Image quality in low-dose coronary computed tomography angiography with a new high-definition CT scanner

A new generation of high definition computed tomography (HDCT) 64-slice devices complemented by a new iterative image reconstruction algorithm-adaptive statistical iterative reconstruction, offer substantially higher resolution compared to standard definition CT (SDCT) scanners. As high resolution confers higher noise we have compared image quality and radiation dose of coronary computed tomography angiography (CCTA) from HDCT versus SDCT. Consecutive patients (n = 93) underwent HDCT, and were compared to 93 patients who had previously undergone CCTA with SDCT matched for heart rate (HR), HR variability and body mass index (BMI). Tube voltage and current were adapted to the patient's BMI, using identical protocols in both groups. The image quality of all CCTA scans was evaluated by two independent readers in all coronary segments using a 4-point scale (1, excellent image quality; 2, blurring of the vessel wall; 3, image with artefacts but evaluative; 4, non-evaluative). Effective radiation dose was calculated from DLP multiplied by a conversion factor (0.014 mSv/mGy × cm). The mean image quality score from HDCT versus SDCT was comparable (2.02 ± 0.68 vs. 2.00 ± 0.76). Mean effective radiation dose did not significantly differ between HDCT (1.7 ± 0.6 mSv, range 1.0-3.7 mSv) and SDCT (1.9 ± 0.8 mSv, range 0.8-5.5 mSv; P = n.s.). HDCT scanners allow low-dose 64-slice CCTA scanning with higher resolution than SDCT but maintained image quality and equally low radiation dose. Whether this will translate into higher accuracy of HDCT for CAD detection remains to be evaluated.

Feasibility and acceptance of electronic quality of life assessment in general practice: an implementation study

Background Patients' health related quality of life (HRQoL) has rarely been systematically monitored in general practice. Electronic tools and practice training might facilitate the routine application of HRQoL questionnaires. Thorough piloting of innovative procedures is strongly recommended before the conduction of large-scale studies. Therefore, we aimed to assess i) the feasibility and acceptance of HRQoL assessment using tablet computers in general practice, ii) the perceived practical utility of HRQoL results and iii) to identify possible barriers hindering wider application of this approach. Methods Two HRQoL questionnaires (St. George's Respiratory Questionnaire SGRQ and EORTC QLQ-C30) were electronically presented on portable tablet computers. Wireless network (WLAN) integration into practice computer systems of 14 German general practices with varying infrastructure allowed automatic data exchange and the generation of a printout or a PDF file. General practitioners (GPs) and practice assistants were trained in a 1-hour course, after which they could invite patients with chronic diseases to fill in the electronic questionnaire during their waiting time. We surveyed patients, practice assistants and GPs regarding their acceptance of this tool in semi-structured telephone interviews. The number of assessments, HRQoL results and interview responses were analysed using quantitative and qualitative methods. Results Over the course of 1 year, 523 patients filled in the electronic questionnaires (1–5 times; 664 total assessments). On average, results showed specific HRQoL impairments, e.g. with respect to fatigue, pain and sleep disturbances. The number of electronic assessments varied substantially between practices. A total of 280 patients, 27 practice assistants and 17 GPs participated in the telephone interviews. Almost all GPs (16/17 = 94%; 95% CI = 73–99%), most practice assistants (19/27 = 70%; 95% CI = 50–86%) and the majority of patients (240/280 = 86%; 95% CI = 82–91%) indicated that they would welcome the use of electronic HRQoL questionnaires in the future. GPs mentioned availability of local health services (e.g. supportive, physiotherapy) (mean: 9.4 ± 1.0 SD; scale: 1 – 10), sufficient extra time (8.9 ± 1.5) and easy interpretation of HRQoL results (8.6 ± 1.6) as the most important prerequisites for their use. They believed HRQoL assessment facilitated both communication and follow up of patients' conditions. Practice assistants emphasised that this process demonstrated an extra commitment to patient centred care; patients viewed it as a tool, which contributed to the physicians' understanding of their personal condition and circumstances. Conclusion This pilot study indicates that electronic HRQoL assessment is technically feasible in general practices. It can provide clinically significant information, which can either be used in the consultation for routine care, or for research purposes. While GPs, practice assistants and patients were generally positive about the electronic procedure, several barriers (e.g. practices' lack of time and routine in HRQoL assessment) need to be overcome to enable broader application of electronic questionnaires in every day medical practice.

Self-motion perception training: thresholds improve in the light but not in the dark

We investigated perceptual learning in self-motion perception. Blindfolded participants were displaced leftward or rightward by means of a motion platform and asked to indicate the direction of motion. A total of eleven participants underwent 3,360 practice trials, distributed over twelve (Experiment 1) or 6 days (Experiment 2). We found no improvement in motion discrimination in both experiments. These results are surprising since perceptual learning has been demonstrated for visual, auditory, and somatosensory discrimination. Improvements in the same task were found when visual input was provided (Experiment 3). The multisensory nature of vestibular information is discussed as a possible explanation of the absence of perceptual learning in darkness.

Overview of dermatologic problems following liver transplantation

Liver transplantation recipients, like other solid organ transplantation recipients, have an increased risk of dermatologic problems due to their long-term immunosuppression and benefit from pre-and post-transplantation screenings, and management by a dermatologist and dermatologic care should be integrated into the comprehensive, multidisciplinary care of liver transplantation recipients [1,2]. Cutaneous findings include aesthetic alterations, infections, precancerous lesions, and malignancies. The severity of skin alterations ranges from benign, unpleasant changes to life-threatening conditions [3-5]. In addition to skin cancer diagnosis and management, visits with a dermatologist serve to educate and improve the patient's sun-protection behavior. Among all solid organ transplantations, liver transplantation requires the least amount of immunosuppression, sometimes even permitting its complete cessation [6]. As a result, patients who have undergone liver transplantation tend to have fewer dermatologic complications compared with other solid organ transplantation recipients [7]. However, due to the large volume of the liver, patients undergoing liver transplantation receive more donor lymphocytes than kidney, heart, or lung transplantation recipients. Because of the immunosuppression, the transplanted lymphocytes proliferate and rarely trigger graft-versus-host-disease [8,9]. This topic will provide an overview of dermatologic disorders that may be seen following liver transplantation. A detailed discussion of skin cancer following solid organ transplantation and the general management of patients following liver transplantation are discussed separately. (See "Development of malignancy following solid organ transplantation" and "Management of skin cancer in solid organ transplant recipients" and "Long-term management of adult liver transplant recipients".)

How Comprehensible, Interesting and Relevant is Current Research in Traditional Chinese Medicine for Practitioners?

Purpose: In traditional Chinese medicine (TCM) as in other fields of complementary medicine, research does not necessarily follow the sequence from in vitro studies via phase I to phase IV clinical trials, but all steps are being investigated simultaneously. Here, we aimed to investigate which kinds of studies were interesting and relevant for practitioners. Methods: Thirty abstracts from articles on TCM published between April and June 2012 were randomly chosen, including 5 abstracts each of in vitro studies, animal studies, case reports or series, studies with healthy volunteers, trials with patients, or reviews and meta-analyses. Six TCM practitioners (2 female, 5 non-medical, average age 46 years, average practical TCM experience 9 years) rated 10 abstracts each on a 5 point Likert scale (1=very poor to 5=very good) regarding comprehensibility, interest, relevance to practice, information for patients, and promoting reputation of TCM. Average ratings for each group of abstracts were calculated. Results: Comprehensibility of the abstracts was generally rated as good. Case reports/series, studies in healthy volunteers and trials with patients were rated interesting by the practitioners (average rating = 3.7, 3.8 and 3.7, respectively). Relevance to practice was mediocre for all types (2.5 to 3.5). In vitro studies and reviews/meta-analyses were not rated useful as information for patients (2.0). Reviews/Meta-analyses were considered negative for the reputation of TCM (2.2). Conclusions: Practitioners of TCM find abstracts of study results generally comprehensible and interesting. Case reports/series were rated in a similar way as trials with patients. Although TCM is commonly taught by means of case reports, practitioners seemed to value clinical trials. Abstracts of reviews/meta-analyses were rated rather uninformative, which was possibly due to several inconclusive results and the lack of detailed information in these abstracts.

New Constraints on Dark Matter Effective Theories from Standard Model Loops

We consider an effective field theory for a gauge singlet Dirac dark matter particle interacting with the standard model fields via effective operators suppressed by the scale Λ≳1  TeV. We perform a systematic analysis of the leading loop contributions to spin-independent Dirac dark matter–nucleon scattering using renormalization group evolution between Λ and the low-energy scale probed by direct detection experiments. We find that electroweak interactions induce operator mixings such that operators that are naively velocity suppressed and spin dependent can actually contribute to spin-independent scattering. This allows us to put novel constraints on Wilson coefficients that were so far poorly bounded by direct detection. Constraints from current searches are already significantly stronger than LHC bounds, and will improve in the near future. Interestingly, the loop contribution we find is isospin violating even if the underlying theory is isospin conserving.

Rivastigmine effects on EEG spectra and three-dimensional LORETA functional imaging in Alzheimer's disease

OBJECTIVE The objective of the study is to investigate the electrocortical and the global cognitive effects of 3 months rivastigmine medication in a group of mild to moderate Alzheimer's disease patients. MATERIALS AND METHODS Multichannel EEG and cognitive performances measured with the Mini Mental State Examination in a group of 16 patients with mild to moderate Alzheimer's Disease were collected before and 3 months after the onset of rivastigmine medication. RESULTS Spectral analysis of the EEG data showed a significant power decrease in the delta and theta frequency bands during rivastigmine medication, i.e., a shift of the power spectrum towards 'normalization'. Three-dimensional low resolution electromagnetic tomography (LORETA) functional imaging localized rivastigmine effects in a network that includes left fronto-parietal regions, posterior cingulate cortex, bilateral parahippocampal regions, and the hippocampus. Moreover, a correlation analysis between differences in the cognitive performances during the two recordings and LORETA-computed intracortical activity showed, in the alpha1 frequency band, better cognitive performance with increased cortical activity in the left insula. CONCLUSION The results point to a 'normalization' of the EEG power spectrum due to medication, and the intracortical localization of these effects showed an increase of cortical activity in frontal, parietal, and temporal regions that are well-known to be affected in Alzheimer's disease. The topographic convergence of the present results with the memory network proposed by Vincent et al. (J. Neurophysiol. 96:3517-3531, 2006) leads to the speculation that in our group of patients, rivastigmine specifically activates brain regions that are involved in memory functions, notably a key symptom in this degenerative disease.

Wirkung sportlicher Aktivität auf das aktuelle Befinden im höheren Erwachsenenalter - Verlaufsanalysen in Sportprogrammen

Mit zunehmendem Alter nimmt das Sportengagement ab. Wichtig für eine langfristige Sportteilnahme sind positive affektive Reaktionen beim Sporttreiben. Fehlende Studien zur Untersuchung affektiver Reaktionen auf Sportaktivitäten im höheren Erwachsenenalter stellen ein Forschungsdefizit dar. Daher untersucht dieser Beitrag die Wirkung sportlicher Aktivitäten auf die aktuelle Befindlichkeit im Verlauf von Sportprogrammen im höheren Erwachsenenalter. Hierfür wurden 108 Personen (≥ 65 Jahre) in acht Sportprogrammen zu Beginn zu ihren sportbezogenen Zielen schriftlich befragt. Bei einem zweiten Kursbesuch wurde die Befindlichkeit vor, während und nach, die Belastungsintensität während und das Kompetenzerleben nach der Sportaktivität schriftlich erfasst. Die Ergebnisse zeigen eine überwiegend positive Wirkung der Sportaktivitäten auf die aktuelle Befindlichkeit sowohl auf Gruppenebene als auch auf individueller Ebene. Im Einklang mit der Dual Mode Theorie stellt sich das Kompetenzerleben als Prädiktor für das aktuelle Befinden während moderaten Sportaktivitäten heraus. Die sportbezogenen Ziele beeinflussen das Befinden nur, wenn die Belastung differenzierter untersucht wird (niedrig vs. mittel). Die Ergebnisse deuten mehrheitlich darauf hin, dass eine weitere Differenzierung der Dual Mode Theorie in niedrige und mittlere Intensität für Sportaktivitäten im höheren Erwachsenenalter angebracht ist.

Diversity Management trainieren

Dieses Buchkapitel vermittelt einen Überblick über die aktuellen wissenschaftlichen Befunde zur Wirksamkeit von Diversity Trainings. Es zeigt auf, dass trotz der sehr unterschiedlichen Ausgestaltung von Diversity Trainings in der Praxis, diese Trainings im Prinzip wirksam sind. Das heisst, Diversity Trainings können Wissen und Fähigkeiten über den Inhalt und das Ziel von Diversity Strategien effizient vermitteln, Einstellungen gegenüber Diversity verbessern sowie auch positive Verhaltensänderungen im Umgang mit Personen aus diversen sozialen Gruppen herbeiführen. Dieses Buchkapitel zeigt aber auch auf, dass die Wirksamkeit von Diversity Trainings stark von einer Reihe weiterer Faktoren abhängt (z.B. Fokus des Trainings oder Teilnahmebedingungen) sowie auch paradoxe und unerwünschte „Nebenwirkungen“ haben können. Werden solche Aspekte berücksichtigt, sind Diversity Trainings eine sinnvolle und wirksame Massnahme zur Umsetzung einer übergreifenden Diversity Management Strategie.

Cognitive effects of masculine generics in German. An overview of empirical findings

This article presents a series of experiments which were conducted among native speakers of German to determine the influence of different types of German generics on the cognitive inclusion of women. Results indicate that the inclusion of women is higher with ‘non-sexist’ alternatives than with masculine generics, a tendency which was consistent across different studies. The different alternatives, however, showed different effects which also varied depending on the context. These results are discussed with regard to their practical consequences in situations such as nominating women and men for awards or political offices.