wall, and parapharyngeal fat pad of 63 healthy participants to further assess the errors caused by the DIXON method. Six participants were excluded from the comparison of the tongue FFs because of technical failures. Paired Student t tests were performed on FFs to detect significant differences between the 2 methods. All measures were obtained using 3 T Siemens MRI scanners.

RESULTS

In the phantoms, the FFs measured by GOOSE agreed with the true FF, with only a 1.2% mean absolute error. However, the same measure by DIXON had a 10.5% mean absolute error. The FFs obtained by DIXON were significantly lower than those obtained by GOOSE (P < 0.0001) in the human participants. We found strong correlations between GOOSE and DIXON in the tongue (R2 = 0.90), soft palate (R2 = 0.66), and parapharyngeal fat pad (R2 = 0.88), but the correlation was weaker in the posterior pharyngeal walls (R2 = 0.32) in participants.

CONCLUSIONS

The widely used 2-point DIXON underestimated FFs, relative to GOOSE, in phantom measurements and tissues studied in vivo. Thus, an advanced method, such as GOOSE, that uses multiecho complex data is preferred for estimating FF.

Do patients prefer face-to-face or telephone consultations in an outpatient cardiology department?

Introduction

There has been a significant rise in the telephone clinic consultations in preference to face-to-face (FTF) clinics in the UK during the COVID 19 pandemic. The cardiology department in a district general hospital has also seen increased use of telephone clinics. We wanted a greater understanding of the impact of telephone consultations on patient satisfaction.

Methods

A patient satisfaction survey was designed based on the joint Royal College of Physicians training board (JRCPTB) patient satisfaction survey. The survey (Image 1) was sent via post to 300 patients reviewed by the cardiology outpatient department during November 2021. 150 who had telephone appointments and to 150 patients who had FTF appointments. Descriptive statistics and student T test were used to compare differences between the two groups with a p value of <0.05.

Results

There were 171 responses returned over a four-week period giving a 57% response rate. Of these, 75 respondents had a telephone appointment and 96 who had FTF appointments. 49% of the FTF patients were male compared to 55% of the telephone clinic respondents. The majority of patients were aged 70–89 in both groups and most patients were retired (79.2% for FTF and 65.3% on the telephone consultation group).

More patients felt the doctor was polite and considerate in FTF clinics compared to telephone consultation (97% compared to 92% positive responses, p value – 0.02). There was no significant difference in patients feeling listened too, being allowed time to ask questions, understanding their condition and being involved in decision making between the two groups (Table 1).

Of the FTF group, 81% preferred FTF clinics with only 3% preferring telephone clinics and 16% with no preference. Of the telephone group 53% stated a preference for FTF clinics, with 11% having a preference for phone clinics and 36% having no preference.

Patients rated overall experience more positively with FTF appointments (95%) compared to telephone clinics (85%, p value 0.02).

Conclusion

Telephone consultations performed at a comparable level to FTF clinics although patients demonstrate an overall preference for FTF clinics.

Funding Acknowledgement

Type of funding sources: None.

Hepatic Iron Quantification Using a Free-Breathing 3D Radial Gradient Echo Technique and Validation With a 2D Biopsy-Calibrated R2* Relaxometry Method

BACKGROUND

Hepatic iron content (HIC) is an important parameter for the management of iron overload. Non-invasive HIC assessment is often performed using biopsy-calibrated two-dimensional breath-hold Cartesian gradient echo (2D BH GRE) R2* -MRI. However, breath-holding is not possible in most pediatric patients or those with respiratory problems, and three-dimensional free-breathing radial GRE (3D FB rGRE) has emerged as a viable alternative.

PURPOSE

To evaluate the performance of a 3D FB rGRE and validate its R2* and fat fraction (FF) quantification with 3D breath-hold Cartesian GRE (3D BH cGRE) and biopsy-calibrated 2D BH GRE across a wide range of HICs.

STUDY TYPE

Retrospective.

SUBJECTS

Twenty-nine patients with hepatic iron overload (22 females, median age: 15 [5-25] years).

FIELD STRENGTH/SEQUENCE

Three-dimensional radial and 2D and 3D Cartesian multi-echo GRE at 1.5 T.

ASSESSMENT

R2* and FF maps were computed for 3D GREs using a multi-spectral fat model and 2D GRE R2* maps were calculated using a mono-exponential model. Mean R2* and FF values were calculated via whole-liver contouring and T2* -thresholding by three operators.

STATISTICAL TESTS

Inter- and intra-observer reproducibility was assessed using Bland-Altman and intraclass correlation coefficient (ICC). Linear regression and Bland-Altman analysis were performed to compare R2* and FF values among the three acquisitions. One-way repeated-measures ANOVA and Wilcoxon signed-rank tests, respectively, were used to test for significant differences between R2* and FF values obtained with different acquisitions. Statistical significance was assumed at P < 0.05.

RESULTS

The mean biases and ICC for inter- and intra-observer reproducibility were close to 0% and >0.99, respectively for both R2* and FF. The 3D FB rGRE R2* and FF values were not significantly different (P > 0.44) and highly correlated (R2  ≥ 0.98) with breath-hold Cartesian GREs, with mean biases ≤ ±2.5% and slopes 0.90-1.12. In non-breath-holding patients, Cartesian GREs showed motion artifacts, whereas 3D FB rGRE exhibited only minimal streaking artifacts.

DATA CONCLUSION

Free-breathing 3D radial GRE is a viable alternative in non-breath-hold patients for accurate HIC estimation.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

Low voltage environmentally friendly plasma electrolytic oxidation process for titanium alloys

Plasma electrolytic oxidation (PEO) is a surface-treatment process extensively used to protect the surfaces of light metals such as Mg, Al, and Ti. Here, we report an environmentally friendly PEO process that uses nitrogen-containing electrolytes and low voltages (120 V) to form ~ 12 micron thick, uniform, adherent and porous oxide coatings on T1 titanium alloy surfaces. We evaluated the influence of nitrogenation by comparing the coatings to alloys treated in PEO baths without nitrogen-containing compounds. Both sets of samples exhibited basalt-like morphologies with distinct variation in the pore structures. The composition analyses showed that the coatings were primarily composites of titanium oxides and silicates. The T1 Ti alloys treated with nitrogen-containing electrolytes also contained TiC and TiN. This is the first ever report of producing Ti_xO_y, Ti–Si–O, TiC, and TiN composite coatings using a single PEO bath without carbide/nitride nanoparticles. The bandgaps of the coatings suggested visible light functionality. The use of nitrogen-based compounds in the PEO baths improved the hardness of the oxide layers but introduced stress-induced cracking which are potentially responsible for the reduction in corrosion resistance of the nitride and carbide containing coatings.

Protecting Light Metal Alloys Using a Sustainable Plasma Electrolytic Oxidation Process

Low-density metals such as Mg and Al (and their alloys) are of high interest for lightweight engineering applications in various industries. Moisture sensitivity, poor tribology, and corrosion susceptibility limit the direct application of these light metals. Plasma electrolytic oxidation (PEO) is extensively used to passivate light metals against corrosion and enhance their mechanical properties. PEO processes in current use are often energy-intensive and use toxic electrolytes. Incorporating composite characteristics to PEO-treated surfaces typically requires modification of electrolytes with nanoparticle addition. Some applications also need post-treatment of oxidized coatings to ensure functionality. We report a versatile, environmentally friendly PEO process that uses organo-silicate electrolytes enriched with nitrogen-containing solutions. The single-step process produces ∼6 μm thick, uniform, adherent, and porous oxide coatings on AZ80 and Al6061 surfaces in 15 min. We evaluated the influence and effectiveness of in situ nitridation by comparing the coating properties with those on alloys treated in PEO electrolytes without nitrogen-containing chemicals. The two sets of coatings were porous with multilayered basalt-like topographies and were composed of metal oxides and metal silicates. Alloys treated in nitrogen-containing electrolytes exhibited the presence of oxynitrides. The use of nitrogen-containing PEO electrolytes resulted in coatings with enhanced mechanical behavior. We found that the corrosion resistance of coatings prepared using low voltages in this study was comparable to the traditional PEO-treated coatings reported in the literature. Nitridation of the coatings, however, appears to have a slightly negative influence on the coatings' corrosion resistance. Our future work will focus on improving the corrosion resistance of the mechanically resilient, nitride-containing PEO-treated coatings.

Factors Influencing Brain Healthy Diets Among Older Midwestern African Americans

Emerging evidence suggests that up to half of Alzheimer’s disease (AD) cases are a result of modifiable risk factors related to poor diet such as blood pressure and diabetes, disproportionately affecting African Americans. Adherence to brain healthy diets remains low among African Americans. Therefore, it is important to understand needs, preferences, and barriers to inform intervention designs aimed to reduce AD risk among African Americans. Using a qualitative community-based research approach, we conducted six semi-structured focus group discussions (n= 30) to explore older African American experiences with brain healthy diets, preferences, and barriers to eating healthy. Secondly, we assessed the feasibility and acceptability of collecting biomarkers of health status and dietary behaviors among African Americans. A thematic analysis was conducted to identify emerging themes and biomarkers of health status were analyzed using descriptive statistics. We identified four themes: “Knowledge and Beliefs about Brain Healthy Diets,” “Eating Practices,” “Ways to Improve Dietary Practices,” and “Preferences for Enhancing Awareness about Brain Healthy Diets.” Themes indicated that older African Americans are receptive to healthy dietary consumption but perceived lack of education, cost, access, and perception of losing one’s culture as barriers to adherence. A total of 87.5% of participants completed biomarker assessments and 82% tested positive for 1 or more cardiovascular risk factor. Our study identified ways to enhance brain healthy dietary practices to reduce dementia risk. Also, our study demonstrated feasibility and acceptability in collecting AD related biomarkers in the African American community.

Toward a Psychological Study of Class Consciousness: Development and Validation of a Social Psychological Model

While social class has recently become a prominent topic in social psychological research, much of this effort has focused on the psychological consequences of objective and subjective indices of class (e.g., income, perceived status). This approach sheds light on the consequences of social class itself, but overlooks a construct of central importance in earlier theorizing on class: class consciousness, or the extent to which individuals acknowledge and situate themselves within class relations. The current paper offers a psychological model of class consciousness comprised of five elements: awareness of social class, perceptions of class conflict, beliefs about the permeability of class groups, identification with a class group, and personal experience of being treated as a member of one’s class. We offer a measure assessing those central dimensions and assess differences in these dimensions by age, gender, indices of social class, political ideology, and among different class groups. Finally, we offer suggestions for how an awareness of class consciousness may enrich social psychology and ultimately foster political change.

A Compensatory Control Account of Meritocracy

Why are people motivated to support social systems that claim to distribute resources based on hard work and effort, even when those systems seem unfair? Recent research on compensatory control shows that lowered perceptions of personal control motivate a greater endorsement of external systems (e.g., God, government) that compensate for a lack of personal control. The present studies demonstrate that U.S. citizens’ faith in a popular economic ideology, namely the belief that hard work guarantees success (i.e., meritocracy), similarly increases under conditions of decreased personal control. We found that a threat to personal control increased participants’ endorsement of meritocracy (Studies 1 and 2). Additionally, lowered perceptions of control led to increased feelings of anxiety regarding the future, but the subsequent endorsement of (Study 2) or exposure to (Study 3) meritocracy attenuated this effect. While the compensatory use of meritocracy may be a phenomenon unique to the United States of America, these studies provide important insight into the appeal and persistence of ideologies in general.

Effect of calcium on moving-bed biofilm reactor biofilms

The effect of calcium concentration on the biofilm structure, microbiology, and treatment performance was evaluated in a moving-bed biofilm reactor. Three experiments were conducted in replicate laboratory-scale reactors to determine if wastewater calcium is an important variable for the design and optimization of these reactors. Biofilm structural properties, such as thickness, oxygen microprofiles, and the composition of extracellular polymeric substances (EPS) were affected by increasing calcium concentrations. Above a threshold concentration of calcium between 1 and 50 mg/L, biofilms became thicker and denser, with a shift toward increasingly proteinaceous EPS at higher calcium concentrations up to 200 mgCa2+/L. At 300 mgCa2+/L, biofilms were found to become primarily composed of inorganic calcium precipitates. Microbiology was assessed through microscopy, denaturing grade gel electrophoresis, and enumeration of higher organisms. Higher calcium concentrations were found to change the bacterial community and promote the abundant growth of filamentous organisms and various protazoa and metazoan populations. The chemical oxygen demand removal efficiency was improved for reactors at calcium concentrations of 50 mg/L and above. Reactor effluents for the lowest calcium concentration (1 mgCa2+/L) were found to be turbid (>50 NTU), as a result of the detachment of small and poorly settling planktonic biomass, whereas higher concentrations promoted settling of the suspended phase. In general, calcium was found to be an important variable causing significant changes in biofilm structure and reactor function.

The clinical needs of patients with chronic gastrointestinal symptoms after pelvic radiotherapy

BACKGROUND

After radiotherapy for pelvic cancer, gastrointestinal symptoms affecting quality of life are common. How they affect daily living is unknown.

AIM

To investigate the day-to-day impact of gastrointestinal symptoms in patients after pelvic radiotherapy.

METHODS

New patients referred for gastroenterological evaluation of radiotherapy-induced symptoms were sent a questionnaire.

RESULTS

Over 15 months, 75 of 100 questionnaires were completed before the gastroenterology appointment by 45 men (median age 70) and 30 women (median age 57) treated for urological (n = 44), gynaecological (n = 27) and gastrointestinal (n = 4) cancers. Time since radiotherapy was 3 years (median) for women and 1.5 years (men). Women experienced 6 (median) symptoms whilst men experienced 4. Having someone listen to problems was often as important as treatment. Urgency, diarrhoea, pain, rectal bleeding, flatulence and bloating were particularly troublesome. 57% women and 33% men were 'very affected'. Symptoms rarely improved with time and in 33% had been present for more than 2 years. Gastrointestinal symptoms affected quality of life through change of routine (F 37%, M 22%), social limitation (F 17%, M 33%), physical limitations (F 33%, M 16%), emotional difficulties (F 47%, M 18%) and sexual problems (F 30%, M 51%).

CONCLUSIONS

Patients experience a high number of physical symptoms for long periods before referral. Clinicians must focus systematically on physical, emotional and psychosexual issues.

Multivariate statistical analysis of a high rate biofilm process treating kraft mill bleach plant effluent

This study reports on a multivariate analysis of the moving bed biofilm reactor (MBBR) wastewater treatment system at a Canadian pulp mill. The modelling approach involved a data overview by principal component analysis (PCA) followed by partial least squares (PLS) modelling with the objective of explaining and predicting changes in the BOD output of the reactor. Over two years of data with 87 process measurements were used to build the models. Variables were collected from the MBBR control scheme as well as upstream in the bleach plant and in digestion. To account for process dynamics, a variable lagging approach was used for variables with significant temporal correlations. It was found that wood type pulped at the mill was a significant variable governing reactor performance. Other important variables included flow parameters, faults in the temperature or pH control of the reactor, and some potential indirect indicators of biomass activity (residual nitrogen and pH out). The most predictive model was found to have an RMSEP value of 606 kgBOD/d, representing a 14.5% average error. This was a good fit, given the measurement error of the BOD test. Overall, the statistical approach was effective in describing and predicting MBBR treatment performance.

Decoloration of a Carpet Dye Effluent Using Trametes Versicolor

Although a non-sterile, undiluted carpet dye effluent (containing two anthraquinone dyes) did not support growth of Trametes versicolor, the pre-grown fungus removed 95% of its color in shake-flasks after 10 h of incubation. After decoloration, the COD of the cell-free supernatant increased and the toxicity was unchanged as determined by the Microtox assay using Vibrio fischeri. Decoloration rates decreased when either glucose alone or Mn2+ and glucose were added. T. versicolor, immobilized on jute twine in a rotating biological contacting reactor, also decolorized four successive batches of the effluent. There was no decoloration in any of the uninoculated, non-sterile controls.

Interactive process of conducting and utilizing research in nursing service administration

The authors report on a project that evolved from a single-purpose project--research use in nursing service administration--to a multipurpose process. The project team initially intended to conduct a classic research use project to develop management interventions to improve job satisfaction. The team eventually conducted three basic research projects and systematically applied this knowledge to the practice of nursing service administration. The members of the team, who came from academic and service settings, collaborated in a dynamic and interactive process of generating and applying knowledge. The products of this work were immediately useful in the setting and can be used more broadly in organizing and managing the care of hospital patients.

Infusing research into practice to promote quality care

This article describes the Iowa Model of Research in Practice, a heuristic model used at the University of Iowa Hospitals and Clinics for infusing research into practice to improve the quality of care. The components of the model are presented with examples. The impact of the model on patient, staff, and fiscal outcomes is delineated.

Nasogastric and nasointestinal feeding tube placement: an integrative review of research

The authors present a review of the research on various methods for determining placement of nasogastric and nasointestinal feeding tubes. They also discuss research on associated risk factors, complications specific to critical care patient populations, and techniques for postpyloric placement. They present research consensus, recommendations for practice, and implementation strategies.

Preferences for decision-making autonomy

Nurses' lack of autonomy has been identified as a leading cause of job dissatisfaction, but attempts to increase satisfaction by increasing autonomy have not always been successful. This survey of 356 randomly selected staff nurses and 130 head nurses from 16 hospitals extends previous work by identifying the preferred level of involvement in 21 patient care and 21 unit operation decisions. Staff nurses agreed on 60 percent of the decisions and, in general, preferred independent decision-making for patient care decisions and shared decision-making for unit operation. Head nurses indicated that staff nurses should have a higher level of autonomy than the staff nurses indicated for themselves.

Aluminium in bone from patients with renal failure

Some samples of bone from patients with renal failure contained more aluminium than others, and the concentration tended to be highest in patients who had been uraemic or on dialysis longest. The significance of the association of raised concentrations of aluminium in bone with renal failure is discussed.