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In this paper, we describe a methodology for improving homeland security investment decisions. The objective is to evaluate multitechnology, multiyear investment choices and the associated development and deployment risks associated with new technologies. The budgeting process in the Homeland Security Department is a complex multicriteria decision problem involving a distributed network of decision makers with diverse areas of expertise. The decision problem in Homeland Security involves game-theoretic aspects as the terrorists are likely to alter their strategies depending on the defensive counter measures selected in the budget. We propose a two-phased systems approach. The first phase employs a visualization tool based on Quality Function Deployment to develop an initial budget allocation. The second phase involves an iterative approach to project selection that dynamically adjusts the investment portfolio based on anticipated reactions taken by the terrorists. This paper is based on a study done as part of a research project for the Department of Homeland Security (DHS). We present a high-level view of the methodology and illustrate it with examples. [ABSTRACT FROM AUTHOR]

Exocrine cancer of pancreas is the fourth leading cause of death in the USA among both men and women. Contrast enhanced multidetector-row computer tomography (MDCT) is the current modality of choice for the detection of distant metastasis in pancreatic cancer as a part of pre-operative workup, which helps decide on resectability. Authors present a first ever reported case of an incidental liver metastasis found on intra-operative wedge hepatic biopsy during Whipple's procedure for pancreatic cancer. This pancreatic cancer was initially thought to be resectable based on MDCT staging per guidelines. The case highlights the importance of diagnostic staging laparoscopy and neoadjuvant chemotherapy before resecting pancreatic adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: Pancreas transplant biopsy practices for the diagnosis of rejection or other pathologies are not well described., Methods: We conducted a survey of staff at US pancreas transplant programs (March 22, 2022, to August 22, 2022) to assess current program practices and perceptions about the utility and challenges in the performance and interpretation of pancreas allograft biopsies., Results: Respondents represented 65% (76/117) of active adult pancreas transplant programs, capturing 66% of recent pancreas transplant volume in the United States. Participants were most often nephrologists (52%), followed by surgeons (46%), and other staff (4%). Pancreas allograft biopsies were performed mostly by interventional radiologists (74%), followed by surgeons (11%), nephrologists (8%), and gastroenterologists (1%). Limitations in the radiologist's or biopsy performer's comfort level or expertise to safely perform a biopsy, or to obtain sufficient/adequate samples were the two most common challenges with pancreas transplant biopsies. Pancreas transplant biopsies were read by local pathologists at a majority (86%) of centers. Challenges reported with pancreas biopsy interpretation included poor reliability, lack of reporting of C4d staining, lack of reporting of rejection grading, and inconclusive interpretation of the biopsy. Staff at a third of responding programs (34%) stated that they rarely or never perform pancreas allograft biopsies and treat presumed rejection empirically., Conclusions: This national survey identified significant variation in clinical practices related to pancreas allograft biopsies and potential barriers to pancreas transplant utilization across the United States. Consideration of strategies to improve program experience with percutaneous pancreas biopsy and to support optimal management of pancreas allograft rejection informed by histology is warranted., Competing Interests: K.L.L. is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation and the National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK120551. The other authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

OBJECTIVE. The purpose of this article is to review the renal injury scale revised by the American Association for the Surgery of Trauma in 2018, to identify terms commonly used in discussions between radiologists and surgeons and to properly apply the new classification parameters to various MDCT findings. CONCLUSION. The updated 2018 kidney injury scale from the American Association for the Surgery of Trauma incorporates the delineations necessary for modern nonoperative management of renal trauma, including percutaneous and endourologic techniques, and discusses the imaging criteria for each injury grade.