The midpoint of cortical thinning between late childhood and early adulthood differs between individuals and brain regions: Evidence from longitudinal modelling in a 12-wave neuroimaging sample.

Charting human brain maturation between childhood and adulthood is a fundamental prerequisite for understanding the rapid biological and psychological changes during human development. Two barriers have precluded the quantification of maturational trajectories: demands on data and demands on estimation. Using high-temporal resolution neuroimaging data of up to 12-waves in the HUBU cohort (N = 90, aged 7-21 years) we investigate changes in apparent cortical thickness across childhood and adolescence. Fitting a four-parameter logistic nonlinear random effects mixed model, we quantified the characteristic, s-shaped, trajectory of cortical thinning in adolescence. This approach yields biologically meaningful parameters, including the midpoint of cortical thinning (MCT), which corresponds to the age at which the cortex shows most rapid thinning - in our sample occurring, on average, at 14 years of age. These results show that, given suitable data and models, cortical maturation can be quantified with precision for each individual and brain region.

Do outpatients with cancer and their relatives want to use an online booking system to book the appointment and radiographer for their CT examination? A small-scale study in Denmark.

INTRODUCTION: Previous studies have found that online booking systems may be the preferred scheduling tool when booking appointments with healthcare providers. The aim of this study was to examine I) if outpatients with cancer and relatives of cancer patients wanted to use an online booking system to book appointments for the CT examinations, and II) if they wanted to book specific radiographers for the CT examinations. METHODS: An online questionnaire was distributed to outpatients with cancer and relatives of cancer patients registered in the user panel of the Danish Cancer Society. The questionnaires consisted of 13 questions for patients and eight questions for relatives. The study applied statistical analysis and qualitative content analysis with an inductive approach. RESULTS: In total, 555 patients out of 760 (73%) and 115 out of 341 (34%) relatives were included in the present study and 54% of the patients and 65% of the relatives responded that they wanted, "To a high degree" or "To some degree", to use an online system for booking the appointment of the CT examination. Furthermore, 49% of the patients and 60% of the relatives found it important, "To a high degree" or "To some degree", that the appointment of the CT examination also suited their relatives. Only 37% of the patients, in contrast to 56% of the relatives, were interested in the opportunity to book specific radiographers. Approximately half of the patients (48%) and relatives (58%) were interested in being scanned by the same radiographers. CONCLUSION: In this study, a majority of patients and relatives were interested in using an online booking system to book their CT examinations. Furthermore, while a majority of the relatives were more interested in booking specific radiographers for the CT examinations, only a few patients were interested in this function. IMPLICATIONS FOR PRACTICE: Using an online booking system to book the appointment could benefit the overall experience for cancer patients and relatives when attending a CT examination to ensure that the appointment also suits the relatives.

Comparison of reporting radiographers' and medical doctors' performance in reporting radiographs of the appendicular skeleton, referred by the emergency department.

INTRODUCTION: There is an increasing trend towards deploying reporting radiographers in Danish hospitals who, among various professional groups, interpret and report skeletal radiographs from the emergency department (ED). This study aimed to compare the quality of the reports issued by reporting radiographers to three different groups of medical doctors (MDs) who interpret or report skeletal radiographs at the ED. METHODS: Four professional groups (i.e. four reporting radiographers, two radiology trainees, two orthopaedic senior trainees, and two orthopaedic trainees) reported 100 radiographs of the appendicular skeleton. The Consequence of clinical Outcome score (CO-score), accuracy, sensitivity, and specificity of each group were compared. The relative risk of a false-negative, false-positive or wrong result, the risk of a serious error, as well as the odds ratio of a more severe CO-score for each of the three MD groups, were compared to the reporting radiographers. RESULTS: There was a significant difference between the groups in reference to the CO-score (P ≤ 0.001), accuracy (P = .003), specificity (P = .022), and in the proportion of serious errors (P ≤ 0.001). Compared to the reporting radiographers, all three groups of MDs showed a significantly higher CO-score and a significantly increased risk of a wrong result. Moreover, two of the MD groups showed a significantly increased risk of a false-positive result and for severe errors. CONCLUSION: Based on the CO-score, the relative risk of errors, which could potentially cause malpractice in treatment and patient recall, significantly decreased when the reports were completed by reporting radiographers. IMPLICATIONS FOR PRACTICE: To explore the need for a 24-h radiographer reporting service to the EDs, an upscaled study, like the current, with more participants representing the professional groups is highly recommended.

CO-score; a new method for quality assessment of radiology reports.

INTRODUCTION: Studies on assessing radiology reports commonly calculates sensitivity, specificity and accuracy, which estimates if the observer has tendency to overdiagnose, overlook pathology, or both. This pilot study examines a new method for assessing the quality of radiology reports, based on the patients' clinical outcome. METHODS: Two observers evaluated five hundred reports by four experienced reporting radiographers on X-ray images of the appendicular skeleton. The observers categorised the reports as true or false and gradated the quality of the report from 1 to 3 based on the patients' clinical outcome. We developed a new performance score, called the Consequence of Clinical Outcome (CO-score), which combines the amount of incorrect reports and the severity of errors, to assess the overall quality of the reports. A low CO-score represents high quality with few or inconsiderate errors. RESULTS: The results showed no direct connection between high accuracy and low CO-score. All radiographers achieved high levels of accuracy (range: 96.8%-100%) but varied in CO-score (range: 0.00-0.14). One radiographer achieved an accuracy of 97.6% but a high CO-score of 0.14 as four reports had clinical consequence for the patients and five reports lacked minor details. One report was classified as true positive but was inadequate and led to wrong treatment. CONCLUSION: This study shows that true reports can affect the patients' clinical outcome and reports classified as false can represent insignificant errors. The new CO-score gives a more nuanced view of the reporting quality by including the patients' clinical outcome in the performance score. IMPLICATIONS FOR PRACTICE: We suggest that the CO-score is included as a supplement to the common methods in future studies assessing the quality of radiology reports as well as in clinical audits.

Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women.

Pivmecillinam is a unique beta-lactam antimicrobial that has been used for the treatment of acute uncomplicated urinary infection for > 20 y. Since this agent was introduced, the quinolone antimicrobials have become widely used for the same indication. This study compared the efficacy of a 3-d regimen of pivmecillinam 400 mg b.i.d. with norfloxacin 400 mg b.i.d. Women aged between 18 and 65 y presenting with symptoms of acute cystitis of < 7 d duration were eligible for enrollment; 483 were randomized to receive pivmecillinam and 471 to receive norfloxacin. In each group, 30% of women had negative urine cultures prior to therapy. Bacteriologic cure at early post-therapy follow-up was achieved in 222/298 (75%) pivmecillinam patients and 276/302 (91%) norfloxacin patients [p < 0.001; 95% confidence interval (CI) 12.0-21.8]. Clinical cure/improvement at Day 4 following initiation of therapy was observed in 434/457 (95%) women who received pivmecillinam and 425/442 (96%) who received norfloxacin (p = 0.39; 95% CI 1.5-3.9). Early post-therapy (11 +/- 2 d) clinical cure was achieved in 360/437 women (82%) who received pivmecillinam and 381/433 (88%) who received norfloxacin (p = 0.019; 95% CI 0.9-10.3). In women aged < or = 50 y, early clinical cure rates were 294/351 (84%) for pivmecillinam and 299/340 (88%) for norfloxacin (p = 0.11; 95% CI 1.0-9.4). Adverse effects were similar for both regimens, and there was no evidence of the emergence of organisms of increasing resistance with therapy. Short-course therapy with norfloxacin was superior to that with pivmecillinam in terms of bacteriologic outcome, although differences in clinical outcome were less marked. In conclusion, short-course therapy with pivmecillinam is an effective empirical treatment for pre-menopausal women.

Clinical mastitis in cows treated with sometribove (recombinant bovine somatotropin) and its relationship to milk yield.

Effect of sometribove (methionyl bovine somatotropin) on mastitis in 15 full lactation trials (914 cows) in Europe and the US and 70 short-term studies (2697 cows) in eight countries was investigated. In full lactation studies, sometribove (500 mg/2 wk) was given for 252 d, commencing 60 d postpartum. Although herds varied considerably, incidence of clinical mastitis within a herd was similar for cows receiving control and sometribove treatments. Relative risk analyses indicated no treatment effect, and percentage of mastitis during treatment was similar for control and sometribove groups. A positive linear relationship existed between peak milk yield and mastitis incidence (percentage of cows contracting mastitis or cases per 100 cow days); sometribove treatment did not alter this relationship. Increases in mastitis related to milk yield increase from sometribove or related to genetic selection were similar. When expressed per unit of milk, mastitis incidence declined slightly as milk yield increased; this relationship was not altered by sometribove. No effect on clinical mastitis was observed in 70 commercial herds utilizing sometribove for 84 d. However, effects were significant for stage of lactation and milk yield. Overall, studies represented a wide range of research and commercial situations demonstrating that sometribove had no effect on incidence of clinical mastitis during the lactation of treatment. Furthermore, sometribove did not alter typical relationships between milk yield or herd factors and incidence of clinical mastitis.

Factors affecting response of cows to biweekly injections of sometribove.

Seventy-eight lactating Holstein cows (18 primiparous and 60 multiparous) were used to study certain factors affecting response in milk yields to biweekly injections of bST. Cows were intramuscularly injected with placebo or with 500 mg of bST every 14 d for 36 wk beginning 60 d postpartum. Primiparous cows responded less to bST than did multiparous cows. Cows were separated into three yield groups within each treatment based on pretreatment yield: low (27.0 kg/d), medium (32.0 kg/d), and high (39.0 kg/d). Response of low yielding cows to bST was numerically greater than that of medium or high yielding cows, but there was no significant interaction between treatment and pretreatment milk yield. Individual cow index for milk yield was used as a measure of genetic potential of cows, which were divided into two index groups: high cow index (greater than -23 kg) and low cow index (less than -23 kg). Cows in the high index group showed significantly higher milk yields than the low index group during treatment, but treatment by cow index interaction was not significant, suggesting that cows of widely ranging genetic potential respond similarly to bST. Response of cows to bST in mid to late lactation was slightly greater than in early lactation (15.9 and 10.6% vs. 17.8%, respectively), but no significant interaction of treatment by days postpartum was noted. Finally, even though cows treated with bST exhibited slightly higher rectal temperatures during the hot summer months, no significant difference in milk yield response to bST was noted during periods of moderate versus high ambient temperatures.

Response of dairy cows to high doses of a sustained-release bovine somatotropin administered during two lactations. 2. Health and reproduction.

Eighty-two lactating Holstein cows in their first, second, or third lactation received either one, three, or five concurrent i.m. injections of a unit dose (.6 g) of zinc methionyl bST (sometribove) or five doses of the vehicle. Injections were given at 14-d intervals from 60 +/- 3 d postpartum until the end of lactation or necropsy. Thirty-eight animals were continued on treatment for a 2nd yr. Sometribove did not affect the incidence of ketosis, milk fever, tetany, or pneumonia. Digestive disorders, primarily cows going off feed, were increased by bST during yr 1 only. The incidence of lameness was increased by bST in some time frames because of an increase in the 3.0-g bST group. Lameness was not associated with treatment-specific histopathologic changes or with abnormalities in cartilage or bone. Reproductive health generally was unaffected by treatment, but delayed conception and increased incidence of abortion were noted. Incidence of cystic ovaries was unaffected by bST. Pregnancy rates were decreased during the 100-d breeding interval of yr 1 but not during the 215-d interval of yr 2. The incidence of clinical mastitis was increased by bST, primarily at the 3.0-g dose. During the 2-yr study, 0, 3, 3, and 2 cows died or became moribund on 0, .6, 1.8, and 3.0 g of bST, respectively. Health issues identified for further evaluation included lameness and clinical mastitis for the 3.0-g group and early removal from the herd and decreased reproductive performance for all bST groups. Bovine somatotropin caused no treatment-specific toxic effects in dairy cows even at 3.0 g every 14 d.

Effect of recombinantly-derived bovine somatotropin on reproductive performance of dairy cattle.

Data from 814 cows involved in five separate full lactation studies were used to assess the effect of recombinantly-derived methionyl bovine somatotropin (sometribove) on reproductive performance. Data were separated by parity (first and second or greater), route of administration (intramuscular: i.m. or subcutaneous: s.c.), length of breeding period (number of days in milk), and level of production (high vs low). Through 305 days in milk, pregnancy rates were reduced 18% in primiparous, sometribove-treated (i.m.) cows but were not significantly affected in multiparous cows. No differences were noted in either parity group when sometribove was administered subcutaneously. The level of production was more often found to be a significant factor affecting reproductive parameters than was sometribove administration. In general, length of the breeding period and level of milk production had a greater influence on reproductive performance than treatment with sometribove.

Factors affecting insulin-like growth factor-I concentration in bovine milk.

To establish the naturally occurring range of insulin-like growth factor-I concentrations in bovine milk, samples from individual cows (n = 409) managed on five Missouri dairy herds were assayed. Parity, stage of lactation, and farm affected milk insulin-like growth factor-I concentration. Milk insulin-like growth factor-I concentration was higher in early lactation than mid and late lactation with concentrations in multiparous cows exceeding those in primiparous cows. Insulin-like growth factor-I concentration was negatively correlated to milk production the day of sample collection (r = -.15) and not correlated to predicted 305-d milk yields. Unprocessed bulk tank milk samples (n = 100) from a commercial processing plant had a mean concentration of insulin-like growth factor-I in milk of 4.32 ng/ml with a range of 1.27 to 8.10 ng/ml. This distribution was similar to the range detected in samples from individual cows, but values were lower than those reported for human milk. Concentration of insulin-like growth factor-I in milk was not altered by pasteurization (at 79 degrees C for 45 s). However, insulin-like growth factor-I was undetectable in milk heated to temperatures (121 degrees C for 5 min) required for infant formula preparation or in commercially available infant formula. These data indicated that insulin-like growth factor-I is a normal but quantitatively variable component of bovine milk that is not destroyed by pasteurization but is undetectable in infant formula. Concentration of insulin-like growth factor-I in bovine milk is lower than concentrations reported for human milk yet similar to those reported for human saliva.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of sometribove in a prolonged-release system in lactating dairy cows--production responses.

Primiparous (n = 105) and multiparous (n = 136) Holstein cows were used to evaluate efficacy of sometribove (n-methionyl bovine somatotropin, bST) in a dose titration study. Cows were fed TMR for ad libitum intake, were milked twice daily, and were allocated randomly within parity (1 vs. 2+) to treatments of 0, 250, 500, or 750 mg bST/14 d in a prolonged-release formulation. Subcutaneous injections commenced 60 +/- 3 d postpartum and continued throughout lactation. During a standardized treatment period of 252 d, treatment with increasing dosages of bST increased 3.5% FCM yield in a dose-dependent manner for both primiparous (2.5 kg/d, 10.2%; 3.5 kg/d, 14.3%; and 5.9 kg/d, 24.1%) and multiparous cows (3.1 kg/d, 12.1%; 3.9 kg/d, 15.2%; and 6.8 kg/d, 26.5%). Milk content of fat, protein, lactose, ash, Ca and P, and SCC were not affected by treatment. Over the 252-d treatment period, voluntary intake of energy was increased in bST-treated cows such that BW gain, body condition score, and net energy balance did not differ among treatment groups. Productive efficiency (milk per unit NEL intake corrected for BW change) over the treatment period was significantly increased in a dose-dependent manner for multiparous cows (4.1, 6.8, and 11.0%). Results demonstrated that bST administered in a prolonged-release formulation was efficacious in enhancing milk production and feed efficiency.

Responses by lactating cows in commercial dairy herds to recombinant bovine somatotropin.

Cows (890) in 15 US herds were assigned randomly in equal numbers to control or bST injections (500 mg in a prolonged-release form every 14 d for 12 wk) within three stages of lactation (57 to 100, 101 to 140, and 141 to 189 d postpartum) and two parity groups (primiparous and multiparous). Yield and milk composition were monitored 1 d/wk for 16 wk including 2 wk pretreatment and 2 wk posttreatment. Increases in milk and FCM due to bST injections were less at 57 to 100 d than at 101 to 189 d postpartum (milk 3.6 vs. 5.5; FCM 3.9 vs. 6.1 kg/d per cow), and increases in milk and FCM were more for multiparous than for primiparous cows (milk 5.5 vs. 4.2; FCM 6.0 vs. 4.7 kg/d cow). Temporarily, concentration of milk fat increased and protein decreased; later, concentrations for control and injected cows were similar. Postinjection milk fat concentration decreased, but milk protein concentration increased temporarily. The net increase in milk (and FCM) varied significantly among herds from 2.9 to 7.6 kg/d per cow (mean, 4.9 kg). Responses in FCM were similar over a wide range of pretreatment yields. A great variety of feed ingredients were fed as total mixed rations, and nutrient concentrations varied greatly. The SCC were similar before, during, and after treatment, but increase in FCM of injected cows exhibited a negative correlation with pretreatment SCC. Changes in body condition score of sometribove-injected cows varied among herds (.25 to -.45) and averaged -.02 compared with .07 for controls. There was no pattern in incidence of mastitis during sometribove injections.

Effects of recombinant methionyl bovine somatotropin (sometribove) in high producing cows milked three times daily.

Effects of daily sometribove administration on milk yield and composition, body condition score, BW, and SCC were evaluated in Holstein cows milked three times daily. Lactating cows (n =104) were assigned randomly to control or sometribove-treated (25 mg/d) groups. The experimental period was 16 wk, consisting of 2-wk pretreatment, 12-wk treatment, and 2-wk posttreatment periods. All cows were injected once daily starting at 53 to 180 d postpartum, housed in free stalls, and fed one of five total mixed rations according to milk production. Body weights were measured weekly, and body condition was scored biweekly. Milk yield was recorded daily, and weekly milk samples were analyzed for fat, protein, lactose, total solids, and SCC. Milk yield and milk protein were increased 18.8% (38.6 vs. 32.5 kg/d) and 3.3% (3.1 vs. 3.0%), respectively, whereas percentage of milk fat, lactose, SNF, SCC, and BW were unaffected by treatment. Overall average body condition scores were lower for the sometribove-treated group versus control (2.2 vs. 2.4). No apparent differences in the number of cows treated for mastitis, foot rot, displaced abomasum, or lameness were observed between treatment groups. Sometribove treatment significantly enhanced milk yield (6.1 kg/d) with no apparent negative effects on health in high producing cows milked three times per day.

The use of an extended baseline period in the evaluation of treatment in a longitudinal Duchenne muscular dystrophy trial.

A trial of Duchenne muscular dystrophy involved tracking boys of all ages through a one-year baseline period, followed by a one-year trial of leucine versus placebo treatment. In this paper we develop a model for a total-muscle-strength score that uses the data of the extended baseline period in the evaluation of the leucine treatment. The model is based on a polynomial growth curve in age whose coefficients can vary according to treatment or phase. Maximum likelihood estimates of the parameters of the model are obtained from use of the EM algorithm. We propose tests for the adequacy of the model as well as for treatment effects. A quadratic model appears the most parsimonious fit to the data and there is no evidence of any leucine effect on scores. We examine the asymptotic power of the test for treatment effect and compare it with that of a simpler analysis.

Follow-up of children of drug-addicted mothers.

During a period of 2 years (1971-72) 19 newborn infants were admitted to hospital because their mothers were drug addicts. To evaluate the prognosis in these children, 17 were followed up by a social adviser, a psychologist, and a paediatrician. During the neonatal period 16 of the infants had withdrawal symptoms, for which 11 required medical treatment. One infant died of congenital malformations. Of the surviving 18 infants 14 were discharged to their mothers and 4 went to a children's home. During follow-up, which varied from up to 2 months to up to 2 years 8 months of age, 10 of the children had to be placed in a children's home for a period. No physical abnormalities were found in the children. Motor and perceptual development were normal in 12 but in 3 speech development was delayed. Five mothers ceased to take drugs after delivery and 2 had done so during early pregnancy. The pre- and perinatal complications and the undesirable environment in which the children grow up show the need for a comprehensive treatment programme.