The Effectiveness of an On-Bicycle Curriculum on Children.

OBJECTIVE: The objective of this study was to determine whether the BikeSafe on-bicycle curriculum affects children's bicycle safety knowledge and collect cross-sectional data on cycling beliefs and attitudes. METHODS: The University of Miami's BikeSafe program collected surveys from 286 participants, aged 7-15, in 10 Miami-Dade County Parks, Recreation, and Open Spaces summer camps from June to August 2015. Pre and post knowledge assessments were analyzed for 83 intervention group and 57 control group participants. Posttesting occurred immediately following program implementation and 2-4 weeks postimplementation. RESULTS: Intervention group participants demonstrated significant differences (P < .05) in knowledge gain between testing points, whereas control group participants did not. Participants (n = 286) were more likely to be encouraged to ride a bicycle by parents/guardians (61.2%) than by friends (38.1%) or schools (19.6%). Older respondents reported lower intentions of helmet use compared to the younger age group, χ2(4) = 27.96, P < .0005. CONCLUSIONS: Children's bicycle safety knowledge increased following implementation of the BikeSafe on-bicycle curriculum. This study confirmed previous research on the decrease in helmet use as children get older and provided insight into how children view their parents' beliefs and attitudes relating to cycling. The findings of this study can be used to effectively target future educational and encouragement initiatives.

Vision Zero in the United States Versus Sweden: Infrastructure Improvement for Cycling Safety.

Inspired by Swedish legislation, Vision Zero policies are being adopted in the United States with increasing frequency. Although some view the goal of eliminating serious injury and death on the road system as impractical, Sweden's lower rates of road-related injury and death provide compelling evidence that more can be done to improve US cycling safety. We examine existing Vision Zero and cycling-related literature to highlight the central components of the Swedish policy, with the goal of providing evidence-based recommendations for successful implementation of similar policies in the United States. Ultimately, infrastructure design should remain central in US Vision Zero plans, but supplemental initiatives promoting a cycling and safety culture also can be incorporated.

Diagnostic yield of recommendations for chest CT examination prompted by outpatient chest radiographic findings.

PURPOSE: To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. RESULTS: There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P < .001) and positive smoking history (P = .001) were associated with increased likelihood of a recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in 20.6% (142 of 691 [95% CI: 17.6%, 23.8%]) of cases, and no corresponding abnormalities in 38.1% (263 of 691 [95% CI: 34.4%, 41.8%]) of cases. Newly diagnosed, biopsy-proven malignancies were detected in 8.1% (56 of 691 [95% CI: 6.2%, 10.4%]) of cases. CONCLUSION: A radiologist recommendation for chest CT to evaluate an abnormal finding on an outpatient chest radiographic examination has a high yield of clinically relevant findings.

MR imaging of the gallbladder: a pictorial essay.

The gallbladder serves as the repository for bile produced in the liver. However, bile within the gallbladder may become supersaturated with cholesterol, leading to crystal precipitation and subsequent gallstone formation. The most common disorders of the gallbladder are related to gallstones and include symptomatic cholelithiasis, acute and chronic cholecystitis, and carcinoma of the gallbladder. Other conditions that can affect the gallbladder include biliary dyskinesia (functional), adenomyomatosis (hyperplastic), and postoperative changes or complications (iatrogenic). Ultrasonography (US) has been the traditional modality for evaluating gallbladder disease, primarily owing to its high sensitivity and specificity for both stone disease and gallbladder inflammation. US performed before and after ingestion of a fatty meal may also be useful for functional evaluation of the gallbladder. However, US is limited by patient body habitus, with degradation of image quality and anatomic detail in obese individuals. With the advent of faster and more efficient imaging techniques, magnetic resonance (MR) imaging has assumed an increasing role as an adjunct modality for gallbladder imaging, primarily in patients who are incompletely assessed with US. MR imaging allows simultaneous anatomic and physiologic assessment of the gallbladder and biliary tract in both initial evaluation of disease and examination of the postoperative patient. This assessment is accomplished chiefly through the use of MR imaging contrast agents excreted preferentially via the biliary system.