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.

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.

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.

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.

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.

Ultrasound of Soft Tissue Masses.

Ultrasound (US) should be considered an integral part of the imaging arsenal of the musculoskeletal radiologist. It offers many advantages over other imaging modalities of which, the contact between the radiologist and the patient at the time of examination and its dynamic imaging capabilities are unique. Coupled with color Doppler it gives important information on the vascularity of soft-tissue masses, and it provides rapid, real-time guidance for fine-needle aspiration and biopsy. This article discusses the role of US in the diagnosis of soft-tissue masses. We also propose an algorithm for the investigation of a patient with a suspected soft-tissue mass which uses US and Doppler studies as the second-line imaging modality after radiographs. US is helpful in the diagnosis of cystic and solid soft-tissue masses but, as with any other imaging studies, it is important to know its limitations. Sometimes MRI should be done in place of, or to complement the US examination. In many cases, a biopsy is needed to arrive at a precise and final diagnosis.

Interventional Musculoskeletal Ultrasound.

The diagnostic value of ultrasound for musculoskeletal pathology is well recognized. Ultrasound offers a low-cost, nonionizing, readily available imaging technique for the evaluation of tendons, muscles, soft-tissue masses, cysts, and other fluid collections. These advantages also make ultrasound a valuable tool for guiding a variety of musculoskeletal interventions. Its real-time capabilities permit continuous monitoring of the needle position relative to the target lesion and to surrounding structures such as vessels. Ultrasound can be regarded as the ÒfluoroscopyÓ for soft tissues. Ultrasound therefore can be used to localize and characterize the lesion, monitor the needle position during the procedure, document the efficacy of the drainage or the technique, and be used for follow-up imaging. Procedures that can be performed under ultrasound guidance include aspiration of fluid for analysis, injection of medication (steroids), decompression of cyst, bursitis or joint, abscess and hematoma drainage, treatment of calcific tendinitis, biopsy, and foreign body retrieval.

Ultrasound of Musculoskeletal Infections.

Ultrasound (US) can play an important role in differentiating infectious processes from other musculoskeletal diseases. US is the imaging modality of choice to diagnose superficial abscesses. These abscesses may have variable echogenicity and their detection can be facilitated by ultrasonographic dynamic evaluation and color Doppler imaging. Septic arthritis either in a native or prosthetic joint may have devastating complications on the joint function. Early diagnosis requires joint fluid analysis. US is very sensitive in the detection of joint effusions and is helpful to guide the arthrocentesis. US may help in the early diagnosis of osteomyelitis, although one must always remember that a normal US never excludes bone infection. This article also reviews the role of US in the diagnosis of necrotizing fasciitis, tenosynovitis, bursitis, and pyomyositis. After initial radiographs, along with nuclear medicine studies, US should be considered as the next imaging step in the investigation of musculoskeletal infections.

"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.

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.

Did Ramesses II really have ankylosing spondylitis? A reappraisal.

OBJECTIVE: To challenge the diagnosis of ankylosing spondylitis in the mummy of Ramesses II that was suggested about 30 years ago and to propose a differential diagnosis for the changes that were detected in the mummy's spine and pelvis. METHODS: We read and interpreted both the published and unpublished radiographs of the mummy. RESULTS: Changes in the mummy's spine and pelvis included ossification of the anterior longitudinal ligament at the cervical spine level, ossified enthesopathy of both the right and left rectus femoris tendons as well as the right ischial tuberosity, a large osteophyte at both acetabula margins, no ankylosis of the cervical apophyseal joints and no ankylosis of the right sacroiliac joint. CONCLUSION: The radiologic evidence does not support the claim that Ramesses II had ankylosing spondylitis. Our radiologic reappraisal suggests instead the diagnosis of diffuse idiopathic skeletal hyperostosis. This new diagnosis needs to be validated by a computed tomographic scan of the mummy.

Micro-computed tomography of a 500-year-old tooth: technical note.

OBJECTIVE: To determine whether micro-computed tomography (micro-CT) could be used to reconstruct ancient dental anatomy accurately and differentiate the enamel from the dentin, as well as to verify whether micro-CT could detect tooth disorders such as attrition or caries accurately. METHODS: Micro-CT imaging was performed, using a cone-beam micro-CT specimen scanner, on a 500-year-old human tooth found in a burial jar in the Cardomom Mountains in southwestern Cambodia. RESULTS: The occlusal surface of the tooth showed marked attrition, with the dentin extending close to the enamel layer on the crown. In addition to this, micro-CT images depicted calculus on the buccal surface and a cervical root caries lesion present on the distal surface. The sclerotic zone of the carious lesion (located deep in the destroyed dentin) and the dentin were effectively differentiated through excellent resolution and superior tissue contrast of the volume data set. Axial slices from apical to coronal show the carious lesion extending vertically along the dentin-enamel junction with an intact outer enamel surface. CONCLUSION: Micro-CT is a reproducible, nondestructive and highly accurate technique that can be successfully applied to the study of ancient teeth.

Iliotibial band thickness: sonographic measurements in asymptomatic volunteers.

PURPOSE: The aims of this study were to measure the thickness of the iliotibial band (ITB) in asymptomatic adult volunteers and to determine whether there was any correlation between these measurements and the subjects' age, weight, or height. METHODS: Sonography was used to measure the ITB thickness in 31 asymptomatic volunteers (13 men and 18 women) ranging from 25 to 68 years old. Two radiologists obtained the sonographic measurements of each volunteer at the levels of the femoral condyle and the tibial condyle of both knees. Findings of fluid or bursae adjacent to the ITB were recorded. RESULTS: The mean ITB thickness was 1.95 mm +/- 0.3 mm (+/- standard deviation) at the level of the femoral condyle and 3.4 mm +/- 0.5 mm at the level of the tibial condyle. There was a statistically significant negative correlation between ITB thickness and subject age. There was no significant correlation between ITB thickness and subject weight or height. Joint fluid was present in the lateral recess of both knees in 29 volunteers (93.5%) and 1 knee joint in 2 volunteers (6.5%). Bursae were present in 3 volunteers (9.7%). CONCLUSIONS: The mean sonographic values of normal ITB thickness established using sonography may be helpful in diagnosing ITB pathology. There is no significant correlation between ITB thickness and subject weight or height, but there is a negative correlation between ITB thickness and subject age. Joint fluid in the lateral recess is present in most asymptomatic individuals, but bursae are rare.

Reactivation in post-traumatic chronic osteomyelitis: ultrasonographic findings.

OBJECTIVE: To describe the ultrasound (US) features of reactivation in post-traumatic chronic osteomyelitis in adults. METHODS: Twelve patients with clinical suspicion of reactivation of chronic osteomyelitis, secondary to trauma, surgery, and who were investigated with US were selected for the study. The following US features were assessed: periosseous fluid collection, bone changes (periosteal reactions, cortical irregularity, callus, sequestrum and cloaca) and soft-tissue changes (cellulitis and sinus tracts). US findings were correlated with plain radiography (n = 11), computed tomography (n = 3) and magnetic resonance imaging (n = 2). RESULTS: US detected fluid collections in all patients (12 periosseous and 3 in soft tissues), bone changes in 10 and sinus tracts and cellulitis in 5 patients each. Bone changes detected were cortical irregularity (n = 10), discontinuity of cortex (n = 7), sequestrum (n = 2), callus (n = 2), periosteal reaction (n = 1) and cloaca (n = 1). Cellulitis was seen in 5 patients and sinus tracts in 5. Reactivation was confirmed at surgery in all patients. CONCLUSION: US is a reliable noninvasive imaging modality for the diagnosis of reactivation of post-traumatic chronic osteomyelitis in adults.