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1.  Classification of chest radiographs for epidemiological purposes by people not experienced in the radiology of pneumoconiosis. 
Under controlled conditions 16 people (eight non-medical) inexperienced in the radiology of occupational lung diseases repeatedly classified 300 selected chest radiographs using the 1971 ILO U/C International Classification of Radiographs of Pneumoconioses. Eight experienced medical readers had previously classified 220 of the selected radiographs for profusion of small rounded opacities. Variability among readers was greater in experimental panels than among the experienced readers. But the average consistency between pairs of novice readers in their use of the 12 categories of profusion for the same radiographs was similar (about 29%) to the average consistency among the experienced readers. Subsequent work with nine of the participants showed that eight of them were able to produce classifications of coal miners' chest radiographs that correlated well with estimates the miners' exposures to respirable coal mine dust. It is concluded that the ILO classification scheme provides a sound descriptive system for recording the appearances of chest radiographs. Under controlled conditions the scheme may be used for epidemiological studies by those with no specialist knowledge or clinical experience. This presupposes that the radiographs concerned will have been examined previously for diagnostic purposes by a suitable qualified physician.
PMCID: PMC1008883  PMID: 7272238
2.  Histocompatibility antigens in coal miners with pneumoconiosis. 
Twenty-five histocompatibility antigens have been measured in 100 coal miners with pneumoconiosis attending a pneumoconiosis medical panel and the results compared with a panel of 200 normal volunteers not exposed to dust. Chest radiographs were read independently by three readers according to the ILO U/C classification. On a combined score, 40 men were thought to have simple pneumoconiosis and 60 men complicated pneumoconiosis. The number of antigens tested and associations between antigens caused difficulties in assessing the statistical significance of differences in prevalence of antigens between groups of men. Using stringent criteria for statistical significance, no significant differences were found in antigen prevalences between miners and controls, or miners with simple or complicated pneumoconiosis. When a less stringent statistical approach was applied, three antigens appeared to have abnormal prevalences in these 100 miners by comparison with the normal volunteers. More detailed examination of these antigen prevalences in relation to radiographic category of pneumoconiosis did not provide any supportive evidence that these slight associations were of statistical or clinical significance. Reports on histocompatibility antigens in miners with pneumoconiosis are reviewed briefly and the results compared. There is no good evidence that any of the histocompatibility antigens so far tested are associated with a clinically important altered risk of simple or complicated pneumoconiosis when dust is inhaled.
PMCID: PMC1009114  PMID: 6824597
3.  A radiographic survey of monumental masonry workers in Aberdeen 
Lloyd Davies, T. A., Doig, A. T., Fox, A. J., and Greenberg, M. (1973).British Journal of Industrial Medicine,30, 227-231. A radiographic survey of monumental masonry workers in Aberdeen. A survey of radiographic appearances of the lungs of monumental masonry workers in Aberdeen was carried out to determine the present prevalence of abnormalities and to serve as a standard for future comparisons in view of changes in methods of working. No major change could be detected in the status of these granite workers in Aberdeen over the past 20 years but the different methods of survey used by Mair in 1951 and by the present study did not allow of strict comparison. Chest radiographs were reported on by three readers independently using the National Coal Board elaboration of the ILO classification and a score was given to each film using Oldham's method. Multiple regression analysis showed that ϰ-ray changes were related to years in granite but progression was slow in comparison with foundry workers. The prevalence of radiographic appearances of category 1 or greater was 3·0% overall and 4·6% for workers in dusty jobs. Evidence of pneumoconiosis was not observed in workers exposed for less than 20 years.
With the environmental control attained the threshold limit values for respirable dust were not often much exceeded.
PMCID: PMC1009516  PMID: 4353240
4.  Childhood hydrocephalus – is radiological morphology associated with etiology 
SpringerPlus  2013;2:11.
Clinicians use a non-standardized, intuitive approach when correlating radiological morphology and etiology of hydrocephalus.
To investigate the possibility of categorizing hydrocephalus in different groups based on radiological morphology, to analyze if these proposed groups relate to the location and type of underlying pathology, and if this can be of use in clinical practice.
Methods and material
A retrospective cohort study including 110 hydrocephalus patients below age seven seen at Rigshospitalet University Hospital, Denmark. Their neuro-imaging was analyzed and categorized based on radiological morphology. Patient charts were reviewed and possible association between the underlying cause of hydrocephalus and the proposed groups of radiological morphology was evaluated.
Radiological appearance varied distinctively between patients. A classification system was created based on the morphology of the lateral ventricles from axial sections at the level of maximal ventricular width. No statistically significant association was found between the suggested groups of morphology and the location and type of pathology.
Distinguishable patterns of radiological morphology exist. The proposed classification system cannot in its current form indicate type and location of the underlying cause of hydrocephalus. A clear need exists for a standardized approach when evaluating etiology and treatment options based on radiological results.
PMCID: PMC3602618  PMID: 23525366
Congenital hydrocephalus; Magnetic resonance imaging; Computed tomography; Aqueduct stenosis; Hydrocephalus classification
5.  Accuracy of death certificates in bronchial asthma. Accuracy of certification procedures during the confidential inquiry by the British Thoracic Association. A subcommittee of the BTA Research Committee. 
Thorax  1984;39(7):505-509.
The Research Committee of the British Thoracic Association conducted a confidential inquiry into death from asthma in adults aged 15-64 years resident in the West Midland and Mersey Regions during 1979. Death certificates recording the word asthma were received for 153 persons. The International Classification of Diseases code for the cause of death was obtained from the Office of Population Censuses and Surveys. Information about the patients, their illness, and their death was obtained by interviews, questionnaires, and inspection of patients' records. A panel of three physicians assisted by a pathologist assessed the clinical and, where applicable, the necropsy findings to ascertain whether bronchial asthma was the true cause of death. Of 147 assessable patients, 89 were considered by the panel to have died from asthma. In 77 of these cases the death certificates were correctly coded, whereas in 12 (13%) death was considered to have been wrongly attributed to another cause (falsely negative). Twenty four deaths on the other hand were considered to have been wrongly attributed to asthma (falsely positive). From this it appears that the total number of 101 certificates recording death from asthma represents a net overestimate of 13%. Accuracy was highest in the youngest age group. There were few discrepancies between the assessment of the panel and certified cause of death when a necropsy had been performed. The most common error (17% of all certificates) was failure to follow the procedure advised for completion of death certificates. This usually occurred when patients suffered from two or more conditions, or when death was sudden and necropsy was not performed.
PMCID: PMC459850  PMID: 6463930
6.  UK Naval Dockyards Asbestosis Study: radiological methods in the surveillance of workers exposed to asbestos 
ABSTRACT In a survey of the effects of exposure to asbestos in the UK Naval Dockyards, small- and large-film chest radiographs of 674 men have been examined. These films have been read under survey conditions by two readers using a simple screening classification, and also in a controlled trial by five readers using the full ILO U/C classification. Comparison between the reading methods showed a deficiency, independent of the size of film, of at least 30% in the detection of asbestos-related radiographic abnormalities when the screening classification was used. For adequate diagnostic sensitivity the ILO U/C classification appears to be essential. There was a deficiency of 43% in significant abnormalities observed by a majority of readers in the small films when directly compared with large film readings. This deficiency could be reduced to 7% by using readings of the small films at any level of abnormality by any of the five readers. When the ILO U/C readings were related to the clinical diagnoses, the only abnormality missed was a small pleural plaque. Films with previously agreed coding were inserted at intervals during the reading trial and helped to maintain the consistency of reading. Right oblique views were taken for 1884 men, in addition to the full-sized postero-anterior view, but the contribution provided by this view proved insufficient to justify its use in large surveys. The cost of a survey when small films are used as a screening method is reduced to between one-third and one-half of the cost when large films are used, assuming that the abnormality rate is not more than 5%. However, this cost advantage for small films is likely to be overtaken by the development of automatic large-film units. The radiation dose when small films are used is increased by a factor of about 20, but is within the prescribed safety level. It is concluded that at least three readers should be involved, using the full ILO U/C classification. Small films may be of particular use in a large-scale survey, in which the abnormality rate is expected to be low, and which might otherwise be too expensive. A sensitive reading method and a high standard of film quality are essential factors in the use of this technique.
PMCID: PMC1008405  PMID: 698132
7.  Tuberculum sellae meningiomas: A series of 41 cases; surgical and ophthalmological outcomes with proposal of a new prognostic scoring system 
Tuberculum sellae meningiomas have proved difficult to treat, partly because of their intimate association with the optic nerves and chiasma, hypothalamus, and internal carotid arteries.
The aim of this study is to analyze the degree of influence of various prognostic factors affecting visual outcome; the pattern of visual recovery and develop a scoring system for prognostication.
Settings and Design:
This is a retrospective study carried out from January 2004 till June 2011.
Materials and Methods:
Patients were analyzed on the basis of clinical, radiological, and surgical factors that appeared to affect the outcome. A special scoring system (according to the guidelines of the German Ophthalmological Society) was adopted to quantify the extent of ophthalmological disturbances.
Statistical Analysis Used:
Comparison of categorical variables between the two was performed using chi-square test and a P value of ≤ 0.05 was considered significant. Logistic regression was used when multivariate analysis was required.
Vision improved in 27% and deteriorated in 7.3%. A prognostic scoring system (score 4–13) was developed depending on the degree of influence of significant prognostic factors. The patients with a score of ≤6 had improved vision postoperatively (44%), whereas none of those with a score > 6 improved. Completeness of visual recovery was perceived in 100% of patients within 3 months. Complete resectability was achieved in 73% of patients.
The proposed scoring system is very useful in prognosticating the visual outcome of these patients. The patients with a score of ≤6 have the best visual outcome postoperatively. Complete resectability is better achieved with extended bifrontal and unilateral frontal approaches. Short-term postoperative visual outcome is a strong indicator of permanent visual outcome after surgery.
PMCID: PMC3505319  PMID: 23188980
Meningioma; prognostic factors; tuberculum sellae; visual outcome
8.  Chest x ray films from construction workers: International Labour Office (ILO 1980) classification compared with routine readings. 
The extent of agreement between International Labour Office (ILO) and clinical readings of chest x ray films from construction workers was studied. From a survey of 5898 workers 258 subjects with a profusion of small opacities of > or = 1/1 and a stratified sample of subjects with profusion < 1/1 were selected. Only 41% of the films classified as ILO profusion category > or = 1/1 were clinically recorded as non-normal for the parenchyma. The proportion of films recorded as pneumoconiotic (or possibly so) was especially low for irregular opacities (22%), but increased with the profusion category (both rounded and irregular) as well as with the size of rounded opacities (p 3/11, q 12/25, r 3/4). Only with the profusion category > or = 2/1 were most of the films recorded as pneumoconiotic. The specificity and sensitivity were highest in the geographical areas where a few clinical readers had assessed many films each. The proportion of false negative clinical reports was low for circumscribed pleural thickening of the chest wall (9%) and diaphragmatic pleural thickening (6%). For calcified pleural changes and for the combination of diffuse pleural thickening and obliteration of the costophrenic angle, false negative reports were absent. The present study shows an unsatisfactory sensitivity for clinical compared with ILO readings as a means for screening the parenchyma of workers with a risk of pneumoconiosis.
PMCID: PMC1061217  PMID: 1472445
9.  Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study. 
Previous studies have suggested that smoking might be protective against the development of osteoarthritis (OA) of the knee. A group of 1003 women aged 45-64 years (mean 54.2 years) from the Chingford general population survey were studied to examine the effect of cigarette smoking on the prevalence of radiologically confirmed OA at different sites. Standard anteroposterior radiographs of the hand and knee were available in 985 women. Disease classification was made on the basis of radiological OA and symptomatic radiological OA. Odds ratios were calculated and adjusted for age and body mass index. A total of 463 (46.2%) women were ever smokers compared with 540 (53.8%) non-smokers. Ever smokers had consumed an average of 14.9 cigarettes a day for a mean of 25.7 years. For radiological OA of the distal interphalangeal joint (DIP) (140 women), proximal interphalangeal joint (40 women), carpometacarpal joint (160 women), and knee joint (118, women) there was no reduced risk of OA in ever smokers. In the small number of subjects with generalised OA (22 women) there was a non-significant 40% reduction of radiological OA in ever smokers (odds ratio 0.63; 95% confidence interval 0.24 to 1.68). Results were similar for subjects with radiographic clinical OA, except the DIP joint which showed a positive association between smoking and Heberden's nodes (odds ratio 2.02, 95% confidence interval 1.89 to 3.42). Results were similar when analysed using current smokers against never smokers. These results do not support an inverse association between cigarette smoking and OA in women. A possible inverse relation with the small subgroup of women with generalised OA and an effect of cigarettes on disease severity cannot, however, be discounted.
PMCID: PMC1004985  PMID: 8447703
10.  Correlation of Radiological Category with Lung Pathology in Coal-workers' Pneumoconiosis 
The relation between the macroscopic pathology of the lungs of coal-workers and the radiological category of pneumoconiosis on a chest film taken not more than two years before death has been investigated in 238 coal-miners in South Wales. Large lung sections were shown to provide more accurate and convenient material than wet lungs for this comparison and were used to assess the number and character of dust foci and the degree of emphysema. The profusion of dust foci was classified into four grades—very sparse, sparse, moderate, and numerous—using standard lung sections. Emphysema was graded slight, moderate, and severe. The chest radiographs were categorized according to the I.L.O. Classification, 1953.
The comparison shows that there is a fairly good correlation between the radiological category and the number and character of dust foci in the lungs at necropsy. The higher the radiological category the greater the likelihood that the lungs will show a large number of dust foci and particularly a higher proportion of fibrotic nodules, and vice versa. Only about 10% of the films read as category 1 showed sparse fibrotic nodules on the lung section, and none showed more than this. Fibrotic nodules occurred more frequently when early complicated pneumoconiosis (category A) was also present. There was no evidence that emphysema was obscuring the recognition of the severity of simple pneumoconiosis on the radiograph. The commonest cause of localized areas of consolidation detected radiologically was progressive massive fibrosis; less commonly, apical scars. Other causes were lung cancer, bronchiectasis, and interstitial fibrosis.
PMCID: PMC1038193  PMID: 13876318
11.  Irregularly shaped small shadows on chest radiographs, dust exposure, and lung function in coalworkers' pneumoconiosis. 
The predominant shapes of small opacities on the chest radiographs of 895 British coalminers have been studied. The aims were to determine whether irregular (as distinct from rounded) small opacities can be identified reproducibly, whether their occurrence is related to dust exposure, and whether they are associated with excess prevalence of respiratory symptoms or impairments of lung function. Six of the doctors responsible for regular radiological surveys of all British coalminers each classified all 895 radiographs twice and independently, using the International Labour Organisation's 1980 classification system. The majority view was that 39 films showed predominantly irregular small opacities, 131 showed predominantly small rounded opacities, and 587 showed no small opacities. Readers' opinions varied about the presence and shapes of shadows on the other 138 films. In general, consistency between readers (and within readers on repeated viewings) was satisfactory. The occurrence and profusion of irregular shadows were related significantly both to the men's ages and additionally to their cumulative exposure to respirable coalmine dust as determined from 15 years' dust monitoring close to where the miners had worked. For any given level of exposure, the average level of profusion of the small irregular opacities was less than the corresponding profusion of small rounded opacities. The prevalence rates of chronic cough and phlegm, and of breathlessness, were higher in those with small irregular opacities than in those with no small opacities (category 0/0), but the differences were not statistically significant after adjustment for other factors including smoking habits. The presence of irregular (but not rounded) small shadows was associated with an impairment in respiratory function averaging about 190 ml deficits in both FEV1 and FVC. These deficits were not explicable in terms of the men's ages, body sizes, and smoking habits and they were in addition to the lung function losses attributable to the miners' dust exposure as such. It is concluded that the presence and profusion of small irregular opacities should be taken into consideration when assessing the severity of coalworkers' simple pneumoconiosis.
PMCID: PMC1007944  PMID: 3342187
12.  Crystalline silica exposure, radiological silicosis, and lung cancer mortality in diatomaceous earth industry workers 
Thorax  1999;54(1):56-59.
BACKGROUND—The role of silicosis as either a necessary or incidental condition in silica associated lung cancer remains unresolved. To address this issue a cohort analysis of dose-response relations for crystalline silica and lung cancer mortality was conducted among diatomaceous earth workers classified according to the presence or absence of radiological silicosis.
METHODS—Radiological silicosis was determined by median 1980 International Labour Organisation system readings of a panel of three "B" readers for 1809 of 2342 white male workers in a diatomaceous earth facility in California. Standardised mortality ratios (SMR) for lung cancer, based on United States rates for 1942-94, were calculated separately for workers with and without radiological silicosis according to cumulative exposures to respirable crystalline silica (milligrams per cubic meter × years; mg/m3-years) lagged 15years.
RESULTS—Eighty one cases of silicosis were identified, including 77 with small opacities of ⩾1/0 and four with large opacities. A slightly larger excess of lung cancer was found among the subjects with silicosis (SMR 1.57, 95% confidence interval (CI) 0.43 to 4.03) than in workers without silicosis (SMR 1.19, 95% CI 0.87to 1.57). An association between silica exposure and lung cancer risk was detected among those without silicosis; a statistically significant (p = 0.02) increasing trend of lung cancer risk was seen with cumulative exposure, with SMR reaching 2.40 (95% CI 1.24 to 4.20) at the highest exposure level (⩾5.0 mg/m3-years). A similar statistically significant (p = 0.02) dose-response gradient was observed among non-silicotic subjects when follow up was truncated at 15 years after the final negative radiograph (SMR 2.96, 95% CI 1.19 to 6.08 at ⩾5.0 mg/m3-years), indicating that the association among non-silicotic subjects was unlikely to be accounted for by undetected radiological silicosis.
CONCLUSIONS—The dose-response relation observed between cumulative exposure to respirable crystalline silica and lung cancer mortality among workers without radiological silicosis suggests that silicosis is not a necessary co-condition for silica related lung carcinogenesis. However, the relatively small number of silicosis cases in the cohort and the absence of radiographic data after employment limit interpretations.

PMCID: PMC1745344  PMID: 10343633
13.  Primary vascular tumors of bone: a spectrum of entities? 
Vascular tumors of bone are a heterogeneous group. Numerous terms have been introduced as well as different classification systems. None of the classification schemes have been accepted due to lack of consistent terminology, accepted histologic criteria, and limited correlation with clinical outcome. It is acknowledged that vascular tumors of bone originate from endothelial cells, resulting in variable expression of endothelial markers. None of these markers are useful to discriminate between benign and malignant lesions. Although radiologic appearance is not specific, radiologic multifocality should trigger to include a vascular neoplasm in the differential diagnosis. This review gives an overview of current literature by describing all different histologic subtypes in correspondence with clinical, radiologic and genetic data. We propose the classification of vascular tumors of bone according to the three-tiered World Health Organization classification scheme for soft tissue tumors dividing entities into a benign, intermediate and malignant category. Hemangioma is the most often and commonly recognized benign lesion. Epithelioid hemangioma has been better defined over the past few years. Based on its locally aggressive behavior and occurrence of lymph node metastases, classification within the intermediate category could be considered. Angiosarcoma is the only accepted term for high-grade malignant vascular tumor of bone and so far, epithelioid hemangioendo-thelioma is the only accepted low-grade malignant vascular tumor of bone. It is still unclear whether other low-grade malignant vascular tumors of bone (e.g. hemangioendothelioma) truly exist. Unfortunately, molecular / genetic studies of vascular tumors of bone which might support the proposed classification are very sparse.
PMCID: PMC3160606  PMID: 21904630
vascular tumor of bone; hemangioma; epithelioid hemangioma; epithelioid hemangioendothelioma; angiosarcoma; bone tumor
14.  Setting exposure standards: a decision process. 
Environmental Health Perspectives  1996;104(Suppl 2):401-405.
Increased emphasis on routine screening of chemicals for potential neurotoxicity has resulted in the development of testing guidelines and standardized procedures. A multiphased, tiered-testing strategy has been proposed by numerous expert panels to evaluate large numbers of chemicals. In a regulatory context, however, a formal tiered-testing approach is not used, mostly because of the constraints of differing regulatory authorities and the potential cost of such a testing strategy. Instead, current regulatory decision making utilizes all available animal and human data to identify a critical adverse effect which is then used for setting standards. Although the current decision-making process does not use a formal tiered-testing approach, it appears to identify chemicals with neurotoxic effects. An analysis of U.S. Environmental Protection Agency integrated risk information system (IRIS) indicates that about 20% of the chemicals having standards or health advisories are based on neurotoxicity.
PMCID: PMC1469596  PMID: 9182048
15.  Estimating Progression of Coal-Workers' Simple Pneumoconiosis from Readings of Radiological Categories 
The 1950 I.L.O. classification of radiological abnormality in simple pneumoconiosis describes four discrete categories, but the actual amount of abnormality in an individual does not change by discrete steps. Radiological progression is the increase of a continuous variable, and methods of measuring it must deal with three problems: (1) the coarse classification into discrete categories; (2) possible variation in the rate of an individual's progression from point to point on the continuum of abnormality; (3) the possible non-uniformity of the continuum in relation to some relevant change in the lungs.
The methods proposed for measuring progression were developed from an analysis of two surveys, two and a half years apart, of 689 coal-face workers in eight pits. Some results from a third survey five and a half years after the second are also used. The merits of different methods of film reading are considered. Smooth curves were fitted to the distributions of abnormality found at each survey of each pit, and the progression of the first smooth curve into the second was estimated by the new method of “percentile pairing”. The amount of progression within category 1 was found to be about double that in category 2 in all the pits. A new scale of abnormality was derived that makes this change more nearly uniform all along the continuum, and a single index was thus obtained for comparing one pit with another. Progression was also measured on the dust retention scale of Rivers, Wise, King, and Nagelschmidt (1960) and again was greater throughout category 1 than throughout category 2, so that in terms of dust retention progression is not uniform at different points in the continuum of radiological abnormality.
Various implications of the new methods and other approaches to the analysis of progression data are critically discussed.
PMCID: PMC1038315  PMID: 14001314
16.  Radiographic abnormalities and mortality in subjects with exposure to crocidolite. 
Plain chest radiographs from a one in six random sample of the workforce of the asbestos industry at Wittenoom, Western Australia between 1943 and 1966 have been classified for degree of profusion and pleural thickening by two independent observers according to the 1980 UICC-ILO Classification of Radiographs for the pneumoconioses to clarify the effect of degree of radiological abnormality on survival. A total of 1106 subjects were selected. Each subject's age, cumulative exposure to crocidolite, and time since first exposure were determined from employment records, the results of a survey of airborne concentrations of fibres > 5 mu in length conducted in 1966, and an exposure rating by an industrial hygienist and an ex-manager of the mine and mill at Wittenoom. By the end of 1986 193 subjects had died. Conditional logistic regression was used to model the relative risk of death in five separate case-control analyses in which the outcomes were deaths from: (1) all causes, (2) malignant mesothelioma, (3) lung cancer, (4) asbestosis, and (5) other causes excluding cancer and asbestosis. Up to 20 controls per case were randomly chosen from all men of the same age who were not known to have died before the date of death of the index case. After adjustment for exposure and time since first exposure, there were significant and independent effects of radiographic profusion and pleural thickening on all cause mortality. The effect of profusion was largely a result of the effect on mortality from malignant mesothelioma and asbestosis but not lung cancer. The effect of pleural thickening was greatest on mortality from other causes, mainly ischaemic heart disease. This study has shown that degree of radiographic abnormality has an independent effect on mortality from malignant mesothelioma, asbestosis, and all causes even after allowing for the effects of age, degree of exposure, and time since first exposure.
PMCID: PMC1035519  PMID: 8217849
17.  The validity of the SF-36 in an Australian National Household Survey: demonstrating the applicability of the Household Income and Labour Dynamics in Australia (HILDA) Survey to examination of health inequalities  
BMC Public Health  2004;4:44.
The SF-36 is one of the most widely used self-completion measures of health status. The inclusion of the SF-36 in the first Australian national household panel survey, the Household, Income and Labour Dynamics in Australia (HILDA) Survey, provides an opportunity to investigate health inequalities. In this analysis we establish the psychometric properties and criterion validity of the SF-36 HILDA Survey data and examine scale profiles across a range of measures of socio-economic circumstance.
Data from 13,055 respondents who completed the first wave of the HILDA Survey were analysed to determine the psychometric properties of the SF-36 and the relationship of the SF-36 scales to other measures of health, disability, social functioning and demographic characteristics.
Results of principle components analysis were similar to previous Australian and international reports. Survey scales demonstrated convergent and divergent validity, and different markers of social status demonstrated unique patterns of outcomes across the scales.
Results demonstrated the validity of the SF-36 data collected during the first wave of the HILDA Survey and support its use in research examining health inequalities and population health characteristics in Australia.
PMCID: PMC524495  PMID: 15469617
18.  Solitary rectal ulcer syndrome mimicking rectal neoplasm on MRI 
The British Journal of Radiology  2010;83(995):e221-e224.
Solitary rectal ulcer syndrome (SRUS) is a rare condition that typically affects young adults and describes a spectrum of clinicopathological abnormalities.
The diagnosis of SRUS is usually made on the basis of a combination of presenting symptoms and endoscopic and histological appearances. Characteristic radiological appearances have been described on transrectal and endoanal ultrasound, defecating proctography and barium enema.
The radiological appearance of solitary rectal ulcer on MRI has not been previously described. MRI appearance of thickened ulcerated mucosa in the anterior rectal wall are non-specific and was indistinguishable from a malignant process.
However, given that solitary rectal ulcer has a pre-disposition to occur in the anterior rectal wall, the presence on MRI of thickened rectal mucosa in this location could suggest solitary rectal ulcer in the correct clinical context.
PMCID: PMC3473720  PMID: 20965892
19.  Ambulation in labour. 
British Medical Journal  1978;2(6137):591-593.
In a randomised prospective study of 68 women in spontaneous labour half were allocated to an ambulant group and half to a recumbent group. The duration of labour was significantly shorter, the need for analgesia significantly less, and the incidence of fetal heart abnormalities significantly smaller in the ambulant group than in the recumbent group. Apgar scores at one and five minutes were also significantly greater in the ambulant group. More patients in the recumbent group required augmentations with oxytocic drugs. There was no statistically significant difference in the third stage loss in the two groups. Ambulation in labour should be encouraged: it may bring human benefits while allowing the advantages of hospital supervision.
PMCID: PMC1607519  PMID: 698606
20.  Partograms and Nomograms of Cervical Dilatation in Management of Primigravid Labour 
British Medical Journal  1973;4(5890):451-455.
Philpott's graphic labour has been modified and used in 15,000 labours; it has been unanimously accepted by the staff. A nomogram has been constructed to show the normal progressive dilatation of the cervix for primigravidae admitted at different stages of cervical dilatation. Retrospective evaluation of the nomogram showed that it can separate normal labour from labour destined to result in an abnormal outcome, such as longer first and second stages, a greater incidence of instrumental delivery, and babies with low Apgar scores.
It is suggested that the use of a stencil representing normal labour progress, together with Philpott's partogram, will be of considerable use, both in specialist and in general-practitioner units.
PMCID: PMC1587584  PMID: 4758447
21.  Pneumoconiosis in Cornish china clay workers. 
A radiological survey of men employed in the china clay industry in Cornwall was carried out in 1977. Each man completed a short questionnaire on respiratory symptoms and smoking habits, his occupational history was determined, and his forced expiratory volume and vital capacity were measured. The radiographs were read independently by three observers, using the 1980 ILO classification. Of the 1728 men in the study, 23 had had dust exposure elsewhere, mostly in tin mining, and were excluded. Readings of the radiographs were available for 1676 men: 77.4% were within category 0, 17.9% in category 1, and 4.7% in categories 2 and 3. In 19 men (1.1%) one or more readers recorded the presence of a large shadow and read it as complicated pneumoconiosis, but in only four men were the readers unanimous. Every job recognised as dusty contributed significantly to the amount of simple pneumoconiosis, and in two jobs the conditions were such that the average worker would reach category 2 in a working lifetime. Smoking appeared unrelated to the radiographic appearance. Vital capacity showed a significant reduction with increasing amount of pneumoconiosis, but not, when this was allowed for, on the duration of exposure in any of the job categories. In addition it depended, as would be expected, on smoking. The effect of one category increase in pneumoconiosis was equivalent to 4.1 years of age in smokers, 3.9 years of age in ex-smokers, and 5.4 years of age in non-smoker. Forced expiratory volume did not decline significantly with amount of pneumoconiosis, so that FEV% VC showed an increase, though not to a significant extent. No extent. No relationship between symptoms and past exposure was detected.
PMCID: PMC1009161  PMID: 6830708
22.  A scoring system for the assessment of clinical severity in osteogenesis imperfecta 
Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures. Patients with OI have clinical features that may range from mild symptoms to severe bone deformities and neonatal lethality. Numerous approaches for the classification of OI have been published. The Sillence classification is the most commonly used. In this study, we aimed at developing a more refined sub-classification by applying a proposed scoring system for the quantitative assessment of clinical severity in different types of OI.
Subjects and methods
This study included 43 patients with OI. Clinical examination and radiological studies were conducted for all patients. Cases were classified according to the Sillence classification into types I–IV. The proposed scoring system included five major criteria of high clinical value: number of fractures per year, motor milestones, long bone deformities, length/height standard deviation score (SDS), and bone mineral density (BMD). Each criterion was assigned a score from 1 to 4, and each patient was marked on a scale from 1 to 20 according to these five criteria.
Applying the proposed clinical scoring system showed that all 11 patients with Sillence type I (100%) had a score between 6 and 10, denoting mild affection. The only patient with Sillence type II had a score of 19, denoting severe affection. In Sillence type III, 7 patients (31.8%) were moderately affected and 15 patients (68.2%) were severely affected. Almost all patients with Sillence type IV (88.9%) were moderately affected.
Applying the proposed scoring system can quantitatively reflect the degree of clinical severity in OI patients and can be used in complement with the Sillence classification and molecular studies.
PMCID: PMC3303020  PMID: 23449141
Osteogenesis imperfecta; Sillence classification; Clinical scoring system; Radiological manifestations; Genetics
23.  Expert agreement confirms that negative changes in hand and foot radiographs are a surrogate for repair in patients with rheumatoid arthritis 
The objective of the present study was to test the hypothesis that experts recognize repair of erosions and, if so, to determine which, if any, morphologic features permitted them to recognize the repair. We also tested whether scoring by a standard method detected repair. Seven experienced readers of radiographs in rheumatoid arthritis were presented with 64 sets of single joints-of-interest at two time points, randomized and blinded for the correct sequence. The readers assessed which joint was better, and recorded whether any of six specific features were seen. Two independent readers, experienced in scoring by the van der Heijde-modified Sharp method who were not on the expert panel, then scored the complete films that included the joint-of-interest. The panel agreed very well on which of two joints was better, and, even though they did not know the true sequence, the panel accurately assigned a sequence slightly better than chance alone (58%) but worse than their agreement on which image was 'better or worse' (78%). The readers therefore indirectly assigned repair by choosing the second film as the best. Putative repair features were seen in cases of both repair and progression, and were not discriminatory. Similar results were obtained when the experts were presented with the entire hand or foot containing the joint-of-interest. In the third repair exercise, two independent readers who scored whole hands and feet using a standard method found a mean negative score in 22/60 joints-of-interest. All 22 joints were also scored as repair by the panel. Repair was detected reliably by a majority of the panel on viewing paired images based on a better/worse decision and assigning sequence in a set of images that were blinded for sequence by an independent project manager. In this test set of images, repair was manifested by a reduction in the size of erosion in many cases. Size was one feature that aided the experts to detect repair but cannot be the only one; the experts had to find other features to determine whether a smaller erosion was the first in a sequence of radiographs in a patient with progressive damage or was the second film in a patient exhibiting repair. The change in size of erosion was also picked up by independent readers applying the van der Heijde-modified Sharp scoring method and was reflected in their scores.
PMCID: PMC2206368  PMID: 17605816
24.  A Hazard Analysis for a Generic Insulin Infusion Pump 
Researchers at the Food and Drug Administration (FDA)/Center for Device and Radiological Health/Office of Science and Engineering Laboratories have been exploring the concept of model-based engineering as a means for improving the quality of medical device software. Insulin pumps were chosen as a research subject because their design provides the desired degree of research complexity and these types of devices present an ongoing regulatory challenge.
Insulin pump hazards and their contributing factors are considered in the context of a highly abstract generic insulin infusion pump (GIIP) model. Hazards were identified by consulting with manufacturers, pump users, and clinicians; by reviewing national and international standards and adverse event reports collected by the FDA; and from workshops sponsored by Diabetes Technology Society. This information has been consolidated in tabular form to facilitate further community analysis and discussion.
A generic insulin infusion pump model architecture has been established. A fairly comprehensive hazard analysis document, corresponding to the GIIP model, is presented in this article.
We believe that this work represents the genesis of an insulin pump safety reference standard upon which future insulin pump designs can be based to help ensure a basic level of safety. More interaction with the diabetes community is needed to assure the quality of this safety modeling process.
PMCID: PMC2864162  PMID: 20307387
hazard analysis; insulin pump; safety
25.  Gene expression signatures: biomarkers toward diagnosing multiple sclerosis 
Genes and Immunity  2011;13(2):146-154.
Identification of biomarkers contributing to disease diagnosis, classification or prognosis could be of considerable utility. For example, primary methods to diagnose multiple sclerosis include magnetic resonance imaging and detection of immunologic abnormalities in cerebrospinal fluid. We determined if gene expression differences in blood discriminated MS subjects from comparator groups and identified panels of ratios that performed with varying degrees of accuracy depending upon complexity of comparator groups. High levels of overall accuracy were achieved by comparing MS to homogeneous comparator groups. Overall accuracy was compromised when MS was compared to a heterogeneous comparator group. Results, validated in independent cohorts, indicate that gene expression differences in blood accurately exclude or include a diagnosis of MS and suggest these approaches may provide clinically useful prediction of MS.
PMCID: PMC3291793  PMID: 21938015

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