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Khaled M Elsayes,1 Ania Z Kielar,2 Victoria Chernyak,3 Ali Morshid,1 Alessandro Furlan,4 William R Masch,5 Robert M Marks,6 Aya Kamaya,7 Richard KG Do,8 Yuko Kono,9 Kathryn J Fowler,9 An Tang,10 Mustafa R Bashir,11 Elizabeth M Hecht,12 Kedar Jambhekar,13 Andrej Lyshchik,14 Shuchi K Rodgers,14 Jay P Heiken,15 Marc Kohli,16 David T Fetzer,17 Stephanie R Wilson,18 Zahra Kassam,19 Mishal Mendiratta-Lala,5 Amit G Singal,17 Christopher S Lim,20 Irene Cruite,21 James Lee,22 Ryan Ash,23 Donald G Mitchell,14 Matthew DF McInnes,24 Claude B Sirlin9 1Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 2Department of Radiology, University of Toronto, ON, Canada; 3Department of Radiology, Montefiore Medical Center, Bronx, NY, USA; 4Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA; 5Department of Radiology, University of Michigan, Ann Arbor, MI, USA; 6Department of Radiology, Naval Medical Center San Diego, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 7Department of Radiology, Stanford University Medical Center, Stanford, CA, USA; 8Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 9Department of Radiology, University of California San Diego, CA, USA; 10Department of Radiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada; 11Department of Radiology, Center for Advanced Magnetic Resonance Development, and Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA; 12Department of Radiology, Columbia University Medical Center, New York, NY, USA; 13Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 14Department of Radiology, Einstein Medical Center, Philadelphia, PA, USA; 15Department of Radiology, Mayo Clinic, Rochester, MN, USA; 16Department of Radiology, University of California San Francisco, CA, USA; 17Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA; 18Department of Radiology, University of Calgary, Calgary, AB, Canada; 19Department of Diagnostic Imaging, Schulich School of Medicine, London, ON, Canada; 20Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada; 21Department of Radiology, Inland Imaging, Spokane, WA, USA; 22Department of Radiology, University of Kentucky, Lexington, KY, USA; 23Department of Radiology, University of Kansas, Kansas City, KS, USA; 24Department of Radiology, University of Ottawa, ON, Canada Abstract: The Liver Imaging Reporting and Data System (LI-RADS®) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver observations in individuals at high risk for hepatocellular carcinoma (HCC). LI-RADS is supported and endorsed by the American College of Radiology (ACR). Upon its initial release in 2011, LI-RADS applied only to liver observations identified at CT or MRI. It has since been refined and expanded over multiple updates to now also address ultrasound-based surveillance, contrast-enhanced ultrasound for HCC diagnosis, and CT/MRI for assessing treatment response after locoregional therapy. The LI-RADS 2018 version was integrated into the HCC diagnosis, staging, and management practice guidance of the American Association for the Study of Liver Diseases (AASLD). This article reviews the major LI-RADS updates since its 2011 inception and provides an overview of the currently published LI-RADS algorithms. Keywords: LI-RADS, v2018, CT, MRI, CEUS, US, HCC, liver imaging, reporting, cirrhosis

Early actions as a dam incident develops are critical to reducing and preventing life, economic, and environmental loss. Being prepared to act in an emergency improves the outcome of the response. According to State Performance Data compiled by ASDSO, as of 2019, 82% of high hazard dams have an Emergency Action Plan (EAP). The primary purpose of an EAP is to identify potential emergency conditions at a dam, document areas that can be affected by the loss of the dam, and specify preplanned actions to be followed to reduce loss of life and damage to property or the environment. Today, the FEMA National Dam Safety Program encourages the implementation of effective EAPs for high and significant hazard dams in the United States, which was not always the case. It has only been in the last 20 to 30 years that EAPs have become a standard risk reduction tool for dam owners, regulators, and emergency responders. During this time, the purpose, contents, and maintenance needs for EAPs have advanced and become more comprehensive and uniform. Owners with large portfolios of dams and key regulatory agencies have developed guidelines for these important documents. Lessons learned from other industries such as emergency management (as well as those from the Dams sector) that rely on emergency action plans have been applied to the content of today's EAPs. This paper provides a historical perspective and follows the evolution of EAPs for dams from their origins to the current state of the practice. It will also identify trends and discuss the future of emergency action planning. [ABSTRACT FROM AUTHOR]

The article offers information on mother Catherine McAuley and the declaration on christian education Gravissimum Educationis of the second vatican council. Topics discussed include Pope Paul VI on October 28, 1965 promulgated Gravissimum Educationis, and Catherine McAuley was declared Venerable by St. John Paul II on April 9, 1990.

Group 2 pulmonary hypertension is most frequently caused by left heart disease, a heterogeneous set of disorders. These processes include left ventricular systolic dysfunction, left ventricular dysfunction with preserved ejection fraction and valvular (mitral and/or aortic) diseases. Left heart disease may cause passive backward transmission of pressure leading to elevated left atrial and pulmonary arterial pressures due to a myriad of processes. Increasingly, it has been recognized that some patients may develop pulmonary arterial pressure out of proportion from what is expected. This is believed to be due to increases in vasomotor tone and/or vascular remodeling. Over time patients may go on to develop progressive right ventricular dysfunction, a marker for poor prognosis. This review will explore the different characteristics of these conditions including the incidence, pathophysiology, clinical implications, prognosis and current state of available medical therapies. [ABSTRACT FROM AUTHOR]

Background: Secondhand tobacco smoke exposure impairs the control of pediatric asthma. Evidence of the efficacy of interventions to reduce children's exposure and improve disease outcomes has been inconclusive.Methods: Caregivers of 519 children aged 3 to 12 years with asthma and reported smoke exposure attended two baseline assessment visits, which involved a parent interview, sampling of the children's urine (for cotinine assay), and spirometry (children≥5 years). The caregivers and children (n=352) with significant documented exposure (cotinine≥10 ng/mL) attended a basic asthma education session, provided a third urine sample, and were randomized to the Lowering Environmental Tobacco Smoke: LET'S Manage Asthma (LET'S) intervention (n=178) or usual care (n=174). LET'S included three in-person, stage-of-change-based counseling sessions plus three follow-up phone calls. Cotinine feedback was given at each in-person session. Follow-up visits at 6 and 12 months postrandomization repeated the baseline data collection. Multivariate regression analyses estimated the intervention effect on the natural logarithm of the cotinine to creatinine ratio (lnCCR), use of health-care services, and other outcomes.Results: In the sample overall, the children in the LET'S intervention had lower follow-up lnCCR values compared with the children in usual care, but the group difference was not significant (β coefficient=-0.307, P=.064), and there was no group difference in the odds of having>one asthma-related medical visit (β coefficient=0.035, P=.78). However, children with high-risk asthma had statistically lower follow-up lnCCR values compared with children in usual care (β coefficient=-1.068, P=.006).Conclusions: The LET'S intervention was not associated with a statistically significant reduction in tobacco smoke exposure or use of health-care services in the sample as a whole. However, it appeared effective in reducing exposure in children at high risk for subsequent exacerbations.Trial Registry: ClinicialTrials.gov; No.: NCT00217958; URL: clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Rationale: Poor adherence to asthma controller medications results in poor treatment outcomes.Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care.Methods: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters.Measurements and Main Results: Refill adherence was measured using continuous medication acquisition (CMA) indices-the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P < 0.0001) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting beta-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures.Conclusions: Negotiating patients' treatment decisions significantly improves adherence to asthma pharmacotherapy and clinical outcomes. Clinical trials registered with www.clinicaltrials.gov (NCT00217945 and NCT00149526). [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate the efficacy and safety of ranolazine in a larger and more diverse group of patients with angina than previously studied.Background: Ranolazine is an antianginal shown to reduce angina and improve exercise performance in selected patients with early-positive exercise testing and those with frequent angina.Methods: We investigated the antianginal effects of ranolazine in the subgroup of patients with prior chronic angina (n = 3,565, 54%) enrolled in the randomized, double-blind, placebo-controlled MERLIN-TIMI (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary Syndromes) 36 trial of patients with acute coronary syndrome. Follow-up was a median of 350 days.Results: Patients with prior angina received evidence-based therapy (95% aspirin, 78% statins, 89% beta-blockers, average 2.9 antianginal agents). The primary end point (cardiovascular death, myocardial infarction, recurrent ischemia) was less frequent with ranolazine (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.75 to 0.97; p = 0.017), due entirely to a significant reduction in recurrent ischemia (HR: 0.78; 95% CI: 0.67 to 0.91; p = 0.002). Ranolazine also reduced worsening angina (HR: 0.77; 95% CI: 0.59 to 1.00; p = 0.048) and intensification of antianginal therapy (HR: 0.77; 95% CI: 0.64 to 0.92, p = 0.005). Exercise duration at 8 months was greater with ranolazine (514 s vs. 482 s, p = 0.002). Cardiovascular death or myocardial infarction did not differ between treatment groups (HR: 0.97; 95% CI: 0.80 to 1.16; p = 0.71). Symptomatic documented arrhythmias (2.9% vs. 2.9%, p = 0.92) and total mortality (6.2% vs. 6.4%, p = 0.96) were similar with ranolazine or placebo.Conclusions: In this largest study of ranolazine in patients with established coronary artery disease, ranolazine was effective in reducing angina with favorable safety in a substantially broader group of patients with angina than previously studied. (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary Syndromes; NCT00099788). [ABSTRACT FROM AUTHOR]

Background: Secondhand smoke triggers childhood asthma. Understanding sources of exposure, parental beliefs about exposure, and readiness to change that exposure are important for designing smoke exposure reduction interventions.Methods: As part of screening for a clinical trial of a smoke exposure reduction intervention, 519 smoke-exposed children 3 to 12 years old with asthma provided urine specimens for cotinine testing, and their primary caregivers completed questionnaires.Results: The urine cotinine to creatinine ratio (CCR) was lowest if neither the primary caregiver nor day-care provider smoked (mean CCR, 14.0; SD, 14.4), greater if either smoked (mean CCR, 22.2; SD, 21.3; and mean, CCR, 26.3; SD, 22.2, respectively), and greatest if both smoked (mean CCR, 39.6; SD, 27.5; p < 0.01). Parental perception of their child's exposure was weakly associated with the child's CCR (r(2) = 0.11, p < 0.001). Most parents (58.3%) reported that tobacco smoke exposure had small/no negative effect on their child's asthma. Substantial proportions of those for whom a specific exposure reduction action was relevant were classified as contemplating, preparing, or had recently taken action to reduce their child's exposure, including smoking cessation (61.3%), keeping the child out of smoke-exposed places (72.7%), and making the child's home (49.2%) and areas out of the home smoke free (66.9%).Conclusions: Smoking by the primary caregiver and day-care provider are important sources of exposure for children with asthma. Parental assessment of their child's exposure is associated with biologically confirmed exposure but cannot be relied on to assess that exposure. Although the harm of smoke exposure was frequently underestimated, many parents appeared receptive to considering action to reduce their child's exposure.Trial Registration: (Clinicaltrials.gov). Identifier: NCT00217958. [ABSTRACT FROM AUTHOR]

Older adults are disproportionately affected by telemarketing fraud, especially those who are socially isolated. Twenty-eight older adult telemarketing fraud victims completed a questionnaire assessing loneliness and other variables related to telemarketing fraud vulnerability. Victims tended to be male, divorced/separated, and college-educated, between ages of 60 and 70. Age and marital status were significantly associated with loneliness. This study is an important first step for additional research in this area and may enhance the prevention and intervention efforts of social service providers who work with older adults who may be most vulnerable. [ABSTRACT FROM AUTHOR]

Objective: To determine whether peak flow monitoring has value above and beyond symptom monitoring when used as part of an asthma management plan.Methods: From a large managed-care organization, 296 adults, aged 50-92 yr, were recruited and randomly assigned in equal numbers to either use of symptoms or peak flow rate (twice daily or "as needed") for asthma monitoring, and monitored every 6 mo for 2 yr. Interventions were delivered in four 90-min small-group classes and included a personalized action plan and coaching in proper use of asthma inhalers.Results: We found no significant differences between peak flow rate and symptom monitoring, or between twice-daily and as-needed peak flow monitoring in the primary or secondary study outcomes: health care utilization (acute, nonacute, or total asthma visits), Asthma Quality-of-Life Questionnaire (AQLQ) scores, and lung function. AQLQ scores and prebronchodilator FEV1 increased significantly for both groups between baseline and 6 mo (AQLQ: mean, 0.4 units; 95% confidence interval, 0.3, 0.5; p < 0.0001; FEV1% predicted: mean, 4%). Inhaler technique improved substantially in both groups.Conclusions: Peak flow monitoring has no advantage over symptom monitoring as an asthma management strategy for older adults with moderate-severe asthma when used in a comprehensive asthma management program. Improved outcomes in both groups suggest that understanding proper medication use, regular monitoring of asthma status, and understanding how to respond to changes are of primary importance. [ABSTRACT FROM AUTHOR]

Child physical abuse is a serious societal problem that communication scholars have been slow to address. This study explores whether a mother's trait verbal aggressiveness (VA) is associated with her risk for child physical abuse. Participants were 42 women in predominately low-income families recruited from two social service agencies in a major metropolitan area. Participants completed Infante and Wigley's (1986) Verbal Aggressiveness Scale (VAS) and Milner's (1994) Child Abuse Potential Inventory (CAPI) as part of a larger data collection. Mothers with higher trait VA scored higher on the total CAPI, as well as on the distress, rigidity, and problems with others subdimensions. Discussion centers on implications for future research on communication and child maltreatment, as well as for treatment and prevention efforts. [ABSTRACT FROM AUTHOR]

Objective/goal: The objective of this study was to investigate potential predictors of consistent condom use (CCU), including the influence of hormonal contraception/surgical sterilization (HC/SS).Study: Regression methods were used to predict CCU and other measures of CU among 214 sexually active, 18- to 45-year-old women previously diagnosed with a sexually transmitted infection.Results: CCU was significantly associated with younger age, African American ethnicity, having casual partners, recent HIV testing, condom use self-efficacy, and concern about partner relationship. HC/SS was not significantly associated with the likelihood of CCU, before (HC/SS, 21.3%, non-HC/SS, 25.3%; odds ratio [OR], 0.798; P=0.4914) or after (OR, 1.209; P=0.5995) controlling for confounders (age, ethnicity, casual partners). Controlling for age and ethnicity eliminated initial significant or near-significant inverse associations between HC/SS and 3 alternative measures of interval condom use ("any use," "number of unprotected acts," "proportion condom-protected contacts") and substantially diminished the association between HC/SS and "condom use at last sex."Conclusions: Choice of condom use measure and control of confounding variables can substantially affect results when studying potential predictors of condom use such as HC/SS. [ABSTRACT FROM AUTHOR]