Evaluation of Vibration Analysis to Assess Bone Mineral Density in Children

The effectiveness of vibration analysis to assess bone mineral density (BMD) in children with suspected reduction in bone density was studied. A system was designed that measured the ulna's vibration responses in vivo. The system was evaluated on the ulnae of 48 children (mean age=12.0, std=3.5 years), 31 of whom had been confirmed to have osteogenesis imperfecta (OI). All children had dual energy X-ray absorptiometry (DXA) scan as part of their routine clinical care and vibration analysis was performed on the same day. Frequency spectra of the ulnae's vibration responses were obtained and processed by principal component analysis. Four main principal components were selected and together with age, sex and right hand ulna's length were used in a regression analysis to estimate BMD. Regression analysis was repeated using the children's leave-one-out and partitioning methods. The percentage similarity and correlation between the DXA-derived and vibration analysis estimated BMDs using the leave-one-out were 80.34% and 0.59 and for partitioning were 74.2% and 0.64 respectively. There was correlation between vibration analysis BMD readings and those derived from DXA however a larger study will be needed to better establish the extent to which vibration analysis can assist in assessing bone density in clinical environments

Assessing material densities by vibration analysis and independent component analysis

The aim of this study was to investigate vibration analysis and independent component analysis (ICA) to assess the density of multiple materials making up a single structure. Density is important as it reveals information about physical properties of materials. The density of a single material can be determined from the relationship between its mass and volume. However, when a structure consists of multiple materials, identification of their individual densities from the structure is complicated. Vibration analysis is a technique that reveals information about an object’s physical properties such as its density. The investigation was carried out using a plastic test tube filled separately with three liquids of known densities; water, Chloroform and Methanol. Vibration was inducted into the tube, through an electronic system that produced a single impact at a predefined location on the tube. The resulting vibration signals were recorded using two vibration sensors placed on the tube. A signal source separation technique called ICA was used to obtain the vibration effects of the liquid and the tube. The power spectral densities (PSD) of ICA extracted vibration signals were examined. The frequency of the largest peak in the PSD was related to the liquid’s density under test. The study indicated that vibration analysis may be effective in assessing materials’ densities in a structure that contains multiple materials, however a larger study is needed to explore the findings

An Irish Experience in Establishing and Evaluating an Intern Led Teaching Programme.

Near-Peer Teaching is a relatively new and expanding area of medical education. The benefit to medical students has been demonstrated in numerous contexts around the world. Our aim was to establish a structured Intern-Led Teaching (ILT) programme in the context of an Irish Intern Training Network affiliated to an Irish Medical School. We then sought to evaluate the success of this programme. Seventy interns were enrolled in the ILT programme and completed a Train the Trainer course involving teaching methods and skills of effective feedback. Following this, the intern tutors delivered several one-hour teaching sessions in small groups to final year medical students on a weekly basis. At the end of each teaching block, a feedback questionnaire was distributed to participating students to evaluate their experiences of this new teaching modality. Tutorial topics were varied. They included clinical examination, history taking, prescribing, and emergencies. Eighty-one percent of students found the intern-led tutorials to be beneficial compared to tutorials run by more senior doctors. Additionally, students felt that with intern led tutorials they could ask questions they otherwise would not. There was a more comfortable environment, and information taught was considered more relevant. A significant number of students felt less nervous about the final medical examinations after the intern-led tutorials. The establishment of a structured intern-led teaching programme was well received by final year medical students. This project shows that interns are a valuable teaching resource in the medical school and should be included in medical schools’ curricula

Elevated platelet counts in a cohort of children with moderate-severe osteogenesis imperfecta suggest that inflammation is present

BACKGROUND: Elevated platelet counts are observed in cancer, autoimmunity and inflammation with concurrent illness. Proinflammatory cytokines are elevated in murine osteogenesis imperfecta (OI) models. We hypothesised that platelet counts might be elevated in children with moderate-severe OI. METHODS: We reviewed the hospital records of 71 children with moderate-severe OI, treated in the Sheffield Children's Hospital's Severe, Complex and Atypical Osteogenesis Imperfecta Highly Specialised Service. Data relating platelet count (below/above average, above upper limit) to prior and concurrent events were summarised as event proportions per child. Additionally, we created platelet SD scores to assess age and time-related trends, and relationship with OI type. RESULTS: 1206 platelet counts were recorded. Platelet SD scores were right-shifted by 0.89 SD overall. 49 of 71 (69%) patients had at least one platelet count above the normal range and 246 (20.4%) of all counts were above the upper limit of normal. Of these, 101 (41%) were high despite no confounding factors being present. For the 47 children with data at age less than 2 years, 89 (30.0%) platelet counts were above the upper limit of normal and 39 (44%) had no associated confounding factor. Elevated platelet counts were recorded most often for children with new or existing vertebral fractures. CONCLUSIONS: Raised platelet counts were observed in association with new and healing vertebral fractures, but also (41%-44%) in the absence of identified proinflammatory factors or events. We speculate that these findings are evidence for a proinflammatory component to OI that could be a target for therapeutic intervention

Emotional intelligence assessment in a graduate entry medical school curriculum.

BACKGROUND: The management of emotions in the workplace is a skill related to the ability to demonstrate empathic behaviour towards patients; to manage emotional reactions in oneself and to lead others as part of a team. This ability has been defined as emotional intelligence (EI) and doctor\u27s EI may be related to communication skills and to patient satisfaction levels. This study reports on the use of two assessments of EI as part of a course on Personal and Professional Development (PPD) in a graduate medical school curriculum. METHODS: Fifty one graduate entry medical students completed an eight session course on PPD between December 2005 and January 2006. Students completed two measures of EI: self-report (EQ-i) and ability (MSCEIT V2.0) over a two year study period. The data gathered were used to explore the relationship between self-report and ability EI and between EI and student demographics, academic performance and change over time. RESULTS: Analysis of the EI data demonstrated that self-report EI did not change over time and was not related to ability EI. Females scored higher than males on a number of self-report and ability EI scores. Self-reported self-awareness was found to deteriorate in males and females over time. High self-reported EI was found to be associated with poor performance on clinical competency assessments but with good performance on a number of bio-medical knowledge based assessments. CONCLUSIONS: This report concludes that assessments of EI can be incorporated into a medical school curriculum as part of a PPD programme and that the concept of EI may be associated with performance in medical school

Feasibility of quantitative ultrasonography for the detection of metabolic bone disease in preterm infants - systematic review.

Metabolic bone disease of prematurity is characterised by disordered bone mineralisation and is therefore an increased fracture risk. Preterm infants are especially at risk due to incomplete in utero bone accretion during the last trimester. Currently, diagnosing metabolic bone disease mainly relies on biochemistry and radiographs. Dual-energy x-ray absorptiometry and quantitative ultrasound (US) are used less frequently. However, biochemical measurements correlate poorly with bone mineralisation and although scoring systems exist for metabolic bone disease, radiographs are subjective and do not detect early features of osteopenia. Dual energy x-ray absorptiometry is the reference standard for determining bone density in older children and adults. However, challenges with this method include movement artefact, difficulty scanning small and sick infants and a lack of normative data for young children. Quantitative US has a relatively low cost, is radiation-free and portable, and may hence be suitable for assessing bone status in preterm infants. This review aims to provide an overview of the use of quantitative US in detecting metabolic bone disease in preterm infants

Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 2: axial skeleton and differential diagnoses

Recognising the skeletal manifestations of inflicted injury (II) in infants and young children is of crucial importance. There are specific fracture patterns which are highly suspicious of II in addition to common differential diagnoses with which radiologists should be familiar. Our objective is to provide a non-exhaustive review of the important factors relevant to the imaging and reporting of II as a platform for further learning. Part 2 encompasses fracture patterns of the axial skeleton and important differential diagnoses

Investigating the mechanical response of paediatric bone under bending and torsion using finite element analysis

Fractures of bone account 25% of all paediatric injuries (Cooper et al. in J Bone Miner Res 19:1976-1981, 2004. https://doi.org/10.1359/JBMR.040902 ). These can be broadly categorised into accidental or inflicted injuries. The current clinical approach to distinguish between these two is based on the clinician's judgment, which can be subjective. Furthermore, there is a lack of studies on paediatric bone to provide evidence-based information on bone strength, mainly due to the difficulties of obtaining paediatric bone samples. There is a need to investigate the behaviour of children's bones under external loading. Such data will critically enhance our understanding of injury tolerance of paediatric bones under various loading conditions, related to injuries, such as bending and torsional loads. The aim of this study is therefore to investigate the response of paediatric femora under two types of loading conditions, bending and torsion, using a CT-based finite element approach, and to determine a relationship between bone strength and age/body mass of the child. Thirty post-mortem CT scans of children aged between 0 and 3 years old were used in this study. Two different boundary conditions were defined to represent four-point bending and pure torsional loads. The principal strain criterion was used to estimate the failure moment for both loading conditions. The results showed that failure moment of the bone increases with the age and mass of the child. The predicted failure moment for bending, external and internal torsions were 0.8-27.9, 1.0-31.4 and 1.0-30.7 Nm, respectively. To the authors' knowledge, this is the first report on infant bone strength in relation to age/mass using models developed from modern medical images. This technology may in future help advance the design of child, car restrain system, and more accurate computer models of children

Tight junctions: a barrier to the initiation and progression of breast cancer?

Breast cancer is a complex and heterogeneous disease that arises from epithelial cells lining the breast ducts and lobules. Correct adhesion between adjacent epithelial cells is important in determining the normal structure and function of epithelial tissues, and there is accumulating evidence that dysregulated cell-cell adhesion is associated with many cancers. This review will focus on one cell-cell adhesion complex, the tight junction (TJ), and summarize recent evidence that TJs may participate in breast cancer development or progression. We will first outline the protein composition of TJs and discuss the functions of the TJ complex. Secondly we will examine how alterations in these functions might facilitate breast cancer initiation or progression; by focussing on the regulatory influence of TJs on cell polarity, cell fate and cell migration. Finally we will outline how pharmacological targeting of TJ proteins may be useful in limiting breast cancer progression. Overall we hope to illustrate that the relationship between TJ alterations and breast cancer is a complex one; but that this area offers promise in uncovering fundamental mechanisms linked to breast cancer progression

Re: Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 1: initial considerations and appendicular skeleton. A reply

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