Predicting Age from White Matter Diffusivity with Residual Learning.

Imaging findings inconsistent with those expected at specific chronological age ranges may serve as early indicators of neurological disorders and increased mortality risk. Estimation of chronological age, and deviations from expected results, from structural magnetic resonance imaging (MRI) data has become an important proxy task for developing biomarkers that are sensitive to such deviations. Complementary to structural analysis, diffusion tensor imaging (DTI) has proven effective in identifying age-related microstructural changes within the brain white matter, thereby presenting itself as a promising additional modality for brain age prediction. Although early studies have sought to harness DTI's advantages for age estimation, there is no evidence that the success of this prediction is owed to the unique microstructural and diffusivity features that DTI provides, rather than the macrostructural features that are also available in DTI data. Therefore, we seek to develop white-matter-specific age estimation to capture deviations from normal white matter aging. Specifically, we deliberately disregard the macrostructural information when predicting age from DTI scalar images, using two distinct methods. The first method relies on extracting only microstructural features from regions of interest (ROIs). The second applies 3D residual neural networks (ResNets) to learn features directly from the images, which are non-linearly registered and warped to a template to minimize macrostructural variations. When tested on unseen data, the first method yields mean absolute error (MAE) of 6.11 ± 0.19 years for cognitively normal participants and MAE of 6.62 ± 0.30 years for cognitively impaired participants, while the second method achieves MAE of 4.69 ± 0.23 years for cognitively normal participants and MAE of 4.96 ± 0.28 years for cognitively impaired participants. We find that the ResNet model captures subtler, non-macrostructural features for brain age prediction.

Orthobiologics: Diagnosis and Treatment of Common Tendinopathies.

Orthobiologics, including platelet-rich plasma, prolotherapy, and mesenchymal stem cells, are seeing increasing use in the treatment of osteoarthritis (OA), muscle injury, and tendinopathy. This article reviews the biology and applications of orthobiologics in tendons, muscles, and joints, and focuses on platelet-rich plasma (PRP). Clinical evidence-based literature related to the use of PRP in the treatment of rotator cuff injury, lateral epicondylosis, Achilles tendinopathy, plantar fasciitis, knee OA, and acute muscle injury are discussed.

Evaluation of lesion burden in a bone-by-bone comparison of osteological and radiological methods of analysis.

OBJECTIVE: To evaluate differences in lesion identification in skeletal remains with respect to bone type and method of analysis. MATERIALS: 212 mostly 19th century adult skeletons from St. Bride's Church in London. METHODS: Using a standard protocol, an osteologist evaluated each set of remains for lesions. A radiologist used the same system to examine radiographs of the crania, humeri, pelves, tibiae, and femora. RESULTS: Osteological analysis noted more lesions per bone type. All bone types examined showed positive, statistically significant correlations between the number of lesions identified by each analytical method. The humerus, tibia, and femur exhibited the strongest correlations. The pelvis exhibited the weakest correlation. For the cranium and pelvis, males showed stronger correlations. CONCLUSIONS: Sex-related differences in correlations were likely influenced by the presence, in females, of lesions affecting the entire skeleton (e.g., osteoporosis). Greater correlations between analytical modalities were observed for long bones. SIGNIFICANCE: Our findings quantify the contexts in which radiological and osteological evaluations converge and diverge and discuss the implications of these results for lesion burden interpretation. LIMITATIONS: Generalizability, potential subjectivity of evaluative methods. SUGGESTIONS FOR FURTHER RESEARCH: Assessment of another study collection using the same methods, to determine if the similar correlations are observed.

Point-of-Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS.

OBJECTIVES: Point-of-care ultrasonography (POCUS) is an increasingly integral part of emergency medicine. This study investigated community emergency department physicians' choices regarding ultrasonography as a branch point in clinical decision making. METHODS: During shifts covering all days of the week and all time-spans over a 3-month period, emergency department physicians were interviewed whenever POCUS was used. Questions focused on the role of POCUS in clinical management and on tests avoided because of ultrasonography use. Cost savings attributable to POCUS were calculated using Center for Medicare and Medicaid Services and FairHealth data. Anonymization of data precluded follow-up testing to account for misdiagnosis. RESULTS: On average, POCUS use eliminated $1134.31 of additional testing for privately insured patients, $2826.31 for out-of-network or uninsured patients, and $181.63 for Center for Medicare and Medicaid Services patients. Differences were significant when the total cost of eliminated additional testing was compared to a baseline of no savings (p < .001). Aggregate cost savings remained significant when analyses were broadened to include POCUS encounters that did not yield changes in management (p < .001). CONCLUSIONS: When physicians' clinical expertise suggests that POCUS may be indicated, its use results in significant cost savings, even in encounters in which management is not directly impacted. POCUS, when incorporated earlier and more frequently into community hospital emergency medicine diagnostic protocols, can lower direct and indirect costs associated with diagnostic workups. Community emergency departments, in particular, would benefit from additional investigation informing specific guidelines for the integration of POCUS into clinical management and the role that this has in cost savings.

Evaluating the relationship between lesion burden and aging among the skeletons of an 18th-19th century London cemetery using osteological and radiological analysis.

Study of disease in the past can help illuminate patterns of human health, disease, and aging in the present. As average human life expectancy and incidence of chronic disease have increased in the last century, efforts to understand this epidemiologic shift have led to more investigation of healthy aging. Using osteological and radiological methods of analysis, this study examined 212 mostly nineteenth century adult skeletons from the crypt of St. Bride's in London, in order to investigate the relationship between age-at-death, sex, and number of lesions observed in bone. Lesions were classified into macro-level categories according to the Rapid Method for Recording Human Skeletal Data, and the correlation between age group and number of lesions in each category, as well as the total number of lesions, were analyzed. Correlations between age-at-death and the number and type of lesions were compared across both methods of analysis. A greater total number of lesions and a greater number of types of lesions was observed for the osteologically analyzed data, compared to the radiologically analyzed data. Correlations between age-at-death and specific pathology groups were in general weak, though stronger for the osteologically analyzed data. For each method of analysis, there were statistically significant differences between the total number of lesions and age group, with total number of lesions increasing with age, regardless of method of analysis. Joint and metabolic lesions were the most significant predictors of age-at-death. The correlations between total lesions observed and age-at-death were similar for radiologically and osteologically analyzed data, for the same set of bones. This suggests that, for the bones analyzed, while the number of lesions recorded differed according to method of analysis, the relationship between overall observed lesion burden and age-at-death was similar for both osteological and radiological analysis.

The Applicability of N: Ancient Debates and Modern Experimental Design.

Medicine has always been characterized by a tension between the particular and the general. A clinician is obligated to treat the individual in front of her, yet she accomplishes this task by applying generalized knowledge that describes an abstract average but not necessarily a specific person. Efforts to systematize this process of moving between the particular and the general have led to the development of randomized controlled trials and large observational studies. Inclusion of tens of thousands of people in such studies, it is argued, will enhance the applicability of the data to more individual circumstances. Yet, as genetic sequencing data have become more widely obtained and used, there has been an increased focus on what has been broadly termed "precision medicine", a highly individualized approach to therapeutics. Moreover, advances in statistical methods have enabled researchers to use N-of-1 study data-traditionally considered too individualized to be broadly applicable-in new ways. This paper contextualizes these apparently modern debates with reference to historical arguments about methods of disease diagnosis and treatment, and earlier physicians' concerns about the tension between the particular and the general that is intrinsic to medical practice.

Evolutionary Medicine: The Ongoing Evolution of Human Physiology and Metabolism.

The field of evolutionary medicine uses evolutionary principles to understand changes in human anatomy and physiology that have occurred over time in response to environmental changes. Through this evolutionary-based approach, we can understand disease as a consequence of anatomical and physiological "trade-offs" that develop to facilitate survival and reproduction. We demonstrate how diachronic study of human anatomy and physiology is fundamental for an increased understanding of human health and disease.

"It may not cure you, it may not save your life, but it will help you".

In the modern world, we are experiencing an epidemiological shift represented by the increasing prevalence of chronic diseases relative to that of acute diseases: more people are living longer, with more diseases, than ever before in human history. How are we to understand and to respond to this change? A study of provision of cancer treatment in Western Australia, especially among Indigenous populations, can illuminate ways in which healthcare providers and societies might better understand the treatment of chronic disease: healthcare providers should take care to appreciate patient perspectives and beliefs about disease aetiology and treatment. Consideration of treatment of disease in the ancient Graeco-Roman world supports the view that effective healing and maintenance of patient wellbeing occurs when healers communicate clearly with their patients about disease and treatment progression, and when healers are open-minded about patients' utilisation of multiple treatment modalities.

Health Is not always written in bone: using a modern comorbidity index to assess disease load in paleopathology.

Paleopathology has revealed much about disease in the past but is usually limited to conditions with osteological manifestations; this often excludes acute soft tissue infections and causes of death for most individuals in the past and present. Our understanding of the evolution of disease is essential for contextualizing and predicting the epidemiological shifts that are happening in modern society, as high rates of infectious disease coexist alongside high rates of chronic disease in rates unlike those observed previously in human history. Moreover, many physiological states not previously classified as "disease" (obesity) have become pathologized, influencing our conception of disease and what defines health. By using the Galler Collection, a pre-antibiotic and pre-chemotherapeutic osteological series with modern autopsy records, our research quantifies disease burden of the past using the Charlson Index (CI), a modern comorbidity index of disease severity. Galler Collection remains and autopsy records were scored with the Charlson Index to correlate bone findings with soft tissue findings, and statistical analysis was performed for cumulative scores and absolute diagnosis counts, with patients stratified by sex and cause of death (pneumonia or cancer). Osteological diagnosis counts were more predictive of soft-tissue autopsy disease counts than were associated cumulative CI scores. Diagnosis counts and CI scores for osteological data were more closely related to associated soft tissue data for cancer patients than for pneumonia patients. This research indicates how interdisciplinary paleopathological analysis assists in making more reliable assessments of health and mortality in the past, with implications for trending and predicting future epidemiological shifts.

Improving palliative care outcomes for Aboriginal Australians: service providers' perspectives.

BACKGROUND: Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers' experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. METHODS: In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient and community settings in Western Australia. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers with QSR NVivo 10 software used to help manage data. Data analysis was informed by multiple theoretical standpoints, including the social ecological model, critical cultural theories and the 'cultural security' framework. Thematic analysis was carried out that identified patterns within data. RESULTS: Fifteen palliative care providers were interviewed. Overall they reported lack of understanding of Aboriginal culture and being uncertain of the needs and priorities of Aboriginal people during end-of-life care. According to several participants, very few Aboriginal people had an understanding of palliative care. Managing issues such as anger, denial, the need for non-medical support due to socioeconomic disadvantage, and dealing with crises and conflicts over funeral arrangements were reported as some of the tensions between Aboriginal patients and families and the service providers. CONCLUSION: Early referral to palliative care is important in demonstrating and maintaining a caring therapeutic relationship. Paramount to meeting the needs for Aboriginal patients was access to appropriate information and logistical, psychological and emotional support. These were often seen as essential but additional to standard palliative care services. The broader context of Aboriginal history and historical distrust of mainstream services was seen to impinge on Aboriginal people's willingness and ability to accept care and support from these services. This context needs to be understood and acknowledged at the system level. More cultural safety training was requested by care providers but it was not seen as replacing the need for an Aboriginal worker in the palliative care team.

Rural health education.

Thirty-five health sciences students and four mentors, including myself, were participating in a 'Country Week' rural health experience in the catchment area of the Murchison River in the midwest of Western Australia. The Murchison, once a gold mining centre, now has a population of about 2500, many of whom live on sheep and cattle stations.