Baseline characteristics, diagnostic efficacy, and peri-examinational safety of IV gadoteric acid MRI in 148,489 patients.

BACKGROUND: Magnetic resonance imaging (MRI) examinations with intravenous (IV) contrast are performed worldwide in routine daily practice. In order to detect and enumerate even rare adverse events (AE) and serious adverse events (SAE), and to relate them with patients' baseline characteristics and diagnostic effectiveness, high quantity sample size is necessary. PURPOSE: To assess safety, diagnostic effectiveness, and baseline characteristics of patients undergoing IV gadoteric acid (Dotarem®) MRI in routine practice. MATERIAL AND METHODS: Data from two observational post-marketing surveillance (PMS) databases compiled by 139 and 52 German centers in 2004-2011 and 2011-2013, respectively, were pooled, yielding data on a total of 148,489 patients examined over a 10-year period. Radiologists used a standardized questionnaire to report data including patient demographics, characteristics of MR examinations, and results in terms of diagnosis and patient safety. RESULTS: Overall, 712 AEs were reported in 467 (0.3%) patients, mainly nausea (n = 224, 0.2%), vomiting (n = 29, <0.1%), urticaria (n = 20, <0.1%), and feeling hot (n = 13, <0.1%). AEs were considered related to gadoteric acid in 362 (0.2%) patients. Higher frequencies of AEs were observed among patients with a previous reaction to a contrast agent (2.0%), liver dysfunction (0.7%), bronchial asthma (0.7%), and a history of allergies (0.6%). There were 49 SAEs in 18 (<0.1%) patients, including two children. No fatal SAE was reported. Examinations were diagnostic in 99.8% of all patients, and image quality was excellent or good in 97.7% of the patients. CONCLUSION: Gadoteric acid is a safe peri-examinational and effective contrast agent for MRI in routine practice.

Identifying technology innovations for marginalized smallholders-A conceptual approach.

This paper adds a contribution in the existing literature in terms of theoretical and conceptual background for the identification of idle potentials of marginal rural areas and people by means of technological and institutional innovations. The approach follows ex-ante assessment for identifying suitable technology and institutional innovations for marginalized smallholders in marginal areas-divided into three main parts (mapping, surveying and evaluating) and several steps. Finally, it contributes to the inclusion of marginalized smallholders by an improved way of understanding the interactions between technology needs, farming systems, ecological resources and poverty characteristics in the different segments of the poor, and to link these insights with productivity enhancing technologies.

Bilateral Orbital IgG4-Related Disease with Systemic and Corneal Involvement Showing an Excellent Response to Steroid and Rituximab Therapy: Report of a Case with 11 Years Follow-Up.

IgG4-related disease is a newly recognized fibro-inflammatory condition. The purpose of this report is to present a patient with 11 years of follow-up, who revealed characteristic features of IgG4-related disease with systemic, orbital and corneal involvement and showed a favorable response to steroids and rituximab treatment.

Role of food choice motives in the socio-economic disparities in diet diversity and obesity outcomes in Kenya.

BACKGROUND: The increased prevalence of overweight and obesity, along with high diet diversity, is observed among higher socio-economic groups in Sub-Saharan Africa. One contributing factor to these observed variations is food choice motives. However, the role of these motives in explaining the observed differences has not been thoroughly explored in this context. OBJECTIVE: This study investigates whether there are significant differences in food choice motives among socio-economic groups and whether these variations can partly explain the socio-economic disparities in diet diversity and overweight and obesity outcomes. METHODS: This study utilizes cross-sectional data from four counties in Kenya: Kiambu, Murang'a, Uasin Gishu, and Nakuru. The survey employed a three-stage cluster sample design to gather data using structured questionnaires on food choice motives, diet diversity, and anthropometrics from 381 adults in 2022. The mediating effects of 8 food choice motives (health, mood, convenience, sensory appeal, natural content, price, weight control, and familiarity) were analyzed using the Karlson-Holm-Breen method. RESULTS: The results show that individuals with higher household incomes place greater importance on health, mood, sensory, and weight concerns. The probability of an overweight and obesity outcome increases by 19% for a standard deviation change in the asset score, and by 8% for a standard deviation change in the years of schooling. Sensory motives significantly mediated these relationships. Sensory motives explained 29% of the income-BMI association and 30% of the education-BMI relationship. Higher education was also associated with increased diet diversity (ß = 0.36, P < 0.001) mediated by higher health and sensory concerns. CONCLUSIONS: The findings suggest significant differences in food choice motives among socio-economic groups, which contribute to outcomes such as overweight and obesity. Therefore, educational and other policies aimed at reducing obesity should also address food choice motives, while considering the disparities among socio-economic segments within populations.

Strategies to decrease inequalities in cancer therapeutics, care and prevention: Proceedings on a conference organized by the Pontifical Academy of Sciences and the European Academy of Cancer Sciences, Vatican City, February 23-24, 2023.

Analyses of inequalities related to prevention and cancer therapeutics/care show disparities between countries with different economic standing, and within countries with high Gross Domestic Product. The development of basic technological and biological research provides clinical and prevention opportunities that make their implementation into healthcare systems more complex, mainly due to the growth of Personalized/Precision Cancer Medicine (PCM). Initiatives like the USA-Cancer Moonshot and the EU-Mission on Cancer and Europe's Beating Cancer Plan are initiated to boost cancer prevention and therapeutics/care innovation and to mitigate present inequalities. The conference organized by the Pontifical Academy of Sciences in collaboration with the European Academy of Cancer Sciences discussed the inequality problem, dependent on the economic status of a country, the increasing demands for infrastructure supportive of innovative research and its implementation in healthcare and prevention programs. Establishing translational research defined as a coherent cancer research continuum is still a challenge. Research has to cover the entire continuum from basic to outcomes research for clinical and prevention modalities. Comprehensive Cancer Centres (CCCs) are of critical importance for integrating research innovations to preclinical and clinical research, as for ensuring state-of-the-art patient care within healthcare systems. International collaborative networks between CCCs are necessary to reach the critical mass of infrastructures and patients for PCM research, and for introducing prevention modalities and new treatments effectively. Outcomes and health economics research are required to assess the cost-effectiveness of new interventions, currently a missing element in the research portfolio. Data sharing and critical mass are essential for innovative research to develop PCM. Despite advances in cancer research, cancer incidence and prevalence is growing. Making cancer research infrastructures accessible for all patients, considering the increasing inequalities, requires science policy actions incentivizing research aimed at prevention and cancer therapeutics/care with an increased focus on patients' needs and cost-effective healthcare.

HiTSEE KNIME: a visualization tool for hit selection and analysis in high-throughput screening experiments for the KNIME platform.

We present HiTSEE (High-Throughput Screening Exploration Environment), a visualization tool for the analysis of large chemical screens used to examine biochemical processes. The tool supports the investigation of structure-activity relationships (SAR analysis) and, through a flexible interaction mechanism, the navigation of large chemical spaces. Our approach is based on the projection of one or a few molecules of interest and the expansion around their neighborhood and allows for the exploration of large chemical libraries without the need to create an all encompassing overview of the whole library. We describe the requirements we collected during our collaboration with biologists and chemists, the design rationale behind the tool, and two case studies on different datasets. The described integration (HiTSEE KNIME) into the KNIME platform allows additional flexibility in adopting our approach to a wide range of different biochemical problems and enables other research groups to use HiTSEE.

Modeling impact and cost-effectiveness of driving-Y gene drives for malaria elimination in the Democratic Republic of the Congo.

Malaria elimination will be challenging in countries that currently continue to bear high malaria burden. Sex-ratio-distorting gene drives, such as driving-Y, could play a role in an integrated elimination strategy if they can effectively suppress vector populations. Using a spatially explicit, agent-based model of malaria transmission in eight provinces spanning the range of transmission intensities across the Democratic Republic of the Congo, we predict the impact and cost-effectiveness of integrating driving-Y gene drive mosquitoes in malaria elimination strategies that include existing interventions such as insecticide-treated nets and case management of symptomatic malaria. Gene drive mosquitoes could eliminate malaria and were the most cost-effective intervention overall if the drive component was highly effective with at least 95% X-shredder efficiency at relatively low fertility cost, and associated cost of deployment below 7.17 $int per person per year. Suppression gene drive could be a cost-effective supplemental intervention for malaria elimination, but tight constraints on drive effectiveness and cost ceilings may limit its feasibility.

Tunneled hemodialysis catheter insertion: Above, within, or below the right atrium-Where is the tip?

Background: One major challenge when inserting a tunneled, cuffed central venous catheter (CVC) for hemodialysis under fluoroscopy is to accurately place the catheter tip by assessing its position in relation to the cardiac silhouette to approximate the right atrium (RA). Purpose: To investigate whether a weighted mean calculated from published results for two two-dimensional landmark reference distances may be useful in assessing CVC tip positions in relation to the RA. Material and Methods: Central venous catheter tip positions attained under fluoroscopic imaging during insertion using the cardiac silhouette as approximation were retrospectively related to two reference distances (carina to cranial RA border and craniocaudal RA extent), which were used to group catheter tip locations above (1), within (2), or below (3) the RA (henceforth referred to as landmark technique approximation, LTA). The LTA-derived catheter tip locations were validated by correlation with postinterventional computed tomography (CT) datasets acquired shortly after implantation (if available). Results: Based on LTA, 45 catheter tips (10.6%) were above, 179 (42.2%) within, and 200 (47.2%) below the RA. Postinterventional CT (n = 57; 13.4%) visualized 26.3% above, 66.7% within, and 7.0% below the RA. Conclusion: The LTA reference distances appear to lead to a rather low categorization of the CVC tips, or the tips have been placed rather low in the study population. Validation using postinterventional CT indicated an underestimation of the RA in the LTA. Patient characteristics with a higher risk of false estimation through LTA have been defined.

Impact of community-based health insurance on utilisation of preventive health services in rural Uganda: a propensity score matching approach.

The effect of voluntary health insurance on preventive health has received limited research attention in developing countries, even when they suffer immensely from easily preventable illnesses. This paper surveys households in rural south-western Uganda, which are geographically serviced by a voluntary Community-based health insurance scheme, and applied propensity score matching to assess the effect of enrolment on using mosquito nets and deworming under-five children. We find that enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%. We postulate that these findings are partly mediated by information diffusion and social networks, financial protection, which gives households the capacity to save and use service more, especially curative services that are delivered alongside preventive services. This paper provides more insight into the broader effects of health insurance in developing countries, beyond financial protection and utilisation of hospital-based services.

Canine embryo-derived stem cells and models for human diseases.

Embryonic stem (ES) cells are pluripotent and permanent cell lines which can differentiate into cell types of all the three germ layers. These features imply multiple opportunities for clinical applications in tissue engineering and regenerative medicine. Most of our knowledge on the biology and technology of ES cells is derived from studies with mouse ES cells. While appropriate for proof-of-principle studies, the mouse model has limitations in its application in translational, pre-clinical studies. This is particularly true for studies evaluating the safety and efficacy of stem cell therapies. For this purpose, large animal models more closely mimicking important aspects of human anatomy, physiology and pathology than mouse models are urgently needed. In this context, the dog is an excellent candidate: the plethora of different dog breeds offer a large phenotypic and genetic variability, which can be exploited increasingly well due to the advanced status of the dog genome project and the rapidly growing box of genomic tools. Recently, the first pluripotent canine embryo-derived stem cells have been described, further increasing the potential of the dog as a model system for regenerative medicine. Although these cells express alkaline phosphatase, NANOG and OCT4, and can be differentiated in vitro towards endoderm-, mesoderm- and ectoderm-lineages (typical features of human and mouse ES cells), their in vivo differentiation capability, i.e. formation of teratomas in immunodeficient mice or contribution to chimeric animals, remains to be demonstrated. Here, we discuss the features of reported canine embryo-derived cells and their potential applications in basic and translational biomedical research.

Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda.

While community-based health insurance increasingly becomes part of the health financing landscape in developing countries, there is still limited research about its impacts on health outcomes. Using cross-sectional data from rural south-western Uganda, we apply a two-stage residual inclusion instrumental variables method to study the impact of insurance participation on child stunting in under-five children. We find that one year of a household's participation in community-based health insurance was associated with a 4.3 percentage point less probability of stunting. Children of two years or less dominated the effect but there were also statistically significant benefits of enrolling in insurance after a child's birth. The expansion of community-based health insurance might have more dividends to improving health, in addition to financial protection and service utilisation in rural developing countries.

Determinants of Enrolment and Renewing of Community-Based Health Insurance in Households With Under-5 Children in Rural South-Western Uganda.

BACKGROUND: The desire for universal health coverage in developing countries has brought attention to communitybased health insurance (CBHI) schemes in developing countries. The government of Uganda is currently debating policy for the national health insurance programme, targeting the integration of existing CBHI schemes into a larger national risk pool. However, while enrolment has been largely studied in other countries, it remains a generally under-covered issue from a Ugandan perspective. Using a large CBHI scheme, this study, therefore, aims at shedding more light on the determinants of households' decisions to enrol and renew membership in these schemes. METHODS: We collected household data from 464 households in 14 villages served by a large CBHI scheme in southwestern Uganda. We then estimated logistic and zero-inflated negative binomial (ZINB) regressions to understand the determinants of enrolment and renewing membership in CBHI, respectively. RESULTS: Results revealed that household's socioeconomic status, husband's employment in rural casual work (odds ratio [OR]: 2.581, CI: 1.104-6.032) and knowledge of health insurance premiums (OR: 17.072, CI: 7.027-41.477) were significant predictors of enrolment. Social capital and connectivity, assessed by the number of voluntary groups a household belonged to, was also positively associated with CBHI participation (OR: 5.664, CI: 2.927-10.963). More positive perceptions on insurance (OR: 2.991, CI: 1.273-7.029), access to information were also associated with enrolment and renewing among others. Burial group size and number of burial groups in a village, were all significantly associated with increased the likelihood of renewing CBHI. CONCLUSION: While socioeconomic factors remain important predictors of participation in insurance, mechanisms to promote inclusion should be devised. Improving the participation of communities can enhance trust in insurance and eventual coverage. Moreover, for households already insured, access to correct information and strengthening their social network information pathways enhances their chances of renewing.

Economic and Political Innovation for Nutritional Improvement.

Large shares of the world population are still affected by nutrition deficiencies and undernutrition. However, the current global agriculture and food system and its international governance shows signs of serious malfunctioning, and is not equipped to cope with the current and future challenges it is facing. In view of the complex and multi-dimensional nature of nutrition problems, a framework is put forward here to improve the understanding of underlying causalities, and to identify priorities for action. In doing so, this paper focuses on economic and policy innovation. Better nutrition policy requires systematic, multi-faceted policy innovations, that is, the re-design of the current global food and nutrition governance system, and the adoption of innovative economic and political approaches. To achieve efficient and effective nutrition policy, more attention, leadership, funds, and a global organizational home for better coordination are needed. A systematic science and policy interface in the form of an International Panel on Food, Nutrition and Agriculture is proposed to provide a strong evidence base for nutrition policies.

Development of Report Turnaround Times in a University Department of Radiology during Implementation of a Reformed Curriculum for Undergraduate Medical Education.

PURPOSE: The implementation of a reformed curriculum for undergraduate medical education with a problem-oriented focus and more bedside teaching in small groups increases the academic teaching workload. The aim of this study was to investigate whether this increase in teaching duties is associated with an increase in report turnaround times of radiologists or increased unplanned absence during term times compared with term breaks (lecture-free periods) and over the whole period under investigation. MATERIALS AND METHODS: The database of all radiological examinations performed at a large German university hospital was retrospectively analyzed for a two-year period from the winter term 2011/12 to the summer term 2013. A total of 192 984 radiological examinations performed during this period were included in an analysis of reporting times (i. e., time from end of examination to completion of report) during term times versus term breaks. Reporting times were analyzed for all radiological examinations and for intensive care unit (ICU) patients. In addition, radiologists' schedules were analyzed in terms of teaching duties, unplanned absence, vacation days, and days away from work for education and training. RESULTS: During the period under investigation, the teaching load increased from overall 1.75 hours/day in the winter term 2011/12 to 6.49 hours/day in the summer term 2013 and in the term break from overall 0.10 hours/day in the winter term 2011/12 to 0.71 hours/day in the summer term 2013. Reporting time increased during this period (p < 0.05) but remained shorter during term times than during term breaks. The difference between term and term break for ICU patients was not significant. There was no increase in unplanned absences during term times. CONCLUSION: Overall, radiologists' reporting times increased during the period when the reformed curriculum for undergraduate medical education was implemented. As this was observed both during term and during term breaks, increased teaching duties alone cannot serve as a sole causal explanation. KEY POINTS: · Digital high-quantitative parameters can be used to evaluate workflow in radiology.. · Reporting time can be a criterion for efficient staffing.. · The acquisition and evaluation of parameters such as reporting times could lead to a more efficient resource allocation by providing hints of changed framework conditions and changing working intensities and/or capicity reserves - which may not be immediately apparent.. · During the period under investigation with the implementation of a teaching-intensive reformed curriculum for undergraduate medical education there was an increase in reporting time, which was not significant in intense care units.. · Since during the period under investigation the increase in reporting times can be stated both during term time and in the lecture free period, the implementation of the reformed curriculum for undergraduate medical education alone cannot serve as a sole causal explanation.. CITATION FORMAT: · Albrecht L, Maurer MH, Seithe T et al. Development of the Report Turnaround Times in a University Department of Radiology during Implementation of a Reformed Curriculum for Undergraduate Medical Education. Fortschr Röntgenstr 2018; 190: 259 - 264.