How breast radiologists can deal with the disruptive technologist.

Physician burnout continues to be a challenge in addressing radiologist wellness. The stressors contributing to breast radiologist burnout are distinctive due to the unique work environments of a breast center. The intimate nature of a subspecialized team of radiologist(s) and technologists at an imaging center may result in interpersonal challenges such as a disruptive technologist. It is important to address the stressors to mitigate the increasing burnout affecting breast radiologists. This article raises awareness among radiologists and administrators and provides strategies to breast centers and breast radiologists for guidance on dealing with a disruptive technologist.

Effects of the Personalized Recovery Oriented Services (PROS) Program on Hospitalizations.

Though the recovery model has been implemented widely in outpatient mental health settings, there are no large sample evaluations of recovery oriented psychiatric rehabilitation programs that address both serious mental illness (SMI) and co-occurring disorders (COD) using a more comprehensive Medicaid reimbursable approach. This study examined preliminary hospitalization outcomes, for adults with SMI and COD enrolled in the NYS Personalized Recovery Oriented Services (PROS) program. McNemar's chi-square test was used to examine changes in hospitalization rates from pre-PROS admission to post-PROS discharge in a sample of 12,006 adults discharged from PROS. Negative binomial regression models were used to calculate adjusted rates of hospitalizations and hospital days. Demographic, psychosocial, and diagnosis predictor variables were extracted from the OMH web-based Child and Adult Integrated Reporting System. Hospitalization data were extracted from the Mental Health Automated Recordkeeping System, and Medicaid. From pre-admission to post-discharge, psychiatric hospitalization rate decreased significantly, from 24% to 14%. Substance related hospitalizations also decreased significantly, from 5% to 3%. Average number of hospitalizations and number of days hospitalized decreased even after adjusting for sociodemographic factors. PROS serves a high number of COD patients, and the number of psychiatric and substance related hospitalizations decreased after an episode of PROS, as did the number of days hospitalized. Findings support the maintenance of psychiatric rehabilitation models that include recovery oriented components. Further analyses with control samples are proposed.

MRI of Native Knee Cartilage Delamination Injuries.

OBJECTIVE: The purpose of this article is to describe the normal imaging appearance of cartilage and the pathophysiologic findings, imaging appearance, and surgical management of cartilage delamination. CONCLUSION: Delamination injuries of knee cartilage signify surgical lesions that can lead to significant morbidity without treatment. These injuries may present with clinical symptoms identical to those associated with meniscal injury, and arthroscopic identification can be difficult, thereby creating a role for imaging diagnosis. A low sensitivity of imaging identification of delamination injury of the knee is reported in the available literature, although vast improvements in MRI of cartilage have since been introduced.

Time in Assertive Community Treatment: A Statewide Quality Improvement Initiative to Reduce Length of Participation.

The investigators describe a New York State initiative to increase flow through assertive community treatment (ACT) while encouraging transition to less intensive services. This initiative began as ACT approached full capacity and as evidence emerged that participants can sustain recovery post-ACT. Comparison of performance indicators over time showed that time in ACT decreased, turnover rate increased, and the percentage of ACT participants who met treatment objectives rose. Also, post-ACT rates of ambulatory behavioral health follow-up increased while rates of psychiatric inpatient hospitalization decreased. Monitoring utilization of services while demonstrating positive outcomes has become increasingly critical as states shift to managed health care.

Intraabdominal Lymphatic Malformations: Pearls and Pitfalls of Diagnosis and Differential Diagnoses in Pediatric Patients.

OBJECTIVE: The purpose of this article is to review the practical imaging workup and characteristic imaging appearances of intraabdominal lymphatic malformations (LMs) in the pediatric population with a brief discussion of some common differential diagnoses found in a vascular anomaly clinic. CONCLUSION: LMs are uncommon pediatric lesions. Because of their rarity among LMs overall, a tendency to present later in life than superficial LMs, and often incidental identification, intraabdominal LMs pose a particular diagnostic challenge, and pathologic entities that are more prevalent must be carefully excluded first. Although the diagnosis of most intraabdominal LMs can be reliably based on clear understanding of characteristic imaging findings, histologic correlation may be necessary in some cases.

Low-Flow Vascular Malformation Pitfalls: From Clinical Examination to Practical Imaging Evaluation--Part 1, Lymphatic Malformation Mimickers.

OBJECTIVE: Palpable subcutaneous masses present in various shapes and sizes in the pediatric population and, accordingly, represent a variety of underlying causes. Lymphatic and venous malformations are among the most common pediatric subcutaneous lesions. However, there are congenital and acquired, as well as benign and malignant, soft-tissue masses that can mimic them clinically and at imaging. CONCLUSION: Here, we review the natural history, wide range of clinical presentations, and varied but characteristic imaging appearance of lymphatic malformations that can pose diagnostic difficulties in children. In addition, the clinical and imaging characteristics of some pediatric soft-tissue pathologies that can mimic lymphatic malformations and clues to reach a proper diagnosis are highlighted.

Low-Flow Vascular Malformation Pitfalls: From Clinical Examination to Practical Imaging Evaluation--Part 2, Venous Malformation Mimickers.

OBJECTIVE: The purpose of this article is to review the unusual clinical and radiographic features of venous malformations that can give rise to diagnostic confusion. Entities that can have overlapping clinical and imaging features with venous malformations are also reviewed. CONCLUSION: Venous malformations are congenital endothelial malformations secondary to errors in vascular morphogenesis and are usually diagnosed in the first 2 decades of life. The clinical and imaging features of venous malformations often overlap those of other pathologic entities, creating diagnostic confusion. Furthermore, the clinical presentation and imaging appearance of venous malformations can vary, making the diagnosis challenging. Thorough knowledge of the various clinical and imaging features not only of venous malformations but also of the major potential mimic lesions is crucial for clinicians caring for patients with these lesions.

Influence of family and school-level factors on age of sexual initiation.

PURPOSE: This study examined the association of individual, family, and school-level characteristics with age of sexual initiation (ASI) and focused specifically on school context as a moderator of known predictors of ASI. METHODS: Data are from Waves I and IV of the National Longitudinal Study of Adolescent Health (N = 10,596). Predictors include grade point average, physical development, attitudes about sex, likelihood of higher education, alcohol use, delinquency, family structure, parents' education level, childhood abuse, maternal approval of sex, parental monitoring, and parent-child relationship quality. School-level predictors are averages of adolescents' attitudes about sex and likelihood of higher education and parents' education. Hierarchical linear models run separately by sex were used to predict ASI. RESULTS: When school-level attitudes about sex are more favorable, both boys and girls report younger ASI, and school mean parental education attainment moderates the influence of individual adolescents' attitudes about sex on ASI. More of the predictors are significant for girls than boys, whereas perception of maternal and peer approval of sexual activity are the most salient predictors of younger ASI for boys. CONCLUSIONS: Results highlight the importance of school context for understanding adolescents' motivations for early ASI. Findings support the need for school-wide prevention interventions that engage adolescents, peers, and parents in addressing attitudes about early sex.

Endovascular treatment of an acute ascending aortic intramural hematoma.

INTRODUCTION: Herein, we present a case of an elderly gentleman who presented with an extensive intramural hematoma of the aorta which was treated with a percutaneous placement of an endovascular stent. PRESENTATION OF CASE: A 79-year-old male with a history of hypertension presented to the emergency department because of sudden onset of substernal chest pain radiating to his back. A chest computerized tomography scan was performed that demonstrated a Type A aortic wall intramural hematoma involving the arch and ascending aorta dissecting both antegrade and retrograde from a penetrating ulcer located in the descending aorta, immediately distal to the left subclavian artery. No dissection flap was noted. The patient opted for an endovascular approach. He was treated with the placement of a stent just distal to the left subclavian artery, with good results noted on follow-up exam performed 3 months later. DISCUSSION: The treatment of a Type A IMH lacks consensus, but the majority do favor surgical management. The data are limited; however, there are reports of patients with Type A intramural hematoma treated with descending aortic endograft at the site of the culprit ulcerated plaque, with satisfactory results. CONCLUSION: In a select group of patients, an endovascular approach for the treatment of a Type A aortic wall intramural hematoma caused by an ulcerated plaque may be a viable treatment option.

Personality disorders and mood disorders: perspectives on diagnosis and classification from studies of longitudinal course and familial associations.

The results of three rigorous studies of the naturalistic course of personality disorders indicate the following: (1) personality psychopathology improves over time at unexpectedly significant rates; (2) particular maladaptive personality traits are more stable than personality disorder diagnoses; (3) although personality psychopathology improves, residual effects are usually seen in the form of persistent functional impairment and ongoing Axis I psychopathology; and (4) improvement in personality psychopathology may eventually be associated with reduction in ongoing personal and social burden. A comparison of the longitudinal stability of personality disorders and mood disorders does not support a clear distinction between them based on differential stability of either psychopathology (at least based on remission rates) or functional impairment. Differences may yet emerge with respect to relapse rates over the longer term. Both types of disorders may share some common underlying vulnerabilities best conceptualized in term of personality traits. A group of promising, though methodologically flawed, family studies suggest familiality of at least BPD among the personality disorders and the coaggregation of BPD and depressive disorders (but not bipolar disorders) that may contribute to their frequent co-occurrence. Again, underlying personality traits may prove to be more heritable than either type of disorder.

Family studies of borderline personality disorder: a review.

This paper reviews the literature examining the psychopathology found in relatives of individuals with borderline personality disorder (BPD). Reflecting changes in how BPD has been conceptualized, researchers have investigated the prevalence of schizophrenia, then mood disorders, and more recently, impulse spectrum disorders in these relatives. This literature does not support a link between BPD and schizophrenia, is ambiguous about a link between BPD and major depressive disorder, and suggests a familial aggregation of impulse spectrum disorders and BPD, as well as of BPD itself. Because of significant methodological problems, most notably indirect assessments and inadequate sample size, major questions persist about the familial aggregation of this disorder that require more definitive methods.