Overdose and take-home naloxone in emergency settings: A pilot study examining feasibility of delivering brief interventions addressing overdose prevention with 'take-home naloxone' in emergency departments.

Objective: Although most unintentional opioid deaths in Australia are attributed to pharmaceutical opioids, take-home naloxone (THN) programmes have to date predominantly targeted people using illicit opioids in drug treatment and harm reduction settings. We sought to examine the feasibility of delivering THN brief interventions (THN-BIs) with intranasal naloxone in EDs.

Methods: This pilot feasibility study was conducted across three major metropolitan EDs in Sydney and Melbourne.

Fair pay petition gets a flying start with 150,000 signatures.

Midwife Natalie Carter is to be congratulated for launching an online petition for fair pay for NHS workers (Letters December 3).

Apologies should not be seen as an admission of guilt or wrong-doing.

The RCN is to be congratulated for its excellent and straightforward 'Good practice for handling feedback' guide (News November 19).

Now is the time to build on our strike and campaign for better pay.

Well, we have finally started to take industrial action over pay and some of us even went on strike - and the heavens didn't fall.

It's our duty to go the extra mile for patients who are vulnerable.

Thank you for publishing Gloria Likupe's insightful article on communicating with older minority ethnic patients (Art & Science June 4).

Quantitative BOLD: the effect of diffusion.

Purpose: To make the quantitative blood oxygenation level-dependent (qBOLD) method more suitable for clinical application by accounting for proton diffusion and reducing acquisition times.

Materials And Methods: Monte Carlo methods are used to simulate the signal from diffusing protons in the presence of a blood vessel network. A diffusive qBOLD model was then constructed using a lookup table of the results.

Intramyocellular lipid levels are associated with peripheral, but not hepatic, insulin sensitivity in normal healthy subjects.

Increased levels of IMCL (intramyocellular lipid) have been shown to be associated with reduced steady-state glucose infusion rates during a hyperinsulinaemic-euglycaemic clamp (M-value). The aim of the present study was to explore how IMCL levels relate to the insulin-mediated suppression of endogenous glucose production [hepatic SI (insulin sensitivity)] and increase in glucose disposal (peripheral SI). In the present study, 11 healthy young adults (7 male, 4 female; aged 21-31 years) undertook, in random order, an hyperinsulinaemic-euglycaemic clamp combined with stable glucose isotope enrichment to measure peripheral and hepatic SI, a 1H-MRS (proton-magnetic resonance spectroscopy) scan to determine IMCL levels and a DXA (dual-energy X-ray absorptiometry) scan to assess body composition.

Magnetic field interactions in adjustable hydrocephalus shunts.

Object: Exposing patients with ventricular shunts to magnetic fields and MR imaging procedures poses a significant risk of unintentional changes in shunt settings. Shunt valves can also generate considerable imaging artifacts. The purpose of this study was to determine the magnetic field safety and MR imaging compatibility of 5 adjustable models of hydrocephalus shunts.

Potential heating caused by intraparenchymal intracranial pressure transducers in a 3-tesla magnetic resonance imaging system using a body radiofrequency resonator: assessment of the Codman MicroSensor Transducer.

Magnetic resonance imaging and spectroscopy may provide important clinical information in the acute stages of brain injury. For this to occur it must be ensured that intracranial pressure (ICP) monitoring devices are safe to bring into the MR imaging suite. The authors tested a Codman MicroSensor ICP Transducer (Codman & Shurtleff, Inc.

How reliable is perfusion MR in acute stroke? Validation and determination of the penumbra threshold against quantitative PET.

Background And Purpose: Perfusion magnetic resonance imaging (pMR) is increasingly used in acute stroke, but its physiologic significance is still debated. A reasonably good correlation between pMR and positron emission tomography (PET) has been reported in normal subjects and chronic cerebrovascular disease, but corresponding validation in acute stroke is still lacking.

Methods: We compared the cerebral blood flow (CBF), cerebral blood volume, and mean transit time (MTT) maps generated by pMR (deconvolution method) and PET ((15)O steady-state method) in 5 patients studied back-to-back with the 2 modalities at a mean of 16 hours (range, 7 to 21 hours) after stroke onset.

Gaussian process modeling for image distortion correction in echo planar imaging.

An enhanced method for correction of image distortion due to B(0)-field inhomogeneities in echo planar imaging (EPI) is presented. The algorithm is based on the measurement of the point spread function (PSF) associated with each image voxel using a reference scan. The expected distortion map in the phase encode direction is then estimated using a nonparametric inference algorithm known as Gaussian process modeling.

Concordant biology underlies discordant imaging findings: diffusivity behaves differently in grey and white matter post acute neurotrauma.

Background: Cerebral edema is a common sequelum post traumatic brain injury (TBI). Quantification of the apparent diffusion coefficient (ADC) using diffusion tensor imaging (DTI) may help to characterize the pathophysiology of brain swelling.

Methods: Twenty-two patients with moderate-to-severe TBI underwent magnetic resonance (MR) imaging, including DTI, within five days of injury.

Application of a probabilistic double-fibre structure model to diffusion-weighted MR images of the human brain.

A Markov chain Monte Carlo (MCMC) algorithm has been reported which is capable of determining the probabilistic orientation of two-fibre populations from high angular resolution diffusion-weighted data (HARDI). We present and critically discuss the application of this algorithm to in vivo human datasets acquired in clinically realistic times. We show that by appropriate model selection areas of multiple fibre populations can be identified that correspond with those predicted from known anatomy.

Does the acute diffusion-weighted imaging lesion represent penumbra as well as core? A combined quantitative PET/MRI voxel-based study.

In acute ischemic stroke, the diffusion-weighted imaging (DWI) lesion is widely held to represent the core of irreversible damage and is therefore crucial in selecting patients for thrombolysis. However, recent research suggests it may also represent penumbra. An illustrative patient was imaged 7 hours after stroke onset with back-to-back 3T diffusion tensor imaging and quantitative positron emission tomography, which showed a DWI lesion and misery perfusion, respectively.

Human immunodeficiency virus-1 infection and multiple sclerosis-like illness in a child.

We present a child with human immune deficiency virus-1 infection associated with a multiple sclerosis-like illness. This case is the first reported of human immune deficiency virus-1 infection and a disease indistinguishable from multiple sclerosis in a child. Because of the rarity of either disease in pediatric patients, their coexistence in a child argues in favor of a casual association between the two illnesses, thus reinforcing the long-held assumption that viral agents may trigger some of the immunologic abnormalities underlying multiple sclerosis.