Parathyroid 4D CT: What the Surgeon Wants to Know.

Parathyroid four-dimensional (4D) CT is an increasingly used and powerful tool for preoperative localization of abnormal parathyroid tissue in the setting of primary hyperparathyroidism. Accurate and precise localization of a single adenoma facilitates minimally invasive parathyroidectomy, and localization of multiglandular disease aids bilateral neck exploration. However, many radiologists find the interpretation of these examinations to be an intimidating challenge. The authors review parathyroid 4D CT findings of typical and atypical parathyroid lesions and provide illustrative examples. Relevant anatomy, embryology, and operative considerations with which the radiologist should be familiar to provide clinically useful image interpretations are also discussed. The most important 4D CT information to the surgeon includes the number, size, and specific location of candidate parathyroid lesions with respect to relevant surgical landmarks; the radiologist's opinion and confidence level regarding what each candidate lesion represents; and the presence or absence of ectopic or supernumerary parathyroid tissue, concurrent thyroid pathologic conditions, and arterial anomalies associated with a nonrecurrent laryngeal nerve. The authors provide the radiologist with an accessible and practical approach to performing and interpreting parathyroid 4D CT images, detail what the surgeon really wants to know from the radiologist and why, and provide an accompanying structured report outlining the key information to be addressed. By accurately reporting and concisely addressing the key information the surgeon desires from a parathyroid 4D CT examination, the radiologist substantially impacts patient care by enabling the surgeon to develop and execute the best possible operative plan for each patient. ©RSNA, 2020.

A comparison of the nutritional quality of organic and conventional ready-to-eat breakfast cereals based on NuVal scores.

OBJECTIVE: To identify whether there were differences in nutritional quality between organic and conventional ready-to-eat breakfast cereals of similar types, based on NuVal scores. DESIGN: The current descriptive study analysed NuVal scores for 829 ready-to-eat breakfast cereals and eighteen different cereal types. ANOVA was used to compare the mean NuVal scores of 723 conventional cereals with those of 106 organic cereals. SETTING: Ready-to-eat breakfast cereals (n 829) with NuVal scores. SUBJECTS: Not applicable. RESULTS: There was no significant difference in NuVal scores between conventional (mean 28·4 (sd 13·4)) and organic (mean 30·6 (sd 13·2)) cereal types. CONCLUSIONS: Consumers who choose the organic version of a ready-to-eat breakfast cereal believing that nutritional quality is superior may not be making a valid assumption. Public health nutrition educators must help consumers understand that organic cereals are not necessarily more nutritious and their consumption could result in excessive intake of undesirable nutrients, such as fat, sugar and sodium.

Educating refugees to improve their home environmental health.

Rochester's Healthy Home was a hands-on home environmental health museum that educated more than 3500 visitors between June 2006 and December 2009. The Healthy Home provided visitors with the tools, resources, and motivation to make their homes healthier by reducing environmental hazards. The Healthy Home focused on empowering low-income renters to protect their families from home health risks, but served a broad audience. On the basis of the Healthy Home's initial successes with diverse visitors, in 2009 the county health department provided funding for a 6-month project to educate 200 recently arrived refugees. This report summarizes the project's innovative approach to home health education, presents evaluation data on impacts on refugees and other visitors, suggests implications for resettlement agencies, and provides guidelines for those interested in replicating this approach in their own community.

Oral Selumetinib Does Not Negatively Impact Photoreceptor Survival in Murine Experimental Retinal Detachment.

Purpose: Mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) signaling is neuroprotective in some retinal damage models but its role in neuronal survival during retinal detachment (RD) is unclear. In addition, serous RDs are a prevalent side effect of MEK inhibitors (MEKi), blocking MAPK/ERK signaling for treatment of certain cancers. We tested the hypothesis that MEKi treatment in experimental RD would increase photoreceptor death. Methods: The MEKi selumetinib was delivered daily to C57BL/6 mice at a clinically relevant dose (10 mg/mL) starting 1 day prior to creating RD with subretinal hyaluronic acid injection. Photoreceptor TUNEL and outer nuclear layer (ONL) thickness were analyzed. Phospho-ERK1/2 (pERK) distribution, glial fibrillary acidic protein (GFAP) accumulation, and Iba-1 (microglia/macrophages) were evaluated with immunofluorescence. Results: pERK accumulated in the Müller glia in detached retinas, but this was effectively blocked by selumetinib. Selumetinib did not induce serous RDs at day 1 and did not increase TUNEL positive photoreceptors or further decrease ONL thickness compared to controls. Retinal gliosis was not altered, but selumetinib did block the increase in intraretinal microglia/macrophage Iba-1 fluorescence intensity and acquisition of amoeboid morphology. Conclusions: MAPK/ERK is neuroprotective in some retinal damage models; in RD, selumetinib blocked Müller pERK accumulation and changed the retinal microglia/macrophage phenotype but did not alter photoreceptor survival. This is consistent with the relatively good visual acuity seen in patients developing transient retinal detachments on MEK inhibitor therapy. Compensation by other neuroprotective pathways in the retina during retinal detachment may occur in the presence of MEK inhibition.

Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups.

BACKGROUND AND OBJECTIVES: Family physicians lack data on how best to address the needs of adults with physical disabilities. We undertook this study to understand how consumers, educators, and other professionals perceive primary care for people with disabilities. METHODS: We conducted six focus groups, three with 27 health professionals in primary care practices affiliated with an urban university medical center and three with 19 local adults, ages 21-64 years, with physical disabilities. From transcribed recordings, three investigators conducted separate content analyses. Independent author reviews and participant review confirmed saturation and agreement for major themes. RESULTS: All groups perceived that generalist physicians and other health professionals need more education about disability issues. Multiple barriers limit care, including physical access and transportation, funding, limitations in professionals' knowledge and attitudes, communication gaps, and health systems failures. Both consumers and professionals recommended reducing barriers by educating professionals and trainees about disabilities and resources, improving provider-patient communication, enhancing physical access (eg, high-low examination tables, wide automatic doors, high-contrast signs and lighting, wheelchair scales), and increasing appointment times. CONCLUSIONS: Primary care must address the unmet needs of people with disabilities. Family medicine educators can begin by teaching learners how to coordinate care, access resources, and communicate about disability issues.

The impact of dietary restraint and moderate-intensity exercise on post-exercise energy intake in sedentary males.

Exercise is often used for successful weight management, particularly by males. However, exercise may have the potential to promote counter-regulatory eating, because of certain cognitive and psychological factors. The purpose of this study was to investigate the unknown role of dietary restraint, BMI, and dieting status on acute and 12-hour post-exercise energy intake (PE-EI) in sedentary males following moderate-intensity exercise. The study consisted of two experimental conditions, exercise and rest, in a counterbalanced-crossover design on two days. Exercise consisted of walking on a treadmill for 60 min. Acute and 12-hour PE-EI were compared on exercise and rest days. Eighty males, mean age 30+/-8 years, participated in the study and were categorized by dietary restraint level, BMI, and dieting status. The main effects of condition and group, and the interaction were not significant for acute or 12-hour PE-EI, suggesting that a single bout of moderate-intensity exercise did not influence PE-EI in sedentary males in reference to dietary restraint, BMI, and dieting status. Therefore, moderate-intensity exercise as a prescription for weight loss does not appear to promote counter-regulatory eating in sedentary males.

Psychosocial risk factors for eating disorders in Hispanic females of diverse ethnic background and non-Hispanic females.

This study investigated differences in psychosocial risk factors for eating disorders among university females (n=406) of diverse Hispanic background (Puerto Rican, Cuban, Central American/Mexican, Dominican, Venezuelan) and among White non-Hispanic (n=102) female students. Risk factors were assessed using the Psychosocial Risk Factor Questionnaire (PRFQ) which includes four subscales: Social Pressure for Thinness, Media Pressure for Thinness, Concern for Physical Appearance, and Perception of Physical Appearance. There were significant differences among the groups in total PRFQ score, F(7,499)=2.76, P<.008, and the subscale score for Concern, F(7,499)=2.99, P<.004, with Dominicans, Venezuelans and Columbians having higher scores than White non-Hispanics and Central Americans/Mexicans. In addition, there was a significant difference in BMI, F(7,499)=2.70, P<.009. Both Puerto Ricans (24.27+0.81) and Venezuelans (24.66+1.00) had higher BMIs than White non-Hispanics (21.87+0.37), Cubans (21.99+0.24) and Brazilians (21.46+0.96). There was also a significant, F(7,498)=2.70, P<.009, difference among the groups in Ideal Body Image score. Puerto Ricans had the highest score and Brazilians the lowest. Acknowledging that differences in psychosocial risk factors exist among Hispanic females of diverse background can assist us in creating more targeted approaches for the prevention of potential eating disorders in this population.

The use of portfolios in coordinated school health programs: benefits and challenges to implementation.

BACKGROUND: Coordinated school health programs (CSHP) frequently struggle with how to adequately evaluate implementation. The CSHP framework provides flexibility in how it is implemented; however, this flexibility makes it a challenge to effectively evaluate. Portfolios have been used as a technique for evaluating progress and achievement. This article describes the development and implementation of a CSHP portfolio and examines the perceptions of school personnel who have used CSHP portfolios. METHODS: This study employed content analysis and key informant interviews. Two elementary, 4 middle, and 2 high schools in Florida participated. RESULTS: Portfolios (N = 5) contained rich descriptions and program artifacts documenting each school's CSHP goals and activities. Key informant interviews (N = 14) revealed that school personnel found value in completing CSHP portfolios. CSHP portfolios were described as helpful in assessing progress, facilitating transition with new members, and building support for their efforts. Barriers to portfolio development included lack of time, money, and human resources. CONCLUSIONS: This study found the use of portfolios in documenting the implementation of the CSHP feasible and useful for school personnel. Portfolios provide a rich description of CSHP activities that may not be apparent through traditional program reports used for evaluation. As portfolios continue to be used in implementing CSHP, they may be viewed as a best process for CSHP implementation and a key element in the evaluation of CSHP.

CDE and non-CDE dietitians' knowledge of exercise and content of exercise programs for older adults with type 2 diabetes.

OBJECTIVE: To study differences between non-certified diabetes educator registered dietitians (non-CDE-RDs) and certified diabetes educator registered dietitians (CDE-RDs) in the design and content of programs to promote physical activity in older adults with type 2 diabetes. DESIGN: The Exercise Teaching Questionnaire was used to assess knowledge of and promotion of physical activity. SETTING AND PARTICIPANTS: Surveys were sent to CDE-RDs and non-CDE-RDs in Florida, California, and Texas. Ninety-four CDE-RDs and 73 non-CDE-RDs completed the study. MAIN OUTCOME MEASURES: The independent variable was CDE status. The dependent variables were knowledge, design, content, and total exercise scores. ANALYSIS: Two-way ANOVA's tested for Knowledge, Design, and Content scores by RD status and one of the following: years practicing in diabetes education, state, and practice setting. RESULTS: The exercise Knowledge, Design and Content scores were significantly (P < .001) higher in the CDE-RDs compared to those of the non-CDE-RDs. CONCLUSIONS AND IMPLICATIONS: The results of this study indicate that education and experience play a key role in the design and content of programs to promote physical activity in older adults. Therefore, the results raise the question of the role the dietitian and nutrition educator should play in the promotion of physical activity in older adults.

Cohabitation, activity level, and energy intake in parent-child resemblance for selected biological traits.

Activity level and energy intake were estimated from 3-day records, including a weekend day, in parents and children from families of French descent. Subcutaneous fat from the summation of six skinfolds, fasting serum triglycerides, total and high-density lipoprotein cholesterol, and submaximal power output (PWC150 ) derived from a cycle ergometer test also were determined in these subjects. Dependent variables were normalized through log10 or squre-root transformation, and scores were adjusted by generation for the effects of age and gender. Correlations with residual scores were performed with pairs of natural parents and child (N ≧ 1057) and pairs of foster parent and adopted child (N ≧ 283). Coefficients were generally little affected by statistical control over current activity level and energy intake. Pairs of biological relatives were classified as either very similar (25% of pairs) or very dissimilar (25% of pairs) in terms of energy intake or activity level. Correlations revealed that similarity or discordance in energy intake or activity level had only a slight effect on parent-child resemblance. In addition, duration of cohabitation had little influence on parent-child covariation. It was concluded that parent-child resemblance in subcutaneous fat, work capacity, and blood lipids are not significantly affected by current patterns of energy intake, activity level, or duration of cohabitation.

Low-fat diet: effect on anthropometrics, blood pressure, glucose, and insulin in older women.

OBJECTIVE: The Women's Health Trial: Feasibility Study in Minority Populations (WHT: FSMP) documented that a low-fat diet was associated with a reduced fat intake in older women of diverse ethnic backgrounds. The purpose of the current study was to examine the effect of the low-fat diet on anthropometric and biochemical variables. DESIGN: Randomized clinical trial in 2,208 postmenopausal women, 50 to 79 years of age. RESULTS: The decrease in fat intake correlated directly with a decrease in body weight (r=.22, P<.001). After 6 months, the intervention group had an average weight loss of 1.8 kg. Body mass index decreased 0.7 kg/m2. Waist circumference decreased 1.8 cm. All of these changes were statistically significant, compared to changes in the control group (P<.01). Changes in systolic (-3.1 mm Hg) and diastolic (-1.1 mm Hg) blood pressures (BP) occurred in the intervention group. The decrease in systolic BP reached statistical significance (P=.02), relative to the control group. Decreases in plasma glucose were small (-0.2 mmol/L) in the intervention group, although there was a trend for difference from the control group (P=.11). Decreases in serum insulin levels were small (-0.5 microIU/mL) in the intervention group, although there was, again, a trend for difference from the control group. CONCLUSIONS: In older White, Black, and Hispanic women, a long-term low-fat dietary intervention was accompanied by modest, but statistically significant, decreases in body weight and anthropometric indices, without any particular attempt being made to reduce calories. Changes in glucose and insulin were small. The long-term biological significance of the glucose and insulin changes is unknown.

Teaching nurses to focus on the health needs of populations: a Master's Degree Program in Population Health Nursing.

Responding to the mandate to prepare nurses for practice in population-based healthcare, the faculty at Cleveland State University (CSU) developed a unique Master of Science in Nursing program to prepare Population Health Nurse Experts. The program prepares nurses to examine the health status of populations and to design, implement, and evaluate nursing interventions accounting for the varied factors impacting on the health of a defined group. The speciality of population health nursing is practiced by nurses who can use population sciences (epidemiology, demography, population projections, and population behavioral theories) along with post-baccalaureate nursing competencies to work with defined populations across care environments. The authors discuss a curriculum that prepares nurses for this emerging speciality.

Eating disorder risk and body dissatisfaction based on muscularity and body fat in male university students.

OBJECTIVE: To investigate the relationship between risk of eating disorders, body dissatisfaction, and perceptual attractiveness in male university students. PARTICIPANTS: Research was conducted January-April 2012 and involved 339 male and 441 female students. METHODS: Eating disorder risk was assessed with the Eating Attitudes Test (EAT) and body dissatisfaction and perceptual attractiveness determined with the Bodybuilder Image Grid (BIG). RESULTS: There was a positive correlation (r=.16, p<.01) between the EAT and fat dissatisfaction and a negative correlation (r=-.14, p<.05) for muscle dissatisfaction, 28% of the males had an EAT score indicating that they were at risk for an eating disorder. Males chose a significantly more muscular and leaner body type than what females chose to be attractive. CONCLUSION: College-aged males may be at risk for eating disorders based on distortions in their perceived ideal body image, both for fat and muscle.

Axis measurement strip for Haag-Streit BM900 series slitlamp.

UNLABELLED: We describe a technique to measure the toric IOL axis using an axis measurement strip applied to the Haag-Streit BM900 series slitlamp. The technique was used by 3 surgeons to determine the postoperative toric IOL position in 47 eyes, and these data were compared with objective measurements derived from images made with a Galilei G2 corneal analyzer. The results indicate that the axis measurement strip provides a precise, clinically efficient measurement of toric IOL position. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Current formulas for water requirements produce different estimates.

BACKGROUND: Weight-based and energy-based formulas are used to estimate the water requirements of patients receiving nutrition support, yet these formulas have not been validated nor quantitatively compared with one another. The objective of this study was to determine if there was agreement among commonly used formulas for estimating water requirements. DESIGN: This cross-sectional survey design was from the continuous National Health and Nutrition Examination Survey 1999-2004. To determine estimated water requirements for each participant, 2 weight-based formulas were used (30 mL/kg body weight and an adjusted body weight formula) and 3 energy-based formulas based on 1 mL/kcal (energy needs estimated by the Harris Benedict, Mifflin St Jeor, and National Research Council equations). Simple linear regression was performed between each pair of formulas to determine correlations. The regression line was then compared to the line of equality to determine agreement between pairs. RESULTS: Although the 5 formulas were strongly correlated to each other (|r| > 0.7), they demonstrated poor agreement with one another with significant differences when the regression line was compared to the line of equality. CONCLUSIONS: Current formulas that estimate the water requirements of patients receiving enteral nutrition and parenteral nutrition all compute a dissimilar quantity of water. The consequences of these estimates could result in major differences in water intake recommendations and prescriptions between patients or in the same patient, thus suggesting a need for improved standardization of practice for estimating water requirements in clinical practice.

Dietary restraint influences accuracies in estimating energy expenditure and energy intake among physically inactive males.

Inaccurate estimations of energy intake (EI) and energy expenditure (EE) may ultimately affect body weight. The purpose of this study was to evaluate accuracy of estimated EI and EE among males in reference to exercise and rest using a counterbalanced, crossover, repeated-measures design. Participants (N = 80) were recruited from a large, urban university in South Florida. Exercise consisted of walking on a treadmill for 60 min at 65% age-predicted maximum heart rate. Food intake was evaluated immediately following exercise and rest. Participants underestimated EI (kcal) on both the exercise (M = 435, SEM = 69) and rest days (M = 439, SEM = 54), overestimated EE (kcal) for exercise (M = 129, SEM = 44), and underestimated EE for rest (M = 54, SEM = 10). Greater accuracy in estimating EE for exercise was significantly (p < .05) associated with higher dietary restraint. The findings suggest that among sedentary males, there is an inability to accurately estimate calories, which has the potential to influence behaviors that affect weight management.

Effect of moderate intensity exercise on acute energy intake in normal and overweight females.

The purpose of this study is to determine the impact of moderate intensity exercise on acute post-exercise energy intake (EI) in normal and overweight females. Twelve normal weight (BMI<25), and 12 over weight (BMI>25) inactive women (mean age 35+/-8) participated in a 2-day experimental study. On the exercise day, participants were asked to walk on a treadmill at 60% maximum heart rate for 1h. After the exercise, participants selected and ate food at a university cafeteria. Post-exercise EI was compared to a non-exercise day. A single mixed model repeated 2 x 2 ANOVA was used to determine the impact of exercise on post-exercise EI. The overweight women consumed significantly more (p<0.02) than the normal weight women on both experimental days and there was a significant (p<0.03) difference in fat intake. The higher post -exercise EI of the overweight group may have been due to the energy needs associated with a higher BMI but it is also possible that cognitive factors, food availability and environment may influence post-exercise EI.

Impact of dieting status and dietary restraint on postexercise energy intake in overweight women.

OBJECTIVE: To investigate the unknown relationship between dieting status and dietary restraint on postexercise energy intake (PE-EI) in overweight sedentary women after a bout of moderate-intensity exercise. Specifically, this was investigated in women who were categorized as dieting with high restraint, nondieting with high restraint, or nondieting with low restraint. RESEARCH METHODS AND PROCEDURES: This study consisted of two experimental conditions, exercise (E) and nonexercise (NE) in a counterbalanced-crossover design on 2 different days. On the E day, the subjects participated in moderate-intensity exercise, walking on a treadmill for 60 minutes at 60% to 70% of their maximum heart rate. PE-EI at lunch and 12 hours after was compared on the E and an NE day. Dietary restraint was determined using the Three-Factor Eating Questionnaire. RESULTS: Participants (n = 36) were 26 +/- 7 years of age, sedentary, and had a mean body mass index of 27 +/- 3 kg/m(2). There was a significant interaction (F((2,33)) = 3.32, p = 0.049) of dieting/restraint status and condition (E vs. NE day) on 12-hour EI. The mean difference in 12-hour EI between the E and the NE day was significantly higher (p < 0.01) for the dieting with high restraint than for the nondieting with high restraint. DISCUSSION: The results of this study demonstrate that dieting status, high dietary restraint, and higher levels of disinhibition may influence PE-EI in overweight women after a bout of moderate-intensity physical activity.