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When planning a picture archiving and communications system (PACS) implementation and determining which equipment will be implemented in earlier and later phases, collection and analysis of selected data will aid in setting implementation priorities. If baseline data are acquired relative to performance objectives, the same information used for implementation planning can be used to measure performance improvement and outcomes. The main categories of data to choose from are: (1) financial data; (2) productivity data; (3) operational parameters; (4) clinical data; and (5) information about customer satisfaction. In the authors' experience, detailed workflow data have not proved valuable in measuring PACS performance and outcomes. Reviewing only one category of data in planning will not provide adequate basis for targeting operational improvements that will lead to the most significant gains. Quality improvement takes into account all factors in production: human capacity, materials, operating capital and assets. Once we have identified key areas of focus for quality improvement in each phase, we can translate objectives into implementation requirements and finally into detailed functional and performance requirements. Here, Integration Resources reports its experience measuring PACS performance relative to phased implementation strategies for three large medical centers. Each medical center had its own objectives for overcoming image management, physical/geographical, and functional/technical barriers. The report outlines (1) principal financial and nonfinancial measures used as performance indicators; (2) implementation strategies chosen by each of the three medical centers; and (3) the results of those strategies as compared with baseline data. Copyright (c) 1999 by W.B. Saunders Company [ABSTRACT FROM AUTHOR]

The continued increase in the number of tourists visiting the Northern Gulf Coast (NGC), USA, in the last century, and the resulting sprawl of large cities along the coast, has degraded and fragmented the available habitat of Arctosa sanctaerosae, a wolf spider endemic to the secondary dunes of the white sandy beaches of the NGC. In addition to anthropogenic disturbance to this coastal region, hurricanes are an additional and natural perturbation to the ecosystem. The data presented here explore the status of populations of this species spanning the entire known range and the factors influencing population demography including anthropogenic disturbance and severe tropical storms. Using microsatellite markers, we were able to document the genetic structure of A. sanctaerosae , including current and historic patterns of migration. These results combined with ecological and census data reveal the characteristics that have influenced population persistence: ecological variables affecting the recovery of the population clusters after severe tropical storms, genetic fragmentation due to anthropogenic disturbance, and their interaction. These findings demonstrate the significance that the high traffic beach communities of the NGC and their impact on the once intact contiguous dune ecosystem have on recovery after severe tropical storms. Contemporary modeling methods that compare current and historic levels of gene flow suggest A. sanctaerosae has experienced a single, contiguous population subdivision, and the isolates reduced in size since the onset of commercial development of the NGC. These results point to the need for monitoring of the species and increased protection for this endangered habitat., Competing Interests: There are no sources or any potential sources of conflict of interest. There is no interest or relationship, financial or otherwise, that might be perceived as influencing the objectivity of this work., (© 2020 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to augment resuscitation in patients with noncompressible torso hemorrhage, which is a leading cause of death on the battlefield. However, the implementation of REBOA has resulted in considerable debate within the military medical community. We present a case of the first successful placement of an REBOA by a small surgical team within a mobile rotary wing platform., (2020.)

Theoretical ecologists have long sought to understand how the persistence of populations depends on the interactions between exogenous (biotic and abiotic) and endogenous (e.g., demographic and genetic) drivers of population dynamics. Recent work focuses on the autocorrelation structure of environmental perturbations and its effects on the persistence of populations. Accurate estimation of extinction times and especially determination of the mechanisms affecting extinction times is important for biodiversity conservation. Here we examine the interaction between environmental fluctuations and the scaling effect of the mean population size with its variance. We investigate how interactions between environmental and demographic stochasticity can affect the mean time to extinction, change optimal patch size dynamics, and how it can alter the often-assumed linear relationship between the census size and the effective population size. The importance of the correlation between environmental and demographic variation depends on the relative importance of the two types of variation. We found the correlation to be important when the two types of variation were approximately equal; however, the importance of the correlation diminishes as one source of variation dominates. The implications of these findings are discussed from a conservation and eco-evolutionary point of view.

The effect of environmental stress on the magnitude of inbreeding depression has a long history of intensive study. Inbreeding-stress interactions are of great importance to the viability of populations of conservation concern and have numerous evolutionary ramifications. However, such interactions are controversial. Several meta-analyses over the last decade, combined with omic studies, have provided considerable insight into the generality of inbreeding-stress interactions, its physiological basis, and have provided the foundation for future studies. In this review, we examine the genetic and physiological mechanisms proposed to explain why inbreeding-stress interactions occur. We specifically examine whether the increase in inbreeding depression with increasing stress could be due to a concomitant increase in phenotypic variation, using a larger data set than any previous study. Phenotypic variation does usually increase with stress, and this increase can explain some of the inbreeding-stress interaction, but it cannot explain all of it. Overall, research suggests that inbreeding-stress interactions can occur via multiple independent channels, though the relative contribution of each of the mechanisms is unknown. To better understand the causes and consequences of inbreeding-stress interactions in natural populations, future research should focus on elucidating the genetic architecture of such interactions and quantifying naturally occurring levels of stress in the wild., (© 2012 New York Academy of Sciences.)

Inbreeding-environment interactions occur when inbreeding leads to differential fitness loss in different environments. Inbred individuals are often more sensitive to environmental stress than are outbred individuals, presumably because stress increases the expression of deleterious recessive alleles or cellular safeguards against stress are pushed beyond the organism's physiological limits. We examined inbreeding-environment interactions, along two environmental axes (temperature and rearing host) that differ in the amount of developmental stress they impose, in the seed-feeding beetle Callosobruchus maculatus. We found that inbreeding depression (inbreeding load, L) increased with the stressfulness of the environment, with the magnitude of stress explaining as much as 66% of the variation in inbreeding depression. This relationship between L and developmental stress was not explainable by an increase in phenotypic variation in more stressful environments. To examine the generality of this experimental result, we conducted a meta-analysis of the available data from published studies looking at stress and inbreeding depression. The meta-analysis confirmed that the effect of the environment on inbreeding depression scales linearly with the magnitude of stress; a population suffers one additional lethal equivalent, on average, for each 30% reduction in fitness induced by the stressful environment. Studies using less-stressful environments may lack statistical power to detect the small changes in inbreeding depression. That the magnitude of inbreeding depression scales with the magnitude of the stress applied has numerous repercussions for evolutionary and conservation genetics and may invigorate research aimed at finding the causal mechanism involved in such a relationship., (© 2010 The Author(s). Evolution© 2010 The Society for the Study of Evolution.)

The extent to which genetic diversity is lost from inbred populations is important for conservation biology, evolutionary ecology, and plant and animal breeding. This importance stems from the fact that the amount of genetic diversity a population has is expected to correlate with evolutionary potential. A population's ability to avert extinction during rapidly changing environmental conditions, or the magnitude of response to selection on a trait, depend on the ability of the genome to maintain potentially adaptive genetic variation in the face of random genetic drift. Although a few previous studies have demonstrated that the rate of inbreeding affects the amount of genetic diversity maintained, the elegant work of Demontis et al., in this issue, clearly demonstrates that slow inbreeding maintains more genetic diversity than fast inbreeding and that the primary mechanism could be balancing selection. In their study, populations that took 19 generations, rather than one generation, to reach the same level of inbreeding maintained 10% higher levels of allelic richness and 25% higher levels of heterozygosity. The use of specifically chosen molecular markers not expected to be neutral makes this study especially noteworthy, as the study provides evidence concerning the mechanisms underlying the maintenance of genetic diversity in the face of inbreeding.

The degree to which, and rapidity with which, inbreeding depression can be purged from a population has important implications for conservation biology, captive breeding practices, and invasive species biology. The degree and rate of purging also informs us regarding the genetic mechanisms underlying inbreeding depression. We examine the evolution of mean survival and inbreeding depression in survival following serial inbreeding in a seed-feeding beetle, Stator limbatus, which shows substantial inbreeding depression at all stages of development. We created two replicate serially inbred populations perpetuated by full-sib matings and paired with outbred controls. The genetic load for the probability that an egg produces an adult was purged at approximately 0.45-0.50 lethal equivalents/generation, a reduction of more than half after only three generations of sib-mating. After serial inbreeding we outcrossed all beetles then measured (1) larval survival of outcrossed beetles and (2) inbreeding depression. Survival of outcrossed beetles evolved to be higher in the serially inbred populations for all periods of development. Inbreeding depression and the genetic load were significantly lower in the serially inbred than control populations. Inbreeding depression affecting larval survival of S. limbatus is largely due to recessive deleterious alleles of large effect that can be rapidly purged from a population by serial sib-mating. However, the effectiveness of purging varied among the periods of egg/larval survival and likely varies among other unstudied fitness components. This study presents novel results showing rapid and extensive purging of the genetic load, specifically a reduction of as much as 72% in only three generations of sib-mating. However, the high rate of extinction of inbred lines, despite the lines being reared in a benign laboratory environment, indicates that intentional purging of the genetic load of captive endangered species will not be practical due to high rates of subpopulation extinction.

Understanding the consequences of inbreeding has important implications for a wide variety of topics in population biology. Although it is often stated in the literature that the deleterious effects of inbreeding (inbreeding depression) are expected to be more pronounced under stressful than benign conditions, this issue remains unresolved and controversial. We review the current literature on the relationship between the magnitude of inbreeding depression and environmental stress and calculate haploid lethal equivalents expressed under relatively benign and stressful conditions based on data from 34 studies. Inbreeding depression increases under stress in 76% of cases, although this increase is only significant in 48% of the studies considered. Estimates of lethal equivalents are significantly greater under stressful (mean = 1.45, median = 1.02) than relatively benign (mean = 0.85, median = 0.61) conditions. This amounts to an approximately 69% increase in inbreeding depression in a stressful vs a benign environment. However, we find strong lineage effects to be ubiquitous among studies that examine inbreeding depression in multiple environments, and a prevalence of conditionally expressed deleterious effects within lineages that are uncorrelated across environments. These results have important implications for both evolutionary and conservation biology.

An individual's or a population's fitness is the result of a large number of interacting life history traits and the environment. Little information is available on the phenotypic correlations among fitness components and fitness itself, especially outside of Drosophila melanogaster. We also lack detailed information on trade-offs among life history traits. Here we present the relationship between adult progeny production and eight components of fitness, as well as some observed trade-offs between life history traits in the housefly (Musca domestica). We briefly discuss some of the ramifications of these relationships., (Copyright 2004 Blackwell Publishing Ltd)

The ability of populations to undergo adaptive evolution depends on the presence of genetic variation for ecologically important traits. The maintenance of genetic variation may be influenced by many variables, particularly long-term effective population size and the strength and form of selection. The roles of these factors are controversial and there is very little information on their impacts for quantitative characters. The aims of this study were to determine the impacts of population size and variable versus constant prior environmental conditions on fitness and the magnitude of response to selection. Outbred and inbred populations of Drosophila melanogaster were maintained under benign, constant stressful, and variably stressful conditions for seven generations, and then forced to adapt to a novel stress for seven generations. Fitness and adaptability were assayed in each replicate population. Our findings are that: (1) populations inbred in a variable environment were more adaptable than those inbred in a constant environment; (2) populations adapted to a prior stressful environment had greater fitness when reared in a novel stress than those less adapted to stress; (3) inbred populations had lower fitness and were less adaptable than the outbred population they were derived from; and (4) strong lineage effects were detectable across environments in the inbred populations.

The ability of populations to undergo adaptive evolution depends on the presence of quantitative genetic variation for ecologically important traits. Although molecular measures are widely used as surrogates for quantitative genetic variation, there is controversy about the strength of the relationship between the two. To resolve this issue, we carried out a meta-analysis based on 71 datasets. The mean correlation between molecular and quantitative measures of genetic variation was weak (r = 0.217). Furthermore, there was no significant relationship between the two measures for life-history traits (r = -0.11) or for the quantitative measure generally considered as the best indicator of adaptive potential, heritability (r = -0.08). Consequently, molecular measures of genetic diversity have only a very limited ability to predict quantitative genetic variability. When information about a population's short-term evolutionary potential or estimates of local adaptation and population divergence are required, quantitative genetic variation should be measured directly.

The PACS committee plays a crucial role in attaining successful outcomes from a PACS implementation. However, most radiology departments do not organize and manage their PACS committees well. This has resulted in poor outcomes and inability to realize projected benefits and return on investment. Ideally, there are two PACS committees: a high-level strategic committee that aligns the goals for the PACS with institutional initiatives, and an operational PACS committee that makes a hands-on approach to the project and manages the entire PACS program. The chairman of radiology, an assigned radiologist or the radiology administrator heads both PACS committees. The strategic PACS committee consists of senior people from information systems, strategic and operational planning, radiology, physicians, nursing, critical care, and other related departments in the hospital. The operational PACS committee consists of people directly involved in radiology operations including the chief of radiology, radiology administrator, technologists, file room manager and other personnel whose daily routines will be affected by the PACS implementation. The operational PACS committee manages the PACS program from initial planning through the post-installation period. Committee tasks include: developing an implementation plan, establishing goals and objectives, conducting a cost/benefits analysis, developing functional specifications, generating an RFP, managing vendor selection and contracting, preparing the site for installation, performing project management functions, conducting acceptance testing, overseeing training, and evolving the PACS operations to meet predicted outcomes.

The evolution of senescence may be explained by two different, but not mutually exclusive, genetic mechanisms. The antagonistic pleiotropy hypothesis predicts that senescence is a consequence of the fixation of alleles with pleiotropic effects favouring early life fitness, but bearing a cost in later life. The mutation-accumulation hypothesis attributes senescence to the accumulation of deleterious mutations with late-acting effects on fitness in mutation-selection balance. Experiments were carried out on the housefly, Musca domestica, in which large and small populations were maintained so that reproduction was limited to four or five days after reaching sexual maturity. Longevity declined significantly under the husbandry protocol and was largely the same in large and small populations; this is consistent with the random accumulation of deleterious alleles affecting longevity under curtailed life span, although laboratory adaptation cannot be ruled out entirely as a causal mechanism. An analysis of life-history data did not provide evidence for a trade-off between longevity and age at sexual maturity, developmental time, or dry body weight, but there was an apparent trade-off between longevity and early progeny production, in support of antagonistic pleiotropy.

Picture archiving and communication systems (PACS) is a complex and vast subject, about which much has been written. A Visual Guide to PACS is an overview of the subject presented as an efficient reference for hospital and department administrators planning for and implementing PACS. A Visual Guide to PACS is adapted from presentation materials developed by Integration Resources/GORCA to capsulize issues relating to PACS. The authors aim to communicate the broad parameter and some of the complexity of the subject.

This study examined the mediating role of anxiety in the self-reports of somatic complaints in 96 depressed adolescent inpatients. Sixty-four subjects with major depressive episodes and comorbid anxiety disorders (MDE-A) determined from the Diagnostic Interview for Children and Adolescents--Revised (DICA-R) reported significantly more somatic complaints than 32 adolescents having major depressive episodes without comorbid anxiety (MDE). An analysis of covariance demonstrated that, with anxiety symptoms controlled, MDE and MDE-A groups did not differ significantly in somatic complaints. A hierarchical multiple-regression analysis revealed that, with demographic and anxiety symptoms controlled, depressive symptoms did not contribute to the explanation or prediction of somatic complaints. The results suggest that anxious, but not depressive symptoms, are independently associated with somatic complaints. The results are discussed in light of new affective models of psychopathology.

A patient with osteomyelitis of the lower thoracic spine is reported in whom computed tomography (CT) revealed a large false aneurysm of the descending aorta. Useful radiological signs of the diagnosis are described, namely a thin aneurysm wall, a multilobulated margin and deformity of the aneurysm by adjacent vascular and osseous structures. Mycotic aneurysms of the aorta have a high mortality and the CT demonstration of a pseudoaneurysm has a vital role in management.

Four patients with seminoma of the testis and coexisting horseshoe kidney are presented. Three patients had stage one disease, which would conventionally be managed by abdominal nodal irradiation. However, because of the risk of radiation nephritis, a surveillance policy was adopted with regular computed tomography (CT). Two of these three patients have relapsed and are disease free after chemotherapy. The fourth patient had Stage IIC disease which initially responded to combined radiotherapy and chemotherapy. This patient's disease relapsed and he died despite further treatment. Because of the altered retroperitoneal anatomy, CT interpretation must be made with special care.

A patient with a congenitally absent uterus and a single pelvic kidney presented with recurrent pain in the left iliac fossa. This proved to be due to a prolapsed left ovary.

Three patients who were evaluated by computed tomography (CT) for possible recurrent tumour of the cervix are described. Two had proven carcinoma and the third had non-Hodgkin's lymphoma of the cervix. In each, soft tissue masses in the iliac fossa, close to the iliopsoas muscles, were demonstrated. The position, shape, symmetry and, in one patient, the presence of surgical clips led to the correct diagnosis that these soft tissue masses were normal ovaries which had been moved out of the true pelvis at the time of hysterectomy. Such ovarian conservation creates a potential cause of error as the ovaries can then simulate enlarged nodal masses.