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On October 24, 2018, the Patient Test Result Information Act, or PA ACT 112, went into effect in the state of Pennsylvania with the objectives of addressing gaps in communication for patients who had a significant abnormality on their radiology imaging studies. The requirements of the mandate state that radiologists must inform patients of a significant abnormality, defined as an imaging finding that would result in "a reasonably prudent person" to seek medical follow-up within 3 months [[1]]. Augmenting patient-radiologist communication through government mandate: initial results from an implementation to address the patient test result information act. [Extracted from the article]

• Small aneurysms compose of the majority of ruptured intracranial aneurysms. • Although small aneurysms are prone to rupture despite having low risk profiles, it should not be implied that they are more prone to rupture than large aneurysms. • Further research is needed to evaluate the factors involved in intracranial aneurysm rupture risk. [ABSTRACT FROM AUTHOR]

Abstract: We compared anthropometric and fitness performance data from graduate male youth players from an elite soccer academy who on leaving the institution were either successful or not in progressing to higher standards of play. Altogether, 161 players were grouped according to whether they achieved international or professional status or remained amateur. Measures were taken across three age categories (under 14, 15 and 16 years of age). Players were assessed using standard measures of anthropometric and fitness characteristics. The skeletal age of players was also measured to determine maturity status. Multivariate analysis (MANCOVA) identified a significant (p <0.001) effect for playing status. Univariate analysis revealed a significant difference in maturity status in amateurs and professionals versus internationals (p <0.05), in body mass in professionals versus amateurs (d =0.56, p <0.05), in height (d =0.85, p <0.01) and maximal anaerobic power (d =0.79, p <0.01) in both professionals and internationals versus amateurs. There was also a significant difference in counter-movement jump (d =0.53, p <0.05) and 40-m sprint time (d =0.50, p <0.05) in internationals versus amateurs, as well as a significant main effect for age and playing position (p <0.001). Significant differences were reported for maturity status, body mass, height, peak concentric torque, maximal anaerobic power, and sprint and jump performance with results dependant on age category and playing position. These results suggest that anthropometric and fitness assessments of elite youth soccer players can play a part in determining their chances of proceeding to higher achievement levels. [Copyright &y& Elsevier]

Summary: Long-distance travel is becoming increasingly common. Whatever the means of transport, any long journey will be associated with “travel fatigue”. The symptoms associated with this phenomenon result from a changed routine (particularly sleep lost and meals) and the general disruption caused by travel. Planning any trip well in advance will minimise many of these problems, but some factors are less easy to guard against. These problems include sitting in cramped and uncomfortable conditions and, with flights, the hypoxic environment in the cabin. After arrival at the destination in another country, there can be problems coping with the local language, alterations in food and different customs. If the flight has crossed the equator, then there is likely to be a change in season and natural lighting and, if it has crossed several time zones, there will also be the problem of “jet lag”, caused by a transient desynchrony between the “body clock” and the new local time. Moreover, the new environment might differ from the place of departure with regard to ambient temperature and humidity, altitude, natural lighting (including ultraviolet radiation) and pollution. The traveller needs to be aware of these changes before setting off, so that appropriate preparations (clothing, for example) can be made. [Copyright &y& Elsevier]

Objective: The objective of this study is to investigate the association between actigraphic estimates of the sleep-wake rhythm and a range of functional domains that contribute to well-being in demented elderly patients. Method: Eighty-seven women aged 85.5 ± 5.9 years (mean ± standard deviation) wore an actigraph for two weeks. Activity profiles were analyzed using nonparametric variables, including dichotomy indices, interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA). The associations between these variables and cognitive, functional, behavioral, and emotional states (obtained from standardized neuropsychologic assessments and questionnaires administered to caregivers) were investigated by partial correlations and stepwise regressions. Results: Cognitive, functional, behavioral, and emotional states showed medium to strong correlations with multiple rhythm variables. Partial correlations indicated that this could not be attributed to a uniform worsening with advancing cognitive decline. Stepwise regressions indicated three most distinctive rhythm variables: 1) the interdaily stability of the 24-hour rhythm was most strongly, negatively, related to cognitive decline and depression; 2) the median level of daytime activity was most strongly, negatively, related to impairments of function, of activities of daily living, and of social interaction; and 3) nocturnal restlessness was secondarily, positively, related to impairments of function and social interaction. Conclusion: Especially the interdaily stability and median daytime activity level, and secondarily nocturnal restlessness, showed a strong relationship with the functional status and well-being of demented elderly. This raises the possibility that treatments that enhance daytime activity and the stability of the rest-activity rhythm may improve well-being. [ABSTRACT FROM AUTHOR]

Objectives: To examine the safety and effectiveness of placing ureteral stents in an office-based setting vs in the operating room (OR).Methods: A retrospective chart review was performed to examine outcomes, specifically complication rate, unanticipated hospitalizations, and stent failures, when patients received JJ stents in the clinic procedure suite, using local analgesia and/or nitrous oxide gas analgesia, compared to patients who had ureteral stents placed in the OR, typically with general anesthesia. Additionally, multivariable analysis was performed to determine predictors of complications.Results: Around 565 procedures were performed in the clinic and 179 were performed in the OR. The complication rate for the clinic group was 4.1%, compared to 7.8% in the OR group. Unplanned admissions to the hospital occurred after 3.0% of clinic procedures and 9.5% of OR procedures. Stent placements failed in 1.1% of clinic procedures and 0.56% of OR procedures. Clinic procedure time was 10 minutes vs 12 minutes in the OR (P <0.01). Clinic vs OR setting was not predictive of complications (P = 0.99). We did not identify factors that impacted complication rate in ureteral stent placement in the clinic vs OR setting. Notably, the procedure time for a clinic stent placement was significantly shorter than the OR stent placement.Conclusions: This study demonstrates excellent outcomes with a novel approach to a standard procedure, with shorter procedure time and no difference in complication rates. [ABSTRACT FROM AUTHOR]

Abstract: Background: The impact of ageing on the human cardiovascular system has been the subject of several studies in recent years, but with insufficient emphasis on defining sex-specific differences. To rectify this, gender-specific differences in structure and function in the human cardiovascular system were studied in a European population during natural ageing. Methods: Cardiac power output (CPO) was measured and integrated with changes in left ventricular (LV) mass, diastolic, systolic and limb blood flow, blood pressure and exercise capacity in 93 health-screened men and 122 women, aged 20 to 75 years. Results: Correlating with a 21% loss of LV mass, maximum cardiac pumping (i.e. CPOmax = Q̇max x MAPmax) and reserve (CR = CPOmax −CPOrest) capacities decreased 20–25% with age in male hearts. In contrast, CPOmax, CR and LV mass were all preserved in ageing women. Maximum cardiac output (Q̇max; 26–32%), peak forearm blood flow (FBFpeak; 61%) and exercise capacity (40–50%) all decreased, but more so in men than women. In contrast, systemic vascular resistance (68–75%) and mean arterial pressure (MAPmax; 14–26%) increased in both sexes. CPOrest decreased 27% in men, but was unchanged in women, despite lower early:late diastolic filling (48–51%), Q̇rest (19–23%) and FBFrest (56%) in both sexes. Conclusions: Understanding sex-specific differences in cardiovascular ageing is important for public health and biomedical research, given increasingly larger older populations and the need to prevent and treat cardiovascular disease. [Copyright &y& Elsevier]