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Purpose To demonstrate the interchangeable neck shape-specific (NSS) coil concept that supplements standard commercial spine and head/neck coils to provide simultaneous high-resolution (hi-res) head/neck imaging with high signal-to-noise ratio (SNR). Methods Two NSS coils were constructed on formers designed to fit two different neck shapes. A 7-channel (7ch) ladder array was constructed on a medium neck former, and a 9-channel (9ch) ladder array was constructed on large neck former. Both coils were interchangeable with the same preamp housing. Results The 7ch and 9ch coils demonstrate SNR gains of approximately 4 times and 3 times over the Siemens 20-channel head/neck coil in the carotid arteries of our volunteers, respectively. Coupling between the Siemens 32-channel spine coil, Siemens 20-channel head/neck coil, and the NSS coils was negligible, allowing for simultaneous hi-res head/neck imaging with high SNR. Conclusions This study demonstrates that supplementing existing commercial spine and head/neck coils with an NSS coil allows uniform simultaneous hi-res imaging with high SNR in the anterior neck, while maintaining SNR of the commercial coil in the head and posterior neck. Magn Reson Med 78:2460-2468, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

PURPOSE To develop a method for rapid prediction of the geometric focus location in MR coordinates of a focused ultrasound (US) transducer with arbitrary position and orientation without sonicating. METHODS Three small tracker coil circuits were designed, constructed, attached to the transducer housing of a breast-specific MR-guided focused US (MRgFUS) system with 5 degrees of freedom, and connected to receiver channel inputs of an MRI scanner. A one-dimensional sequence applied in three orthogonal directions determined the position of each tracker, which was then corrected for gradient nonlinearity. In a calibration step, low-level heating located the US focus in one transducer position orientation where the tracker positions were also known. Subsequent US focus locations were determined from the isometric transformation of the trackers. The accuracy of this method was verified by comparing the tracking coil predictions to thermal center of mass calculated using MR thermometry data acquired at 16 different transducer positions for MRgFUS sonications in a homogeneous gelatin phantom. RESULTS The tracker coil predicted focus was an average distance of 2.1 ± 1.1 mm from the thermal center of mass. The one-dimensional locator sequence and prediction calculations took less than 1 s to perform. CONCLUSION This technique accurately predicts the geometric focus for a transducer with arbitrary position and orientation without sonicating. Magn Reson Med 77:2424-2430, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

BACKGROUND Data suggest that delays in discharges from inpatient units affect hospital throughput and contribute to emergency department crowding. Lean/Six Sigma (LSS) has been shown to improve inefficiencies in other industries. There are no published data on what impact LSS can have on advancing and sustaining earlier patient discharges. OBJECTIVE Determine the impact LSS has on advancing times of placement of discharge order and patient discharge compared to control. Secondary outcomes were length of stay (LOS) and readmission rates. DESIGN Prospective quality study with concurrent controls. SETTING Academic medical center. PATIENTS Hospitalized pediatric patients compared to remainder of the children's hospital services. INTERVENTIONS Staff reallocation, creation of standard workflow, multidisciplinary predischarge planning, and creation of a discharge checklist. MEASUREMENTS Median time of discharge order entry and median time of actual patient discharge, proportion of patients discharged before noon and 2 pm, and LOS and readmission rates. RESULTS The median time of order entry was 10:45 compared to 14:05, and the median time of discharge was 14:15 compared to 15:48. The LOS and the readmission rates remained the same in both cohorts. The control group had faster baseline discharge order entry and patient discharge, but discharge performance did not improve, despite a significantly lower average daily census. CONCLUSIONS We determined that Lean approaches can have an immediate and sustained impact on advancing patient discharges, with no negative affect on LOS or readmission rates. Our intervention generated consistent results independent of personnel during the busiest months of the year at a tertiary care children's hospital. Journal of Hospital Medicine 2015;10:220–227. © 2014 Society of Hospital Medicine

Purpose The purpose of this work was to develop and evaluate a system consisting of an insertable gradient, RF coils, and animal positioning hardware to enable imaging of the internal structure of the cochlea and other inner ear structures of a guinea pig model at 3T. Methods Transmit and receive RF coils, and an animal positioning system, were developed and integrated with an insertable gradient and animal monitoring system for improved guinea pig cochlea imaging when compared to a standard clinical 3T MRI system. A resolution phantom with 120 μm line separations was used to assess the contrast improvements with the insertable gradient. A homogeneous phantom was used to assess the SNR and homogeneity of the RF coils. FLASH imaging was used to observe the temporal passage of gadolinium contrast through the guinea pig cochlea. Results The insertable gradient enabled increased resolution imaging with nearly twice the contrast-to-noise ratio. The small animal array had better SNR for imaging the guinea pig cochlea (about 14 mm deep) than the commercial Siemens wrist coil (2.2×) and the small birdcage coil (1.6×). The positioning device kept the animal secure and stationary. Injected gadolinium contrast allowed visualization of the internal cochlear structures with FLASH image acquisition, which achieved 100 μm isotropic resolution images in 33 min. Conclusion The specialized RF coils and animal holding equipment designed to operate within the composite gradient enabled higher resolution images than could be obtained from the available RF coils operating in the conventional gradients on the clinical MRI system. © 2015 Wiley Periodicals, Inc. Concepts Magn Reson Part B (Magn Reson Engineering) 44B: 89–101, 2015

Within our own bodies our cells are constantly in a process of repair and disassemblage. It is this process of disassemblage which is the physical analog of psychological destructive ness. In some families, the primary interchanges are not aimed at encouraging constructive ness, and if the family is uncomfortable with this state of affairs they may seek professional help. If the counselor does nothing to relieve the anxiety engendered by their hostile interchanges, the family may view him as just one more discordant element in their unhappy system and leave him very quickly. They may take up the gauntlet with another counselor or they may go on to continue to engage in the process of feeding their energy into the perpetuation of a system which takes up so much of the family's energy that it permits the family to accomplish little else besides maintaining the status quo.