A meta-analysis of the performance of ultrasound, hepatobiliary scintigraphy, CT and MRI in the diagnosis of acute cholecystitis.

PURPOSE: To evaluate the recently reported relative diagnostic accuracy of US, CT, MRI, and cholescintigraphy for diagnosing acute cholecystitis. METHODS: 2 radiologists independently performed systematic electronic searches for articles published between 2000 and 2021 and applied inclusion/exclusion criteria. 2 different radiologists extracted data from the articles and scored each with a methodological quality tool. Pooled estimates of sensitivity and specificity were calculated with a bivariate linear mixed model. A second analysis made head-to-head comparisons (US vs. CT, US vs. cholescintigraphy). Factors were also analyzed for potential confounding effects on diagnostic accuracy. RESULTS: Of 6121 initial titles, 22 were included. The prevalence of cholecystitis varied widely across studies (9.4-98%). Pooled sensitivity and specificity estimates were 69% (confidence limit [CL] 62-76%) and 79% (CL 71-86%) for US, 91% (CL 86-94%) and 63% (CL 51-74%) for cholescintigraphy, 78% (CL 69-84%) and 81% (CL 71-88%) for CT, and 91% (CL 78-97%) and 93% (CL 70-99%) for MRI. Regarding head-to-head comparisons, the sensitivity of CT (87.6%, CL 70-96%) was significantly higher than US (66.8%, CL 43-84%), while specificities (81.7% with CL 54-95% for US, 91.9% with CL 67-99% for CT) were similar. The sensitivity of cholescintigraphy (87.4%, CL 76-94%) was significantly greater than US (61.6%, CL 44-77%), while the specificity of US (82%, CL 65-92%) was significantly higher than cholescintigraphy (68%, CL 47-84%). CONCLUSION: Recent data suggests that CT may have a higher sensitivity than US for diagnosing acute cholecystitis, with similar specificity. Cholescintigraphy remains a highly sensitive modality with lower specificity than previously reported. MRI remains under studied, but with promising results.

SkiMon: A Wireless Body Area Network for Monitoring Ski Flex and Motion during Skiing Sports.

Monitoring and gathering data on sporting activities holds significant promise for athletes, equipment developers, and physical fitness clinicians. Wireless Body Area Networks are being used in sporting environments as a means of gathering data, providing feedback, and helping to gain understanding of athletic activities. Applying WBANs to skiing situations, which have higher vibration, velocities, and damp environments than many other sports, can open up opportunities to understand the dynamics of skiing equipment behaviors, skiing routes on mountains, and how individuals react when skiing. To support these outcomes, a prototype WBAN-style off the shelf component system called SkiMon was proposed, implemented, and tested. The SkiMon system uses inexpensive ESP8266, Raspberry Pi, and sensor devices to gather high quality motion and location tracking data on skiers in real-world skiing conditions. By using IEEE 802.11b/g/n wireless networks, SkiMon is able to sample data at a minimum of 50 Hz, which is enough to model most ski vibration behaviors. These data results are shown to reflect ground truth 3D maps and the acceleration data comports with earlier works on ski vibration testing. Overall, a WBAN-based commodity components solution shows promise as a high quality sensor platform for tracking and modeling skiing activities.

Unusual presentation of left sided acute appendicitis in elderly male with asymptomatic midgut malrotation.

INTRODUCTION: Acute appendicitis in the setting of midgut malrotation is uncommon. Midgut malrotation commonly presents within the first month of life. A minority remain asymptomatic and may present with concomitant abdominal pathology making diagnosis difficult. PRESENTATION OF CASE: This paper reports a rare case of a 73-year-old male diagnosed with acute appendicitis and asymptomatic MM .The patient underwent a laparoscopic appendectomy, but had an unplanned return to theatre for washout of post-operative intra-abdominal haematoma. DISCUSSION: Midgut malrotation is commonly described by the stringer classification and type 1a is the most common in adults. There have only been a handful of documented cases of acute appendicitis with midgut malrotation occurring in the adult population. Previous delay in diagnosis has led to a delay in definitive management. Both laparoscopic and open surgery has been used in the past. CONCLUSION: Acute appendicitis with malrotation should be considered in elderly patients presenting with atypical signs and symptoms. Imaging offers significant advantage for timely and definitive management.

The MSH Effective and Efficient Utilization Committee: An Approach to Improving Care Quality, Value and Patient Experience.

Hospitals are faced with reduced funding but must deliver high-quality care, and increase service capacity (MOHLTC 2013). In response, Mount Sinai Hospital (MSH) has established an organizational approach that engages clinicians and front-line caregivers. MSH's Effective and Efficient Utilization Committee (EEUC) focuses on cross-departmental collaboration to maximize resources, accessibility and quality, while minimizing cost. The challenges were tackled by team coordination guided by senior administration and project management review of evidence-based data supported by health analytics. Over a three-year period, the EEUC has helped reduce wait times, increase service accessibility, provide cost savings and enhance patient experience in several areas.

Physicochemical characterisation of depleted uranium (DU) particles at a UK firing test range.

Depleted uranium (DU) particles were isolated from soils at Eskmeals, UK, where DU munitions have been tested against hard targets and unfired DU buried in soils for corrosion studies. Using electron microscopy and X-ray analyses, three classes of particles were identified: (1) DU aerosols and fragments, typically 1-20 µm diameter, composed mainly of uranium as UO(2) and U(3)O(8), (2) solidified molten particles, typically 200-500 µm diameter, composed of U, mixed with Fe from target materials and (3) deposits and coatings, often of metaschoepite on sand grains up to 500 µm diameter. The first two particle types are derived from firing impacts, the last from corrosion of buried uranium metal. Alpha and mass spectrometry allowed quantitative elemental and isotopic characterisation of DU-containing particulate environmental samples.

Genetic and morphological variation of bee-parasitic Tropilaelaps mites (Acari: Laelapidae): new and re-defined species.

Mites in the genus Tropilaelaps are parasites of social honeybees. Two species, Tropilaelaps clareae and T. koenigerum, have been recorded and their primary hosts are presumed to be the giant honeybees of Asia, Apis dorsata and A. laboriosa. The most common species, T. clareae, is also an economically important pest of the introduced Western honeybee (A. mellifera) throughout Asia and is considered an emerging threat to world apiculture. In the studies reported here, genetic (mtDNA CO-I and nuclear ITS1-5.8S-ITS2 gene sequence) and morphological variation and host associations were examined among Tropilaelaps isolates collected from A. dorsata, A. laboriosa and A. mellifera throughout Asia and neighbouring regions. The results clearly indicate that the genus contains at least four species. Tropilaelaps clareae, previously assumed to be ubiquitous in Asia, was found to be two species, and it is here redefined as encompassing haplotypes (mites with distinct mtDNA gene sequences) that parasitise native A. dorsata breviligula and introduced A. mellifera in the Philippines and also native A. d. binghami on Sulawesi Island in Indonesia. Tropilaelaps mercedesae n. sp., which until now has been mistaken for T. clareae, encompasses haplotypes that, together with haplotypes of T. koenigerum, parasitise native A. d. dorsata in mainland Asia and Indonesia (except Sulawesi Island). It also parasitises introduced A. mellifera in these and surrounding regions and, with another new species, T. thaii n. sp., also parasitises A. laboriosa in mountainous Himalayan regions. Methods are described for identifying each species. These studies help to clarify the emerging threat of Tropilaelaps to world apiculture and will necessitate a revision of quarantine protocols for countries that import and export honeybees.