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Background: Radiology does not routinely solicit feedback on radiology reports. The aim of the study is to report the feasibility and initial results of a multi-institutional quality improvement project implementing patient and provider feedback for radiology reports.Methods: A HIPAA-compliant, institutional review board-waived quality improvement effort at two institutions obtaining patient and provider feedback for radiology reports was implemented from January 2018 to May 2020.Intervention: A two-question survey (quantitative review and open text box feedback) was embedded into the electronic health records for patients and providers. Text-based feedback was evaluated, and patterns of feedback were categorized: thoroughness of reports, error in reports, timeliness of reports, access to reports, desire for patient summary, and desire for key images. We performed the χ2 test for categorical variables. P < .05 was considered significant.Results: Of 367 responses, patients provided 219 of 367 (60%), and providers provided 148 of 367 (40%) of the feedback. A higher proportion of patients reported satisfaction with reports (76% versus 65%, P = .023) and provided more feedback compared with providers (71% versus 50%, P < .0001). Both patients and providers commented on the thoroughness of reports (12% of patients versus 9% of providers) and errors in reports (8% of patients and 9% of providers). Patients disproportionately commented on timeliness of reports (11%) and access to the reports (6%) compared with providers (3% each). In addition, 7% of patients expressed a desire for patient summaries.Conclusion: Report-specific patient and provider feedback demonstrate the feasibility of embedding surveys into electronic medical records. Up to 9% of the feedback addressed an error in reports. [ABSTRACT FROM AUTHOR]

Abstract: Millions of people rely on savannas for ecosystem services, such as the provision of grazing and fuel wood, so it is important to determine the extent to which utilization affects woody vegetation resources. Using airborne LiDAR from the Carnegie Airborne Observatory (CAO), we quantified and compared tree canopy cover and height distributions between areas of contrasting management in the Lowveld savanna region of South Africa – a region connecting communal landscapes with heavy utilization (especially fuel wood harvesting) to fully protected public (Kruger National Park – KNP) and private reserves (SabiSand Game Reserve – SSGR) that conserve biodiversity. Differences in total woody vegetation cover and cover within functional height classes (1–2m, 2–3m, 3–5m, 5–7m and >7m) were investigated between 7 sites located within (i) conservation areas (in KNP, SSGR), (ii) communal rangelands or (iii) cultivated fields in communal areas. The impact of human utilization on wood resources in the communal areas varied widely between sites. Heavy utilization on gabbro substrate greatly reduced total woody cover of the rangelands, while two other communal rangelands that were presumably less intensively utilised had double the total woody cover of conservation areas. Rangelands and fields in most of the communal sites had more vegetation cover in the 5–7m and >7m classes than most of the conservation sites, presumably due to the absence of elephants in communal rangelands and the active preservation of large fruiting trees. On granite substrates, which account for the majority of the study area, there was a 50% reduction in woody cover below 5m in communal rangelands. Although large trees were clearly being conserved in communal rangelands and fields, there was a relatively low cover of vegetation below 5m, which raise doubts about recruitment and long-term sustainability of the tree resources. These results in conjunction with other studies based on the CAO LiDAR data for experimental burn plots and large mammal exclosures in KNP, suggest that communal land use on granite substrates have a higher impact on the woody cover below 5m than both elephants and fire. [Copyright &y& Elsevier]

Summary: Objective: To ascertain the predictive role of longitudinally acquired biochemical measures of cartilage turnover in relation to X-ray defined knee osteoarthritis (OAK), knee pain and functioning. Methods: This is a feasibility study based on 72 enrollees of the Michigan site of Study of Women''s Health Across the Nation (SWAN), a longitudinal, population-based cohort study with 11 annual visits to characterize health at the mid-life. At visits in 1996, 1998 and 2007, radiographs were evaluated for the presence of OAK [≥2 on the Kellgren and Lawrence (K–L) scale]. Knee pain and stiffness were assessed by interview. Functioning was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Cartilage oligomeric matrix protein (COMP) and Type II collagen telopeptides (CTX-II) were assayed in serum and urine samples collected on alternate years from 1997 to 2006. We related trajectories of the cartilage biochemical markers from these five time points to OAK severity (no OAK, K–L score<2; mild OAK, K–L score=2; moderate/severe OAK, K–L score=3 or 4), pain, stiffness, or functioning, using longitudinal non-linear mixed modeling. Results: The 2007 prevalence of X-ray defined OAK was 50% in these 72 women. Upward trajectories of COMP (P =0.02) and CTX-II (P =0.006) were associated with increased OAK severity and body size. COMP trajectories were associated with pain and stiffness, but not functioning. CTX-II trajectories were associated with stiffness scores, but not knee pain or functioning scores. Conclusion: Multiple, biennial measures of COMP or CTX-II taken over a 10-year period were predictive of subsequent OAK and knee stiffness. [Copyright &y& Elsevier]

Summary: Objective: To elucidate the role of body mass index (BMI) and knee osteoarthritis (OAK) by evaluating measures of body composition including fat mass and skeletal muscle mass (SMM). Methods: Data are from 541 women enrolled in the Michigan Bone Health Study, a longitudinal, population-based study. At visits in 1998 and 2002, radiographs were taken of both knees and were evaluated for the presence of OAK (≥2 on the Kellgren–Lawrence (K–L) scale). Joint space width (JSW) was measured with electronic calipers. Fat mass and SMM were determined using bioelectrical impedance analysis. Results: In 2002, the prevalence of OAK was 11% in this population of women whose mean age was 47 years. Fat mass, lean mass, SMM, waist circumference and BMI were greater in women with OAK compared to those without OAK. In multiple variable analyses adjusted for age, fat mass and SMM explained OAK prevalence and increasing OAK severity better than models with BMI; further SMM explained more variation than did fat mass. SMM was positively associated with level of left and right medial JSW while there was no consistent association of JSW and BMI or fat mass. Conclusion: Fat mass and SMM were associated with K–L OAK score and the amount of joint space, with more variation explained by SMM. SMM was highly associated with JSW. Therefore, though obesity, frequently characterized by BMI, is a frequently reported risk factor for OAK, this mis-attribution may mean that interventions that focus on weight loss as treatment for osteoarthritis should be aware that this may negatively impact muscle mass. [Copyright &y& Elsevier]

Objective: Our goal was to determine the effects of a repeated course of the gonadotropin-releasing hormone agonist nafarelin on symptoms and signs of endometriosis and lumbar and distal radius bone mineral density.Study Design: Forty-five women previously treated for 6 months with nafarelin, who had recurrent symptoms and signs of endometriosis, received 400 mcg/day of nafarelin intranasally for 3 months. Efficacy was evaluated by changes in severity of symptoms and signs. Lumbar bone mineral density was measured by dual-energy x-ray absorptiometry and distal radius bone mineral density by single-photon absorptiometry. Bone mineral density was also measured in 10 control volunteers.Results: Repeated 3-month treatment significantly alleviated recurrent symptoms and signs of endometriosis. Lumbar bone mineral density decreased significantly by a mean of 2% at the end of treatment; this loss was restored within 3 to 6 months after treatment completion. No bone mineral density decline occurred in the radius. Bone mineral density changes in the control group were statistically insignificant.Conclusions: A repeated 3-month course of nafarelin treatment significantly relieved recurrent endometriotic symptoms and signs without sustained loss of bone mineral density. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to analyze cervical specimens and semen from a closed colony of baboons for the presence of the papillomavirus consensus L1 gene.Study Design: Cervical swabs were collected from lightly anesthetized female baboons. Semen was collected from a male baboon by standard electroejaculation techniques. Deoxyribonucleic acid was extracted from the cells by two different methods and analyzed by polymerase chain reaction targeting the L1 consensus gene common for >25 genital papillomaviruses.Results: Analyses of the polymerase chain reaction-amplified products did not reveal bands for the papillomavirus in either the cervical specimens or the semen.Conclusions: The hypothesis of a linkage between primates with papillomavirus as a common factor is not supported by the results of this study. This information is also important in assisting clinicians in setting up specific pathogen-free colonies of baboons. [ABSTRACT FROM AUTHOR]

Mechanical circulatory support (MCS) provides hemodynamic support for cardiogenic shock (CS) as well as electrical instability. We present a case of cardiogenic shock requiring stepwise escalation of MCS for sequential biventricular failure from a myocardial infarction (MI) and subsequent malignant ventricular tachycardia (VT). A 63-year-old male was admitted with a late-presentation of anterior wall MI. Coronary angiography revealed proximal 100% left anterior descending artery (LAD) occlusion and chronic total occlusion of the right coronary artery. He underwent percutaneous coronary intervention (PCI) of the LAD and placement of an Impella CP for a low cardiac index and hypotension. However, the patient remained in a low output state and an Impella 5.5 was placed with resultant hemodynamic stabilization. After multiple failed attempts at MCS weaning, the patient underwent placement of a HeartMate 3 LVAD. Perioperatively, he developed recurrent monomorphic VT that continued post-operatively and was refractory to anti-arrhythmic therapy, requiring innumerable cardioversions (Figure 1A, 1B). Incessant VT led to progressive right ventricular (RV) failure, and required Impella RP placement. (Figure 1C,1D).However, VT persisted with recurrent low flow from the LVAD. The patient was escalated to Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) to facilitate VT ablation. Seven VT morphologies arising from a scar around the Purkinje and fascicular system were targeted. Subsequently, he did not have any inducible VT and was able to be weaned off VA-ECMO successfully. He was discharged home on LVAD support with an implantable cardioverter defibrillator and has not had any recurrent VT. This case illustrates the stepwise escalation of MCS for biventricular failure and highlights the utility of MCS in patient with incessant VT and successful ablation for stabilization and a positive outcome. [ABSTRACT FROM AUTHOR]

A nuclear fuel cycle systems modeling and code-to-code comparison effort was coordinated across multiple national laboratories to verify the tools needed to perform fuel cycle analyses of the transition from a once-through nuclear fuel cycle to a sustainable potential future fuel cycle. For this verification study, a simplified example transition scenario was developed to serve as a test case for the four systems codes involved (DYMOND, VISION, ORION, and MARKAL), each used by a different laboratory participant. In addition, all participants produced spreadsheet solutions for the test case to check all the mass flows and reactor/facility profiles on a year-by-year basis throughout the simulation period. The test case specifications describe a transition from the current US fleet of light water reactors to a future fleet of sodium-cooled fast reactors that continuously recycle transuranic elements as fuel. After several initial coordinated modeling and calculation attempts, it was revealed that most of the differences in code results were not due to different code algorithms or calculation approaches, but due to different interpretations of the input specifications among the analysts. Therefore, the specifications for the test case itself were iteratively updated to remove ambiguity and to help calibrate interpretations. In addition, a few corrections and modifications were made to the codes as well, which led to excellent agreement between all codes and spreadsheets for this test case. Although no fuel cycle transition analysis codes matched the spreadsheet results exactly, all remaining differences in the results were due to fundamental differences in code structure and/or were thoroughly explained. The specifications and example results are provided so that they can be used to verify additional codes in the future for such fuel cycle transition scenarios. [ABSTRACT FROM AUTHOR]

Abstract: Magnetic resonance imaging is increasingly used to assess neonatal hypoxic-ischemic injury, and several scoring systems were developed to predict neurologic outcomes in these patients. We examined the magnetic resonance imaging studies of 33 neonates/infants who manifested acute perinatal hypoxic-ischemic injuries. Using a seven-point susceptibility-weighted imaging categorical grading scale, each patient received a “prominence of vein” score, which was dichotomized into a “normal” or “abnormal” group. Six-month outcomes were assessed using the Pediatric Cerebral Performance Category Scale. We then determined whether “prominence of vein” scores correlated with neurologic outcomes in patients with hypoxic-ischemic injuries, and compared these results with the Barkovich magnetic resonance imaging scoring system. Patients with “normal” “prominence of vein” scores demonstrated better outcomes (mean Pediatric Cerebral Performance Category Scale value = 2) than patients with “abnormal” “prominence of vein” scores (mean Pediatric Cerebral Performance Category Scale value = 4). The dichotomized “prominence of vein” groups demonstrated correlations with the Barkovich magnetic resonance imaging scores of the proton density-weighted basal ganglia, watershed, and combined basal ganglia/watershed regions. The susceptibility-weighted imaging categorical grading scale may aid in predicting neurologic outcomes after hypoxic-ischemic injuries. [Copyright &y& Elsevier]

Objective: This study assesses the efficacy and tolerability of fluoxetine in the acute treatment of child and adolescent obsessive-compulsive disorder (OCD) during a 13-week, double-blind, placebo-controlled study.Method: Eligible patients aged 7 to 17 (N = 103) were randomized at a ratio of 2:1 to receive either fluoxetine or placebo. Dosing was initiated at 10 mg daily for 2 weeks, then increased to 20 mg daily. After 4 weeks of treatment, and again after 7 weeks of treatment, non-responders could have their dosage increased by 20 mg daily, for a maximum possible dosage of 60 mg daily. Primary measure of efficacy was improvement in OCD symptoms as measured by the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). All analyses were intent-to-treat.Results: Fluoxetine was associated with significantly greater improvement in OCD as assessed by the CY-BOCS (p = .026) and other measures than was placebo. Fluoxetine was well tolerated and had a rate of discontinuation for adverse events similar to that of placebo (p = 1.00).Conclusions: Fluoxetine 20 to 60 mg daily was effective and well tolerated for treatment of OCD in this pediatric population. [ABSTRACT FROM AUTHOR]