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BACKGROUND: Little data exists on the association of missed care opportunities (MCOs) in children referred for nuclear medicine/nuclear oncology imaging examinations and socioeconomic disparities. OBJECTIVE: To determine the prevalence of MCOs in children with lymphoma/leukemia scheduled for fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and the impact of sociodemographic factors and Child Opportunity Index (COI). MATERIALS AND METHODS: Retrospective analysis of MCOs in children with lymphoma/leukemia scheduled for FDG-PET/CT (2012 to 2022) was performed. In univariate analysis, patient, neighborhood, and appointment data were assessed across MCOs and completed appointments. Logistic regression evaluated independent effects of patient-, neighborhood-, and appointment-level factors with MCOs. Two-sided P-value < .05 was considered statistically significant. RESULTS: In 643 FDG-PET/CT appointments (n = 293 patients; median age 15 years (IQR 11.0-17.0 years); 37.9% female), there were 20 MCOs (3.1%) involving 16 patients. Only 8.2% appointments involved Black/African American non-Hispanic/Latino patients, yet they made up a quarter of total MCOs. Patients living in neighborhoods with very low or low COI experienced significantly higher MCOs versus zip codes with very high COI (6.9% vs. 0.8%; P = 0.02). Logistic regression revealed significantly increased likelihood of MCOs for patients aged 18 to 21 [odds ratio (OR) 4.50; 95% CI 1.53-13.27; P = 0.007], Black/African American non-Hispanic/Latino (OR 3.20; 95% CI 1.08-9.49; P = 0.04), zip codes with very low or low COI (OR 9.60; 95% CI 1.24-74.30; P = 0.03), and unknown insurance status. CONCLUSION: Children with lymphoma/leukemia, living in zip codes with very low or low COI, and who identified as Black/African American non-Hispanic/Latino experienced more MCOs. Our study supports the need to address intersecting sociodemographic, neighborhood, and health system factors that will improve equitable access to necessary healthcare imaging for children.
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Fluorodesoxiglucosa F18 , Disparidades en Atención de Salud , Leucemia , Linfoma , Tomografía Computarizada por Tomografía de Emisión de Positrones , Radiofármacos , Humanos , Masculino , Femenino , Adolescente , Niño , Linfoma/diagnóstico por imagen , Linfoma/terapia , Estudios Retrospectivos , Tomografía Computarizada por Tomografía de Emisión de Positrones/estadística & datos numéricos , Leucemia/diagnóstico por imagen , Factores Sociodemográficos , Factores SocioeconómicosAsunto(s)
Diabetes Mellitus , Enfermedades Renales Quísticas , Humanos , Masculino , Adulto Joven , Quistes , Riñón/diagnóstico por imagenRESUMEN
The addition of floral resources is a common intervention to support the adult life stages of key crop pollinators. Fly (Diptera) crop pollinators, however, typically do not require floral resources in their immature life stages and are likely not supported by this management intervention. Here, we deployed portable pools filled with habitat (decaying plant materials, soil, water) in seed carrot agroecosystems with the intention of providing reproduction sites for beneficial syrphid (tribe Eristalini) fly pollinators. Within 12 to 21 days after the pools were deployed, we found that the habitat pools supported the oviposition and larval development of two species of eristaline syrphid flies, Eristalis tenax (Linnaeus, 1758) and Eristalinus punctulatus (Macquart, 1847). Each habitat pool contained an average (±S.E.) of 547 ± 117 eristaline fly eggs and 50 ± 17 eristaline fly larvae. Additionally, we found significantly more eggs were laid on decaying plant stems and carrot roots compared to other locations within the pool habitat (e.g., on decaying carrot umbels, leaves, etc.). These results suggest that deploying habitat pools in agroecosystems can be a successful management intervention that rapidly facilitates fly pollinator reproduction. This method can be used to support future studies to determine if the addition of habitat resources on intensively cultivated farms increases flower visitation and crop pollination success by flies.
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RATIONALE AND OBJECTIVES: Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals. MATERIALS AND METHODS: A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption. RESULTS: 50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (pâ¯=â¯0.028). No other factors were statistically significant (p > 0.05). CONCLUSION: Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.
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Lactancia Materna , Radiología , Femenino , Humanos , Lactancia , Embarazo , Radiólogos , Apoyo Social , Lugar de TrabajoRESUMEN
Given the increasing use of MRI in the pediatric population, the need for sedation in MRI performed in young children is a topic of growing importance. Although sedation is generally tolerated well by children, the financial and operational impacts of anesthesia on MRI workflow, as well as potential adverse effects of anesthetic medications, highlight the need to perform MRI in children without sedation whenever possible. This review focuses on current techniques to facilitate non-sedation MRI in children, including exam preparation with MRI simulation; asleep but not sedated techniques; awake and relaxed techniques using certified child life specialists, animal-assisted therapy, a child-friendly environment and in-scan entertainment; and non-sedated MRI protocol modifications such as shorter scan time, prioritizing sequences, reducing motion artifact, noise reduction, limiting use of gadolinium, employing an open MRI and modifying protocols.
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Anestesia , Terapia Asistida por Animales , Artefactos , Niño , Preescolar , Sedación Consciente , Gadolinio , Humanos , Imagen por Resonancia MagnéticaRESUMEN
A 50-year-old male presented with bilateral lower extremity plain is found to have a wedge-shape hypodense region in the hepatic quadrate lobe. The hypoenhancement was thought to be a result of systemic-portal venous shunting due to IVC obstruction, a "cold" version of the classically described hot quadrate sign. Follow-up CT confirmed the diagnosis. Venous drainage pathway for both hot and cold quadrate signs is discussed.
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Enfermedades Vasculares , Vena Cava Inferior , Infarto Hepático , Humanos , Masculino , Persona de Mediana Edad , Vena PortaRESUMEN
OBJECTIVE. The objective of this article is to review strategies to reduce the use of gadolinium-based contrast agents for pediatric abdominal MRI. CONCLUSION. Alternative contrast agents that do not contain gadolinium and unenhanced pediatric abdominal MRI protocols have shown clinical utility. Sequences such as DWI and new multicontrast MRI pulse sequences offer promise for tissue characterization without IV contrast agents. Patients requiring repeat MRI to evaluate for change in focal disease can be monitored with unenhanced abdominal MRI.
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Abdomen/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Gadolinio/administración & dosificación , Imagen por Resonancia Magnética/métodos , Niño , Medios de Contraste/efectos adversos , Hipersensibilidad a las Drogas , Gadolinio/efectos adversos , HumanosAsunto(s)
Disparidades en Atención de Salud/economía , Medicare/economía , Mejoramiento de la Calidad , Radiología/organización & administración , Femenino , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Mecanismo de Reembolso , Estados UnidosRESUMEN
OBJECTIVES: A growing body of evidence shows that frailty and functional performance predict liver transplant outcomes. The Organ Procurement and Transplant Network uses the Karnofsky Performance Status scale to adjust for transplant center case mix in assessing quality measures. This study explores the strength of the relationship between Karnofsky Performance Status scores and objective measures of frailty. MATERIALS AND METHODS: This observational study includes 136 adult, first-time liver transplant recipients at UMass Memorial (2006-2015) who had 2 abdominal computed tomography scans available (at ≤ 90 days pretransplant and ≥ 7 days before that). We analyzed the relationship between Karnofsky Performance Status and muscle wasting using absolute and change in psoas muscle size and quality pretransplant. RESULTS: The mean age was 55 years, mean Model for End-Stage Liver Disease was 22, and 34% of patients were women. In the study group, 50% of patients had sarcopenia pretransplant and 71.3% demonstrated declined lean psoas area at an average rate of 11% per month. Patients who experienced muscle wasting at a rate of ≥ 1% per month had 2.83 times the risk (95% confidence interval, 1.18-6.80) of being severely impaired/disabled pretransplant. The risk increased by 2.32-fold (95% confidence interval, 1.44-3.75) for every standard deviation decrease in pretransplant lean psoas area. CONCLUSIONS: Provider-assessed physical health status moderately correlates with objective measures of frailty.