Human Papillomavirus Vaccinations: Provider Education to Enhance Vaccine Uptake.

Human papillomavirus (HPV) is the number one sexually transmitted infection (STI) worldwide. The Centers for Disease Control and Prevention (CDC) approximated that 92% of HPV-related cancers might be prevented by receiving the HPV 9-valent vaccine (Gardasil 9). The 2-dose HPV vaccine for children ages 11 to 12 years provides almost 100% protection against strains affiliated with cervical, vaginal, and vulvar cancers. Provider education is essential to decrease clinical knowledge deficits and increase vaccination uptake. Evidence-based provider recommendations expressed to eligible individuals improves vaccination rates. Evidence-based approaches for vaccine-hesitant parents involve using the presumptive announcement approach, asking for and addressing main concerns, and trying again if the parent initially declines. Seventy percent of parents who initially decide not to get their child vaccinated later agree to the vaccine or schedule a follow-up appointment. The CDC guidelines for HPV vaccinations, including the catch-up and adult guidelines, are reviewed. A clinical vignette with case scenarios and a Q&A quiz are included.

Integrating the impact of large-scale hydraulic engineering with a sustainable groundwater development strategy: A case study of Zhengzhou City, China.

With the rapid growth of China's economy, the increase in water demand has threatened the sustainable development of groundwater. Construction of the South-to-North Water Diversion Project alleviated this problem. Zhengzhou, with a large population and high-intensity energy consumption, is a water-receiving city of the South-to-North Water Diversion Central Line Project (CLP). A series of ecological risks caused by the excessive exploitation of groundwater have been exposed. It is urgent to strengthen the assessment and management of groundwater to ensure sustainable development. In this study, the multi-criteria decision analysis (MCDA) underpinned the assessment of the sustainable groundwater development (ASGD) framework. Eight assessment factors were established based on the resource supply function (RSF) and eco-environment stability function (ESF). The novelty of this study lies in the integration of ASGD results with the impact of the CLP on the evolution of groundwater levels in Zhengzhou. Thus, more comprehensive and scientific management suggestions for groundwater development in Zhengzhou were obtained. GIS technology was integrated with the ASGD framework to identify five visualized areas: centralized groundwater supply area (8.61%), decentralized groundwater supply area (27.91%), vulnerable eco-environment area (14.34%), recharge protection area (45.67%), and unsuitable exploitation area (3.47%). The CLP changed the groundwater evolution pattern in Zhengzhou. The results showed that the operation of the CLP effectively slowed the decline in groundwater levels, thus confirming that the CLP has a positive impact on the rational utilization of groundwater. The disuse of two groundwater sources (G1 and G9) were able to enhance sustainable groundwater development. Meanwhile, five groundwater sources in the plain area proved unsuitable. Overall, this study provides a scientific basis for groundwater management in Zhengzhou City, while generating new ideas for sustainable groundwater development in cities affected by large-scale hydraulic projects worldwide.

Size distribution and sex ratio between populations of the artisanal harvested land crab Cardisoma guanhumi (Decapoda: Gecarcinidae), with the estimation of relative growth and size at sexual maturity in Puerto Rico / Distribución de tallas y proporción de sexos entre poblaciones del cangrejo de tierra cosechado artesanalmente Cardisoma guanhumi (Decapoda: Gecarcinidae), con la estimación del crecimiento relativo y tamaño en la madurez sexual en Puerto Rico

Abstract Introduction: Knowledge of growth patterns, sex ratio, and sexual maturity are of importance to exploited populations. The land crab Cardisoma guanhumi is an artisanal and subsistence exploited species in Puerto Rico. However, the growth patterns and sexual maturity of the local populations are not known. Objectives: This study has a double objective: (1) to compare the size and sex structure between populations and (2) to model the relative growth of structures related to reproduction to estimate the average size of morphometric sexual maturity (MSM) for both males and females. Methods: A total of 2 849 specimens were captured from nine dispersed populations on the island between 2001 and 2020. Carapace width (CW) was measured as an estimator of the absolute size of all individuals, together with the propodus length (PL) in males and the abdomen width in females (AW). Differences in length structure between sexes and populations were tested by applying goodness-of-fit tests based on Kernel Density Estimators (KDE). The relative growth pattern was modeled adjusting a spline from which the maximum of its second derivative was calculated as an estimator of the MSM, and bootstrapping was used to generate confidence intervals. Results: Differences were found in size structures, between sexes, and between sites. Our estimates of morphometric sexual maturity resulted in a sexual maturity size for males between 57.9 and 79.0 mm CW, while in females, morphological maturity occurs between 43.8 to 51.5 mm CW. Conclusions: We found inter-population differences in body size that can be attributed to differences in the history of changes of land use and the exploitation biased towards larger individuals, though differences in recruitment should also be considered. Current regulations in Puerto Rico protect female crabs but not to larger male crabs. The regulation establishes that crabs smaller than 64 mm carapace width cannot be captured, leaving immature male crabs over 64 mm CW unprotected. We suggest considering different size limits depending on the sex of the crab. This will allow the full range of sizes where sexual maturity is reached to be protected, increasing the likelihood of the population's size to increase.

Resumen Introducción: El conocimiento de los patrones de crecimiento, la proporción de sexos y la madurez sexual son de suma importancia para las poblaciones explotadas. El cangrejo terrestre Cardisoma guanhumi es una especie explotada artesanalmente y para subsistencia en Puerto Rico. Sin embargo, se desconocen los patrones de crecimiento y la madurez sexual para la isla. Objetivos: Este estudio tiene un doble objetivo: (1) comparar el tamaño y la estructura sexual entre las poblaciones y (2) modelar el crecimiento relativo de estructuras relacionadas con la reproducción (propodo en machos y abdomen en hembras) para estimar el tamaño promedio de madurez sexual morfométrica (MSM). Métodos: Se capturaron un total de 2 849 especímenes de nueve poblaciones dispersas en la isla, entre 2001 y 2020. Se midió el ancho del caparazón (AC) como un estimador del tamaño absoluto de todos los individuos, junto con el largo de propodo en los machos y el ancho del abdomen en las hembras. Las diferencias en la estructura de tallas entre sexos y poblaciones se probaron aplicando la prueba de bondad de ajuste basado en estimaciones de densidad kernel (KDE). El patrón de crecimiento relativo se modeló ajustando un spline a partir del cual se calculó el máximo de su segunda derivada como estimador del MSM y se utilizó bootstrapping para generar intervalos de confianza. Resultados: Se encontraron diferencias en las estructuras de tallas, entre sexos y poblaciones. Nuestras estimaciones de madurez sexual morfométrica dieron como resultado un tamaño de madurez sexual para los machos entre 57.9 y 79.0 mm AC, mientras que, en las hembras, la madurez morfométrica se produce entre 43.8 y 51.5 mm AC. Conclusiones: La diferencia en el tamaño de la población se puede atribuir a las diferencias entre poblaciones en el cambio de uso de la tierra y la presión de explotación asociada con el sesgo hacia la captura de individuos más grandes o el reclutamiento. Las regulaciones actuales en Puerto Rico brindan protección a las hembras, pero no a los machos más grandes. El reglamento establece que no se pueden capturar cangrejos de menos de 64 mm de AC dejando desprotegidos los cangrejos machos inmaduros de más de 64 mm AC. Sugerimos considerar diferentes límites de tamaño según el sexo del cangrejo. Esto permitirá proteger un rango más amplio de tamaños donde se alcanza la madurez sexual, aumentando la probabilidad de un incremento en el tamaño de la población.

Assessing the management of major bleeding events in patients treated by direct oral anticoagulant in an emergency department.

Since direct oral anticoagulants have been marketed, the management of major bleeding in emergency departments has become more challenging. In 2013 and 2016, the Working Group in Perioperative Haemostasis made several proposals for this. The objective of the present study was to evaluate conformity with these proposals in daily clinical practice. We performed a retrospective single-center cohort study addressing the management of major bleeding in patients treated by direct oral anticoagulant in an emergency department. Patients were included between January 1, 2015 and November 30, 2017. Among 3,365 patients admitted to the emergency department for bleeding, a total of 191 were treated by direct oral anticoagulant and 55 (28.8%) with major bleeding were included in the present study. The majority of patients received rivaroxaban (n = 44, 80.0%) and were treated for atrial fibrillation (n = 47, 85.0%). Bleeding concerned gastrointestinal (n = 30, 54.6%) and (n = 14, 25.5%) intracranial location. Twenty-one patients (38.2%) were treated by prothrombin complex concentrate, and 31 patients (56.4%) were transfused. Intervention for hemostatic control was performed for 30 patients (54.6%). Thirty-three patients (60.0%) presented a deviation from protocol. There is no significant difference for mortality at 3 months according to whether or not there was a deviation from protocol. Nearly two-thirds of patients with major bleeding associated with direct oral anticoagulant administration had protocol deviation, but there was no effect on mortality.

Austrian recommendations for the management of essential thrombocythemia.

According to the World Health Organization (WHO) classification, essential (primary) thrombocythemia (ET) is one of several Bcr-Abl negative chronic myeloproliferative neoplasms (MPN). The classical term MPN covers the subcategories of MPN: ET, polycythemia vera (PV), primary myelofibrosis (PMF), and prefibrotic PMF (pPMF). ET is marked by clonal proliferation of hematopoietic stem cells, leading to a chronic overproduction of platelets. At the molecular level a JAK2 (Janus Kinase 2), calreticulin, or MPL mutation is found in the majority of patients. Typical ongoing complications of the disease include thrombosis and hemorrhage. Primary and secondary prevention of these complications can be achieved with platelet function inhibitors and various cytoreductive drugs including anagrelide, hydroxyurea and interferon. After a long follow up, in a minority of ET patients the disease transforms into post-ET myelofibrosis or secondary leukemia. Overall, life expectancy with ET is only slightly decreased.

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool.

BACKGROUND: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme's performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. METHODS: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm's performance and sensitivity to surveillance quality. RESULTS: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. CONCLUSION: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.

The Recommendations for the Management of Chinese Children With Epilepsy During the COVID-19 Outbreak.

The coronavirus disease (COVID-19) is the most severe public health problem facing the world currently. Social distancing and avoidance of unnecessary movements are preventive strategies that are being advocated to prevent the spread of the causative virus [severe acute respiratory syndrome (SARS)-CoV2]. It is known that epileptic children need long term treatments (antiepileptic drugs and/or immunosuppressive agents) as well as close follow up due to the nature of the disease. In addition, it is clear that epilepsy can concur with other chronic illnesses which can lower body immunity. As a result, epileptic children have high risk of acquiring this novel disease due to weak/immature immune system. Of concern, the management of children with epilepsy has become more challenging during this outbreak due to the prevention measures that are being taken. Although children with controlled seizures can be managed at home, it is challenging for pediatricians when it comes to cases with uncontrolled seizures/severe cases. To this end, we provide recommendations for the management of epileptic children at home, outpatient and inpatient settings.

Compliance of Primary Care Providers With Gout Treatment Recommendations-Lessons to Learn: Results of a Nationwide Survey.

Objectives: Gout is generally managed in the primary health care sector. Compliance of primary care physicians with gout management recommendations has been shown to be insufficient in the past. The primary aims of this study were to assess primary care providers' knowledge regarding gout and to determine if their treatment decisions are influenced by recommendations. Facing considerable variations in postgraduate training options in Austria, we secondly looked for possible knowledge differences between urban and rural areas and eastern and western parts of Austria. Methods: We conducted a survey among 343 primary care physicians in Austria, using a questionnaire consisting of 10 questions on acute, intercritical and general gout management. Gout treatment recommendations served as the therapeutic gold standard. Results: Of the 343 physicians surveyed, 336 completed the questionnaire, leading to a very high return rate of 98%. 289 (86%) physicians were aware of the agreed-upon SUA target (<6 mg/dl). 323 (96.1%) reported change of therapy in case of missing this target. 112 (33.3%) physicians voted for long term ULT. No geographical differences in knowledge regarding gout or its management were revealed, except that colchicine was rated as being a safe medication significantly more often in rural areas (p = 0.035) and in western Austria (p = 0.014). Conclusion: As opposed to former studies, gout knowledge among primary care physicians has improved - however, treatment patterns are still not fully concordant with gout recommendations. Our findings may help to better tailor future postgraduate training to improve primary care physicians' education in gout.

Garbage source classification performance, impact factor, and management strategy in rural areas of China: A case study in Hangzhou.

Garbage classification and reduction is imperative in many developing countries, where the imbalance between the rapid growth of solid waste and insufficient disposal capacity can be challenging. In order to evaluate whether a novel '2 + T' source classification method (biodegradable waste, other waste, and toxic waste) and three types of source classification and resourcing treatment patterns implemented in the rural areas of Hangzhou can be widely applied, field investigations, questionnaire interviews, and factor analysis were carried out comprehensively. By means of '2 + T' source classification method, biodegradable waste, accounting for the largest proportion of rural domestic waste, can be effectively separated for the subsequent reduction and resource treatment. Classified deposition in the doorway and door-to-door collection of biodegradable and other wastes provided the best solution for the accuracy of source classification and public participation. Based on the analysis, appropriate classification methods and patterns, sustainable publicity and supervision of source classification behavior as well as sufficient financial support will be key factors for rural domestic waste classification and resourcing management. These methods have a great potential for promoting solid waste classification in the rural areas of China and in other developing countries.

Population structure, genetic connectivity, and adaptation in the Olympia oyster (Ostrea lurida) along the west coast of North America.

Effective management of threatened and exploited species requires an understanding of both the genetic connectivity among populations and local adaptation. The Olympia oyster (Ostrea lurida), patchily distributed from Baja California to the central coast of Canada, has a long history of population declines due to anthropogenic stressors. For such coastal marine species, population structure could follow a continuous isolation-by-distance model, contain regional blocks of genetic similarity separated by barriers to gene flow, or be consistent with a null model of no population structure. To distinguish between these hypotheses in O. lurida, 13,424 single nucleotide polymorphisms (SNPs) were used to characterize rangewide population structure, genetic connectivity, and adaptive divergence. Samples were collected across the species range on the west coast of North America, from southern California to Vancouver Island. A conservative approach for detecting putative loci under selection identified 235 SNPs across 129 GBS loci, which were functionally annotated and analyzed separately from the remaining neutral loci. While strong population structure was observed on a regional scale in both neutral and outlier markers, neutral markers had greater power to detect fine-scale structure. Geographic regions of reduced gene flow aligned with known marine biogeographic barriers, such as Cape Mendocino, Monterey Bay, and the currents around Cape Flattery. The outlier loci identified as under putative selection included genes involved in developmental regulation, sensory information processing, energy metabolism, immune response, and muscle contraction. These loci are excellent candidates for future research and may provide targets for genetic monitoring programs. Beyond specific applications for restoration and management of the Olympia oyster, this study lends to the growing body of evidence for both population structure and adaptive differentiation across a range of marine species exhibiting the potential for panmixia. Computational notebooks are available to facilitate reproducibility and future open-sourced research on the population structure of O. lurida.

Seasonal Influenza (Flu).

Seasonal influenza, or flu, is an airborne respiratory virus that occurs every year in the fall to early spring in the United States. The virus is highly contagious and symptoms can run from mild to severe. In some populations (very young, individuals with chronic comorbid conditions, immunocompromised individuals of all ages, pregnant women, and frail older adults), the virus can lead to increased morbidity and mortality. In a majority of cases, seasonal influenza is preventable through safe and readily available vaccinations.

Austrian recommendations for the management of polycythemia vera.

Polycythemia vera (PV) is a clonal disease arising from hematopoietic stem cells. Erythrocytosis is the hallmark of the disease but leukocytosis, thrombocytosis and splenomegaly may also be present. Thromboembolic complications occur in about 20% of patients. Circulatory disturbances as well as pruritus represent frequent symptoms of the disease. Mutations in the JAK2 gene are present in 95% of patients in exon 14 (V617F) and in 3% in exon 12. The main goal of the treatment for patients with PV is the prevention of thromboembolic events, transformation to myelofibrosis and acute myeloid leukemia. Interferon alpha and hydroxyurea are used as first-line treatment for high risk patients. For patients unresponsive to first-line therapy ruxolitinib is available.

Preventive medicine of von Hippel-Lindau disease-associated pancreatic neuroendocrine tumors.

Pancreatic neuroendocrine tumors (PanNETs) are rare in von Hippel-Lindau disease (VHL) but cause serious morbidity and mortality. Management guidelines for VHL-PanNETs continue to be based on limited evidence, and survival data to guide surgical management are lacking. We established the European-American-Asian-VHL-PanNET-Registry to assess data for risks for metastases, survival and long-term outcomes to provide best management recommendations. Of 2330 VHL patients, 273 had a total of 484 PanNETs. Median age at diagnosis of PanNET was 35 years (range 10-75). Fifty-five (20%) patients had metastatic PanNETs. Metastatic PanNETs were significantly larger (median size 5 vs 2 cm; P < 0.001) and tumor volume doubling time (TVDT) was faster (22 vs 126 months; P = 0.001). All metastatic tumors were ≥2.8 cm. Codons 161 and 167 were hotspots for VHL germline mutations with enhanced risk for metastatic PanNETs. Multivariate prediction modeling disclosed maximum tumor diameter and TVDT as significant predictors for metastatic disease (positive and negative predictive values of 51% and 100% for diameter cut-off ≥2.8 cm, 44% and 91% for TVDT cut-off of ≤24 months). In 117 of 273 patients, PanNETs >1.5 cm in diameter were operated. Ten-year survival was significantly longer in operated vs non-operated patients, in particular for PanNETs <2.8 cm vs ≥2.8 cm (94% vs 85% by 10 years; P = 0.020; 80% vs 50% at 10 years; P = 0.030). This study demonstrates that patients with PanNET approaching the cut-off diameter of 2.8 cm should be operated. Mutations in exon 3, especially of codons 161/167 are at enhanced risk for metastatic PanNETs. Survival is significantly longer in operated non-metastatic VHL-PanNETs.

Austrian recommendations for the management of primary myelofibrosis, post-polycythemia vera myelofibrosis and post-essential thrombocythemia myelofibrosis: an expert statement.

The entity "myelofibrosis" represents a subgroup of the Philadelphia chromosome-negative myeloproliferative neoplasms. It comprises primary myelofibrosis, post-polycythemia vera myelofibrosis and post-essential thrombocythemia myelofibrosis. This heterogeneous disease is characterized by clonal myeloproliferation, dysregulated kinase signalling and the abnormal expression of several proinflammatory cytokines. Clinically, patients present with symptoms related to thrombocytosis/leukocytosis, anemia and/or progressive splenomegaly. Mutations in Janus kinase 2, an enzyme that is essential for the normal development of erythrocytes, granulocytes, and platelets, notably the V617F mutation, have been identified in approximately 60% of patients with primary myelofibrosis. Recent molecular advances have not only elucidated critical pathways in the pathogenesis of the disease, but also contributed to a more precise assessment of a patient's individual risk. While allogeneic stem cell transplantation remains the only curative treatment, the natural course of the disease and the patient's survival and quality of life may be improved by new treatments, notably ruxolitinib, the first Janus kinase 1/2 inhibitor approved for the management of myelofibrosis. Additional treatment options are being explored.

[Leukemia research in Germany: the Competence Network Acute and Chronic Leukemias]. / Entstehung, Entwicklung und Erfolge des Kompetenznetzes Akute und Chronische Leukämien (KNL).

The Competence Network "Acute and Chronic Leukemias" was founded in 1997 by the consolidation of the leading leukemia study groups in Germany. Key results are the development of new trials and cooperative studies, the setup of patient registries and biobanking facilities, as well as the improvement of study infrastructure. In 2003, the concept of the competence network contributed to the foundation of the European LeukemiaNet (ELN). Synergy with the ELN resulted in cooperation on a European and international level, standardization of diagnostics and treatment, and recommendations for each leukemia and interdisciplinary specialty. The ultimate goal of the network is the cure of leukemia through cooperative research.

Management of epidermal growth factor receptor inhibitor-associated rash: a systematic review.

Cancer patients treated with epidermal growth factor receptor inhibitors (EGFRIs) frequently experience skin toxicities (rash) that can compromise their quality of life and lead to dose reduction or discontinuation of treatment. Reflecting the need for effective management of EGFRI-associated rash, a number of clinical practice guidelines and management recommendations have been developed. The objective of this systematic review is to identify and summarize all available published recommendations of rash management strategies and evaluate their basis of evidence, to describe consensus in the recommendations, and where there is a lack of consensus to describe the opportunities for future clinical research to improve clinical practice in the management of EGFRI rash. Fifty-nine articles published from 2005-2011 were selected for inclusion in the systematic review. Common drug recommendations were oral and topical antibiotics, topical corticosteroids, and antihistamines; low-grade rash was generally recommended to be managed with topical antibiotics or corticosteroids, grade 2 rash with oral antibiotics or antihistamines, and severe grades of rash with oral corticosteroids or delay/dose reduction of EGFRI. The focus of clinical practice guidelines and recommendations was on reactive management. A better understanding of pre-emptive versus reactive treatment with the implementation of appropriately designed randomized controlled studies could support a more effective management of EGFRI-associated rash and improve patient outcomes. Consideration of patients' self-reported outcomes and consistent grading of rash toxicity are also recommended. Funding/sponsor: Eli Lilly & Co, Bristol-Myers Squibb.

Equilibrium strategy-based optimization method for the coal-water conflict: A perspective from China.

Environmental water problems have become increasingly severe, with the coal-water conflict becoming one of the most difficult issues in large scale coal mining regions. In this paper, a bi-level optimization model based on the Stackelberg-Nash equilibrium strategy with fuzzy coefficients is developed to deal with environmental water problems in large scale coal fields, in which both the groundwater quality and quantity are considered. Using the proposed model, and fully considering the relationship between the authority and the collieries and also the equilibrium between economic development and environmental protection, an environmental protection based mining quotas competition mechanism is established. To deal with the inherent uncertainties, the model is defuzzified using a possibility measure, and a solution approach based on the Karush-Kuhn-Tucker condition is designed to search for the solutions. A case study is presented to demonstrate the practicality and efficiency of the model, and different constraint violation risk levels and related results are also obtained. The results showed that under the environmental protection based mining quotas competition mechanism, collieries attempt to conduct environmentally friendly exploitation to seek greater mining quotas. This demonstrates the practicality and efficiency in the proposed model of reducing the coal-water conflict. Finally, a comprehensive discussion is provided and some propositions is given as a foundation for the proposed management recommendations.

Atopic dermatitis.

Atopic dermatitis (AD) is a common chronic inflammatory skin condition characterized by intense pruritus and a waxing and waning course. AD often presents in infancy and childhood and can persist throughout adulthood. The exact cause of AD is unknown, but it likely reflects an interplay between genetic and environmental factors. AD affects up to 20% of children in the United States, and prevalence may be increasing. Treatment can be effective in alleviating symptoms but serves only to manage the disease, not cure it. Appropriate therapy can also prevent significant complications, such as infection, sleep disturbance, behavioral problems, and growth impairment.

Variability in management recommendations for incidental thyroid nodules detected on CT of the cervical spine in the emergency department.

PURPOSE: Incidental thyroid nodules are common on CT. Variability in management recommendations for these nodules due to a lack of accepted CT base guidelines has not been demonstrated. METHODS: Consecutive CT cervical spine radiology reports describing thyroid nodules performed in an emergency department from January 1, 2009, to December 31, 2011, were retrospectively reviewed. Number of nodules, nodule size, and type of recommended management were recorded. RESULTS: Three hundred fifteen examinations met the inclusion criteria. The mean study age was 64 ± 20 years. Fifty-eight percent were women. Thirty percent (n = 95) of thyroid nodules measured <10 mm, 20% (n = 63) were ≥10 but <15 mm, 11% (n = 36) were ≥15 but <20 mm, and 15.5% (n = 49) were ≥20 mm. Size was not reported for 22.9% (n = 72). Two hundred twenty-seven recommendations were made in 181 (57.5%) studies. Recommendations were made for 51.6% (49 of 95) of nodules <10 mm, for 52.4% (33 of 63) of those ≥10 but <15 mm, for 83.3% (30 of 36) of those ≥15 but <20 mm, and for 81.6% (40 of 49) of those ≥20 mm. Management was recommended in 40.0% (29 of 72) of nodules with no size reported. Fifty-four percent (123 of 227) of recommendations were for ultrasound, followed by no follow-up recommended (17.2% [39 of 227]), clinical correlation (13.7% [31 of 227]), thyroid serology (6.2% [14 of 227]), clinical follow-up (4.8% [11 of 227]), comparison with prior studies (2.2% [5 of 227]), fine-needle aspiration (1.3% [3 of 227]), and nuclear scintigraphy (0.4% [1 of 227]). Nodule size was significantly associated with the likelihood of recommendation (odds ratio, 1.79; 95% confidence interval, 1.37-2.35). CONCLUSIONS: Management recommendations for incidental thyroid nodules detected on cervical spine CT are made inconsistently, and the type of management recommended is variable.