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Study design Reliability study. Objectives The aim of this study was to evaluate the interrater-reliability of the interpretation of diagnostic ultrasound in patients with shoulder pain between physical therapists and radiologists. Background Although physical therapists in The Netherlands increasingly use diagnostic ultrasound in clinical practice, there is no evidence available on its reliability. Methods A cohort study included patients with shoulder pain from primary care physiotherapy. Patients followed the usual diagnostic pathway of which diagnostic ultrasound could be a part. Patients that received diagnostic ultrasound also visited a radiologist within one week for a second one. Patients and radiologists were blinded for the diagnostic ultrasound diagnosis of the physical therapists. Agreement was assessed using Cohen's kappa statistics. Subgroup analysis was performed on education and experience. Results A total of 65 patients were enrolled and 13 physical therapists and 9 radiologists performed diagnostic ultrasound. We found substantial agreement (0.63 K) between physical therapists and radiologists on the assessment of full thickness tears. The overall kappa of all four diagnostic categories was 0.36, indicating fair agreement. The more experienced and highly trained physical therapists showed moderate agreement (0.43 K) compared to only slight agreement (0.17 and 0.09 K) from the less experienced and trained physical therapists with radiologists. Conclusion The reliability between physical therapists and radiologist on diagnostic ultrasound of shoulder patients in primary care is borderline substantial (Kappa = 0.63) for full thickness tears only. This level of reliability is relatively low when compared with the high reliability between radiologists. More experience and training of physical therapists may increase the reliability of diagnostic ultrasound. [ABSTRACT FROM AUTHOR]

Summary: Propranolol, a lipophilic non-selective beta-blocker, has proven to be effective in the treatment of infantile haemangioma (IH). However, several side effects have been reported. Atenolol, a hydrophilic selective beta-1 blocker, could be an alternative and associated with fewer side effects. Thirty consecutive patients with IH were treated with atenolol between June 2010 and May 2011. The therapeutic effect was judged by clinical assessment and quantified by using a visual analogue scale (VAS) and the Haemangioma Activity Score (HAS). Side effects were also evaluated. The atenolol cohort was compared with a previously described cohort of 28 patients treated with propranolol between July 2008 and December 2009. Clinical involution was present in 90% (27/30) of the IH patients treated with atenolol. Mild side effects occurred in 40% (12/30) of these patients and severe side effects occurred in 3% (1/30). Compared with the previously described cohort treated with propranolol, mild side effects occurred in 50% (14/28) and severe side effects in 25% (7/28) of the patients (p = 0.04). Quantitative improvement of the IH in the atenolol group (n = 27) showed no significant difference in either the VAS score or the HAS compared to the propranolol group (n = 24). This study indicates that atenolol is effective in the treatment of IH. Compared with a historical control group treated with propranolol, the effects of atenolol seem to be similar and less frequently associated with severe side effects. Randomised clinical trials are necessary to evaluate the efficacy and safety of atenolol treatment in IH. [Copyright &y& Elsevier]

Background: Infantile hemangioma (IH) is a frequently encountered tumor with a potentially complicated course. Recently, propranolol was discovered to be an effective treatment option.Objective: To describe the effects and side effects of propranolol treatment in 28 children with (complicated) IH.Methods: A protocol for treatment of IH with propranolol was designed and implemented. Propranolol was administered to 28 children (21 girls and 7 boys, mean age at onset of treatment: 8.8 months).Results: All 28 patients had a good response. In two patients, systemic corticosteroid therapy was tapered successfully after propranolol was initiated. Propranolol was also an effective treatment for hemangiomas in 4 patients older than 1 year of age. Side effects that needed intervention and/or close monitoring were not dose dependent and included symptomatic hypoglycemia (n = 2; 1 patient also taking prednisone), hypotension (n = 16, of which 1 is symptomatic), and bronchial hyperreactivity (n = 3). Restless sleep (n = 8), constipation (n = 3) and cold extremities (n = 3) were observed.Limitations: Clinical studies are necessary to evaluate the incidence of side effects of propranolol treatment of IH.Conclusions: Propranolol appears to be an effective treatment option for IH even in the nonproliferative phase and after the first year of life. Potentially harmful adverse effects include hypoglycemia, bronchospasm, and hypotension. [ABSTRACT FROM AUTHOR]

Abstract: The link between the African Monsoon systems and aerosol loading in Africa is studied using multi-year satellite observations of UV-absorbing aerosols and rain gauge measurements. The main aerosol types occurring over Africa are desert dust and biomass burning aerosols, which are UV-absorbing. The abundance of these aerosols over Africa is characterised in this paper using residues and Absorbing Aerosol Index (AAI) data from Global Ozone Monitoring Experiment (GOME) on board ERS-2 and SCanning Imaging Absorption SpectroMeter for Atmospheric ChartograpHY (SCIAMACHY) on board Envisat. Time series of regionally averaged residues from 1995 to 2008 show the seasonal variations of aerosols in Africa. Zonally averaged daily residues over Africa are related to monthly mean precipitation data and show monsoon-controlled atmospheric aerosol loadings. A distinction is made between the West African Monsoon (WAM) and the East African Monsoon (EAM), which have different dynamics, mainly due to the asymmetric distribution of land masses around the equator in the west. The seasonal variation of the aerosol distribution is clearly linked to the seasonal cycle of the monsoonal wet and dry periods in both studied areas. The residue distribution over Africa shows two distinct modes, one associated with dry periods and one with wet periods. During dry periods the residue varies freely, due to aerosol emissions from deserts and biomass burning events. During wet periods the residue depends linearly on the amount of precipitation, due to scavenging of aerosols and the prevention of aerosol emissions from the wet surface. This is most clear over east Africa, where the sources and sinks of atmospheric aerosols are controlled directly by the local climate, i.e. monsoonal precipitation. Here, the wet mode has a mean residue of −1.4 and the dry mode has a mean residue of −0.3. During the wet modes a reduction of one residue unit for every 160 mm monthly averaged precipitation was found. Shielding effects due to cloud cover may also play a role in the reduction of the residue during wet periods. A possible influence of aerosols on the monsoon, via aerosol direct and indirect effects, is plausible, but cannot directly be deduced from these data. [Copyright &y& Elsevier]

Abstract: Leave patches, uncut areas in a harvested forest, may conserve herbaceous layer species that decline after forest clearcutting. They may also serve to maintain source populations for the recolonization of the harvest area. The main objective of this study is to characterize the short-term response of the herbaceous layer to clearcut harvesting disturbance within and adjacent to leave patches. Four experimental 1ha patches and two uncut references were established. Within each patch or reference, belts of five 1m2 quadrats were placed at 50m and 5m outside the patch, at 0m (edge), and at 25m, 35m, and 50m (centre) inside. These belts of quadrats were replicated at all four aspects (North, South, East, and West). Ground vegetation was sampled yearly for 1 year before harvest and 3 years after harvest in the experimental patches and for 2 consecutive years in the references. Some common residual species declined significantly in the clearcuts, but remained stable inside the patches in the short term (3 years after harvest). Overall species composition changed little in the patch interior and edge after harvest. Colonizing species (those that appeared in quadrats after harvest) in the patch exterior were predominantly early-seral species, whereas colonizers in the patch interior tended to be shade-tolerant forest species. Species were grouped a priori based on two habitat preferences (amounts of canopy cover and disturbed substrate). Species characteristic of a habitat with closed canopy and undisturbed substrates that decreased significantly over time in the patch exterior were negatively correlated with the amount of exposed mineral soil and open canopy. Species characteristic of a habitat with open canopy and disturbed substrates that increased significantly at the patch exterior showed a positive correlation with the amount of exposed mineral soil and open canopy. No species’ habitat preference groups declined significantly in the patch interior or edge over time. Based on species’ responses to forest operations, it appears that at least the common forest species are maintained in the short term within leave patches. [Copyright &y& Elsevier]

Background: Accurate preablation localization of accessory pathways and ventricular tachycardia (VT) origins would have clinical electrophysiologic value by reducing operation time and outcome. Present-day localization of accessory pathways and VT origins has been done using a semiquantitative method of describing ECG wave forms from various leads of the standard 12-lead ECG. No quantitative evaluation method has been created that can be updated. Methods and Results: We developed a new pace mapping algorithm and an automatic morphing software tool to derive an accurate cardiac anatomic model from magnetic resonance imaging (MRI) for each patient. The measured ECGs from pacemaker electrode-activated ventricles were used to calibrate our new pace mapping algorithm. This pace mapping algorithm translates the measured ECG into electrode-generated isochrones on the accurate cardiac model (Figure 1). The first 5EGI is an abbreviation for the initial 5 ms of the electrode-generated isochrones. For comparison, 5EGIs were derived from both 65 BSM signals and the standard 12-lead ECG. This site was compared to the electrode location derived from X-ray, the gold standard. The pacemapping 5EGIs were determined for 7 patients from different pace tip locations. The distances from pace tip location to both the BSM 5EGIs (11 ± 4 mm) and 12-lead 5EGIs (15 ± 5 mm) were the same. A new pace mapping algorithm has been calibrated using different pacing sites. The ventricular pacing sites estimated from the standard 12-lead ECG were similar to those obtained from the 65 BSM signals. Conclusions: This quantitative technique can be updated with new data. These preliminary results indicate that the standard 12-lead ECG can be utilized to localize accurately the origins of VT and accessory pathways. Display Omitted [ABSTRACT FROM AUTHOR]

This phase II study investigated the role of screening for coronary artery disease (CAD) in Hodgkin lymphoma survivors treated with mediastinal radiotherapy, by means of CT coronary angiography (CTA). We found a high prevalence of significant stenosis, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA but needs to be evaluated in a larger cohort.Background Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions. Patients and methods Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis >50%) on CTA. CTA screening was considered to be indicated for testing in a larger population if ≥6 of 50 CTA scanned patients (12%) would need revascularization. Screening was evaluated with a questionnaire before and after screening. Results Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20% (N = 9), significantly increased compared with the 7% expected abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities. Conclusions Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127. [ABSTRACT FROM PUBLISHER]