Ultrafast Brain MRI Can Be Used for Indications beyond Shunted Hydrocephalus in Pediatric Patients.

BACKGROUND AND PURPOSE: Evaluation of shunted hydrocephalus is the most common indication for ultrafast brain MRI. Radiation-/sedation-free imaging capabilities make this protocol more desirable over CT and standard brain MRI. We hypothesized that ultrafast brain MRI can be used for selected indications beyond shunted hydrocephalus without adverse outcomes. MATERIALS AND METHODS: Ultrafast brain MRI was performed with axial, sagittal, and coronal HASTE. The radiology information system was used to identify pediatric patients (0-18 years of age) who underwent ultrafast brain MRI between March 2014 and May 2016. A retrospective chart review was completed to identify indications other than shunted hydrocephalus, such as ventriculomegaly, macrocephaly, or intracranial cyst. All ultrafast brain MRIs were evaluated by a certified neuroradiologist and a neurosurgeon. Ultrafast brain MRI was deemed of sufficient diagnostic value for these indications if no further standard brain MRI was required for the study indication or if additional imaging was performed for an alternate indication. RESULTS: The radiology information system identified 800 patients who had undergone an ultrafast brain MRI during the study period. One hundred twenty-two of these patients had ventriculomegaly, macrocephaly, or intracranial cyst as the study indication. Twenty-one of the 122 patients were excluded due to insufficient follow-up. Of the remaining 101 patients, only 5 had a standard brain MRI for the same indication, with no additional clinically significant information identified on those studies. CONCLUSIONS: These results suggest that ultrafast brain MRI is sufficient to evaluate ventriculomegaly, macrocephaly, or intracranial cyst. Ultrafast brain MRI is radiation- and sedation-free; therefore, we recommend its use as the primary screening neuroimaging study for these indications.

Two-dimensional plasmonic grating for increased quantum efficiency in midwave infrared nBn detectors with thin absorbers.

We demonstrate a strategy for increasing the operating temperatures of nBn midwave infrared (MWIR) focal plane arrays, based on the use of two-dimensional plasmonic gratings to enhance the quantum efficiency (QE) of structures with very thin absorbers. Reducing the absorber volume correspondingly reduces the dark current in a diffusion-limited photodiode, while light trapping mediated by the plasmonic grating increases the net absorbance to maintain high QE. The plasmonically enhanced nBn MWIR sensors with absorber thicknesses of only 0.5 µm exhibit peak internal QEs as high as 57%, which enables a 5-fold reduction in dark current. Numerical simulations indicate the potential for further improvement.

How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center.

BACKGROUND AND PURPOSE: Lean Six Sigma methodology is increasingly used to drive improvement in patient safety, quality of care, and cost-effectiveness throughout the US health care delivery system. To demonstrate our value as specialists, radiologists can combine lean methodologies along with imaging expertise to optimize imaging elements-of-care pathways. In this article, we describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in our population of patients with hydrocephalus by 50% within 6 months. MATERIALS AND METHODS: We applied a Lean Six Sigma methodology using a multidisciplinary team at a quaternary care academic children's center. The existing baseline imaging practice for hydrocephalus was outlined in a Kaizen session, and potential interventions were discussed. An improved radiation-free workflow with ultrafast MR imaging was created. Baseline data were collected for 3 months by using the departmental radiology information system. Data collection continued postintervention and during the control phase (each for 3 months). The percentage of neuroimaging per technique (head CT, head ultrasound, ultrafast brain MR imaging, and routine brain MR imaging) was recorded during each phase. RESULTS: The improved workflow resulted in a 75% relative reduction in the percentage of hydrocephalus imaging performed by CT between the pre- and postintervention/control phases (Z-test, P = .0001). CONCLUSIONS: Our lean interventions in the pediatric hydrocephalus care pathway resulted in a significant reduction in head CT orders and increased use of ultrafast brain MR imaging.

Formalehyde in personal care products.

Personal care products reported to cause allergic contact dermatitis from the presence of formaldehyde need to be re-examined in light of recent chemical developments in our understanding of the film former, toluene sulfonamide formaldehyde resin, the preservatives diazolidinyl urea and imidazolidinyl urea, and formalin. This paper will elucidate these chemistries as well as review how formaldehyde is used in personal care products in raw materials and formaldehyde donor preservatives.

Subungual penetration of dibutyl phthalate in human fingernails.

Dibutyl phthalate (DBP) has a wide variety of manufacturing applications and is used in both commercial and consumer products. Results of animal reproductive toxicity and teratogenicity animal studies have not been consistent in identifying DBP as a reproductive toxicant. Expert reviews for its use in consumer products have consistently concluded that it is not a reproductive risk to consumers. Results from a subungual penetration study of 100% fluid DBP applied to human fingernails showed levels of penetration at the limits of chemical detection. Even if DBP penetrated the human fingernail, its rapid metabolism by the human body would prevent its having any toxic reproductive effects. Furthermore, DBP functions as a plasticizer in consumer products such as cosmetic nail products (nail polish, basecoats, topcoats, nail hardeners), resulting in its becoming unavailable for subungual penetration seconds after application of the cosmetic nail product since it is then trapped in the rapidly forming coating.

Kinetics and plasma concentrations of 26-hydroxycholesterol in baboons.

26-Hydroxycholesterol (26OHC), a major oxysterol in human blood, is believed to play an important role in reverse cholesterol transport, bile acid formation, and regulation of various cellular processes. Using isotope dilution mass spectrometry, we measured plasma 26OHC concentrations in baboons fed either a high cholesterol/saturated fat (HC-SF) or normal chow diet. Plasma 26OHC levels in baboons were comparable to those reported for humans and were positively correlated with plasma cholesterol concentrations. Animals on the HC-SF diet had significantly higher 26OHC levels (0.274+/-0.058 microM, mean+/-S.D.) than those on the chow diet (0.156+/-0.046 microM). In separate experiments, [(3)H]26OHC was injected into four tethered baboons, and multiple blood samples drawn over a 1-h period were analyzed for [(3)H]26OHC and 26OHC. Fitting the specific radioactivity data to a two-pool compartmental model indicated a rapidly turning over plasma compartment (t(1/2) 2.9-6.0 min) and a second compartment with slow turnover (t(1/2) 76-333 min). The calculated 26OHC production rate was 2.5 micromol/kg body weight/day. Assuming all 26OHC is converted to bile acids, the 26OHC production rate corresponds to about 10% of total bile acid production in adult baboons. These results indicate that rapid turnover of plasma 26OHC at submicromolar concentrations could significantly contribute to bile acid synthesis.

A global inventory of hospitals using powder-free gloves: a search for principled medical leadership.

Scientific experimental and clinical studies have demonstrated that cornstarch on surgical and examination gloves promotes disease by acting as a reactive foreign body in tissue and serving as a vector for latex allergy. Consequently, hospitals have selected an innovative glove selection program utilizing only powder-free gloves. Healthcare workers in emergency medical systems are now wearing powder-free, latex-free gloves to care for the growing number of patients sensitized to latex. A global Internet search has now identified 70 hospitals in the United States and three hospitals in Europe that use only powder-free gloves.

Trigeminal neuralgia: a diagnostic challenge.

A 38-year-old white woman came to the emergency department complaining of severe, unilateral jaw pain. She had consulted her primary care physician and dentist without achieving the correct diagnosis or significant relief of her symptoms. The emergency physician made the diagnosis of trigeminal neuralgia by obtaining a history of severe paroxysmal ipsilateral facial pain activated by numerous facial stimuli. A light stimulation of the trigger point precipitated the pain. Her pain relief from carbamazepine lent further credence to the diagnosis of trigeminal neuralgia and appropriate referral to a neurosurgeon. Pain relief was ultimately achieved for the last 8 months by a neurectomy of the right infraorbital nerve.

Integrity of powder-free examination gloves to bacteriophage penetration.

The purpose of this study was to compare the resistance to viral penetration of powder-free synthetic examination gloves with powder-free latex examination gloves commonly used in hospitals. Because these gloves had no holes, this study examined viral penetration through a membrane. Using a standard bacteriophage penetration model, no bacteriophage penetration was detected through the membrane for any of the gloves tested. The new powder-free nitrile and polyvinyl chloride synthetic examination gloves provided comparable resistance to viral penetration as did the powder-free latex examination gloves.

Assessing the bioactivity of cosmetic products and ingredients.

Cosmetic ingredients can produce physical effects on the skin as well as positive and negative bioactive effects. Such effects have now been identified, categorized and interpreted. Because of this ongoing research and increased understanding, cosmetics, especially skin care products, are being improved. Targeting specific bioactive effects from newly developed cosmetic products is now possible. This development is aided by refining and expanding existing instrumental analysis which is now capable of elucidating more detailed and statistically significant differences from the use of certain ingredients in cosmetics. However, the ultimate proof of these changes will remain the consumer response to such products. Physical effects and the positive and negative bioactive effects from specific cosmetic ingredients will be discussed in relationship to the anatomy, physiology and condition of human skin. Examples of selected cosmetic ingredients in relationship to the anatomy, physiology and condition of human skin will be given. Demonstrations of selected cosmetic ingredient effects will be by way of clinical observation, instrumental analysis and consumer evaluation.

Biomechanical performance of examination gloves.

The purpose of this study was to compare the biomechanical performance of new powder-free commercially available synthetic examination gloves to that of commercially available powder-free latex examination gloves. The synthetic gloves were significantly thinner than the latex gloves. Despite the decreased thickness, all three nitrile gloves, as well as the polyvinyl chloride glove, exhibited a greater resistance to glove puncture. The glove donning forces varied considerably among all gloves, and wet donning forces were greater than dry donning forces. Under dry conditions, the donning forces for the synthetic gloves were less than or equal to the forces for the latex gloves. Because of their increased puncture resistance and similar donning forces, synthetic gloves are a safe alternative to latex examination gloves.

Biomechanical performance of orthopedic gloves.

The purpose of this study was to compare the biomechanical performance of commercially available orthopedic gloves to that of a single surgical glove, as well as a double glove system. The orthopedic gloves were found to be thicker than the single surgical glove. This increased thickness of the orthopedic glove was associated with a greater resistance to glove puncture. The thickest orthopedic gloves also had reduced tactile sensitivity when compared to the single surgical glove. In addition, the glove donning forces and glove hydration rates varied considerably. These latter biomechanical performance parameters were not significantly related to glove thickness. The double glove systems tested in this study had similar performance characteristics in regard to many of the orthopedic gloves. The glove donning forces for the double glove systems were the lowest of the gloves tested. In addition, the double glove systems displayed the greatest resistance to glove hydration of the gloves tested. Their performance in the glove hydration tests and the force required to don the double glove systems were much more desirable than any of the orthopedic gloves. The results of this study indicate that the double glove systems may provide a desirable alternative to the use of the single orthopedic gloves.

Failure of glove hole detection device for synthetic gloves.

Holes in latex gloves can be reliably detected by commercially available electronic devices. The purpose of this study was to compare the performance of an electronic glove hole detection device using latex gloves to that of neoprene, vinyl, and nitrile latex-free gloves. The electronic hole detection device accurately detected holes in the latex gloves during the 2-h study. In contrast, the latex-free gloves were immediately conductive of electricity in the absence of holes. Consequently, electronic glove hole detection devices cannot be reliably used with latex-free gloves.

Comparison testing of the irritancy of children's liquid bubble bath using a modified human repeat insult patch test.

BACKGROUND: Bubble baths are common products used by parents with young children. Some dermatologists and pediatricians do not recommend the use of these products. OBJECTIVE: The purpose of this study was to compare the irritancy of nine children's liquid bubble bath solutions. METHODS: A modified human repeat insult patch test (HRIPT) was used to rank order the irritancy of nine bubble bath preparations. Erythema, scaling, and fissuring were evaluated at the patch test sites. RESULTS: The nine products tested varied in their ability to cause irritation. Based on the degree of erythema, the least irritation was produced with Sesame Street Fresh Apple Splash bubble bath. CONCLUSION: This study suggests that there are differences in the irritancy of brands of children's liquid bubble bath and that recommendations can be made by both dermatologists and pediatricians when parents choose to use these products on their children.

Prognostic patch testing: the other kind of patch test.

Prognostic patch testing differs from diagnostic patch testing. Clinicians routinely perform diagnostic patch testing, but prognotic patch testing is the province of corporate research and development departments and, in the United States, contract laboratories. The three types of prognostic patch testing are described and referenced in the scientific and medical literature. A comparison among the three types of prognostic patch testing and diagnostic patch testing is provided. In addition, the variables in both prognostic and diagnostic patch testing are listed, as well as the types of ingredients and products routinely tested in prognostic patch testing.

Ease of donning commercially available latex examination gloves.

There are a wide variety of latex examination gloves now available for use by health care providers. A prospective randomized trial was completed to quantify the forces required to don a sample of seven cornstarch-lubricated gloves and 13 powder-free latex examination gloves. The data collected was analyzed by a 20 x 2 general factorial ANOVA, as well as two 1-way ANOVAs using a least significance difference post hoc test. Some powder-free gloves can be easily donned with dry or wet hands without tearing with forces comparable to those encountered with powdered gloves. With the advent of these powder-free examination gloves, powdered gloves can now be abandoned, protecting health professionals and patients from the dangers of absorbable dusting powders. Despite the dangers of the absorbable dusting powders and the Food and Drug Administration's requirement for labeling examination glove boxes, some manufacturers of powdered examination gloves do not appropriately label their boxes with a warning to the health professional and patient of the presence of powder.