Training opportunities in thoracic ultrasound for respiratory trainees: are current guidelines practical?

Introduction

Respiratory trainees in the UK face challenges in meeting current Royal College of Radiologists (RCR) Level 1 training requirements for thoracic ultrasound (TUS) competence, specified as attending 'at least one session per week over a period of no less than 3 months, with approximately five scans per session performed by the trainee (under supervision of an experienced practitioner)'. We aimed to clarify where TUS training opportunities currently exist for respiratory registrars.

Methods

Data were collected (over a 4-week period) to clarify the number of scans (and therefore volume of training opportunities) within radiology departments and respiratory services in hospitals in the South West, North West deaneries and Oxford.

Results

14 hospitals (including three tertiary pleural centres) provided data. Of 964 scans, 793 (82.3%) were conducted by respiratory teams who performed a mean of 17.7 scans per week, versus 3.1 TUS/week in radiology departments. There was no radiology session in any hospital with ≥5 TUS performed, whereas 8/14 (86%) of respiratory departments conducted such sessions. Almost half (6/14) of radiology departments conducted no TUS scans in the period surveyed.

Conclusions

The currently recommended exposure of regularly attending a list or session to undertake five TUS is not achievable in radiology departments. The greatest volume of training opportunities exists within respiratory departments in a variety of scheduled and unscheduled settings. Revision of the competency framework in TUS, and where this is delivered, is required.

Using structural equation modeling to examine McCollough Effects (orientation-contingent color aftereffects): influence of dissociative experiences and age on illusory aftereffects

Conventional accounts of the McCollough Effect (ME) have focused on strictly bottom-up processing accounts of the phenomenon, most commonly involving the fatiguing of orientation-selective neurons; although association-learning mechanisms have also gained acceptance. These lower order accounts do not take into account higher order variables related to key personality traits and/or associated cognitive control processes. This article reports the use of confirmatory factor analysis and follow-up structural equation style regressions that model MEs and also the part played by the personality trait of dissociation. After considering the relative impact of age and dissociative processes, the article concludes that trait dissociation is positively associated with reports of MEs.

Hypnotizability, eating behaviors, attitudes, and concerns: a literature survey

The literature suggests that aspects of hypnotizability may be involved in the etiology and maintenance of self-defeating eating. However, interpretation of the published research findings has been complicated by the use of instruments that appear to have measured different or, at best, only related facets of the underlying constructs. This article reports relationships between weight, shape, dietary concerns, hypnotizability, dissociative capacity, and fantasy proneness. Implications for a key role for hypnosis in the treatment of eating behaviors, attitudes, and concerns are discussed.

Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

BACKGROUND

Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection.

OBJECTIVE

We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis.

MATERIALS AND METHODS

We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course.

RESULTS

Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100% (10/10) sensitivity and 100% (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86% (24 of 28) of the cases. Bleeding complicated the biopsy in 46% (13/28) and hastened one death.

CONCLUSION

Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection.

Differences in reasons for smoking between younger and older smokers

The reasons why older people smoke have not been examined in the literature. This paper attempted to examine the differences in motivation and maintenance factors of elderly and young smokers using the Horn-Waingrow Why do you smoke questionnaire. One hundred and thirteen clinical patients and 112 non-patient controls were used in this study. The clinical group was divided into an elderly group (n = 58) and a younger group (n = 55). The results of a discriminant analysis showed that patients significantly differed from non-patients on 'automatic habit and stimulation', and 'crutch/tension reduction' factors. Elderly patients were found to be significantly differentiated from both younger patients and the control group on the 'pleasurable relaxation' factor. These findings offer support for the US Surgeon Generals' report that elderly smokers do have different motivating factors for their smoking behaviours from younger smokers.

Interferometric Null Method for Measuring Stress-induced Birefringence

A sensitive apparatus utilizing a scanning Fabry-Perot interferometer excited by circularly polarized laser radiation is developed for measuring birefringence. A birefringent sample within the interferometer produces a difference in the resonance length for radiation polarized in two orthogonal directions. A Kerr cell properly oriented within the interferometer is used to cancel sample birefringence by adjusting the cell voltage. This adjustment is made by using the scanning interferometer as a spectrum analyzer and observing the displacement between the resonance curves associated with each polarization. The Kerr cell is calibrated in terms of the voltage required to produce a relative path retardation of lambda/2. The stress-induced birefringence in YAG, sapphire, and fused silica in the 26-75 degrees C temperature range is measured, and the accuracy and sensitivity of the instrument are assessed.