Concordance between a gastrointestinal consultant radiologist, a consultant radiologist and qualified reporting radiographers interpreting abdominal radiographs.

INTRODUCTION: Radiographers can accurately report musculoskeletal and chest radiographs, but there is paucity of research comparing the performance of reporting radiographers (RRs) with consultant radiologists when interpreting and reporting abdominal radiographs. This study assessed interobserver agreement in the clinical setting between reporting radiographers and a consultant radiologist compared to an expert gastrointestinal radiologist in a District General Hospital. Major discordant reports affecting patient management were also examined. METHODS: 126 abdominal radiographs reported by 3 RRs in clinical practice were randomly selected and reported by a consultant radiologist and index gastrointestinal radiologist. The reports of the RRs and consultant radiologist were compared against the reports made by the index radiologist for agreement by a colorectal consultant surgeon. All 126 reports were scored as being in either complete agreement, minor disagreement or major disagreement which would have resulted in a change to patient management. RESULTS: There was no significant difference in overall agreement between the consultant radiologist (CR) and RRs when compared to the index radiologist (CR: n = 90/126, 71.4% and RRs: n = 94/126, 74.6%. p = 0.57). Major disagreements were found, but there was no significant difference between both groups (CR: n = 23/126, 18.3% and RRs: n = 17/126, 13.5%. p = 0.30). CONCLUSION: RRs can report abdominal radiographs to a comparable level of agreement as a consultant radiologist in the clinical setting. There was no significant difference in reports deemed to affect patient management. IMPLICATIONS FOR PRACTICE: This study addresses the gap in assessing the performance of RRs reporting abdominal radiographs. This small scale study indicates that radiographers could provide additional support in the reporting of abdominal radiographs. This would help to reduce radiologist workload and enhance the role of the reporting radiographer. CLASSIFICATION: Agreement between reporting radiographers and radiologists interpreting and reporting abdominal radiographs.

Novel bioactive from Lactobacillus brevis DSM17250 to stimulate the growth of Staphylococcus epidermidis: a pilot study.

Commensal skin microbiota plays an important role in both influencing the immune response of the skin and acting as a barrier against colonisation of potentially pathogenic microorganisms and overgrowth of opportunistic pathogens. Staphylococcus epidermidis is a key constituent of the normal microbiota on human skin. It balances the inflammatory response after skin injury and produces antimicrobial molecules that selectively inhibit skin pathogens. Here we describe Lactobacillus brevis DSM17250 that was identified among hundreds of Lactobacillus strains to exhibit an anti-inflammatory effect in human keratinocytes in vitro and specific stimulatory impact on the growth of S. epidermidis. The aqueous cell-free extract of L. brevis DSM17250 was used in an ointment formulation and tested in a randomized placebo-controlled double blinded human pilot study. Healthy volunteers with diagnosed dry skin were treated for four weeks. The study data shows that L. brevis DSM17250 extract induces re-colonisation of the skin by protective commensal microorganisms as judged from selective bacterial cultivation of surface-associated skin microorganism of the lower leg. Furthermore, the 4 week administration of the L. brevis DSM17250 extract significantly improved the transepidermal water loss value (TEWL), reduced the xerosis cutis symptoms and stinging. The data shows that daily application of L. brevis DSM17250 extract in a topical product significantly improves the microbial skin microbiota by promoting the growth of species which possess beneficial regulatory and protective properties such as S. epidermidis. Restoring the natural skin microbiota leads to significantly improved skin barrier function (as transepidermal water loss) and decrease of xeroderma (xerosis cutis) symptoms (as measured by dry skin area and severity index, DASI). We propose that improving and stabilizing the natural skin microbiota by specifically stimulating the growth of S. epidermidis is an important and novel concept to manage skin diseases associated with microbiota dysbiosis.

Imaging of focal calvarial lesions.

Focal calvarial lesions may present as a visible, palpable, or symptomatic lump; however, with increasing use of cross-sectional imaging they are often encountered as an incidental finding. Knowledge of the possible disease entities along with a structured approach to imaging is required to suggest an appropriate diagnosis and assist in management planning. Abnormalities range from common neoplastic lesions to rarer congenital conditions, benign pathologies, and calvarial defects that can mimic lesions. The aim of this article is to demonstrate the salient imaging features that may help to limit the differential diagnosis of a focal calvarial lesion.

The effect of ventilation on indoor exposure to semivolatile organic compounds.

A mechanistic model was developed to examine how natural ventilation influences residential indoor exposure to semivolatile organic compounds (SVOCs) via inhalation, dermal sorption, and dust ingestion. The effect of ventilation on indoor particle mass concentration and mass transfer at source/sink surfaces, and the enhancing effect of particles on mass transfer at source/sink surfaces are included. When air exchange rate increases from 0.6/h to 1.8/h, the steady-state SVOC (gas-phase plus particle phase with log KOA varying from 9 to 13) concentration in the idealized model decreases by about 60%. In contrast, for the same change in ventilation, the simulated indoor formaldehyde (representing volatile organic compounds) gas-phase concentration decreases by about 70%. The effect of ventilation on exposure via each pathway has a relatively insignificant association with the KOA of the SVOCs: a change of KOA from 10(9) to 10(13) results in a change of only 2-30%. Sensitivity analysis identifies the deposition rate of PM2.5 as a primary factor influencing the relationship between ventilation and exposure for SVOCs with log KOA = 13. The relationship between ventilation rate and air speed near surfaces needs to be further substantiated.