Pestilence and famine: Continuing down the vicious cycle with COVID-19.

Despite the fact that we produce enough food to feed everyone on Earth, world hunger is on the rise. On the other side of the table, the obesity crisis also weighs heavily. Malnutrition is less about food than about socioeconomic factors such as conflict, poverty, and global disasters such as climate change and the novel Coronavirus Disease 2019 (COVID-19) pandemic. Nutrition and infectious disease exist in an intricate dance. Adequate and balanced nutrition is critical for appropriate response to infection and any changes in the balance can serve as a tipping point for the next pandemic. On the other hand, pandemics, such as COVID-19, lead to greater malnutrition. Both over- and undernutrition increase severity of disease, alter vaccine effectiveness, and potentially create conditions for viral mutation and adaptation-further driving the disease and famine vicious cycle. These long-term health and socioeconomic repercussions have direct effects at individual and global levels and lead to long-term consequences. Therefore, investing in and strengthening public health, pandemic prevention, and nutrition programs become vital at a much more complex systems level.

Academic Responses to Fukushima Disaster.

Since radiation accidents, particularly nuclear disasters, are rarer than other types of disasters, a comprehensive radiation disaster medical curriculum for them is currently unavailable. The Fukushima compound disaster has urged the establishment of a new medical curriculum in preparation for any future complex disaster. The medical education will aim to aid decision making on various health risks for workers, vulnerable people, and residents addressing each phase in the disaster. Herein, we introduce 3 novel educational programs that have been initiated to provide students, professionals, and leaders with the knowledge of and skills to elude the social consequences of complex nuclear disasters. The first program concentrates on radiation disaster medicine for medical students at the Fukushima Medical University, together with a science, technology, and society module comprising various topics, such as public risk communication, psychosocial consequences of radiation anxiety, and decision making for radiation disaster. The second program is a Phoenix Leader PhD degree at the Hiroshima University, which aims to develop future leaders who can address the associated scientific, environmental, and social issues. The third program is a Joint Graduate School of Master's degree in the Division of Disaster and Radiation Medical Sciences at the Nagasaki University and Fukushima Medical University.

Health effects of radiation and other health problems in the aftermath of nuclear accidents, with an emphasis on Fukushima.

437 nuclear power plants are in operation at present around the world to meet increasing energy demands. Unfortunately, five major nuclear accidents have occurred in the past--ie, at Kyshtym (Russia [then USSR], 1957), Windscale Piles (UK, 1957), Three Mile Island (USA, 1979), Chernobyl (Ukraine [then USSR], 1986), and Fukushima (Japan, 2011). The effects of these accidents on individuals and societies are diverse and enduring. Accumulated evidence about radiation health effects on atomic bomb survivors and other radiation-exposed people has formed the basis for national and international regulations about radiation protection. However, past experiences suggest that common issues were not necessarily physical health problems directly attributable to radiation exposure, but rather psychological and social effects. Additionally, evacuation and long-term displacement created severe health-care problems for the most vulnerable people, such as hospital inpatients and elderly people.

Nuclear disasters and health: lessons learned, challenges, and proposals.

Past nuclear disasters, such as the atomic bombings in 1945 and major accidents at nuclear power plants, have highlighted similarities in potential public health effects of radiation in both circumstances, including health issues unrelated to radiation exposure. Although the rarity of nuclear disasters limits opportunities to undertake rigorous research of evidence-based interventions and strategies, identification of lessons learned and development of an effective plan to protect the public, minimise negative effects, and protect emergency workers from exposure to high-dose radiation is important. Additionally, research is needed to help decision makers to avoid premature deaths among patients already in hospitals and other vulnerable groups during evacuation. Since nuclear disasters can affect hundreds of thousands of people, a substantial number of people are at risk of physical and mental harm in each disaster. During the recovery period after a nuclear disaster, physicians might need to screen for psychological burdens and provide general physical and mental health care for many affected residents who might experience long-term displacement. Reliable communication of personalised risks has emerged as a challenge for health-care professionals beyond the need to explain radiation protection. To overcome difficulties of risk communication and provide decision aids to protect workers, vulnerable people, and residents after a nuclear disaster, physicians should receive training in nuclear disaster response. This training should include evidence-based interventions, support decisions to balance potential harms and benefits, and take account of scientific uncertainty in provision of community health care. An open and joint learning process is essential to prepare for, and minimise the effects of, future nuclear disasters.

Current status and future challenges for controlling malaria with the sterile insect technique: technical and social perspectives.

The intolerable burden of malaria, when faced with high levels of drug resistance, increasing insecticide resistance and meagre resources at the national level, remains a great public health challenge to governments and the research/control community. Efficient control methods against the vectors of malaria are desperately needed. Control strategies for malaria that integrate the transfer of sterile sperm by released males to wild virgin females with other control tactics are currently being developed, and optimised mass-rearing, irradiation and release techniques are being validated in several field sites. However, the success of this strategy as part of wider pest control or health management programmes strongly depends on gaining public understanding and acceptance. Here we attempt to review what progress has been made and the remaining challenges surrounding the use of the sterile insect technique against malaria from technical and social perspectives.

"Educating the educators" guidelines for education in radiation medicine: a pragmatic approach at International Atomic Energy Agency.

Drawing on the experience of the Division of Human Health within the Department of Nuclear Sciences and Applications, we explore "educating the educators" guidelines for planning, developing, implementing, and evaluating education and training programs in radiation medicine for the International Atomic Energy Agency's Member States. The guidelines are based on a pragmatic approach to strengthen an internal quality-assurance framework. This article is based on the consultants' meetings and reports, participatory observations, bi monthly capacity-building sessions, and informal communication with staff members of the Division of Human Health, held between December 2009 and August 2012. This article contributes to the theoretical and practical applications of "educating the educators" philosophy as continuously cultivated in an international organization that transforms itself as a learning organization.

The International Atomic Energy Agency's activities in radiation medicine and cancer: promoting global health through diplomacy.

Global health has been an issue of seemingly low political importance in comparison with issues that have direct bearing on countries' national security. Recently, health has experienced a "political revolution" or a rise in political importance. Today, we face substantial global health challenges, from the spread of infectious disease, gaps in basic maternal and child health care, to the globalization of cancer. A recent estimate states that the "overall lifetime risk of developing cancer (both sexes) is expected to rise from more than one in three to one in two by 2015." These issues pose significant threats to international health security. To successfully combat these grave challenges, the international community must embrace and engage in global health diplomacy, defined by scholars Thomas Novotny and Vicanne Adams as a political activity aimed at improving global health, while at the same time maintaining and strengthening international relations. The IAEA (International Atomic Energy Agency) is an international organization with a unique mandate to "accelerate and enlarge the contribution of atomic energy to peace, health, and prosperity throughout the world." This article discusses global health diplomacy, reviews the IAEA's program activities in human health by focusing on radiation medicine and cancer, and the peaceful applications of atomic energy within the context of global health diplomacy.

Health and health-care systems in southeast Asia: diversity and transitions.

Southeast Asia is a region of enormous social, economic, and political diversity, both across and within countries, shaped by its history, geography, and position as a major crossroad of trade and the movement of goods and services. These factors have not only contributed to the disparate health status of the region's diverse populations, but also to the diverse nature of its health systems, which are at varying stages of evolution. Rapid but inequitable socioeconomic development, coupled with differing rates of demographic and epidemiological transitions, have accentuated health disparities and posed great public health challenges for national health systems, particularly the control of emerging infectious diseases and the rise of non-communicable diseases within ageing populations. While novel forms of health care are evolving in the region, such as corporatised public health-care systems (government owned, but operating according to corporate principles and with private-sector participation) and financing mechanisms to achieve universal coverage, there are key lessons for health reforms and decentralisation. New challenges have emerged with rising trade in health services, migration of the health workforce, and medical tourism. Juxtaposed between the emerging giant economies of China and India, countries of the region are attempting to forge a common regional identity, despite their diversity, to seek mutually acceptable and effective solutions to key regional health challenges. In this first paper in the Lancet Series on health in southeast Asia, we present an overview of key demographic and epidemiological changes in the region, explore challenges facing health systems, and draw attention to the potential for regional collaboration in health.

Undergraduate radiology education in the era of dynamism in medical curriculum: an educational perspective.

Radiology undergraduate curriculum has undergone a tremendous transformation in the decades reflecting a change in the structure, content and delivery of instruction. These changes are not unique to the discipline, but rather a response in the cycle of the re-engineering process in the medical curriculum in order to ensure its proper role into the ever-changing context. Radiology education is now more integrated across the curriculum than ever. The diversity of how radiology is being taught within the medical undergraduate curriculum is extensive and promising with the expanding role of the radiologist in the spectrum within the medical curriculum. A strong interface between the medical student and the clinicians must always be integrated in the learning process in order to convey the essential and practical use of the different aspects of radiology essential to the student's career as a future clinician. With the recent advancement in educational and technological innovations, radiology education is mobilized in the most pioneering ways, stimulating a rekindled interest in the field of medical imaging. This paper describes the increasing interest in current role of undergraduate radiology education in the context of constant medical curriculum innovations and in the digital age.

Impact of new technologies on dose reduction in CT.

The introduction of slip ring technology enables helical CT scanning in the late 1980's and has rejuvenated CT's role in diagnostic imaging. Helical CT scanning has made possible whole body scanning in a single breath hold and computed tomography angiography (CTA) which has replaced invasive catheter based angiography in many cases because of its easy of operation and lesser risk to patients. However, a series of recent articles and accidents have heightened the concern of radiation risk from CT scanning. Undoubtedly, the radiation dose from CT studies, in particular, CCTA studies, are among the highest dose studies in diagnostic imaging. Nevertheless, CT has remained the workhorse of diagnostic imaging in emergent and non-emergent situations because of their ubiquitous presence in medical facilities from large academic to small regional hospitals and their round the clock accessibility due to their ease of use for both staff and patients as compared to MR scanners. The legitimate concern of radiation dose has sparked discussions on the risk vs benefit of CT scanning. It is recognized that newer CT applications, like CCTA and perfusion, will be severely curtailed unless radiation dose is reduced. This paper discusses the various hardware and software techniques developed to reduce radiation dose to patients in CT scanning. The current average effective dose of a CT study is ∼10 mSv, with the implementation of dose reduction techniques discussed herein; it is realistic to expect that the average effective dose may be decreased by 2-3 fold.

Radiation protection: some philosophical and ethical issues.

The ethical issue of justification has become an urgent issue in radiology. There has been a shift in emphasis in the discussion from what has been regarded as a rather paternalistic attitude of practitioners to one that stresses the rights of the individual patient. This article comments on this current move on the part of the profession by offering certain relevant philosophical considerations. Using a medical scenario as the context to comment on this shift, it discusses important and fundamental issues, such as the autonomy and the rights of the patient in addition to the question of consent on the patient's part.

A bony connection signals laryngeal echolocation in bats.

Echolocation is an active form of orientation in which animals emit sounds and then listen to reflected echoes of those sounds to form images of their surroundings in their brains. Although echolocation is usually associated with bats, it is not characteristic of all bats. Most echolocating bats produce signals in the larynx, but within one family of mainly non-echolocating species (Pteropodidae), a few species use echolocation sounds produced by tongue clicks. Here we demonstrate, using data obtained from micro-computed tomography scans of 26 species (n = 35 fluid-preserved bats), that proximal articulation of the stylohyal bone (part of the mammalian hyoid apparatus) with the tympanic bone always distinguishes laryngeally echolocating bats from all other bats (that is, non-echolocating pteropodids and those that echolocate with tongue clicks). In laryngeally echolocating bats, the proximal end of the stylohyal bone directly articulates with the tympanic bone and is often fused with it. Previous research on the morphology of the stylohyal bone in the oldest known fossil bat (Onychonycteris finneyi) suggested that it did not echolocate, but our findings suggest that O. finneyi may have used laryngeal echolocation because its stylohyal bones may have articulated with its tympanic bones. The present findings reopen basic questions about the timing and the origin of flight and echolocation in the early evolution of bats. Our data also provide an independent anatomical character by which to distinguish laryngeally echolocating bats from other bats.

High-frequency ultrasound to grade disease progression in murine models of Duchenne muscular dystrophy.

OBJECTIVE: This study used high-frequency ultrasound (HFU) imaging to assess muscle damage noninvasively in a longitudinal study of 2 transgenic murine models of Duchenne muscular dystrophy (DMD): mdx, which has mutated cytoskeletal protein dystrophin; and udx, which has mutated dystrophin and lacks another cytoskeleton protein, utrophin. The mdx group was further subdivided into exercised and nonexercised subgroups to assess exercise-induced damage. METHODS: Muscle damage was assessed with HFU imaging (40 MHz) at biweekly intervals for 16 weeks. The assessment was based on the number of hyperechoic lesions, the lesion diameter, and muscle disorganization, giving a combined grade according to a 5-point scale. RESULTS: High-frequency ultrasound discriminated the severity of muscle damage between wild-type and transgenic models of DMD and between mdx and udx models. Qualitative comparisons of 3-dimensional HFU images with serial histologic sections of the skeletal muscle showed the ability of ultrasound to accurately depict changes seen in the muscle architecture in vivo. CONCLUSIONS: High-frequency ultrasound images soft tissue in mice at high contrast and spatial resolution, thereby showing that this microimaging modality has the capability to assess architectural changes in muscle fibers due to myotonic dystrophy-related diseases such as DMD.

US guided injections in arthritis.

US guided procedures for diagnosis or treatment of different forms of arthritis are becoming more and more important. This review describes general considerations for fluid aspiration, articular or periarticular injections and biopsies by US guidance according to the recent literature. Guidelines regarding instrumentation, different techniques, pre- and postprocedural care as well as complications are outlined and in the second part a more detailed overview of different interventions in joints, tendons and other periarticular regions (nerves, bursae, etc.) is included. Furthermore, some newer, more sophisticated techniques are briefly discussed.

Hepatocellular carcinoma bone metastasis in an 11-year-old boy.

Hepatocellular carcinoma (HCC) is the second most common primary hepatic malignant tumor in children older than 4 years. We describe a rare case of an 11-year-old boy with HCC who presented with HCC of the right liver lobe followed by multiple osseous metastases, confirmed by imaging and biopsy.