Contrast agents and ionization with respect to safety for patients and doctors

In hemodialysis patients, radiographic imaging with iodinated contrast medium (ICM) application plays a central role in the diagnosis and/or follow-up of disease-related conditions. Therefore, safety aspects concerning ICM administration and radiation exposure have a great impact on this group of patients. Current hardware and software improvements including the design and synthesis of modern contrast compounds allow the use of very small amounts of ICM in concert with low radiation exposure. Undesirable ICM side effects are divided into type A (predictable reactions such as heat feeling, headache, and contrast-induced acute kidney injury, for example) and type B (nonpredictable or hypersensitivity) reactions; this chapter deals with the latter. The first onset cannot be prevented. To prevent hypersensitivity upon reexposure of ICM, an allergological workup is recommended. If this is not possible and ICM is necessary, the patient should receive a premedication (H1 antihistamine with or without corticosteroids). Current imaging hardware and software improvements (e.g. such as additional filtration of the X-ray beam) allow the use of very small amount of ICM and small X-ray doses. Proper communication among the team involved in the treatment of a patient may allow to apply imaging protocols and efficient imaging strategies limiting radiation exposure to a minimum. Practical recommendations will guide the reader how to use radiation and ICM efficiently to improve both patient and staff safety.

Intravenous Iodinated Contrast Agents Amplify DNA Radiation Damage at CT

PURPOSE To determine the effect of the use of iodinated contrast agents on the formation of DNA double-strand breaks during chest computed tomography (CT). MATERIALS AND METHODS This study was approved by the institutional review board, and written informed consent was obtained from all patients. This single-center study was performed at a university hospital. A total of 179 patients underwent contrast material-enhanced CT, and 66 patients underwent unenhanced CT. Blood samples were taken from these patients prior to and immediately after CT. In these blood samples, the average number of phosphorylated histone H2AX (γH2AX) foci per lymphocyte was determined with fluorescence microscopy. Significant differences between the number of foci that developed in both the presence and the absence of the contrast agent were tested by using an independent sample t test. RESULTS γH2AX foci levels were increased in both groups after CT. Patients who underwent contrast-enhanced CT had an increased amount of DNA radiation damage (mean increase ± standard error of the mean, 0.056 foci per cell ± 0.009). This increase was 107% ± 19 higher than that in patients who underwent unenhanced CT (mean increase, 0.027 foci per cell ± 0.014). CONCLUSION The application of iodinated contrast agents during diagnostic x-ray procedures, such as chest CT, leads to a clear increase in the level of radiation-induced DNA damage as assessed with γH2AX foci formation.

Towards harmonised procedures in wildlife epidemiological investigations: A serosurvey of infection with Mycobacterium bovis and closely related agents in wild boar (Sus scrofa) in Switzerland

Bovine tuberculosis (bTB) is a (re-)emerging disease in European countries, including Switzerland. This study assesses the seroprevalence of infection with Mycobacterium bovis and closely related agents in wild boar (Sus scrofa) in Switzerland, because wild boar are potential maintenance hosts of these pathogens. The study employs harmonised laboratory methods to facilitate comparison with the situation in other countries. Eighteen out of 743 blood samples tested seropositive (2.4%, CI: 1.5-3.9%) by ELISA, and the results for 61 animals previously assessed using culture and PCR indicated that this serological test was not 100% specific for M. bovis, cross-reacting with M. microti. Nevertheless, serology appears to be an appropriate test methodology in the harmonisation of wild boar testing throughout Europe. In accordance with previous findings, the low seroprevalence found in wild boar suggests wildlife is an unlikely source of the M. bovis infections recently detected in cattle in Switzerland. This finding contrasts with the epidemiological situation pertaining in southern Spain.

The Effects of Physical and Chemical Modulating Agents on the Induction of Vaccine-Induced Immune Responses

After the development of the viral-based prostate cancer vaccine, Ad5-PSA, much research has been orientated to help enhance the induced immune response by combining the vaccine with physical and chemical modulating agents, more specifically the polymers polyethylenimine (PEI), chitosan, and chitosan coated with CD3 complex antibodies; all previously shown to stimulate an immune response as isolated gene carriers. To compare the vaccine-induced immune responses between the naked vaccine and the polymer-vaccine combinations, a mouse model using the ovalbumin- specific Ad-OVA vaccine was tested using intracellular cytokine staining (ICS), tetramer staining, and cytotoxic T-cell lymphocyte assays to measure the activation of CD8+ T-cells, interferon gamma proteins (INFƒ×), and the induced cytotoxicity to ovalbumin. The Ad-OVA vaccine combined with both chitosan and chitosan with CD3 complex antibodies, both natural polymers, were found to induce similar immune responses to the naked vaccine while the vaccine combined with the synthetic polymer, PEI, diminished the immune response.

"An attentive Ear, a watchful Eye, and a Calm judicious Pen": William Samuel Johnson, the Colonial Agents, and the Transformation of the British Atlantic World

By looking at Great Britain and the American colonies in conjunction with the larger British Atlantic Empire, historians can better understand the political, social, and cultural transformations that occurred when transatlantic actors met. William Samuel Johnson is an example of an "ordinary" agent who nonetheless had extensive contacts with numerous British and American thinkers. While acting on Connecticut's behalf in London between 1767 and 1771, he sent reports back to Connecticut governors Jonathan Trumbull and William Pitkin on parliamentary proceedings while corresponding with the people who traveled around the Atlantic world during this critical period-merchants, seafarers, emigrants, soldiers, missionaries, radicals and conservatives, reformers, and politicians. He is also representative of the late eighteenth-century empire writ large. Agents, who had once been a source of stability in the far-flung colonies, became a destabilizing force as confusion and conflict grew over conceptual ideas of what constituted "the empire" and who was included in it. Johnson was a sane observer in the midst of the ideological and administrative upheaval of the 1760's and 1770's. His subsequent loyalism and political obscurity during the war years was in many ways a result of his attempts to reconcile various factional interests during his tenure as an agent. Although he did his best to resolve these divisions and provide an accurate account of the powerful nationalistic forces gathering on both sides of the Atlantic on the eve of the American Revolution, the agents' collective failures as transatlantic mediators helped bring about the collapse of an imperial community. This disintegration had dramatic effects on the whole of the Atlantic world.

Now You See it, Now You Don't: Why Do Real Estate Agents Withhold Available Houses from Black Customers?

Potential home buyers may initiate contact with a real estate agent by asking to see a particular advertised house. This paper asks whether an agent's response to such a request depends on the race of the potential buyer or on whether the house is located in an integrated neighborhood. We build on previous research about the causes of discrimination in housing by using data from fair housing audits, a matched-pair technique for comparing the treatment of equllay qualified black and white home buyers. However, we shift the focus from differences in the treatment of paired buyers to agent decisions concerning an individual housing unit using a sample of all houses seen during he 1989 Housing Discrimination study. We estimate a random effect, multinomial logit model to explain a real estate agent's joint decisions concerning whether to show each unit to a black auditor and to a white auditor. We find evidence that agents withhold houses in suburban, integrated neighborhoods from all customers (redlining), that agents' decisions to show houses in integrated neighborhoods are not the same for black and white customers (steering), and that the houses agents show are more likely to deviate from the initial request when the customeris black than when the customer is white. These deviations are consistent with the possibility that agents act upon the belief that some types of transactions are relatively unlikely for black customers (statistical discrimination).

Asset Pricing with Heterogeneous Agents, Incomplete Markets and Trading Constraints

The consumption capital asset pricing model is the standard economic model used to capture stock market behavior. However, empirical tests have pointed out to its inability to account quantitatively for the high average rate of return and volatility of stocks over time for plausible parameter values. Recent research has suggested that the consumption of stockholders is more strongly correlated with the performance of the stock market than the consumption of non-stockholders. We model two types of agents, non-stockholders with standard preferences and stock holders with preferences that incorporate elements of the prospect theory developed by Kahneman and Tversky (1979). In addition to consumption, stockholders consider fluctuations in their financial wealth explicitly when making decisions. Data from the Panel Study of Income Dynamics are used to calibrate the labor income processes of the two types of agents. Each agent faces idiosyncratic shocks to his labor income as well as aggregate shocks to the per-share dividend but markets are incomplete and agents cannot hedge consumption risks completely. In addition, consumers face both borrowing and short-sale constraints. Our results show that in equilibrium, agents hold different portfolios. Our model is able to generate a time-varying risk premium of about 5.5% while maintaining a low risk free rate, thus suggesting a plausible explanation for the equity premium puzzle reported by Mehra and Prescott (1985).

Progestational agents and preterm birth: An updated review of the literature

The preterm birth rate has been increasing over time in the United States, causing a large social and individual financial burden. Though the cause of preterm birth is now known, risk factors such as a previous preterm birth and a short cervical length have been identified as possible predictors. There are many contributing social and behavioral factors that play a role was well as medical problems that occur before and during pregnancy. Though there have been prevention methods identified, such as prenatal care, tocolytic therapy and cervical cerclage, none of these methods have shown to definitively prevent preterm birth over a long period of time. 17 alpha hydroxyprogesterone has been recognized as a possible prevention method for women at high risk for preterm birth. Three out of the five studies assessed in this review showed a significant reduction in preterm birth with administration of progesterone, both for women with a previous preterm birth and with a short cervical length. Currently there is no standard of care for those at high risk for preterm birth. More large clinical trials need to be conducted to determine if this progesterone for the prevention of preterm birth is effective. ^

Cytogenetic assessment of occupational exposure to antineoplastic agents

This study has evaluated the utility of measuring effects of low level occupational exposure of nursing personnel to antineoplastic agents. The effect measured in this study is chromosomal damage in peripheral lymphocytes (chromosomal breakage and micronuclei frequency).^ Using nursing personnel in three exposure classifications (low, moderate and high) and breast cancer patients before and after treatment with antineoplastic agents, a weak but statistically significant association was found between exposure and chromosomal damage. Of special interest was the finding that consistent glove usage was negatively associated with increased chromosomal damage.^ The study also demonstrated a statistically significant association between the two measures of chromosomal damage: chromosomal breakage and micronuclei frequency. This suggests that the micronucleus method is a useful test for studying cytogenetic effects in lymphocytes. ^