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A protein kinase bound to the projection portion of MAP 2 (microtubule-associated protein 2).

In previous work we have demonstrated that the microtubule-associated protein 2 (MAP 2) molecule consists of two structural parts. One part of the molecule, referred to as the assembly-promoting domain, binds to the microtubule surface and is responsible for promoting microtubule assembly; the other represents a filamentous projection observed on the microtubule surface that may be involved in the interaction of microtubules with other cellular structures. MAP 2 is known to be specifically phosphorylated as the result of a protein kinase activity that is present in microtubule preparations. We have now found that the activity copurifies with the projection portion of MAP 2 itself. Kinase activity coeluted with MAP 2 when microtubule protein was subjected to either gel- filtration chromatography on bio-gel A-15m or ion-exchange chromatography on DEAE- Sephadex. The activity was released from microtubules by mild digestion with chymotrypsin in parallel with the removal by the protease of the MAP 2 projections from the microtubule surface. The association of the activity with the projection was demonstrated directly by gel filtration chromatography of the projections on bio-gel A-15m. Three protein species (M(r) = 39,000, 55,000, and 70,000) cofractionated with MAP 2, and two of these (M(r) = 39,000 and 55,000) may represent the subunits of an associated cyclic AMP- dependent protein kinase. The projection-associated activity was stimulated 10-fold by cyclic AMP and was inhibited more than 95 percent by the cyclic AMP-dependent protein kinase inhibitor from rabbit skeletal muscle. It appeared to represent the only significant activity associated with microtubules, almost no activity being found with tubulin, other MAPs, or the assembly-promoting domain of MAP 2, and was estimated to account for 7-22 percent of the total brain cytosolic protein kinase activity. The location of the kinase on the projection is consistent with a role in regulating the function of the projection, though other roles for the enzyme are also possible.

Animals↗

Image/patient registration from (partial) projection data by the Fourier phase matching method.

A technique for 2D or 3D image/patient registration, PFPM (projection based Fourier phase matching method), is proposed. This technique provides image/patient registration directly from sequential tomographic projection data. The method can also deal with image files by generating 2D Radon transforms slice by slice. The registration in projection space is done by calculating a Fourier invariant (FI) descriptor for each one-dimensional projection datum, and then registering the FI descriptor by the Fourier phase matching (FPM) method. The algorithm has been tested on both synthetic and experimental data. When dealing with translated, rotated and uniformly scaled 2D image registration, the performance of the PFPM method is comparable to that of the IFPM (image based Fourier phase matching) method in robustness, efficiency, insensitivity to the offset between images, and registration time. The advantages of the former are that subpixel resolution is feasible, and it is more insensitive to image noise due to the averaging effect of the projection acquisition. Furthermore, the PFPM method offers the ability to generalize to 3D image/patient registration and to register partial projection data. By applying patient registration directly from tomographic projection data, image reconstruction is not needed in the therapy set-up verification, thus reducing computational time and artefacts. In addition, real time registration is feasible. Registration from partial projection data meets the geometry and dose requirements in many application cases and makes dynamic set-up verification possible in tomotherapy.

Algorithms↗

Variance in parametric images: direct estimation from parametric projections.

Recent work has shown that it is possible to apply linear kinetic models to dynamic projection data in PET in order to calculate parameter projections. These can subsequently be back-projected to form parametric images--maps of parameters of physiological interest. Critical to the application of these maps, to test for significant changes between normal and pathophysiology, is an assessment of the statistical uncertainty. In this context, parametric images also include simple integral images from, e.g., [O-15]-water used to calculate statistical parametric maps (SPMs). This paper revisits the concept of parameter projections and presents a more general formulation of the parameter projection derivation as well as a method to estimate parameter variance in projection space, showing which analysis methods (models) can be used. Using simulated pharmacokinetic image data we show that a method based on an analysis in projection space inherently calculates the mathematically rigorous pixel variance. This results in an estimation which is as accurate as either estimating variance in image space during model fitting, or estimation by comparison across sets of parametric images--as might be done between individuals in a group pharmacokinetic PET study. The method based on projections has, however, a higher computational efficiency, and is also shown to be more precise, as reflected in smooth variance distribution images when compared to the other methods.

Animals↗

The course of cortico-hypoglossal projections in the human brainstem. Functional testing using transcranial magnetic stimulation.

Cortico-hypoglossal projections were investigated in 11 patients with unifocal ischaemic lesions of different brainstem levels using transcranial magnetic stimulation. Lesion topography was documented by MRI studies. In seven patients the projections to the ipsi- and contralateral hypoglossal nuclei were separately affected. Pontine lesions at the ventral paramedian base close to the midline affect the contralateral projections while lateral lesions at the pontine base affect the ipsilateral projections. Lesions of the paramedian dorsal pontine base do not involve the cortico-hypoglossal projections. Our findings indicate that the cortico-hypoglossal fibres branch off the main ventral pyramidal tract. Lesions of the dorso- and mediolateral medulla impair only the ipsilateral projections. We conclude that ipsilateral projections enter the hypoglossal nucleus from its lateral aspect and that the contralateral projections cross the midline at the pontomedullary junction.

Aged↗

Postnatal maturation of the direct corticospinal projections in the macaque monkey.

Postnatal changes in the topography of the multiple corticospinal projections in the macaque monkey were followed using retrogradely transported fluorescent tracers, and related to the monkey's acquisition of manual dexterity; both behavioral and anatomical maturation were completed by about 8 postnatal months. Cortical origins of the corticospinal projections were examined by constructing planar projection maps of the distributions of labeled corticospinal neuron somas; these somas were found only in lamina V. At birth elaborate somatotopically organized corticospinal projections from primary motor cortex (area 4), the mesial supplementary motor area and cingulate areas 23 and 24, area 12, dorsolateral area 6a beta, the dorsolateral and ventral area 6a alpha (area F4), parietal areas 2/5, 7b and the peri-insular cortex (including area SII), were clearly defined, with axons extending to all spinal cord segments. While this pattern of regional projections broadly resembled that of the mature macaque, there were, however, substantial maturational changes during the 8 months after birth. These included (1) a halving of the area of cerebral cortex from which the contralateral corticospinal projection originated and (2) a threefold reduction in the number of labeled corticospinal neurons projecting to all segments of the cord. Collateral elimination rather than neuronal cell death was the likely mechanism for this reduction in the population and areal extent of corticospinal neurons in the maturing macaque. The surviving corticospinal axon terminals also developed substantially during the postnatal period. At birth some terminals had invaded the intermediate zone in each spinal segment, but few had penetrated the dorsal and ventral horns. By 6 postnatal months, however, many corticospinal neurons were retrogradely labeled following the injection of fluorescent labels into each of these spinal zones in cervical and lumbar spinal segments. These data demonstrate a considerable postnatal reduction in corticospinal neurons projecting to the contralateral spinal cord, and imply that many of the axons that are eliminated never synapse on spinal neurons. It is suggested that during the middle fetal period the axons of many of the cortical neurons in lamina V that in the mature monkey will terminate on particular neuron populations in the thalamus, brainstem, or spinal cord, traverse a common pathway down through the internal capsule into the spinal cord, passing close to these successive targets, and possibly forming collaterals at these levels. In the postnatal period each such neuron establishes a stable, effective synaptic input to only one or a few of these subcortical target populations, and the remaining collateral branches regress. The postnatal maturation of corticospinal neurons, examined in this study, is compatible with such a model.

Animals↗

Gustatory projections from the nucleus of the solitary tract to the parabrachial nuclei in the hamster.

Taste-responsive cells in the nucleus of the solitary tract (NST) either project to the parabrachial nuclei (PbN) of the pons, through which taste information is transmitted to forebrain gustatory nuclei, or give rise to axons terminating locally within the medulla. Numerous anatomical studies clearly demonstrate a substantial projection from the rostral NST, where most taste-responsive cells are found, to the PbN. In contrast, previous electrophysiological studies in the rat have shown that only a small proportion (21-45%) of taste-responsive NST cells are antidromically activated from the PbN, suggesting that less than half the cells recorded from the NST are actually involved in forebrain processing of gustatory information. In the present experiment we investigated the projections from the NST to the PbN electrophysiologically in urethane anesthetized hamsters. Responses of 101 single neurons in the rostral NST were recorded extracellularly following lingual stimulation with 32 mM NaCl, sucrose and quinine hydrochloride (QHCl) and 3.2 mM citric acid. The taste-responsive region of the PbN was identified electrophysiologically and stimulated with a concentric bipolar electrode to antidromically activate each NST cell. Of the 101 taste-responsive NST cells, 81 (80.2%) were antidromically activated from the ipsilateral PbN. The mean firing rates to taste stimulation and the spontaneous activity of these projection neurons were significantly greater than those of non-projecting cells. Every sucrose-best neuron in the sample projected to the PbN. The mean conduction velocity of the 23 QHCl-best neurons was significantly lower than that of the other 58 PbN projection neurons, suggesting that the most QHCl-responsive cells are a subset of smaller neurons. These data show that a large majority of NST cells responsive to taste stimulation of the anterior tongue project to the gustatory subdivisions of the PbN and that these cells have the most robust responses to gustatory stimulation.

Action Potentials↗

Evaluation of a primary school drug drama project: methodological issues and key findings.

This paper describes the impact evaluation of a primary school drug drama project developed by a health promotion service and a theatre's education department in England. The project targeted 10-11 year olds in 41 schools with an interactive drama production and workshop day on attitudes, choices, decisions and risks of alcohol, tobacco and illegal drug use. Parents were also involved in parents' evenings and watching children's performances. The research consisted of both process evaluation, consultation with pupils, teachers, parents, actors and health promotion staff on the project itself, and impact evaluation which looked at potential changes in children's knowledge, attitudes and decision-making skills. This paper reports findings of the impact evaluation, from six of the schools participating in the project. The impact evaluation consisted of pre- and post-project testing using a 'draw and write' and a problem-solving exercise. These findings suggest that the project had a significant impact on the children's knowledge of names of specific illegal drugs, and on their awareness that alcohol and cigarettes were also drugs, and secondly encouraged the children to think in less stereotypical terms about drugs and drug users. The problem-solving exercise, involving decision-making scenarios, showed small but positive trends between pre- and post-project solutions in more than half of the response categories. Methodological difficulties relating to evaluating such a project are discussed.

Child↗

UK Quality Indicator Project (UK QIP) and the UK independent health care sector: a new development.

PURPOSE: To describe implementation of the UK Quality Indicator Project (UK QIP) in the independent health care sector, drawing upon 10 years experience in the UK and approaching 20 years experience in the USA. We describe the history of the project, with an emphasis on recent developments, reflecting upon the critical features of the project and its value for participants. BACKGROUND: The International Quality Indicator Project is the largest international data set of quality indicators. It provides participants with quarterly feedback of comparative indicator data and support for effective use of these data within the participants' own quality improvement programmes. The UK QIP now includes about two-thirds of UK private sector acute hospitals. The UK QIP began as a pilot project in the National Health Service (NHS) public sector in 1991. Implementation of the NHS performance assessment framework, and associated indicator programme, led to a reduction in public sector involvement. In contrast, the private sector, led by the Independent Healthcare Association, sought to identify a provider of key performance indicators to support both internal, within-sector drives for quality improvement and external demands produced by governmental review and the introduction of the National Care Standards Commission. The UK QIP was chosen since it provided a validated, epidemiologically sound system with capacity for support, education and flexibility to meet the changing demands of the sector. The future development of the QIP within the sector, including expansion from acute hospitals to mental health, is described. CONCLUSIONS: Reflection on the process of engagement of the UK independent sector with the QIP emphasizes the generic nature of the project and offers insights into the value of the project. Future challenges, including the issue of public accountability, are discussed in light of the project's underlying philosophy and purpose.

Private Sector↗

Methods for projecting course of acquired immunodeficiency syndrome epidemic.

Three methods for projecting the short-term course of the acquired immunodeficiency syndrome (AIDS) epidemic are discussed: (a) empirical extrapolation, (b) the method of "back calculation," and (c) projections based on compartmental models. Extrapolation, which requires only data on AIDS incidence, is based on an assumed functional form and on the supposition that previous trends will continue. The method of back calculation incorporates both information on previous AIDS incidence and knowledge about the incubation period distribution. These calculations provide some evidence of how many infections occurred during previous time intervals. Although this information is not precise, particularly for the recent past, it is sufficient to produce stable short-term projections. Compartmental models can be used to project future prevalence of infection as well as future AIDS incidence. However, such projections are very dependent on assumptions about initial numbers of individuals infected, rates of transmission, changes in high-risk behaviors over time, and assumptions about transmission among subpopulations with differing transmission rates and initial prevalence of infection. Thus, compartmental models offer insights into the trends in an epidemic but do not currently provide a practical tool for obtaining quantitative projections. We present projections for various risk groups based on the method of back calculation and discuss the use of additional epidemiologic data to obtain accurate projections a decade in advance.

Acquired Immunodeficiency Syndrome↗

Innovative approaches to educating medical students for practice in a changing health care environment: the National UME-21 Project.

In today's continually changing health care environment, there is serious concern that medical students are not being adequately prepared to provide optimal health care in the system where they will eventually practice. To address this problem, the Health Resources and Services Administration (HRSA) developed a $7.6 million national demonstration project, Undergraduate Medical Education for the 21st Century (UME-21). This project funded 18 U.S. medical schools, both public and private, for a three-year period (1998-2001) to implement innovative educational strategies. To accomplish their goals, the 18 UME-21 schools worked with more than 50 organizations external to the medical school (e.g., managed care organizations, integrated health systems, Area Health Education Centers, community health centers). The authors describe the major curricular changes that have been implemented through the UME-21 project, discuss the challenges that occurred in carrying out those changes, and outline the strategies for evaluating the project. The participating schools have developed curricular changes that focus on the core primary care clinical clerkships, take place in ambulatory settings, include learning objectives and competencies identified as important to providing care in the future health care system, and have faculty development and internal evaluation components. Curricular changes implemented at the 18 schools include having students work directly with managed care organizations, as well as special demonstration projects to teach students the knowledge, skills, and attitudes necessary for successfully managing care. It is already clear that the UME-21 project has catalyzed important curricular changes within 12.5% of U.S. medical schools. The ongoing national evaluation of this project, which will be completed in 2002, will provide further information about the project's impact and effectiveness.

Clinical Clerkship↗

Properties of C1 and other ventrolateral medullary neurones with hypothalamic projections in the rat.

1. This study compared (i) the properties of C1 cells with those of neighbouring non-C1 neurones that project to the hypothalamus and (ii) the properties of C1 cells that project to the hypothalamus with those of their medullospinal counterparts. 2. Extracellular recordings were made at three rostrocaudal levels of the ventrolateral medulla (VLM) in alpha-chloralose-anaesthetized, artificially ventilated, paralysed rats. Recorded cells were filled with biotinamide. 3. Level I (0-300 microm behind facial nucleus) contained spontaneously active neurones that were silenced by baro- and cardiopulmonary receptor activation and virtually unaffected by nociceptive stimulation (firing rate altered by < 20 %). These projected either to the cord (type I; 36/39), or to the hypothalamus (type II; 2/39) but rarely to both (1/39). 4. Level II (600-800 microm behind facial nucleus) contained (i) type I neurones (n = 3) (ii) type II neurones (n = 11), (iii) neurones that projected to the hypothalamus and were silenced by baro- and cardiopulmonary receptor activation but activated by strong nociceptive stimulation (type III, n = 2), (iv) non-barosensitive cells activated by weak nociceptive stimulation which projected only to the hypothalamus (type IV, n = 9), (v) cells that projected to the hypothalamus and responded to none of the applied stimuli (type V, n = 7) and (vi) neurones activated by elevating blood pressure which projected neither to the cord nor to the hypothalamus (type VI, n = 4). 5. Level III (1400-1600 microm behind facial motor nucleus) contained all the cell types found at level II except type I. 6. Most of type I and II (17/26) and half of type III cells (4/8) were C1 neurones. Type IV-V were rarely adrenergic (2/12) and type VI were never adrenergic (0/3). 7. All VLM baroinhibited cells project either to the cord or the hypothalamus and virtually all (21/23) C1 cells receive inhibitory inputs from arterial and cardiopulmonary receptors.

Animals↗

Aberrant visual projections in the Siamese cat.

1. Guillery has recently shown that the Siamese cat has a grossly abnormal lateral geniculate body. His anatomical study suggested that certain fibres originating in the temporal retina of each eye cross in the chiasm instead of remaining uncrossed. They thus reach the wrong hemispheres, but in the geniculate they terminate in the regions that the missing fibres from the ipsilateral eye would normally have occupied. The result is that each hemisphere receives an input from parts of the ipsilateral field of vision, this input being entirely from the opposite eye. The purpose of the present work was to study the physiological consequences of this aberrant projection, in the lateral geniculate body and visual cortex.2. Single-cell recordings from the lateral geniculate body confirmed the presence of projections from the ipsilateral visual field of the contralateral eye. The part of layer A(1) receiving these projections was arranged so that the receptive fields of the cells were situated at about the same horizontal level and at the same distance from the vertical meridian as the fields of cells in the layers above and below (layers A and B), but were in the ipsilateral visual field instead of the contralateral. They thus occupied a region directly across the mid line from their normal position.3. In the cortex of all animals studied, we found a systematic representation of part of the ipsilateral visual field, inserted between the usual contralateral representations in areas 17 and 18. When the visual cortex was crossed from medial to lateral the corresponding region of visual field moved from the contralateral periphery to the mid line, and then into the ipsilateral field for 20 degrees . The movement then reversed, with a return to the mid line and a steady progression out into the contralateral field. The entire double representation was, with some possible exceptions, a continuous one. The point of reversal occurred at or near the 17-18 boundary, as judged histologically, and this boundary was in about the same position as in ordinary cats.4. Cells in the part of the cortex representing the ipsilateral fields had normal receptive fields, simple, complex, or hypercomplex. These fields tended to be larger than those in corresponding parts of the contralateral visual fields. Receptive-field size varied with distance from the area centralis, just as it does in the normal cat, so that cells with the smallest fields, in the area centralis projection, were situated some distance from the 17-18 border.5. Projections originating from the first 20 degrees from the midvertical in both visual half-fields had their origin entirely in the contralateral eye, as would be expected from the abnormal crossing at the chiasm. Beyond this visual-field region, and out as far as the temporal crescents, there were projections from both eyes, but we found no individual cells with input from the two eyes. The cells were aggregated, with some groups of cells driven by one eye and some by the other.6. From previous work it is known that ordinary cats raised with squint show a decline in the proportion of cells that can be driven binocularly, whereas animals raised with both eyes closed show little or no decline. A Siamese cat raised with both eyes closed had binocular cells in the regions of 17 and 18 subserving the peripheral visual fields, suggesting that the absence of binocular cells seen in the other Siamese cats was indeed secondary to the squint.7. In two Siamese cats there were suggestions of an entirely different projection pattern, superimposed upon that described above. In the parts of 17 and 18 otherwise entirely devoted to the contralateral visual field, we observed groups of cells with receptive fields in the ipsilateral field of vision. The electrode would pass from a region where cells were driven from some part of the contralateral visual field, to regions in which they were driven from a part of the ipsilateral field directly opposite, across the vertical mid line. The borders of these groups were not necessarily sharp, for in places there was mixing of the two groups of cells, and a few cells had input from two discrete regions located opposite one another on either side of the vertical mid line. The two receptive-field components of such cells were identical, in terms of orientation, optimum direction of movement, and complexity. Stimulation of the two regions gave a better response than was produced from either one alone, and the relative effectiveness of the two varied from cell to cell. These cells thus behaved in a way strikingly reminiscent of binocular cells in common cats.8. The apparent existence of two competing mechanisms for determining the projection of visual afferents to the cortex suggests that a number of factors may cooperate in guiding development. There seems, furthermore, not to be a detailed cell-to-cell specificity of geniculocortical connexions, but rather a tendency to topographic order and continuity, with one part of a given area such as 17 able to substitute for another. Whether or not these tentative interpretations are ultimately proved correct, it seems clear that this type of genetic anomaly has potential usefulness for understanding mechanisms of development of the nervous system.

Animals↗

Readjustment of retinotectal projection following reimplantation of a rotated or inverted tectal tissue in adult goldfish.

1. The pattern of visual projection from the retina on to the optic tectum following reimplantation of a piece of the tectal tissue was studied with neurophysiological mapping methods in adult goldfish. 2. When a rectangular piece of the tectum was dissected, lifted free, and then reimplanted to the same tectum after rotation by 180 degrees around the dorsoventral axis, the re-established visual projection later showed a complete reversal of retinotopic order within the reimplanted area with reference to the normal projection on to the intact surrounding area of the same tectum. The localized reversal was observed as early as 65 days, and also as late as 721 days after the 180 degree rotated reimplantation. 3. If a square piece of the tectal tissue was reimplanted after rotation by 90 degrees anticlockwise around the dorsoventral axis, the restored visual projection later showed a corresponding localized 90 degrees rotation within the reimplanted ares. 4. When the entire laminar structure of a dissected tectal tissue was inverted, and the reimplanted upside-down along the same rostrocaudal axis of the tectum, the restored visual projection on to the inverted tectal reimplant was found to be organized in a reverse retinotopic order along only the mediolateral axis within the reimplanted area. The restored visual projection retained a correct retinotopic order along the rostrocaudal axis. The same trends were also observed after regeneration of the optic fibres following section of the contralateral optic nerve. 5. If the inverted tectal tissue was reimplanted along the same mediolateral axis of the tectum, the re-established visual projection showed a localized reversal of retinotopic order along only the rostrocaudal axis within the reimplanted area. Sectioning the contralateral optic nerve made no difference to the result. 6. These results suggest that a piece of adult tectal tissue retains its original topographic polarity regardless of the orientation of reimplantation after either a rotation or an inversion. Furthermore the retention is not a short-lived transitory phenomenon. It persisted as long as the reimplanted tissue survived. 7. Histological examination of the operated tecta revealed that the reimplanted tectal tissues underwent a severe derangement in their laminar structures. It was impossible to identify the main target zone of retinotectal projection (the stratum fibrosum et griseum superficiale) or the central cellular layer (the stratum griseum centrale) in the reimplants. The prominent feature of the deranged tectal tissue was irregular vortices of tangled fibre bundles. Sparse tectal neurones of bipolar and granular types were irregularly scattered in the deranged structure of the reimplant. 8. Thus, the retention of original topographic polarity did not require an integrity of the cytoarchitectonic structure of the reimplanted tectal tissue.

Action Potentials↗

Pulmonary stretch receptor relay neurones of the cat: location and contralateral medullary projections.

1. The activity of pump (p.) cells, second-order neurones in the pulmonary stretch receptor pathway, was recorded extracellularly in the nucleus of the tractus solitarius (n.t.s.) of the decerebrate cat. Their firing was proportional to changes in lung volume but unrelated to the centrally determined respiratory rhythm. A systematic search of the n.t.s. for the location of p. cells was made and an assessment of their efferent projection to the contralateral n.t.s. was determined electrophysiologically by the antidromic mapping technique. 2. P. cells were located around, and in close proximity to, the solitary tract. The two sites of greatest density were ventromedial and dorsolateral to the tract, with lower concentrations found laterally and ventrolaterally. 3. For twelve of the thirty p. cells tested, evidence of a projection to the contralateral n.t.s. was obtained; in seven of these cells, axonal arborizations within the projection area were identified. Almost all the cells that sent axons to the contralateral n.t.s. were located dorsolateral to the tract; there was no evidence that cells in the ventromedial region had contralateral projections. 4. No evidence that R beta neurones project to the contralateral commissural and ventrolateral subnuclei was found. 5. No p. cells projected to the contralateral ventrolateral n.t.s. The site of projection and branching was consistently localized just caudal to the obex and medial to the solitary tract, in the caudal medial, and commissural subnuclei of the n.t.s. This same region has been shown to receive a dense, direct projection from pulmonary rapidly adapting receptors.

Animals↗

A quantitative study of the central projection patterns of unmyelinated ventral root afferents in the cat.

1. The ventral roots of the spinal cord contain a large number of unmyelinated primary afferent neurones. There is some controversy, however, about the function of these fibres and the route of their central projection. Here we have used electrophysiological techniques to quantify the central projection patterns of these neurones in the segment S2 of adult chloralose-anaesthesized cats. 2. A total of 1185 single unmyelinated units were recorded in small filaments isolated from intact and de-efferented ventral roots or intact dorsal roots of the segment S2 in nineteen cats. The projection patterns of these neurones were tested using supramaximal electrical stimulation of the pelvic and pudendal nerve (the main tributaries of the spinal nerve of this segment) and of the segmental companion root (dorsal or ventral as appropriate). 3. The principal finding of this study is that 85% of unmyelinated afferent axons in the ventral root are direct and exclusive projections. They constitute a separate class of afferents which is only capable of transmitting information from the periphery via the ventral roots. However, the proportion of these fibres that enter the central nervous system is unknown and it seems likely that some of them peter out as they approach the spinal cord and end blindly. The functional role of such afferents remains obscure. 4. For the remaining 15% of unmyelinated ventral root afferents, a projection into the segmental dorsal root was found. The majority of those fibres (about two-thirds) are primary afferent neurones innervating the pia mater. Some of these units had a small spot-like receptive field and responded to mechanical stimuli such as pressure and stretch of the root. They did not have axon projections in a peripheral nerve. 5. A few (5%) unmyelinated ventral root fibres are collateral branches of normal primary afferents projecting through the dorsal root. These trifurcating neurones are a small population which make up only some 0.5% of all dorsal root ganglion cells. The functional significance of this population too is unknown. 6. For none of the fibres that projected into both dorsal and ventral root was there positive evidence for the existence of looping axons that merely make a detour into one of the roots. Although the existence of loops cannot completely be excluded, our evidence suggests that they can constitute at most 5% of the unmyelinated ventral root afferents.

Action Potentials↗

A reconstruction algorithm for coherent scatter computed tomography based on filtered back-projection.

Coherent scatter computed tomography (CSCT) is a reconstructive x-ray imaging technique that yields the spatially resolved coherent-scatter form factor of the investigated object. Reconstruction from coherently scattered x-rays is commonly done using algebraic reconstruction techniques (ART). In this paper, we propose an alternative approach based on filtered back-projection. For the first time, a three-dimensional (3D) filtered back-projection technique using curved 3D back-projection lines is applied to two-dimensional coherent scatter projection data. The proposed algorithm is tested with simulated projection data as well as with projection data acquired with a demonstrator setup similar to a multi-line CT scanner geometry. While yielding comparable image quality as ART reconstruction, the modified 3D filtered back-projection algorithm is about two orders of magnitude faster. In contrast to iterative reconstruction schemes, it has the advantage that subfield-of-view reconstruction becomes feasible. This allows a selective reconstruction of the coherent-scatter form factor for a region of interest. The proposed modified 3D filtered back-projection algorithm is a powerful reconstruction technique to be implemented in a CSCT scanning system. This method gives coherent scatter CT the potential of becoming a competitive modality for medical imaging or nondestructive testing.

Algorithms↗

Projecting mammographic screens.

OBJECTIVE: The purpose of mammographic screening is to reduce mortality from breast cancer. This study describes a method for projecting the number of screens to be performed by a mammographic screening programme, and applies this method in the context of New South Wales, Australia. METHOD: The total number of mammographic screens was projected as the sum of initial screens and re-screens, and is based on projections of the population, rates of new recruitment, rates of attrition within the programme, and the mix of screening intervals. The baseline scenario involved: 70% participation of women aged 50-69 years, 90% return rate for the second and subsequent re-screens, 5% annual screens (95% biennial screens), and a specified population projection. The results were assessed with respect to variations in these assumptions. RESULTS: The projections were strongly influenced by: the rate of screening of the target age group; the proportion of women re-screened annually; and the rates of attrition within the programme. Although demographic change had a notable effect, there was little difference between different population projections. Standard assumptions about attrition within the programme suggest that the current target participation rates in NSW may not be achieved in the long term. CONCLUSIONS: A practical model for projecting mammographic screens for populations is described which is capable of forecasting the number of screens under different scenarios. IMPLICATIONS: Projections of mammographic screens provide important information for the planning and financing of equipment and personnel, and for testing the effects of variations in important operational parameters. Re-screening attrition is an important contributor to screening viability.

Adult↗

Methods for evaluation of small scale quality improvement projects.

Evaluation is an integral component of quality improvement and there is much to be learned from the evaluation of small scale quality improvement initiatives at a local level. This type of evaluation is useful for a number of different reasons including monitoring the impact of local projects, identifying and dealing with issues as they arise within a project, comparing local projects to draw lessons, and collecting more detailed information as part of a bigger evaluation project. Focused audits and developmental studies can be used for evaluation within projects, while methods such as multiple case studies and process evaluations can be used to draw generalised lessons from local experiences and to provide examples of successful projects. Evaluations of small scale quality improvement projects help those involved in improvement initiatives to optimise their choice of interventions and use of resources. Important information to add to the knowledge base of quality improvement in health care can be derived by undertaking formal evaluation of local projects, particularly in relation to building theory around the processes of implementation and increasing understanding of the complex change processes involved.

Family Practice↗