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Background Ferumoxytol is approved for use in the treatment of iron deficiency anemia, but it can serve as an alternative to gadolinium-based contrast agents. On the basis of postmarketing surveillance data, the Food and Drug Administration issued a black box warning regarding the risks of rare but serious acute hypersensitivity reactions during fast high-dose injection (510 mg iron in 17 seconds) for therapeutic use. Whereas single-center safety data for diagnostic use have been positive, multicenter data are lacking. Purpose To report multicenter safety data for off-label diagnostic ferumoxytol use. Materials and Methods The multicenter ferumoxytol MRI registry was established as an open-label nonrandomized surveillance databank without industry involvement. Each center monitored all ferumoxytol administrations, classified adverse events (AEs) using the National Cancer Institute Common Terminology Criteria for Adverse Events (grade 1-5), and assessed the relationship of AEs to ferumoxytol administration. AEs related to or possibly related to ferumoxytol injection were considered adverse reactions. The core laboratory adjudicated the AEs and classified them with the American College of Radiology (ACR) classification. Analysis of variance was used to compare vital signs. Results Between January 2003 and October 2018, 3215 patients (median age, 58 years; range, 1 day to 96 years; 1897 male patients) received 4240 ferumoxytol injections for MRI. Ferumoxytol dose ranged from 1 to 11 mg per kilogram of body weight (≤510 mg iron; rate ≤45 mg iron/sec). There were no systematic changes in vital signs after ferumoxytol administration (P > .05). No severe, life-threatening, or fatal AEs occurred. Eighty-three (1.9%) of 4240 AEs were related or possibly related to ferumoxytol infusions (75 mild [1.8%], eight moderate [0.2%]). Thirty-one AEs were classified as allergiclike reactions using ACR criteria but were consistent with minor infusion reactions observed with parenteral iron. Conclusion Diagnostic ferumoxytol use was well tolerated, associated with no serious adverse events, and implicated in few adverse reactions. Registry results indicate a positive safety profile for ferumoxytol use in MRI. © RSNA, 2019 Online supplemental material is available for this article.

Background We investigated the associations of healthcare worker status with multisystem illness trajectory in hospitalised post-COVID-19 individuals.Methods and results One hundred and sixty-eight patients were evaluated 28–60 days after the last episode of hospital care. Thirty-six (21%) were healthcare workers. Compared with non-healthcare workers, healthcare workers were of similar age (51.3 (8.7) years vs 55.0 (12.4) years; p=0.09) more often women (26 (72%) vs 48 (38%); p

Abstract Background Vascular calcification is an independent predictor of cardiovascular disease in patients with chronic kidney disease. Computed tomography (CT) is the gold-standard for detecting vascular calcification. Radial volumetric-interpolated breath-hold examination (radial-VIBE), a free-breathing gradient-echo cardiovascular magnetic resonance (CMR) sequence, has advantages over CT as it is ionising radiation-free. However, its capability in detecting thoracic aortic calcification (TAC) has not been investigated. This study aims to compare radial-VIBE to CT for the detection of TAC in the descending aorta of patients with end-stage renal disease (ESRD) using semi-automated methods, and to investigate the association between TAC and coronary artery calcification (CAC). Methods Paired cardiac CT and radial-VIBE CMR scans from ESRD patients participating in 2 prospective studies were obtained. Calcification volume was quantified using semi-automated methods in a 9 cm segment of the thoracic aorta. Correlation and agreement between TAC volume measured on CMR and CT were assessed with Spearman’s correlation coefficient (ρ), linear regression, Bland–Altman plots and intraclass correlation coefficient (ICC). Association between CAC Agatston score and TAC volume determined by CT and CMR was measured with Spearman’s correlation coefficient. Results Scans from 96 participants were analysed. Positive correlation was found between CMR and CT calcification volume [ρ = 0.61, 95% confidence interval (CI) 0.45–0.73]. ICC for consistency was 0.537 (95% CI 0.378–0.665). Bland–Altman plot revealed that compared to CT, CMR volumes were systematically higher at low calcification volume, and lower at high calcification volume. CT did not detect calcification in 41.7% of participants, while radial-VIBE CMR detected signal which the semi-quantitative algorithm reported as calcification in all of those individuals. Instances of suboptimal radial-VIBE CMR image quality were deemed to be the major contributors to the discrepancy. Correlations between CAC Agatston score and TAC volume measured by CT and CMR were ρ = 0.404 (95% CI 0.214–0.565) and ρ = 0.211 (95% CI 0.008–0.396), respectively. Conclusion Radial-VIBE CMR can detect TAC with strong positive association to CT, albeit with the presence of proportional bias. Quantification of vascular calcification by radial-VIBE remains a promising area for future research, but improvements in image quality are necessary.

Abstract Background With over 2.35 million records, the National Joint Registry (NJR) is the largest arthroplasty registry in the world. It provides a powerful tool to monitor implant survivorship and influence different surgical strategies. To date, little work has been undertaken to investigate the validity of the ‘Reason for Revision’ recorded in Consultant Outcome Reports on the NJR. Methods The NJR was queried to identify all revisions on the THR performed at a single centre over an 11-year period. Review and validation of ‘Reason for Revision’ for each case was undertaken using radiological imaging studies, pathology, histology, microbiology and electronic medical records. Results Of the 22,046 primary total hip replacements (THR) and total knee replacements (TKR) undertaken by 23 surgeons at our hospital, over an 11-year period, 1.35% (297) were subsequently reported to the NJR as revised. Discrepancies in reporting to the NJR were identified for 41 cases (25.63%) for THR and 28 (20.40%) cases for TKR. Revision for infection was under-reported for both THR and TKR by 1.88% and 3.65% respectively. Reporting of adverse soft tissue reaction to particulate debris for THR was unreported by 11%. Progressive arthritis following a TKR was unreported by 6.56%. All the cases reported as ‘other’ (8.75% for THRs and 3.65% for TKRs) were reclassified to the most appropriate ‘reason for revision’ category. The ‘reason for revision’ data is recorded to the NJR with findings at the time of surgery. It is some days before microbiology and histology reports become available and source data is not always updated. Conclusion If an average of 23% wrong data entry at a highly organised institution is replicated throughout the UK, a formal process to validate primary and revision data submitted to the NJR should be considered. Local scrutiny, review and validation of revision data are all vital to optimise the value of the NJR. Accurate data recorded to the NJR is imperative to provide safe and effective improvements in orthopaedic surgery.

Objective To determine provision of MRI for patients with cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators) in England, to understand regional variation and assess the impact of guideline changes.Methods Retrospective data related to MRI scans performed in patients with CIED over the preceding 12 months was collected using a structured survey tool distributed to every National Health Service Trust MRI unit in England. Data were compared with similar data from 2014/2015 and with demand (estimated from local CIED implantation rates and regional population data by sustainability and transformation partnerships (STPs)).Results Responses were received from 212 of 223 (95%) hospitals in England. 112 (53%) MRI units’ scan patients with MR-conditional CIEDs (10% also scan non-MR conditional devices), compared with 46% of sites in 2014/2015. Total annual scan volume increased over fourfold between 2014 and 2019 (1090 to 4896 scans). There was widespread geographical variation, with five STPs (total population >3·5 million representing approximately 25 000 patients with CIED) with no local provision. There was no correlation between local demand (CIED implantation rates) and MRI provision (scan volume). Complication rates were extremely low with three events nationally in 12 months (0·06% CIED–MRI scans).Conclusions Provision of MRI for patients with CIEDs in England increased over fourfold in 4 years, but an estimated 10-fold care gap remains. Almost half of hospitals and 1 in 10 STPs have no service, with no relationship between local supply and demand. Availability of MRI for patients with non-MR conditional devices, although demonstrably safe, remains limited.

Aim A modified Delphi approach was used to develop consensus opinion among British Society for Cardiac Imaging/British Society of Cardiac CT (BSCI/BSCCT) members in order to prioritise research questions in cardiovascular imaging.Methods All members of the BSCI/BSCCT were invited to submit research questions that they considered to be of the highest clinical and/or academic priority in the field of cardiovascular imaging (phase 1). Subsequently a steering committee removed duplicate questions and combined questions of a similar theme by consensus agreement where appropriate. BSCI/BSCCT members were invited to rank the resulting research questions in two further iterative rounds (phases 2 and 3) to determine a final list of high-priority research questions.Results A total of 111 research questions were submitted in phase 1 by 30 BSCI/BSCCT members. While there was a broad range of topics, from determining the optimal features/markers of the vulnerable plaque to investigating how cardiac imaging can best be used to maximise clinical outcomes and economic costs, multimodality imaging-related (n=44, 40%) questions dominated the categories and coronary artery imaging (n=40, 36%) was the most common topic. Over two iterative rounds of prioritisation of these research questions, the original 111 were reduced to 75 questions in round 2, and 25 in round 3. From these 25 a final Top 10 list was distilled by consensus grouping.Conclusion This study has identified and ranked the top research priorities in cardiovascular imaging, as identified by the BSCI/BSCCT membership. This is a first step towards identifying the cardiovascular imaging research priorities within the UK and may assist researchers and funding bodies alike in setting priorities.

Despite their extensive use, the absolute dating of tree-ring chronologies has not hitherto been independently validated at the global scale. Here, the identification of distinct 14C excursions in 484 individual tree rings, enable the authors to confirm the dating of 44 dendrochronologies from five continents.

This paper presents results from a comparison of wholewood and cellulose carbon and oxygen isotope ratios for four UK tree species. These species occur within the historic buildings archive as both primary and supplementary construction materials and have been used to reconstruct the climate of the past. New advances in the application of stable isotopes have widened the scope of the isotope approach, but require the time-consuming purification of cellulose. Comparison of the oxygen and carbon isotope signals preserved in the wood and cellulose components confirms and builds upon previous research in this field and provides additional insight into the covariance of these two sample types between species, and the potential to employ wood isotope analysis for both pre-screening trees for palaeoclimatology and chronology research.

Continuous cover forestry (CCF) has gained interest as an alternative to even-aged management particularly on drained peatland forests. However, relatively little is known about the physiological response of suppressed trees when larger trees are removed as a part of CCF practices. Consequently, studies concentrating on process-level modeling of the response of trees to selection harvesting are also rare. Here, we compared, modeled and measured harvest response of previously suppressed Norway spruce (Picea abies) trees to a selection harvest. We quantified the harvest response by collecting Norway spruce tree-ring samples in a drained peatland forest site and measuring the change in stable carbon and oxygen isotopic ratios of wood formed during 2010–20, including five post-harvest years. The measured isotopic ratios were compared with ecosystem-level process model predictions for |${\kern0em }^{13}$| C discrimination and |${\kern0em }^{18}$| O leaf water enrichment. We found that the model predicted similar but lower harvest response than the measurements. Furthermore, accounting for mesophyll conductance was important for capturing the variation in |${\kern0em }^{13}$| C discrimination. In addition, we performed sensitivity analysis on the model, which suggests that the modeled |${\kern0em }^{13}$| C discrimination is sensitive to parameters related to CO2 transport through stomata to the mesophyll. [ABSTRACT FROM AUTHOR]

We report carbon and oxygen isotope ratios measured from the pith at breast height (ca. 1.2m) of three European larch (Larix decidua Mill.) trees growing in a mixed wood in West Wales, UK. The non-climatic rising trend of carbon isotope ratios reported for other species during early (juvenile) growth is not present and neither isotope shows significant trends as the tree matures. Results from the first ten rings are not significantly different from the next two sets of ten rings. Absence of a juvenile effect in carbon isotopes of European larch has been reported from trees growing in a low density stand in France and attributed to an absence of shading and no use of respired carbon dioxide. This site, in contrast, is densely wooded and the dominant oaks predate the larch trees, suggesting that juvenile effects, when present, may instead be caused by changes in hydraulic conductivity. More research is needed on juvenile effects as the current practice of avoiding juvenile wood is restricting the potential of stable isotope analysis of tree rings for dendroclimatology and plant physiology.

Carbon isotope composition of tree‐ring (δ13CRing) is a commonly used proxy for environmental change and ecophysiology. δ13CRing reconstructions are based on a solid knowledge of isotope fractionations during formation of primary photosynthates (δ13CP), such as sucrose. However, δ13CRing is not merely a record of δ13CP. Isotope fractionation processes, which are not yet fully understood, modify δ13CP during sucrose transport. We traced, how the environmental intra‐seasonal δ13CP signal changes from leaves to phloem, tree‐ring and roots, for 7 year old Pinus sylvestris, using δ13C analysis of individual carbohydrates, δ13CRing laser ablation, leaf gas exchange and enzyme activity measurements. The intra‐seasonal δ13CP dynamics was clearly reflected by δ13CRing, suggesting negligible impact of reserve use on δ13CRing. However, δ13CP became increasingly 13C‐enriched during down‐stem transport, probably due to post‐photosynthetic fractionations such as sink organ catabolism. In contrast, δ13C of water‐soluble carbohydrates, analysed for the same extracts, did not reflect the same isotope dynamics and fractionations as δ13CP, but recorded intra‐seasonal δ13CP variability. The impact of environmental signals on δ13CRing, and the 0.5 and 1.7‰ depletion in photosynthates compared ring organic matter and tree‐ring cellulose, respectively, are useful pieces of information for studies exploiting δ13CRing. Summary statement: Intra‐annual tree‐ring δ13C signal of Scots pine recorded faithfully the environmental signal in leaf sucrose δ13C, with no clear signs of reserve use. The 13C‐enrichment of studied sink organs relative to leaves was dominated by post‐photosynthetic fractionations, such as sink organ respiration. [ABSTRACT FROM AUTHOR]

Describes a project based on the Global Positioning System (GPS) that offers students a chance to design and implement a mini-research program to prepare them for an undergraduate research project. Discusses the context of the GPS exercise, teaching and learning outcomes, and advantages and evaluation of the exercise. (CMK)

Students who used the Geohazards course were compared with those using the Malta Fieldcourse, both intended to develop skills in communications and information technology. The result was that both courses were altered, particularly in terms of the learning environment. (JOW)