Introductory anatomy and physiology in an undergraduate nursing curriculum.

Using an educational data mining approach, first-year academic achievement of undergraduate nursing students, which included two compulsory courses in introductory human anatomy and physiology, was compared with achievement in a final semester course that transitioned students into the workplace. We hypothesized that students could be grouped according to their first-year academic achievement using a two-step cluster analysis method and that grades achieved in the human anatomy and physiology courses would be strong predictors of overall achievement. One cohort that graduated in 2014 (n = 105) and one that graduated in 2015 (n = 94) were analyzed separately, and for both cohorts, two groups were identified, these being "high achievers" (HIGH) and "low achievers" (LOW). Consistently, the anatomy and physiology courses were the strongest predictors of group assignment, such that a good grade in these was much more likely to put a student into a high-achieving group. Students in the HIGH groups also scored higher in the Transition to Nursing course when compared with students in the LOW groups. The higher predictor importance of the anatomy and physiology courses suggested that if a first-year grade-point average was calculated for students, an increased weighting should be attributed to these courses. Identifying high-achieving students based on first-year academic scores may be a useful method to predict future academic performance.

Tracking undergraduate student achievement in a first-year physiology course using a cluster analysis approach.

A cluster analysis data classification technique was used on assessment scores from 157 undergraduate nursing students who passed 2 successive compulsory courses in human anatomy and physiology. Student scores in five summative assessment tasks, taken in each of the courses, were used as inputs for a cluster analysis procedure. We aimed to group students into high-achieving (HA) and low-achieving (LA) clusters and to determine the ability of each summative assessment task to discriminate between HA and LA students. The two clusters identified in each semester were described as HA (n = 42) and LA (n = 115) in semester 1 (HA1 and LA1, respectively) and HA (n = 91) and LA (n = 42) in semester 2 (HA2 and LA2, respectively). In both semesters, HA and LA means for all inputs were different (all P < 0.001). Nineteen students moved from the HA1 group into the LA2 group, whereas 68 students moved from the LA1 group into the HA2 group. The overall order of importance of inputs that determined group membership was different in semester 1 compared with semester 2; in addition, the within-cluster order of importance in LA groups was different compared with HA groups. This method of analysis may 1) identify students who need extra instruction, 2) identify which assessment is more effective in discriminating between HA and LA students, and 3) provide quantitative evidence to track student achievement.

Laparoendoscopic single site (LESS) radical prostatectomy: a review of the initial experience.

Surgical treatment for prostate cancer has changed dramatically in recent years due to the incorporation of minimally invasive techniques in the surgical armamentarium. Open surgical approaches to the prostate have largely given way to laparoscopic and robotic techniques. In order to further reduce incisional morbidity and improve cosmesis, there has been a recent interest in laparoendoscopic single site (LESS) approaches to the prostate. Despite a rising interest, there is little available data on these procedures. We performed a systematic review of the literature using MEDLINE, OVID, and Web of Science to identify all publications including LESS radical prostatectomy to date. Manual bibliographic review of cross-referenced items was also performed. We attempt to identify and summarize existing data on these procedures both with and without robotic assistance. Additionally, we review the emerging devices, instruments, cameras, and ports that have made these procedures possible. Next, we offer insight into how this rapidly moving field may transition in the future. Finally, we provide our commentary on this surgical approach, its impact on urology, and how it may help us evolve in the future.

Detection of neuroendocrine liver metastases with MnDPDP-enhanced MRI.

PURPOSE: The sensitivity of computerised tomography (CT) in detecting neuroendocrine liver metastases is variable and three-phase imaging is advocated. However, patients are often young and may require prolonged follow-up, thus a technique that avoids radiation exposure would be desirable. Our purpose was to assess the diagnostic performance of MRI, before and after administration of mangafodipir trisodium (MnDPDP), in the detection of neuroendocrine liver metastases. METHODS: Patients who had undergone single-phase or multi-phase contrast-enhanced MD-CT for neuroendocrine liver metastases were invited to have MRI. Two independent observers made quantitative measurements (number and size of lesions). All measurements were made on each available CT phase and all MRI sequences independently, and repeated after an interval to assess reproducibility. The final number of lesions was agreed on by consensus of three observers. A qualitative assessment (contrast and spatial resolution) and preferred modality were agreed on by consensus. RESULTS: 265 lesions were detected by consensus in 11 patients. Non-contrast CT was available in 4/11, arterial phase in 6/11 and portal phase in 10/11 patients. When compared with the consensus number of lesions, MD-CT identified 17% on non-contrast, 44% on arterial and 43% on portal venous imaging. Lesion detection on MRI was 48% on T(1)W, 52% on T(2)W and 92% on MnDPDP-MRI. The number of lesions detected on MnDPDP-MRI was closest to the final consensus reading (variance = 0.994, p = 0.0027). The reproducibility of lesion size measurements was best on MnDPDP-MRI (variance = 0.033, p = 0.0021). The preferred modality subjectively was MnDPDP-MRI in 9/11 cases and T(2)W MRI in 2/11. CONCLUSION: MRI is a robust technique in the demonstration of neuroendocrine liver metastases. It is highly reproducible in both detecting the number and measuring the size of lesions. We recommend T(2)W MRI and MnDPDP-MRI in detection and follow-up of neuroendocrine liver metastases.

The appendix on CT.

Appendicitis can be a difficult clinical diagnosis to make. A negative appendicectomy rate of 20% has traditionally been accepted as the consequences of appendiceal perforation can be grave. Cross-sectional imaging is increasingly being employed in the investigation of adults with suspected appendicitis. This review will demonstrate the appearance of the normal appendix on computed tomography (CT) and its appearance in a range of inflammatory and neoplastic processes including appendicitis, Crohn's disease, infections, and benign and malignant tumours.

Cross-sectional imaging of gastric neoplasia.

The detection of gastric neoplasia has traditionally been limited to barium examination and direct visualization at endoscopy. The rapid development of techniques such as multidetector computed tomography (MDCT) and endoscopic ultrasound (EUS) has resulted in more accurate diagnosis and staging of gastric neoplasia. In this review we describe the normal anatomy of the stomach with multi-modality illustrations and review the imaging manifestations of gastric neoplasia, including adenocarcinoma, lymphoma, neuroendocrine and gastro-intestinal stromal tumours. We also describe the optimal techniques for up-to-date and accurate gastric imaging, outlining the role of MDCT and EUS.

Urological injuries following trauma.

Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

A technical, economic, and environmental analysis of energy production from newspaper in Ireland.

The production of newspaper corresponds to 37 kg per person per annum in Ireland. Newspaper becomes a waste product in a short period of time; only 13% of domestic waste paper is recycled (data on newspaper is not available). Four scenarios, which generate energy from newspaper, are analysed. These scenarios may be summarised as follows: lignocellulosic biomass conversion to ethanol (transport fuel); co-digestion with the organic fraction of municipal solid waste and production of CH4-enriched biogas (transport fuel); co-firing with the residue of municipal solid waste in an incinerator; and gasification of newspaper as a sole fuel. Two of the scenarios involve transport fuel production; two involve the production of electricity and heat. Two of the scenarios involve newspaper as the sole ingredient; two involve co- utilisation of newspaper with another waste stream. Assuming no economic market for heat, then only the transport scenarios have the potential to be economic; indeed the biogas scenario is shown to be extremely competitive generating a potential profit of euro 227/t newspaper. A greenhouse-gas analysis indicates that the biogas scenario generated the best net greenhouse-gas savings. However when a market for heat is available, gasification was shown to be most advantageous.

Optimization of scanning parameters for CT colonography.

To determine the optimal collimation, pitch and reconstruction interval for CT colonography, 10 spherical polyps between 1 mm and 10 mm diameter and made of tissue equivalent material with a CT number of 40 Hounsfield units (HU) were placed in the colon of an anthropomorphic phantom. The phantom was scanned at slice thicknesses of 3 mm, 5 mm and 7 mm and pitches of 1.0, 1.3, 1.5, 1.7 and 2.0 on an IGE Hispeed advantage system. Images were reconstructed for each scanning parameter at the minimum intervals allowed along the z-axis. The optimum scanning protocol was assessed by measuring maximum contrast between the polyp and air, sensitivity for detection of each polyp along the z-axis, and relative radiation dose. In addition, images were reviewed separately by two radiologists who graded polyp conspicuity as: 0, not seen; 1, faintly seen; 2, well seen. It was found that varying the scanning parameters caused a marked alteration in the maximum contrast between each polyp and air. For example, for the 5 mm polyp, the range of contrasts from best to worst case was 910-490 HU. It was noted that with contrasts of less than 500 HU, polyps were only faintly seen. A slice thickness of 3 mm with a pitch of 2 offers optimal polyp conspicuity with a relatively low radiation dose, we conclude that scanning parameters can be optimized for threshold contrast, radiation dose and subjective conspicuity. We propose an optimal parameter of 3 mm slice thickness and pitch 2.

Ultrasound-guided thrombin injection of iatrogenic groin pseudoaneurysm: Doppler features and technical tips.

The practice of angiographic procedures is increasing and, concomitantly, there has been an increase in the incidence of iatrogenic femoral pseudoaneurysms (PA). Ultrasound-guided thrombin injection is becoming the accepted gold standard in the treatment of PA. It is a cost-effective, safe and efficacious treatment that requires a short learning curve. The aim of this pictorial review is to demonstrate the Doppler and ultrasound features used to diagnose PA and those that help differentiate it from alternative diagnoses, and to describe the procedure of thrombin injection, highlighting technical tips and ways to avoid potential complications.

CT assessment of anastomotic bowel leak.

AIM: To evaluate the predictors of clinically important gastrointestinal anastomotic leaks using multidetector computed tomography (CT). SUBJECTS AND METHODS: Ninety-nine patients, 73 with clinical suspicion of anastomotic bowel leak and 26 non-bowel surgery controls underwent CT to investigate postoperative sepsis. Fifty patients had undergone large bowel and 23 small bowel anastomoses. The time interval from surgery was 3-30 days (mean 10+/-5.9 SD) for the anastomotic group and 3-40 days (mean 14+/-11 SD) for the control group (p=0.3). Two radiologists blinded to the final results reviewed the CT examinations in consensus and recorded the presence of peri-anastomotic air, fluid or combination of the two; distant loculated fluid or combination of fluid and air; free air or fluid; and intestinal contrast leak. Final diagnosis of clinically important anastomotic leak (CIAL) was confirmed at surgery or by chart review of predetermined clinical and laboratory criteria. RESULTS: The prevalence of CIAL in the group undergoing CT was 31.5% (23/73). The CT examinations with documented leak were performed 5-28 (mean; 11.4+/-6 SD) days after surgery. Nine patients required repeat operation, 10 percutaneous abscess drainage, two percutaneous drainage followed by surgery, and two prolonged antibiotic treatment and total parenteral nutrition (TPN). Of the CT features examined, only peri-anastomotic loculated fluid containing air was more frequently seen in the CIAL group as opposed to the no leak group (p=0.04). There was no intestinal contrast leakage in this cohort. Free air was present up to 9 days and loculated air up to 26 days without CIAL. CONCLUSION: Most postoperative CT features overlap between patients with and without CIAL. The only feature seen statistically more frequently with CIAL is peri-anastomotic loculated fluid containing air.

Amplification of DNA sequences in polar bodies from human oocytes for diagnosis of mitochondrial disease.

When a preovulatory oocyte reinitiates meiosis, it sheds a cytoplasmic fragment containing mitochondria and a redundant set of chromosomes. We have detected DNA sequences from both the mitochondrial and nuclear genomes in polar bodies from unfertilised human oocytes, demonstrating the feasibility of diagnosing mitochondrial diseases before conception.

Mercury vapour suppression by various liquid media.

Fresh and used photographic fixer, Merconvap and water were evaluated for their ability to suppress the vapourization of mercury. Mercury vapour concentration above the four test storage liquids was measured at various times between 10 min and 335 days, using a mercury vapour measuring instrument. The data were analysed using a Student-Newman-Keuls multiple comparison test (P = 0.05). The results showed that fresh and used fixer and Merconvap suppressed the vapourization of mercury to below the detection limit of the measuring instrument (0.01 mg/m3). Water was much less effective compared with the other liquids and showed an increase in mercury vapour concentration with log t.