Osteoporosis: Diagnosis and management updates.

ABSTRACT: Osteoporosis, a common chronic bone disease, results in reduced bone mineral density and heightened fracture risk, particularly vertebral fractures. This article provides an overview of the condition's diagnosis and management updates.

Glioblastoma radiomics: can genomic and molecular characteristics correlate with imaging response patterns?

PURPOSE: For glioblastoma (GBM), imaging response (IR) or pseudoprogression (PSP) is frequently observed after chemoradiation and may connote a favorable prognosis. With tumors categorized by the Cancer Genome Atlas Project (mesenchymal, classical, neural, and proneural) and by methylguanine-methyltransferase (MGMT) methylation status, we attempted to determine if certain genomic or molecular subtypes of GBM were specifically associated with IR or PSP. METHODS: Patients with GBM treated at two institutions were reviewed. Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Mantel-cox test determined effect of IR and PSP on OS and PFS. Fisher's exact test was utilized to correlate IR and PSP with genomic subtypes and MGMT status. RESULTS: Eighty-two patients with GBM were reviewed. The median OS and PFS were 17.9 months and 8.9 months. IR was observed in 28 (40%) and was associated with improved OS (median 29.4 vs 14.5 months p < 0.01) and PFS (median 17.7 vs 5.5 months, p < 0.01). PSP was observed in 14 (19.2%) and trended towards improved PFS (15.0 vs 7.7 months p = 0.08). Tumors with a proneural component had a higher rate of IR compared to those without a proneural component (IR 60% vs 28%; p = 0.03). MGMT methylation was associated with IR (58% vs 24%, p = 0.032), but not PSP (34%, p = 0.10). CONCLUSION: IR is associated with improved OS and PFS. The proneural subtype and MGMT methylated tumors had higher rates of IR.

Beyond the Page: A Process Review of Using Ethnodrama to Disseminate Research Findings.

Public health researchers are charged with communicating study findings to appropriate audiences. Dissemination activities typically target the academic research community. However, as participatory research grows, researchers are increasingly exploring innovative dissemination techniques to reach broader audiences, particularly research participants and their communities. One technique is ethnodrama/ethnotheatre, a written or live performance based on study findings. Though used effectively in social change programs, dramas are seldom used to distribute research findings exclusively. Therefore, little information is available about planning and implementing an ethnodrama for this purpose. We present a case study describing the process of planning and implementing an ethnodrama in the context of the Durham Focus Group Study, which explored men's health-seeking behaviors and experiences with health and healthcare services in Durham, North Carolina. Here, we highlight lessons learned throughout the production of the ethnodrama, and how we addressed challenges associated with transforming research data into educational entertainment. Additionally, we provide discussion of audience feedback, which indicated that our ethnodrama evoked an urgency to change health behaviors among lay persons (67%) and delivery of health services among those identifying as providers (84%), pointing to the success of the performance in both entertaining and educating the audience.

Multi-generational benefits of genetic rescue.

Genetic rescue-an increase in population fitness following the introduction of new alleles-has been proven to ameliorate inbreeding depression in small, isolated populations, yet is rarely applied as a conservation tool. A lingering question regarding genetic rescue in wildlife conservation is how long beneficial effects persist in admixed populations. Using data collected over 40 years from 1192 endangered Florida panthers (Puma concolor coryi) across nine generations, we show that the experimental genetic rescue implemented in 1995-via the release of eight female pumas from Texas-alleviated morphological, genetic, and demographic correlates of inbreeding depression, subsequently preventing extirpation of the population. We present unequivocal evidence, for the first time in any terrestrial vertebrate, that genetic and phenotypic benefits of genetic rescue remain in this population after five generations of admixture, which helped increase panther abundance (> fivefold) and genetic effective population size (> 20-fold). Additionally, even with extensive admixture, microsatellite allele frequencies in the population continue to support the distinctness of Florida panthers from other North American puma populations, including Texas. Although threats including habitat loss, human-wildlife conflict, and infectious diseases are challenges to many imperiled populations, our results suggest genetic rescue can serve as an effective, multi-generational tool for conservation of small, isolated populations facing extinction from inbreeding.

Initial experience with bendamustine in patients with recurrent primary central nervous system lymphoma: a case report.

Novel therapeutic options for patients with recurrent primary central nervous system lymphoma (RPCNSL) are needed. Bendamustine, a bifunctional purine analog/alkylating agent, is approved for use in patients with progressive systemic indolent non-Hodgkin's B-cell lymphomas. Limited data suggests that bendamustine may partition into the brain in the setting of a disrupted blood-brain barrier. This report describes the first known experience of patients with RPCNSL treated with bendamustine. Therapy was well-tolerated and best response was noted as stable disease after eight cycles of bendamustine followed by a subsequent local systemic recurrence found at five months follow-up. CNS involvement in this patient remained stable 20 + months post-bendamustine treatment. Based on our observations, further neuropharmacokinetic and efficacy studies with bendamustine may be warranted in this patient population.

The TIS Methodology: An Approach for Purposeful, Relational Communication.

Patients frequently identify communication with nurses as the most important aspect that influences their health-care experience. Nursing education curricula tend to emphasize the preparation of nurses to excel in scientific knowledge, technological expertise, and practical skills. Instruction in communication is often inadequate. While these educational programs may inform learners of what they should do to communicate effectively, they do not tell or show learners how to do it. Failure to develop theoretical instruction in fundamental interactive communication can impair nurses' ability to engage patients in meaningful relationships, and can impact the delivery of patient-centered quality care. The TIS Methodology (Theme, Invitation, Simplicity) is an innovative, systematic approach to purposeful, relational communication. TIS offers an effective way to listen attentively and engage effectively in interpersonal relationships. The primary focus of TIS is the learned ability to listen to what another is saying or meaning, and to respond appropriately. A case study approach is used to illustrate the effective application of the TIS Methodology and to enhance an understanding of TIS principles and standards.

Cohort study of structured reporting compared with conventional dictation.

PURPOSE: To determine if radiology residents who used a structured reporting system (SRS) produced higher quality reports than residents who used conventional free-text dictation to report cranial magnetic resonance (MR) imaging in patients suspected of having a stroke. MATERIALS AND METHODS: The study was approved by an institutional review board and was HIPAA compliant; informed consent was obtained. This study included residents, with 16 in the control group and 18 in the intervention group. For phase 1, each subject reviewed the same set of 25 brain MR imaging cases and dictated the cases by using free-text conventional dictation. For phase 2, 4 months later, the control group repeated the same process, whereas the intervention group reread the same MR imaging cases by using SRS to create reports. Resident-generated reports were graded for accuracy and completeness by a neuroradiologist on the basis of consensus interpretations and criterion standard diagnoses as established with at least 6 months of clinical follow-up, imaging follow-up, and/or histologic examination where appropriate. Accuracy and completeness scores were analyzed by using a Wilcoxon signed rank test for paired data and a Mann-Whitney U test for nonpaired data. Intervention group residents were surveyed regarding their opinions of SRS. RESULTS: For phase 1 reports, no significant difference in accuracy or completeness scores between control and intervention groups was found. Decreases in accuracy (91.5 to 88.7) and completeness (68.7 to 54.3) scores for phase 2 compared with phase 1 for the intervention group were found; increases in accuracy (91.4 to 92.4) and completeness (67.8 to 71.7) scores for phase 2 compared with phase 1 for the control group were found (all P values < .001). The most common complaints were that the SRS was overly constraining with regard to report content and was time-consuming to use. CONCLUSION: While there are many potential benefits of structuring radiology reports, such changes cannot be assumed to improve report accuracy or completeness. Any SRS should be tested for effect on intrinsic report quality.

Lumbar split cord malformation with lateral hemimyelomeningocele and associated Chiari II malformation and other visceral and osseous anomalies: a case report.

Split cord malformation and lateral hemimyelomeningocele are 2 rare spinal anomalies, which were both discovered in a female newborn. The constellation of anomalies is presented in the setting of Chiari II malformation. Cross-sectional imaging of the salient abnormalities in the form of computed tomography and magnetic resonance imaging along with 3-dimensional and multiplanar reformatting is highlighted.

CE: Type 2 Diabetes: A Pharmacologic Update.

Of the more than 30 million Americans who have diabetes mellitus, as many as 95% have type 2 diabetes. While interventions for type 2 diabetes include modifying diet and exercise, pharmacologic therapy is a mainstay in diabetes treatment. In recent years, with the addition of new medications and medication classifications, pharmacologic therapy for type 2 diabetes has changed dramatically. Nurses need to understand the many pharmacologic agents and combination therapies now in use. This article includes established as well as more recently introduced type 2 diabetes medications, as well as nursing implications regarding patient education and the monitoring of patients for adverse effects.

Beyond the Individual: Social and Cultural Influences on the Health-Seeking Behaviors of African American Men.

Morbidity and mortality rates are alarmingly high among African American men and are influenced by the health-seeking behaviors of this population. This study examined data from 40 focus groups with African American men in Durham, North Carolina, to better understand social and cultural influences on health-seeking behaviors. Data were analyzed using inductive thematic analysis. Three broad types of social/cultural influence on motivation to seek health care services were identified: family, culture and upbringing, and peers. Study findings confirm the importance of social relationships in influencing African American men's health-seeking behaviors and offer characterization of the nature of influence across different types of relationships, according to the direct support or indirect messages they provide. Future programs can draw on these data to inform efforts to include family and peers as well as utilize existing cultural gender norms to the advantage of health promotion for African American men.

Big Cypress fox squirrel (Sciurus niger avicennia) ecology and habitat use in a cypress dome swamp-pine forest mosaic.

Forested wetlands are in decline, as are many species that are obligate residents. Big Cypress fox squirrels (BCFS; Sciurus niger avicennia) are a threatened endemic to wet pine and cypress forests in southwestern Florida. The region is characterized by development resulting in habitat loss, habitat fragmentation, and hydrological change that influence the quality of these wet forests. Through radiotelemetry and field observations, we examined the ecology and habitat use of BCFS in a natural cypress dome-pine forest mosaic. BCFS selected cypress domes for food and nests throughout the year. Cypress dome habitats were the only habitat type to be used more than available; however, the availability of nearby pine forest was also important. Home ranges were large relative to other tree squirrels, with male home ranges exceeding female ranges. Males overlapped more females than males, while sharing similar food preferences and use patterns with females, suggesting that the sexual dimorphism in home range size is related to mate searching. Roads and oil extraction pads were used less frequently than expected and were incorporated into home ranges less than randomly generated features. The importance of cypress domes within the wet forests and grasslands of Big Cypress National Preserve demonstrates the value of maintaining this delicate mosaic.

Tumor resection with carmustine wafer placement as salvage therapy after local failure of radiosurgery for brain metastasis.

Prolonged survival in brain metastasis patients increases recurrence rates and places added importance on salvage therapies. Research examining carmustine polymer wafers as an adjuvant therapy for brain metastasis is limited. We present a single institution retrospective series documenting the use of BCNU wafers placed in the cavity of resected recurrent brain metastases that had failed prior stereotactic radiosurgery (SRS). Between February 2002 and April 2013, a total of 31 patients with brain metastases failed SRS and underwent resection with intracavitary placement of carmustine wafers. Clinical outcomes including local control, survival, cause of death, and toxicity were determined from electronic medical records. Kaplan-Meier analysis was performed to assess local control and survival. Imaging features were reviewed and described for patients with serial post-operative follow-up imaging examinations over time. Overall survival at 6 months and 12 months was 63% and 36%, respectively. Fourteen of 31 patients (45%) died from neurologic causes. Local control within the resection cavity was 87% and 70% at 6 and 12 months, respectively. Five patients (16%) underwent further salvage therapy following carmustine wafer placement after local failure. Resection cavities of all six patients with follow-up imaging showed linear peripheral enhancement. Pericavity and wafer enhancement was present as early as the same day as surgery and persisted in all cases to 6 months or longer. Carmustine polymer wafers are an effective salvage treatment following resection of a brain metastasis that has failed prior SRS. For patients with successful local control after wafer implantation, linear enhancement at the cavity is common.

American Society of Neuroradiology research survey 2001.

RATIONALE AND OBJECTIVES: Research is a critical component of the mission of academic radiology, and success in research is necessary for the future of neuroradiology. Thus, the authors set out to establish a baseline of research activities of American Society of Neuroradiology (ASNR) members. MATERIALS AND METHODS: The authors surveyed 100 fellowship program directors. The survey was Web based, with recruitment from the ASNR Fellowship Database survey site and with e-mail and fax solicitations to the Web site. Questions focused on neuroradiologist and neuroradiology fellow involvement in research. RESULTS: Forty-eight of the 100 program directors (48%) responded. Several key findings emerged: (a) About one-third of fellowship programs require all fellows to do some research, with most fellows receiving less than 1 day per week of academic time; (b) just over half of the programs expect fellows to publish a paper; (c) about two-thirds of academic neuroradiologists get at least 1 academic day per week; (d) most academic neuroradiologists perform research, but most of this research is unfunded; and (e) about nine of 10 academic sections have at least one neuroradiologist with some extramural funding. CONCLUSION: The relative lack of extramural funding among academic neuroradiologists is a reality that is probably multifactorial; however, there may be a direct relationship between amount of academic time free from clinical duties and successful competition for funding. The time (and, thus, financial) support of research-oriented fellows and faculty should be increased.

Limited margins using modern radiotherapy techniques does not increase marginal failure rate of glioblastoma.

OBJECTIVE: We investigate the patterns of failure in the treatment of glioblastoma (GBM) based on clinical target volume (CTV) margin size, dose delivered to the site of initial failure, and the use of temozolomide and intensity-modulated radiotherapy (IMRT). METHODS: Between August 2000 and May 2010, 161 patients with GBM were treated with radiotherapy with or without concurrent temozolomide. Patients were treated with CTV expansions that ranged from 5 to 20 mm using a shrinking field technique. Patterns of failure and time to progression and overall survival were compared based on CTV margin, use of temozolomide, and use of IMRT. Kaplan Meier analysis was used to estimate survival times, and χ test was used for comparison of cohorts. RESULTS: For patients treated with 5-, 10-, and 15- to 20-mm CTV, 79%, 77%, and 86% experienced failures in the 60 Gy volume, respectively. Forty-eight percent, 55%, and 66% of patients with 5-, 10-, and 15- to 20-mm CTV experienced failures in the 46 Gy volume, respectively. There was no statistical difference between patients treated with 5-, 10-, 15- to 20-mm margins with regard to 60 Gy failure (P=0.76), 46 Gy failure (P=0.51), or marginal failure (P=0.73). Eighty percent of patients receiving temozolomide experienced failures in the 60 Gy volume. There was no increased likelihood of marginal failures in patients receiving IMRT (P=0.97). CONCLUSIONS: Modern treatment techniques including use of concurrent temozolmide, limited CTV margin size, and IMRT have not greatly changed the patterns of failure of GBM.