Radiographers and COVID-19 pneumonia: Diagnostic performance using CO-RADS.

INTRODUCTION: A more structured role of radiographers is advisable to speed up the management of patients with suspected COVID-19. The purpose of our study was to evaluate the diagnostic performance of radiographers in the detection of COVID-19 pneumonia on chest CT using CO-RADS descriptors. METHODS: CT images of patients who underwent RT-PCR and chest CT due to COVID-19 suspicion between March and July 2020 were analysed retrospectively. Six readers, including two radiologists, two highly experienced radiographers and two less experienced radiographers, independently scored each CT using the CO-RADS lexicon. ROC curves were used to investigate diagnostic accuracy, and Fleiss'κ statistics to evaluate inter-rater agreement. RESULTS: 714 patients (419 men; 295 women; mean age: 64 years ±19SD) were evaluated. CO-RADS> 3 was identified as optimal diagnostic threshold. Highly experienced radiographers achieved an average sensitivity of 58.7% (95%CI: 52.5-64.7), an average specificity of 81.8% (95%CI: 77.9-85.2), and a mean AUC of 0.72 (95%CI: 0.68-0.75). Among less experienced radiographers, an average sensitivity of 56.3% (95%CI: 50.1-62.2) and an average specificity of 81.5% (95%CI: 77.6-84.9) were observed, with a mean AUC of 0.71 (95%CI: 0.68-0.74). Consultant radiologists achieved an average sensitivity of 60.0% (95%CI: 53.7-65.8), an average specificity of 81.7% (95%CI: 77.8-85.1), and a mean AUC of 0.73 (95%CI: 0.70-0.77). CONCLUSION: Radiographers can adequately recognise the classic appearances of COVID-19 on CT, as described by the CO-RADS assessment scheme, in a way comparable to expert radiologists. IMPLICATIONS FOR PRACTICE: Radiographers, as the first healthcare professionals to evaluate CT images in patients with suspected SARS-CoV-2 infection, could diagnose COVID-19 pneumonia by means of a categorical reporting scheme at CT in a reliable way, hence playing a primary role in the early management of these patients.

Characterizing pharmaceutical, personal care product, and hormone contamination in a karst aquifer of southwestern Illinois, USA, using water quality and stream flow parameters.

Karst aquifers are drinking water sources for 25% of the global population. However, the unique geology of karst areas facilitates rapid transfer of surficial chemicals to groundwater, potentially contaminating drinking water. Contamination of karst aquifers by nitrate, chloride, and bacteria have been previously observed, but little knowledge is available on the presence of contaminants of emerging concern (CECs), such as pharmaceuticals. Over a 17-month period, 58 water samples were collected from 13 sites in the Salem Plateau, a karst region in southwestern Illinois, United States. Water was analyzed for 12 pharmaceutical and personal care products (PPCPs), 7 natural and synthetic hormones, and 49 typical water quality parameters (e.g., nutrients and bacteria). Hormones were detected in only 23% of samples, with concentrations of 2.2-9.1ng/L. In contrast, PPCPs were quantified in 89% of groundwater samples. The two most commonly detected PPCPs were the antimicrobial triclocarban, in 81% of samples, and the cardiovascular drug gemfibrozil, in 57%. Analytical results were combined with data of local stream flow, weather, and land use to 1) characterize the extent of aquifer contamination by CECs, 2) cluster sites with similar PPCP contamination profiles, and 3) develop models to describe PPCP contamination. Median detection in karst groundwater was 3 PPCPs at a summed concentration of 4.6ng/L. Sites clustered into 3 subsets with unique contamination models. PPCP contamination in Cluster I sites was related to stream height, manganese, boron, and heterotrophic bacteria. Cluster II sites were characterized by groundwater temperature, specific conductivity, sodium, and calcium. Cluster III sites were characterized by dissolved oxygen and barium. Across all sites, no single or small set of water quality factors was significantly predictive of PPCP contamination, although gemfibrozil concentrations were strongly related to the sum of PPCPs in karst groundwater.

Estimating background and threshold nitrate concentrations using probability graphs.

Because of the ubiquitous nature of anthropogenic nitrate (NO3(-)) in many parts of the world, determining background concentrations of NO3(-) in shallow ground water from natural sources is probably impossible in most environments. Present-day background must now include diffuse sources of NO3(-) such as disruption of soils and oxidation of organic matter, and atmospheric inputs from products of combustion and evaporation of ammonia from fertilizer and livestock waste. Anomalies can be defined as NO3(-) derived from nitrogen (N) inputs to the environment from anthropogenic activities, including synthetic fertilizers, livestock waste, and septic effluent. Cumulative probability graphs were used to identify threshold concentrations separating background and anomalous NO(3)-N concentrations and to assist in the determination of sources of N contamination for 232 spring water samples and 200 well water samples from karst aquifers. Thresholds were 0.4, 2.5, and 6.7 mg/L for spring water samples, and 0.1, 2.1, and 17 mg/L for well water samples. The 0.4 and 0.1 mg/L values are assumed to represent thresholds for present-day precipitation. Thresholds at 2.5 and 2.1 mg/L are interpreted to represent present-day background concentrations of NO(3)-N. The population of spring water samples with concentrations between 2.5 and 6.7 mg/L represents an amalgam of all sources of NO3(-) in the ground water basins that feed each spring; concentrations > 6.7 mg/L were typically samples collected soon after springtime application of synthetic fertilizer. The 17 mg/L threshold (adjusted to 15 mg/L) for well water samples is interpreted as the level above which livestock wastes dominate the N sources.

Characterization and identification of na-cl sources in ground water.

Elevated concentrations of sodium (Na+) and chloride (Cl-) in surface and ground water are common in the United States and other countries, and can serve as indicators of, or may constitute, a water quality problem. We have characterized the most prevalent natural and anthropogenic sources of Na+ and Cl- in ground water, primarily in Illinois, and explored techniques that could be used to identify their source. We considered seven potential sources that included agricultural chemicals, septic effluent, animal waste, municipal landfill leachate, sea water, basin brines, and road deicers. The halides Cl-, bromide (Br), and iodide (I) were useful indicators of the sources of Na+-Cl- contamination. Iodide enrichment (relative to Cl-) was greatest in precipitation, followed by uncontaminated soil water and ground water, and landfill leachate. The mass ratios of the halides among themselves, with total nitrogen (N), and with Na+ provided diagnostic methods for graphically distinguishing among sources of Na+ and Cl- in contaminated water. Cl/Br ratios relative to Cl- revealed a clear, although overlapping, separation of sample groups. Samples of landfill leachate and ground water known to be contaminated by leachate were enriched in I and Br; this provided an excellent fingerprint for identifying leachate contamination. In addition, total N, when plotted against Cl/Br ratios, successfully separated water contaminated by road salt from water contaminated by other sources.

Technical note: a device for obtaining time-integrated samples of ruminal fluid.

A device was adapted to allow for time-integrated sampling of fluid from the rumen via a cannula. The sampler consisted of a cup-shaped ceramic filter positioned in the ventral rumen of a cannulated cow and attached to a tube through which fluid entering the filter was removed continuously using a peristaltic pump. Rate of ruminal fluid removal using the device was monitored over two 36-h periods (at 6-h intervals) and was not affected (P > .05) by time, indicating that the system was not susceptible to clogging during this period. Two cows having ad libitum access to a totally mixed ration were used in a split-block design to evaluate the utility of the system for obtaining time-integrated samples of ruminal fluid. Ruminal fluid VFA concentration and pattern in samples collected in two replicated 8-h periods by the time-integrated sampler (at 1-h intervals) were compared with composite samples collected using a conventional suction-strainer device (at 30-min intervals). Each 8-h collection period started 2 h before or 6 h after feeding. Results indicated that total VFA concentration was not affected (P > .05) by the sampling method. Volatile fatty acid patterns were likewise unaffected (P > .05) except that acetate was 2.5% higher (P < .05) in samples collected 2 h before feeding and valerate was 5% higher (P < .05) in samples collected 6 h after feeding by the suction-strainer device. Although significant, these differences were not considered physiologically important. We concluded that use of the ceramic filter improved the sampling of ruminal fluid by simplifying the technique and allowing time-integrated samples to be obtained.

[Complete atrioventricular block in a youth with mitral prolapse]. / Blocco atrio-ventricolare completo in giovane con prolasso della mitrale.

A case of total A-V block observed in a 16 year old who had been suffering for two years from episodes of MAS and in whom further investigation revealed a prolapse of the rear flap of the mitral valve is reported. In the light of literature data, possible relations between the two conditions, A-V block and mitral valve prolapse are reviewed. In view of the youth of the patient, it is considered that the pathogenic agent underlying mitral valve prolapse (probable rheumatic aetiology) was also responsible for the conduction disturbance.