Survival time and relapse in dogs with meningoencephalomyelitis of unknown origin treated with prednisolone and ciclosporin: a retrospective study.

OBJECTIVE: To analyse outcome in dogs with a presumptive diagnosis of meningoencephalomyelitis of unknown origin (MUO) treated with prednisolone and ciclosporin and to assess the effect of a number of patient variables on survival time and rate of relapse. DESIGN: Retrospective case series. METHODS: Medical records of 40 client-owned dogs with a diagnosis of MUO treated with prednisolone and ciclosporin at one institution between June 2010 and January 2018 were reviewed retrospectively to assess survival times and prognostic indicators for death and/or relapse. The minimum follow-up time was 11 months post-diagnosis. RESULTS: Median survival was 1345 days (95% confidence interval: 487-∞). No associations with hazard of death or relapse were detected for the presence of multifocal magnetic resonance imaging (MRI) abnormalities, caudal fossa location of MRI abnormalities, value of cerebrospinal fluid total nucleated cell count or total protein at time of diagnosis, or suspected elevation in intracranial pressure at time of diagnosis. CONCLUSION: Protracted survival time may be achieved with a treatment combination of prednisolone and ciclosporin. Suspected elevation in intracranial pressure at the time of diagnosis did not affect long-term outcome in this cohort.

Biochar fails to enhance nutrient removal in woodchip bioreactor columns following saturation.

Denitrifying bioreactors are edge-of-field structures that remove excess nitrogen (N) from intercepted agricultural drainage by supporting the activity of denitrifying microorganisms with a saturated organic carbon substrate. Although these bioreactors successfully mitigate N export, the typical woodchip systems have little effect on phosphorus (P), which is also often present in environmentally harmful quantities in drainage waters. Currently, the evidence that amending woodchip bioreactors with biochar enhances both N and P removal rates is mixed, but more work is required to test this hypothesis under controlled conditions. To determine the effect of biochar amendment on nitrate (NO3-N) and phosphate (PO4-P) removal in woodchip bioreactors, three media types-aged woodchips (W), 10% (B10) and 30% (B30) biochar by volume-were tested under different operational conditions during five-day laboratory trials with horizontal, flow-through columns. Nutrient removal was observed under different flow rates yielding hydraulic residence times of 3, 6, and 12 hours with four formulations of simulated agricultural drainage, all combination of 16.1 or 4.5 mg L-1 NO3-N and 1.9 or 0.6 mg L-1 PO4-P. Each unique treatment with respect to media type, HRT, and influent formulation was tested in triplicate using independent columns. All treatments successfully removed NO3-N, but PO4-P removal was inconsistent. Cumulative NO3-N removal efficiencies ranged 15-98% with an average removal rate of 11.0 g m-3 d-1; biochar amendment enhanced removal only in response to sufficiently high loading rates. Cumulative PO4-P removal efficiencies ranged from 66% removal to 170% export of the influent load; biochar addition was associated with increased export. These results indicate that pine-feedstock biochar poses a substantial increase to PO4-P leaching risk and only modestly enhances NO3-N removal given sufficiently high loading.

Performance of an under-loaded denitrifying bioreactor with biochar amendment.

Denitrifying bioreactors are recently-established agricultural best management practices with growing acceptance in the US Midwest but less studied in other agriculturally significant regions, such as the US Mid-Atlantic. A bioreactor was installed in the Virginia Coastal Plain to evaluate performance in this geographically novel region facing challenges managing nutrient pollution. The 25.3 m3 woodchip bed amended with 10% biochar (v/v) intercepted subsurface drainage from 6.5 ha cultivated in soy. Influent and effluent nitrate-nitrogen (NO3-N) and total phosphorus (TP) concentrations and flowrate were monitored intensively during the second year of operation. Bed surface fluxes of greenhouse gases (GHGs) nitrous oxide (N2O), methane (CH4), and carbon dioxide (CO2) were measured periodically with the closed dynamic chamber technique. The bioreactor did not have a statistically or environmentally significant effect on TP export. Cumulative NO3-N removal efficiency (9.5%) and average removal rate (0.56 ±â€¯0.25 g m-3 d-1) were low relative to Midwest tile bioreactors, but comparable to installations in the Maryland Coastal Plain. Underperformance was attributed mainly to low NO3-N loading (mean 9.4 ±â€¯4.4 kg ha-1 yr-1), although intermittent flow, periods of low HRT, and low pH (mean 5.3) also likely contributed. N removal rates were correlated with influent NO3-N concentration and temperature, but decreased with hydraulic residence time, indicating that removal was often N-limited. GHG emissions were similar to other bioreactors and constructed wetlands and not considered environmentally concerning. This study suggests that expectations of NO3-N removal efficiency developed from bioreactors receiving moderate to high NO3-N loading with influent concentrations exceeding 10-20 mg L-1 are unlikely to be met by systems where N-limitation becomes significant.

Full Dose-Reduction Potential of Statistical Iterative Reconstruction for Head CT Protocols in a Predominantly Pediatric Population.

BACKGROUND AND PURPOSE: A statistical iterative reconstruction algorithm provides an effective approach to reduce patient dose by compensating for increased image noise in CT due to reduced radiation output. However, after a point, the degree to which a statistical iterative algorithm is used for image reconstruction changes the image appearance. Our aim was to determine the maximum level of statistical iterative reconstruction that can be used to establish dose-reduced head CT protocols in a primarily pediatric population while maintaining similar appearance and level of image noise in the reconstructed image. MATERIALS AND METHODS: Select head examinations (brain, orbits, sinus, maxilla, and temporal bones) were investigated. Dose-reduced head protocols using an adaptive statistical iterative reconstruction were compared for image quality with the original filtered back-projection reconstructed protocols in a phantom by using the following metrics: image noise frequency (change in perceived appearance of noise texture), image noise magnitude, contrast-to-noise ratio, and spatial resolution. Dose-reduction estimates were based on CT dose index values. Patient volume CT dose index and image noise magnitude were assessed in 737 pre- and post-dose-reduced examinations. RESULTS: Image noise texture was acceptable for up to 60% adaptive statistical iterative reconstruction for the soft reconstruction kernel (at both 100 and 120 kV[peak]) and up to 40% adaptive statistical iterative reconstruction for the standard reconstruction kernel. Implementation of 40% and 60% adaptive statistical iterative reconstruction led to an average reduction in the volume CT dose index of 43% for brain, 41% for orbit, 30% for maxilla, 43% for sinus, and 42% for temporal bone protocols for patients between 1 month and 26 years of age, while maintaining an average noise magnitude difference of 0.1% (range, -3% to 5%), improving the contrast-to-noise ratio of low-contrast soft-tissue targets and the spatial resolution of high-contrast bony anatomy, compared with filtered back-projection. CONCLUSIONS: The methodology in this study demonstrates maximizing patient dose reduction and maintaining image quality by using statistical iterative reconstruction for a primarily pediatric population undergoing head CT examinations.

Estimating pediatric entrance skin dose from digital radiography examination using DICOM metadata: A quality assurance tool.

PURPOSE: To develop an automated methodology to estimate patient examination dose in digital radiography (DR) imaging using DICOM metadata as a quality assurance (QA) tool. METHODS: Patient examination and demographical information were gathered from metadata analysis of DICOM header data. The x-ray system radiation output (i.e., air KERMA) was characterized for all filter combinations used for patient examinations. Average patient thicknesses were measured for head, chest, abdomen, knees, and hands using volumetric images from CT. Backscatter factors (BSFs) were calculated from examination kVp. Patient entrance skin air KERMA (ESAK) was calculated by (1) looking up examination technique factors taken from DICOM header metadata (i.e., kVp and mA s) to derive an air KERMA (k air) value based on an x-ray characteristic radiation output curve; (2) scaling k air with a BSF value; and (3) correcting k air for patient thickness. Finally, patient entrance skin dose (ESD) was calculated by multiplying a mass-energy attenuation coefficient ratio by ESAK. Patient ESD calculations were computed for common DR examinations at our institution: dual view chest, anteroposterior (AP) abdomen, lateral (LAT) skull, dual view knee, and bone age (left hand only) examinations. RESULTS: ESD was calculated for a total of 3794 patients; mean age was 11 ± 8 yr (range: 2 months to 55 yr). The mean ESD range was 0.19-0.42 mGy for dual view chest, 0.28-1.2 mGy for AP abdomen, 0.18-0.65 mGy for LAT view skull, 0.15-0.63 mGy for dual view knee, and 0.10-0.12 mGy for bone age (left hand) examinations. CONCLUSIONS: A methodology combining DICOM header metadata and basic x-ray tube characterization curves was demonstrated. In a regulatory era where patient dose reporting has become increasingly in demand, this methodology will allow a knowledgeable user the means to establish an automatable dose reporting program for DR and perform patient dose related QA testing for digital x-ray imaging.

Characterization of adaptive statistical iterative reconstruction algorithm for dose reduction in CT: A pediatric oncology perspective.

PURPOSE: This study demonstrates a means of implementing an adaptive statistical iterative reconstruction (ASiR™) technique for dose reduction in computed tomography (CT) while maintaining similar noise levels in the reconstructed image. The effects of image quality and noise texture were assessed at all implementation levels of ASiR™. Empirically derived dose reduction limits were established for ASiR™ for imaging of the trunk for a pediatric oncology population ranging from 1 yr old through adolescence∕adulthood. METHODS: Image quality was assessed using metrics established by the American College of Radiology (ACR) CT accreditation program. Each image quality metric was tested using the ACR CT phantom with 0%-100% ASiR™ blended with filtered back projection (FBP) reconstructed images. Additionally, the noise power spectrum (NPS) was calculated for three common reconstruction filters of the trunk. The empirically derived limitations on ASiR™ implementation for dose reduction were assessed using (1, 5, 10) yr old and adolescent∕adult anthropomorphic phantoms. To assess dose reduction limits, the phantoms were scanned in increments of increased noise index (decrementing mA using automatic tube current modulation) balanced with ASiR™ reconstruction to maintain noise equivalence of the 0% ASiR™ image. RESULTS: The ASiR™ algorithm did not produce any unfavorable effects on image quality as assessed by ACR criteria. Conversely, low-contrast resolution was found to improve due to the reduction of noise in the reconstructed images. NPS calculations demonstrated that images with lower frequency noise had lower noise variance and coarser graininess at progressively higher percentages of ASiR™ reconstruction; and in spite of the similar magnitudes of noise, the image reconstructed with 50% or more ASiR™ presented a more smoothed appearance than the pre-ASiR™ 100% FBP image. Finally, relative to non-ASiR™ images with 100% of standard dose across the pediatric phantom age spectrum, similar noise levels were obtained in the images at a dose reduction of 48% with 40% ASIR™ and a dose reduction of 82% with 100% ASIR™. CONCLUSIONS: The authors' work was conducted to identify the dose reduction limits of ASiR™ for a pediatric oncology population using automatic tube current modulation. Improvements in noise levels from ASiR™ reconstruction were adapted to provide lower radiation exposure (i.e., lower mA) instead of improved image quality. We have demonstrated for the image quality standards required at our institution, a maximum dose reduction of 82% can be achieved using 100% ASiR™; however, to negate changes in the appearance of reconstructed images using ASiR™ with a medium to low frequency noise preserving reconstruction filter (i.e., standard), 40% ASiR™ was implemented in our clinic for 42%-48% dose reduction at all pediatric ages without a visually perceptible change in image quality or image noise.

Establishing a standard calibration methodology for MOSFET detectors in computed tomography dosimetry.

PURPOSE: The use of metal-oxide-semiconductor field-effect transistor (MOSFET) detectors for patient dosimetry has increased by ~25% since 2005. Despite this increase, no standard calibration methodology has been identified nor calibration uncertainty quantified for the use of MOSFET dosimetry in CT. This work compares three MOSFET calibration methodologies proposed in the literature, and additionally investigates questions relating to optimal time for signal equilibration and exposure levels for maximum calibration precision. METHODS: The calibration methodologies tested were (1) free in-air (FIA) with radiographic x-ray tube, (2) FIA with stationary CT x-ray tube, and (3) within scatter phantom with rotational CT x-ray tube. Each calibration was performed at absorbed dose levels of 10, 23, and 35 mGy. Times of 0 min or 5 min were investigated for signal equilibration before or after signal read out. RESULTS: Calibration precision was measured to be better than 5%-7%, 3%-5%, and 2%-4% for the 10, 23, and 35 mGy respective dose levels, and independent of calibration methodology. No correlation was demonstrated for precision and signal equilibration time when allowing 5 min before or after signal read out. Differences in average calibration coefficients were demonstrated between the FIA with CT calibration methodology 26.7 ± 1.1 mV cGy(-1) versus the CT scatter phantom 29.2 ± 1.0 mV cGy(-1) and FIA with x-ray 29.9 ± 1.1 mV cGy(-1) methodologies. A decrease in MOSFET sensitivity was seen at an average change in read out voltage of ~3000 mV. CONCLUSIONS: The best measured calibration precision was obtained by exposing the MOSFET detectors to 23 mGy. No signal equilibration time is necessary to improve calibration precision. A significant difference between calibration outcomes was demonstrated for FIA with CT compared to the other two methodologies. If the FIA with a CT calibration methodology was used to create calibration coefficients for the eventual use for phantom dosimetry, a measurement error ~12% will be reflected in the dosimetry results. The calibration process must emulate the eventual CT dosimetry process by matching or excluding scatter when calibrating the MOSFETs. Finally, the authors recommend that the MOSFETs are energy calibrated approximately every 2500-3000 mV.

Characterization of the gene encoding a histidine and aspartic acid-rich protein from Pneumocystis carinii.

A cDNA clone derived from Pneumocystis carinii contained an unusual sequence (GTGATG)2(ATGGTG)4(ATG)4 and many GAT repeats. It was found to encode a histidine and aspartic acid-rich protein (HARP). The complete cDNA contained an 888-bp open reading frame encoding a putative protein of 32.6 kDa. The deduced HARP protein contained 39 aspartic acid and 22 histidine residues. The genomic copy of the HARP gene (1203 bp in length) was found to contain 3 small introns of 46, 44, and 38 bp, respectively. HARP was predicted by computer programs to be a plasma membrane protein with nickel-binding activity.

Simultaneous videofluoroscopic swallow study and modified Evans blue dye procedure: An evaluation of blue dye visualization in cases of known aspiration.

The reliability of the modified Evans blue dye (MEBD) test for the detection of aspirated materials in patients with tracheostomy has been questioned. The videofluoroscopic swallow study (VFSS) has been the standard procedure used to detect aspiration, but there are known risks and the VFSS is not always an available evaluation option for aspiration detection. The purpose of the present study was to investigate the visualization of blue tracheal secretions in cases of known aspiration as documented by the VFSS. Twenty consecutive simultaneous MEBD study and VFSS were completed on patients with tracheostomies at an acute rehabilitation hospital. Overall, the MEBD showed a 50% false-negative error rate. The MEBD identified aspiration in 100% of patients who aspirated more than trace amounts but failed to identify aspiration of trace amounts (0%).

Amplification of Pneumocystis carinii DNA on specimens scraped from slides.

A method for the detection of Pneumocystis carinii by polymerase chain reaction using specimens obtained by scraping bronchoalveolar lavage or tissue impression smears is described. The smears were scraped into water and then absorbed onto a glass-fiber filter. After fixing with methanol, the specimen on the filter was digested with proteinase K. The digestion mixture was then clarified, and a portion of the clarified supernatant was used as a template for the amplification of a portion of the mitochondrial rRNA gene of P. carinii. Using this method of sample preparation, we were able to amplify P. carinii DNA from both unstained and Giemsa stained smears.

Discrimination of temporal jitter in patterned sequences of tones.

The perception of pure tone sequences in highly dependent on the serial pattern of tone frequencies. We propose that this phenomenon is mediated by a frequency-selective mechanism. Three models of the selective mechanism were evaluated in a temporal discrimination task. The observer was required to discriminate between two sequences of tone bursts. In one sequence the time interval between each tone burst was constant; in the other sequence the time interval was a random variable. A set of fixed and random pattern rules determined the frequency of each tone in the sequence. Discrimination performance was studied as a function of the magnitude of the time interval jitter and the serial pattern of tone frequency. Performance in the fixed pattern conditions was well described by a multiple-channel model in which timing information is available between tones within the same frequency region. The influence of higher order attentional factors was randomly determined. The frequency-selective mechanism appears to be sensitive to uncertainty about the frequency pattern of the input. Repeating the random pattern within each trial effectively eliminated this uncertainty. This result is consistent with experiments on the discrimination of word-length auditory patterns and temporal cues in speech.