Effects of providing personalized feedback of child's obesity risk on mothers' food choices using a virtual reality buffet.

BACKGROUND: Providing personalized genetic-risk feedback of a child's susceptibility to adult-onset health conditions is a topic of considerable debate. Family health history (FHH), specifically parental overweight/obesity status, is a useful assessment for evaluating a child's genetic and environmental risk of becoming obese. It is unclear whether such risk information may influence parents' efforts to reduce their child's risk of obesity. PURPOSE: To evaluate whether telling mothers the magnitude of their child's risk of becoming obese based on personal FHH influenced food choices for their young child from a virtual reality-based buffet restaurant. METHODS: Overweight/obese mothers of a child aged 4-5 years who met eligibility criteria (N=221) were randomly assigned to one of three experimental arms, which emphasized different health information: arm 1, food safety control (Control); arm 2, behavioral-risk information (BRI) alone or arm 3, behavioral-risk information plus personal FHH-based risk assessment (BRI+FHH). Mothers donned a head-mounted display to be immersed in a virtual restaurant buffet, where they selected virtual food and beverages as a lunch for their child. RESULTS: Mothers who were randomized to BRI+FHH filled the index child's plate with an average of 45 fewer calories than those in the Control arm (P<0.05); those in the BRI arm filled the plate with 35 fewer calories than the Control arm, a non-significant difference. Calorie restriction was greatest among mothers in the BRI+FHH arm who received the weaker-risk message (that is, only one overweight parent). CONCLUSIONS: The influence of communicating a child's inherited risk of obesity on mothers' feeding practices may vary by the risk level conveyed. High-risk messages may best be coupled with strategies to increase mother's perceptions that efforts can be undertaken to reduce risk and build requisite behavioral skills to reduce risk.

Imaging of traumatic and non-traumatic emergencies--one approach.

Selection and design of the most appropriate imaging studies during an emergency involving pregnant and/or potentially pregnant female has been the topic of numerous recent articles. While radiation dose must be limited to the necessary amount, a cautious application must never be so severe as to compromise the ability to make the correct diagnosis. No one approach suits all facilities or all circumstances. All approaches need to be institution specific, and may be country or continent dependent. In this article we review our approach to this scenario.

Pfaffian pairing wave functions in electronic-structure quantum Monte Carlo simulations.

We investigate the accuracy of trial wave functions for quantum Monte Carlo based on Pfaffian functional form with singlet and triplet pairing. Using a set of first row atoms and molecules we find that these wave functions provide very consistent and systematic behavior in recovering the correlation energies on the level of 95%. In order to get beyond this limit we explore the possibilities of multi-Pfaffian pairing wave functions. We show that a small number of Pfaffians recovers another large fraction of the missing correlation energy comparable to the larger-scale configuration interaction wave functions. We also find that Pfaffians lead to substantial improvements in fermion nodes when compared to Hartree-Fock wave functions.

Management of patient skin dose in fluoroscopically guided interventional procedures.

PURPOSE: To simulate dose to the skin of a large patient for various operational fluoroscopic conditions and to delineate how to adjust operational conditions to maintain skin dose at acceptable levels. MATERIALS AND METHODS: Patient entrance skin dose was estimated from measurement of entrance air kerma (dose to air) to a 280-mm water phantom for two angiographic fluoroscopes. Effects on dose for changes in machine floor kVp, source-to-skin distance, air gap, electronic magnification, fluoroscopic dose rate control settings, and fluorographic dose control settings were examined. RESULTS: Incremental changes in operational parameters are multiplicative and markedly affect total dose delivered to a patient's skin. For long procedures, differences in doses of 8 Gy or more are possible for some combinations of operational techniques. CONCLUSIONS: Effects on skin dose from changes in operational parameters are multiplicative, not additive. Doses in excess of known thresholds for injury can be exceeded under some operating conditions. Adjusting operational parameters appropriately will markedly reduce dose to a patient's skin. Above all other operational factors, variable pulsed fluoroscopy has the greatest potential for maintaining radiation exposure at low levels.

Protecting patients by training physicians in fluoroscopic radiation management.

During the past 15 years, developments in x-ray technologies have substantially enhanced the ability of practitioners to treat patients using fluoroscopically guided interventional techniques. However, many of these procedures require a greater use of fluoroscopy and serial imaging (cine). This has increased the potential for radiation-induced dermatitis, epilation, and severe radiation-induced burns to patients. It has also increased the potential for radiation injury and radiation-induced cancer in personnel. This work will describe a number of the cases that have appeared in the literature and current recommendations and credentialing requirements of various organizations whose members use fluoroscopy. Finally, a program for implementing training of physicians in radiation management as a means of reducing the risk of injury to patients and personnel is recommended.

Severe skin reactions from interventional fluoroscopy: case report and review of the literature.

Some patients with certain preexisting health conditions may be at elevated risk for unusually intense radiation-induced skin reactions and late tissue damage from high-dose interventional procedures. The authors present a case report of a patient with mixed connective tissue disease and non-insulin-dependent diabetes mellitus who developed an unusual complication after placement of a transjugular intrahepatic portosystemic shunt. On the basis of a review of the literature, the following experiences may help identify patients at increased risk: previous high-dose procedures, connective tissue disease, diabetes mellitus, and homozygosity for ataxia telangiectasia.

Characteristics of radiation detectors for diagnostic radiology.

The use of X-rays for diagnosis has been significant since its discovery. A measurement of the X-ray dose is the main determinant for risk vs benefit of these examinations. Radiation detectors are important for dose measurement. A description of these detectors, including the most frequently used ionization chamber, aids in the understanding necessary for their use. Proper and accurate use of detectors depends on an understanding of their calibration and their characteristics. Detectors such as ionization chamber, including specialized chambers, and solid detectors, including luminescent detectors, are described. This is followed by a description of the calibration process. The precision of measurements can be greatly affected by an understanding of the detector in use.

Real-time portal monitoring to estimate dose to skin of patients from high dose fluoroscopy.

Since doses to skin of patients from fluoroscopically-guided interventional procedures can be very high, real-time monitoring of skin dose is important for both patient management and quality control. The use of a scintillation detector, placed on the X-ray port to measure potential skin dose, was investigated, focusing on the uncertainties related to the technique. Sources of uncertainty include performance characteristics of the dosemeter, errors in calibration, patient set-up and changes during the procedure. Some of the largest sources of error include uncertainty in source-to-skin distance, heel effect, difficulty in identifying the area of skin principally exposed, calibration error, energy dependence of the dosemeter and the dose rate dependence of the monitor. This technique is found to be beneficial for radiation management, but users must be cognizant of the potential errors of the method and the limitations that these place on quality control and patient management. Knowing the limitations and minimizing the sources of error enhance the utility of the technique.

Induction of cyclooxygenase-2 expression by peroxisome proliferators and non-tetradecanoylphorbol 12,13-myristate-type tumor promoters in immortalized mouse liver cells.

Increased expression of cyclooxygenase-2 (COX-2), the rate-limiting enzyme in prostaglandin synthesis, has been associated with growth regulation and carcinogenesis in several systems. COX-2 is known to be induced by cytokines and the skin tumor promoter 12-tetradecanoylphorbol-13-myristate (TPA). In the present study, we investigated the effects of several non-TPA-type tumor promoters on COX-2 expression in immortalized mouse liver cells. Specifically, we tested peroxisome proliferators (PPs), which are rodent liver tumor promoters that cause gross alterations in cellular lipid metabolism, the rodent liver tumor promoter phenobarbital, and the skin tumor promoters okadaic acid and thapsigargin. The PPs Wy-14643, mono-ethylhexyl phthalate, clofibrate, ciprofibrate ethyl ester, and eicosatetraynoic acid each caused large increases in COX-2 mRNA and protein, with maximal expression seen approximately 10 h after treatment of quiescent cells. COX-2 expression was also induced by thapsigargin, okadaic acid, and calcium ionophore A23187, but not by phenobarbital or the steroid PP dehydroepiandrosterone sulfate. Induction of COX-2 expression generally resulted in increased synthesis of prostaglandin E2 (PGE2). However, the PPs caused little or no increase in PGE2 levels, and they inhibited serum-induced PGE2 synthesis. Unlike non-steroidal anti-inflammatory drugs, the PPs do not directly inhibit cyclooxygenase enzyme activity in vitro. Thus, PPs regulate prostaglandin metabolism via both positive (COX-2 induction) and inhibitory mechanisms. In summary, the strong induction of COX-2 expression by PPs, thapsigargin, and okadaic acid suggests a possible role for COX-2 in the growth regulatory activity of these non-TPA-type tumor promoters.

Reproducibility and accuracy of measurements with a hand held autorefractor in children.

AIM: To determine reproducibility and accuracy of the Nikon Retinomax autorefractor when used with children who were made cycloplegic. METHODS: Autorefraction and retinoscopy or subjectively refined retinoscopy (where, under the patient's direction, the refraction was varied until the best visual acuity was achieved) were performed on the right eye of 47 children, age 11-93 months. Autorefraction was performed using the Nikon Retinomax, which provides up to eight measured values of refractive error and one representative measurement of refractive error. RESULTS: Autorefractor measurements were successfully obtained from 7/9 children age 3 years or younger, and from all older children. Vector methods were used to calculate differences. Retinomax reproducibility averaged 0.43 D. Unbiased Retinomax and retinoscopy measurements differed by an average of 0.82 D. Unbiased Retinomax and subjectively refined retinoscopy differed by an average of 1.03 D. CONCLUSIONS: Reproducibility of Retinomax measured values in children is comparable with reproducibility of retinoscopy, subjective refraction, and autorefraction measurements in adults. Agreement between Retinomax and retinoscopy and agreement between Retinomax and subjective refinement in children is comparable with agreement between autorefraction and subjective refraction in adults. The study indicates that the Retinomax is a useful instrument for measuring refractive errors in young children.

Growth regulation by peroxisome proliferators: opposing activities in early and late G1.

Peroxisome proliferators (PPs) are a diverse group of nongenotoxic rodent liver carcinogens. One potential mechanism for the carcinogenicity of PPs is epigenetic modulation of growth-regulatory signal transduction pathways. We investigated the effects of PPs on growth-regulatory gene expression and cell proliferation in immortalized mouse liver cells, comparing PPs with other growth regulators and tumor promoters of known activity. The PPs Wy-14643, mono-ethylhexyl phthalate, clofibrate, and ciprofibrate ethyl-ester were found to be potent inducers of immediate-early gene expression (including c-fos, c-jun, junB, egr-1, NUP475, and to a lesser extent fosB, JE, and KC, with maximal expression seen 1 h after treatment of serum-deprived quiescent cells. The gene induction was potently inhibited by protein kinase inhibitor H7 [1-(5-isoquinolinesulfonyl)-2-methylpiperazine dihydrochloride] but not by H8 [N-¿2-(methyl-amino)ethyl¿-5-isoquinolinesulfonamide dihydrochloride], indomethacin, or nordihydroguaiaretic acid. Compared with other growth regulators, the profile of PP-induced gene expression was most similar to that induced by arachidonic acid and eicosatetraynoic acid. The induction of immediate-early gene expression by PPs was followed by enhanced progression into S phase (DNA synthesis) when quiescent cells were treated with the PPs for only 1 h, washed, and then incubated without PPs. However, no stimulation of DNA synthesis was seen when the PPs were continually present. Furthermore, the PPs inhibited serum-induced DNA synthesis, even when they were added 6 h after serum stimulation (in late G1). Dehydroepiandrosterone-sulfate, a unique PP in being a steroid, had no detectable effect on immediate-early gene expression, did not stimulate DNA synthesis when applied for only 1 h, but did inhibit serum-induced DNA synthesis. Thapsigargin and A23187 mimicked this mitoinhibitory activity of PPs, suggesting that calcium mobilization by PPs might be involved. Our results demonstrate that PPs can modulate cell proliferation either by a stimulatory activity that functions in early G1, associated with activation of immediate-early gene expression, or by an inhibitory activity that functions in late G1; both activities could potentially play a role in tumor promotion by PPs.

Radiation-attenuating surgical gloves: effects of scatter and secondary electron production.

PURPOSE: To evaluate the effects of scatter and secondary electron production on the protection provided by flexible radiation-attenuating gloves. MATERIALS AND METHODS: Four sets of radiation-attenuating flexible gloves and one set of standard surgical gloves were tested for scattering characteristics and secondary electron production caused by the interactions of x rays inside the gloves. A thin-window ion chamber was used to measure the penetration of secondary electrons in polyethylene. A diagnostic-type chamber was used to measure forward-scattered and backscattered x rays produced by the gloves. RESULTS: Forward-scattered and backscattered x rays added an average of about 13% to the exposure of the hands. Secondary electrons increased the signal in the thin-window chamber by large factors but were weakly penetrating, and only a small fraction produced by x rays of 90 kVp and higher energies contributed to dose to basal cells. CONCLUSION: Forward-scattered and backscattered x rays reduce the effectiveness of radiation-attenuating gloves, and secondary electron dose to basal cells in the back of the hand can further reduce effectiveness.

Radiologic management of abdominal trauma in pregnancy.

Radiologic management of the pregnant female who has sustained blunt abdominal trauma must be individualized and based on the pathophysiology and medical status of the mother and of the conceptus. The potential effects of ionizing radiation and their dependence on the age and size of the conceptus are all considerations in a rational approach to patient management but must not overshadow any exigent need for a diagnostic study.