Which factors are associated with bone marrow oedema suspicious of axial spondyloarthritis as detected by MRI in the sacroiliac joints and the spine in the general population?

OBJECTIVE: Identify factors associated with presence and extension of spinal and sacroiliac joints (SIJ)-MRI lesions suggestive of axial spondyloarthritis (axSpA) in a population-based cohort (Study of Health in Pomerania) aged <45 years. METHODS: Spinal (sagittal T1/T2) and SIJ (semicoronal STIR sequences) MRIs were evaluated by two trained blinded readers. The presence (yes/no) and extension (Berlin MRI Score) of bone marrow oedema (BME) were captured. Degenerative spinal lesions were excluded and discrepancies resolved by consensus. Cross-sectional associations between clinical factors and presence/extension of BME were analysed by logistic/negative binomial regression. Record linkage of claims data was applied to identify participants with axSpA. RESULTS: MRIs of 793 volunteers were evaluated. The presence of SIJ-BME (odds ratio) was strongly associated delivery during the last year (4.47, 1.49-13.41). For SIJ-BME extension, associations (incidence rate ratios, 95% CI) were found for delivery ((during last year) 4.52, 1.48-13.84), human leucocyte antigen (HLA)-B27+ (2.32, 1.30-4.14), body mass index (25-30 vs <25 kg/m²; 1.86 (1.19-2.89)) and back pain ((last 3 months) 1.55, 1.04-2.31), while for spinal BME, associations were found for age per decade (1.46, 1.13-1.90) and physically demanding work (1.46, 1.06-2.00). Record linkage was available for 694 (87.5%) participants and 9/694 (1.3%) had a record of axSpA (ICD M45.09). CONCLUSION: These population-based data support the hypothesis of mechanic strain contributing to BME in the general population aged <45 years and the role of HLA-B27+ as a severity rather than a susceptibility factor for SIJ-BME.

Europe-Wide Atmospheric Radionuclide Dispersion by Unprecedented Wildfires in the Chernobyl Exclusion Zone, April 2020.

From early April 2020, wildfires raged in the highly contaminated areas around the Chernobyl nuclear power plant (CNPP), Ukraine. For about 4 weeks, the fires spread around and into the Chernobyl exclusion zone (CEZ) and came within a few kilometers of both the CNPP and radioactive waste storage facilities. Wildfires occurred on several occasions throughout the month of April. They were extinguished, but weather conditions and the spread of fires by airborne embers and smoldering fires led to new fires starting at different locations of the CEZ. The forest fires were only completely under control at the beginning of May, thanks to the tireless and incessant work of the firefighters and a period of sustained precipitation. In total, 0.7-1.2 TBq 137Cs were released into the atmosphere. Smoke plumes partly spread south and west and contributed to the detection of airborne 137Cs over the Ukrainian territory and as far away as Western Europe. The increase in airborne 137Cs ranged from several hundred µBq·m-3 in northern Ukraine to trace levels of a few µBq·m-3 or even within the usual background level in other European countries. Dispersion modeling determined the plume arrival time and was helpful in the assessment of the possible increase in airborne 137Cs concentrations in Europe. Detections of airborne 90Sr (emission estimate 345-612 GBq) and Pu (up to 75 GBq, mostly 241Pu) were reported from the CEZ. Americium-241 represented only 1.4% of the total source term corresponding to the studied anthropogenic radionuclides but would have contributed up to 80% of the inhalation dose.

Frequency of MRI changes suggestive of axial spondyloarthritis in the axial skeleton in a large population-based cohort of individuals aged <45 years.

OBJECTIVE: To investigate the frequency of bone marrow oedema (BME) and fatty lesions (FL) suggestive of axial spondyloarthritis (axSpA) on MRI of the spine and sacroiliac joints (SIJ) in a general population sample. METHODS: As part of a community-based cohort project (Study of Health in Pomerania), volunteers underwent spinal (sagittal T1/T2) and SIJ (semicoronal short tau inversion recovery) MRI examinations. Two calibrated readers evaluated the images to detect BME in SIJ and vertebral corners (VC) and FL in VC suggestive of axSpA using Assessment of SpondyloArthritis international Society definitions. RESULTS: MRIs of 793 volunteers (49.4% males, mean age 37.3±6.3 years, 8.4% human leucocyte antigen-B27+) aged <45 years were evaluated. SIJ BME was seen in 136 (17.2%), VC BME in 218 (27.5%) and FL in 645 (81.4%) volunteers. SIJ BME in ≥1, ≥3 and ≥5 SIJ quadrants was seen in 136 (17.2%), 7 (0.9%) and 1 (0.1%) volunteers, respectively. In VC, BME≥1, ≥3 and ≥5 lesions were seen in 218 (27.5%), 38 (4.8%) and 6 (0.8%) volunteers, respectively, while FL≥1, ≥3 and ≥5 were seen in 645 (81.3%), 351 (44.3%) and 185 (23.3%) volunteers, respectively. Logistic regression analysis showed that BME and FL in VC were related to increasing age: OR 1.33, 95% CI 1.02 to 1.72, and OR 1.73, 95% CI 1.32 to 2.27, per decade increase, respectively. CONCLUSIONS: In this large population-based study, a high frequency of inflammatory and fatty MRI lesions suggestive of axSpA was found, especially in the spine. This indicates a limited value of such MRI findings for diagnosis and classification of axSpA. The increasing frequency with age suggests that mechanical factors could play a role.

Size distributions of airborne radionuclides from the fukushima nuclear accident at several places in europe.

Segregation and radioactive analysis of aerosols according to their aerodynamic size were performed in France, Austria, the Czech Republic, Poland, Germany, and Greece after the arrival of contaminated air masses following the nuclear accident at the Fukushima Dai-ichi nuclear power plant in March 2011. On the whole and regardless of the location, the highest activity levels correspond either to the finest particle fraction or to the upper size class. Regarding anthropogenic radionuclides, the activity median aerodynamic diameter (AMAD) ranged between 0.25 and 0.71 µm for (137)Cs, from 0.17 to 0.69 µm for (134)Cs, and from 0.30 to 0.53 µm for (131)I, thus in the "accumulation mode" of the ambient aerosol (0.1-1 µm). AMAD obtained for the naturally occurring radionuclides (7)Be and (210)Pb ranged from 0.20 to 0.53 µm and 0.29 to 0.52 µm, respectively. Regarding spatial variations, AMADs did not show large differences from place to place compared with what was observed concerning bulk airborne levels registered on the European scale. When air masses arrived in Europe, AMADs for (131)I were about half those for cesium isotopes. Higher AMAD for cesium probably results from higher AMAD observed at the early stage of the accident in Japan. Lower AMAD for (131)I can be explained by the adsorption of gaseous iodine on particles of all sizes met during transport, especially for small particles. Additionally, weathering conditions (rain) encountered during transport and in Europe in March and April contributed to the equilibrium of the gaseous to total (131)I ratio. AMAD slightly increased with time for (131)I whereas a clear decreasing trend was observed with the AMADs for (137)Cs and (134)Cs. On average, the associated geometric standard deviation (GSD) appeared to be higher for iodine than for cesium isotopes. These statements also bear out a gaseous (131)I transfer on ambient particles of a broad size range during transport. Highest weighted activity levels were found on the 0.49-0.95 µm and on the 0.18-0.36 µm size ranges in France and in Poland, respectively. The contribution from resuspension of old deposited (137)Cs was assessed for the coarse particle fractions only for the first sampling week.

Online spectral unmixing in gamma-ray spectrometry.

We introduced in a previous paper a time-dependent full-spectrum analysis algorithm speeding up the estimation of the activity of the radionuclides present in a sample. In this paper, we present a new version of the algorithm allowing online estimation. It uses only on a buffer of few segments while keeping the time information by using a time dependent regularization, thus reducing the size of the data matrices and the length of the processing of each iteration. The algorithm is optimized and tested on both simulated and measured spectra of aerosol samples.

Common clinical blood and urine biomarkers for ischemic stroke: an Estonian Electronic Health Records database study.

BACKGROUND: Ischemic stroke (IS) is a major health risk without generally usable effective measures of primary prevention. Early warning signals that are easy to detect and widely available can save lives. Estonia has one nation-wide Electronic Health Record (EHR) database for the storage of medical information of patients from hospitals and primary care providers. METHODS: We extracted structured and unstructured data from the EHRs of participants of the Estonian Biobank (EstBB) and evaluated different formats of input data to understand how this continuously growing dataset should be prepared for best prediction. The utility of the EHR database for finding blood- and urine-based biomarkers for IS was demonstrated by applying different analytical and machine learning (ML) methods. RESULTS: Several early trends in common clinical laboratory parameter changes (set of red blood indices, lymphocyte/neutrophil ratio, etc.) were established for IS prediction. The developed ML models predicted the future occurrence of IS with very high accuracy and Random Forests was proved as the most applicable method to EHR data. CONCLUSIONS: We conclude that the EHR database and the risk factors uncovered are valuable resources in screening the population for risk of IS as well as constructing disease risk scores and refining prediction models for IS by ML.

Transforming Estonian health data to the Observational Medical Outcomes Partnership (OMOP) Common Data Model: lessons learned.

Objective: To describe the reusable transformation process of electronic health records (EHR), claims, and prescriptions data into Observational Medical Outcome Partnership (OMOP) Common Data Model (CDM), together with challenges faced and solutions implemented. Materials and Methods: We used Estonian national health databases that store almost all residents' claims, prescriptions, and EHR records. To develop and demonstrate the transformation process of Estonian health data to OMOP CDM, we used a 10% random sample of the Estonian population (n = 150 824 patients) from 2012 to 2019 (MAITT dataset). For the sample, complete information from all 3 databases was converted to OMOP CDM version 5.3. The validation was performed using open-source tools. Results: In total, we transformed over 100 million entries to standard concepts using standard OMOP vocabularies with the average mapping rate 95%. For conditions, observations, drugs, and measurements, the mapping rate was over 90%. In most cases, SNOMED Clinical Terms were used as the target vocabulary. Discussion: During the transformation process, we encountered several challenges, which are described in detail with concrete examples and solutions. Conclusion: For a representative 10% random sample, we successfully transferred complete records from 3 national health databases to OMOP CDM and created a reusable transformation process. Our work helps future researchers to transform linked databases into OMOP CDM more efficiently, ultimately leading to better real-world evidence.

Analysis of gamma-ray spectra with spectral unmixing, Part II: Recalibration for the quantitative analysis of HPGe measurements.

In the context of radioactivity measurements, the quantitative analysis of a gamma-ray spectrum depends on the analysis algorithm. To that end, we recently introduced a Poisson statistics-based spectral unmixing approach. However, it also relies on a proper instrument recalibration as well as on an uncertainty estimation, for which no solution has been proposed so far. The goal of this article is twofold: i) we first present a novel method to correct for the instrument calibration of an HPGe detection system, which is tailored to spectral unmixing algorithms, and ii) we apply this new approach to the quantitative analysis of real data as well as on the evaluation of the uncertainty. Along with the characteristic limits determination investigated, this paper introduces the first full metrological analysis sequence of aerosol filter measurements based on spectral unmixing, which allows to quantify both the radionuclides' activities and their associated uncertainties.

Analysis of gamma-ray spectra with spectral unmixing - Part I: Determination of the characteristic limits (decision threshold and statistical uncertainty) for measurements of environmental aerosol filters.

Poisson-statistics based spectral unmixing has been shown to be an efficient analysis tool for the radionuclides activity estimation from gamma-ray spectrometry measurements. However, the calculation of the corresponding characteristic limits has not been investigated so far. In this paper, we present the quantification of the decision threshold and the limits of the coverage interval for the metrological use of such spectral unmixing algorithms. The proposed approach is evaluated and validated with simulated spectra of HPGe and NaI measurements by comparing the results to characteristic limits calculated from Monte-Carlo simulations. We focus particularly on the validation of the method for the metrological analysis of environmental measurements, for which the low-level activity quantification requires an accurate characteristic limits determination. Along with the instrument calibration, we establish a metrological analysis tool by using the spectral unmixing algorithm for environmental aerosol filters measured by gamma-ray spectrometry.

A Review of the Design and Implementation of a Hybrid Cardiac Rehabilitation Program: AN EXPANDING OPPORTUNITY FOR OPTIMIZING CARDIOVASCULAR CARE.

PURPOSE: This review describes the considerations for the design and implementation of a hybrid cardiac rehabilitation (HYCR) program, a patient-individualized combination of facility-based cardiac rehabilitation (FBCR) with virtual cardiac rehabilitation (CR) and/or remote CR. REVIEW METHODS: To help meet the goal of the Millions Hearts Initiative to increase CR participation to 70% by 2022, a targeted review of the literature was conducted to identify studies pertinent to the practical design and implementation of an HYCR program. Areas focused upon included the current use of HYCR, exercise programming considerations (eligibility and safety, exercise prescription, and patient monitoring), program assessments and outcomes, patient education, step-by-step instructions for billing and insurance reimbursement, patient and provider engagement strategies, and special considerations. SUMMARY: A FBCR is the first choice for patient participation in CR, as it is supported by an extensive evidence base demonstrating effectiveness in decreasing cardiac and overall mortality, as well as improving functional capacity and quality of life. However, to attain the CR participation rate goal of 70% set by the Million Hearts Initiative, CR programming will need to be expanded beyond the confines of FBCR. In particular, HYCR programs will be necessary to supplement FBCR and will be particularly useful for the many patients with geographic or work-related barriers to participation in an FBCR program. Research is ongoing and needed to develop optimal programming for HYCR.

A comprehensive assessment of two-decade radioactivity monitoring around the Channel Islands.

The Channel Islands are located in the Normand-Breton Gulf (NBG), in the mid-part of the English Channel (France, Normandy). In the northern part, off Cap La Hague, controlled amounts of radioactive liquid waste are discharged by the ORANO La Hague nuclear fuel reprocessing plant (RP). Radionuclides were monitored in the NBG to assess the dispersion of radioactive discharges from the RP in the marine environment. The temporal and spatial distribution of the data are consistent with the history of the discharges, with most gamma emitter radionuclide environmental levels being close to or below the current limits of detection. A clear fingerprint of H-3, C-14 and I-129 radionuclides discharged from the RP is measured. The hydrodynamics in the NBG do not yield a simple gradient with linear distance from the outfall of the RP. Modelling tools were used to understand how radioactive discharges spread from the source of input. Dispersion patterns clearly illustrate the different behaviours of soluble and non-soluble radionuclides. The study indicated that the footprint of radioactive liquid discharges by French nuclear facilities was still measurable in species collected from the NBG for the mostly dissolved radionuclides. The less conservative ones, with a high affinity for suspended matter, are potentially influenced by old releases. These pathways could be investigated by dedicated hydrodynamic dispersion models. Overall, in the Channel Islands the levels are low and consistent with the general decrease in liquid radionuclide discharges by the RP since the 1990s.

Coordinated underground measurements of gamma-ray emitting radionuclides for plasma physics research.

Forty-eight samples made of CaF2, LiF and YVO4 were placed inside the KSTAR Tokamak and irradiated by neutrons and charged particles from eight plasma pulses. The aim was to provide information for plasma diagnostics. Due to the short pulse durations, the activities induced in the samples were low and therefore measurements were performed in five low-background underground laboratories. Details of the underground measurements, together with data on the quality control amongst the radiometric laboratories, are presented.

Variation in airborne 134Cs, 137Cs, particulate 131I and 7Be maximum activities at high-altitude European locations after the arrival of Fukushima-labeled air masses.

The Fukushima-labeled air mass arrival, and later the cesium-134 (134Cs), cesium-137 (137Cs) and particulate iodine-131 (hereafter noted 131Ip) maximum levels were registered in Europe at different dates depending on the location. Most of those data were obtained at low-altitude sampling areas. Here, we compare the airborne levels registered at different high-altitude European locations (from 850 m to about 3500 m). The integrated 137Cs activity concentration was not uniform with regard to the altitude even after a long travel time/distance from Japan. Moreover, the relation of integrated 137Cs vs. altitude showed a linear decrease up to an altitude of about 3000 m. A similar trend was noticed for 131Ip (particulate fraction) while it increased above 3000 m. Comparison with 7Be activity concentration showed that, as far as the high altitude location is concerned, the 137Cs and 134Cs maximum concentrations corresponded to the 7Be maximum, suggesting downdraft movements from high tropospheric or stratospheric layers to be responsible for 137,134Cs increase and peak values. This was also confirmed by high potential vorticity and low relative humidity registered during the peak values.