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1.
J Ultrasound Med ; 43(2): 307-314, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37853981

RESUMO

OBJECTIVE: To assess the prevalence and impact of sexual harassment among a nationwide sample of medical sonographers. METHODS: A survey was distributed anonymously to a convenience sample of medical sonographers via email contacts and sonographer-specific social media pages. Data were analyzed to determine respondent demographics, the prevalence of sexual harassment in the last 2 years, the type and severity of harassment experienced, demographics of perpetrators, personal and institutional responses to such experiences, and the impact of sexual harassment on sonographer physical and mental health and job satisfaction. RESULTS: Of the 220 sonographers (83% female) most (45%) were between 18 and 34 years and identified as white (81%). A total of 192 (87%) reported experiencing at least 1 incident of harassment within the last 2 years. Female respondents experienced higher harassment rates (76%) compared to males (50%, P = .02). The most common forms of harassment were verbal, including suggestive or sexist jokes (69%) and offensive sexist remarks (61%). Perpetrators were predominantly male (78%) and most commonly patients (89%) or their friends/family members (46%). The majority of respondents either ignored the harassing behavior (70%) or treated it like a joke (50%), with only a minority (12%) officially reporting incidents. Of those who reported, 44% were unsatisfied with their institution's response. Among respondents, 34% reported negative impacts of workplace sexual harassment, such as anxiety, depression, sleep loss, or adverse workplace consequences. DISCUSSION: Workplace sexual harassment is a common occurrence for sonographers and often leads to negative health and career outcomes. Further institutional policies to prevent harassment and mitigate its effects are needed.


Assuntos
Assédio Sexual , Humanos , Masculino , Feminino , Assédio Sexual/prevenção & controle , Assédio Sexual/psicologia , Prevalência , Local de Trabalho/psicologia , Inquéritos e Questionários
2.
Skeletal Radiol ; 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38238456

RESUMO

OBJECTIVE: Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis. MATERIALS AND METHODS: An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors. RESULTS: A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures. CONCLUSION: Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures.

3.
Skeletal Radiol ; 52(5): 1033-1038, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36348042

RESUMO

OBJECTIVE: The aim of this study is to describe an ultrasound (US)-guided temporomandibular joint (TMJ) arthrocentesis technique and determine its microbial yield in the workup of suspected TMJ septic arthritis. MATERIALS AND METHODS: A retrospective review of US-guided TMJ arthrocentesis for the work-up of septic arthritis performed by radiologists at two institutions was performed. Patient demographics, risk factors for septic arthritis, blood culture results, and pre-procedural imaging findings were recorded. Procedural data included fluid aspirate quantity, needle gauge and length, and any immediate complications. Post-procedural data included synovial fluid analysis including culture, final diagnosis of TMJ disease, type of treatment, and any delayed complications from arthrocentesis. RESULTS: A total of six US-guided TMJ arthrocenteses were identified, all of which yielded at least 1 mL of synovial fluid. Five patients were subsequently diagnosed with septic arthritis, and one patient was diagnosed with GVHD arthritis. The synovial fluid in four out of five patients with a final diagnosis of septic arthritis produced positive cultures. There were no immediate or delayed complications from arthrocentesis. CONCLUSION: Basic US-guided procedural skills are transferrable to TMJ arthrocentesis, which is a low-risk procedure with a high microbial yield in our small series of patients with septic arthritis.


Assuntos
Artrite Infecciosa , Transtornos da Articulação Temporomandibular , Humanos , Artrocentese/métodos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/cirurgia , Ultrassonografia , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Ultrassonografia de Intervenção , Articulação Temporomandibular/diagnóstico por imagem
4.
Skeletal Radiol ; 52(4): 751-761, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36318320

RESUMO

OBJECTIVE: To determine if MR neurography of the common peroneal nerve (CPN) predicts a residual motor deficit at 12-month clinical follow-up in patients presenting with foot drop. MATERIALS AND METHODS: A retrospective search for MR neurography cases evaluating the CPN at the knee was performed. Patients were included if they had electrodiagnostic testing (EDX) within 3 months of imaging, ankle and/or forefoot dorsiflexion weakness at presentation, and at least 12-month follow-up. Two radiologists individually evaluated nerve size (enlarged/normal), nerve signal (T2 hyperintense/normal), muscle signal (T2 hyperintense/normal), muscle bulk (normal/Goutallier 1/Goutallier > 1), and nerve and muscle enhancement. Discrepancies were resolved via consensus review. Multivariable logistical regression was used to evaluate for association between each imaging finding and a residual motor deficit at 12-month follow-up. RESULTS: Twenty-three 3 T MRIs in 22 patients (1 bilateral, mean age 52 years, 16 male) met inclusion criteria. Eighteen cases demonstrated common peroneal neuropathy on EDX, and median duration of symptoms was 5 months. Six cases demonstrated a residual motor deficit at 12-month follow-up. Fourteen cases underwent CPN decompression (1 bilateral) within 1 year of presentation. Three cases demonstrated Goutallier > 1 anterior compartment muscle bulk. Multivariable logistical regression did not show a statistically significant association between any of the imaging findings and a residual motor deficit at 12-month follow-up. CONCLUSION: MR neurography did not predict a residual motor deficit at 12-month follow-up in patients presenting with foot drop, though few patients demonstrated muscle atrophy in this study.


Assuntos
Neuropatias Fibulares , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neuropatias Fibulares/diagnóstico por imagem , Neuropatias Fibulares/cirurgia , Nervo Fibular/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Debilidade Muscular/diagnóstico por imagem
5.
Skeletal Radiol ; 52(8): 1585-1590, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36800001

RESUMO

OBJECTIVE: The aim of this study is to investigate the safety and feasibility of ultrasound-guided nerve block prior to biopsy of potentially neurogenic tumors. MATERIALS AND METHODS: A retrospective review of the medical record from June 2017 to June 2022 identified ultrasound-guided biopsies of potentially neurogenic tumors that were performed with a pre-procedural nerve block. Patient demographics, biopsy site, number of passes, needle gauge, use of sedation, pathology results, and procedural complications were recorded and summarized. RESULTS: The structured search found 16 patients that underwent biopsies of 18 potentially neurogenic tumors with the use of a pre-procedural nerve block at a variety of upper and lower extremity locations. Average patient age was 52 (range 18-78) and 9 patients (56%) were female. Of the 16 patients, 10 were performed without intravenous sedation. Three patients were unable to tolerate biopsy until a nerve block was used. All biopsies yielded a diagnostic sample with 13 of the tumors neurogenic in origin. One patient reported mild postprocedural pain which resolved with conservative treatment; no other complications were reported. CONCLUSION: Nerve block prior to ultrasound-guided biopsy of potentially neurogenic tumors is a safe and feasible technique. Further study is needed to determine the extent to which nerve block can decrease intra-procedural pain and reduce or eliminate the need for sedation during biopsy.


Assuntos
Bloqueio Nervoso , Humanos , Feminino , Masculino , Projetos Piloto , Estudos de Viabilidade , Bloqueio Nervoso/métodos , Biópsia Guiada por Imagem/métodos , Ultrassonografia de Intervenção , Estudos Retrospectivos
6.
AJR Am J Roentgenol ; 218(2): 234-240, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34523955

RESUMO

BACKGROUND. Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. OBJECTIVE. The aim of this study was to determine the most cost-effective treatment pathway for symptomatic Morton neuromas when conservative management has failed. METHODS. An incremental cost-utility analysis was performed comparing a direct to surgical neurectomy strategy with three selective injection strategies in which one or more ultrasound-guided injection therapies was tried first before surgery for patients who did not respond to treatment. The three selective injection strategies were selective steroid injection, selective alcohol injection, and selective steroid/alcohol injection in which both steroid injections and alcohol sclerosing injections were trialed successively before surgical neurectomy. The direct-to-surgery approach was compared with the three different selective injection strategies and with a no-treatment strategy in a decision-analytic model for a hypothetical group of patients with symptomatic Morton neuroma in whom conservative management had failed. Model parameters, including treatment costs, effectiveness, complication rates, and health utility states, were estimated from the literature, reimbursement databases, and expert opinion. The outcome was cost per quality-adjusted life year (QALY) with a time horizon of 3 years. A societal cost perspective was adopted with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses for key model parameters were performed. RESULTS. For the base input values, the steroid/alcohol selective injection strategy was dominant and yielded an incremental cost-effectiveness ratio of $4401.61/QALY compared with no treatment. The probabilistic sensitivity analysis supported this strategy in 74% of 10,000 simulated trials. Results were robust with low sensitivity to most input parameters. However, when the probability of successful alcohol injection treatment dropped below 40%, the steroid selective injection strategy became most cost-effective. CONCLUSION. A trial of ultrasound-guided injection therapies for Morton neuroma is a cost-effective strategy compared with proceeding directly to surgical neurectomy. CLINICAL IMPACT. Ultrasound-guided injection therapies are indicated as first-line treatment of patients with symptomatic Morton neuromas when conservative management fails.


Assuntos
Análise Custo-Benefício/métodos , Denervação/economia , Denervação/métodos , Custos de Cuidados de Saúde/estatística & dados numéricos , Neuroma Intermetatársico/terapia , Ultrassonografia de Intervenção/métodos , Corticosteroides/administração & dosagem , Análise Custo-Benefício/economia , Análise Custo-Benefício/estatística & dados numéricos , Etanol/administração & dosagem , Humanos , Neuroma Intermetatársico/diagnóstico por imagem , Neuroma Intermetatársico/cirurgia , Resultado do Tratamento
7.
Radiographics ; 42(5): 1546-1561, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35776677

RESUMO

US is commonly performed to help diagnose traumatic peripheral nerve injury and entrapment neuropathy, particularly with superficial nerves, where higher spatial resolution provides an advantage over MRI. Other advantages of US include dynamic evaluation, easy contralateral comparison, fewer implant contraindications, less artifact from ferromagnetic debris, and facile needle guidance for perineural injections. The authors review peripheral nerve US for traumatic peripheral nerve injury with an emphasis on injury grading and entrapment neuropathy and describe best-practice techniques for US-guided perineural injections while highlighting specific techniques and indications. Online supplemental material is available for this article. ©RSNA, 2022.


Assuntos
Síndromes de Compressão Nervosa , Traumatismos dos Nervos Periféricos , Humanos , Injeções/métodos , Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos
8.
Emerg Radiol ; 29(1): 125-132, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34713355

RESUMO

OBJECTIVE: To examine the trends in CT utilization in the emergency department (ED) for different racial and ethnic groups, factors that may affect utilization, and the effects of increased insurance coverage since passage of the Affordable Care Act in 2010. MATERIALS AND METHODS: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 2009-2018 were used for the analysis. The NHAMCS is a cross-sectional survey which has random and systematical samples of more than 200,000 visits to over 250 hospital EDs in the USA. Patient demographic characteristics, source of payment/insurance, clinical presentation, and disposition from the ED were recorded. Descriptive statistics and multivariate logistic regression were performed. RESULTS: Between 2009 and 2018, the rate of uninsured patients in the ED decreased from 18.1% to as low as 9.9%, but this was not associated with a decrease in the disparity in CT utilization between non-Hispanic Black and non-Hispanic White patients. CT use rate increased 38% over the study period. Factors strongly associated with CT utilization include age, source of payment, triage category, disposition from the ED, and residence. After controlling for these factors, non-Hispanic White patients were 21% more likely to undergo CT than non-Hispanic Black patients, though no disparity was seen for Hispanic or Asian/other groups. CONCLUSION: Despite increased insurance coverage over the sample period, racial disparities between non-Hispanic Black and non-Hispanic White patients persist in CT utilization, though no disparity was seen for Hispanic or Asian/other patients. The source of this disparity remains unclear and is likely multifactorial.


Assuntos
Disparidades em Assistência à Saúde , Patient Protection and Affordable Care Act , Estudos Transversais , Serviço Hospitalar de Emergência , Hospitais , Humanos , Tomografia Computadorizada por Raios X , Estados Unidos
9.
Radiographics ; 41(7): 2011-2028, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34623945

RESUMO

Chest, abdominal, and groin pain are common patient complaints that can be due to a variety of causes. Once potentially life-threatening visceral causes of pain are excluded, the evaluation should include musculoskeletal sources of pain from the body wall and core muscles. Percutaneous musculoskeletal procedures play a key role in evaluating and managing pain, although most radiologists may be unfamiliar with applications for the body wall and core muscles. US is ideally suited to guide these less commonly performed procedures owing to its low cost, portability, lack of ionizing radiation, and real-time visualization of superficial soft-tissue anatomy. US provides the operator with added confidence that the needle will be placed at the intended location and will not penetrate visceral or vascular structures. The authors review both common and uncommon US-guided procedures targeting various portions of the chest wall, abdominal wall, and core muscles with the hope of familiarizing radiologists with these techniques. Procedures include anesthetic and corticosteroid injection as well as platelet-rich plasma injection to promote tendon healing. Specific anatomic structures discussed include the sternoclavicular joint, costochondral joint, interchondral joint, intercostal nerve, scapulothoracic bursa, anterior abdominal cutaneous nerve, ilioinguinal nerve, iliohypogastric nerve, genitofemoral nerve, pubic symphysis, common aponeurotic plate, and adductor tendon origin. Relevant US anatomy is depicted with MRI correlation, and steps to performing successful safe US-guided injections are discussed. Confidence in performing these procedures will allow radiologists to continue to play an important role in diagnosis and management of many musculoskeletal pathologic conditions. ©RSNA, 2021.


Assuntos
Imageamento por Ressonância Magnética , Manejo da Dor , Humanos , Dor Pélvica , Nervos Periféricos
10.
Skeletal Radiol ; 50(4): 673-681, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32935196

RESUMO

OBJECTIVE: To present our experience with contrast-enhanced ultrasound (CEUS)-guided musculoskeletal soft tissue biopsies in a busy interventional clinic. MATERIALS AND METHODS: After IRB approval was obtained and informed consent was waived, we retrospectively reviewed all CEUS-guided musculoskeletal biopsies performed from December 1, 2018 to March 2, 2020. Relevant pre-procedure imaging was reviewed. Number of samples, suspected necrosis on pre-procedure imaging, specimen adequacy for pathologic analysis, correlation with pathologic diagnosis of surgical resection specimens, and procedural complications were recorded. RESULTS: Thirty-six CEUS-guided musculoskeletal biopsies were performed in 32 patients (mean age 57, range 26-88; 22 males, 10 females). All procedures were performed using 16-gauge biopsy needles, and all procedures provided adequate samples for pathologic analysis as per the final pathology report. Between two and seven core specimens were obtained (mean 3.7). In 30/36 cases (83%), a contrast-enhanced MRI was obtained prior to biopsy, and 10/30 (33%) of these cases showed imaging features suspicious for necrosis. In 15/36 cases, surgical resection was performed, and the core biopsy and surgical resection specimens were concordant in 14/15 cases (93%). One patient noted transient leg discomfort at the time of microbubble bursting. Otherwise, no adverse reactions or procedural complications were observed. CONCLUSION: CEUS is an accurate way to safely target representative areas of soft tissue lesions for biopsy and can be implemented in a busy interventional clinic. Our early experience has shown this to be a promising technique, especially in targeting representative areas of heterogeneous lesions and lesions with areas of suspected necrosis on prior imaging.


Assuntos
Biópsia Guiada por Imagem , Ultrassonografia de Intervenção , Biópsia com Agulha de Grande Calibre , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia
11.
Skeletal Radiol ; 50(12): 2483-2494, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34021773

RESUMO

OBJECTIVE: To evaluate the effect of intravenous (IV) contrast on sensitivity, specificity, and accuracy of magnetic resonance (MR) neurography of the knee with attention to the common peroneal nerve (CPN) in identifying nerve lesions and active muscle denervation changes. MATERIALS AND METHODS: A retrospective search for contrast-enhanced MR neurography cases evaluating the CPN at the knee was performed. Patients with electrodiagnostic testing (EDX) within 3 months of imaging were included and those with relevant prior surgery were excluded. Two radiologists independently reviewed non-contrast sequences and then 4 weeks later evaluated non-contrast and contrast sequences. McNemar's tests were performed to detect a difference between non-contrast only and combined non-contrast and contrast sequences in identifying nerve lesions and active muscle denervation changes using EDX as the reference standard. RESULTS: Forty-four exams in 42 patients (2 bilateral) were included. Twenty-eight cases had common peroneal neuropathy and 29, 21, and 9 cases had active denervation changes in the anterior, lateral, and posterior compartment/proximal muscles respectively on EDX. Sensitivity, specificity, and accuracy of non-contrast versus combined non-contrast and contrast sequences for common peroneal neuropathy were 50.0%, 56.2%, and 52.3% versus 50.0%, 56.2%, and 52.3% for reader 1 and 57.1%, 50.0%, and 54.5% versus 64.3%, 56.2%, and 61.4% for reader 2. Sensitivity, specificity, and accuracy of non-contrast and combined non-contrast and contrast sequences in identifying active denervation changes for anterior, lateral, and posterior compartment muscles were not significantly different. McNemar's tests were all negative. CONCLUSION: IV contrast does not improve the ability of MR neurography to detect CPN lesions or active muscle denervation changes.


Assuntos
Denervação Muscular , Nervo Fibular , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Nervo Fibular/diagnóstico por imagem , Estudos Retrospectivos
12.
BMC Health Serv Res ; 20(1): 840, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894129

RESUMO

BACKGROUND: An established body of literature has shown evidence of implicit bias in the health care system on the basis of patient race and ethnicity that contributes to well documented disparities in outcomes. However, little is known about the influence of patient race and ethnicity on the decision to order diagnostic radiology exams in the acute care setting. This study examines the role of patient race and ethnicity on the likelihood of diagnostic imaging exams being ordered during United States emergency department encounters. METHODS: Publicly available data from the National Hospital Ambulatory Medical Care Survey Emergency Department sample for the years 2006-2016 was compiled. The proportion of patient encounters where diagnostic imaging was ordered was tabulated by race/ethnicity, sub-divided by imaging modality. A multivariable logistic regression model was used to evaluate the influence of patient race/ethnicity on the ordering of diagnostic imaging controlling for other patient and hospital characteristics. Survey weighting variables were used to formulate national-level estimates. RESULTS: Using the weighted data, an average of 131,558,553 patient encounters were included each year for the 11-year study period. Imaging was used at 46% of all visits although this varied significantly by patient race and ethnicity with white patients receiving medical imaging at 49% of visits and non-white patients at 41% of visits (p < 0.001). This effect persisted in the controlled regression model and across all imaging modalities with the exception of ultrasound. Other factors with a significant influence on imaging use included patient age, gender, insurance status, number of co-morbidities, hospital setting (urban vs non-urban) and hospital region. There was no evidence to suggest that the disparate use of imaging by patient race and ethnicity changed over the 11-year study time period. CONCLUSION: The likelihood that a diagnostic imaging exam will be ordered during United States emergency department encounters differs significantly by patient race and ethnicity even when controlling for other patient and hospital characteristics. Further work must be done to understand and mitigate what may represent systematic bias and ensure equitable use of health care resources.


Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Fatores Raciais/estatística & dados numéricos , Adulto , Etnicidade/estatística & dados numéricos , Feminino , Pesquisas sobre Atenção à Saúde , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Preconceito , Estados Unidos
13.
AJR Am J Roentgenol ; 213(2): 417-426, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30973781

RESUMO

OBJECTIVE. Sesamoids and accessory ossicles are frequently encountered normal osseous structures in the foot that may be an uncommon cause of pain. Familiarity with their imaging findings allows the radiologist to provide reassurance in normal cases and increase confidence when making the relatively uncommon diagnosis of a pathologic sesamoid or symptomatic ossicle. CONCLUSION. Image-guided injections targeted to the symptomatic ossicle can confirm the suspected diagnosis and predict therapeutic outcomes before surgical intervention.


Assuntos
Ossos do Pé/anatomia & histologia , Ossos do Pé/diagnóstico por imagem , Manejo da Dor/métodos , Dor/tratamento farmacológico , Dor/etiologia , Variação Anatômica , Diagnóstico Diferencial , Humanos , Injeções , Medição da Dor , Ossos Sesamoides/anatomia & histologia , Ossos Sesamoides/diagnóstico por imagem
14.
Skeletal Radiol ; 48(12): 1991-1997, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31172207

RESUMO

OBJECTIVE: To determine the pubic bone fracture incidence and associated injury patterns in patients with core muscle injury. MATERIALS AND METHODS: Ninety-three consecutive patients with core muscle injury protocol MRI showing rectus abdominis-adductor longus aponeurotic plate injuries from June 2007 through August 2017 were independently analyzed in blinded fashion by two musculoskeletal radiologists for the presence or absence of pubic bone fracture. A variety of other osseous and soft tissue injury characteristics were recorded. Pain duration prior to MRI and return to play time were taken from the clinical record. Statistical analysis included fracture incidence as well as the association of fracture with other injury characteristics, duration of pain, and return to play time. RESULTS: Eighty-seven men and six women with a mean age of 34.4 years (range, 16-66 years) were included in the study cohort. Overall fracture incidence was 18.3% (17/93) including 13 fatigue fractures of the pubic body and four elevated cortical fractures/fragments. After correction for multiple comparisons, no strong association was identified with osseous or soft tissue injury characteristics, pain duration, or return to play time. CONCLUSIONS: Pubic fractures-particularly fatigue fractures-are a common co-existing injury in patients with a wide range of core muscle injury patterns. The presence of fracture did not have a strong correlation with injury patterns, pain duration, or return to play time but may have implications for patient management.


Assuntos
Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/lesões , Traumatismos em Atletas/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Osso Púbico/diagnóstico por imagem , Osso Púbico/lesões , Adolescente , Adulto , Idoso , Aponeurose/diagnóstico por imagem , Aponeurose/lesões , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Skeletal Radiol ; 48(1): 103-108, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29915937

RESUMO

OBJECTIVE: To determine the diagnostic accuracy of an abbreviated, two-sequence MRI protocol using limited pulse sequences for the detection of radiographically occult hip and pelvis fractures in the elderly compared to the complete MRI examination. MATERIALS AND METHODS: One hundred and eleven consecutive emergency department patients age 65 or older who had undergone MRI to evaluate for clinically suspected hip fracture after negative radiographs were included in the study. The large field-of-view coronal T1 and STIR sequences were isolated from the complete six-sequence MRI protocol and reviewed independently in a blinded fashion by two musculoskeletal fellowship-trained radiologists who recorded presence or absence of fractures of the proximal femora or pelvis, fracture type, and presence or absence of soft tissue injury. Test accuracy was calculated with 95% confidence intervals and accuracy of fracture classification for the abbreviated protocol was compared to that made on the basis of the full exam. RESULTS: For proximal femoral fractures, the abbreviated protocol had a pooled sensitivity and specificity for the two readers of 100 and 97%, respectively. For pelvic fractures, sensitivity was 92% and specificity was 98%. The kappa coefficient for fracture classification was 0.90 for reader 1 and 0.88 for reader 2, indicating excellent agreement for both readers in fracture classification compared to the classification made based on the complete MRI protocol. CONCLUSIONS: An abbreviated MRI protocol that includes only coronal T1 and STIR sequences maintains high sensitivity and specificity for hip and pelvis fracture detection and fracture classification.


Assuntos
Fraturas do Fêmur/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Fraturas do Quadril/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Ossos Pélvicos/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Sensibilidade e Especificidade
16.
Anaerobe ; 57: 28-31, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30876932

RESUMO

Higher order alcohols, such as 1-butanol and 1-hexanol, have a large number of applications but are currently prepared from non-renewable feedstocks. Here, the ability of Thermoanaerobacter pseudoethanolicus to reduce short-chain fatty acids to their corresponding alcohols using reducing potential generated by glucose catabolism with yields between 21.0 and 61.0%. 13C-labelled acetate, 1-propionate and 1-butyrate demonstrates that exogenously added fatty acids are indeed reduced to their corresponding alcohols. This mode of producing primary alcohols from fatty acids using a thermophilic anaerobe opens the door for the production of such alcohols from low-value materials using an inexpensive source of reducing potential.


Assuntos
Álcoois/metabolismo , Ácidos Graxos Voláteis/metabolismo , Thermoanaerobacter/metabolismo , Biotransformação , Glucose/metabolismo
18.
BMC Pregnancy Childbirth ; 14: 424, 2014 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-25522741

RESUMO

BACKGROUND: In June of 2010, an antenatal ultrasound program was introduced to perform basic screening examinations at a health care clinic in rural Uganda. The impact of the program on the existing antenatal care infrastructure including the proportion and number of women receiving recommended antenatal care at clinic visits was unknown. The aim of this study was to investigate the relationship between the advent of the ultrasound program and the proportion of women receiving recommended antenatal interventions at their clinic visits. Change in the absolute numbers of antenatal services provided was also assessed. METHODS: Records at the Nawanyago clinic were reviewed to determine the total numbers of women receiving specific interventions before and after the advent of the ultrasound program including HIV testing, intermittent preventive therapy for malaria, presumptive anti-parasitic treatment, and provision of iron and folate for anemia. The rate at which these interventions were provided (number of interventions per clinic visit) was also assessed. The differences in absolute numbers of antenatal interventions before and after the introduction of the ultrasound program were assessed using the Wilcoxon rank-sum test. Differences in intervention rate were assessed using negative binomial regression modeling. RESULTS: The mean monthly numbers of women receiving each of these interventions increased significantly with the greatest increase seen in numbers of women receiving anemia and deworming treatments at +113% and +102% respectively (p < 0.001). The intervention rate increased for anemia treatment, deworming treatment, and 2nd dose of intermittent preventive therapy for malaria. A slight decrease in intervention rate was observed for 1st dose of malaria treatment with a rate ratio of 0.88 (0.79 - 0.98, 95% CI). Intervention rate for HIV testing was not significantly changed. CONCLUSION: The introduction of a low-cost antenatal ultrasound program at a health care clinic in rural Uganda was associated with increases in the number of women receiving specific recommended antenatal care interventions. Effect on intervention rates was mixed but showed an overall increase. The use of ultrasound in this context may provide a benefit to the maternal and neonatal health of the community.


Assuntos
Infecções por HIV/diagnóstico , Cuidado Pré-Natal/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Anemia/prevenção & controle , Anti-Helmínticos/uso terapêutico , Feminino , Ácido Fólico/uso terapêutico , Humanos , Ferro/uso terapêutico , Malária/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/tendências , População Rural , Uganda
19.
J Environ Manage ; 146: 189-197, 2014 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-25173727

RESUMO

Biochar has potential to sequester carbon in soils and simultaneously improve soil quality and plant growth. More understanding of biochar variation is needed to optimise these potential benefits. Slow pyrolysis at 600 °C was undertaken to determine how yields and characteristics of biochars differ when produced from eight different agricultural residues. Biochar properties such as carbon content, surface area, pH, ultimate and proximate analysis, nutrient and metal content and the R50 recalcitrance index were determined. Significant variations seen in biochar characteristics were attributed to feedstock variation since pyrolysis conditions were constant. Biochar yields varied from 28% to 39%. Average carbon content was 51%. Ash content of both feedstocks and biochars were correlated with biochar carbon content. Macronutrients were concentrated during pyrolysis, but biochar macronutrient content was low in comparison to biochars produced from more nutrient rich feedstocks. Most biochars were slightly alkaline, ranging from pH 6.1 to pH 11.6. pH was correlated with biochar K content. Aromaticity was increased with pyrolysis, shown by a reduction in biochar H/C and O/C ratios relative to feedstock values. The R50 recalcitrance index showed biochars to be either class 2 or class 3. Biochar carbon sequestration potential was 21.3%-32.5%. The R50 recalcitrance index is influenced by the presence of alkali metals in the biochar which may lead to an under-estimation of biochar stability. The residues assessed here, at current global availability, could produce 373 Mt of biochar. This quantity of biochar has the potential to sequester 0.55 Pg CO2 yr(-1) in soils over long time periods.


Assuntos
Sequestro de Carbono , Carvão Vegetal/química , Solo/química , Produtos Agrícolas , Humanos , Temperatura
20.
Data Brief ; 54: 110547, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38882190

RESUMO

The draft genome sequence of an isolate of Bacillus safensis U41 from the soils of Santiniketan (23040'12″ N and 87039'52″ E) is reported here. Bacillus safensis is a bacterium that produces cellulases, which is essential for the breakdown of plant biomass. As such, it is a valuable source of digestive enzymes from plant biomass, especially cellulases. The genomic DNA was extracted from a single colony using a QIAgen Blood and Tissue kit (QIAgen Inc., Canada). Sequencing was performed via Illumina HiSeq X using 2 × 150 paired-end chemistry, generating 7,352,576 reads with sequence coverage of 509x. The assembly produced 20 contigs over 200 base pairs (bp) in length, with an N50 value of 901304 and an L50 of 2. The genome size was 3,732,407 bp, and the average GC content was 41.43 %. Genome annotation and gene predictions were performed using Prokka v.1.14.6, which identified 3783 coding sequences, 64 tRNA genes, and 3 rRNA genes.

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