The gendered impact of the COVID-19 pandemic on academics working in medical imaging and radiation therapy.

INTRODUCTION: Healthcare workers have been particularly impacted by the COVID-19 pandemic, as have those educating them, albeit differently. Several papers have identified a gendered difference in the impact of the pandemic. This study aims to determine impact of COVID-19 on the health and wellbeing of Medical Imaging and Radiation Therapy (MIRT) academics. METHODS: An electronic survey was designed in English on Qualtrics and distributed via email and online platforms to MIRT academics. Fifty-one questions were used; demographic (n = 9), work patterns (n = 11), general health (n = 8), mental health (n = 2), physical health (n = 10), and workload (n = 11). Overall, 46 were quantitative and five were qualitative 'open-ended' questions. The survey was open between 3rd March 2021 to 1st May 2021. Quantitative analysis was carried out using MS Excel v 16.61.1ss and SPSS v26. RESULTS: The survey reached 32 countries globally and 412 participants; 23.5% identified as men (n = 97) and 76.5% as women (n = 315). Women reported worse sleep quality than men and overwhelmingly felt they would not like to work remotely again if given a choice. A higher percentage of males, 73% versus 40.5% of females reported getting outdoors less. The CORE-10 validated questionnaire found that 10.3% of males (n = 42) and 2.7% of females (n = 11) experienced severe psychological distress the week immediately before the survey was conducted. CONCLUSION: While the study has identified some gender-related differences in the impact of COVID-19 on the mental and physical health of MIRT academics, both males and females have experienced significant deterioration in health and wellbeing due to the pandemic. IMPLICATION FOR PRACTICE: Developing mental health support for MIRT academics and defining optimum methods for raising awareness is recommended.

Survey of monitor specification and viewing conditions in breast screening units in the North West of England.

INTRODUCTION: Monitor specification and viewing conditions are important factors affecting image assessment in mammography. This survey evaluates the different viewing conditions and monitor specifications that exist in acquisition and reporting rooms in UK breast screening units. METHODS: Static (n = 10) and mobile (n = 2) breast screening units were evaluated in North West England. Room illumination levels were measured in 3 locations for each room using a calibrated Lux meter and the specification of 122 monitors recorded. Room layout, wall colour, location and number of doors, windows and light sources were recorded. RESULTS: In reporting rooms, 90/91 of monitors had similar technical specifications and were compliant to guidelines. The ambient light levels ranged from 10 to 25.8 lux. The mean illuminance was 12.32 ± 4.6 lux. In acquisition rooms, great variances appeared in monitor specification and ambient light levels. The majority of monitors (24/34) had 3 megapixel (MB) optimum resolution but the ambient light level ranged from 10 to 1020 lux. The mean illuminance was 105.3 ± 178.8 lux. The mobile units were consistent with each other and compliant with guidelines. CONCLUSION: A lack of consistency and great variances appeared in terms of ambient light levels and monitor specifications in the image acquisition rooms. However, there was excellent consistency among the illumination measurements and the monitors' technical specifications in the reporting rooms. IMPLICATIONS FOR PRACTICE: This research demonstrates, for the first time, the need for further research and specialised guidelines for acquisition rooms.

Evaluation of X-ray table mattresses for radiation attenuation and impact on image quality.

INTRODUCTION: Mattresses in the radiology department tend to be an overlooked aspect of imaging equipment. This paper evaluates the radiation attenuation characteristics of mattresses and the effect they have on image quality. METHODS: Thirteen mattresses (from new to 20 years of age) were evaluated. Incident air kerma (IAK) was measured in two conditions, with and without mattress over a range of exposure factors using a digital dosimeter. Image quality was assessed by calculating the inverse image quality factor (IQFinv) using a commercially available phantom (CDRAD) for the same exposure factors. The correlation of age and attenuation and image quality was calculated. RESULTS: Measured IAK and image quality was affected by the addition of a mattress with older mattresses having greater attenuation; there is a moderate/large correlation (0.38-0.51) between age and IAK. IQFinv deteriorated with the addition of a mattress but there was no correlation with age (-0.41 to 0.16). Clinically, there is no impact of any mattress in the study as changes to the exposure factors to account for the attenuation are smaller than the increments in mAs available on X-ray equipment. CONCLUSION: The results indicate that while the presence of a mattress does impact on transmitted radiation and the quality of the image, the clinical impact is insignificant. Attenuation correlates with age but with no clinical significance. There is no correlation between age and image quality. IMPLICATIONS FOR PRACTICE: Quality control tests for attenuation and impact on image quality are not required in clinical practice. The method could be used by manufacturers to test new materials and mattresses and could provide users with specifications of new products.

2019 UK National Guideline for consultations requiring sexual history taking : Clinical Effectiveness Group British Association for Sexual Health and HIV.

This guideline is an update of a previous version published in 2013. In this new version, we have reflected changes in the way sexual health services are now provided by assuming an integrated Sexual Health/Sexual and Reproductive Healthcare service. There are new recommendations for online testing, female genital mutilation (FGM), chemsex and considerations for transgender (and non-binary) individuals. Previous versions rather assumed a cis-gender clientele and so we have taken a more mechanistic approach to sex and risk without assuming gender identification. We have updated our gender terminology in line with the British Association for Sexual Health and HIV 'sexual health standards for trans, including non-binary, people' although have retained the terminology of 'men' and 'women' in a few cases where it related to other guidelines, e.g. human papillomavirus vaccination and FGM.

A systematic review of viewing conditions and monitor specifications in mammography.

OBJECTIVES: The purpose of this systematic review was to establish the current status of recommended monitor specifications and viewing conditions in mammography for image acquisition and reporting rooms. A literature search was completed between August 2018 and March 2019 using ScienceDirect, PubMed, Web of Science and MEDLINE databases. An additional manual search was performed to identify relevant guidelines to support the review. Only articles and guidelines written in English were included. KEY FINDINGS: Results were selected according to the following criteria; articles detailing (i) monitor specification and, (ii) viewing conditions in mammography acquisition and reporting rooms. Twenty-one studies met the inclusion criteria. Six papers described monitor specifications, five described viewing conditions and ten guideline documents were identified from the UK, Europe and the US. Common outcomes were that monitors with 3 or 5 MP resolution seemed to be preferred and at the same time higher illumination levels (>15 lux) were found to decrease the luminance of the monitors and negatively impact the assessment of image quality. Contrary to this, the majority of guideline documents recommended illumination levels above 20 Lux. Finally, there is a lack of guidance for viewing conditions in acquisition rooms. CONCLUSION: This review did not reveal any strong evidence for the proposed room illumination levels in acquisition rooms. In reference to monitors specifications, there is preference for using higher resolution displays (3 and 5 MP) but again, the evidence is not strong. Moreover, variance exists in the guidelines and that promotes inconsistency in mammography departments. IMPLICATIONS FOR PRACTICE: This review highlights the lack of standardised guidelines and the need for further research on the viewing conditions and monitor specifications for the acquisition rooms in mammography.

Can the anode heel effect be used to optimise radiation dose and image quality for AP pelvis radiography?

INTRODUCTION: A study was conducted to determine whether the anode heel effect can be used to influence optimisation of radiation dose and image quality (IQ) for AP pelvis radiography. METHODS: ATOM dosimetry phantom and an anthropomorphic phantom were positioned for AP pelvis. Using a CR system, images were acquired and doses were measured with phantom feet toward anode and then feet toward cathode. Exposure factors (kVp, mAs and SID) were systematically generated using a factorial design. Images were scored visually for quality using relative visual grading together with a 3 point Likert scale. Signal to noise ratio was also calculated as a physical measure of image quality. Dosimetry data were collected for the ovaries and testes. RESULTS: The optimum technique for male, which resulted in lower dose and suitable image quality, was with feet positioned toward the anode (0.80 ± 0.03 mGy; SNR of 38 ± 2.9; visual IQ score 3.13 ± 0.35). The optimum technique for female was with feet toward anode (0.23 ± 0.02 mGy; SNR of 34.7 ± 2.6; visual IQ score 3.15 ± 0.26). kVp had the biggest effect on both visual and physical image quality metrics (p < 0.001) for both tube orientations, whereas SID had the lowest effect on both visual and physical image quality metrics compared with mAs and kVp (p < 0.001). The effect of SID on the SNR was not significant (p > 0.05) with feet toward anode. CONCLUSION: Positioning the patient with feet toward the anode, as opposed to the cathode, has no adverse effect on visual image quality assessment but it does have an effect on physical image quality. IMPLICATIONS FOR PRACTICE: This study would add a new clinical concept in positioning of AP pelvis radiography especially for male positioning.

The impact of hoist sling fabrics on interface pressure whilst sitting in healthy volunteers and wheelchair users: A comparative study.

AIM OF THE STUDY: To evaluate the effect of three sling fabrics on gluteal interface pressure whilst sitting in a population of wheelchair users and to compare these to data previously collected in a pilot study with a healthy population. MATERIALS AND METHODS: A repeated measures experimental design was used with 32 adult wheelchair users (15 women, 17 men). Healthy population pilot study consisted of 61 participants (51 women, 10 men) recruited from staff and students at The University of Salford. METHODS: Gluteal pressures at six pressure zones were recorded using the X-sensor PX100 pressure sensor at 30 s intervals for 10 min. Data were collected in 4 conditions with participants seated in a standardised chair, followed by the chair with slings made of three different fabrics. RESULTS: The spacer fabric reduced the mean gluteal pressure more effectively than slipfit and polyester (p = 0.014 and p = 0.01 respectively, 95%CI) and reduced peak pressure at the left ischial tuberosity and coccyx when compared to the slipfit (p = 0.003 and p = 0.005) with the wheelchair users. When comparing data with the pilot study, the mean gluteal pressure and peak pressures at the ischial tuberosities and coccyx were significantly higher in the wheelchair user group (p < 0.005). CONCLUSION: The fabric identified as the most effective in reducing mean and peak pressures in both groups was the spacer fabric, suggesting that a spacer fabric sling is more likely to reduce the risk of pressure ulcer development. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Quantitative analysis of iontophoretic drug delivery from micropipettes.

Microiontophoresis is a drug delivery method in which an electric current is used to eject molecular species from a micropipette. It has been primarily utilized for neurochemical investigations, but is limited due to difficulty controlling and determining the ejected quantity. Consequently the concentration of an ejected species and the extent of the affected region are relegated to various methods of approximation. To address this, we investigated the principles underlying ejection rates and examined the concentration distribution in microiontophoresis using a combination of electrochemical, chromatographic, and fluorescence-based approaches. This involved a principal focus on how the iontophoretic barrel solution affects ejection characteristics. The ion ejection rate displayed a direct correspondence to the ionic mole fraction, regardless of the ejection current polarity. In contrast, neutral molecules are ejected by electroosmotic flow (EOF) at a rate proportional to the barrel solution concentration. Furthermore, the presence of EOF was observed from barrels containing high ionic strength solutions. In practice, use of a retaining current draws extracellular ions into the barrel and will alter the barrel solution composition. Even in the absence of a retaining current, diffusional exchange at the barrel tip will occur. Thus behavior of successive ejections may slightly differ. To account for this, electrochemical or fluorescence markers can be incorporated into the barrel solution in order to compare ejection quantities. These may also be used to provide an estimate of the ejected amount and distribution provided accurate use of calibration procedures.

Lessons learned from making and implementing vaccine recommendations in the U.S.

After publication of certain vaccine recommendations made by the Advisory Committee on Immunization Practices, several unexpected events have occurred during implementation of these recommendations. These have included changes in recommendations following adverse events involved with a particular vaccine and the conferral of community protection as an offshoot of vaccination of a specific population. Vaccine shortages and hesitancy have also been proven impediments to full implementation, and vaccine recommendations have not gone unaffected by either public perception of a vaccine or by cost considerations.

Lessons Learned From Making and Implementing Vaccine Recommendations in the U.S.

After publication of certain vaccine recommendations made by the Advisory Committee on Immunization Practices, several unexpected events have occurred during implementation of these recommendations. These have included changes in recommendations following adverse events involved with a particular vaccine and the conferral of community protection as an offshoot of vaccination of a specific population. Vaccine shortages and hesitancy have also been proven impediments to full implementation, and vaccine recommendations have not gone unaffected by either public perception of a vaccine or by cost considerations.

iCarer: AAL for the Informal Carers of the Elderly.

In the context of the long-term care for older adults, informal carers play a key role. Daily competing priorities or a care-skills deficit may lead them to stress, anxiety and/or depression. The iCarer project (AAL-2012-5-239) proposes the design and implementation of a cloud-inspired personalised and adaptive platform which will offer support to informal carers of older adults with cognitive impairment. By means of a holistic approach comprising technologies and services addressing the intelligent and interactive monitoring of activities, knowledge management for personalised guidance and orientation, virtual interaction, e-learning, care coordination facilities and social network services, iCarer aims to reduce the informal carer stress and to enhance the quality of care they provide, thus improving their quality of life. The iCarer platform will be evaluated through a multi-centre non-controlled study (4 months; 48 homes located in England and in Slovenia). Currently the iCarer project is completing the development work. The evaluation trial is expected to start in August 2015.

The history of the United States Advisory Committee on Immunization Practices (ACIP).

The United States Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee that develops written recommendations for use of vaccines licensed by the Food and Drug Administration (FDA) for the U.S. civilian population. Vaccine development and disease outbreaks contributed to the need for a systematized, science-based, formal mechanism for establishing national immunization policy in this country. Formed in 1964, the ACIP was charged with this role. The committee has undergone significant changes in structure and operational activities during its 50-year history. The ACIP works closely with many liaison organizations to develop its immunization recommendations, which are harmonized among key professional medical societies. ACIP vaccine recommendations form two immunization schedules, which are updated annually: (1) the childhood and adolescent immunization schedule and (2) the adult immunization schedule. Today, once ACIP recommendations are adopted by the Director of the Centers for Disease Control and Prevention and the Secretary of the Department of Health and Human Services, these recommendations are published in Morbidity and Mortality Weekly Report (MMWR), become official policy, and are incorporated into the appropriate immunization schedule.

Can we forget the Mini-Mental State Examination? A systematic review of the validity of cognitive screening instruments within one month after stroke.

OBJECTIVE: To review systematically studies investigating the convergent, criterion, and predictive validity of multi-domain cognitive screening instruments in the first four weeks after stroke. DATA SOURCES: Electronic databases (Pubmed, PsycINFO, CINAHL, Embase) were searched until June 2014. REVIEW METHODS: Studies concerning screening for cognitive dysfunction in stroke patients using multi-domain instruments, within four weeks postinfarct or haemorrhagic stroke, using tests taking no longer than one hour. Convergent, criterion, and predictive validity were examined. RESULTS: A total of 51 studies investigating 16 cognitive screening instruments were identified. None of the instruments covered all of the most affected cognitive domains. Only one study investigated the convergent validity of a multi-domain test during the (sub)acute phase after stroke. A total of 15 studies examined the criterion validity of cognitive measurements during the acute phase after stroke. The Montreal Cognitive Assessment and Higher Cortical Function Deficit Test had good criterion validity. A total of 24 studies examined the predictive ability of multi-domain cognitive instruments applied in the acute phase after stroke. The Cognistat, Montreal Cognitive Assessment, and Functional Independence Measure-cognitive showed good predictive validity. The Mini-Mental State Examination is the most widely used cognitive screening instrument, but shows insufficient criterion validity. CONCLUSION: None of the existing instruments fulfils all criteria. The Montreal Cognitive Assessment is the best candidate at present, provided items measuring speed of information processing are added, and further studies investigating the optimal cut-offs are conducted.

Localized micro- and nano-scale remodelling in the diabetic aorta.

Diabetes is strongly associated with cardiovascular disease, but the mechanisms, structural and biomechanical consequences of aberrant blood vessel remodelling remain poorly defined. Using an experimental (streptozotocin, STZ) rat model of diabetes, we hypothesized that diabetes enhances extracellular protease activity in the aorta and induces morphological, compositional and localized micromechanical tissue remodelling. We found that the medial aortic layer underwent significant thickening in diabetic animals but without significant changes in collagen or elastin (abundance). Scanning acoustic microscopy demonstrated that such tissue remodelling was associated with a significant decrease in acoustic wave speed (an indicator of reduced material stiffness) in the inter-lamellar spaces of the vessel wall. This index of decreased stiffness was also linked to increased extracellular protease activity (assessed by semi-quantitative in situ gelatin zymography). Such a proteolytically active environment may affect the macromolecular structure of long-lived extracellular matrix molecules. To test this hypothesis, we also characterized the effects of diabetes on the ultrastructure of an important elastic fibre component: the fibrillin microfibril. Using size exclusion chromatography and atomic force microscopy, we isolated and imaged microfibrils from both healthy and diabetic aortas. Microfibrils derived from diabetic tissues were fragmented, morphologically disrupted and weakened (as assessed following molecular combing). These structural and functional abnormalities were not replicated by in vitro glycation. Our data suggest that proteolysis may be a key driver of localized mechanical change in the inter-lamellar space of diabetic rat aortas and that structural proteins (such as fibrillin microfbrils) may be biomarkers of diabetes induced damage.

A DNA sequence element that advances replication origin activation time in Saccharomyces cerevisiae.

Eukaryotic origins of DNA replication undergo activation at various times in S-phase, allowing the genome to be duplicated in a temporally staggered fashion. In the budding yeast Saccharomyces cerevisiae, the activation times of individual origins are not intrinsic to those origins but are instead governed by surrounding sequences. Currently, there are two examples of DNA sequences that are known to advance origin activation time, centromeres and forkhead transcription factor binding sites. By combining deletion and linker scanning mutational analysis with two-dimensional gel electrophoresis to measure fork direction in the context of a two-origin plasmid, we have identified and characterized a 19- to 23-bp and a larger 584-bp DNA sequence that are capable of advancing origin activation time.

Vaccines in the pipeline: the path from development to use in the United States.

New vaccines in the United States go through a complex process on their path from development to the domestic market involving an intricate partnership of public and private agencies and organizations. This process includes licensure by the US Food and Drug Administration, the development of recommendations by the Advisory Committee on Immunization Practices, and safety oversight post-licensure. This article examines the roles of the US Food and Drug Administration and the Centers for Disease Control and Prevention as well as certain professional organizations in governing the testing, marketing, and usage of new vaccines. Vaccines currently in development to treat numerous infectious and noninfectious diseases are also examined and compared with frameworks of domestic vaccine development prioritization, past and present, as assessed by the Institute of Medicine.

Concordancia entre histología pre, intra y postoperatoria en cáncer de endometrio / Concordance between pre and intraoperatory biopsy in endometrial cancer

Antecedentes: En pacientes con cáncer de endometrio se discute la concordancia entre biopsia pre e intraoperatoria versus la definitiva, en grado de diferenciación, tipo histológico y profundidad de mioinvasión. Método: Se determinó sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de: grado de diferenciación bien diferenciado y tipo histológico sólo endometrioide en biopsia preoperatoria; y grado de diferenciación bien diferenciado, tipo histológico sólo endometrioide y profundidad de mioinvasión menor o igual a la mitad interna del miometrio, en biopsia intraoperatoria, para resultados similares en biopsia definitiva en serie clínica de pacientes con cáncer de endometrio clínicamente limitado al útero sometidas a tratamiento quirúrgico primario. Resultados: Biopsia preoperatoria: grado de diferenciación bien diferenciado S: 100 por ciento, E: 77,8 por ciento, VPP: 78,9 por ciento y VPN: 100 por ciento. Tipo histológico sólo endometrioide S: 86,4 por ciento, E: 33,3 por ciento, VPP: 86,4 por ciento y VPN: 33,3 por ciento, para resultado similar en biopsia definitiva. Biopsia intrao-peratoria: grado de diferenciación bien diferenciado S: 91,7 por ciento, E: 94,4 por ciento, VPP: 91,7 por ciento y VPN: 100 por ciento. Tipo histológico sólo endometrioide S: 95,7 por ciento, E: 77,8 por ciento, VPP: 95,7 por ciento y VPN: 70 por ciento. Profundidad de mioinvasión menor o igual a mitad interna del miometrio S: 95,2 por ciento, E: 30 por ciento, VPP: 74,1 por ciento y VPN: 75 por ciento, para resultado similar en la biopsia definitiva. Conclusión: No hubo concordancia absoluta de grado de diferenciación bien diferenciado entre biopsia preoperatoria y biopsia definitiva, ni de grado de diferenciación bien diferenciado ni tipo histológico sólo endometrioide entre biopsia intraoperatoria y biopsia definitiva, por lo que se recomienda etapificación quirúgica independiente de los resultados de las biopsias pre e...

Background: Among patients with endometrial cancer there is discussion about concordance between pre and intraoperatory biopsy and the definitive one, for diferentiation grade, histologyc type and depth of myoinvasion. Method: To determinate sensibility (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of: good diferenciated diferentiation grade and only endometrioid histologyc type on preoperatory biopsy, and good diferenciated diferentiation grade, only endometrioid histologyc type and inner half of the miometryum or less myoinvasion depth on intraoperatory biopsy, for similar result on definitive biopsy in a clinical cohort of patients with endometrial cancer clinically limited to uterus treated with primary surgery. Results: Preoperatory biopsy: good diferentiated diferentiation grade S: 100 percent, Sp: 77.8 percent, PPV: 78.9 percent and NPV: 100 percent. Only endometrioid histologyc type S: 86.4 percent, Sp: 33.3 percent, PPV 86.4 percent and NPV 33.3 percent, for similar result on definitive biopsy. Intraoperatory biopsy: Good diferentiated diferentiation grade S: 91.7 percent, Sp: 94.4 percent, PPV: 91.7 percent and NPV 100 percent. Only endometrioid histologyc type S: 95.7 percent, Sp 77.8 percent, PPV 95.7 percent and NPV 70 percent. Inner half of the myometrium or less myoinvasion depth S: 95.2 percent, Sp 30 percent, PPV 74.1 percent and NPV 75 percent, for similar result on definitive biopsy. Conclusion: There wasn't absolute concordance of good diferentiated diferentiation grade between preoperatory and definitive biopsy. Also there weren't absolute concordance of neither good diferentiated diferentiation grade, nor only endometrioid histologyc type, between intraoperatory and definitive biopsy, for that it is recommended surgical staging, independent of results of pre and intraoperatory biopsies.

Hyperchromatic crowded cell groups in gynaecological liquid-based cytology samples.

Cervical cytology screening is a complex and demanding procedure. Correct diagnosis depends on accurate interpretation of cells, including dense clusters known as hyperchromatic crowded cell groups (HCCG). These groups are frequently encountered in liquid-based cytology (LBC) samples and can be difficult to identify as a specific cell type. Although usually benign and thus often overlooked, they may occasionally represent severely abnormal cells. Thus, their correct interpretation is vital for accurate reporting. Such groups are responsible for false-positive and false-negative reporting and have been implicated in cases of missed dyskaryosis and cervical cancer. Normal and abnormal cells of both squamous and glandular origin, together with non-epithelial elements, may present as HCCG and this review uses the authors' experience with SurePath to describe the morphological criteria used to evaluate them when screening. Despite the introduction of semi-automated screening systems for LBC, there is currently no complete replacement for human interpretation of cell morphology in cytology screening.

Nasal bleeding and non-accidental injury in an infant.

Bleeding from the nose has been a point of controversy in the field of child protection in the UK in recent years. Epistaxis in childhood is common but is unusual in the first year of life. Oronasal blood in infancy has been proposed as a marker of child abuse in this age group, but despite this widely held belief, there is a lack of published evidence in this area. The case is reported of an infant who presented at one month of age with serious inflicted injuries, who had been seen in the emergency department only 13 days previously with a "spontaneous" self-limiting nose bleed.