Comparison of different imaging models handling partial coherence for aberration-corrected HRTEM at 40-80 kV.

Partial coherence of the electron waves leaving the specimen is taken into account in the high-resolution transmission electron microscopy (HRTEM) image simulation by mainly three methods - the incoherent summation approach, the transmission cross-coefficient (TCC) model, and the quasi-coherent model. In the incoherent summation approach, coherent images are calculated for each point in the effective source and summed up incoherently. The TCC is the transfer function of the microscope obtained based on the incoherent summation approach. An analytical form of the TCC can be derived by assuming a Gaussian distribution for the source radiation and for the variation of the focal length caused by the energy spread of the effective source. In the quasi-coherent model, the partial coherence effect is simplified by multiplying the wave function at the diffraction plane with the envelope functions. Envelope functions suppress the contributions to the image contrast from waves which do not propagate along the optical axis. The quasi-coherent model is usually sufficient for the image simulation of weak phase objects. This model is more computationally efficient than both the incoherent summation approach and the TCC model. For the Cs-corrected and Cc/Cs-corrected microscopes operating at 80 kV, we have compared images simulated by using the three models with the experimental images. The comparison shows that the quasi-coherent model also provides a sufficient approximation for the image simulation of high-Z materials if chromatic aberration is corrected and the samples comprise only several atomic layers. In the case of only Cs-correction, the incoherent summation approach or the TCC model needs to be employed for modelling the imaging of high-Z samples even though it is more computationally consuming.

Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

BACKGROUND: Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. OBJECTIVE: To investigate preferences for home- and community-based long-term care services packages. DESIGN: Discrete choice experiment conducted in mailed survey. SETTING AND PARTICIPANTS: Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). MAIN VARIABLES STUDIED: Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. RESULTS: Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. CONCLUSIONS: Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

[The Role of Preferences in the German Long-Term Care Insurance - Results from Expert Interviews]. / Die Rolle von Präferenzen für Langzeitpflege in der sozialen Pflegeversicherung ­ Ergebnisse von Experteninterviews.

BACKGROUND: As a result of population aging, the number of persons dependent on long-term care (LTC) is expected to increase considerably in Germany. Information about LTC preferences is important to decision-makers in future reforms. Taking into account the preferences of people can lead to a better congruence between desired and utilized LTC services. The aim of this study was to evaluate LTC preferences, their underlying reasons, and the potential to satisfy individual preferences within the German LTC insurance system. METHODS: Interviews with 20 LTC (insurance) experts in Germany between July and September 2014 were analyzed using qualitative content analysis methods. RESULTS: Irrespective of the care setting, people prefer flexible LTC (services), which allow for as much autonomy and independence as possible. Ideally, care is provided by close relatives at the dependent's home. Besides informal homecare, professional care at home is also (becoming increasingly) important, whereas inpatient LTC (nursing home) is rarely preferred over homecare arrangements. To most LTC dependents, interpersonal needs are more important than bodily and professional aspects of care. CONCLUSION: While the flexible choices and manifold options to combine services (high degree of person-centeredness) within the German LTC insurance constitute an important basis for the satisfaction of individual preferences, the widespread lack of information about entitlements, costs of services, and corresponding LTC options in the general population (future dependents) substantially hampers long-term care that is in line with preferences.

Intra-individual comparison of CAIPIRINHA VIBE technique with conventional VIBE sequences in contrast-enhanced MRI of focal liver lesions.

PURPOSE: To evaluate the impact of controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) volume interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) technique on image quality, reader confidence, and inter-observer agreement for the assessment of focal liver lesions in comparison with the standard VIBE approach. MATERIAL AND METHODS: In this IRB-approved intra-individual comparison study, abdominal arterial and portal-venous contrast-enhanced MRI studies were retrospectively analyzed in 38 patients with malignant liver lesions. Each patient underwent both CAIPIRINHA and conventional VIBE 3T MRI within 3 months, showing stable disease. Images were evaluated using 5-point rating scales by two blinded radiologists with more than 20 and 5 years of experience in MRI, respectively. Readers scored dignity of liver lesions and assessed which liver segments were affected by malignancy (ranging from 1=definitely benign/not affected to 5=definitely malignant/affected by malignancy). Readers also rated overall image quality, sharpness of intrahepatic veins, and diagnostic confidence (ranging from 1=poor to 5=excellent). RESULTS: Reviewers achieved a higher inter-observer reliability using CAIPIRINHA when they reported which liver segments were affected by malignancy compared to traditional VIBE series (κ=0.62 and 0.54, respectively, p<0.05). Similarly, CAIPIRINHA showed a slightly higher inter-rater agreement for the dignity of focal liver lesions versus the standard VIBE images (κ=0.50 and 0.49, respectively, p<0.05). CAIPIRINHA series also scored higher in comparison to standard VIBE sequences (mean scores: image quality, 4.2 and 3.5; sharpness of intrahepatic vessels, 3.8 and 3.2, respectively, p<0.05) for both reviewers and allowed for higher subjective diagnostic confidence (ratings, 3.8 and 3.2, respectively, p<0.05). CONCLUSION: Compared to the standard VIBE approach, CAIPIRINHA VIBE technique provides improved image quality and sharpness of intrahepatic veins, as well as higher diagnostic confidence. Additionally, this technique allows for higher inter-observer agreement when reporting focal liver lesions for both dignity and allocation.

Systematic Comparison of Reduced Tube Current Protocols for High-pitch and Standard-pitch Pulmonary CT Angiography in a Large Single-center Population.

RATIONALE AND OBJECTIVES: Benefits of iterative reconstruction (IR) algorithms combined with dose-reduction techniques have been shown at computed tomography pulmonary angiography (CTPA) in several medium to small patient collectives. In this study, we performed a systematic comparison of image quality to combinations of reduced tube current (RC) and IR for both standard-pitch (SP) single-source and high-pitch (HP) dual-source CTPA in a large, single-center population. MATERIALS AND METHODS: Three hundred eighty-two consecutive patients (October 2010 through December 2012) received clinically indicated CTPA with one of four consecutively changed protocols: (1) HPSC: 180 mAs, weighted filtered back projection, pitch = 3; (2) HPRC: 90 mAs, IR, pitch = 3; (3) SPSC: 180 mAs, weighted filtered back projection, pitch = 1.2; and (4) HPRC: 90 mAs, IR, pitch = 1.2. Tube potential was 100 kV. Vascular attenuation and standardized signal-to-noise ratio (sSNR) were measured in the pulmonary trunk (sSNRPT) and on segmental artery level (sSNRS1, sSNRS10). Dose-length-product was recorded per series. Two independent investigators rated image quality. Kolmogorov-Smirnov test, Kruskal-Wallis test, and kappa statistics were used for statistical analysis. Median values are presented per group. RESULTS: Image quality was consistent between all groups (observer 1: P = 0.118; observer 2: P = 0.122). Inter-reader consistency was very good (κ = 0.866, P < 0.001). Dose-length-product was significantly reduced in HP and RC groups (P < 0.001 for each; SPSC: 139.5 mGycm; HPRC: 92 mGycm; SPSC: 211 mGycm; HPRC: 137 mGycm). sSNR was comparable (sSNRPT overall: P = 0.052; sSNRS1 overall: P = 0.161; and sSNRS10 overall: P = 0.259). CONCLUSIONS: Substantial dose reduction can be within a routine clinical setting without quantifiable loss of image quality either by HP pulmonary angiography or by a combination of IR and RC in either HP or SP acquisition.

Advanced Modeled Iterative Reconstruction in Low-Tube-Voltage Contrast-Enhanced Neck CT: Evaluation of Objective and Subjective Image Quality.

BACKGROUND AND PURPOSE: Dose-saving techniques in neck CT cause increased image noise that can be counteracted by iterative reconstruction. Our aim was to evaluate the image quality of advanced modeled iterative reconstruction (ADMIRE) in contrast-enhanced low-tube-voltage neck CT. MATERIALS AND METHODS: Sixty-one patients underwent 90-kV(peak) neck CT by using third-generation 192-section dual-source CT. Image series were reconstructed with standard filtered back-projection and ADMIRE strength levels 1, 3, and 5. Attenuation and noise of the sternocleidomastoid muscle, internal jugular vein, submandibular gland, tongue, subscapularis muscle, and cervical fat were measured. Signal-to-noise and contrast-to-noise ratios were calculated. Two radiologists assessed image noise, image contrast, delineation of smaller structures, and overall diagnostic acceptability. Interobserver agreement was calculated. RESULTS: Image noise was significantly reduced by using ADMIRE compared with filtered back-projection with the lowest noise observed in ADMIRE 5 (filtered back-projection, 9.4 ± 2.4 Hounsfield units [HU]; ADMIRE 1, 8.3 ± 2.8 HU; ADMIRE 3, 6.7 ± 2.0 HU; ADMIRE 5, 5.4 ± 1.7 HU; all, P < .001). Sternocleidomastoid SNR and internal jugular vein-sternocleidomastoid contrast-to-noise ratios were significantly higher for ADMIRE with the best results in ADMIRE 5 (all, P < .001). Subjective image quality and image contrast of ADMIRE 3 and 5 were consistently rated better than those for filtered back-projection and ADMIRE 1 (all, P < .001). Image noise was rated highest for ADMIRE 5 (all, P < .005). Delineation of smaller structures was voted higher in all ADMIRE strength levels compared with filtered back-projection (P < .001). Global interobserver agreement was good (0.75). CONCLUSIONS: Contrast-enhanced 90-kVp neck CT is feasible, and ADMIRE 5 shows superior objective image quality compared with filtered back-projection. ADMIRE 3 and 5 show the best subjective image quality.

Identification and management of the ilio-inguinal and ilio-hypogastric nerves in open inguinal hernia repair: benefits of self-gripping mesh.

PURPOSE: A large randomized, multicenter European study recently reported a reduction in early pain after open inguinal surgery when self-gripping mesh was used compared with sutured Lichtenstein repair. This secondary exploratory study is focused on the influence of nerve identification and handling on post-operative pain. METHODS: Post-operative VAS pain data and Surgical Pain Scores (SPS) from 507 patients included in this study were analyzed according to whether inguinal nerves were preserved or resected during surgery to investigate whether identification and peri-operative nerve handling impact post-operative pain. RESULTS: Preservation of the ilio-hypogastric nerve during Lichtenstein mesh repair with suture fixation was associated with significantly more post-operative pain compared with resection at each follow-up (p ≤ 0.003). This difference was not significant with self-gripping mesh repair. The decrease from baseline in post-operative VAS and SPS scores were significantly greater after self-gripping mesh repair compared to Lichtenstein repair at 1 year, but only when the ilio-hypogastric nerve was preserved (VAS scores, p = 0.009; SPS scores, p = 0.015). No such difference was observed with the ilio-inguinal nerve. When self-gripping mesh was used, preservation of the ilio-hypogastric nerve was associated with significantly greater decreases in post-operative pain (change in VAS score from baseline) compared with Lichtenstein repair at each follow-up (p ≤ 0.018). CONCLUSIONS: The ilio-hypogastric nerve is in danger of being traumatized during Lichtenstein mesh repair with suture fixation. The use of self-gripping mesh was shown to reduce the level of post-operative pain when the ilio-hypogastric nerve was preserved. Resection of the ilio-hypogastric nerve during Lichtenstein repair eliminates this difference.

Miniaturized implantable sensors for in vivo localized temperature measurements in mice during cold exposure.

We report on in vivo temperature measurements performed in mice at two specific sites of interest in the animal body over a period of several hours. In particular, the aim of this work was to monitor mouse metabolism during cold exposure, and to record possible temperature differences between the body temperature measured in the abdomen and the temperature of the brown adipose tissue (BAT) situated in the interscapular area. This approach is of biological interest as it may help unravelling the question whether biochemical activation of BAT is associated with local increase in metabolic heat production. For that purpose, miniaturized thermistor sensors have been accurately calibrated and implanted in the BAT and in the abdominal tissue of mice. After 1 week of recovery from surgery, mice were exposed to cold (6 °C) for a maximum duration of 6 h and the temperature was acquired continuously from the two sensors. Control measurements with a conventional rectal probe confirmed good performance of both sensors. Moreover, two different mouse phenotypes could be identified, distinguishable in terms of their metabolic resistance to cold exposure. This difference was analyzed from the thermal point of view by computational simulations. Our simple physical model of the mouse body allowed to reproduce the global evolution of hypothermia and also to explain qualitatively the temperature difference between abdomen and BAT locations. While with our approach, we have demonstrated the importance and feasibility of localized temperature measurements on mice, further optimization of this technique may help better identify local metabolism variations.

Necrotizing pulmonary aspergillosis and ventricular assist device infection: case report and review of literature.

Necrotizing pulmonary aspergillosis and Aspergillus device infection are rare and have potentially fatal complications after left ventricular assist device (LVAD) implantation. To date, few cases of patients surviving Aspergillus device infection have been published, with survival reported only after device removal. We present a patient implanted with an LVAD in whom necrotizing pulmonary aspergillosis with device involvement was successfully treated by segmentectomy and prolonged antifungal treatment without device exchange or removal. Similar cases in the literature were searched for and are discussed in view of the severity of this complication.

Seventy kilovolt ultra-low dose CT of the paranasal sinus: first clinical results.

AIM: To evaluate the diagnostic image quality and radiation dose of low-dose 70 kV computed tomography (CT) of the paranasal sinus in comparison to 100 and 120 kV CT. MATERIALS AND METHODS: CT of the paranasal sinus was performed in 127 patients divided into three groups using different tube voltages and currents (70 kV/75 mAs, ultra-low dose protocol, n = 44; 100 kV/40 mAs, standard low-dose protocol, n = 42; 120 kV/40 mAs, standard protocol, n = 41). CT dose index (CTDIvol), dose-length product (DLP), attenuation, image noise and signal-to-noise ratio (SNR) were compared between the groups using Wilcoxon-Mann-Whitney U-test. Subjective diagnostic image quality was compared by using a five-point scale (1 = non-diagnostic, 5 = excellent, read by two readers in consensus) and Cohen's weighted kappa analysis for interobserver agreement. RESULTS: Radiation dose was significantly lower with 70 kV acquisition than 100 and 120 kV (DLP: 31 versus 52 versus 82 mGy·cm; CTDI 2.33 versus 3.95 versus 6.31 mGy, all p < 0.05). Mean SNR (70 kV: 0.37; 100 kV: 0.21; 120 kV: 0.13; p < 0.05) and organ attenuation increased significantly with lower voltages. All examinations showed diagnostic image quality. Subjective diagnostic image quality was higher with standard protocols than the 70 kV protocol (120 kV: 5.0; 100 kV: 4.5; 70 kV: 3.5, p < 0.05) without significant differences with substantial interobserver agreement (κ > 0.59). CONCLUSION: The ultra-low dose (70 kV) CT imaging of the paranasal sinus allowed for significant dose reduction by 61% and an increased attenuation of organ structures in comparison to standard acquisition while maintaining diagnostic image quality with a slight reduction in subjective image quality.

Estimating the lifetime cost of childhood obesity in Germany: Results of a Markov Model.

BACKGROUND: Child obesity is a growing public health concern. Excess weight in childhood is known to be associated with a high risk of obesity and obesity-related comorbidities in adulthood. OBJECTIVES: This study quantifies lifetime excess costs of overweight and obese adults in Germany taking the history of obesity in childhood into account. METHODS: A two-stage Markov cohort state transition model was developed. At stage 1, the distribution of body mass index (BMI) categories was tracked from childhood (ages 3-17) to adulthood (age 17 and up). Based on these results, it was distinguished whether adults had been normal in weight or overweight/obese as child. At stage 2, age-specific and lifetime costs from age 18 onwards were simulated in two further Markov cohort models, one for each of the two BMI groups. Model parameter values were obtained from the German Interview and Examination Survey for Children and Adolescents (KiGGS), the German Microcensus 2009 and published literature. RESULTS: When compared with normal weight adults, lifetime excess costs are higher among adults who had been overweight or obese at any point during childhood. For 18-year-old women (men), who have been overweight/obese during their childhood (ages 3-17), undiscounted lifetime excess costs are estimated at €19,479 (€14,524), with 60% (67%) occurring beyond age 60. Discounted (3%) lifetime excess costs are considerably lower, amounting to €4262 for men and €7028 for women. CONCLUSIONS: Because childhood obesity determines healthcare costs occurring in adulthood, interventions preventing the persistence of child obesity and obesity-related comorbidities during adulthood could have a substantial impact on reducing the burden of the obesity epidemic.

Significance of MR angiography in the diagnosis of aberrant renal arteries as the cause of ureteropelvic junction obstruction in children.

PURPOSE: To determine the importance of MRI with contrast-enhanced MRA for the detection or exclusion of aberrant or obstructing renal arteries in ureteropelvic junction obstruction in children. MATERIALS AND METHODS: Key word-based search in RIS database (ureteropelvic junction obstruction/ MRI) and retrospective comparison of arterial findings from preoperative contrast -enhanced MRA and intra-operative inspection. From 2007 to 2013, 19 children with ureteropelvic junction obstruction underwent contrast-enhanced MRA. Based on the results of the MRI scan and MAG3 scintigraphy, the children were referred to surgery (Anderson-Hynes-pyeloplasty). RESULTS: An aberrant renal artery was diagnosed with MRI in 14 of 19 children, and intra-operative inspection confirmed 13 of those 14. In the remaining 5 children, no aberrant vessel could be observed in MRI and this was confirmed intra-operatively in 3 of the 5 cases, while in the remaining 2, an aberrant vessel was found. Of the 14 children with aberrant vessels, 12 underwent surgery due to assumed ureteral obstruction, which was confirmed by surgery in 11 cases. In one case, an aberrant artery was found intra-operatively, but obstruction could not be confirmed. In one of the 14 children, the vessel was found in MRI, but its obstructing character was negated via MRA, which was confirmed intra-operatively. In the diagnosis of aberrant and obstructing renal arteries, contrast-enhanced MRA presents 85% sensitivity and 80% specificity, with a positive predictive value of 0.8. CONCLUSION: MRI with contrast-enhanced MRA is suitable to detect aberrant and obstructing renal arteries. An obstructive effect of the aberrant vessel is to be assumed if the vessel has a close relationship to the ureteropelvic junction and if it is linearly stretched. KEY POINTS: • MRI with contrast-enhanced MRA is a sure method for the detection of aberrant renal arteries in children with ureteropelvic junction obstruction. • The obstructive effect of the aberrant vessel can be derived from the close proximity of the vessel to the ureteropelvic junction and from the streched course of the vessel.

Non-linear image blending improves visualization of head and neck primary squamous cell carcinoma compared to linear blending in dual-energy CT.

AIM: To compare non-linear and linear image-blending post-processing techniques in dual-energy CT (DECT) of primary head and neck squamous cell carcinoma (SCC) regarding subjective and objective image quality. MATERIALS AND METHODS: Head and neck DECT studies from 69 patients (48 male, 21 female; mean age 62.3 years) were retrospectively evaluated. All tumour lesions were histologically confirmed SCC. Linearly blended 80/140 kVp images series with varying weighting factors of 0.3 (M_0.3), 0.6 and 0.8 were compared with non-linearly blended images. Attenuation of tumour lesion, various soft-tissue structures, the internal jugular vein, and image noise were measured, tumour signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Overall image quality, delineation of tumour lesion, image sharpness, and noise level were rated individually by three radiologists using five-point Likert scales. Interobserver agreement was calculated using intraclass correlation coefficient (ICC). RESULTS: Enhancement of tumour lesions (non-linear, 137.5 ± 20.1 HU; M_0.3, 92.7 ± 14.4 HU; M_0.6, 110 ± 15.4 HU; M_0.8, 123 ± 18.2 HU), CNR (non-linear, 12 ± 8; M_0.3, 4 ± 4.7; M_0.6, 7.5 ± 5.5; M_0.8, 8 ± 5.5), subjective overall image quality and tumour delineation were significantly increased (all p < 0.001) with the non-linear blending technique compared to all investigated linear blending weighting factors. Overall interobserver agreement was substantial (ICC 0.70; 95% CI: 0.66-0.73). CONCLUSION: Post-processing of DECT using a non-linear blending technique provides improved objective and subjective image quality of head and neck SCC compared to linearly blended images series.

Low-tube-voltage 80-kVp neck CT: evaluation of diagnostic accuracy and interobserver agreement.

BACKGROUND AND PURPOSE: Low-tube-voltage acquisition has been shown to facilitate substantial dose savings for neck CT with similar image contrast compared with standard 120-kVp acquisition. However, its potential for the detection of neck pathologies is uncertain. Our aim was to evaluate the effects of low-tube-voltage 80-kV(peak) acquisitions for neck CT on diagnostic accuracy and interobserver agreement. MATERIALS AND METHODS: Three radiologists individually analyzed 80-kVp and linearly blended 120-kVp image series of 170 patients with a variety of pathologies who underwent dual-energy neck CT. Reviewers were unblinded to the clinical indication for CT but were otherwise blinded to any other data or images and were asked to state a final main diagnosis. Findings were compared with medical record charts, CT reports, and pathology results. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each observer. Interobserver agreement was evaluated by using intraclass correlation coefficients. RESULTS: Diagnoses were grouped as squamous cell carcinoma-related (n = 107, presence/absence of primary/recurrent squamous cell carcinoma), lymphoma-related (n = 40, presence/absence of primary/recurrent lymphoma), and benign (n = 23, eg, abscess). Cumulative sensitivity, specificity, positive predictive value, and negative predictive value for 80-kVp and blended 120-kVp images were 94.8%, 93.0%, 95.9%, and 91.1%, respectively. Results were also consistently high for squamous cell carcinoma-related (94.8%/95.3%, 89.1%/89.1%, 94.3%/94.4%, 90.1%/91.0%) and lymphoma-related (95.0%, 100.0%, 100.0%, 95.2%) 80-kVp/120-kVp image series. Global interobserver agreement was almost perfect (intraclass correlation coefficient, 0.82, 0.80; 95% CI, 0.76-0.74, 0.86-0.85). Calculated dose-length product was reduced by 48% with 80-kVp acquisitions compared with the standard 120-kVp scans (135.5 versus 282.2 mGy × cm). CONCLUSIONS: Low-tube-voltage 80-kVp CT of the neck provides sufficient image quality with high diagnostic accuracy in routine clinical practice and has the potential to substantially decrease radiation exposure.

[Cost of fractures in German hospitals--what role does osteoporosis play?]. / Frakturkosten im deutschen Krankenhaussektor--Welche Rolle spielt die Osteoporose?

OBJECTIVE: The objective of this study was to examine the total and osteoporosis-attributable inpatient costs of 16 fracture types accrued in the German hospital sector in the year 2009. METHODS: To calculate the inpatient fracture costs in the hospital sector we combined data from different official German statistics, i.e., fracture-specific diagnosis data from female and male inpatients in 2009, population data, fracture-specific diagnosis-related groups (DRGs), and per diem capital costs in hospitals. The share of fractures which were attributable to osteoporosis had been estimated by the epidemiological concept of "population attributable risk". Calculation of these risks was based on empirical data obtained from the national and international literature. RESULTS: For the year 2009 the total inpatient costs accrued by the 16 fracture types considered in our analyses amounted to 2.4 billion Euros. Of these, 860 million Euros (36%) were attributable to osteoporosis. The main cost drivers were hip fractures. CONCLUSION: Fractures accrue relevant hospital costs in Germany. In order to use the limited resources of the German health-care system in an efficient way, future measures to reduce the number of incident fractures should be designed and evaluated in terms of cost-effectiveness.

Acute intracranial hemorrhage in CT: benefits of sinogram-affirmed iterative reconstruction techniques.

BACKGROUND AND PURPOSE: Acute intracranial hemorrhage represents a severe and time critical pathology that requires precise and quick diagnosis, mainly by performing a CT scan. The purpose of this study was to compare image quality and intracranial hemorrhage conspicuity in brain CT with sinogram-affirmed iterative reconstruction and filtered back-projection reconstruction techniques at standard (340 mAs) and low-dose tube current levels (260 mAs). MATERIALS AND METHODS: A total of 94 consecutive patients with intracranial hemorrhage received CT scans either with standard or low-dose protocol by random assignment. Group 1 (n=54; mean age, 64 ± 20 years) received CT at 340 mAs, and group 2 (n=40; mean age, 57 ± 23 years) received CT at 260 mAs. Images of both groups were reconstructed with filtered back-projection reconstruction and 5 iterative strengths (S1-S5) and ranked blind by 2 radiologists for image quality and intracranial hemorrhage on a 5-point scale. Image noise, SNR, dose-length product (mGycm), and mean effective dose (mSv) were calculated. RESULTS: In both groups, image quality and intracranial hemorrhage conspicuity were rated subjectively with an excellent/good image quality. A higher strength of sinogram-affirmed iterative reconstruction showed an increase in image quality with a difference to filtered back-projection reconstruction (P < .05). Subjective rating showed the best score of image quality and intracranial hemorrhage conspicuity achieved through S3/S4-5. Objective analysis of image quality showed in an increase of SNR with a higher strength of sinogram-affirmed iterative reconstruction. Patients in group 2 (mean: 744 mGycm/1.71 mSv) were exposed to a significantly lower dose than those in group 1 (mean: 1045 mGycm/2.40 mSv, P < .01). CONCLUSIONS: S3 provides better image quality and visualization of intracranial hemorrhage in brain CT at 260 mAs. Dose reduction by almost one-third is possible without significant loss in diagnostic quality.

[Taxing unhealthy foods. A measure to promote public health in Germany?]. / Gesundheitssteuern auf Lebensmittel. Eine Maßnahme zur Förderung der Gesundheit in Deutschland?

Due to the substantial health burden and costs caused by malnutrition in Germany, for instance as a result of obesity, diabetes, and cardiovascular diseases, the taxation of unhealthy foods/nutrients has been proposed as a possible health promoting measure. In order to evaluate whether such a fiscal intervention constitutes an effective and suitable measure to promote population health in Germany, the article outlines central empirical findings regarding malnutrition in Germany. Subsequently, the economic background (price elasticity of demand) is explained, and empirical evidence on the influence of changes in price on changes in consumption and health is presented. As a result of findings from the international literature being heterogeneous, and because very little research has been conducted in Germany on this matter until now, the taxation/subsidization of foods in order to promote population health is difficult to justify at this point.

[Effects of multimorbidity on health care utilization and costs]. / Auswirkungen von Multimorbidität auf die Inanspruchnahme medizinischer Versorgungsleistungen und die Versorgungskosten.

Multiple chronic conditions (multimorbidity) are common among elderly patients; however, little is known about the specific effects of multimorbidity on health care utilization and health care costs. This article reviews empirical studies from the international literature that investigated the relationship between multiple chronic conditions and health care utilization (e.g. ambulatory care, stationary care, pharmacotherapy) and/or health care costs in elderly general populations. Although synthesis of studies was complicated, especially because of ambiguous definitions and measurements of multimorbidity, almost all studies observed a positive association of multimorbidity and utilization and costs. Many studies found that utilization and costs significantly increased with each additional chronic condition. In light of these findings coupled with the fear that current care arrangements may be inappropriate for many multimorbid patients, important implications for research and policy are presented and discussed.

The long-term cost-effectiveness of obesity prevention interventions: systematic literature review.

Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision-analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long-term cost-effectiveness of such interventions. This literature review summarizes long-term economic findings (defined as ≥ 40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost-utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n=21), community (n=12) and environmental interventions (n=8). The majority of interventions offered good value for money, while seven were cost-saving. Ten interventions were not cost-effective (defined as >50,000 US dollar), however. Interventions that modified a target population's environment, i.e. fiscal and regulatory measures, reported the most favourable cost-effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost-effectiveness of interventions.

Role of uterine artery Doppler in the management of uterine leiomyoma by arterial embolization.

OBJECTIVES: To study Doppler changes in the uterine artery immediately following and 3 months after uterine artery embolization (UAE) and to test the feasibility of using uterine artery Doppler as a predictor of the predominant side of arterial supply to leiomyomas, amount of embolizing material needed and leiomyoma tumor volume at follow-up. METHODS: The study included 38 patients undergoing UAE for leiomyomas. Uterine artery Doppler was performed transabdominally before, within 6 hours after and 3 months after UAE to determine the peak systolic (PSV) and end-diastolic (EDV) velocities and resistance index (RI). Leiomyoma volume was measured using contrast-enhanced magnetic resonance imaging (MRI) before and 3 months after UAE. The predominant side of arterial supply to the leiomyoma was determined on digital subtraction angiography using the uterine artery diameter and tumor blush after contrast injection. For correlations with leiomyoma volume, the average PSV, EDV and RI of both sides was used, while for prediction of the predominant side of supply and for correlation with the amount of embolizing material needed, separate measurements from each side were used. RESULTS: Relative to the pre-embolization value, the uterine artery PSV and EDV were significantly reduced (P < 0.05) immediately following UAE, while the RI was significantly elevated (P < 0.05). For prediction of the predominant side of supply, the lowest RI showed the highest accuracy (81.6%). There was no significant correlation between the pre-embolization PSV, EDV or RI and the amount of embolizing material utilized. Immediately post-embolization EDV and RI values were statistically significantly correlated with the 3-month follow-up leiomyoma volume, with RI showing the strongest correlation (P = 0.0400 and 0.0002, rho = 0.34 and - 0.58, respectively). The leiomyoma volume was predicted to have reduced by 38-61% after 3 months if the immediate post-embolization average RI value was between 0.82 and 0.88. CONCLUSION: Pre-interventional Doppler assessment can be used to predict the predominant side of supply to leiomyomas but not the amount of embolizing material needed. Immediate post-interventional Doppler assessment can predict the leiomyoma volume after UAE.