Open-source magnetic resonance imaging: Improving access, science, and education through global collaboration.

Open-source practices and resources in magnetic resonance imaging (MRI) have increased substantially in recent years. This trend started with software and data being published open-source and, more recently, open-source hardware designs have become increasingly available. These developments towards a culture of sharing and establishing nonexclusive global collaborations have already improved the reproducibility and reusability of code and designs, while providing a more inclusive approach, especially for low-income settings. Community-driven standardization and documentation efforts are further strengthening and expanding these milestones. The future of open-source MRI is bright and we have just started to discover its full collaborative potential. In this review we will give an overview of open-source software and open-source hardware projects in human MRI research.

On-site construction of a point-of-care low-field MRI system in Africa.

PURPOSE: To describe the construction and testing of a portable point-of-care low-field MRI system on site in Africa. METHODS: All of the components to assemble a 50 mT Halbach magnet-based system, together with the necessary tools, were air-freighted from the Netherlands to Uganda. The construction steps included individual magnet sorting, filling of each ring of the magnet assembly, fine-tuning the inter-ring separations of the 23-ring magnet assembly, gradient coil construction, integration of gradient coils and magnet assembly, construction of the portable aluminum trolley and finally testing of the entire system with an open source MR spectrometer. RESULTS: With four instructors and six untrained personnel, the complete project from delivery to first image took approximately 11 days. CONCLUSIONS: An important step in translating scientific developments in the western world from high-income industrialized countries to low- and middle-income countries (LMICs) is to produce technology that can be assembled and ultimately constructed locally. Local assembly and construction are associated with skill development, low costs and jobs. Point-of-care systems have a large potential to increase the accessibility and sustainability of MRI in LMICs, and this work demonstrates that technology and knowledge transfer can be performed relatively seamlessly.

Assessing the utility of low resolution brain imaging: treatment of infant hydrocephalus.

As low-field MRI technology is being disseminated into clinical settings around the world, it is important to assess the image quality required to properly diagnose and treat a given disease and evaluate the role of machine learning algorithms, such as deep learning, in the enhancement of lower quality images. In this post hoc analysis of an ongoing randomized clinical trial, we assessed the diagnostic utility of reduced-quality and deep learning enhanced images for hydrocephalus treatment planning. CT images of post-infectious infant hydrocephalus were degraded in terms of spatial resolution, noise, and contrast between brain and CSF and enhanced using deep learning algorithms. Both degraded and enhanced images were presented to three experienced pediatric neurosurgeons accustomed to working in low- to middle-income countries (LMIC) for assessment of clinical utility in treatment planning for hydrocephalus. In addition, enhanced images were presented alongside their ground-truth CT counterparts in order to assess whether reconstruction errors caused by the deep learning enhancement routine were acceptable to the evaluators. Results indicate that image resolution and contrast-to-noise ratio between brain and CSF predict the likelihood of an image being characterized as useful for hydrocephalus treatment planning. Deep learning enhancement substantially increases contrast-to-noise ratio improving the apparent likelihood of the image being useful; however, deep learning enhancement introduces structural errors which create a substantial risk of misleading clinical interpretation. We find that images with lower quality than is customarily acceptable can be useful for hydrocephalus treatment planning. Moreover, low quality images may be preferable to images enhanced with deep learning, since they do not introduce the risk of misleading information which could misguide treatment decisions. These findings advocate for new standards in assessing acceptable image quality for clinical use.

Powerful turbidity currents driven by dense basal layers.

Seafloor sediment flows (turbidity currents) are among the volumetrically most important yet least documented sediment transport processes on Earth. A scarcity of direct observations means that basic characteristics, such as whether flows are entirely dilute or driven by a dense basal layer, remain equivocal. Here we present the most detailed direct observations yet from oceanic turbidity currents. These powerful events in Monterey Canyon have frontal speeds of up to 7.2 m s-1, and carry heavy (800 kg) objects at speeds of ≥4 m s-1. We infer they consist of fast and dense near-bed layers, caused by remobilization of the seafloor, overlain by dilute clouds that outrun the dense layer. Seabed remobilization probably results from disturbance and liquefaction of loose-packed canyon-floor sand. Surprisingly, not all flows correlate with major perturbations such as storms, floods or earthquakes. We therefore provide a new view of sediment transport through submarine canyons into the deep-sea.

Chemistry of silica scale mitigation for RO desalination with particular reference to remote operations.

Silica scaling in reverse osmosis of groundwater is a significant issue in water stressed areas due to the limitations that scaling imposes on water recovery. While calcium and magnesium scaling potential can be significantly reduced by the use of ion exchange or other softening processes, the silica scaling potential typically remains. Improving the recovery of reverse osmosis by limiting the potential for silica scale is important in ensuring maximum water recovery. This is particularly important for mining and natural gas industries that are located in remote regions. The remote nature of these sites imposes three major restrictions on the silica scale mitigation process. Firstly, the generation of poorly dewaterable sludges must be avoided. Also, the quality of any reverse osmosis (RO) permeate must be able to meet the end use requirements, particularly for boilers. Finally, silica removal should not impact upon other potentially useful or valuable components within the brine, and should not make the disposal of the unusable waste brine components more difficult. Reduction of scaling potential can be achieved in three main ways: operating RO at high pH after hardness has been removed, operating at low pH, and reducing the silica concentration either in pretreatment or by using an interstage technique. Operating at high pH has the initial requirement of hardness removal to prevent scaling and this could be an issue on some sites. Hardness removal operations that use ion exchange resins may be challenged by water chemistry and the operational costs associated with high chemical regeneration costs. Operating at low pH may be more desirable than high pH operation as this can help to reduce the risk of scale formation from calcium or magnesium salts. The drawback comes from the cost of acid, particularly for high-alkalinity waters. There are numerous silica removal techniques including chemical dosing of lime, or aluminium or iron salts, electrocoagulation, adsorption, ion exchange and seeded precipitation. Of these, adsorption onto aluminium compounds appears to give the best results and have received the most attention where restrictions on sludge production and brine disposal common to operations in remote locations are in place. Adsorption onto iron compounds appears to occur more quickly, but leads to the formation of a hard, glass-like scale that may be more difficult to remove, making this process unattractive from the point of view of sorbent regeneration.

Does raising morning rectal temperature to evening levels offset the diurnal variation in muscle force production?

Muscle force production and power output in active males, regardless of the site of measurement (hand, leg, or back), are higher in the evening than in the morning. This diurnal variation is attributed to motivational, peripheral and central factors, and higher core and, possibly, muscle temperatures in the evening. This study investigated whether increasing morning rectal temperatures to evening resting values, by active or passive warm-ups, leads to muscle force production and power output becoming equal to evening values in motivated subjects. Ten healthy active males (mean ± SD: age, 21.2 ± 1.9 yrs; body mass, 75.4 ± 8 kg; height, 1.76 ± .06 m) completed the study, which was approved by the University Ethics Committee. The subjects were familiarized with the techniques and protocol and then completed four sessions (separated by at least 48 h): control morning (07:30 h) and evening (17:30 h) sessions (with an active 5-min warm-up) and then two further sessions at 07:30 h but proceeded by an extended active or passive warm-up to raise rectal temperature to evening values. These last two sessions were counterbalanced in order of administration. During each trial, three measures of handgrip strength, isokinetic leg strength measurements (of knee flexion and extension at 1.05 and 4.19 rad.s(-1) through a 90° range of motion), and four measures of maximal voluntary contraction (MVC) on an isometric ergometer (utilizing the twitch-interpolation technique) were performed. Rectal and intra-aural temperatures, ratings of perceived exertion (RPE) and thermal comfort (TC) were measured. Measurements were made after the subjects had reclined for 30 min and after the warm-ups and prior to the measurement of handgrip and isokinetic and isometric ergometry. Muscle temperature was taken after the warm-up and immediately before the isokinetic and MVC measurements. Warm-ups were either active (cycle ergometer at 150 W) or passive (resting in a room at 35 °C, relative humidity 45%). Data were analyzed using analysis of variance models with repeated measures. Rectal and intra-aural temperatures were higher at rest in the evening (.56 °C and .74 °C; p < .05) than in the morning, but there were no differences after the active or passive warm-ups, the subjects' ratings of thermal comfort reflecting this. Muscle temperatures also displayed significant diurnal variation, with higher values in the evening (~.31 °C; p < .05). Grip strength, isokinetic knee flexion for peak torque and peak power at 1.05 rad.s(-1), and knee extension for peak torque at 4.19 rad.s(-1) all showed higher values in the evening. All other measures of strength or power showed a trend to be higher in the evening ( .10 > p > .05). There was no significant effect of active or passive warm-ups on any strength or power variable, and subjects reported maximal values for effort for each strength measure. In summary, effects of time of day were seen in some measures of muscle performance but, in this population of motivated subjects, there was no evidence that increasing morning rectal temperature to evening values by active or passive warm-up increased muscle strength to evening values.

Quantification of the physiological loading of one week of "pre-season" and one week of "in-season" training in professional soccer players.

The aim of this study was to quantify the physiological loads of programmed "pre-season" and "in-season" training in professional soccer players. Data for players during each period were included for analysis (pre-season, n = 12; in-season, n = 10). We monitored physiological loading of training by measuring heart rate and rating of perceived exertion (RPE). Training loads were calculated by multiplying RPE score by the duration of training sessions. Each session was sub-categorized as physical, technical/tactical, physical and technical/tactical training. Average physiological loads in pre-season (heart rate 124 ± 7 beats · min(-1); training load 4343 ± 329 Borg scale · min) were higher compared with in-season (heart rate 112 ± 7 beats · min(-1); training load 1703 ± 173 Borg scale · min) (P < 0.05) and there was a greater proportion of time spent in 80-100% maximum heart rate zones (18 ± 2 vs. 5 ± 2%; P < 0.05). Such differences appear attributable to the higher intensities in technical/tactical sessions during pre-season (pre-season: heart rate 137 ± 8 beats · min(-1); training load 321 ± 23 Borg scale · min; in-season: heart rate 114 ± 9 beats · min(-1); training load 174 ± 27 Borg scale · min; P < 0.05). These findings demonstrate that pre-season training is more intense than in-season training. Such data indicate that these adjustments in load are a direct attempt to deliver training to promote specific training adaptations.

Francisella acid phosphatases inactivate the NADPH oxidase in human phagocytes.

Francisella tularensis contains four putative acid phosphatases that are conserved in Francisella novicida. An F. novicida quadruple mutant (AcpA, AcpB, AcpC, and Hap [DeltaABCH]) is unable to escape the phagosome or survive in macrophages and is attenuated in the mouse model. We explored whether reduced survival of the DeltaABCH mutant within phagocytes is related to the oxidative response by human neutrophils and macrophages. F. novicida and F. tularensis subspecies failed to stimulate reactive oxygen species production in the phagocytes, whereas the F. novicida DeltaABCH strain stimulated a significant level of reactive oxygen species. The DeltaABCH mutant, but not the wild-type strain, strongly colocalized with p47(phox) and replicated in phagocytes only in the presence of an NADPH oxidase inhibitor or within macrophages isolated from p47(phox) knockout mice. Finally, purified AcpA strongly dephosphorylated p47(phox) and p40(phox), but not p67(phox), in vitro. Thus, Francisella acid phosphatases play a major role in intramacrophage survival and virulence by regulating the generation of the oxidative burst in human phagocytes.

Body composition of English Premier League soccer players: influence of playing position, international status, and ethnicity.

Body composition is a key consideration in the physical make-up of professional soccer players. The aims of the present study were to determine whether the body composition of professional soccer players varied according to playing position, international status or ethnicity, and to establish which variables best distinguished the soccer players from a reference group. Body composition was assessed using dual-energy X-ray absorptiometry in 64 male professional soccer players. Measured variables included bone mineral density and the relative amounts of lean and fat mass. Data were analysed using analysis of variance and stepwise discriminant function. The soccer players recorded better values than a reference group (n = 24) for all body composition compartments. Percent lean mass and bone mineral density were the variables best able to identify the soccer players (95.5% correctly classified). Differences in body composition were evident between goalkeepers and outfield players, but not between outfield playing positions. No differences were found on the basis of international status. The non-Caucasian players demonstrated significantly lower percent body fat (9.2 +/- 2.0%) than the Caucasian players (10.7 +/- 1.8%). It was concluded that body composition is important for elite soccer players, but that homogeneity between players at top professional clubs results in little variation between individuals.

The efficacy of exercise as an intervention to treat recurrent nonspecific low back pain in adolescents.

The purpose of this study was to evaluate the efficacy of a specific 8-week exercise rehabilitation program as an intervention to treat recurrent nonspecific low back pain in adolescents. A randomized controlled trial involving 54 adolescents (14.6 +/- 0.6 years) who suffered from recurrent nonspecific low back pain participated in either the exercise rehabilitation program or a control condition. Pre- and postintervention measures of low back pain status and biological risk indicators were taken. Two-way mixed ANOVA was conducted and significance was set at p < .01. Significant improvement was noted in the exercise rehabilitation group for perceived severity of pain (effect size 1.47) and number of occasions missing physical activity (effect size 0.99). Significant improvement in the exercise rehabilitation group for sit-and-reach performance, hip range of motion, lumbar sagittal mobility (modified Schöber), and number of sit-ups in 60 s were also identified. In conclusion, the specific exercise program appeared to provide positive benefits for adolescents suffering from recurrent nonspecific low back pain. Further evaluation is required to evaluate the effectiveness of the exercise rehabilitation program in relation to other interventions and to assess the long-term effectiveness.

Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation.

Operative management of a thoracolumbar burst fracture varies according to many factors. Fracture morphology, neurologic status, and surgeon preference play major roles in deciding upon anterior, posterior, or combined approaches. Optimizing neural decompression while providing stable internal fixation over the least number of spinal segments is the goal. Short-segment constructs via a single-stage approach (anterior versus posterior) have become viable options with advances in instrumentation and techniques. This study compares anterior-only fixation utilizing a corpectomy strut graft and a modern thoracolumbar plating system with a posterior-only construct using pedicle screws and load sharing hooks for the treatment of unstable burst fractures. Functional outcome and sagittal plane restoration and maintenance of sagittal plane alignment were evaluated. Fifty-three patients with unstable burst fractures were assessed with 40 undergoing an anterior-only construct and 13 having a short-segment posterior-only construct. The posterior-only group had no hardware failures; however, the loss of sagittal plane correction averaged 8.1 degrees, whereas the anterior-only group averaged only a 1.8-degree increase in sagittal plane kyphosis. Both techniques resulted in statistically significant initial improvement in sagittal alignment; however, the posterior short-segment group lost this statistical significance at follow-up whereas the anterior-only group continued to demonstrate statistically significant improvement in sagittal alignment at follow-up compared to preoperative measurements.