bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Model Hands for Learning Orthotic Fabrication
Authors: Hagemann Eric , Williams Camille K. , McKee Pat , Stefanovich Andonia , Carnahan Heather
Published: December 2013

Trainees could benefit from practicing orthotic fabrication on simulated hands with joint deformities. As a first step toward such training, we explored the use of a nonpathological model hand. Twenty-one participants were randomized into one of two groups that practiced using a person’s right hand or a model right hand. One week later, all participants returned for a transfer test in which they made one orthosis on a person’s left hand. All participants’ performance and orthoses were evaluated using a validated checklist and a global rating scale (GRS). Fabrication time for each orthosis also was recorded. The GRS score and fabrication time changed significantly over the course of practice. Trainees who practiced with the model hand made better orthoses during practice and on the transfer test, as measured with the checklist’s final product subscore. Instructional and contextual factors that may affect trainees’ performance and learning are discussed.
Method for the Systematic Reviews on Occupational Therapy and Neurodegenerative Diseases
Authors: Arbesman Marian , Lieberman Deborah , Berlanstein Debra R.
Published: December 2013

Systematic reviews of the literature relevant to neurodegenerative diseases, including Parkinson’s disease (PD), multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS), are important to the practice of occupational therapy. We describe the four questions that served as the focus for systematic reviews of the effectiveness of occupational therapy interventions for PD, MS, and ALS. We include the background for the reviews; the process followed for addressing each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the themes of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented.
Five Years of Mental Health Research in the American Journal of Occupational Therapy, 2009–2013
Authors: Gutman Sharon A. , Raphael-Greenfield Emily I.
Published: December 2013

In the past 5 years, the number of research articles on occupational therapy in mental health published in the American Journal of Occupational Therapy has steadily declined. This article identifies the strengths and limitations of this body of research and provides directions for practitioners and researchers to enhance the profession’s role as a valued mental health service provider.
Defining the Value of Occupational Therapy: A Health Policy Lens on Research and Practice
Authors: Lamb Amy Jo , Metzler Christina A.
Published: December 2013

As occupational therapy leaders position the profession to seize opportunities within the landmark policy shift created by the Affordable Care Act, it is essential to identify, produce, and effectively use evidence demonstrating the value of occupational therapy to nurture the growth of the profession.
Concise Review: Skeletal Muscle Stem Cells and Cardiac Lineage: Potential for Heart Repair
Authors: Hassan Narmeen , Tchao Jason , Tobita Kimimasa
Published: December 2013

Valuable and ample resources have been spent over the last two decades in pursuit of interventional strategies to treat the unmet demand of heart failure patients to restore myocardial structure and function. At present, it is clear that full restoration of myocardial structure and function is outside our reach from both clinical and basic research studies, but it may be achievable with a combination of ongoing research, creativity, and perseverance. Since the 1990s, skeletal myoblasts have been extensively investigated for cardiac cell therapy of congestive heart failure. Whereas the Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC) trial revealed that transplanted skeletal myoblasts did not integrate into the host myocardium and also did not transdifferentiate into cardiomyocytes despite some beneficial effects on recipient myocardial function, recent studies suggest that skeletal muscle-derived stem cells have the ability to adopt a cardiomyocyte phenotype in vitro and in vivo. This brief review endeavors to summarize the importance of skeletal muscle stem cells and how they can play a key role to surpass current results in the future and enhance the efficacious implementation of regenerative cell therapy for heart failure.
Targeting the Hypoxia-Sensing Pathway in Clinical Hematology
Authors: Forristal Catherine E. , Levesque Jean-Pierre
Published: December 2013

Hypoxia-inducible factors (HIFs) are oxygen-sensitive transcription factors regulated by oxygen-dependent prolyl hydroxylase domain (PHD) enzymes and are key to cell adaptation to low oxygen. The hematopoietic stem cell (HSC) niche in the bone marrow is highly heterogeneous in terms of microvasculature and thus oxygen concentration. The importance of hypoxia and HIFs in the hematopoietic environment is becoming increasingly recognized. Many small compounds that inhibit PHDs have been developed, enabling HIFs to be pharmacologically stabilized in an oxygen-independent manner. The use of PHD inhibitors for therapeutic intervention in hematopoiesis is being increasingly investigated. PHD inhibitors are well established to increase erythropoietin production to correct anemia in hemodialysis patients. Pharmacological stabilization of HIF-1α protein with PHD inhibitors is also emerging as an important regulator of HSC proliferation and self-renewal. Administration of PHD inhibitors increases quiescence and decreases proliferation of HSCs in the bone marrow in vivo, thereby protecting them from high doses of irradiation and accelerating hematological recovery. Recent findings also show that stabilization of HIF-1α increases mobilization of HSCs in response to granulocyte colony-stimulating factor and plerixafor, suggesting that PHD inhibitors could be useful agents to increase mobilization success in patients requiring transplantation. These findings highlight the importance of the hypoxia-sensing pathway and HIFs in clinical hematology
Impact of dose rounding of cancer therapy on cost avoidance: a pilot study
Authors: Ibrahim Nagwa
Published: December 2013

BACKGROUND: A significant and progressive cost rising in medical oncology due to the incorporation of novel and highly expensive drugs into clinical practice have been seen in the past ten years. Dose rounding is an option might be used in oncology settings to avoid extra cost. The purpose of this project is to determine the theoretical cost saving related to a dose rounding process for biological and chemotherapy agents in adult oncology settings and to determine the opinion of oncologists about dose rounding.MATERIALS AND METHODS: Data was obtained prospectively during April 2011. All chemotherapy and targeted therapy orders prescribed in adult oncology outpatient clinics as well as in-patient wards have been collected. We considered rounding to an amount within 15% for targeted therapy and 10% for cytotoxic drugs. Chemotherapy dosing was calculated according to body surface area. Prescriptions that include cancer therapy in doses that might be rounded according to study criteria were identified.RESULTS: Two hundred and thirty three orders of chemotherapy and targeted therapy were processed by Adult Oncology Satellite Pharmacy during the period of data collection. Forty percent of the collected prescriptions fulfilled the criteria. The potential cost savings from dose rounding per year was $192,800. Data was extrapolated from the determined monthly cost savings. The highest cost saving was for breast cancer orders $80,820 (42%), followed by colorectal cancer $47,965 (25%), while in non-Hodgkin's lymphoma cost savings was $ 45,107 (23%) and for other types of cancer that include non small cell lung cancer, prostate and ovarian cancer, in addition to head and neck cost savings was $18,867 (10%).CONCLUSIONS: Our experience confirms the significant cost savings of cancer therapy by applying dose rounding to chemotherapy and biologic drugs prescriptions. While clinical impact of the suggested percentage needs to be evaluated.
Multiple frequency bioimpedance is an adequate tool to assess total and regional fat mass in HIV‐positive patients but not to diagnose HIV‐associated lipoatrophy: a pilot study
Authors: Pérez‐Matute Patricia , Pérez‐Martínez Laura , Blanco José R , Ibarra Valvanera , Metola Luis , Sanz Mercedes , Hernando Luis , Martínez Sagrario , Ramírez Arsenio , Ramalle‐Gomara Enrique , Oteo José A
Published: December 2013

Introduction

HIV‐associated lipodystrophy syndrome causes systemic metabolic alterations and psychological distress that worsen the quality of life of these patients. An early detection should be considered to efficiently treat it. Objective criteria or reference indices are needed for an early diagnosis. Bioelectrical Impedance Analysis (BIA) is an operator‐independent, repeatable and non‐invasive method of body composition evaluation that is less expensive than dual‐energy X‐ray absorptiometry (DXA) and/or CT scans. The aims of this pilot study were to validate the data obtained by BIA to measure fat mass in HIV‐positive patients with/without lipoatrophy and to determine if BIA correctly diagnoses lipoatrophy in HIV‐positive patients.

Methods

Thirty‐nine participants were included in this preliminary study. Fourteen were HIV‐negative (eight men) whereas 25 were HIV‐positive patients (17 men). Eleven of the HIV‐positive patients were classified as lipoatrophic according to subjective evaluation by the physicians. Total and regional body composition was measured in basal conditions by DXA and by BIA. To obtain abdominal CT scan fat values, transverse slices with 6‐mm thickness were acquired at the L4‐L5 intervertebral space.

Results

BIA measurements of total and regional body fat were significantly correlated with those obtained by DXA (p < 0.05 to <0.01) in HIV‐positive patients. However, agreement between methods was poor as not very high ICC (intraclass correlation coefficient) values were observed. BIA and DXA showed higher ICC values in lipoatrophic patients. The visceral index obtained by BIA was correlated with total and visceral fat in L4 measured by CT scan (r = 0.607 and r = 0.617, respectively, p < 0.01) in HIV‐positive patients. The Fat Mass Ratio (FMR) calculated by BIA did not correlate or agree with DXA values.

Conclusions

Multi‐frequency BIA could be an effective method to evaluate the evolution of total and regional fat composition in HIV‐positive patients with/without lipoatrophy. The correlations between BIA and DXA improved in lipoatrophic patients and in men, suggesting that its efficacy depends on fat mass, gender and probably other factors. The visceral index obtained by BIA seems to be a reliable indicator of abdominal obesity. However, BIA did not fulfil the need for easy quantitative diagnostic tools for lipoatrophy, and it did not provide sufficient diagnostic cut‐off values for this syndrome.
Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
Authors: Sandella Jeanne M. , Smith Larissa A. , Gallagher Laurie A. , Langenau Erik E.
Published: December 2013

Context: A health care team depends on the accurate documentation of the patient-physician encounter, be it written or electronic. If documentation is inaccurate or incomplete, patient care may be adversely affected. Previous studies have identified factors that influence documentation errors, such as fatigue, carelessness, and being overworked. More research, however, is needed into the patterns of errors and, by extension, these patterns' potential effect on patient care. Insights about these areas would be valuable to practicing physicians, as well as to medical educators, who could incorporate such insights into the training of medical students.

Objective: To identify potential patterns of commissive documentation errors on SOAP notes during the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE); specifically, to calculate the frequency with which specific items are misrepresented in SOAP (subjective, objective, assessment, plan) notes and to explore patterns of misrepresentation in relation to the documentation of history taking and physical examination.

Methods: Among the 12,510 candidates tested between July 2007 and June 2010, there were 24 candidates who failed the COMLEX-USA Level 2-PE because they misrepresented clinical findings on SOAP notes. These errors of commission (over-documentation) were categorized as errors in either history-taking or physical examination, and then subcategorized and analyzed to determine if meaningful patterns in the documentation of these errors occurred.

Results: A total of 662 errors were recorded among the 24 candidates. History-taking items were more often misrepresented (n=378) than physical examination items (n=284). Patient history—a subcategory that included past medical, surgical, medication, allergy, and family histories—was more likely to be misrepresented than other subcategories under history taking (eg, “history of present illness” and ”associated symptoms”) and many physical examination subcategories. Results of the analysis indicated that the misrepresentations were not evenly distributed (

χ
10
2

=
323.1

; P<.01): candidates whose SOAP notes contained misrepresentations were statistically more likely to misrepresent in some categories rather than in others.

Conclusion: Physicians and medical students should pay particular attention to patient history, lifestyle history, and neurologic examination to minimize the risk of documentation errors.
A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
Authors: Gevitz Norman
Published: December 2013

This article is the first installment in a series of 6 articles on the history of and controversies related to the DO degree. Four questions about the origins of osteopathy and the initial use of the DO designation will be addressed in this particular article. First, did Andrew Taylor Still earn an MD diploma?—he being invariably described as an MD in current osteopathic periodical literature. Second, what was the importance of “magnetic healing” in the evolution of Still's thought? Third, how did the principles and practice of “bonesetting” complete his new system? Finally, when did he originate the termosteopathyand first devise and employ the DO designation? Future articles will examine episodically the history of the DO degree from Still's establishment of the American School of Osteopathy in 1892 up through to the present debate over its significance and value.
A Research Primer, Part 2: Guidelines for Developing a Research Project
Authors: Yens David P. , Brannan Grace D. , Dumsha Jane Z.
Published: December 2013

In this article, the second in a series on the basic concepts of research, the authors review aspects of research design including participant considerations, randomization, reliability and validity of measurements, and data collection and management. The authors also discuss considerations for research using questionnaires and tests. The goal of this article is to assist the novice researcher in identifying potential problems that must be addressed during the design of a research project.
A Case of Seasonal Recurrent Myopericarditis
Authors: Divoky Laura , Wilford Rex D.
Published: December 2013

Myopericarditis occurs in 15% of patients with pericarditis. Recurrent myopericarditis occurs in 15% to 30% of patients after partial or complete recovery from acute myopericarditis. Relapse often occurs within 1 month of an initial episode. The standard of care for pericarditis or myopericarditis is initial treatment with nonsteroidal anti-inflammatory drugs for 10 to 14 days. Colchicine is often administered for 3 to 6 months for residual chest pain due to myopericarditis. The authors present a case of seasonal recurrent myopericarditis in a 32-year-old man who presented with severe chest pain in nearly the same month for 4 consecutive years. The authors conducted an extensive review of the literature but found no other case reports of seasonal recurrent myopericarditis. If a patient presents with severe chest pain requiring hospitalization, physicians should consider prescribing nonsteroidal anti-inflammatory drugs or colchicine before seasonal symptom recurrence.
A Case of Idiopathic Colonic Varices
Authors: Speicher Matthew V. , Keegan Michael T. , Kirk Kathryn E.
Published: December 2013

Colonic varices, usually detected by means of colonoscopy, are extremely rare and typically indicative of portal hypertension or chronic hepatopathology. Even more rare are those cases with no underlying disease, or idiopathic colonic varices. The authors report a case of these unexplained varices found during colonoscopy of a 30-year-old man with a 10-year history of diarrhea and occasional bloody stool. A thorough workup was performed, revealing no underlying abnormalities for his varices. Additionally, the authors review the literature of this rare diagnosis. Physicians must rule out hepatic, vascular, and cardiac causes before classifying a case of varices as idiopathic.
Use of Contrast‐Enhanced Sonography to Investigate Intraneural Vascularity in a Cohort of Macaca fascicularis With Suspected Median Mononeuropathy
Authors: Evans Kevin D. , Volz Kevin R. , Pargeon Rachel L. , Fout Larry T. , Buford John , Roll Shawn C.
Published: December 2013

Objectives

The purpose of this study was to provide clinical evidence of the use of contrast‐enhanced sonography in detecting and quantifying changes in intraneural vascularity due to median mononeuropathy.

Methods

Five Macaca fascicularis monkeys were exposed to 20 weeks of repetitive work to increase their risk of developing median mononeuropathy. Contrast‐enhanced sonograms were obtained in 30‐second increments for 7 minutes while a contrast agent was being delivered. Data were collected immediately at the conclusion of the 20‐week work exposure and then again during a recovery phase approximately 3 months after the completion of work. Quantitative analysis and trend graphs were used to analyze median nerve perfusion intensity. This study also compared the use of both manual counting of pixels and semiautomatic measurement using specialized software.

Results

Based on the average data, maximum intensity values were identified as the best indicators of nerve hyperemia. Paired t tests demonstrated significantly higher maximum intensities in the working stage for 4 of the 5 subjects (P < .01).

Conclusions

This study provides preliminary evidence that (1) in a controlled exposure model, a change in intraneural vascularity of the median nerve between working and recovery can be observed; (2) this vascular change can be measured using an objective technique that quantifies the intensity of vascularity; and (3) contrast‐enhanced sonography may improve the ability to reliably capture and measure low‐flow microvascularity.
Correlation Between Systolic Deformation and Dyssynchrony Indices and the Grade of Left Ventricular Hypertrophy in Hypertensive Patients With a Preserved Systolic Ejection Fraction Undergoing Coronary Angiography, Based on Tissue Doppler Imaging
Authors: Zoroufian Arezoo , Razmi Tannaz , Savandroomi Zahra , Tokaldany Masoumeh Lotfi , Sadeghian Hakimeh , Sahebjam Mohammad , Jalali Arash
Published: December 2013

Objectives

The purpose of this study was to investigate whether systolic mechanical dyssynchrony occurs in hypertensive patients with a normal coronary artery and a normal ejection fraction and its relationship with different degrees of left ventricular (LV) hypertrophy.

Methods

A total of 125 angiographically normal coronary patients (42.4% male; mean age ± SD, 57.16 ± 8.26 years) with an ejection fraction greater than 50% were included, of which 84 were hypertensive and 41 normotensive. The hypertensive patients were categorized into 3 groups: no, mild, and moderate LV hypertrophy. Tissue Doppler and deformation imaging parameters were measured in the 6 LV basal segments at peak systole.

Results

The frequency of dyssynchrony was 40.5% in the hypertensive patients compared to 19.5% in the control patients (P = .020). Among the hypertensive patients, LV dyssynchrony was found in 5 patients (20%) with no hypertrophy, 20 (42.6%) with mild hypertrophy, and 9 (75%) with moderate hypertrophy. There was a moderate correlation between the grade of hypertrophy and septal‐lateral wall delay (r = 0.497), 6–basal segment delay (r = 0.454), overall strain (r = 0.453), overall peak systolic velocity (r = −0.430), and standard deviation of the time to peak systolic velocity in the basal segments (r = 0.429). After adjustment for the LV end‐systolic diameter and body surface area, overall strain was the best correlate of the hypertrophy grade (odds ratio, 7.043; 95% confidence interval, 1.839–26.980; P = .0044).

Conclusions

Among tissue Doppler and deformation indices, overall peak systolic strain was the strongest correlate of the LV hypertrophy grade. Therefore, in hypertensive patients with normal cardiac systolic function, a reduction in overall strain in the 6 basal LV segments may be a good indicator of progression of the LV hypertrophy grade and systolic dysfunction.
Strain Elastography for Prediction of Breast Cancer Tumor Grades
Authors: Grajo Joseph R. , Barr Richard G.
Published: December 2013

Objectives

The purpose of this study was to determine whether the elasticity imaging/B‐mode ratio on strain elastography can predict breast cancer tumor grades.

Methods

A retrospective review of patients with breast lesions who underwent strain elastography and had a diagnosis of breast cancer by image‐guided or surgical biopsy was performed. The axis of the maximum elastographic dimension was compared to the B‐mode dimension to form an elasticity imaging/B‐mode ratio. Lesions were categorized according to their pathologic type, including atypical ductal hyperplasia (ADH), mucinous or colloid cancer, ductal carcinoma in situ (DCIS), grade I invasive ductal carcinoma (IDC), grade II IDC, grade III IDC, invasive lobular carcinoma (ILC), and lymphoma. The mean elasticity imaging/B‐mode ratio of each tumor type was calculated. The elasticity imaging/B‐mode ratio of the tumor was compared to the tumor type by Kruskal‐Wallis and Tukey‐Kramer tests (lymphoma and ADH excluded because of small numbers).

Results

Tumor grades included lymphoma (n = 3), ADH (n = 2), mucinous cancer (n = 11), DCIS (n = 19), IDC (grades I–III; n = 200), and ILC (n = 31). The mean elasticity imaging/B‐mode ratio varied with increasing tumor grade. Tumor grades could not have been selected at random from one population (P < .0001, χ2 test). Invasive lobular carcinoma and grade III IDC were statistically different from mucinous or colloid cancer, DCIS, and grade I and II IDC.

Conclusions

The elasticity imaging/B‐mode ratio on strain elastography is related to the tumor grade.
First‐Trimester Sonographic Prediction of Obstetric and Neonatal Outcomes in Monochorionic Diamniotic Twin Pregnancies
Authors: Allaf M. Baraa , Vintzileos Anthony M. , Chavez Martin R. , Wax Joseph A. , Ravangard Samadh F. , Figueroa Reinaldo , Borgida Adam , Shamshirsaz Amir , Markenson Glenn , Davis Sarah , Habenicht Rebecca , Haeri Sina , Ozhand Ali , Johnson Jeffery , Sangi-Haghpeykar Haleh , Spiel Melissa , Ruano Rodrigo , Meyer Marjorie , Belfort Michael A. , Ogburn Paul , Campbell Winston A. , Shamshirsaz Alireza A.
Published: December 2013

Objectives

The purpose of this study was to investigate whether discordant nuchal translucency and crown‐rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes.

Methods

We conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11‐week to 13‐week 6‐day sonographic examination who had serial follow‐up sonography until delivery. Isolated nuchal translucency, crown‐rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin‐twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted.

Results

Fifty‐four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52–0.72), and 0.54 (95% confidence interval, 0.46–0.61), respectively.

Conclusions

In our population, nuchal translucency, crown‐rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.
Natural History of Vasa Previa Across Gestation Using a Screening Protocol
Authors: Rebarber Andrei , Dolin Cara , Fox Nathan S. , Klauser Chad K. , Saltzman Daniel H. , Roman Ashley S.
Published: December 2013

Objectives

The purpose of this study was to estimate the prevalence and persistence rate of vasa previa in at‐risk pregnancies using a standardized screening protocol.

Methods

We conducted a descriptive study of patients with a diagnosis of vasa previa from a single ultrasound unit between June 2005 and June 2012. Vasa previa was defined as a fetal vessel within 2 cm of the internal cervical os on transvaginal sonography. Screening for vasa previa using transvaginal sonography with color flow mapping was performed routinely in the following situations: resolved placenta previa, prior pregnancy with vasa previa, velamentous insertion of the cord in the lower uterine segment, placenta succenturiata in the lower uterine segment, and twin gestations.

Results

A total of 27,573 patients were referred to our unit for fetal anatomic surveys over the study period. Thirty‐one cases of vasa previa were identified, for an incidence of 1.1 per 1000 pregnancies. Twenty‐nine cases had full records available for analysis. Five patients (17.2%) had migration and resolution of the vasa previa. When the diagnosis was made during the second trimester (<26 weeks), there was a 23.8% resolution rate (5 of 21); when the diagnosis was made in the third trimester, none resolved (0 of 8 cases). Of the 24 pregnancies (5 twin gestations and 19 singleton gestations) with persistent vasa previa, there was 100% perinatal survival and a median length of gestation of 35 weeks (range, 27 weeks 5 days–36 weeks 5 days). No known missed cases were identified over the study period.

Conclusions

The use of standardized screening for vasa previa based on focused criteria was found to be effective in diagnosing vasa previa, with a 100% survival rate. Vasa previa diagnosed during the second trimester resolves in approximately 25% of cases.
Likelihood Ratio of Sonohysterographic Findings for Discriminating Endometrial Polyps From Submucosal Fibroids
Authors: Bhaduri Mousumi , Tomlinson George , Glanc Phyllis
Published: December 2013

Objectives

The purpose of this study was to determine which combination of sonohysterographic features has the highest likelihood ratios (LRs) in discriminating polyps from submucosal fibroids.

Methods

This retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure resulting in a positive pathologic diagnosis. A reader, masked to the imaging and pathologic findings, independently reviewed the 200 sonograms and recorded the findings using a standardized checklist for sonographic features on sonohysterography. The features assessed included angle, echogenicity, endometrial‐myometrial interface, and vascular pattern, among others. The reader chose one final diagnosis from the list of possibilities, which included normal, hyperplasia, polyp, submucosal fibroid, cancer, adhesions, and clots. Sonographic observations were then compared to pathologic findings.

Results

The LR of 13.4 was achieved for polyps when there was a combination of an intact endometrial‐myometrial interface, a single vessel, an acute angle, and homogeneous echogenicity. The highest LR of 27.8 was achieved for submucosal fibroids when the combination of sonographic features included an absent endometrial‐myometrial interface, an arborized/multiple vascular pattern, an obtuse angle, and heterogeneous echogenicity.

Conclusions

A combination of sonographic findings may provide high LRs for discriminating endometrial polyps from submucosal fibroids.
Sonography of Female Genital Hernias Presenting as Labia Majora Masses
Authors: Patel Bhargavi , Zivin Sean , Panchal Neil , Wilbur Andrew , Bresler Michael
Published: December 2013

Inguinal herniation of the ovary or uterus presenting as a labia majora mass is a rare congenital condition that may be complicated by strangulation, torsion, and infertility. A labial mass in a prepubertal female patient can represent an inguinal hernia, a hydrocele of the canal of Nuck, a congenital labial cyst, leiomyoma, an abscess, lipoma, or lymphangioma. With a large differential diagnosis and an often limited physical examination, imaging plays an importance diagnostic role. We present 3 cases in which a labial mass contained an ovary alone and both ovaries and the uterus. We demonstrate sonographic findings and discuss the utility of sonography in the diagnosis of genital hernias and in detecting potential complications.
The Fetal Urinoma Revisited
Authors: Yitta Silaja , Saadai Payam , Filly Roy A.
Published: December 2013

The fetal urinoma is a rare but important diagnosis, as it indicates substantial underlying obstruction with implications for the functionality of the affected kidney. This case series describes a single center's experience with the diagnosis and management of fetal urinomas. All 25 cases were diagnosed or referred to our medical center over an 11‐year period. Most cases were secondary to either posterior urethral valves or ureteropelvic junction obstruction. Fetal interventions, including percutaneous drainage of the urinoma and cystoscopic alleviation of bladder outlet obstruction, were performed in 4 cases.
Point‐of‐Care Ultrasound Education
Authors: Lewiss Resa E. , Hoffmann Beatrice , Beaulieu Yanick , Phelan Mary Beth
Published: December 2013

This article reviews the current technology, literature, teaching models, and methods associated with simulation‐based point‐of‐care ultrasound training. Patient simulation appears particularly well suited for learning point‐of‐care ultrasound, which is a required core competency for emergency medicine and other specialties. Work hour limitations have reduced the opportunities for clinical practice, and simulation enables practicing a skill multiple times before it may be used on patients. Ultrasound simulators can be categorized into 2 groups: low and high fidelity. Low‐fidelity simulators are usually static simulators, meaning that they have nonchanging anatomic examples for sonographic practice. Advantages are that the model may be reused over time, and some simulators can be homemade. High‐fidelity simulators are usually high‐tech and frequently consist of many computer‐generated cases of virtual sonographic anatomy that can be scanned with a mock probe. This type of equipment is produced commercially and is more expensive. High‐fidelity simulators provide students with an active and safe learning environment and make a reproducible standardized assessment of many different ultrasound cases possible. The advantages and disadvantages of using low‐ versus high‐fidelity simulators are reviewed. An additional concept used in simulation‐based ultrasound training is blended learning. Blended learning may include face‐to‐face or online learning often in combination with a learning management system. Increasingly, with simulation and Web‐based learning technologies, tools are now available to medical educators for the standardization of both ultrasound skills training and competency assessment.
Trained Simulated Ultrasound Patients
Authors: Blickendorf J. Matthew , Adkins Eric J. , Boulger Creagh , Bahner David P.
Published: December 2013

Objectives

Medical educators must develop ultrasound education programs to ensure that future physicians are prepared to face the changing demands of clinical practice. It can be challenging to find human models for hands‐on scanning sessions. This article outlines an educational model from a large university medical center that uses medical students to fulfill the need for human models.

Methods

During the 2011–2012 academic year, medical students from The Ohio State University College of Medicine served as trained simulated ultrasound patients (TSUP) for hands‐on scanning sessions held by the college and many residency programs. The extracurricular program is voluntary and coordinated by medical students with faculty supervision. Students receive a longitudinal didactic and hands‐on ultrasound education program as an incentive for serving as a TSUP.

Results

The College of Medicine and 7 residency programs used the program, which included 47 second‐year and 7 first‐year student volunteers. Participation has increased annually because of the program's ease, reliability, and cost savings in providing normal anatomic models for ultrasound education programs. A key success of this program is its inherent reproducibility, as a new class of eager students constitutes the volunteer pool each year.

Conclusions

The TSUP program is a feasible and sustainable method of fulfilling the need for normal anatomic ultrasound models while serving as a valuable extracurricular ultrasound education program for medical students. The program facilitates the coordination of ultrasound education programs by educators at the undergraduate and graduate levels.
Diagnostic Value of an Automated Breast Volume Scanner for Abdominal Hernias
Authors: Diao Xuehong , Chen Yue , Qiu Zhiying , Pang Yun , Zhan Jia , Chen Lin
Published: December 2013

Objectives

This study explored the diagnostic values of an automated breast volume scanner (ABVS) for abdominal external hernias.

Methods

Conventional sonograms and ABVS images from 128 abdominal external hernias in 104 patients (98 male and 6 female; age range, 41–79 years; mean age ± SD, 68.0 ± 14.6 years) were analyzed. The results were identified by surgical outcomes. The hernia type, hernial ring position, hernial sac size, hernia content, and hernia structure were evaluated by both sonographic modalities.

Results

The sensitivity and accuracy differences between the ABVS and conventional sonography for diagnosis of abdominal hernias and hernia size measurements were compared. The hernia types, as confirmed by surgery, included 45 indirect inguinal hernias (30 reducible and 15 irreducible), 12 reducible direct inguinal hernias, 5 femoral hernias, 62 incisional hernias (42 isolated and 20 multiple), and 4 umbilical hernias. The sensitivity of the ABVS was higher than that of conventional sonography for incisional hernias (P < .01), whereas there were no statistical differences in sensitivity for other types of hernias. The ABVS hernial sac number detection rate for both isolated and multiple incisional hernias was significantly higher compared with that of conventional sonography (both P < .01). The ABVS measurements correlated well with surgical results (length, P = .47; width, P = .31).

Conclusions

Automated breast volume scanner images have the outstanding advantage of displaying the entire scope of the internal structure and the relationship with adjacent tissues of abdominal hernias. Therefore, an ABVS has good application prospects for diagnosis of abdominal external hernias and merits further research.
Routine Intraoperative Hepatic Sonography Does Not Affect Staging or Postsurgical Hepatic Recurrence in Pancreatic Adenocarcinoma
Authors: Mui Leonora W. , Pursell Lisa J. , Botwinick Isadora C. , Allendorf John D. , Chabot John A. , Newhouse Jeffrey H.
Published: December 2013

Objectives

The purpose of this study was to evaluate the utility of intraoperative sonography of the liver in the staging of pancreatic adenocarcinoma and its impact on the rate of postoperative tumor recurrence in the liver.

Methods

We performed a retrospective analysis of the rate in which intraoperative sonography of the liver changed surgical management in 470 surgical candidates with pancreatic adenocarcinoma. In postsurgical patients, we performed a χ2 analysis to examine whether the patients who underwent hepatic intraoperative sonography had a lower rate of recurrent disease in the liver within the first 6 months of surgery compared to patients who did not undergo the procedure.

Conclusions

Hepatic intraoperative sonography affected management in less than 1% of cases, detecting 1 unsuspected liver metastasis in 470 surgical patients with pancreatic adenocarcinoma. Of 3 patients with equivocal liver lesions identified on preoperative computed tomography or magnetic resonance imaging, hepatic intraoperative sonography excluded metastasis and cleared all the patients for surgical resection. There was no significant difference in postoperative liver recurrence between the group of patients who received intraoperative sonography before resection and patients who did not have the procedure done (P > .99).

Conclusions

Routine intraoperative sonography of the liver does not affect staging of pancreatic adenocarcinoma. It may be useful for evaluating equivocal lesions.
Indirect Prediction of Liver Fibrosis by Quantitative Measurement of Spleen Stiffness Using the FibroScan System
Authors: Hu Xiangdong , Xu Xiaoluan , Zhang Qing , Zhang Hong , Liu Jing , Qian Linxue
Published: December 2013

Objectives

To evaluate quantitative measurement of spleen stiffness for indirect assessment of liver fibrosis in patients with chronic hepatitis B and to correlate spleen stiffness with liver stiffness using pathologic examination as a reference standard.

Methods

Sixty patients with clinically confirmed chronic hepatitis B (n = 54) and liver cirrhosis (n = 6) were enrolled. Quantitative stiffness measurements (kilopascals) were obtained from spleen and liver parenchyma with the FibroScan system (Echosens, Paris, France). Correlation analyses were performed between spleen and liver stiffness and between spleen stiffness and liver fibrosis stages. The diagnostic performance of spleen stiffness for indirect prediction of liver fibrosis was estimated by receiver operating characteristic curves.

Results

Both spleen and liver stiffness increased as liver fibrosis progressed. Spleen stiffness values had a positive correlation with liver stiffness values in all patients (Pearson r = 0.810; P < .001). The correlation between spleen stiffness and fibrosis stages was statistically significant (Spearman r = 0.833; P < .001). The areas under the receiver operating characteristic curves for spleen stiffness were 0.902 (95% confidence interval [CI], 0.825–0.978) for stage S1 (fibrous portal expansion and limited perisinusoidal or lobular fibrosis) or higher, 0.927 (95% CI, 0.852–1.0) for S2 (periportal fibrosis and few fibrous septa but intact architecture) or higher, 0.962 (95% CI, 0.918–1.0) for S3 (numerous fibrous septa with architectural distortion but no obvious cirrhosis) or higher, and 0.983 (95% CI, 0.957–1.0) for S4 (cirrhosis) (all P < .001). The differences between the areas under the curves for spleen and liver stiffness in liver fibrosis staging were not statistically significant (P = .115–.756).

Conclusions

Quantitative measurement of spleen stiffness is a feasible and promising technique for estimating liver fibrosis. The overall diagnostic performance of spleen stiffness for liver fibrosis staging is comparable with that of liver stiffness.
A Computer‐Aided Diagnostic Algorithm Improves the Accuracy of Transesophageal Echocardiography for Left Atrial Thrombi
Authors: Sun Lin , Li Yang , Zhang Ying Tao , Shen Jing Xia , Xue Feng Hua , Cheng Heng Da , Qu Xiu Fen
Published: December 2013

Objectives

We investigated whether transesophageal echocardiography (TEE) assisted with a computer‐aided diagnostic (CAD) algorithm was superior to TEE in diagnosing left atrial (LA)/left atrial appendage (LAA) thrombi in patients with atrial fibrillation (AF) in a single prospective study.

Methods

Transesophageal echocardiography was performed in patients with AF, and images were reconstructed. Gray level co‐occurrence matrix–based features were calculated and then classified using an artificial neural network. The original data and processed images by the CAD system were studied by 5 radiologists independently in a blind manner. The diagnostic performance of each radiologist was evaluated.

Results

One hundred thirty patients with AF were investigated. Thirty‐one patients (23.9%) had a diagnosis of LA/LAA thrombi. The mean sensitivity ± SD of TEE for LA/LAA thrombi was 0.933 ± 0.027, which was noticeably improved by CAD (0.955 ± 0.021; P < .05). The specificity of TEE was 0.811 ± 0.055, which was markedly lower than that by TEE plus CAD (0.970 ± 0.009; P < .05). The positive predictive value of TEE was low (0.613 ± 0.073) compared to that of TEE plus CAD (0.908 ± 0.027; P < .001), whereas the negative predictive values were comparable for TEE, CAD, and TEE plus CAD. Diagnosis of an LA/LAA thrombus by TEE plus CAD had a higher accuracy rate (0.966 ± 0.011) than that by TEE (0.840 ± 0.047; P < .01). The mean area under the receiver operating characteristic curve (Az) for TEE was 0.834 ± 0.009 (95% confidence interval [CI], 0.815–0.852), which was markedly lower than the Az for TEE plus CAD (0.932 ± 0.005; 95% CI, 0.921–0.943). The use of CAD significantly improved the Az values for all 5 radiologists (P < .001).

Conclusions

The CAD algorithm significantly improves the diagnostic accuracy of TEE for LA/LAA thrombi in patients with AF.
Clinical Problem Solving
Authors: Cooley Christine , Nishino Mizuki , Jagannathan Jyothi , Ramaiya Nikhil , Di Salvo Donald , Krajewski Katherine M.
Published: December 2013

This review demonstrates the unique advantages of sonography in the oncologic setting. Although computed tomography, magnetic resonance imaging, and positron emission tomography–computed tomography are primary imaging modalities for evaluation of the oncologic patient, sonography is useful for evaluation of various conditions and clinical scenarios associated with cancer. The following article will illustrate the utility of sonography at a tertiary cancer center for diagnosis and problem solving.
How well do general circulation models represent low‐frequency rainfall variability?
Authors: Rocheta Eytan , Sugiyanto Michael , Johnson Fiona , Evans Jason , Sharma Ashish
Published: December 2013

General circulation models (GCMs) provide reliable simulations of global‐ and continental‐scale atmospheric variables, yet have limited skill in simulating variables important for water resource management at regional to catchment scales. GCM simulations suffer from a range of uncertainties leading to transient (changing over time) and systemic (consistent over time) biases in the output when compared to observed records. An important GCM bias in managing water resources infrastructure is the underrepresentation of low‐frequency variability a characteristic central to the simulation of floods and droughts. This study presents a performance metric, the aggregated persistence score (APS), which is used to assess the reliability of GCMs in simulating low‐frequency rainfall variability. The APS identifies regions where GCMs poorly represent the amount of variability seen in the observed precipitation. This study calculated the APS at monthly aggregations for GCM precipitation as well as GCM precipitation that was bias‐corrected to better represent low‐frequency variability. It was found that there were (1) large spatial variations in the skill of GCMs to capture observed rainfall persistence, (2) widespread undersimulation of rainfall persistence characteristics in GCMs, and (3) substantial improvement in rainfall persistence after applying bias correction.
First satellite detection of volcanic OClO after the eruption of Puyehue‐Cordón Caulle
Authors: Theys Nicolas , De Smedt Isabelle , Van Roozendael Michel , Froidevaux Lucien , Clarisse Lieven , Hendrick François
Published: December 2013

Volcanoes release large amounts of halogen species such as HCl and HBr, which can be converted into reactive halogens by heterogeneous photochemical reactions that are currently not fully characterized. Here we report on the first satellite detection of volcanic chlorine dioxide (OClO). Measurements were performed using the Scanning Imaging Absorption Spectrometer for Atmospheric Chartography instrument for the ash‐laden plume emitted after the 2011 eruption of Puyehue‐Cordón Caulle in Chile. We also identified volcanic BrO using the Ozone Monitoring Instrument, as well as enhanced HCl in data of the Microwave Limb Sounder instrument. These observations suggest that OClO was formed in the plume by the ClO + BrO reaction in presence of a large excess of ClO. The present satellite data set could help better understand reactive halogen chemistry in volcanic plumes and its impact on atmospheric composition.
Rayleigh and Love wave anisotropy in Southern California using seismic noise
Authors: Riahi Nima , Saenger Erik H.
Published: December 2013

We study surface wave anisotropy using three‐component frequency‐wave number analysis of 1 year (2012) of ambient seismic noise measured by the Southern California Seismic Network. Significant 2θ and 4θ Rayleigh wave anisotropy is observed over most of the frequency range 15 to 100 mHz (Millihertz). The wide Rayleigh wave illumination and large data volume allow for relatively high precision and sensitivity: the estimation variability above 35 mHz as well as the magnitude of the weakest significant detections is about 0.1%. The estimates are consistent with previous anisotropy studies of the region. We also show preliminary results for Love waves, but ambient Love wave illumination in Southern California may not be sufficient for the approach.
Weakening of atmospheric information flow in a warming climate in the Community Climate System Model
Authors: Deng Yi , Ebert‐Uphoff Imme
Published: December 2013

We introduce a new perspective of climate change by revealing the changing characteristics of atmospheric information flow in a warming climate. The key idea is to interpret large‐scale atmospheric dynamical processes as information flow around the globe and to identify the pathways of this information flow using a climate network based on causal discovery and graphical models. We construct such networks using the daily geopotential height data from the Community Climate System Model Version 4.0 (CCSM4.0)'s 20th century climate simulation and 21st century climate projection. We show that in the CCSM4.0 model under enhanced greenhouse gases (GHGs) forcing, prominent midlatitude information pathways in the midtroposphere weaken and shift poleward, while major tropical information pathways start diminishing. Averaged over the entire Northern Hemisphere, the atmospheric information flow weakens. The implications of this weakening for the interconnectivity among different geographical locations and for the intrinsic predictability of the atmosphere are discussed.