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Tuberculosis (TB) remains the second leading cause of death globally from a single infectious agent, and there is a critical need to develop improved imaging biomarkers and aid rapid assessments of responses to therapy. We aimed to utilize radiomics, a rapidly developing image analysis tool, to develop a scoring system for this purpose. A chest X-ray radiomics score (RadScore) was developed by implementing a unique segmentation method, followed by feature extraction and parameter map construction. Signature parameter maps that showed a high correlation to lung pathology were consolidated into four frequency bins to obtain the RadScore. A clinical score (TBscore) and a radiological score (RLscore) were also developed based on existing scoring algorithms. The correlation between the change in the three scores, calculated from serial X-rays taken while patients received TB therapy, was evaluated using Spearman's correlation. Poor correlations were observed between the changes in the TBscore and the RLscore (0.09 ( p -value = 0.36)) and the TBscore and the RadScore (0.02 ( p -value = 0.86)). The changes in the RLscore and the RadScore had a much stronger correlation of 0.22, which is statistically significant ( p -value = 0.02). This shows that the developed RadScore has the potential to be a quantitative monitoring tool for responses to therapy.

Purpose: Accurate segmentation (separating diseased portions of the lung from normal appearing lung) is a challenge in radiomic studies of non-neoplastic diseases, such as pulmonary tuberculosis (PTB). In this study, we developed a segmentation method, applicable to chest X-rays (CXR), that can eliminate the need for precise disease delineation, and that is effective for constructing radiomic models for automatic PTB cavity classification., Methods: This retrospective study used a dataset of 266 posteroanterior CXR of patients diagnosed with laboratory confirmed PTB. The lungs were segmented using a U-net-based in-house automatic segmentation model. A secondary segmentation was developed using a sliding window, superimposed on the primary lung segmentation. Pyradiomics was used for feature extraction from every window which increased the dimensionality of the data, but this allowed us to accurately capture the spread of the features across the lung. Two separate measures (standard-deviation and variance) were used to consolidate the features. Pearson's correlation analysis (with a 0.8 cut-off value) was then applied for dimensionality reduction followed by the construction of Random Forest radiomic models., Results: Two almost identical radiomic signatures consisting of 10 texture features each (9 were the same plus 1 other feature) were identified using the two separate consolidation measures. Two well performing random forest models were constructed from these signatures. The standard-deviation model (AUC = 0.9444 (95% CI, 0.8762; 0.9814)) performed marginally better than the variance model (AUC = 0.9288 (95% CI, 0.9046; 0.9843))., Conclusion: The introduction of the secondary sliding window segmentation on CXR could eliminate the need for disease delineation in pulmonary radiomic studies, and it could improve the accuracy of CXR reporting currently regaining prominence as a high-volume screening tool as the developed radiomic models correctly classify cavities from normal CXR., (© 2023. The Author(s).)

Background: Severe iron deficiency is associated with anaemia, but iron deficiency with normal haemoglobin (Hb) may also affect morbidity and quality of life and contribute to psychiatric illness onset and severity. Psychiatric presentations in adolescence are often indicative of serious long-term morbidity, and addressing contributing health risk factors, such as iron deficiency, is important., Objectives: To determine rates of iron deficiency in a South African inpatient adolescent psychiatric population and possible associations between psychiatric diagnosis and iron deficiency risk factors., Methods: We conducted a retrospective chart review of all adolescent patients (13-18 years old) who were admitted to the Adolescent Psychiatric Inpatient Unit at Tygerburg Hospital (Cape Town, South Africa) during 2016. Patient records were limited to those with haemoglobin and ferritin levels available, as well as a psychiatric disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The final sample consisted of 93 patients., Results: Of all participants, 7.6% were anaemic, while 22.6% were iron deficient. We found 29% of our population to have anaemia in the absence of iron deficiency. Gender was the only statistically significant correlate, with adolescent females at particular risk of compromised iron status as indicated by a low ferritin level (45% of female sample)., Conclusion: Iron deficiency rates remain a relevant health concern, and testing Hb alone is inadequate to assess iron status in this population. Ferritin is a necessary additional parameter and should be included in the usual medical workup., Competing Interests: The authors have declared that no competing interests exist.

Background: Inaccurate allergy labelling results in inappropriate antimicrobial management of the patient, which may affect clinical outcome, increase the risk of adverse events and increase costs. Inappropriate use of alternative antibiotics has implications for antimicrobial stewardship programmes and microbial resistance., Methods: All adult inpatients labelled as penicillin allergic were identified and screened for eligibility by the study pharmacist. An accurate allergy and medication history was taken. Patients were 'de-labelled', underwent oral challenge or were referred to an immunology clinic, if study criteria were met. All patients included in the study were followed-up 1 year after intervention., Results: Two hundred and fifty eligible patients with a label of 'penicillin allergy' were identified. The prevalence of reported penicillin allergy at Middlemore Hospital was 11%. We found that 80% of study patients could be 'de-labelled'. Of those, 80% were 'de-labelled' after an interview with the pharmacist alone, 16% had an uneventful oral challenge and 4% were deemed to be inappropriately labelled after referral to an immunology clinic. Appropriately labelled patients accounted for 20% of the study population. Changes to inpatient antibiotic therapy were recommended in 61% of 'de-labelled' patients, of which no patients had adverse events after commencing on penicillin antibiotics. At the 1 year follow-up, 98% of patients who were 'de-labelled' had no adverse events to repeated administration of penicillin antibiotics., Conclusions: This study showed that a pharmacist-led allergy management service is a safe option to promote antimicrobial stewardship and appropriate allergy labelling., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Increasing antimicrobial resistance is a serious concern in New Zealand and worldwide. Antimicrobial resistance is tied to increased community antimicrobial consumption. Investigation of the drivers of antimicrobial prescribing in different locales is needed so that targeted interventions can be devised. Counties Manukau District Health Board (CMDHB) serves a diverse, relatively socio-economically deprived population that has the highest rate of community antimicrobial prescribing in New Zealand. We hypothesise that socio-economic factors are important in determining much of the prescribing of antimicrobials in the CMDHB population., Methods: We collected data on the number of antibacterial prescriptions per person in each pre-defined geographical Area Unit in the CMDHB community in 2013, and compared these with demographic and socioeconomic parameters collected in the 2013 New Zealand census. Simple and multiple linear regression analyses were used to identify factors that correlated with antimicrobial prescribing., Results: Multiple regression analysis showed that antimicrobial prescribing was strongly associated with a higher ratio of number of people to bedrooms in a dwelling (an index of crowding), with some added association with Māori ethnicity. When these factors were accounted for, there was no significant added influence from a range of other factors such as income, smoking or educational qualifications., Conclusions: Antimicrobial prescribing may be influenced by different factors within different communities. It is important to target the determinants of antimicrobial prescribing when addressing the issue of high community antimicrobial consumption. In the CMDHB community, crowding in homes is associated with higher rates of antimicrobial prescribing. This association may be because crowding directly increases infection rates, or that crowding serves as a proxy for other factors yet to be identified. Further investigation of the determinants of antimicrobial prescribing is needed.

This study was undertaken to determine the effect of low-dose gamma irradiation on aseptically admixed total parenteral nutrition (TPN) solutions to which large inocula of three test bacterial species were added. Microbiological safety levels were quantified in terms of sterility assurance levels (SALs), indicating the probability of contamination occurring expressed as 10-n. The radiation sensitivity (D10 values) of test bacteria in TPN solutions inoculated with a series of bacteria recognized as common contaminants of these products, was determined. Attainable SALs of TPN solutions containing test bacteria were subsequently calculated from the D10 values. Results showed that a minimum absorbed radiation dose as low as 1.5 kGy improved the SAL of aseptically prepared TPN solutions from a probability value of 10(-3) to a value of less than 10(-8) for the microorganisms investigated. At an absorbed dose as high as 8.3 kGy, no measurable changes in amino acid, electrolyte, glucose and lipid components of the solutions were detected. These findings have important implications for the enhancement of microbiological safety levels of aseptically prepared intravenous fluids in general.

The radiation crosslinking of high-density polyethylene prostheses was investigated over a wide range of doses in the presence and absence of gaseous crosslinking agents. It was found that in the bulk polymer the crosslinking pattern is completely different from the homogeneous crosslinking that occurs in polymer films. The presence of crosslinking agents causes highly crosslinked polymer to be formed on the surface while the bulk of the polymer is largely unaffected--which is explained in terms of diffusion phenomena. This surface crosslinking has a profound effect on the mechanical properties of the prostheses and restricts cold flow and deformation of the polymer without sacrificing the excellent abrasion-resistance properties of the polyethylene when subjected to high pressures. Based on this research a number of high-density polyethylene knee prostheses have been radiation-crosslinked and the results in vitro appear to be very promising.

Cysticerci of Taenia solium were exposed to gamma radiation in doses varying from 20-140 krad. Radiation had an adverse effect on the ability of the cysticerci to evaginate in vitro after a time lag of 9 days. This effect was most marked at doses of 100 krad and higher, thus no cysticerci exposed to 140, 120 and 100 krad evaginated after 12, 18 and 21 days, respectively. On Day +24, when 60% of the control cysticerci evaginated, 55%, 50%, 30% and 40% of the cysticerci exposed to 20, 40, 60, and 80 krad, respectively, evaginated in vitro. Cysticerci exposed to radiation doses of 20-120 krad are as infective to golden hamsters as are unirradiated cysticerci. Cestodes resulting from irradiated cysticerci, however, cannot maintain themselves indefinitely, and are excreted or digested at varying times from Day +12 onwards. Moreover, cestodes resulting from such irradiated cysticerci do not grow, but are resorbed, and finally consist of only a scolex. By Day +30 the mean length of the worms resulting from the unirradiated cysticerci is 173,8 mm, while those resulting from cysticerci exposed to 20 and 40 krad consist of scolices only and the hamsters fed material exposed to 60 krad were negative. It appears, therefore, that radiation inhibits the ability of the cells in the neck region to divide and thus form new proglottids. Carcasses infested with cysticercosis can possibly be rendered fit for human consumption by exposure to gamma radiation at doses between 20 and 60 krad.

The products of the radiolysis of deaerated aqueous solutions of ethylene at atmospheric pressure are butane, hexane, octane, decane, acetaldehyde, butyraldehyde, ethanol, butanol, and hydrogen perioxide. Product yields, especially those of the aldehydes and hydrogen peroxide, increase with increasing ethylene concentration and decrease with increasing pH and radiation dose. Addition of efficient electron scavengers increases the yields of oxidized products and decreases the yields of reduced products. The results are compatible with a mechanism in which OH radicals add to rather than abstract from ethylene. Computer-aided analysis of the kinetics of competing reactions indicates that the low yields of aldehydes are related to the ability of these compounds to act as internal scavengers of solvated electrons.