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Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available. We also discuss the use of spectral imaging in abdominal pathologies, emphasizing the strengths and pitfalls of the technique and its main applications in general and in specific organs.

Objectives To assess 3D T1-SPACE combined with 3D-TOF sequence for follow-up evaluation of stent-assisted coil embolization for intracranial aneurysm. Materials and methods Between Oct 2018 and May 2019, we enrolled 25 patients with intracranial aneurysm who underwent stent-assisted coil embolization. All patients were followed up for 6 to10 months after endovascular treatment (EVT) using 3D-TOF MRA, 3D T1-SPACE and DSA to evaluate aneurysm occlusion and parent artery patency. Results With regards to aneurysm occlusion, the specificity of 3D-TOF MRA was 86.9% (20/23) and the accuracy was 84% (21/25). There was no statistical significance (P ​= ​0.409) compared with the DSA. The parent artery by 3D-TOF MRA showed that there were 14 patients with grade 3, 8 patients with grade 2 and 3 patients with grade 1. However, 3D T1-SPACE showed that all 25 patients were grade 4, and were clearly displayed without metal artifacts. The comparison of the two MR techniques demonstrated that 3D T1-SPACE was superior to 3D-TOF MRA in the evaluation of parent artery (P Conclusions 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. This study also shows that 3D-TOF MRA has a merit to evaluate aneurysm occlusion. The combination of these two modalities can be used as an optional follow-up evaluation after EVT of intracranial aneurysms.

목적 : 이 연구는 인지훈련 기반의 언어치료 중요성을 알아보고자 한다. 특히, 치료종결 후에서 6개월 이후의 사후평가에서 인지치료와 언어치료를 병행한 집단과 언어치료만을 실시한 실어증 집단 내에서의 치료효과 정도를 알아보았다. 방법 : 연구 대상자는 22명의 비유창성 실어증 환자이며, 연령대는 50~60대이다. 두 그룹으로 구분하여 집단 A는 언어치료(PACE)만 실시되었고, 집단 B는 인지치료(Rehacom)와 언어치료(PACE)가 실시되었다. 언어능력 및 인지능력의 평가는 치료가 종결된 시점에서 6개월 이후에 사후평가를 실시하였다. 집단 내 사후평가와 치료종결 시점의 결과를 비교분석하기 위해 집단 내 대응표본 t -검정을 실시하였다. 사후평가의 언어능력과 인지기능과의 상관성을 알아보기 위해 피어슨상관계수를 구하였다. 결과 : 첫째, 인지치료와 언어치료를 병행한 집단 B에서 AQ점수와 LQ점수가 증가되었으며, 통계적으로 유의하였다. 하위 언어영역 평가결과에서도 동일한 결과가 나타났다. 반면 언어치료만 실시한 집단 A에서는 약간의 감소된 경향이 나타났으나 통계적으로 유의한 차이는 나타나지 않았다. 둘째, 인지평가 결과에서는 집단 B의 경우, 6개의 인지기능 중에서 5개 영역에서 통계적으로 유의미하게 향상되었다. 반면 집단 A의 경우 5개의 인지기능에서 수행력이 저조하였고, 4개 영역에서 통계적으로 유의미하였다. 셋째, 실어증 평가(AQ, LQ, 스스로말하기 영역, 청각적 이해력, 따라말하기, 이름대기) 점수와 인지기능평가의 하위 영역(시각적 연속수행력, 단어학습과 시각적 학습, 기호잇기 A와 B 평가) 간의 통계적으로 유의미한 상관성이 나타났다. 결론 : 이 연구결과는 인지기능 훈련을 병행한 의사소통 치료가 치료종결 이후 중재 효과가 비교적 잘 유지되고 있었음을 제시하고 있다. 연구결과의 타당성을 뒷받침하기 위해서는 체계적인 인지 기반 언어치료 프로그램을 개발하여, 실어증자의 언어능력 및 의사소통 기능의 회복력을 종단적으로 비교연구해야 할 것이다.

The National Institute of Environmental Health Sciences Worker Training Program piloted an Opioids and the Workplace: Prevention and Response training tool and program in 2019. The pilot trainees ( N = 97) were surveyed ( n = 27) and interviewed ( n = 6) six months posttraining, and those who downloaded the training tool from the Worker Training Program website ( n = 87) were surveyed ( n = 19) and interviewed ( n = 1) two to six months postdownload, to evaluate the impact of the training program. Workplace policy and program-level actions were reported less frequently than individual-level actions by trainees, except for planning and conducting training and education. Barriers to taking actions included not being able to make changes on their own without supervisor support and lack of upper management support and approval. We found some evidence that the Opioids in the Workplace training program and materials contributed to helping workers introduce policies and programs related to opioids within their workplace or union.

Background Acute Cerebral Nervous System Infections (ACNS) may cause death or severe complications even to promptly treated children. The role of the immune system in influencing the course and the outcome of meningitis has been studied but it is not yet completely understood. The aim of the research is to ascertain whether children who experienced ACNS infection had a normal immune system. Methods Patients under 18 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for meningitis were asked to participate to the follow-up study. The immune status was evaluated both clinically and by laboratory investigations. Results Most of the patients over 3 years at follow up had at least one immunological alteration at follow-up evaluation (74%). Considering ACNS infection etiology, certain pathogens were almost exclusive of patients affected by some immunological alteration, regardless of their age. Discussion Our preliminary results indicate that sub-clinical immunological defects may be associated to ACNS pediatric infections. Moreover, to the best of our knowledges, this is the first study correlating pathogens to immune evaluation in ACNS infections. It is, however, important to underline the high frequency of persistent immunological alterations in the analyzed patients. Further studies are needed to confirm our conclusions. Conclusions We recommend an immunological assessment at follow up evaluation in children who experienced an ACNS infection.

Coach education has been positioned as an important catalyst in enabling coaches to maximise the positive influence of high school sport on student-athlete development. The purpose of the study was to conduct a subsequent season follow-up evaluation, examining longer-term changes in coach-athlete relationship, coach interpersonal behaviours, and life skills teaching in coaches who completed the Coaching for Life Skills (CLS) online training program. A 2 × 2 prospective causal comparative design was used. Coaches ( n = 285) were asked to complete follow-up measures during the high school sport season that followed their completion of the trial. The response rate was 36.84%, with the final sample consisting of 64 participants. Data were analysed using independent sample t-tests. From baseline to subsequent season follow-up, scores for coach-athlete relationship and coach interpersonal behaviours significantly increased for the CLS group and significantly decreased for the comparison group. No significant differences in scores were found on life skills teaching from baseline to subsequent season follow-up. The results suggest that the intervention may have helped CLS group coaches remain consistent in their use of relational coaching behaviours.

Disability support workers (DSWs) are an occupational group identified as at high risk of exposure to psychosocial work hazards. This research reports on follow‐up findings from action research und...

Safe prescribing requires successful interprofessional working. One way to facilitate this is to develop interprofessional education across disciplines. This paper presents findings from a follow-up evaluation of an interprofessional workshop for prescribing safety to assess the perceptions and attitudes toward working interprofessionally in non-medical prescribers and MPharm students. The objectives were to further validate an internal workshop questionnaire and the use of the of a scale to assess the readiness for interprofessional learning. An interprofessional workshop, centered around the issue of prescriptions and determinants of competence and safety, was attended by 126 non-medical prescribers and MPharm students. The workshop was evaluated using the Readiness for Interprofessional Learning questionnaire and an internally-produced evaluation, The workshop was evaluated using the Readiness for Interprofessional Learning questionnaire and an internally-produced evaluation. As part of this process, internal consistency of the internally-produced evaluation was verified.. The workshop was rated highly by all participants with overall positivity toward working interprofessionally. There was no evidence that non-medical prescribers and students rated the workshop significantly differently, but MPharm students scored slightly higher than non-medical prescribers on one domain of the internally-produced instrument. All domains of this instrument demonstrated good internal consistency. The workshop overall was received well and appears to meet the standards set out by The Centre for the Advancement of Interprofessional Education. While reliability measures of the internally produced instrument are promising, further work is needed to develop internal validity; and to determine whether any adaptations to the Readiness for Interprofessional Learning Scale are needed for subsequent use with different groups of participants.

Background We sought first to determine the efficacy of lateral ankle fixation alone in maintenance of medial clear space and talar valgus in bimalleolar equivalent ankle fractures not receiving primary deltoid repair, and second to assess perceived outcomes via the Foot and Ankle Outcome Score. To our knowledge, no study has quantified the reduction of medial clear space and talar valgus in bimalleolar equivalent ankle fractures receiving lateral ankle fixation alone. Methods We compared preoperative, initial postoperative, and greater than 1-year follow-up radiographs of medial clear space and talar valgus in individuals who received lateral ankle fixation alone in bimalleolar equivalent ankle fractures. Subjective outcomes were measured via the Foot and Ankle Outcome Score. Results Thirty-seven patients participated in the study and showed a statistically significant reduction of medial clear space and restoration of talar position, and maintenance with this fixation method during follow-up in patients with bimalleolar equivalent ankle fractures. Adjunctively, patients perceived their outcomes to be satisfactory, as demonstrated by the results of the Foot and Ankle Outcome Score. Conclusions We aimed to assess the efficacy of lateral ankle fixation in the maintenance of medial clear space and talar valgus reduction at midterm follow-up. Although some authors contend that primary deltoid repair in bimalleolar equivalent ankle fractures is warranted, these midterm study results suggest that isolated lateral ankle fixation is adequate for medial ankle stabilization in bimalleolar equivalent fractures, and thus primary deltoid repair is not indicated.

Medical treatment with antibiotic therapy remains the mainstay of treatment for pyogenic spondylodiscitis (PS). Nevertheless, orthopaedic treatment is also very important in relieving pain, preventing neurological damage, and avoiding development of spinal deformities (e.g., scoliosis, kyphosis) due to spinal instability. Rigid thoracolumbosacral orthosis (TLSO) bracing is often needed in patients with PS, and average duration of treatment of 3 to 4 months. However, TLSO bracing can be poorly tolerated and limit ability of the patient to go back to a normal life. In 2004 our group developed an alternative surgical treatment to TLSO bracing by percutaneous posterior screw-rod bridge instrumentation of the infected level. This treatment allows early and free mobilization of the patients and is associated with faster recovery, lower pain scores and improved quality of life as previously reported. Herein, we report the clinical outcome of the first 3 patients who have completed the 10 years follow-up mark after the procedure. A case report is also described and details of the procedure are provided.

Research findings suggest that teachers’ education and training is a key factor in improving the preschool quality. Teachers’ qualifications can lead to high-quality preschool education and positive developmental outcomes for the children. This study examines the effectiveness of the teachers’ professional development program “Upgrading the Quality of the Preschool Environment” on improving the quality of the Kindergartens. The research followed a quasi-experimental design and included 26 kindergarten teachers from 23 public Greek kindergartens, who were divided into an Experimental and a Control Group. The quality of the kindergartens was initially assessed using the ECERS-R scale and a five-month professional development program, based on this initial evaluation and on collaborative practices, was designed and implemented to the Experimental Group. Our results show that although the mean scores of quality before the implementation of the program did not differ significantly (t = 6.45, p =.52), the mean scores, for the Experimental Group (M = 4.71, SD = .62) were significantly higher after the intervention (t = 4.30, p Article visualizations

OBJECTIVES We examined the effect of fluoridation cessation on children's dental caries experience in the Canadian cities of Calgary (cessation in 2011) and Edmonton (still fluoridated). METHODS We used a pre-post cross-sectional design with comparison group. We studied Grade 2 schoolchildren (approximately 7 years old) 7-8 years after fluoridation cessation in Calgary, thus capturing children born after cessation occurred. Data collection included a dental examination conducted in school by calibrated dental hygienists, a questionnaire completed by parents, and fingernail clippings for a small subsample. Our overall analytic approach was twofold. We first examined differences in dental caries experience (deft and DMFT, and smooth surface caries based on defs and DMFS) between Calgary and Edmonton and over time (comparing 2018/2019 data to pre-cessation and early post-cessation surveys in our setting). Second, we evaluated whether differences were likely to reflect fluoridation cessation in Calgary, rather than other factors. RESULTS The prevalence of caries in the primary dentition was significantly higher (P

We aimed to evaluate the alteration of diagnosis of individual expert and multidisciplinary discussion (MDD) team in the longitudinal diagnostic assessment of idiopathic interstitial pneumonia (IIP). The retrospective analysis included 56 patients diagnosed as IIP by The First Affiliated Hospital of Guangzhou Medical University with follow-up visits during Jan 1st to Aug 31st 2014. Each expert was provided information in a sequential manner and was asked to assign an individual diagnosis and an MDD diagnosis after group discussion. The level of agreement among individual experts and between different visits was calculated by kappa and the agreement between individual specialist and MDD team with different consensus levels was measured by weighted-kappa coefficients. Follow-up data changed the original clinical diagnosis and MDD diagnosis in 24.1% and 10.7% of all cases, respectively, and clinician and MDD consensus level in 55.4% and 25.0%, respectively. The diagnostic performance of individual clinicians or radiologist was closer to that of the MDD compared with the pathologist, and follow-up further increased the agreement. The longitudinal evaluation of patients with IIP improved the inter-observer agreement in a multidisciplinary team. The performance of individual clinicians or radiologist was approaching the accuracy of multidisciplinary team when provided with follow-up data.

BACKGROUND Since 2013, pediatric oncologists from Central and South America discuss neuro-oncology cases with experts from North America and Europe in a web-based "Latin American Tumor Board" (LATB). Here, we evaluate the feasibility of recommendations rendered by the Board. METHODS An electronic questionnaire was distributed to physicians who had received recommendations between October 2017 and October 2018. Physicians were asked regarding the feasibility of each recommendation given during the LATB discussion. Baseline case characteristics of all presented cases were obtained from anonymized minutes. RESULTS Of the 142 patients discussed, data on 103 patients from 15 countries were available, corresponding to 283 recommendations. Physicians followed 60% of diagnostic procedural recommendations and 69% of therapeutic recommendations. The most difficult recommendations to follow were genetic and molecular testing, pathology review, chemotherapy, surgery, and molecular targeted therapies. Histological diagnoses changed in eight of 18 cases in which a pathology review was undertaken. Fifty-four percent of the recommendations that could not be implemented were considered not feasible in the specific context of the patient, while 31% were not implemented due to a decision of the medical staff or the parents (15% not specified). However, 96% of respondents considered the recommendations useful. CONCLUSION Recommendations were frequently perceived as useful, and were applicable in the participating institutions. Nevertheless, limitations in availability of diagnostic procedures and treatment modalities affected the feasibility of some recommendations. Tele-oncology tumor boards offer physicians from low- and middle-income countries access to real-time, high-level subspecialist expertise and provide a valuable platform for worldwide information exchange.

Objective To approach the clinical value of MRI with vessel wall imaging (VWI) in patients with central nervous system vasculitis (CNSV), we analyzed patterns of VWI findings both at the time of initial presentation and during follow-up. Methods Stenoocclusive lesions, vessel-wall contrast enhancement (VW-CE) and diffusion-restricted lesions were analyzed in patients with a diagnosis of CNSV. On available VWI follow-up, progression, regression or stability of VW-CE were evaluated and correlated with the clinical status. Results Of the 45 patients included, 28 exhibited stenoses visible on MR angiography (MRA-positive) while 17 had no stenosis (MRA-negative). VW-CE was found in 2/17 MRA-negative and all MRA-positive patients (p p p Conclusion Concentric VW-CE is a common finding in medium/large-sized vessel CNSV. VW-CE might represent active inflammation in certain situations. However, follow-up VWI findings proved ambiguous as persisting VW-CE despite immunosuppressive therapy and clinical remission was a frequent finding.

The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value

Introduction: The surgical treatment of Rotator cuff repair ranges from open to arthroscopic assisted mini open repair to full arthroscopic repair. The anterior approach or lateral deltoid approach has its advantages and disadvantages depending upon the site and the extent of the rotator cuff tear. Aim and objective: To assess the functional outcome of mini-open anterolateral approach for degenerative rotator cuff tear by trans-osseous sutures in elderly in terms of pain and range of movements. Methodology: The present study was prospective observational study conducted on Patients with degenerative rotator cuff tears presenting at Department of Orthopaedics. Patients underwent mini-open anterolateral approach for degenerative rotator cuff tear by trans-osseous sutures. Follow-up of patients was done immediate after suture removal, at six weeks, at twelve weeks, twenty-four weeks following the surgery. Pre-op and Final follow up evaluation was done for each patient using VAS scale and range of movement. Shoulder index using ASES scores were noted. Results and discussion: Majority of the patients (52%) were males and (48%) were females. 44% cases were between 61 to 70 years of age. In our study in follow up at 6,12, 24 weeks, range of motion was found to be increasing during subsequent follow ups. (p

Telehealth systems have shown success in the remote management of several neurological disorders, but there is a paucity of evidence in disorders of consciousness (DOC). In this study, we explore the effectiveness of a new telemonitoring system, for monitoring Vegetative State (VS) and Minimally Conscious State (MCS) patients. This was a prospective, mono-center randomized controlled study. We included only traumatic brain injury (TBI) patients who required long-term motor/cognitive assistance having a stable clinical condition. We examined their clinical evolution over ~4 years of the follow-up period. Twenty-two TBI patients were enrolled and equally divided into two groups: one telemonitored at home with our service and the second admitted to a standard long-stay hospitalization (LSH) program. Patients enrolled in the telehealth service (age: 49.9 ± 20.4; 45% female; diagnosis: 36% VS/64% MCS) were demographically and clinically-matched with those admitted to the LSH program (age: 55.1 ± 15; 18% female; diagnosis: 54% VS/46% MCS). Thirty-six percent of patients in the LSH program died before completing follow up evaluation with respect to 18% of death in the group of TBI patients telemonitored at home. At follow-up, patients in LSH and telemonitoring groups showed similar clinical progression, as measured by CRS-r, NCS, WHIM, and LCF scales, as well as by the number of medical complications (i.e., bedsores, infections). Finally, we estimated the total daily cost per patient. Severe TBI patients enrolled in the conventional LSH program cost 262€ every single day, whereas the cost per patient in the telehealth service resulted to be less expensive (93€). Here, we highlight that our telehealth monitoring service is as efficacious as in-person usual care to manage a severe neurological disorder such as TBI in a cost-effective way.

Purpose or Objective To limit hospital visits and transportation of the patients with early breast cancer (BC) especially during the covid-19 pandemic, we aimed to implement a workflow of treatment to prepare and deliver adjuvant breast radiotherapy (RT) within 1 week. Materials and Methods Based on the Fast Forward RT schedule of 5 fractions of 5.2 Gy over 5 days for adjuvant BC, we designed a workflow to perform BC RT over 1 week from the first RT consultation to the end of treatment (figure 1). Patients were seen in consultation on Monday morning. The planning CT was carried out immediately after the consultation. A deep inspiration breath-hold technique was systematically offered to all patients. Automatic delineation using an artificial Intelligence (AI) based model with ART-PlanTM software was first corrected by a junior radiation oncologist (RO) then, independently by a senior RO. As 3D conformal RT failed to achieve dose constraints of the fast forward trial in many cases (due to breast hotspots), we developed a restricted IMRT (rIMRT) technique based on 2 tangential beams (internal and external) using inverse planning restricted optimization parameters to improve the dose homogeneity. Treatment planning was semi-automated by scripting the creation and optimization steps of rIMRT plans. After validation of the reliability of rIMRT treatment delivery by patient-specific quality assurance (PSQA) with gamma index evaluation on 20 patients, we decided to abandon systematic PSQAs. In-vivo dosimetry was validated by end-to-end controls and performed for each patient during the first fraction on Monday afternoon. Daily repositioning was controlled by portal images of the largest segment of each beam. Structured baseline, end of treatment and follow up evaluation forms were used to prospectively collect toxicities and oncological outcomes at each consultation. Patient agreement for data collection and analysis was prospectively obtained. $Φg Results From February 2021 to March 2021, the 1-week breast procedure was proposed to up to 3 patients/week, >65 years, in complete resection after conservative surgery, with pT1-T3 N0 BC, without tumor bed boost or regional lymph nodes irradiation. Six out of seven patients (85.7%) accepted the 1-week breast procedure. All procedures were successfully conducted over 5 days with complete patient and RT team satisfaction. A followup of acute toxicities by online consultation on day 10, structured evaluation forms and management decision trees has been implemented for these patients. No grade >2 acute toxicities (CTACE V4.0) have been reported so far. Conclusion The successful implementation of this comprehensive 1-week breast workflow with AI based delineation and semi-automated rIMRT without PSQA demonstrates the practical feasibility of the whole procedure over 5 days reducing drastically the coming-and-going to the hospital and the overall RT management time per patient. Our work opens the way for further development of comprehensive compact workflows in various settings.

Introduction In May 2017, a service evaluation of the management of primary biliary cholangitis in Aneurin Bevan University Health Board was performed. The evaluation identified three groups of patients: 1) non-responders to optimal ursodeoxycholic acid (UDCA), 2) patients on sub-optimal UDCA ( Methods Of 112 patients evaluated in 2017, 30 were identified for review of their management. 11, 15, and 4 patients were in groups 1, 2, and 3 respectively. Clinical letters, weight, medications, and liver biochemistry results of these 30 patients were reviewed again in January 2020. Treatment response to UDCA was assessed using the Toronto criteria (ALP of >1.67 the upper limit of normal). Optimal UDCA therapy was considered to be ≥15 mg/kg based on most recent patient weight available. Results UDCA-non-responders (n=11) 3 did not have information available since 2017; 1 since deceased and 2 did not attend follow-up. Of the 8 reviewed 5 now have an ALP Sub-optimal UDCA patients (n=15) 2 did not have information available since 2017, both deceased. Of the 13 reviewed, 8 had an ALP Patients intolerant to UDCA (n=4) 2 patients have since died, and 1 was discharged due to old age and frailty. 1 patient would be eligible for OCA if pruritus resolves. Discussion Of the 22 patients that were reviewed, 13 now have an ALP

Introduction: Telemedicine allows health care professionals to diagnose and treat patients remotely. Enuresis is one of the most common chronic problems in childhood and specialized care can be lim...

Object: Follow-up evaluation of intracranial aneurysms treated by flow-diverting stents using MRI is challenging due to the presence of imaging artifacts. This study evaluated 3D T1-SPACE in combination with 3D-TOF sequence for follow-up evaluation of intracranial aneurysms treated with Pipeline embolization devices.Methods: Forty patients with 53 intracranial aneurysms who were treated with Pipeline Embolization Devices from October 2018 to July 2019 were enrolled in this study. All patients were evaluated for aneurysm occlusion and stent patency 4 to 7 months post-treatment using 3D T1-SPACE sequence, 3D-TOF MRA, and DSA examinations.Results: With regards to aneurysm occlusion, the intermodality (DSA and 3D-TOF MRA) agreement was good (κ = 0.755). The specificity of 3D-TOF MRA was 94.4% (34/36), the sensitivity was 76.5% (13/17), the total coincidence rate was 88.7% (47/53). With regards to the patency of the stented arteries after PED treatment, 3D T1-SPACE sequence was more accurate compared to 3D-TOF MRA (Z = −6.283, P < 0.001), with a no-artifact rate of 95.7% (44/46).Conclusions: 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. 3D-TOF MRA may be valuable in the evaluation of aneurysm occlusion. The combination of these two modalities may be used for long-term follow-up of intracranial aneurysms treated with Pipeline Embolization Devices.

Obesity in youth is associated with increased risk of metabolic disorders. Adipose tissue hormones are involved in body-weight regulation. Among these, apelin is recognized as an insulin-sensitizer adipokine. Data on apelin levels in obese children and its relation to insulin-sensitivity are limited.We aimed to evaluate apelin levels in relation to obesity and insulin sensitivity in a large cohort of overweight/obese children and adolescents. Furthermore, these youths were reevaluated after a median 6.5 years of follow-up, thus allowing assessing changes in apelin levels in relation to increasing age and weight changes.Clinical data in 909 children and adolescents were collected between 2007 and 2010. Two hundred and one were reexamined at a median 6.5 years of follow-up. All subjects at baseline and at follow-up underwent an OGTT. Apelin levels were measured on sera by ELISA method.At baseline, lower apelin levels were associated with increasing age and puberty (Tanner ≥II 0.67 ± 0.96 ng/mL vs. Tanner I 0.89 ± 1.13 ng/mL,Apelin levels decrease significantly with pubertal development, whilst body-weight in children and adolescents did not determine changes in apelin. Reduced levels of apelin in children and adolescents may therefore represent a necessary response to maintain the "physiological" insulin resistance of puberty.

Background Pulmonary arterial hypertension (PAH) is a severe disease that progressively leads to right ventricular (RV) failure and cardiovascular death. Evaluation of right heart mechanics by means of 2-dimensional speckle tracking echocardiography (2D-STE) has displayed to be a promising tool to estimate prognosis in PAH patients. Purpose To evaluate the association between right ventricular free wall longitudinal strain (RVFWLS) and right peak atrial longitudinal strain (RPALS) at follow-up after initiation of specific vasodilator therapy in PAH patients, with outcomes. Methods 83 subjects diagnosed with PAH Group 1 at three University Hospitals (Hammersmith Hospital, London, United Kingdom; Trieste University Hospital, Trieste, Italy; FTGM, Pisa, Italy), who were naive from specific treatment for PAH at the time of diagnosis, were retrospectively enrolled in this study. Standard echocardiographic parameters were collected. Outcomes were defined as the combination of all-cause mortality, hospitalization for PAH and first prostanoid administration. We investigated the correlation between RVFWLS and RPALS with outcomes adjusting for validated echocardiographic parameters strongly associated with prognosis in PAH (right atrial area – RAA and pericardial effusion – PE) and patients’ haemodynamics. Results 30 patients experienced outcomes during a median follow-up time of 33 months. Median RVFWLS at follow-up was -15.8% (IQR: -12.1%/- 21.1%). Median RPALS at follow-up was 25% (IQR: 17.9%/36.6%). In the multivariate analysis, RVFLWS at follow-up was independently associated with outcomes (95% confidence interval [CI]: 1.01 – 1.24, p = 0.04), irrespectively from RAA (95% CI: 0.98 – 1.20, p = 0.12) and pulmonary arterial systolic pressure (PASP, 95% CI: 0.99 – 1.06, p = 0.12). We also observed a trend towards superiority of RPALS at follow-up (95% CI 0.90 – 1.00, p = 0.07) over RAA (95% CI: 0.98 – 1.20, p = 0.14) and PASP (95% CI: 0.99 - 1.05, p= 0.31). Finally, RPALS (95% CI: 0.88 – 1.00, p = 0.05) was independently associated with outcomes over PE (95% CI: 0.14 – 1.89, p = 0.32) and RVFWLS (95% CI: 0.97 – 1.20, p = 0.16). Conclusions In PAH group 1, assessment of both RVFWLS and RPALS at follow-up is associated with outcomes, independently from standard echocardiographic parameters.

This paper reports the findings on the implementation of compulsory food safety standard General Hygienic Regulation for Food Production (GB14881) in China. 18 of regulatory agencies (17.1%), 11 of research institutions (10.5%) and 76 of food enterprises (72.4%) were involved in this study. Overall, food enterprises had a higher awareness rate of GB14881 and there was an high level of satisfaction among the local regulatory agencies、research institutions and food enterprises. The results indicated that the major difficulty encountered during GB 14881 implementation was lack of finance. The most important motivation for implementing GB14881 was to comply with regulatory requirement. Structural changes to plant, investment in new equipment and product investigation/analysis were the biggest cost. The most important identified benefit was regulatory approval. The comprehensive data obtained from the implementation of compulsory food safety standards in China would be valuable consultation for substantial improvement to the policy makers on the standards.

To investigate F-wave as a method to identify a specific root lesion of L5 or S1 and to quantitatively evaluate the severity and progression of motor root lesions in lumbosacral radiculopathies (LR). Both peroneal and tibial F-waves were performed bilaterally in 142 patients with unilateral L5 or S1 radiculopathies and 37 controls along with Medical Research Council (MRC) evaluation, and soleus H-reflexes were tested bilaterally in 78 of these 142 cases. Both F-wave and MRC were re-evaluated approximately 1 year after initial examination in 65 patients. Abnormal peroneal F-waves were found in 34 patients with L5 radiculopathy (34/67, 50.7%) along with normal tibial F-waves and soleus H-reflexes in all tested cases. By contrast, 27 patients with S1 radiculopathy presented abnormal tibial F-waves (27/76, 36.0%) along with normal peroneal F-waves in all 76 cases and abnormal soleus H-reflexes in 38 of 47 (80.9%) cases. There were significant differences in involved side F-duration among different MRC scales in both radiculopathy groups (P

Introduction. To evaluate the quantification of corneal sub-basal whorl-like nerve plexus parameters as a sensitive and static marker in early diagnosis of small fiber neuropathy (SFN) and monitor disease progression in familial amyloid polyneuropathy (FAP) patients. Methods. Fifteen FAP patients and fifteen healthy controls underwent neurological evaluation (including clinical scales and electrophysiological tests) and corneal nerve observation. Corneal nerve fiber density (CNFD), Corneal nerve fiber branch density (CNBD), Corneal nerve fiber length (CNFL) were detected in the central cornea (conventional method) and the whorl-like inferocentral cornea (new method). The Langerhans cells (LC) density in each image was calculated. Results. Corneal parameters were significantly reduced with disease progression. Only inferior whorl length (IWL) was significantly reduced in preclinical patients (with normal SSR and CHEPs results) comparing with age matched controls. IWL, CNFL, CNBD and CNFD were significantly lower in early phase patients. LC density was significantly increased around the central whorl in early phase patients than in healthy controls (p = 0.009), and was lower in the progressive patients. Both IWL and CNFL correlated with severity of neuropathy. IWL was more significantly reduced with the progression of disease than CNFL. The area under the ROC curve to distinguish FAP with CNFL and IWL was 88.0% and 89.3%, respectively, exceeding other parameters. The coefficient of variation of the IWL value was significantly (P Conclusion. The observation of corneal sub-basal whorl-like nerve plexus can detect SFN in preclinical FAP patients earlier than traditional electrophysiological methods. IWL is the most sensitive and reliable parameters and it can best discriminate FAP patients from controls. The clustering of immature LCs at the whorl area might reflect the inflammatory response of small- fiber nerves at the very early stage.

Objective: There is no detailed information available about trend in the morphological change after conservative medical treatment in patients with symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods: We enrolled 27 consecutive patients with symptomatic SISMAD who underwent conservative medical treatment between 2006 and 2015. The long-term prognosis, natural history, and serial follow-up computed tomography (CT) findings of risk factors of rupture such as arterial diameter and false lumen enhancement were retrospectively assessed. Results: Spontaneous isolated superior mesenteric artery dissection usually developed in middle-aged men around 50 years old who had a history of smoking. Follow-up CT was performed at 1 to 6 months, 7 to 12 months, and after 12 months. Superior mesenteric artery (SMA) maximum diameter was 10.3 mm (quartile 9.5-11.3) on initial CT and expanded in 47.1% patients during 1- to 6-month follow-up, which decreased over time ( P < .001 at 7- to 12-month follow-up, P = .001 after 12-month follow-up). On the other hand, false lumen enhancements were revealed in 9 (33.3%) patients on initial CT. The size of false lumen enhancement was expanded in the longest diameter in 35.3% patients and in shortest diameter in 29.4% during 1- to 6-month follow-up. However, the size of false lumen decreased in all patients after 12-month follow-up. All patients were alive without arterial aneurysm rupture and hospital readmission during the median of 523 days (170-799) study period. Conclusion: We demonstrated that both SMA maximum diameter and false lumen enhancement were transiently expanded in some patients during 6-month follow-up, but no longer expanded after 12-month follow-up. Patients with symptomatic SISMAD could be treated medically with scheduled careful follow-up CT evaluations.

Background Despite the devastating impact of alcohol and other drug involvement and misuse within society, medical students still receive very limited exposure to these issues. The Scaife Advanced Medical Student Fellowship in Alcohol and Other Drug Dependency, offered by the Institute for Research, Education and Training in Addictions for over 10 years, offers a unique, 3-week intensive educational experience, including didactic, observation, and experiential learning in these topics to first-year medical students. The goal of this project was to evaluate the impact of the Scaife Fellowship on medical students’ attitudes toward patients with alcohol and other drug involvement 1 to 5 years after completion of the experience. Methods Past Scaife students and individuals who applied but did not attend were located and recruited to participate in an online attitude survey. Results Results indicated that Scaife Fellowship students largely retain their sense of role security around working with patients with alcohol and other drug involvement at the follow-up time point. Although therapeutic commitment or the motivation to work with these patients decreased for drug use, the decrease was smaller than that typically noted in the literature. The group of comparison students showed lower scores on both subscales at the evaluation time point compared with Scaife students. Conclusions A three-week experiential program significantly improved medical students’ Role Security and Therapeutic Commitment toward working with patients with substance use disorders. Moreover, the positive effects gained from the program were sustained over time.

Objectives To evaluate the clinical and functional results of closed fixation of humeral diaphysial fractures using Ender nails. Material and methods This was an observational study conducted between January 2008 and September 2014 in which 46 cases of humeral diaphyseal fractures were treated by closed reduction and percutaneous fixation with Enders nails. Clinical follow up evaluation was done and Serial radiographs were taken to look for the time taken for the fracture union and the fracture alignment, positioning and migration of the nails if any. Results Average blood loss during the surgery was 30 ml while average radiation exposure time was 1 min. Fracture united in mean 12.8 weeks (range 12-28 weeks). Primary union was achieved in 40 cases, whereas 6 had delayed union at 24 weeks for which autogenous bone grafting was done. Proximal migration of nails occurred in 6 cases and 3 cases had superficial stitch infection. Full range of shoulder and elbow movement was achieved in 40 cases within 24 weeks. In rest of the cases, there was limitation of abduction (average 75°, Range 65° to 85°). Conclusion Ender nailing for fracture shaft of humerus is a cost effective, time saving, minimally invasive technique with minimal blood loss. It has many benefits, with good results attainable and comparable with those seen with conservative modalities and other surgical modalities making it a viable option.

Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital-based to psychodynamically- and cognitively-oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high-intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4-year period in 3 groups of patients with personality disorders (N = 162) treated in a specialist community-based (CBP, N = 30), a step-down (RT-CBP, N = 87), and a specialist residential programme (RT, N = 45) in psychiatric distress, deliberate self-injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early-dropout were significantly different (p = .0001) for the 3 programmes (CBP = 13.4%, RT-CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress (p = .001), with CBP and RT-CBP achieving more marked changes (g = 1.20 and g = 0.68, respectively) compared to RT (g = 0.30) at 48-month follow-up. CBP and RT-CBP were found to significantly reduce impulsive behaviour (deliberate self-injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long-term RT showed no advantage over long-term CBP, either as stand-alone or as step-down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results.

BACKGROUND Since 2013, pediatric oncologists from Latin America have discussed neuro-oncology cases with experts from North America and Europe in a web-based “Latin American Tumor Board” (LATB). This descriptive study evaluates the feasibility of the recommendations rendered during the Board. METHODS An electronic questionnaire was distributed to physicians who received recommendations between October 2017 and October 2018, two months after their case presentation on the LATB. Physicians were asked regarding the feasibility of each recommendation given during the Board. Baseline case characteristics of all presented cases were obtained from anonymized minutes prepared after the presentations. RESULTS 36 physicians from 15 countries answered 103 of 142 questionnaires (72.5%), containing 283 recommendations. Physicians followed 60% of diagnostic procedural recommendations and 70% of therapeutic recommendations. Overall, 96% of respondents considered the recommendations applicable and useful. The most difficult recommendations to follow were genetic and molecular testing, pathology review, locally adapted chemotherapy protocols administration, neurosurgical interventions and access to molecular targeted therapies. The most cited reasons for not implementing the recommendations were lack of resources, inapplicable recommendations to that low-to-middle income country (LMIC) setting, and lack of parental consent. CONCLUSION The recommendations given on the LATB are frequently applicable and helpful for physicians in LMIC. Nevertheless, limitations in availability of both diagnostic procedures and treatment modalities affected the feasibility of some recommendations. Virtual tumor boards offer physicians from LMIC access to real time, high-level subspecialist expertise and provide a valuable platform for information exchange among physicians worldwide.

The COVID-19 pandemic has brought rapid changes to the way care must be delivered to keep patients and providers safe while simultaneously managing limited resources. Multiple fields have used telemedicine to continue care while maintaining social distancing and quarantine practices in the pandemic. Presented in this paper is a review describing the application of telemedicine in caring for surgical patients, and methods for potential implications of telehealthcare for surgical patients during the COVID-19 pandemic. A review of the PubMed Central and Medline provides articles examining the role of telemedicine for preoperative, postoperative, and follow up evaluation of surgical patients encompassing the past two decades. Additionally, articles examining the financial and legal considerations of telemedicine, and the effect COVID-19 has had on the current legislature were included. We report the summarized findings of these studies, the financial and HIPAA considerations of using telemedicine, potential benefits, pitfalls and strategies for the utilization of telemedicine into the clinical practice of general surgery and its subspecialties during the COVID-19 pandemic., Highlights • Telehealth has become a medical necessity during the COVID-19 pandemic. • Surgeons must integrate this new technology into surgical practice. • Effective for detecting post-operative complications and preoperative counseling.

To assess the impact of a brief training for obstetricians and midwives about screening for domestic violence during pregnancy follow-up and to identify barriers to a routine enquiry. A monocentric quasi-experimental study was performed in an obstetrics department in Paris, France. We asked patients during their pregnancy follow-up to complete a survey describing their demographic characteristics. They were also asked if a health professional had screened them for domestic violence during the current pregnancy. Exclusion criteria were refusal and inability to complete the survey alone. Health professionals attended a brief training about domestic violence. The intervention provided general information about domestic violence to alert health professionals (prevalence, risk factors, consequences on women’s health, pregnancy, and children) and guidelines on screening and how to deal with women disclosing domestic violence. They also had to complete a survey about their knowledge and practice concerning domestic violence. Two months later, patients consulting for their pregnancy follow-up completed the same survey. Health professionals were not aware of the study’s aim throughout its course. The primary outcome was the rate of patients screened for domestic violence during pregnancy follow-up. The secondary outcome was the identification of barriers to a routine enquiry. Four hundred ninety-five patients completed the first survey (control group): 21 patients (4.8%) had been screened for domestic violence. Twenty-one health professionals attended the intervention. Eight (38.1%) stated that they never screened for domestic violence, and 3 (14.3%) stated that they always did. Three hundred ninety-five patients completed the second survey (experimental group): 17 patients (4.3% vs 4.8%, p = 0.53) stated that they had been screened for domestic violence. The main barriers to screening mentioned by health professionals were the presence of the partner, the lack of awareness of the need to screen, uncomfortable feelings, and the difficulty to identify victims. There was no increased screening for domestic violence during pregnancy follow-up after a brief training of obstetricians and midwives. An early training during medical studies or more extensive training for professionals could be more efficient.

This study was conducted to investigate one-piece narrow-diameter implants installed in maxillary lateral and mandibular incisor sites using immediate nonfunctional loading.In this 10-year clinical trial study, 42 narrow-diameter (3.0-mm) one-piece implants for 35 patients were inserted. Clinical and radiographic measurements were recorded in 10 years and analyzed statistically using t test.A total of 26 patients (20 females and 6 males) with 30 implants were available for the 10-year follow-up. The 10-year implant survival rate was 100%. A statistically significant mean marginal bone loss was observed between 12 months and 10 years (0.18 ± 0.29 mm). The mean pocket depth increase was statistically significant (0.68 ± 0.83 mm). No bleeding on probing was observed around 90% of the implants. Full-mouth plaque index was registered at 20% of the implants.The results obtained in this analysis suggest that modest marginal bone loss was observed around the implants. One-piece narrow-diameter implants (Maximus 3.0; BioHorizons) can predictably restore missing maxillary lateral incisors and mandibular incisors in cases of careful patient selection.

Circulating tumor cells (CTCs) reportedly have been detected in the peripheral blood of more than 50% of breast carcinoma cases with distant metastases. Moreover, the survival period is shorter for patients who had more than five CTCs after a single chemotherapy treatment. However, a few data show the relationships between CTCs and expressions of disseminated tumor cells in the bone marrow (DTCs-BM), including treatment effects and prognoses in early breast carcinomas.In this study, CTCs and DTC-BMs were measured by the CellSearch System for 20 patients with stages 1-3 carcinomas, who were followed for 8-11 years.CTCs in 2 (10%) of 20 breast carcinomas, more than 1 CTC was detected before adjuvant therapy, and both cases showed a decrease to 0 after chemotherapy. DTC-BMs in 19 (95%) of the 20 primary cases, more than 1 cell was found in the BM. After adjuvant therapy, 16 cases showed a decrease to 0-10 cells, 2 cases to 11-20 cells, and 2 cases to more than 21 cells. Six patients experienced recurrence. One of the two CTC-positive cases (21 cells) had bone and liver metastasis within 11 months. Among the DTC-BM cases, only 1 (16.7%) of the 6 primary patients with 11-20 cells had recurrence, whereas 4 (80%) of the 5 patients with more than 21 cells had recurrence 3-6 years later.Detection of DTC-BMs is useful for observing adjuvant therapy effects and for predicting relatively late-phase metastasis. The cluster status of CTCs suggests early relapsing.

This report describes the correction of a clinical case of malocclusion with anteroposterior discrepancy and transverse, sagittal and vertical deficiencies. A nonextraction technique was used to preserve space in the dental arches and control facial growth for the correction of the sagittal skeletal relationship and of overbite. The mechanics adopted efficiently corrected malocclusion: all functional and esthetic goals were achieved, and results remained stable eight years after treatment completion. This case was presented to the Committee of the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) as part of the requirements necessary to obtain the BBO Diploma.

Diagnostic methods used in the initial and post-treatment evaluation of canine lymphoma are heterogeneous and can vary within countries and institutions. Accurate reporting of clinical stage and response assessment is crucial in determining the treatment efficacy and predicting prognosis. This study comprises a systematic review of all available canine multicentric lymphoma studies published over 15 years. Data concerning diagnosis, clinical stage evaluation and response assessment procedures were extracted and compared. Sixty-three studies met the eligibility criteria. Fifty-five (87.3%) studies were non-randomized prospective or retrospective studies. The survey results also expose variations in diagnostic criteria and treatment response assessment in canine multicentric lymphoma. Variations in staging procedures performed and recorded led to an unquantifiable heterogeneity among patients in and between studies, making it difficult to compare treatment efficacies. Awareness of this inconsistency of procedure and reporting may help in the design of future clinical trials.

Zusammenfassung Fragestellung: Die stationare psychotherapeutische Behandlung alterer Patienten kann noch nicht auf lange Verlaufe zuruckblicken. Auserdem wurde die Stabilitat von Behandlungserfolgen bisher nicht ausreichend untersucht, zumal altersbedingte Erkrankungen Risikofaktoren der psychischen Stabilitat darstellen.Wie stabil sind die psychotherapeutischen Behandlungsergebnisse bei uber 60-Jahrigen funf Jahre nach stationarer Therapie?WelchenVorhersagewert haben OPD-Ratings fur den langerfristigen Ruckgang der Symptombelastung? Methode: 46 Patienten wurden 2009 in einer Einjahres-Katamnese zu ihrer Symptombelastung, Weiterbehandlung und ruckwirkenden Beurteilung der stationaren Therapie befragt. Vier Jahre spater wurden sie erneut befragt. BeiAufnahme und Entlassung lagen die Psy-BaDo, die SCL-90-R und Diagnosen vor. Der eigene Katamnesebogen wurde zusammen mit dem Brief Symptom Inventory (BSI) erneut versandt. Ein OPD-Rating war wahrend der stationaren Behandlung von zwei geschulten Ratern vorgeno...

Purpose: To evaluate the usefulness of the “Motion Correction” function of the dual volume-3D-volume-rendering technique (DV-3D-VRT) in follow-up digital subtraction angiography (DSA) of intracranial coiled aneurysms. Materials and Methods: This study used data collected from consecutive, follow-up DSAs after the coiling of 64 intracranial aneurysms in 59 patients. We performed subtracted 3D-rotational angiographies (3D-RAs) on all DSAs and obtained DV-3D-VRT images. We then assessed recurrence using DV-3D-VRT images with and without the motion correction functions (MC(+) vs. MC(-)) and observed which method showed better agreement with the reference assessment (using a combination of 2D DSA and TOF MRA images). Results: The recurrence of MC(-) DV-3D-VRT images showed 51.6% (33/64) agreement with the reference assessment, whereas the MC(+) DV-3D-VRT images showed 78.1% (50/64) (P = 0.035, McNemar test). Conclusion: Motion correction is a useful complementary imaging technique in evaluating aneurysm recurrence after endovascular embolization. MC(+) DV-3D-VRT image showed higher inter-observer agreement than MC(-) DV-3D-VRT.

Aim:The purpose of this study is to report the 20-year follow-up of a continuous series of 232 total hip arthroplasties (THAs) performed in patients aged less than 50 at the index surgery.Patients and methods:This is a retrospective monocentric study which reports the clinical, radiographical and survival results of 232 THAs performed with a custom cementless femoral stem in 212 patients evaluated at follow-up ranging from 14 to 27 years.Results:At the time of follow-up, the mean Harris Hip Score was 94.1 (range 48–100). The Hip disability and Osteoarthritis Outcome Score was >80 points in all 5 categories for 146 patients (68.9%). 18 hips (8.5%) showed radiographical femoral abnormalities. 23 hips (10.8%) underwent revision of the implants. 13 were isolated cup revisions. 3 more hips had bipolar revisions for aseptic loosening at 15, 20 and 21 years. Taking stem revision for aseptic loosening as an endpoint, survivorship was 96.8% at 20 years (95% confidence interval, 95.1–98.5; patients at risk 76) and 94.5% at 25 years (91.7–97.3; patients at risk 12).Conclusions:The results of this study confirm that THA using this custom-designed stem can provide excellent clinical and radiographical outcomes at a mean follow-up of 20 years in patients younger than 50. The individual 3D femoral stem and prosthetic neck has been able to restore extra- and intramedullary functional anatomy in this young and active cohort of patients.

As the world becomes more diverse, campus and communities must provide opportunities and conditions conducive to learning for all students of color. Iowa State University is attempting to increase awareness about agriculture-related areas among minority high school and undergraduate students. The College of Agriculture has sponsored an Agriculture Minority Summer Research Program (AMSRIP) each summer since 1994. Students utilize experiential learning skills working under the guidance of faculty mentors to conduct research in agriculture-related areas. The primary purpose of this study was to evaluate the impact of the experiences students received while attending the Iowa State University Agriculture Minority Summer Research Internship Program. A second purpose of this study was to assess the effectiveness of the AMSRIP as a recruitment and retention tool. This research addresses experiential learning, recruitment strategies, retention methods, and career exploration relating to minorities, specifically within agriculture-related areas. A descriptive survey method was used in this census study to collect data from 19982001 for Agriculture Minority Summer Research Interns. A total of 85% of the former interns completed and returned the survey. Results of this study indicate that participants were interested in attending the internship program to gain research experience. Respondents indicated they were interested in learning more about the career options available to them in agriculture-related areas. The program is successfully recruiting and retaining minority students in agriculture-related