Testing telediagnostic thyroid ultrasound in Peru: a new horizon in expanding access to imaging in rural and underserved areas.

PURPOSE: Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. METHODS: The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. RESULTS: Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen's kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. CONCLUSION: Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.

Optimal NH4 + /NO3 - ratios enhance the shade tolerance of soybean seedlings under low light conditions.

In the maize-soybean intercropping system, shade is the major chronic restraint that affects normal growth of soybean. Different spatial patterns of this system affect the microclimate of soybean through shading from maize plants. However, the negative impacts of shading stress can be mitigated by providing optimal ratios of different fertilizers. Therefore, to test this hypothesis, soybean plants were grown under different light conditions (normal light or shade) to evaluate the response to varying NH4 + /NO3 - ratios. Seeds of soybean (Glycine max L. cv. Nan-99-6) were grown in nutrient solution with a total concentration of 5 mM N using different NH4 + /NO3 - ratios (T0  = 0:0, T1  = 0:100, T2  = 25:75, T3  = 50:50 and T4  = 75:25) for 40 days in a greenhouse at PPFD 320.95 µmol m-2  s-1 (low light) or 967.53 µmol m-2  s-1 (normal light). Under low light, growth and photosynthesis of soybean seedlings significantly decreased as compared to normal light conditions. However, the optimal ratios of NH4 + / NO3 - improved growth and photosynthesis of soybean seedlings under both light conditions. Our results indicated that soybean seedlings supplied with optimal NH4 + /NO3 - ratios (25:75 and 50:50) have maximum biomass yield, chlorophyll pigments, leaf gas exchange, photochemical activity and root growth as compared to low and high NH4 + /NO3 - ratios (T1 and T4 ). High ratios of NH4 + /NO3 - (T4 ) resulted in reduced plant growth due to nutrient accumulation in plant tissues; therefore, we suggest that optimal ratios of NH4 + /NO3 - (T2 and T3 ) can enhance the shade tolerance of soybean seedlings.

Infant hunger and satiety cues during the first two years of life: Developmental changes of within meal signalling.

Overfeeding in infancy may lead to overweight and obesity in later childhood. Mothers are advised to "tune in" to their infant's hunger, appetite and satiation cues to prevent overfeeding. The present study aimed to 1) assess stability and change in infant hunger and satiety cues (first two years of life) taken at six monthly intervals; 2) track the expression of appetite cues during the course of a meal (beginning, middle and end). Thirty-eight women (mean age 35.3 + 3.7 years) participated in the study. Mothers were within a normal weight range (BMI = 22 + 3.3 kg/m2), most were married (N = 35; 95%) and for most this was not their first child. After an initial investigation (T1) follow-up visits took place every six months with filmed meals involving solid foods. A typical meal contained foods high in protein and carbohydrate plus cooked vegetables. Films were viewed and communication cues (engagement indicating appetite and disengagement indicating satiation) identified and recorded by appearance using the NCAST (Nursing Child Assessment Satellite Training). Coding included the frequency and time at which each cue appeared. Results showed that infants were more likely to communicate potent engagement cues such as babbling, mutual gaze and looking at mother with age. None of the disengagement cues showed any significant main effects of time of follow up. Most, not all, feeding cues were stable across the segment of the feed and did not show a simple linear change across the meal, rather this appeared to develop with age. Raising awareness of these cues with mothers may encourage more responsive and positive mealtime interactions.

Typical bronchial carcinoid tumour presenting as pneumomediastinum.

The authors present a case of a 44-year-old man who presented with acute onset shortness of breath. He had severe subcutaneous emphysema and his chest x-ray and CT scan confirmed presence of air in mediastinum. Rigid bronchoscopy revealed a bronchial tumour which was proven to be a carcinoid on histology. Patient recovered following the surgical excision of the tumour.

Study of the dispersion and electrical properties of carbon nanotubes treated by surfactants in dimethylacetamide.

In this study, the effects of sodium dodecyl benzene sulfonate, polyvinylpyrrolidone, sodium dodecyl benzene sulfonate/polyvinylpyrrolidone, and Triton X-100 on the dispersion of 0.1 wt% carbon nanotubes in dimethylacetamide are reported. Sedimentation results show that except for sodium dodecyl benzene sulfonate, all the surfactant-assisted carbon nanotube solutions have visually-stable dispersions for at least two months, and even the samples without a surfactant gave no obvious deposition. UV-Vis spectra of the dispersions with and without acid-treatment proved that the carboxyl group attached to the carbon nanotubes positively improves the dispersion effect. The states of aggregation of carbon nanotubes treated by different surfactants are distinctive, and the electrical properties of carbon nanotubes are strongly related to these states of aggregation. The best dispersing and stabilizing effect was found in the sodium dodecyl benzene sulfonate/polyvinylpyrrolidone sample, which also gave the lowest resistance (2.15 x 10(4) omega at 20 V) among all the surfactant-treated stable suspensions.