bluuebunny/crossref_metadata_2025 huggingface dataset:
Thought Beats: New Technology, Music Video and Media Education
Authors: Archer Steve
Published: March 2018

This paper has as its focus two key strands that are significant to contemporary media education. The first is the increasing move towards creative production work as the central and dominant feature of media studies courses. In UK schools, this has largely been facilitated by the rapid expansion of digital technologies. Whilst this offers unprecedented opportunities for students to construct advanced and highly polished artefacts, it has also created new challenges for the media teacher in relation to pedagogy and classroom management. The second strand is the emergence of globalised, commercial media cultures and their relation to new media forms facilitated by digital technology. Here, this paper is interested in the relatively new media form of the music video which, in its dominant mode of distribution and exhibition, exists globally as part of satellite and digital packages. Music video as a form is ideal for use in Media Studies as an object of study and as a framework for facilitating creative work. Based on practitioner research methods, this paper teases out the tensions that exist between popular culture, media education and digital technology, incorporating the way a sense of community located beyond the school can create opportunities for student creative work.
Some Things We Should Know about Talkback Radio
Authors: Turner Graeme
Published: March 2018

This article serves as the introduction to this special issue, but it also presents an overview of the current state of research into talkback radio in Australia. It is only recently that significant interest in researching this format has surfaced, despite its importance within the Australian mediascape. In what follows. I argue that this comparative neglect has had its effects — for instance, we are still working through elite assumptions about the inherently tabloid nature of the format which research into other media such as television has overcome. Most importantly, though, I argue that we need to move beyond the notion that talkback is defined by its demographic profile in order to more fully and more contingently examine its social, cultural and political functions.
Popular Music: Networks, Industries and Spaces
Authors: Homan Shane , Gibson Chris
Published: March 2018

There has been much recent media coverage and public speculation about change in the music industries. This issue of MIA examines the shifting technological, production and consumption contexts of local popular music. Australian music practices have reflected global changes in corporate structures, methods of distribution and what it means to construct and maintain a music ‘career’. How traditional music-making and consumption practices work with or against emerging media technologies, and what this means for older understandings of music creativity, is a key focus.
Broadcasting and the Enemy Within: Political Surveillance and the ABC, 1951–64
Authors: McKnight David
Published: March 2018

For many years, Australia's internal securtity agency, ASIO, ran security checks on potential and actual ABC staff and monitored ABC radio and TV broadcasts, noting examples of left-wing influence. This was done with the cooperation of ABC senior management and the encouragement of the conservative federal government. These facts, long suspected, are now confirmed by the use of recently released archives which give specific instances of security surveillance and vetting.
Cultural Studies and Journalism
Authors: Meadows Michael
Published: March 2018

The study of journalism has not been — nor should it be — restricted to those who call themselves ‘journalists' or ‘journalism educators’. The cultural practice of journalism focuses on issues, institutions and events ‘from the outside’, so it would seem hypocritical to suggest that journalists alone should have the right to critique journalism. This article looks at the usefulness of cultural studies in enabling a critique and analysis of journalism from a broad range of theoretical and methodological approaches. Drawing from the work of Gramsci and Canadian journalism educator and cultural studies advocate G. Stuart Adam, it suggests that journalism is a set of cultural practices which frame experience and form public consciousness of the here and now.
Public Journalism: The Media's Intellectual Journey
Authors: Hippocrates Cratis
Published: March 2018

Journalism is important to public life: it helps to define public life and mediate debate about it through all its forms, from tabloid press to high-quality broadsheets, and news and current affairs programs. And while many scholars debate the vagaries of which theoretical approach best explains the media, the Public Journalism movement in the United States and Australia is an example of how theory can impact on the practice of journalism. Merritt (1996) describes Public Journalism as an ‘intellectual journey’. This paper develops that notion and reflects on how this kind of innovation can be an exemplar to media theorists and practitioners, as well as on how their respective traditions and critiques can evolve an new industry paradigm, designed to bring together the key stakeholders in public policy formulation: the media, political organisations and a range of community groups.

The paper reviews Public Journalism as a movement from its origins in the late 1980s in the United States, refers to American examples of Public Journalism and details how readers, audiences, editors, community groups and political organisations have reacted to this news approach to doing journalism.
Policy Discourse and the 1982 ABT Pay TV Inquiry
Authors: Pearce Matthew
Published: March 2018

The 1982 ABT Pay TV Inquiry revealed the complexities of broadcasting policy discourse in contemporary Australian government. The inquiry became a crucible in which discourses of public interest, and alliances of private interests, were distilled. Throughout the inquiry, and in the resulting report, the ‘public interest’ was continuously invoked to purchase legitimacy in the policy process. Yet the ‘public interest’ is a contested, malleable concept with no definite singular meaning. This paper examines and explains the various concepts which were used to underpin notions of the public interest in a contested policy zone.
Pay TV in Australia and the Concentration of Media Ownership
Authors: Minehan Mike
Published: March 2018

This article examines the history of Australis Media from its acquisition of the Pay TV B licence on 18 November 1993 to its financial collapse on 5 May 1998. The article analyses the reasons for the collapse of Australis Media and examines the way in which Pay TV was penetrated by the media interests of Rupert Murdoch and Kerry Packer.
‘Let’s check-in with our tummies’: Orienting to feelings-talk in group supervision for psychotherapy counsellors
Authors: Hutchby Ian , Dart Alison
Published: March 2018

This article examines a particular kind of business-opening activity found in a specific, and little analysed, type of institutional group meeting: group supervision for psychotherapeutic counsellors. The data consist of a particular set of activities that occur in the initial stages of these meetings, which are neither the kind of pre-meeting talk identified by previous research on interaction in meetings, nor specifically the business of group supervision itself. This phase, referred to as the ‘check-in’, functions as an interim stage between small talk and getting down to business. The analysis shows how the check-in comprises a highly structured set of linguistic sequences whose production is bound up with one of the key interactional features of group supervision: the collaborative orientation to the production and relevance of ‘feelings-talk’.
Prevention Diaries
Authors: Mosst Jennifer
Published: March 2018

Disease prevention is an effective means for improving health outcomes and reducing the cost burden of chronic diseases. Prevention Diaries is a collection of short accounts and learnings with the goal of making the case for prevention as a transformative tool to drive health and social change. The book provides insight from the field and outlines why prevention is the solution to many social challenges and provides innovative ideas that are needed to advance the prevention agenda. The book was designed for newcomers to public health and students of health and related fields, and is also a tool for health leaders and health practitioners interested in moving the needle from crisis intervention to community-level prevention.
Hydroentangled nonwoven eri silk fibroin scaffold for tissue engineering applications
Authors: Balan Karthic K , Sundaramoorthy Subramanian
Published: March 2018

Electrospun scaffolds are being widely studied for its potential application in tissue engineering because of its nanostructure that mimics the extracellular matrices. Although it has several advantages, it lacks mechanical strength and causes structural deformation during handling of the scaffold. It is well known that the textile-based structures like woven and nonwoven fabrics have excellent structural stability. In this study, a woven and a hydroentangled nonwoven fabric were fabricated from eri silk fibroin and their characteristics were compared with electrospun scaffold. The functional groups, contact angle, thermal degradation, hemocompatibility studies showed that all the three scaffolds can be used as biomaterials. The pore and pore size distribution were better with electrospun scaffold due to smaller fiber diameter and more number of layers of fibers. The tensile behaviour was found to be better for woven and nonwoven scaffolds. The enzymatic degradation showed that the stability of woven and nonwoven scaffolds were better and electrospun scaffold degrades and disintegrates quickly. Mouse 3T3 L1 fibroblast and Human Wharton’s jelly Mesenchymal Stem Cells adhered on all the three scaffolds and a higher attachment and growth coverage were obtained on the electrospun and nonwoven scaffolds. It was found that the hydroentangled nonwoven silk scaffold exhibited similar biological characteristics as that of electrospun scaffold and also had higher mechanical strength and structural stability. Hence, it is inferred that the hydroentangled nonwoven scaffold can be considered as a suitable structure for tissue engineering applications.
Do Constituents Influence Issue-Specific Bill Sponsorship?
Authors: Waggoner Philip D.
Published: March 2018

Bill sponsorship is a valuable form of legislative activity in which all legislators are free to signal priorities, stake out positions, and influence legislative agendas. However, decisions to hone in on specific issues have been mostly overlooked, resulting in drivers of issue-specific sponsorship remaining unclear. A reasonable place to look for drivers is constituent preferences, given the representational responsibilities underlying most legislative behavior. To address this question, I leverage advances in opinion estimation to generate a new fine-grained measure of constituent issue preferences at the district level. By keeping the focus on issues, this approach is preferable to other measures of constituent preferences, in that it assumes nothing about constituents’ ideology. Through numerous tests across several issues spanning the 109th to 113th Congresses, I find a largely indirect effect of preferences on sponsorship through employment proxies, yet no consistent direct impact from constituents, opposite expectations of the delegate model of representation.
Decision-Making Practices During the Instrument Selection Process: The Choices We Make
Authors: Rueter Jessica A. , McWhorter Rochell , Delello Julie
Published: March 2018

The purpose of this article is to understand the decision-making processes by assessment personnel when choosing instruments to evaluate students with learning disabilities. Eight school personnel responsible for the evaluation of students in Texas participated in face-to-face, semistructured interviews. The instruments chosen were based on a variety of factors including the personnel’s basic knowledge and training on the use of the instruments, the culture and climate of the district, and the overall characteristics of the child being tested. The findings of this study suggested that assessment personnel encounter many decisions when evaluating children with learning disabilities. Implications from this study include the need for frequent support in encouraging reflective thinking and assessment training for those responsible for the important decisions regarding the identification and placement of students who are learning disabled.
A Case Study Demonstrating the Utility of Duplex Ultrasonography as the Sole Imaging Modality in the Surveillance and Repair of Lower Extremity Arterial Bypass Grafts
Authors: Brown Sandra L. , Clay Amber L. , Upchurch Gilbert
Published: March 2018

Introduction

Traditionally, duplex ultrasonography has played a secondary role in the pre-operative assessment of lower extremity arterial bypass graft revision, being used more as a follow-up tool, with more expensive and invasive modalities being used primarily. This case demonstrates the accuracy and reliability of using duplex ultrasonography alone in the management of lower extremity bypass graft revision, as well as postoperative follow-up.

Case Report

A 76-year-old man was seen in the diagnostic vascular unit for 2-week postoperative assessment after a left common femoral artery (CFA) aneurysm repair. Five months previously he had undergone right lower extremity femoral-to-posteriortibia in situ bypass graft for superficial femoral artery occlusion and a popliteal artery aneurysm. Ankle brachial indices were performed at his 2-week follow-up and showed a significant decrease in the right ankle brachial index (ABI) from 0.79 to 0.41. A right lower extremity duplex ultrasonography was performed and revealed significantly decreased flow velocities within the graft secondary to an arteriovenous fistula (AVF) found at the midthigh. The patient was scheduled for ligation of the AVF to restore adequate flow to the right lower extremity. The right thigh AV fistula was marked with duplex ultrasonography immediately before surgery. An incision was made directly over the marked AVF site, and the vein graft was isolated, revealing a large posterior medial AV fistula. Postoperative ABIs were significantly increased to 0.85 on the right side.

Conclusions

This case demonstrates the usefulness, accuracy, and reliability of duplex ultrasonography in the management of lower extremity arterial bypass grafts. All preoperative decisions were made on the basis of noninvasive vascular laboratory studies.
“Stealing” from a Subclavian Steal: A Case Study
Authors: Blackburn Donna , Sula Ruta , Janowska Margaret , Eskandari Mark
Published: March 2018

A 51-year-old woman was seen with new-onset right hemispheric transient ischemic attacks consisting of left arm weakness and light-headedness. Previous medical history included medically controlled hypertension and coronary artery bypass. A carotid duplex study 2 years previously revealedless than 60% internal carotid stenosis bilaterally. The left subclavian artery signal was abnormal, and the flow in the left vertebral had a to-and-fro signal consistent with early subclavian steal. Carotid duplex ultrasonography was performed on this admission and again demonstrated hemodynamically insignificant stenosis in the internal carotid arteries. Flow in the left vertebral artery was antegrade with normal flow characteristics. The velocities in the right common carotid (CCA), subclavian, and vertebral arteries were low (CCA peak systolic velocity [PSV] of 58 cm/sec versus the left CCA PSV of 102 cm/sec) with tardus parvus waveforms, consistent with proximal obstructive disease. The innominate artery had a poststenotic signal with a PSV of 200 cm/sec. Angiography revealed 90% stenosis at the origin of the innominate artery and 50% stenosis of the left subclavian artery. Angioplasty and stenting of the innominate lesion was performed with an excellent radiographic result. Carotid duplex ultrasonography was performed 2 weeks after stent placement. Flow velocities and waveforms were significantly improved in the right CCA (PSV of 68 cm/sec versus 72 cm/sec on the left). Signals in the subclavian and vertebral arteries were also improved. The left vertebral signal was again abnormal and consistent with early subclavian steal. The varying flow direction in the left vertebral artery is of interest and demonstrates the hemodynamic effects of severe extracranial cerebrovascular disease. In this patient with left subclavian stenosis and steal, when the innominate stenosis became severe enough to decrease the flow to the brain, flow in the left vertebral reversed from a to-and-fro signal to antegrade flow. After angioplasty and stenting of the innominate lesion, flow in the left vertebral artery reverted to one consistent with subclavian steal.
Color Duplex Ultrasound Characteristics: Can we Predict Aortic Aneurysm Expansion following Endovascular Repair?
Authors: Nelms Courtney , Carter Kathleen , DeMasi Richard , Meier George
Published: March 2018

Introduction

The goal of aortic endovascular repair (EVAR) is to successfully exclude the aneurysm. Color duplex ultrasonography (CDU) is effective in the identification of endoleak and assessment of abdominal aortic aneurysm (AAA) morphology after EVAR. In a subset of patients with subtle endoleak, there is a characteristic appearance that predicts significant endoleak leading to AAA expansion. These endoleaks are difficult to detect by computed tomography (CT), and CDU and may represent the phenomenon known as endotension when endoleak is not identified.

Methods

All patients with several EVAR devices were prospectively followed with CDU for evaluation of endoleak at intervals during a 4-year period. All CDU exams were performed using Philips 5000, 3000, and IU22 systems according to protocol. Assessment of the AAA sac with spectral and color Doppler was used to identify endoleak. The B-mode echogenicity of the AAA sac was characterized for echogenicity and sac symmetry. The patients were followed with CT scan and/or angiography for confirmation of endoleaks.

Results

There were 12 patients with subtle Type II endoleaks and a characteristic texture by CDU identified from 1 month to 16 months after intervention. The endoleaks had low velocities within the sac ranging from 10 to 50 cm/sec with a bidirectional spectral Doppler waveform. An asymmetrical AAA sac with a “spongy” multiechogenic texture was a finding in all 12 patients. The endoleaks were difficult to detect by both CDU and CT scan because of the low velocities despite AAA sac enlargement in all patients. The average AAA sac enlargement was 4.4 mm. CT scan and/or angiography failed to detect endoleak in 6 of 12 patients positive by CDU for endoleak with AAA sac expansion.

Conclusion

CDU after EVAR can effectively detect the presence of endoleak and assess the B-mode characteristics of the AAA sac. Important clues such as low flow, sac expansion, sac asymmetry, and a “spongy” B-mode appearance are consistent with subtle endoleak that may lead to AAA expansion. When undetected, this type of endoleak may be misdiagnosed as endotension.
Quantitative Assessment of Chronic Venous Insufficiency Using Duplex Ultrasound and Air Plethysmography
Authors: Asbeutah Akram M. , Riha Andrea Z. , Cameron James D. , McGrath Barry P.
Published: March 2018

Purpose

Using noninvasive methods, we studied patients 5 years after they received an index deep vein thrombosis (DVT) to quantify venous reflux in the lower limb and to relate it to venous disease severity.

Methods

Thirty-eight patients (76 limbs) with DVT were studied 5 years after being diagnosed by ultrasound and/or venography and treated with warfarin through a hospital-in-the-home program. There were 15 men and 23 women, their average age (±SD) was 56.7 years (±16 years), and their average body mass index (±SD) was 28.8 (±5.7 kg/m2). The limbs were classified according to the clinical, etiologic, anatomic, and pathophysiologic (CEAP) clinical classification. There were 10 limbs in CEAP class 0, 28 in classes 1–3, and 22 in classes 4–6. Duplex ultrasound and air plethysmography (APG) techniques were used to assess venous reflux. A total of 14 limbs of healthy volunteers underwent APG of the lower limb for comparison.

Results

At follow-up, 60 limbs exhibited reflux, 35 in the DVT affected limb and 25 in the non-DVT limb. DUS indexes did not differentiate between venous disease severity in terms of reflux duration or reflux flow volume. APG indexes were significantly different, with venous filling index (VFI) being most discriminating. In limbs with skin changes, median (range) VFI was 3.5 mL/sec (1.6–17), compared with 1.5 ml/sec (0.6–3.4) in limbs with class 0, 2.1 ml/sec (0.6–11) in limbs with classes 1–3, and 0.8 ml/sec (0.6–1.7) in normal controls.

Conclusion

Duplex ultrasound provides excellent anatomical imaging, but its indexes lack discrimination in relation to disease severity. However, APG indexes do differ in relation to clinical venous disease severity, and VFI appear to be a useful index for following the progression of chronic venous insufficiency disease.
Thrombus Extension into the Common Femoral Vein after Endovenous Ablation of the Greater Saphenous Vein for the Treatment of Venous Insufficiency
Authors: Berland Todd L. , Hakaim Albert G. , Oldenburg W. Andrew , Paz-Fumagalli Ricardo , Turan Naciye , Falkensammer Juergen
Published: March 2018

Increasingly, endovenous ablation of the greater saphenous vein (GSV) is used for the treatment of symptomatic varicose veins. The propagation of thrombus can result in a “tail of thrombus” within the common femoral vein (CFV). In two cases, patients were treated with low molecular weight heparin and re-imaged within 1 week. In both cases, complete resolution of the thrombus was confirmed, and anticoagulation was discontinued. Thrombus extension into the CFV after endovenous ablation may be safely treated with short-term anticoagulation and followed by duplex ultrasound. If unresolved, standard deep vein thrombosis anticoagulation is indicated.
Diagnosing Lower-Extremity Deep Vein Thrombosis: Can an Emergent Referral System be Improved?
Authors: Giuca Janice , Danes Stratton , Drezner A. David
Published: March 2018

Introduction

—Clinical diagnosis of deep vein thrombosis (DVT) can be difficult. This fact, along with our litigious environment and the expediency of obtaining venous duplex ultrasound (VDU) studies, has led to the overuse of this examination. To improve the appropriateness of VDU orders from the emergency department (ED), a quality improvement project was initiated with the ED and vascular lab.

Methods

—A prospective study was conducted involving ED patients referred for lower-extremity VDU to diagnose DVT. The registered vascular technologist (RVT) assessed the patients before the examination by using a pretest probability (PTP) scoring system for DVT. The results were shared with the ED physicians at regular intervals. For the last 6 months of the project, the RVT made a pretest clinical impression of test outcome. The VDU results, the distribution of pretest scores and the results of the RVT's pretest impression were analyzed.

Results

—A total of 291 ED patients with suspected lower-extremity DVT were assigned a PTP score. Of all positive studies, 72% (36/50) had a high PTP score. A moderate PTP score lacked accuracy for predicting DVT, with 24% (12/50) of the positive and 42% (102/241) of negative exams in this group. A total of 36% (104/291) of the patients had a low PTP score, and the incidence of DVT was 2% (2/104) in this group. Of the total 291 patients, 177 patients had a RVT pretest clinical impression performed. The RVT impression was accurate for the presence of DVT 83% (24/29) of the time. The RVT correctly predicted that there was no DVT in 92% (136/148) of the negative exams. Furthermore, in the moderate PTP group, where the PTP score was not as predictive of the presence or absence of DVT, the RVT impression was accurate 89.5% (60/67) of the time.

Conclusions

—Although a moderate PTP score is not a reliable predictor of a positive VDU, a high score validates the need for a VDU, whereas a low score does not warrant the exam. If ED practitioners consistently used a pretest clinical scoring system, the number of negative examinations could be significantly reduced. In addition, the overall accuracy of the RVT's clinical impression demonstrates that experience in DVT diagnosis can likely improve patient selection for VDU.
Transthoracic Echocardiogram and Transcranial Doppler Detection of Emboli after foam Sclerotherapy of Leg Veins
Authors: Hansen Kristin , Morrison Nick , Neuhardt Diana L. , Salles-Cunha Sergio X.
Published: March 2018

Purpose

Patients with chronic venous insufficiency have been successfully treated with foam sclerotherapy. Reports of cerebral and respiratory symptoms after the foam procedure have been related to an open foramen ovale (PFO) between the right and left sides of the heart. This work evaluated the value of ultrasonography to demonstrate that bubbles may traverse a PFO and may be detected at the middle cerebral artery.

Methods

Patients describing cerebral or respiratory symptoms or suspected of having a PFO entered this study. Cerebral symptoms included visual disturbance, lightheadedness, dizziness and migraine. Respiratory problems included cough. A total of 20 patients had transthoracic echocardiography (TTE), and 12 had transcranial Doppler (TCD) of the middle cerebral artery.

Results

TTE detected bubbles in the left heart in 13 (65%) of 20 patients. The 12 TCDs were performed in nine patients with positive and three with negative TTE evaluation; five TCDs were positive for emboli at the middle cerebral artery. All five patients had positive transthoracic echocardiography.

Conclusions

This single-institution evaluation for quality control demonstrated that 1) patients with cerebral or respiratory symptoms after foam sclerotherapy may have PFO; and 2) patients with patent PFO may embolize the gas particles to the brain. Therefore, patients with known PFO must be evaluated before foam injection, and patients that are candidates for this treatment may have to be screened for PFO.
Tandem High-grade Stenoses in the Innominate and Right Internal Carotid Arteries Diagnosed with Carotid Duplex Ultrasound
Authors: Whitelaw Susan M. , Grattan Alia , Bajzer Christopher , Gornik Heather L.
Published: March 2018

Peak systolic velocity criteria for assessing the severity of internal carotid artery (ICA) stenosis may be inadequate in the setting of a critical proximal lesion. A 54-year-old man with a history of panvascular atherosclerosis presented for re-evaluation of known carotid stenosis. Carotid duplex ultrasound was performed by using B-mode ultrasound (Philips) with color and pulsed Doppler. Velocities within the innominate artery were markedly increased (PSV 553 cm/sec; EDV 211 cm/sec), consistent with high-grade stenosis. Waveforms in the right subclavian and common carotid (CCA) arteries were poststenotic in appearance, and velocity in the distal right CCA was very low (PSV 39 cm/sec). There was an additional step-up in velocity in the proximal right ICA with extensive homogeneous plaque visualized (right ICA PSV 210 cm/sec; EDV 115 cm/sec). Although the ICA lesion did not meet peak systolic velocity or end diastolic velocity criteria for >80% stenosis in our laboratory, the lesion was interpreted as an 80–99% lesion on the basis of the markedly increased ICA/CCA ratio (ICA/CCA ratio 5.38). The left subclavian artery had low, monophasic flow and was likely occluded near its origin with filling from a retrograde vertebral artery. The patient was referred for percutaneous intervention. Angiography confirmed a 99% stenosis of the innominate artery and a 90% stenosis of the right ICA in its proximal portion. The left subclavian artery was occluded. The left CCA arose from a bovine aortic arch. The innominate and right ICA lesions were treated successfully with balloon angioplasty and stenting. Duplex ultrasound is an outstanding diagnostic tool for the evaluation of extracranial carotid and innominate lesions. In the setting of tandem lesions, critical stenosis of the ICA may be missed with reliance on traditional PSV criteria alone. In such cases, interpretation of secondary criteria, particularly the ICA/CCA ratio, is crucial to establish an accurate diagnosis.
Evolving Patterns of Vascular Lab Testing in the Hospital and Private Lab Settings
Authors: Samson Russell H. , Ricci Kerri E. , Manire Ruth , Ramamurthy Rithika
Published: March 2018

Introduction

We evaluated laboratory use in a 600–bed community hospital and a private practice lab. The study spanned from 1996 to 2007.

Method

The hospital laboratory used 5 duplex scanners and 2 physiologic plethysmography units and was staffed by 7 technologists. The private laboratory expanded over time, growing from 4 technologists with 4 duplex scanners and 1 physiologic machine to 7 technologists, 7 duplex scanners, and 3 physiologic units in 2007.

Results

A total of 43.5% of tests performed in the hospital were venous tests in 1999 and 55.5% in 2007. Cerebrovascular scans decreased (32.8% to 23.1%). Lower-extremity arterial tests also decreased. Other tests were uncommon (394 tests, or 5.1%). In the private lab cerebrovascular duplex scans decreased from 36.9% to 24.4%. Lower-extremity physiologic studies remained stable. Aortic scans became more common. Lower-extremity venous scans accounted for 14.2% of studies in 1996 and 11.8% in 2007 but with twice the number of tests.

Conclusion

The hospital laboratory is predominantly involved in the diagnosis of venous thrombosis and cerebrovascular events. The less-used and uncommon studies such as upper-extremity arterial studies and dialysis access studies remain uncommon but are performed in greater volume in the private lab than the hospital.
Renal Artery Duplex Examinations in Neonates
Authors: Blackburn Donna R. , Astleford Patricia , Zurbano Nida , Dwyer Ann , Andrushkiv Myroslava , Pearce William H.
Published: March 2018

Introduction

Hypertension in neonates, although uncommon, may be the result of congenital renal artery stenosis, or, more frequently, coarctation of the aorta. Renal artery duplex examinations have been used in our institution to evaluate neonates. The purpose of this study was to evaluate the efficacy of duplex ultrasound in the evaluation of renal arteries and kidneys in neonates.

Methods

Eleven infants from January 2006 through January 2009 were studied with the use of color duplex ultrasound. Seven examinations were performed for hypertension, one for renal failure, one with increased creatinine, one for suspicion of renal vein thrombosis, and one for hematuria. Protocols were modified during this 3-year period and now consist of examining the kidneys, renal artery, and vein and aorta from both flanks with the use of a 9–3 MHz transducer.

Results

By the use of standard renal artery protocols, 8 neonates were found to be healthy, with the exception that all subjects had greater-than-expected aortic velocities. Two subjects (identical twins) had abnormal signals in the aorta and renal arteries consistent with proximal aortic obstruction. One infant in renal failure had high resistance signals in both kidneys consistent with renal parenchymal disease. Kidney size varied with infant weight and ranged from 2 to 4 cm. Symmetrical measurements were interpreted as normal.

Conclusion

This study demonstrates that duplex examinations in neonates is feasible and that minor adjustments in standard protocol and interpretation criteria allow for adequate assessment to evaluate for vascular causes of hypertension.
ECG Gating is Not Required for Brachial Artery Flow-Mediated Dilation Measurement
Authors: Jaffer Usman , Aslam Mohammed
Published: March 2018

Objectives

Brachial artery flow-mediated dilation is a well-established technique in the noninvasive assessment of endothelial function. Endothelial dysfunction is thought to be a potential precursor of atherosclerosis. In this study we compared the electrocardiogram (ECG) R-wave-gated acquisition of brachial artery measurement versus averaged measurement throughout the cardiac cycle.

Study Design

Cohort study: participant data was analyzed by use o the ECG-gated and nongated techniques and then analyzed.

Materials and Methods

Patients with peripheral vascular disease were studied. Upper limb ischemia was caused by inflating a blood pressure cuff at the right upper arm for 3 minutes. Brachial artery diameter measurements were taken in longitudinal section using a Sonosite Titan ultrasound machine with a 38 mm 5–10 MHz broadband linear array transducer.

Results

Twenty-three participants were tested (10 lower limb claudicants and 13 healthy volunteers). There was good correlation between ECG R-wave gated and nongated measurement R2 = 0.58 and Pearson's correlation coefficient was 0.762 ( p < 0.0001). Bland and Altman's method demonstrated good agreement and no heteroscedastic error.

Conclusions

We suggest that the use of automated image acquisition and analysis throughout the cardiac cycle to be preferable to ECG-gated acquisition. This may be important in the design of clinical trials involving noninvasive assessment of endothelial function.
Lower-Extremity Arterial Continuous-Wave Doppler Evaluation
Authors: Poe Patricia
Published: March 2018

Analysis of continuous-wave Doppler waveforms acquired from peripheral arteries has been a cornerstone of vascular laboratory testing for decades. However, appropriate terminology for describing waveform morphology still remains controversial. Many clinicians classify waveforms on the basis of phasicity because it relates to waveform components that cross the zero baseline in the classic display. Others describe waveforms on the basis primarily of peripheral resistance and its effect on phasic directional changes on flow or on acceleration and deceleration of waveform parameters. Improved diagnostic efficacy may be achieved by combining all of the pertinent components of peripheral arterial waveforms when performing lower-extremity physiologic assessment. This article focuses on the classical use of qualitative peripheral arterial Doppler waveform descriptors with the use of continuous-wave Doppler.
Ultrasound Mapping of Arterial and Venous Patterns of the Upper Extremities in Patients with End-Stage Renal Disease
Authors: Salles-Cunha Sergio X. , Neuhardt Diana L. , Pohle-Schulze Barbara , Neuhardt Marresa , Straight Nicole
Published: March 2018

Objectives

We sought to (1) to determine prevalence of high brachial artery bifurcation, forearm cephalic-arm cephalic connection, forearm cephalic-arm basilic vein alternate connection, and levels of basilic-brachial vein junction; and (2) to compare average diameters of forearm and arm cephalic and basilic venous segments according to the results of ultrasound mapping of the upper extremities (UE).

Methods

Consecutive ultrasound mappings were performed in 100 UE of 23 women, 69 ± 12 (47–84), and 27 men, 62 ± 12 (34–79) years of age. Brachial, radial and ulnar arteries and cephalic and basilic veins were scanned from wrist to axilla.

Results

Brachial artery bifurcation at the proximal/mid arm was noted in 25 UE of 18 subjects. Arm (a) or forearm (f) cephalic (ce) or basilica (ba) veins were absent in 18 (ace), 15 (fce), 10 (aba), and 14 (fba) UE, respectively. A forearm cephalic-arm cephalic vein connection was noted in 67 UE; of these, 9 (13.6%) also had a significant forearm cephalic-arm basilic connection. A primary forearm cephalic-arm basilic connection was noted in 5 UE, one with a secondary connection to the arm cephalic vein. The basilic joined the brachial vein at the proximal, proximal-mid, mid, mid-distal and distal arm in 29, 17, 26, 4, and 2 UE; a complex connection to radial/ulnar veins was noted in 14 UE. Average diameters were 4.2 ± 1.4 (1.2–7.8), 3.1 ± 1.1 (0.6–6.3), 2.9 ± 0.9 (1.4–4.9), and 2.2 ± 0.9 (0.7–4.5) mm for the arm basilic, arm cephalic, forearm cephalic and forearm basilic veins.

Conclusions

A significant prevalence of anatomical anomalies was noted, justifying mapping of the upper extremity vasculature prior to planning an arteriovenous fistula or prosthetic graft in patients with end-stage renal disease.
Occurrence of Simultaneous Left Ventricular Mural Thrombus and a Fresh Floating Thrombus in the Left Common Carotid Artery
Authors: Medepalli Lalitha C. , Braum Paul F. , Tummala Pradyumna E. , Yen Andrew D.
Published: March 2018

Stroke is the third-leading cause of death in the United States after cardiovascular disease and cancer. It remains the leading cause of serious long-term disability in the United States. Mechanisms of ischemic stroke include embolism, decreased perfusion, and thrombosis. Cardio-embolism, defined as a source of embolus originating from the heart, may account for an estimated 20% of ischemic strokes. Intracavity thrombus from wall motion abnormalities, especially in the first 2 weeks after anterior myocardial infarction, has been described as a potential cardiac source of emboli. The finding of an LV apical thrombus detected by transthoracic echocardiography as a possible embolic source and the simultaneous discovery of a fresh floating thrombus in the left common carotid artery as detected by duplex ultrasonography are rare findings. We report a case of a 77-year-old man with both of these findings with signs and symptoms of a myocardial infarction with late presentation. Trans-thoracic echocardiography revealed an echo density consistent with mural thrombus that was located adjacent to the severely hypokinetic left ventricular apical wall. A carotid duplex revealed a totally occluded left common carotid artery with an echo density suggestive of thrombus. Atheromatous deposits in the extra-cranial carotid arteries may cause localized thrombosis. However, a free-floating thrombus in the carotid artery could be a result of a cardiac source of embolism. Cardioembolic syndromes typically presents as emergencies. Prompt diagnosis and urgent optimal medical and surgical treatments are warranted because these patients have an increased risk for distal embolization and vessel occlusion that lead to severe disability or death.
Virtual Guidance Ultrasound: A New Instructional Concept for Untrained Scanners
Authors: Caine Timothy L. , Martin David S. , Matz Timothy , Lee Stuart M. C. , Stenger Michael B. , Platts Steven H.
Published: March 2018

Successful acquisition of high-quality ultrasound images for medical diagnoses and scientific research entails several years of intensive training. This time commitment, combined with training requirements for space flight operations, precludes astronauts from proficiently conducting ultrasound examinations without assistance. Therefore, experts in the Johnson Space Center Cardiovascular Laboratory developed a technique called Remote Guidance in which astronauts who possess limited ultrasound training before they launch perform ultrasound examinations in space while receiving real-time feedback about ultrasound probe positioning, scanning technique, study protocol, and image quality through two-way, real-time communication with sonographers on the ground. For instances when time and distance make two-way communication impractical, such as during a mission to Mars or an asteroid, we have developed a form of “just-in-time training” called Virtual Guidance that allows astronauts to autonomously obtain diagnostic ultrasound images by viewing ultrasound tutorials using audio-video glasses while simultaneously performing ultrasound scans. We recently conducted two trials in which we demonstrated the ability of untrained scanners to complete carotid artery and ophthalmic examinations using Virtual Guidance as their only form of instruction. Virtual Guidance can be an important training tool to ensure high-quality ultrasound imaging for scientific and medical applications during future space exploration missions and also could be valuable on Earth in remote areas or applications when a trained sonographer is not readily accessible.
Standing versus Supine Evaluation for Superficial Venous Reflux
Authors: Carty George A. , Steele Janelle L. , Clemens John
Published: March 2018

Objective

—The established belief in the absolute need to perform duplex ultrasound evaluations for venous insufficiency in the standing position continues to be, in our view, an unsettled issue. To our knowledge the circumstances when a supine examination is both accurate and advantageous have not been prospectively evaluated or definitively resolved. The primary purpose of this study was to address this problem.

Methods

—To address this issue, 645 lower-limb venous segments were examined in 72 consecutive patients, first supine and subsequently in the standing position. Valsalva maneuver and manual compressions were used as provocative maneuvers. Measurements of reflux duration were recorded. Reflux was considered positive if the measurement was ≥0.5 sec. The length of the examination as well as the degree of patient and examiner ease and comfort also were noted.

Results

—We observed that when reflux at the saphenofemoral junction in the initial supine examination was ≥1.13 sec in duration, reflux ≥0.5 sec was always present during the standing examination ( p < 0.001). We also noted that reflux duration at all levels was consistently greater in the supine position with a tendency for such differences to increase distally.

Conclusion

—Testing in the standing position only needs to be performed if the initial supine evaluation demonstrates reflux <1.13 sec in duration.
Common Carotid Dissection following a Bike Injury—Unusual Cause of Carotid Bruit
Authors: Dan Mei , Nguyen Lisa , Pak Laura K.
Published: March 2018

Carotid dissection is not typically a diagnosis made on ultrasound in an asymptomatic individual. Several factors made this case unique in the literature, including the fact that the dissection was in the distal common carotid artery rather than internal carotid, which allowed the injury to be directly visible by ultrasound. Rather than presenting with acute transient ischemic attack or stroke, headache, or cranial nerve palsy, this patient was referred for an asymptomatic bruit several months after the trauma, which presumably caused the dissection. The lesion identified by ultrasound was unusual, with a high-grade stenosis created by a mobile flap in the artery.
Splenic Artery Aneurysms and Hepatic Artery Dissection
Authors: Jackson Adam E.
Published: March 2018

Abdominal aorta aneurysms (AAAs) are common in the vascular field. Testing for this phenomenon is rather easy; simply order an AAA screening via ultrasound. What is not common, however, is finding an aneurysm of the much smaller branches of the splanchnic arteries. These arteries consist of the celiac artery (CA), common hepatic artery (CHA), splenic artery (SA), gastric artery, and superior mesenteric (SMA) and inferior mesenteric arteries (IMA). The most common aneurysm location in these vessels is the SA. These aneurysms can prove fatal if ruptured and are most dangerous in young women who are pregnant and of child bearing age. Even more rare than SA, aneurysms are hepatic artery aneurysms and dissections. In one case study from 1995, there had only been 12 cases documented with isolated hepatic artery dissection. With the increase in technology and imaging modalities, small visceral aneurysms are now found much more prevalently. Treatment options for these unique problems are still under debate, as there are a limited number of occurrences and the ability to accurately track the progression of the aneurysms has improved.
“The Entrepreneurial Gamer”: Regendering the Order of Play
Authors: Jenson Jennifer , de Castell Suzanne
Published: March 2018

The designation “gamer” is structurally bound to networked economies of digital play that are rewarded fiscally, socially, and publically, an order of play that is proving difficult to overturn. That girls and women have enjoyed at best marginal positions within video game cultures is by now well recognized, yet at the very same time is too easily dismissed in light of persuasively documented increases in the numbers of women who play. This article traces a large-scale transformation of ludic engagement from participation to spectatorship that parallels the professionalizing and commodifying of traditionally embodied sports, games, and play to demonstrate how new and emerging economies of gameplay, far from opening up the playing field, threaten a further entrenchment of gendered relations.
The Use of Botulinum Toxin Injection for Brachial Plexus Birth Injuries: A Systematic Review of the Literature
Authors: Buchanan Patrick J. , Grossman John A. I. , Price Andrew E. , Reddy Chandan , Chopan Mustafa , Chim Harvey
Published: March 2018

Background: Most brachial plexus birth injuries (BPBIs) are caused by traction on the brachial plexus during a difficult delivery. Fortunately, the possibility of complete recovery from such an incident is relatively high, with only 10% to 30% of patients having prolonged and persistent disability. These patients have muscle imbalances and co-contractions typically localized around the shoulder and elbow. These imbalances and co-contractures cause abnormal motor performances and bone/joint deformities. Typically, physical/occupational therapies are the conventional therapeutic modalities but are often times inadequate. Botulinum toxin A (BTX-A) injections into targeted muscles have been used to combat the muscular imbalances and co-contractions. Methods: With compliance to PRISMA guidelines, a systematic review was performed to identify studies published between 2000 and 2017 that used BTX-A to treat neonatal brachial plexus palsies. Results: Ten studies were included, involving 325 patients. Three groups of indications for the use of BTX-A were identified: (1) internal rotation/adduction contracture of the shoulder; (2) elbow flexion lag/elbow extension lag; and (3) forearm pronation contracture. Conclusions: The included studies show an overall beneficial effect of BTX-A in treating co-contractures seen in patients with BPBI. Specifically, BTX-A is shown to reduce internal rotation/adduction contractures of the shoulder, elbow flexion/extension contractures, and forearm pronation contractures. These beneficial effects are blunted when used in older patients. Nevertheless, BTX-A is a useful treatment for BPBIs with a relatively low-risk profile.
Will the “new biology” Affect the Future of Histopathology?
Authors: Carbone A.
Published: March 2018

The technologies used in histopathology are changing as a consequence of the current revolutionary progress in several areas of biology. It is likely that general cancer management will improve because of the impact of molecular techniques and immunohistochemistry on tumor diagnosis and classification and on the determination of prognosis and response to therapy. Moreover, as therapies are starting to be modelled after the distinctive molecular characteristics of a specific tumor, the availability of molecular tests to all patients will become a matter of great importance.