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1.
Abdom Radiol (NY) ; 46(10): 4720-4728, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34216245

RESUMO

PURPOSE: To evaluate angle-corrected peak systolic cystic artery velocity (CAv) as a predictor of acute cholecystitis among patients presenting to the emergency department (ED) with right upper quadrant (RUQ) pain. METHODS: In this IRB-approved and retrospective study, CAv was evaluated in 73 patients, 43 who underwent definitive treatment with cholecystectomy or percutaneous cholecystostomy and 30 control patients without clinical suspicion for cholecystitis. In addition to CAv, the following were reviewed by 3 radiologists: CBD diameter, cholelithiasis, impacted stone in the neck, sludge, gallbladder wall thickness > 3 mm, gallbladder transverse dimension ≥ 4 cm, longitudinal dimension ≥ 8 cm, tensile gallbladder fundus sign, pericholecystic fluid, pericholecystic echogenic fat, and sonographic Murphy sign. RESULTS: Of the 43 patients who underwent definitive treatment, 25 had acute cholecystitis (34%) and 18 (25%) had chronic cholecystitis. Average CAv measurements were 50 ± 16 cm/s (acute), 28 ± 8 cm/s (chronic), and 22 ± 8 cm/s (control; p < 0.0001). In univariate analysis, among patients who underwent definitive therapy, CAv ≥ 40 cm/s, gallbladder wall thickness, stone impaction, GB long dimension ≥ 8 cm, and elevated WBC were associated with acute cholecystitis (p < 0.05). In multivariate analysis, CAv ≥ 40 cm/s was the only statistically significant variable (p = 0.016). CAv ≥ 40 cm/s alone had a PPV of 94.7% and overall accuracy of 81.4% in diagnosing acute cholecystitis. CONCLUSION: CAv ≥ 40 cm/s is highly associated with acute cholecystitis in patients presenting to the ED with RUQ pain.


Assuntos
Colecistite Aguda , Colecistite , Colecistite Aguda/complicações , Colecistite Aguda/diagnóstico por imagem , Artéria Hepática , Humanos , Estudos Retrospectivos
2.
Behav Res Ther ; 143: 103885, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34089923

RESUMO

Deficits in response inhibition, defined as an inability to stop a behavior that is no longer relevant, are characteristic of posttraumatic stress disorder (PTSD). Given that impaired response inhibition is associated with worse symptom recovery and accumulating evidence pointing to the effectiveness of cognitive control trainings in reducing PTSD symptoms, individuals with moderate to severe PTSD total severity (Posttraumatic Diagnostic Scale total score ≥ 21) and pre-training response inhibition deficits (M ≤ 75% successful inhibition on the Go/No-go) completed a 3-h, adaptive Go/No-go training designed to improve ability to withhold prepotent motor responses. Then forty-nine participants were randomized to an adaptive response inhibition training (n = 24, M = 19.27 years, SD = 0.70) or a waitlist condition (n = 25, M = 18.31 years, SD = 4.80). Behavioral response inhibition and self-reported trauma-related symptoms were assessed at pre- and post-training. Response inhibition training was associated with improved response inhibition on an untrained transfer Stop-Signal task and symptom reduction in PTSD compared to a waitlist group, at post-training. There was, however, reduced inhibition on a modified Go/No-go task from pre-to post-training. Overall, response inhibition deficits and PTSD symptoms are amenable to top-down remediation using response inhibition training. Our study provides preliminary evidence for the feasibility of response inhibition training in a PTSD sample characterized by response inhibition deficits.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Humanos , Inibição Psicológica , Autorrelato , Transtornos de Estresse Pós-Traumáticos/terapia
3.
Neuropsychopharmacology ; 46(9): 1650-1657, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33833400

RESUMO

Dimensional models of anxiety and depression highlight common and distinct symptom clusters that are thought to reflect disruptions in underlying functional processes. The current study investigated how functioning of threat neurocircuitry relates to symptom dimensions of anxiety and depression. Participants were aged 18-19 years (n = 229, 158 female) and were selected to ensure a range of scores on symptom measures. Symptom dimensions of "General Distress" (common to anxiety disorders and depression), "Fears" (more specific to anxiety disorders), and "Anhedonia-apprehension" (more specific to depression) were evaluated. Participants underwent functional magnetic resonance imaging during a Pavlovian fear conditioning paradigm. Multilevel modeling analyses estimated relationships between symptom dimensions and activation in threat neural circuitry. Exploratory whole brain analyses were also conducted. Threat-related neural activity was not associated with General Distress or Fears. Anhedonia-apprehension was associated with activation of bilateral amygdala, anterior insula and dACC during late extinction. We found no evidence to support an association between symptom dimensions of General Distress or Fears with threat circuitry activation in a large sample of young adults. We did, however, find that the symptom dimension of Anhedonia-apprehension was significantly associated with threat-related neural activation during fear extinction. This effect requires replication in future work but may reflect anhedonic impairments in learning when contingencies are altered, possibly linked to the rewarding relief of an unexpectedly absent threat.


Assuntos
Anedonia , Extinção Psicológica , Mapeamento Encefálico , Condicionamento Clássico , Medo , Feminino , Humanos , Imageamento por Ressonância Magnética , Adulto Jovem
4.
J Am Coll Health ; 68(4): 419-429, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30908123

RESUMO

Objective: To examine the effects of universal and targeted suicide prevention programs on relevant outcomes in college campuses. Methods: College suicide prevention programs published from 2009 to 2018 were assessed on outcomes including knowledge, skills, self-efficacy, suicidal ideation, and suicidal behaviors. Effects of the interventions on outcome variables with sufficient studies to warrant meta-analysis (ie, knowledge, skills, and self-efficacy) were meta-analyzed. Studies reporting on the remaining outcomes (ie, suicidal ideation and behaviors) were systematically reviewed. Results: Significant increases in suicide prevention knowledge, skills, and self-efficacy were observed in universal prevention interventions that typically employed gatekeeper prevention strategies. Evidence of reductions in suicidal ideation and behaviors was observed across targeted suicide prevention programs for at-risk students. Conclusion: Prevention programs are beneficial for training those likely to come in contact with people endorsing suicidality, but further research is needed to show that suicide interventions can consistently have significant effects on suicidal students as well.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/estatística & dados numéricos , Serviços de Saúde para Estudantes/estatística & dados numéricos , Prevenção do Suicídio , Humanos , Autoeficácia , Estudantes , Ideação Suicida , Universidades
5.
Contemp Clin Trials Commun ; 16: 100464, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31701038

RESUMO

This paper provides a methodological description of a multi-site, randomized controlled trial (RCT) of a cognitive-behavioral intervention for enhancing employment success among unemployed persons whose employment efforts have been undermined by social anxiety disorder (SAD). SAD is a common and impairing condition, with negative impacts on occupational functioning. In response to these documented employment-related impairments, in a previous project, we produced and tested an eight-session work-related group cognitive-behavioral therapy provided alongside vocational services as usual (WCBT + VSAU). WCBT is delivered by vocational service professionals and is designed in a context and style that overcomes accessibility and stigma-related obstacles with special focus on employment-related targets. Our previous project found that WCBT + VSAU significantly improved social anxiety, depression, and a range of employment-related outcomes compared to a control group of socially anxious job-seekers who received vocational services as usual without WCBT (VSAU-alone). Participants in this study were all homeless, primarily African American job-seekers with high levels of psychiatric comorbidity and limited education and employment histories. The present, two-region study addresses whether WCBT + VSAU enhances job placement, job retention and mental health outcomes in a larger sample assessed over an extended follow-up period. In addition, this trial evaluates whether the effects of WCBT + VSAU generalize to a new population of urban-based, racially diverse job-seekers with vocational and educational histories that differ from our original sample. This study also investigates the system-effects of WCBT + VSAU in a new site that will be informative for broad implementation of WCBT + VSAU. Finally, this project involves a refined, technology-assisted form of WCBT + VSAU designed to be delivered more easily by vocational services professionals.

6.
J Vasc Interv Radiol ; 30(11): 1870-1875, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587951

RESUMO

PURPOSE: To examine the impact of targeted efforts to increase the number of female speakers at the Society of Interventional Radiology (SIR) Annual Scientific Meeting (ASM) by reporting gender trends for invited faculty in 2017/2018 vs 2016. MATERIALS AND METHODS: Faculty rosters for the 2016, 2017, and 2018 SIR ASMs were stratified by gender to quantify female representation at plenary sessions, categorical courses, symposia, self-assessment modules, and "meet-the-expert" sessions. Keynote events, scientific abstract presentations, and award ceremonies were excluded. In 2017, the SIR Annual Meeting Committee issued requirements for coordinators to invite selected women as speakers. Session coordinators are responsible for issuing speaker invitations, and invited speakers have the option to decline. RESULTS: Years 2017 and 2018 showed increases in female speaker representation, with women delivering 13% (89 of 687) and 14% (85 of 605) of all assigned presentations, compared with 9% in 2016 (46 of 514; P = .03 and P = .01, respectively). Gender diversity correlated with the gender of the session coordinator(s). When averaged over a 3-year period, female speakers constituted 7% of the speaker roster (112 of 1,504 presentations) for sessions led by an all-male coordinator team, compared with 36% (108 of 302) for sessions led by at least 1 female coordinator (P < .0001). Results of the linear regression model confirmed the effect of coordinator team gender composition (P < .0001). CONCLUSIONS: Having a woman as a session coordinator increased female speaker participation, which suggests that the inclusion of more women as coordinators is one mechanism for achieving gender balance at scientific meetings.


Assuntos
Congressos como Assunto/tendências , Médicas/tendências , Radiologistas/tendências , Sexismo/tendências , Sociedades Médicas/tendências , Fala , Mulheres Trabalhadoras , Feminino , Humanos , Masculino , Fatores de Tempo
7.
J Am Coll Radiol ; 16(12): 1656-1662, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31173745

RESUMO

PURPOSE: The aim of this study was to evaluate the clinical performance of the ACR's Ultrasound Liver Reporting and Data System (US LI-RADS™) for detecting hepatocellular carcinoma (HCC) in patients at high risk for HCC. METHODS: In this retrospective, multicenter study, 2,050 patients at high risk for HCC (1,078 men and 972 women; mean age, 57.7 years) at five sites in the United States had undergone screening liver ultrasound from January 2017 to February 2018, and US LI-RADS observation categories and visualization scores were assigned on a clinical basis. Ultrasound reports and patient records were retrospectively reviewed and follow-up imaging studies and/or pathologic reports recorded. Descriptive statistics were generated, and multivariate logistic regression analysis was used to analyze the relationship of clinical and reader-based predictors of limited visualization. Diagnostic performance data were calculated in the subset of patients with confirmatory testing. RESULTS: The most common indications for HCC screening were cirrhosis (n = 1,054 [51.4%]), noncirrhotic hepatitis B virus infection (n = 555 [27.1%]), and noncirrhotic hepatitis C virus infection (n = 234 [11.4%]). US LI-RADS observation categories assigned were US-1 (negative) in 90.4% (n = 1,854), US-2 (subthreshold) in 4.6% (n = 95), and US-3 (positive) in 4.9% (n = 101). Visualization scores were A (no or minimal limitations) in 76.8% (n = 1,575), B (moderate limitations) in 18.9% (n = 388), and C (severe limitations) in 4.2% (n = 87). Confirmatory tests, including multiphase contrast-enhanced CT or MRI (n = 331) or histopathology (n = 18), were available for 349 patients (17.0%). The sensitivity of US LI-RADS in this subset of patients was 82.4%, specificity was 74.2%, positive predictive value was 35.3%, and negative predictive value was 96.1%. CONCLUSIONS: Approximately 90% of US LI-RADS screening examinations were negative, 5% subthreshold, and 5% positive. Visualization scores were diagnostically acceptable in the vast majority (>95%) of examinations. US LI-RADS emphasized sensitivity and negative predictive value, which are key characteristics of a screening test.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Ultrassonografia/métodos , Coleta de Dados , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Estados Unidos
8.
Traffic Inj Prev ; 20(4): 413-418, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31074650

RESUMO

Objective: Crash reports contain precoded structured data fields and a crash narrative that can be a source of rich information not included in the structured data. The narrative can be useful for identifying vulnerable roadway users, such as agricultural workers. However, using the narratives often requires manual reviews that are time consuming and costly. The objective of this research was to develop a simple and relatively inexpensive, semi-automated tool for screening crash narratives and expediting the process of identifying crashes with specific characteristics, such as agricultural crashes. Methods: Crash records for Louisiana from 2010 to 2015 were obtained from the Louisiana Department of Transportation (LaDOTD). Records with narratives were extracted and stratified by vehicle type. The majority of analyses focused on a vehicle type of farm equipment (Type T). Two keyword lists, an inclusion list and an exclusion list, were created based on the published literature, subject-matter experts, and findings from a pilot project. Next, a semi-automated tool was developed in Microsoft Excel to identify agricultural crashes. Lastly, the tool's performance was assessed using a gold standard set of agricultural narratives identified through manual review. Results: The tool reduced the search space (e.g., number of narratives that need manual review) for narratives requiring manual review from 6.7 to 59.4% depending on the research question. Sensitivity was high, with 96.1% of agricultural crash narratives being correctly classified. Of the gold standard agricultural narratives, 58.3% included an equipment keyword and 72.8% included a farm equipment brand. Conclusion: This article provides information on how crash narratives can supplement structured crash data. It also provides an easy-to-implement method to facilitate incorporating narratives into safety research along with keyword lists for identifying agricultural crashes.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Agricultura/estatística & dados numéricos , Saúde Ocupacional/estatística & dados numéricos , Acidentes de Trânsito/prevenção & controle , Agricultura/instrumentação , Fazendas/estatística & dados numéricos , Louisiana , Projetos Piloto , Meios de Transporte/instrumentação
9.
J Vasc Interv Radiol ; 30(4): 579-583, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772166

RESUMO

PURPOSE: To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators. MATERIALS AND METHODS: Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012-2017) were statistically compared to that of recurring male faculty. RESULTS: From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P = .722; total publications P = .689; and authorship P = .662). CONCLUSIONS: This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record.


Assuntos
Escolha da Profissão , Médicas/tendências , Radiologistas/tendências , Radiologia Intervencionista/educação , Sexismo/tendências , Especialização/tendências , Mulheres Trabalhadoras , Congressos como Assunto/tendências , Educação de Pós-Graduação em Medicina/tendências , Feminino , Humanos , Masculino , Radiologistas/educação , Radiologia Intervencionista/tendências , Sociedades Médicas/tendências , Mulheres Trabalhadoras/educação
10.
Abdom Radiol (NY) ; 44(4): 1415-1422, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30539252

RESUMO

PURPOSE: To evaluate the association between imaging and clinical features and visualization scores, as specified by American College of Radiology (ACR) Ultrasound Liver Imaging Reporting and Data System (LI-RADS), on hepatocellular carcinoma (HCC) screening ultrasound examinations. METHODS: In this dual-center retrospective study, HCC screening ultrasound reports containing ultrasound elastography measurements (January to September, 2017) were reviewed. Ultrasound point shear wave elastography and 2-dimensional shear wave elastography were used to assess liver stiffness; median shear wave velocity was translated to METAVIR fibrosis scoring, per previously published data. Reports were analyzed for subject age, sex, reason for HCC screening, spleen size, fibrosis scores, and assigned ultrasound visualization scores. Jonckheere-Terpstra trend and Kendall's tau-b coefficient analyses were performed. RESULTS: 714 subjects (mean age 55; 51% male, 49% female) were included. 308 (43%) subjects had clinically declared cirrhosis; 406 (57%) did not. Majority (535, 75%) of exams were adequate (Visualization Score A), 156 (22%) moderately limited (Visualization Score B), and 23 (3%) severely limited (Visualization Score C). Increasing spleen size and patient age were associated with worsening visualization scores (p < 0.001). Suboptimal visualization was also associated with clinically significant fibrosis (≥ F2) by elastography (Kendall's tau-b = 0.181, p < 0.001) and clinically declared cirrhosis (Kendall's tau-b = 0.433, p < 0.001). There was no association with patient sex. CONCLUSION: Using ACR Ultrasound LI-RADS visualization score assessment, majority (75%) of HCC screening exams were diagnostically adequate, and only 3% were severely limited. Sonoelastographic diagnosis of clinically significant fibrosis, as well as clinical cirrhosis, increased patient age, and spleen size, were associated with greater diagnostic limitations.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Cirrose Hepática/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , California , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Michigan , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
11.
Urol Nurs ; 35(3): 134-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26298948

RESUMO

Phalloplasty, or creation of the penis, is one of the steps in gender confirming surgery for a female-to-male patient and for males with absence or malformation of the penis. Here, the most common techniques for phalloplasty, along with the pre-operative and post-operative care are discussed.


Assuntos
Pênis/cirurgia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Cirurgia de Readequação Sexual/métodos , Coleta de Tecidos e Órgãos/métodos , Transexualidade/cirurgia , Feminino , Antebraço , Humanos , Masculino , Complicações Pós-Operatórias , Retalhos Cirúrgicos , Coxa da Perna
12.
Sci Rep ; 4: 7144, 2014 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-25413454

RESUMO

Advanced age is associated with an increased risk of vascular morbidity, attributable in part to impairments in new blood vessel formation. Mesenchymal stem cells (MSCs) have previously been shown to play an important role in neovascularization and deficiencies in these cells have been described in aged patients. Here we utilize single cell transcriptional analysis to determine the effect of aging on MSC population dynamics. We identify an age-related depletion of a subpopulation of MSCs characterized by a pro-vascular transcriptional profile. Supporting this finding, we demonstrate that aged MSCs are also significantly compromised in their ability to support vascular network formation in vitro and in vivo. Finally, aged MSCs are unable to rescue age-associated impairments in cutaneous wound healing. Taken together, these data suggest that age-related changes in MSC population dynamics result in impaired therapeutic potential of aged progenitor cells. These findings have critical implications for therapeutic cell source decisions (autologous versus allogeneic) and indicate the necessity of strategies to improve functionality of aged MSCs.


Assuntos
Envelhecimento , Células-Tronco Mesenquimais/metabolismo , Tecido Adiposo/citologia , Animais , Células Cultivadas , Análise por Conglomerados , Técnicas de Cocultura , Citocinas/metabolismo , Redes Reguladoras de Genes , Células Endoteliais da Veia Umbilical Humana , Humanos , Masculino , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Camundongos , Camundongos Endogâmicos C57BL , Transdução de Sinais , Transcriptoma , Tubulina (Proteína)/metabolismo , Cicatrização
14.
Blood ; 118(13): 3622-33, 2011 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-21788341

RESUMO

Reduced gene dosage of ribosomal protein subunits has been implicated in 5q- myelodysplastic syndrome and Diamond Blackfan anemia, but the cellular and pathophysiologic defects associated with these conditions are enigmatic. Using conditional inactivation of the ribosomal protein S6 gene in laboratory mice, we found that reduced ribosomal protein gene dosage recapitulates cardinal features of the 5q- syndrome, including macrocytic anemia, erythroid hypoplasia, and megakaryocytic dysplasia with thrombocytosis, and that p53 plays a critical role in manifestation of these phenotypes. The blood cell abnormalities are accompanied by a reduction in the number of HSCs, a specific defect in late erythrocyte development, and suggest a disease-specific ontogenetic pathway for megakaryocyte development. Further studies of highly purified HSCs from healthy patients and from those with myelodysplastic syndrome link reduced expression of ribosomal protein genes to decreased RBC maturation and suggest an underlying and common pathophysiologic pathway for additional subtypes of myelodysplastic syndrome.


Assuntos
Dosagem de Genes , Síndromes Mielodisplásicas/genética , Proteínas Ribossômicas/genética , Proteína Supressora de Tumor p53/metabolismo , Animais , Regulação para Baixo/genética , Feminino , Dosagem de Genes/genética , Dosagem de Genes/fisiologia , Predisposição Genética para Doença , Masculino , Camundongos , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Modelos Biológicos , Síndromes Mielodisplásicas/etiologia , Síndromes Mielodisplásicas/metabolismo , Proteínas Ribossômicas/metabolismo , Fatores de Risco , Proteína Supressora de Tumor p53/fisiologia
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