Digitizing UK analogue magnetogram records from large geomagnetic storms of the past two centuries.

Continuous geomagnetic records of the strength and direction of the Earth's field at the surface extend back to the 1840s. Over the past two centuries, eight observatories have existed in the United Kingdom, which measured the daily field variations using light-sensitive photographic paper to produce analogue magnetograms. Around 350,000 magnetograms have been digitally photographed at high resolution. However, converting the traces to digital values is difficult and time consuming as the magnetograms can have over-lapping lines, low quality recordings and obscure metadata for conversion to SI units. We discuss our approach to digitizing the traces from large geomagnetic storms and highlight some of the issues to be aware of when capturing magnetic information from analogue measurements. These include cross-checking the final digitized values with the recorded hourly mean values from observatory year books and comparing several observatory records for the same storm to catch errors such as sign inversions or incorrect 'wrap-around' of data on the paper records.

Cranial meningioma with bone involvement: surgical strategies and clinical considerations.

BACKGROUND: Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients. METHODS: A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0. RESULTS: Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%). CONCLUSION: Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.

Superiorization-inspired unrolled SART algorithm with U-Net generated perturbations for sparse-view and limited-angle CT reconstruction.

Objective.Unrolled algorithms are a promising approach for reconstruction of CT images in challenging scenarios, such as low-dose, sparse-view and limited-angle imaging. In an unrolled algorithm, a fixed number of iterations of a reconstruction method are unrolled into multiple layers of a neural network, and interspersed with trainable layers. The entire network is then trained end-to-end in a supervised fashion, to learn an appropriate regularizer from training data. In this paper we propose a novel unrolled algorithm, and compare its performance with several other approaches on sparse-view and limited-angle CT.Approach.The proposed algorithm is inspired by the superiorization methodology, an optimization heuristic in which iterates of a feasibility-seeking method are perturbed between iterations, typically using descent directions of a model-based penalty function. Our algorithm instead uses a modified U-net architecture to introduce the perturbations, allowing a network to learn beneficial perturbations to the image at various stages of the reconstruction, based on the training data.Main Results.In several numerical experiments modeling sparse-view and limited angle CT scenarios, the algorithm provides excellent results. In particular, it outperforms several competing unrolled methods in limited-angle scenarios, while providing comparable or better performance on sparse-view scenarios.Significance.This work represents a first step towards exploiting the power of deep learning within the superiorization methodology. Additionally, it studies the effect of network architecture on the performance of unrolled methods, as well as the effectiveness of the unrolled approach on both limited-angle CT, where previous studies have primarily focused on the sparse-view and low-dose cases.

Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation.

OBJECTIVE: Cranioplasty remains an essential procedure following craniectomy but is associated with high morbidity. We investigated factors associated with outcomes following first alloplastic cranioplasty. METHODS: A single-centre, retrospective cohort study of patients undergoing first alloplastic cranioplasty at a tertiary neuroscience centre (01 March 2010-01 September 2021). Patient demographics and craniectomy/cranioplasty details were extracted. Primary outcome was all-cause explantation. Secondary outcomes were explantation secondary to infection, surgical morbidity and mortality. Multivariable analysis was performed using Cox proportional hazards regression or binary logistic regression. RESULTS: Included were 287 patients with a mean age of 42.9 years [SD = 15.4] at time of cranioplasty. The most common indication for craniectomy was traumatic brain injury (32.1%, n = 92). Cranioplasty materials included titanium plate (23.3%, n = 67), hydroxyapatite (22.3%, n = 64), acrylic (20.6%, n = 59), titanium mesh (19.2%, n = 55), hand-moulded PMMA cement (9.1%, n = 26) and PEEK (5.6%, n = 16). Median follow-up time after cranioplasty was 86.5 months (IQR 44.6-111.3). All-cause explantation was 12.2% (n = 35). Eighty-three patients (28.9%) had surgical morbidity. In multivariable analysis, the risk of all-cause explantation and explantation due to infection was reduced with the use of both hydroxyapatite (HR 0.22 [95% CI 0.07-0.71], p = .011, HR 0.22 [95% CI 0.05-0.93], p = .040) and acrylic (HR 0.20 [95% CI 0.06-0.73], p = .015, HR 0.24 [95% CI 0.06-0.97], p = .045), respectively. In addition, risk of explantation due to infection was increased when time to cranioplasty was between three and six months (HR 6.38 [95% CI 1.35-30.19], p = .020). Mean age at cranioplasty (HR 1.47 [95% CI 1.03-2.11], p = .034), titanium mesh (HR 5.36 [95% CI 1.88-15.24], p = .002), and use of a drain (HR 3.37 [95% CI 1.51-7.51], p = .003) increased risk of mortality. CONCLUSIONS: Morbidity is high following cranioplasty, with over a tenth requiring explantation. Hydroxyapatite and acrylic were associated with reduced risk of all-cause explantation and explantation due to infection. Cranioplasty insertion at three to six months was associated with increased risk of explantation due to infection.

"Can differences in hospitalised mild traumatic brain injury (mTBI) outcomes at 12 months be predicted?"

OBJECTIVES: To identify risk factors for poor outcome one year post-mild traumatic brain injury (mTBI). DESIGN: This study was a prospective observational study using consecutive adult hospital admissions with mTBI. SUBJECTS: A total of 869 consecutive mTBI patients were enrolled in this study. METHODS: All patients were reviewed by the specialist TBI rehabilitation team at six weeks and one year following mTBI. Demographic and injury data collected included: age, gender, TBI severity and Glasgow Coma Scale (GCS). At twelve months, global outcome was assessed by the Extended Glasgow Outcome Score (GOSE) and participation restriction by the Rivermead Head Injury Follow-up Questionnaire (RHFUQ) via semi-structured interview. An ordinal regression (OR) was used to identify associated factors for poor GOSE outcome and a linear regression for a poor RHFUQ outcome. RESULTS: In the GOSE analysis, lower GCS (p < 0.001), medical comorbidity (p = 0.027), depression (p < 0.001) and male gender (p = 0.008) were identified as risk factors for poor outcome. The RHFUQ analysis identified: lower GCS (p = 0.002), female gender (p = 0.001) and injuries from assault (p = 0.003) were variables associated with worse social functioning at one year. CONCLUSION: mTBI is associated with a significant impact upon the physical health and psychosocial function of affected individuals. The results of this study demonstrate that differences in mTBI outcome can be identified at twelve months post-mTBI and that certain features, particularly GCS, are associated with poorer outcomes.

Vocational Outcomes After Traumatic Brain Injury; Prevalence and Risk Factors After 1 Year in a Multivariable Model.

OBJECTIVE: To determine the prevalence of employment status (ES) or full-time study after traumatic brain injury (TBI) in a representative population and its predictive factors. DESIGN: Prospective cohort study. SETTING: Regional Major Trauma Centre. Participants: In total, 1734 consecutive individuals of working age, admitted with TBI to a Regional Trauma Centre, were recruited and followed up at 8 weeks and 1 year with face-to-face interview. Median age was 37.2 years (17.5-58.2); 51% had mild TBI, and 36.8% had a normal computed tomographic (CT) scan. MAIN OUTCOME MEASURE: Complete or partial/modified return to employment or study as an ordinal variable. RESULTS: At 1 year, only 44.9% returned to full-time work/study status, 28.7% had a partial or modified return, and 26.4% had no return at all. In comparison with status at 6 weeks, 9.9% had lower or reduced work status. Lower ES was associated with greater injury severity, more CT scan abnormality, older age, mechanism of assault, and presence of depression, alcohol intoxication, or a psychiatric history. The multivariable model was highly significant (P < .001) and had a Nagelkerke R2 of 0.353 (35.3%). CONCLUSIONS: Employment at 1 year is poor and changes in work status are frequent, occurring in both directions. While associations with certain features may allow targeting of vulnerable individuals in future, the majority of model variance remains unexplained and requires further investigation.

Understanding the Pain Management Landscape Within the US Bleeding Disorder Community: A Multi-Center Survey.

OBJECTIVES: Pain is a known complication in persons with hemophilia (PWH) as a result of muscle and joint bleeding. Little is known regarding national Hemophilia Treatment Center (HTC) practice patterns related to pain management. The aim of this study was to: 1) Describe pain management practice patterns of HTC providers, 2) Identify gaps and areas of alignment with the CDC pain guidelines, and 3) Address educational opportunities for pain management. This survey is the first extensive description of multidisciplinary practice patterns of pain management for PWH. METHODS: This descriptive study involved physicians, nurse practitioners, nurses, physical therapists, and social workers from federally funded Hemophilia Treatment Centers (HTC) eligible to complete an online survey exploring pain management practice patterns within the CDC pain guidelines. RESULTS: Results of this survey shed light on areas of strength and cohesiveness between HTC providers, including the following: dedication to effective pain management, utilization of non-pharmacological pain options, trial of non-opioid medications first before opioids, maintaining follow-up with patients after opioid prescription initiation, recognizing and utilizing clinically important findings before prescribing opioids, and counseling their patients regarding potential risk factors. CONCLUSIONS: There remain opportunities to incorporate into clinical practice consistent use of tools such as formal screening questionnaires, opioid use agreements, written measurable goals, ongoing prescription monitoring, and written plans for discontinuation of opioid therapy. These results provide opportunities for improvement in education of HTC team members thus optimizing pain management in persons with bleeding disorders.

Early prognostication of COVID-19 to guide hospitalisation versus outpatient monitoring using a point-of-test risk prediction score.

INTRODUCTION: Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking. METHODS: Multivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290). RESULTS: 983 patients (median age 70, IQR 53-83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0-1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%). CONCLUSION: The SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.

Superiorized method for metal artifact reduction.

PURPOSE: Metal artifact reduction (MAR) is a challenging problem in computed tomography (CT) imaging. A popular class of MAR methods replace sinogram measurements that are corrupted by metal with artificial data, typically generated from some combination of interpolation along with other heuristics. While these "projection completion" approaches are successful in eliminating severe artifacts, secondary artifacts may be introduced by the artificial data. In this paper, we propose an approach which uses projection completion to generate a prior image, which is then incorporated into an iterative reconstruction algorithm based on the superiorization framework. The rationale is that the image produced by the iterative algorithm can inherit the desirable properties of the prior image, while also reducing secondary artifacts. METHODS: The prior image is reconstructed using normalized metal artifact reduction (NMAR), a popular projection completion approach. The iterative algorithm is a modified version of the simultaneous algebraic reconstruction technique (SART), which reduces artifacts by incorporating a polyenergetic forward model, least-squares weighting, and superiorization. The penalty function used for superiorization is a weighted average between a total variation (TV) term and a term promoting similarity with the prior image, similar to penalty functions used in prior image constrained compressive sensing (PICCS). Because the prior is largely free of severe metal artifacts, these artifacts are discouraged from arising during iterative reconstruction; additionally, because the iterative approach uses the original projection data, it is able to recover information that is lost during the NMAR process. RESULTS: We perform numerical experiments modeling a simple geometric object, as well as several more realistic scenarios such as metal pins, bilateral hip implants, and dental fillings placed within an anatomical phantom. The proposed iterative algorithm is largely successful at eliminating severe metal artifacts as well as secondary artifacts introduced by the NMAR process, especially lost edges of bone structures in the neighborhood of the metal regions. In one case modeling severe photon starvation, the NMAR algorithm is found to provide better results. CONCLUSION: The proposed algorithm is effective in applying the superiorization methodology to the problem of MAR, providing better results than both NMAR and a purely total variation-based superiorization approach in nearly all cases.

The effect of socioeconomic deprivation on 12 month Traumatic Brain Injury (TBI) outcome.

Objectives: To assess the impact of social deprivation on Traumatic Brain Injury (TBI) global outcome.Design: The study was a prospective observational study conducted using consecutive admissions with TBI.Subjects: 1322 consecutive adult patients with TBI were recruited into the study between 2010 and 2015.Methods: All patients were assessed by the TBI rehabilitation team at both six weeks and 12 months following TBI. Details of the injury and demographic data was collated at six weeks. This included age, gender and ZIP Code. Social deprivation was measured by the Indices of Multiple Deprivation (IMD) Score. The outcome measure used was the Extended Glasgow Outcome Score (GOSE) at 12 months. Univariate analysis was followed by a Multi-Ordinal Regression to evaluate predictor variables.Results: With regard to the representation of IMD deciles, the study population approximated to the general Sheffield population (p = .139). Within the univariate analysis, statistically significant relationships were noted between IMD and GOSE (p = <.001). The Ordinal Regression revealed a significant relationship between worse GOSE and IMD (p = .002), age (p = .001), GCS (p < .001), alcohol intoxication (p < .001) and Medical Comorbidity (p = .041).Conclusion: Increasing social deprivation is associated with poorer global TBI outcomes at 12 months.

Cerebral microbleeds: hearing through the silence-a narrative review.

OBJECTIVE: The term cerebral microbleed (CMB) refers to lesions documented as unexpected findings during computed tomography or magnetic resonance imaging examination of the brain. Initially, a CMB was thought to represent hemosiderin-laden macrophages marking an area of a tiny hemorrhage. Recently, histopathologic studies have shown that the structure of a CMB can be variable. To aid in dealing with this finding and judging its clinical significance, this review addresses important aspects of a CMB, including the definition, prevalence, and incidence in various populations, end-organ damage, associated conditions, and whether any action or treatment by the clinician might be indicated. METHODS: PubMed Medline, EMBASE, BIOSIS, Current Contents, and Derwent Drug Files databases were searched for the keywords "microbleeds-detection-damage", "silent bleeds", "microbleeds", or "silent bleeds AND hemophilia" from 2011-2016. References of retrieved articles were also reviewed and included if applicable. RESULTS: The published data are found primarily in the imaging literature and focus on diagnostic techniques. Some publications address relationships with diverse, co-existing clinical conditions and implications for treatment, especially in stroke, intracranial hemorrhage, and antithrombotic therapy. CONCLUSIONS: It is critical for non-radiologist clinicians (primary care, internists, neurologists, hematologists) to be aware of the potential importance of the finding of a CMB, and the fact that these lesions are not always truly silent or without important clinical consequences. As additional studies appear, clinicians may be able to "hear" more clearly through the silence of the CMB and understand potential clinical implications in patients.

Cardiovascular comorbidities in a United States patient population with hemophilia A: A comprehensive chart review.

PURPOSE: Previous retrospective claims database analyses reported increased prevalence and earlier onset of cardiovascular comorbidities in patients with versus without hemophilia A. A comprehensive chart review was designed to further investigate previous findings. METHODS: This retrospective chart review study was conducted at Henry Ford Health System (Detroit, MI, USA). Baseline demographics, bleeding events, treatment parameters, coexisting diseases, hemophilia-associated events, Charlson Comorbidity Index score, and prevalence of 12 cardiovascular risk factors and associated diseases were compared between hemophilia A and control cohorts. P values from a chi-square test for categorical variables and a t test for continuous variables were calculated. Because of small sample sizes (N = 0-90, most <50), statistical differences between cohorts were also assessed using absolute standardized difference. RESULTS: Both groups were well matched by age, race, healthcare payer, and study year. The Charlson Comorbidity Index score was similar between groups. Prevalence of bleeds, hepatitis B and C, and HIV/AIDS was higher in the hemophilia cohort. Hemophilia A severity was severe, moderate, mild, or unknown in 52.7%, 10.8%, 10.8%, and 25.7% of patients, respectively. Prevalence of 12 cardiovascular risk factors and diseases was numerically higher in the control cohort, but differences were statistically significant (P ≤ 0.05) only for diabetes and hyperlipidemia. Meaningful statistical differences using standardized differences were not reached for venous and arterial thrombosis and atrial fibrillation. CONCLUSIONS: This retrospective chart review did not confirm statistically significant differences in cardiovascular comorbidities and their earlier onset in hemophilia A versus controls. Results suggest numerically higher comorbidities in controls.

The incidence of anosmia after traumatic brain injury: the SHEFBIT cohort.

BACKGROUND: While anosmia is common after Traumatic Brain Injury(TBI) (prevalence 4%-68%),studies differ in the associations found with other variables. AIMS: To assess the incidence of anosmia within a large, mixed TBI cohort and examine relationships with other injury or demographic features, including depression and global outcome(GOSE). DESIGN, SUBJECTS AND SETTING: 774 consecutive TBI admissions over 2 years, assessed within a specialist neurorehabilitation clinic. METHODS: All patients assessed at 6-8 weeks and 1 year. Tools included the Extended Glasgow Outcome Scale(GOSE), Rivermead Head Injury Follow-up Questionnaire, Rivermead Post-Concussion Symptoms and the Hospital Anxiety and Depression Score. Olfactory function assessed with sensitivity to coffee granules. RESULTS: The overall incidence of anosmia was 19.7%; mild TBI (9.55%), moderate (20.01%), and severe (43.5%). On a logistic regression, features of TBI severity (p < 0.001 (95% CI 0.098-0.438)), medical comorbidities (p = 0.026 (95% CI 0.301-0.927)) and depression (p = 0.006 (95% CI 1.202-2.981)) were significant. Sixty percent of patients with anosmia at 1 year were found to be clinically depressed, compared to 36% of patients without anosmia. CONCLUSION: In the largest prospective study of post-TBI anosmia, the incidence increased with TBI severity and other medical illness. The presence of anosmia should also raise the clinical suspicion of depression.

Assessment of olfactory function after traumatic brain injury: comparison of single odour tool with detailed assessment tool.

OBJECTIVES: Olfactory disturbance (OD) is common after traumatic brain injury (TBI). Screening for OD can be performed by several different methods. While odour identification tools are considered more accurate, they are time consuming. The predominant method in clinical practice remains the use of a single odour. This study aimed to compare a brief single-odour identification tool (BSOIT) with a more detailed 12-odour assessment tool. MATERIALS/METHODS: One hundred seventy consecutive patients with TBI had their olfaction assessed using BSOIT and a 12-item tool at a single time point. The sensitivity and specificity of the BSOIT were calculated. RESULTS: The sensitivity and specificity of the BSOIT as compared to the Burghart tool were 57.5% and 100%, respectively, for all ODs (anosmia and hyposmia). The sensitivity and specificity for anosmia only were 93.5% and 96.7%, respectively. For the two tools, the Cohen's kappa coefficient showed moderate agreement when both anosmia and hyposmia were considered (k = 0.619, p < 0.001) but a very strong agreement when only anosmia was considered (k = 0.844, p < 0.001). For both the tools, anosmia had a significant association with TBI severity (p < 0.001). However, hyposmia showed no such association. CONCLUSIONS: The BSOIT is very effective at identifying anosmia but not hyposmia, producing comparable results to a more detailed test. It can be effective in clinical practice and takes considerably less time.

Point-of-care ultrasonography (POCUS) in hemophilia A: a commentary on current status and its potential role for improving prophylaxis management in severe hemophilia A.

In patients with severe hemophilia A, recurrent bleeding into joints results in increased morbidity and reduced quality of life. Prophylaxis using replacement factor products, especially when initiated early, has established benefits in terms of reducing joint bleeds and preserving joint function. Poor adherence to prophylactic regimens is a common cause for breakthrough bleeds and resultant arthropathy. Improving prophylaxis management, especially in the transitional age group, is a challenge. Here, we discuss the current status of ultrasonography (US) in hemophilia A, challenges in its wider implementation, and the potential for use of point-of-care US (POCUS) as an adjunct in the routine management of patients with hemophilia following prophylaxis regimens. Using POCUS, in which US is performed by trained hematologists and nonphysician operators (rather than comprehensive US performed by imaging specialists), specific clinical questions can be addressed in a time-efficient, user-friendly manner to promote adherence to prophylaxis and guide or modify treatment approaches. This review also discusses barriers to acceptance of POCUS as a part of routine management of patients with hemophilia, including questions related to its diagnostic accuracy, dependence on trained operators, agreement on appropriate scoring systems, and potential usefulness in patient management.

Sucrose-Formulated Recombinant Factor VIII Dosing Flexibility in Prophylaxis Regimens: Experience from Postmarketing Surveillance Studies.

Objectives. Prophylaxis regimens for severe hemophilia A allowing more flexible dosing while maintaining efficacy may improve adherence and decrease the cost of prophylaxis. Here, we compared the clinical effectiveness of once- or twice-weekly versus ≥3-times-weekly prophylaxis with sucrose-formulated recombinant factor VIII (rFVIII-FS) in a "real-world" practice setting. Methods. Data from 3 postmarketing studies were pooled. Patients with severe hemophilia A receiving ≥1 prophylaxis infusion/wk of rFVIII-FS for ≥80% of a prophylaxis observation period (≥5 months) were included. Patients were categorized based on physician-assigned treatment regimens of 1-2 prophylaxis injections/wk (n = 63) or ≥3 prophylaxis injections/wk (n = 76). Descriptive statistics were determined for annualized bleeding rates (ABRs). Results. Median (quartile 1; quartile 3) ABR for all bleeds was 2.0 (0; 4.0) in the 1-2 prophylaxis injections/wk group and 3.9 (1.5; 9.3) in the ≥3 prophylaxis injections/wk group. Median ABRs for joint, spontaneous, and trauma-related bleeds were numerically lower with 1-2 prophylaxis injections/wk. As an estimate of prophylaxis success, 63% (≥3 prophylaxis injections/wk) to 84% of patients (1-2 prophylaxis injections/wk) had ≤4 annualized joint bleeds. Conclusions. Dosing flexibility and successful prophylaxis with rFVIII-FS were demonstrated. Very good bleeding control was achieved with both once-twice-weekly and ≥3-times-weekly prophylaxis dosing regimens.