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Background Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses’ burnout and selected objective quality metrics in long-term care wards in Japan. Methods This is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards—the equivalent of skilled nursing homes in Western countries— completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses’ burnout, and other confounders (e.g., ward size, participants’ years of experience, and patients’ conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators. Results Data from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = −.001, p-value = .019). Conclusions Staff nurses’ burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes—specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.

Purpose We evaluated the diagnostic performance of histogram analysis of data from a combination of dynamic susceptibility contrast (DSC)-MRI and dynamic contrast-enhanced (DCE)-MRI for quantitative differentiation between central nervous system lymphoma (CNSL) and high-grade glioma (HGG), with the aim of identifying useful perfusion parameters as objective radiological markers for differentiating between them. Methods Eight lesions with CNSLs and 15 with HGGs who underwent MRI examination, including DCE and DSC-MRI, were enrolled in our retrospective study. DSC-MRI provides a corrected cerebral blood volume (cCBV), and DCE-MRI provides a volume transfer coefficient (Ktrans) for transfer from plasma to the extravascular extracellular space. Ktrans and cCBV were measured from a round region-of-interest in the slice of maximum size on the contrast-enhanced lesion. The differences in t values between CNSL and HGG for determining the most appropriate percentile of Ktrans and cCBV were investigated. The differences in Ktrans, cCBV, and Ktrans/cCBV between CNSL and HGG were investigated using histogram analysis. Receiver operating characteristic (ROC) analysis of Ktrans, cCBV, and Ktrans/cCBV ratio was performed. Results The 30th percentile (C30) in Ktrans and 80th percentile (C80) in cCBV were the most appropriate percentiles for distinguishing between CNSL and HGG from the differences in t values. CNSL showed significantly lower C80 cCBV, significantly higher C30 Ktrans, and significantly higher C30 Ktrans/C80 cCBV than those of HGG. In ROC analysis, C30 Ktrans/C80 cCBV had the best discriminative value for differentiating between CNSL and HGG as compared to C30 Ktrans or C80 cCBV. Conclusion The combination of Ktrans by DCE-MRI and cCBV by DSC-MRI was found to reveal the characteristics of vascularity and permeability of a lesion more precisely than either Ktrans or cCBV alone. Histogram analysis of these vascular microenvironments enabled quantitative differentiation between CNSL and HGG.

To compare visualization using whole-heart coronary magnetic resonance angiography (CMRA) acquired during a single breath-hold (BH) with that using conventional respiratory-gated (RG) CMRA.The CMRAs of 14 healthy subjects under either BH or RG conditions were studied using a 1.5 T system equipped with a whole-body phased-array coil and 16-channel receivers. The BH examination was accelerated using parallel imaging (PI) by factors of 2.5 and 2 in the phase and section directions, respectively. For the RG examination, a PI factor of 2 was used only in the phase direction. The visualization quality of 15 coronary segments using each condition was evaluated with a five-point scale (0-4). Differences between two conditions were compared at segments with an average score greater than 2 in RG-CMRA.The average examination time for BH and RG acquisition scans was 34 s and 11 min 31 s, respectively. Ten segments (segments 1-3, 5-9, 11, and 13) had average scores higher than 2 in RG-CMRA. Of these, BH-CMRA had significantly lower scores than RG-CMRA at six segments (segments 1, 5-8, and 11) after correction for multiple comparisons (p0.005). However, in BH-CMRA, proximal segments (segments 1-2, 5-7, and 11) showed average scores over 2, indicating marginally acceptable image quality.Compared with the relatively limited degree of image degradation with RG-CMRA, the present data suggest that BH-CMRA would be useful for screening and as an adjunct to RG-CMRA that is occasionally incomplete.

Purpose To evaluate the capability of flow-sensitive black blood (FSBB) acquisition to visualize the lenticulostriate artery (LSA) in comparison with time-of-flight (TOF) angiography. Materials and methods Twenty-one healthy subjects (13 males and 8 females, 19-44 years old) were enrolled in this study after obtaining written informed consent. Magnetic resonance imaging (MRI) examinations were performed with FSBB and TOF to visualize the LSA using a 1.5T MRI unit. In FSBB acquisition a motion probing gradient of b = 4 sec/mm(2) was applied to dephase blood flow. Images were reconstructed into coronal sections and were evaluated in terms of number, length, and image quality at origins and distal areas of visualized LSA branches with a four-point scale. Results In all, 145 LSA branches were visualized with FSBB and 66 branches with TOF. There was no LSA visualized only with TOF. In all evaluated terms, FSBB was significantly better than TOF. Conclusion We could better visualize the LSA with FSBB than with TOF, both quantitatively and qualitatively. FSBB is a promising method, although it remains to be evaluated in clinical cases.

There have been no previous reports on contrast enhancement of the cochlear aqueduct in magnetic resonance imaging. The purpose of the present study was to evaluate the frequency and significance of this finding. Thirty-one patients (15 men and 16 women; age range 18-81 years) with otologic symptoms (sudden sensorineural hearing loss, vertigo, or tinnitus) were examined using contrast-enhanced imaging on a 1.5-T MR scanner. The normal ear served as the control. Two radiologists evaluated contrast enhancement in the area of the cochlear aqueduct. Forty-eight of 62 ears (77.4%) showed contrast enhancement of the cochlear aqueduct, but no significant differences in the frequency of contrast enhancement were observed between patients with and patients without vertigo, tinnitus, sensorineural hearing loss, cerebellopontine angle tumors, or a high-riding jugular bulb. In addition, no gender- or age-related differences were noted. Contrast enhancement of the cochlear aqueduct was frequently observed, but the frequency of enhancement in symptomatic ears was not significantly higher than in control ears. The results of this study may prove helpful in avoiding unnecessary examinations and potential diagnostic confusion.

Synaptic plasticity requires an activity-dependent, rapid, and long-lasting modification of synaptic character, including morphology and coupling strength. Here we show that a serine protease, neuropsin, directly and specifically modifies the synaptic adhesion molecule L1, which was localized to the presynaptic site of the asymmetric synapse in the mouse hippocampus. Increased neural activity triggered the rapid, transient activation of the precursor form of neuropsin in an NMDA receptor-dependent manner. The activated neuropsin immediately cleaved L1 and released a neuropsin-specific extracellular 180 kDa fragment. This neuropsin-specific L1-cleaving system is involved in NMDA receptor-dependent synaptic plasticity, such as the Schaffer collateral long-term potentiation.

Uterine decidualization is accompanied by the remodeling of the cell-matrix and cell-cell interactions around the endometrial stromal cells to allow an appropriate invasion of trophoblasts. This remodeling is thought to require the proteolysis of extracellular matrix proteins or cell adhesion molecules; however, the molecular mechanism remains poorly understood. In this study, decidualization induced the expression and activation of an extracellular serine protease neuropsin in the mouse uterus. Although nonpregnant uteri contained little neuropsin, the protein content and enzymatic activity increased markedly and peaked at the midgestational period in pregnant uteri. Neuropsin expression and activity was also upregulated in artificially induced deciduomata but not in nondecidualized pseudopregnant uteri. Neuropsin is the first extracellular protease to show the evident induction of expression and activity by decidualization and might contribute to the remodeling of extracellular components after decidualization.

Virtual endoscopy (VE) of the labyrinth was performed using three-dimensional (3D)-fast asymmetric spin-echo MR imaging. The spatial resolution requirements and the usefulness of zero-fill interpolation (ZIP) were evaluated, and VE was used to examine three patients. The (0.6-mm) voxel data with ZIP satisfies the minimum requirements for VE for evaluation of the complex 3D anatomy and pathology of the labyrinth. J. Magn. Reson. Imaging 2001;13:792–796. © 2001 Wiley-Liss, Inc.

Introduction WH MRCA [1] examinations are usually performed during free breathing, and the Realtime Motion Correction (RMC) coefficient is important for obtaining good image quality. However, this coefficient differs in each patient, which may result in image degradation. We have developed the Motion Pre-Analysis Method to determine the appropriate RMC coefficient before WH MRCA and have conducted feasibility studies to investigate the appropriate method for using an abdominal band.

Three dimensional (3D) whole-heart (WH) coronary MR angiography (CMRA) requires an extended imaging time, but it may be reduced by providing a subject with visual feedback (VFB). Thirteen healthy volunteers were scanned and quality of 3D WH-CMRA images was compared among three scan conditions: free breathing (FB) with and without VFB (FB + VFB and FB - VFB, respectively) and multiple breath-holds with VFB (MBH + VFB). All but two subjects were able to complete all scans. The average scan times were 10.0 +/- 2.2, 10.0 +/- 2.5, and 8.2 +/- 1.3 min for FB - VFB, FB + VFB, and MBH + VFB, respectively. In the MBH + VFB condition, scan time was significantly reduced by 18% compared with both FB scans. No significant difference in image quality was observed between the FB - VFB and MBH + VFB conditions, but scores were significantly deteriorated at some segments in the FB + VFB condition. The MBH + VFB scan can be performed with a shorter scan time without failure or impairment of image quality.

To evaluate visualization of the whole-heart coronary arteries accelerated with parallel imaging (PI) applied in two-dimension (2D) in comparison with one-dimension (1D).Seventeen healthy subjects were studied with a 1.5-T scanner equipped with a whole body phased array coil system and 16-channel receivers. Using 16 coil elements, whole-heart coronary magnetic resonance angiography (CMRA) was acquired in two conditions of 1D-PI and 2D-PI. The former scan was accelerated in phase direction by factor of 2 and the latter in phase and slice directions by factors of 2.5 and 2, respectively. Visualized length of right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) was measured. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) was also measured. The CMRA quality was assessed in segment-wise with a five-point scale.The average scan time decreased to 5.3+/-2.2 min in 2D-PI from 11.6+/-3.5 min in 1D-PI, reducing the scan time to 45%. The visualized length, SNR, and CNR in average were smaller for images of 2D-PI compared with those of 1D-PI, however, statistically significant results were observed only in RCA (P0.05). Score reduction of 2D-PI image quality was limited to 0.34 in average, and only two out of fifteen segments (#2, 6) showed significant score deterioration (P0.05).Compared with the relatively limited degree of image degradation, 2D-PI offered a large reduction of the acquisition time, which is of large benefit in clinical situations.

Uterine decidualization is accompanied by the remodeling of the cell-matrix and cell-cell interactions around the endometrial stromal cells to allow an appropriate invasion of trophoblasts. This remodeling is thought to require the proteolysis of extracellular matrix proteins or cell adhesion molecules; however, the molecular mechanism remains poorly understood. In this study, decidualization induced the expression and activation of an extracellular serine protease neuropsin in the mouse uterus. Although nonpregnant uteri contained little neuropsin, the protein content and enzymatic activity increased markedly and peaked at the midgestational period in pregnant uteri. Neuropsin expression and activity was also upregulated in artificially induced deciduomata but not in nondecidualized pseudopregnant uteri. Neuropsin is the first extracellular protease to show the evident induction of expression and activity by decidualization and might contribute to the remodeling of extracellular components after decidualization.

In the present study, we produced null-mutant mice of neuropsin, an extracellular matrix serine protease, to examine the neural functions of this protein particularly in the hippocampus. Golgi-Cox impregnation and Nissl-staining revealed morphological change of cell soma in the mutant mice compared to wild-type mice. However, Golgi-Cox impregnation revealed no apparent change in the dendritic arborization and spine density. Quantitative electronmicroscopic analysis revealed that number of asymmetrical synapses were significantly decreased in the stratum radiatum, the major terminal field of Schaffer-collaterals, whereas free boutons still holding synaptic vesicles but with no synaptic specialization were increased in number in the same microscopic fields. An increased number of parvalbumin-immunoreactive cells (known as fast spiking cells) in mutant was also observed. These results strongly suggest that neuropsin is involved in connectivity of a group of CA1 synapses and consequently in the hippocampal networking.

Whole-heart (WH) magnetic resonance coronary angiography (MRCA) studies are usually performed during free breathing while monitoring the position of the diaphragm with real-time motion correction. However, this results in a long scan time and the patient’s breathing pattern may change, causing the study to be aborted. Alternatively, WH MRCA can be performed with multiple breath-holds (mBH). However, one problem in the mBH method is that patients cannot hold their breath at the same position every time, leading to image degradation. We have developed a new WH MRCA imaging method that employs both the mBH method and automatic breathing-level tracking to permit automatic tracking of the changes in breathing or breath-hold levels. Evaluation of its effects on WH MRCA image quality showed that this method can provide high-quality images within a shorter scan time. This proposed method is expected to be very useful in clinical WH MRCA studies.

Introduction WH MRCA studies are usually performed during the stationary period of coronary arteries, which is determined using cine display and therefore depends on the operator's experience. Several automatic methods have been developed. One such method uses the global heart signal for analysis [1] and is suitable for detecting motion during all cardiac phases, but this method tends to suffer from noise. Another method employs a ROI for analysis [2] and is suitable for precise detection of the stationary period, but not for all cardiac phases. We have developed the Global-to-Local Tandem Method, in which the coronary stationary period is roughly analyzed by the global method and then precisely analyzed by the local method. We have also conducted clinical feasibility studies.