Marshcooney2292

Trauma is widespread, and its symptoms can adversely impact wellbeing at end of life, a time when hospice seeks to maximize quality of life. This article reviews research on trauma at end of life, provides an overview of trauma-informed principles, and explores possibilities for applying trauma-informed care through an illustrative case study of a patient at end of life. The case discussion applies findings from the literature using Feldman's Stepwise Psychosocial Palliative Care model as a roadmap. #link# As shown in the case study, trauma-related symptoms may complicate care, making it an important subject of clinical attention for interdisciplinary hospice team members. As part of this team, social workers are particularly well suited to provide more targeted interventions where indicated, though all members of the team should take a trauma-informed approach. Lastly, this article reflects on the need for organizations to take a systems-level approach when implementing trauma-informed care and suggests implications for practice through a universal approach to trauma and the need for trauma-specific assessments and interventions at end-of-life, along with areas for future research.

The study was aimed to explore the differences between the

osteosynthesis-associated infection (OAI) and non-implant related infections (NIRI) in terms of epidemiology, resistance characteristics, virulence determinants, treatment, risk factors, and outcome.

A prospective study was conducted from 2018 through 2019. The phenotypic and genotypic characterization of

, risk factors, treatment, and outcome were compared.

A total of 60 patients were included. 50% had OAIs (70%) (p= .045). Overall, MRSA (OR 0.69; p = .020) and old age (OR 0.95; p =0.035) were the important risk factors. Implanted patients presented with the features of chronic osteomyelitis (93.3%, p =0.01). NIRI cases composed of only 66.7% of OM, and 55% of them were acute. OAI isolates were more frequently

gene positives (50%) than isolates from the NIRI group (33.3%). Patients with OAI by luk positive isolates significantly had prolonged hospital stay

. Most of the NIRIs (60%) managed with antibiotics, but frequent surgical intervention (OR 10.68; p = .024) with prolonged systemic antibiotics (OR 1.07; p = .029) helped all OAIs to recover. link2 Patients without implants were recovered in a higher number (83.3%).

Our study highlighted that the differences exist between the OAI and NIRI, specifically in terms of clinical features, distribution of

genes, treatment approach, and outcome. Risk factors for both types of infection remained the same.

Our study highlighted that the differences exist between the OAI and NIRI, specifically in terms of clinical features, distribution of luk genes, treatment approach, and outcome. Risk factors for both types of infection remained the same.Bioaerosols are known to be an important transmission pathway for SARS-CoV-2. We report a framework for estimating the risk of transmitting SARS-CoV-2 via aerosols in laboratory and office settings, based on an exponential dose-response model and analysis of air flow and purification in typical heating, ventilation, and air conditioning (HVAC) systems. High-circulation HVAC systems with high-efficiency particulate air (HEPA) filtration dramatically reduce exposure to the virus in indoor settings, and surgical masks or N95 respirators further reduce exposure. As an example of our risk assessment model, we consider the precautions needed for a typical experimental physical science group to maintain a low risk of transmission over six months of operation. We recommend that, for environments where fewer than five individuals significantly overlap, work spaces should remain vacant for between one (high-circulation HVAC with HEPA filtration) to six (low-circulation HVAC with no filtration) air exchange times before a new worker enters in order to maintain no more than 1% chance of infection over six months of operation in the workplace. Our model is readily applied to similar settings that are not explicitly given here. We also provide a framework for evaluating infection mitigation through ventilation in multiple occupancy spaces.Transgender and non-binary people assigned female at birth (TNB/AFAB) have unintended pregnancies, but there is a dearth of information about effective pregnancy prevention care for this population. This needs assessment study aimed at discerning pregnancy prevention care best practices involved interviews of 20 healthcare providers solicited for experience providing pregnancy counseling with this group. Findings were organized via the ecological model, revealing four layers of themes. 1) Social structural level themes related to the gender binary system and other forms of oppression (racism, sexism, heterosexism); 2) the systems level theme related to access to and barriers to care; 3) provider level themes included lack of formal education, need to provide trauma-informed care, and provider discomfort or assumptions; and 4) patient-level themes included the fact that patients do not usually raise issues related to contraception and that TNB/AFAB patients have unique contraception needs. Implications of the findings are discussed.MRI is firmly established as an essential modality in the imaging of the temporal bone and lateral skull base. It is used to evaluate normal anatomic structures, evaluate for vestibular schwannomas, assess for inflammatory and/or infectious processes, and detect residual and/or recurrent cholesteatoma. It is also extensively used in pre- and postoperative evaluations, particularly in patients with vestibular schwannomas and candidates for cochlear implantation. Nevertheless, despite the widespread use of MRI for these purposes, many radiologists remain unfamiliar with the complex anatomy and expected imaging findings with such examinations. EI1 research buy of this review is to provide an overview of the most useful MRI sequences for internal auditory canal and labyrinthine imaging, review the relevant anatomy, and discuss the expected appearances of the most commonly encountered pathologic entities. In addition, the features at pre- and postprocedural MRI will be discussed to help ensure that diagnostic radiologists may be of greatest use to the ordering physicians. © RSNA, 2020.Background The performance of a deep learning algorithm for lung cancer detection on chest radiographs in a health screening population is unknown. Purpose To validate a commercially available deep learning algorithm for lung cancer detection on chest radiographs in a health screening population. Materials and Methods Out-of-sample testing of a deep learning algorithm was retrospectively performed using chest radiographs from individuals undergoing a comprehensive medical check-up between July 2008 and December 2008 (validation test). To evaluate the algorithm performance for visible lung cancer detection, the area under the receiver operating characteristic curve (AUC) and diagnostic measures, including sensitivity and false-positive rate (FPR), were calculated. The algorithm performance was compared with that of radiologists using the McNemar test and the Moskowitz method. Additionally, the deep learning algorithm was applied to a screening cohort undergoing chest radiography between January 2008 and Decemb be helpful for radiologists in healthy populations with a low prevalence of lung cancer. © RSNA, 2020 Online supplemental material is available for this article. link3 See also the editorial by Armato in this issue.Background Stiffness thresholds for liver MR elastography in children vary between studies and may differ from thresholds in adults. Normative liver stiffness data are needed to optimize diagnostic thresholds for children. Purpose To determine normal liver stiffness, and associated normal ranges for children, as measured with MR elastography across vendors and field strengths. Materials and Methods This was a prospective multicenter cohort study (ClinicalTrials.gov identifier NCT03235414). Volunteers aged 7-17.9 years without a known history of liver disease were recruited at four sites for a research MRI and blood draw between February 2018 and October 2019. MRI was performed on three vendor platforms and at two field strengths (1.5 T and 3.0 T). All MRI scans were centrally analyzed; stiffness, proton density fat fraction (PDFF), and R2* values were expressed as means of means. Mean and 95% confidence intervals (CIs) for liver stiffness were calculated. Pearson correlation coefficient (r), two-sample t test, or analysis of variance was used to assess univariable associations. Results Seventy-one volunteers had complete data and no documented exclusion criterion (median age, 12 years; interquartile range [IQR], 10-15 years; 39 female participants). Median body mass index percentile was 54% (IQR, 32.5%-69.5%). Mean liver stiffness was 2.1 kPa (95% CI 2.0, 2.2 kPa) with mean ± 1.96 kPa standard deviation of 1.5-2.8 kPa. Median liver PDFF was 2.0% (IQR, 1.7%-2.6%). There was no association between liver stiffness and any patient variable or MRI scanner factor. Conclusion Mean liver stiffness measured with MR elastography in children without liver disease was 2.1 kPa (similar to that in adults). The 95th percentile of normal liver stiffness was 2.8 kPa. Liver stiffness was independent of sex, age, or body mass index and did not vary with MRI scanner vendor or field strength. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Yin in this issue.Background A superselective (SS) arterial spin labeling (ASL) MRI technique can be used to monitor the revascularization area as a supplementary or alternative modality to digital subtraction angiography (DSA), with the advantage of being noninvasive. Purpose To evaluate whether SS-ASL perfusion MRI could be used to visualize the revascularization area after combined direct and indirect bypass surgery in adults with moyamoya disease compared with DSA. Materials and Methods Patients diagnosed with moyamoya disease who underwent DSA and SS-ASL 6 months after surgery between June 2017 and November 2019 in a single institution were retrospectively evaluated. Subjective grading of the revascularization area and collateral grading in 10 Alberta Stroke Program Early CT Score (ASPECTS) locations were performed. The change in perfusion status in a subgroup that underwent both preoperative and postoperative SS-ASL studies was evaluated. Intermodality agreement was analyzed by using weighted κ statistics. Results Thirtynderwent bypass surgery, and it showed the changes in the vascular supplying territories before and after bypass surgery. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Hendrikse in this issue.Background The 2019 Bosniak classification (version 2019) of cystic renal masses (CRMs) provides a systematic update to the currently used 2005 Bosniak classification (version 2005). Further validation is required before widespread application. Purpose To evaluate the interobserver agreement of MRI criteria, the impact of readers' experience, and the diagnostic performance between version 2019 and version 2005. Materials and Methods From January 2009 to December 2018, consecutive patients with CRM who had undergone renal MRI and surgical-pathologic examination were included in this retrospective study. On the basis of version 2019 and version 2005, all CRMs were independently classified by eight radiologists with different levels of experience. By using multirater κ statistics, interobserver agreement was evaluated with comparisons between classifications and between senior and junior radiologists. Diagnostic performance between classifications by dichotomizing classes I-IV into lower (I-IIF) and higher (III-IV) classes was compared by using the McNemar test.