Additional Topics Research Articles

Managing COVID-19 from the epicenter: adaptations and suggestions based on experience.

In March 2020, the New York City metropolitan area became the epicenter of the United States’ SARS-CoV-2 pandemic and the surge of new cases threatened to overwhelm the area’s hospital systems. This article describes how an anesthesiology department at a large urban academic hospital rapidly adapted and deployed to meet the threat head-on. Topics included are preparatory efforts, development of a team-based staffing model, and a new strategy for resource management. While still maintaining a fully functioning operating theater, discrete teams were deployed to both COVID-19 and non-COVID-19 intensive care units, rapid response/airway management team, the difficult airway response team, and labor and delivery. Additional topics include the creation of a temporary ‘pop-up’ anesthesiology-run COVID-19 intensive care unit utilizing anesthesia machines for monitoring and ventilatory support as well as the development of a simulation and innovation team that was instrumental in the rapid prototyping of a controlled split-ventilation system and conversion of readily available BIPAP units into emergency ventilators. As the course of the disease is uncertain, the goal of this article is to assist others in preparation for what may come next with COVID-19 as well as potential future pandemics.Electronic supplementary materialThe online version of this article (10.1007/s00540-020-02860-1) contains supplementary material, which is available to authorized users.

DMD – BIOMARKERS & OUTCOME MEASURES: P.119 Identification of disease progression stages in patients with Duchenne muscular dystrophy using administrative claims data in the United States

Duchenne muscular dystrophy (DMD) is a rare genetic disorder characterized by fast progressing muscular degeneration primarily in males. The rarity of DMD has limited real-world study of disease progression in these patients. This study aims to classify DMD patients by stage of progression using administrative claims data fields. Data were drawn from an administrative claims and electronic medical record (EMR) dataset from Decision Resources Group covering more than 300 million U.S. patients during 2011-2019. DMD patients were identified using EMR codes specific to DMD (SNOMED-CT). Clinical diagnosis and procedure markers reflecting disease progression were used as classification criteria. DMD progression was classified into 4 stages based on indicators of ambulatory and pulmonary ability: early ambulatory, late ambulatory, early non-ambulatory, and late non-ambulatory. Stage was assessed monthly for each patient based on observed stage classification markers and evaluated beginning at 12 months of data availability to ensure accurate classification. Identified stage was carried forward until markers of a later stage were observed. Patients were assumed not to revert to an earlier stage following observation of a given stage. 77% (N=758) of EMR-identified DMD patients had claims and markers allowing for stage classification. Classified patients had claims spanning a median period of 81.8 months. Among these patients, 27% were identified at the early ambulatory stage (median age 7 years old), 34% at the late ambulatory stage (median age 13 years old), and 23% and 16% at the early and late non-ambulatory stages with median ages of 17 and 22 years old, respectively. Classification of DMD disease progression within claims data provides insight into the real-world distribution of patients by stage and can enable future use of claims data to study additional topics such as disease burden by stage and rates of disease progression.

Integrating stakeholder theory and sustainability accounting: A conceptual synthesis

This paper aims at integrating the bodies of literature on stakeholder theory and sustainability accounting. Using the conceptual methodological approach of theory synthesis, stakeholder theory is employed as a method theory to advance sustainability accounting as a domain theory. On this basis the concept of ‘Accounting for Sustainability and Stakeholders’ is developed. This concept highlights which sustainability topics and which stakeholders to consider in accounting for a given organization and how the inclusion of additional stakeholders and topics can contribute to creating value for stakeholders. In conclusion, this paper highlights that an overly broad inclusion of stakeholder groups and sustainability topics can be replaced by a purposeful selection of stakeholders and topics of particular relevance for the specific organization. As an additional advantage, the concept prevents disconnecting sustainability accounting from conventional accounting.

Mainstreaming environmental education for architects: the need for basic literacies

What are recent architectural graduates’ perceptions about the level of knowledge required of interns entering architectural practice and the suitability of architectural education? Research is presented that examines recent alumni’s engagement with environmental sustainability while in school. Two aspects of their educational experience are surveyed: their readiness for sustainable design work and their familiarity with the benefits of reusing existing buildings. Recent alumni of the Virginia Tech School of Architecture + Design were asked to explain the areas of practice for which they were best and least prepared, to identify additional educational topics they would have found useful, to name the key purposes and priorities of the discipline of architecture, and to articulate changes they wished to see in schools of architecture. The results point to a current pedagogy where the tacit and explicit knowledge that is critical to the adoption of sustainable approaches to design of new and retrofit structures is undervalued in architectural education. Suggestions from the literature and strategies to ameliorate this situation are presented. Practice relevance Two basic areas of literacy necessary for graduating architecture students are addressed. The first is readiness for environmentally sustainable work, which includes understanding building science concepts. Results of rating and open-ended survey questions indicate that many recent undergraduate alumni feel a sense of obligation to protect the natural environment through their design efforts, but do not claim facility with tangible means to achieve this goal in the design of buildings. The second is appreciation of the existing building fabric, which involves engaging a range of preservation and reuse strategies that preserve the embodied energy present in existing structures. Many alumni felt their education did not prepare them for renovation and reuse work that is often prevalent in their current practices. Architectural educators can take an active role to anticipate the changing needs of the profession and adjust their curricula to provide appropriate capabilities.

84. CAN FACULTY DEVELOPMENT BE EFFICIENT AND EFFECTIVE IN OUR OVER-SCHEDULED WORLD?

Background Faculty are responsible for teaching medical learners, yet most have little training on how to be effective educators. The ACGME common program requirements mandate that all physicians supervising trainees receive faculty development on an annual basis, but time and resources for educational faculty development are scarce. We led brief faculty development sessions at division meetings. Feedback was chosen as the first topic based on a faculty needs assessment and resident ACGME survey results. Purpose: To evaluate 1. Feasibility of visiting all departmental divisions to conduct brief educational faculty development sessions 2. Effectiveness of a faculty development session on knowledge of specific feedback. Methods Baseline quantity of specific feedback reported by residents and faculty was obtained by survey. Our session on specific feedback consisted of power point slides and video clips. It was delivered during regularly scheduled division meetings. A knowledge quiz was given before and after each session. Results 62 Faculty from 15 divisions completed the sessions over a 7-week period. 22/62 (35%) faculty answered all pre-test questions correctly. This increased to 48/62 (77%) post intervention. Post-session, faculty self-reported a positive trend in the specificity of their feedback. Survey comments also indicate the session was well-received. Discussion As 14 sessions were completed by two presenters during a short time period and with limited resources, this approach to educational faculty development seems feasible. Each session was completed in under 20 minutes, making it efficient. Improved post-test results indicate effectiveness. Next steps include utilizing the knowledge quiz and quantitative survey 3 months after the initial intervention to evaluate for lasting effects. Similar sessions could cover additional faculty development topics in the future, both within our department and in other departments at our institution. This would address weaknesses of the pilot study, which include a small study size and assessing for generalizability of the approach.

The development of a digital educational program with parents of preterm infants and neonatal nurses to meet parents educational needs

The aim of this research project is to explore parents and staff opinion about the development of a digital educational program to meet parent's educational needs in neonatology. For this qualitative study, one-on-one and group interviews were conducted in person or via a web platform with 15 mothers, 5 fathers and 9 neonatal nurses. Participants considered the digital educational program presented relevant and complete. They believed the digital educational program should be available as soon as possible for parents, at admission or even before. More than half thought it was better to have the information presented on a website, while an equal number of participants considered an application to be optimal. In addition, participants proposed several additional topics to add, such as information about discharge, resources available in the NICU or after discharge, and breastfeeding complications, among others. In conclusion, a digital educational program addressing topics such as parenting, infants' behaviour and appearance, and the care environment is appropriate to meet the needs of premature infants' parents.

Highlights in Medical Entomology, 2019: Familiar Foes and New Frontiers.

The 2019 Entomological Society of America annual meeting was held in St. Louis, Missouri, just blocks away from the iconic Gateway Arch. Representing a ‘gateway to the West’, this inspired the theme of the Highlights in Medical Entomology to reflect on the accomplishments of the past year as we move into a ‘new frontier’ of vector biology research. Papers were selected broadly across arthropods that influence public health, focusing on topics ranging from West Nile virus transmission, ticks and tick-borne disease, to advances in genetics and ‘big data’ studies. This included current perspectives on West Nile virus ecology and epidemiology, which has now been endemic in the United States for 20 yr. Additional topics such as the advantages of citizen science and the importance of scientific communication were also discussed. Together, these papers demonstrate the achievements of the vector community while emphasizing the challenges that we collectively face to reduce the burden of vector-borne disease.

Integration and workflow framework for virtual visualisation of cultural heritage. Revisiting the tell of Çukuriçi Höyük, Turkey

<p class="VARKeywords">This article sets a framework for computer-based visualisations of cultural heritage sites. The project focuses on a workflow for a visualisation illustrated on a specific solution for the site of Çukuriçi Höyük, a tell settlement in Turkey. With the virtual presentation, an interdisciplinary research group tries to offer complex scientific results to the general public as well as to experts. The team utilised data acquisition and communication techniques, interpretative approaches, and dissemination methods. The three-dimensional (3D) outcome is based on a large amount of scientific data, usually available only via analogue or digital publications for a specialised audience. The work focused on constructed and personal authenticity to reach the viewer’s feelings. As an interpretative narrative, the daily lives of the inhabitants were selected. A communication plan was constructed, and a video animation with narration and a musical background was selected as the most appropriate communication tool. The movie was divided into four chapters <em>(Introduction, Neolithic Period, Chalcolithic Period </em>and <em>Early Bronze Age Period</em>). A separate webpage was designed to provide additional information when the video is viewed online. The webpage was divided into tabs that describe each chapter and three additional topics (<em>Visualisation Process, Further Reading, </em>and <em>Credits</em>). The video was shared in different settings, e.g. at public talks and on social media. The process resulted in a complex workflow that consists of several stages: data acquisition, first interpretation, 3D model creation, communication plan, second interpretation, 3D model adjustment, and dissemination output. Each stage of the workflow serves as an example to show the types of nodes these parts can include. The result is a flexible framework with predefined process stages, which can be re-used for similar projects.</p><p>Highlights:</p><ul><li><p>Computer-aided visualisations bring hidden cultural heritage to life –an individual outcome for Çukuriçi Höyük, a tell settlement in Turkey.</p></li><li><p>The interdisciplinary team combined data acquisition and communication techniques, interpretative approaches, and dissemination methods for achieving the best result.</p></li><li><p>Integrative framework optimises the information and communication potential of virtual visualisations with the help of pre-defined workflow stages.</p></li></ul>

Actions, indicators, and outputs in urban biodiversity plans: Amultinational analysis of city practice.

Urban biodiversity offers important benefits to residents and may be crucial to reaching global biodiversity conservation targets, but little research has been conducted on how cities actually plan for biodiversity. In this study, we conducted a mixed methods content analysis of biodiversity plans by 39 cities around the world to determine whether they measured their actions, how they did so (via quantitative indicators and qualitative outputs), and what topics these actions and measures covered. We based our analytical framework on the Singapore Index on Cities’ Biodiversity (also known as the City Biodiversity Index), a widely applied 23-indicator index that helps cities track their progress in biodiversity planning. The Singapore Index groups its indicators into the following three core components: native biodiversity, ecosystem services, and governance and management. For actions and measures not classifiable by the Singapore Index, we inductively derived additional categories. Across all plans, we identified 2,231 actions, 346 indicators, and 444 outputs. We found that all of the plans included actions, while 82% included measures (67% included indicators and 72% included outputs). Only 29% of actions were associated with a measure. Overall, the plans covered all of the categories in the Singapore Index, particularly within the core components of native biodiversity and governance and management, though some plans had a narrower focus. The 20 additional urban biodiversity topics that were not covered by the Singapore Index framework included socioeconomic considerations, data collection, genetic diversity, urban agriculture and forestry, green infrastructure, human-wildlife conflicts, indigenous concerns, and citizen science. Indicators were the most common measures for native biodiversity and ecosystem service topics, while outputs were the most common measures for governance and management. Our results may inform the revision and development of urban biodiversity indicators in the post-2020 framework and of other initiatives that guide cities in contributing to local and global biodiversity goals.

Mechanism investigation on coal and gas outburst: An overview

Coal and gas outburst is a frequent dynamic disaster during underground coal mining activities. After about 150 years of exploration, the mechanisms of outbursts remain unclear to date. Studies on outburst mechanisms worldwide focused on the physicochemical and mechanical properties of outburst-prone coal, laboratory-scale outburst experiments and numerical modeling, mine-site investigations, and doctrines of outburst mechanisms. Outburst mechanisms are divided into two categories: single-factor and multi-factor mechanisms. The multi-factor mechanism is widely accepted, but all statistical phenomena during a single outburst cannot be explained using present knowledge. Additional topics about outburst mechanisms are proposed by summarizing the phenomena that need precise explanation. The most appealing research is the microscopic process of the interaction between coal and gas. Modern physical-chemical methods can help characterize the natural properties of outburst-prone coal. Outburst experiments can compensate for the deficiency of first-hand observation at the scene. Restoring the original outburst scene by constructing a geomechanical model or numerical model and reproducing the entire outburst process based on mining environment conditions, including stratigraphic distribution, gas occurrence, and geological structure, are important. Future studies can explore outburst mechanisms at the microscale.

The Appropriateness of Adapting the Australian Environmental Assessment Tool-High Care (EAT-HC) for Persons With Dementia in Singapore.

This study investigated the level of acceptance in Singapore of the eight principles of design underpinning the Environmental Assessment Tool-High Care (EAT-HC), which is commonly used in Australia to evaluate environments for the care of people living with dementia. A secondary goal was to identify topics particularly relevant to the Singaporean context, which are not included in the Australian EAT-HC. This study was undertaken in preparation for the development of a Singaporean version of the Australian EAT-HC. Discussions from 23 focus groups involving 150 family caregivers, aged care staff, administrators, and architects were recorded and thematically analyzed to identify the characteristics of the principles underpinning the EAT-HC that are unlikely to be relevant in a Singaporean version and to identify additional topics required to tailor it to reflect the Singaporean culture. The thematic analysis was supplemented with quantitative data obtained through the use of simple Likert-type scales measuring the appropriateness of each principle in the Singaporean context. The principles of design that underpin the EAT-HC were highly accepted by participants and provided a framework for a systematic exploration of Singaporean residential care for people with dementia. Some topics of particular relevance to Singapore were identified. These can be subsumed by the principles without the need for the principles to be changed. The results support the use of the design principles underpinning the EAT-HC as the foundation of a tool for the evaluation of Singaporean dementia facilities.

Barriers and facilitators for screening and treatment of hyperlipidemia among patients with inflammatory arthritis

BackgroundPatients with inflammatory arthritis (IA), defined as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), are at increased risk for cardiovascular disease (CVD). The frequency of screening and treatment of hyperlipidemia, a modifiable CVD risk factor, is low in these patients. The reasons for low screening and treatment rates in this population are poorly understood. Our objective was to elicit the barriers and facilitators for screening and treatment of hyperlipidemia from the perspective of patients with IA.MethodsWe conducted a qualitative study using focus groups of patients with IA, guided by Bandura’s Social Cognitive Theory. We recruited patients with IA aged 40 years and older from a single academic center. Data were analyzed thematically.ResultsWe conducted three focus groups with 17 participants whose mean age was 56 (range 45–81) years; 15 were women. Four themes emerged as barriers: 1) need for more information about arthritis, prognosis, and IA medications prior to discussing additional topics like CVD risk; 2) lack of knowledge about how IA increases CVD risk; 3) lifestyle changes to reduce overall CVD risk rather than medications; and 4) the need to improve doctor-patient communication about IA, medications, and CVD risk. One theme emerged as a facilitator: 5) potential for peer coaches (patients with IA who are trained about concepts of CVD risk and IA) to help overcome barriers to screening and treatment of hyperlipidemia to lower CVD risk.ConclusionPatients with IA identified educational needs about IA, increased CVD risk in IA and the need for improved doctor-patient communication about screening for hyperlipidemia and its treatment. Patients were receptive to working with peer coaches to facilitate achievement of these goals.

Abstract A024: Planning for scale-up of an evidence-based intervention in community settings: Project HEAL insights from the SPRINT Initiative

Abstract Project HEAL (Health through Early Awareness and Learning) is an evidence-based intervention rooted in health behavior change theory and aiming to increase cancer awareness and early detection through African American faith-based organizations. This study explored the potential for broader scale-up and dissemination of Project HEAL through the team's participation in a training program called Speeding Research-tested INTerventions (SPRINT). The SPRINT training was framed using tools from the Business Model Canvas and the Value Proposition Canvas to guide trainees in designing (1) compelling value propositions, (2) a minimal viable product, and (3) questions to gain critical insight from various stakeholders during a process called Customer Discovery. We report on our experiences in the SPRINT training and insights on intervention scale-up that we gained from the training, including key findings from 41 discovery interviews conducted with various stakeholders of the church ecosystem. We learned several valuable lessons from the discovery interviews, including the realization that scale-up will likely be more incremental than immediate. Additional refinement will be needed to scale up the intervention for “real world” application, including making our technology more user-friendly and including additional health topics beyond cancer. The SPRINT training helped our team consider broader scale-up and dissemination in a constituent-informed way. We discuss how insights from the training helped to refine our plans for future intervention scale-up. Citation Format: Laundette P. Jones, Jimmie L. Slade, Felicia Davenport, Sherie Lou Z. Santos, Cheryl L. Holt. Planning for scale-up of an evidence-based intervention in community settings: Project HEAL insights from the SPRINT Initiative [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A024.

Ureteral Reimplantation, Psoas Hitch, and Boari Flap.

Introduction: Ureteral reimplantation is indicated for patients with congenital distal ureteral strictures, for iatrogenic intraoperative distal ureteral injuries, and for those who require distal ureterectomy for transitional cell carcinoma. Methods: Using the da Vinci system from Intuitive, we demonstrate distal ureterectomy with reimplantation. Both a refluxing extravesical reimplant and nonrefluxing extravesical reimplant are shown. We also demonstrate modifications, including psoas hitch and Boari flap. Results: Robotic ureteral reimplantation with psoas hitch and Boari flap are demonstrated in a reproducible manner. Additional topics covered include the delineation of diseased ureter vs healthy ureter, the applications of indocyanine green, and the use of interoperative ureteral stents. Conclusions: Robotic ureteral reimplantation is safe and feasible when performed with proper technique. Ureteroscopy and near-infrared fluorescence technology facilitate improved detection of diseased ureteral segments. Key points include the maintenance of principles of open surgery such as a tension-free, watertight, and stented anastomosis.

Annual Meeting Update

In addition to the substantial technical program provided during the SEG Annual Meeting, there are also special sessions designed to bring focus to important and relevant topics of interest to attendees. A global technical session this year will highlight Africa while the Business of Applied Geophysics (BAGS) plenary sessions will highlight several additional topics of interest. We believe these special sessions fit the needs and interests of many, and we look forward to seeing you 11–16 October in Houston.

Pharmacy practice faculty and preceptor development

AbstractFaculty development is a priority for colleges and schools of pharmacy for both corporate and individual success. Recommendations in the 2008 American College of Clinical Pharmacy (ACCP) position statement and white paper on faculty development remain relevant today. However, changes in educational standards, delivery of pharmacy education, and faculty and learners have prompted an update of the 2008 documents. This 2020 white paper focuses on three components: preceptor development, updates in pharmacy practice faculty development, and program formation and implementation. The paper provides evidence and recommendations for preceptor development and summarizes the literature updates related to pharmacy practice faculty development in several areas, including teaching, practice, and research. This update explores additional topics not emphasized in the previous paper, including faculty well‐being, holistic career‐long development, and challenges with implementing and assessing development programs.

Medicolegal training in radiology; an overlooked component of the non-interpretive skills curriculum

ObjectiveRadiologists comprise approximately 3.6% of US physicians while ranked 6th–8th in medicolegal claims. Studies suggest that by the age of 60, about half of all radiologists will be sued at least once. Given this likelihood, it is surprising how little attention is paid to teaching of medicolegal issues. It is hypothesized that most trainees emerge from residency with only a vague notion of the medicolegal issues inherent in radiology. MethodsAll of the radiology attendings, trainees and alumni in our tertiary care teaching hospital were surveyed via an electronic questionnaire. Respondents were surveyed on overall knowledge of job-related medicolegal issues and willingness to receive additional education. The survey also included two real life medicolegal scenarios and the radiologists were asked to choose the most likely outcome. ResultsA questionnaire was sent to total of 359 trainees, attendings and alumni. There were 168 responses, constituting a 46.7% response rate, F:M 48:112. Only 41% of the respondents were aware that by the age of 60, half of them would be involved in at least one lawsuit. All knew the most common causes of malpractice claims; however, one-fourth were not aware of available medicolegal resources offered by radiological organizations; 85% of the respondents expressed willingness to attend medicolegal CME courses. All residents surveyed believed that medicolegal lectures should be included in their didactics. ConclusionThere is a dearth of knowledge among radiologists on job-related medicolegal topics. This survey suggests that incorporating additional medicolegal topics into the non-interpretive skills curriculum of residents and medicolegal CME for graduates would be well received.

Facilitators and barriers of the management of knee and hip osteoarthritis in intermediate care - a qualitative study

Purpose: Osteoarthritis is one of the leading musculoskeletal causes of global disability, with knee and hip osteoarthritis (KHOA) as most prevalent types. A relatively new healthcare setting for KHOA has been launched with the aim to shift a part of healthcare from secondary care to primary care: the intermediate care. Intermediate care aims to prevent referrals of less severe patients with KHOA to secondary care. It is often constructed as a one-time consultation for patients by a medical specialist in general practices. To date, no research has been done on the benefits of intermediate care for KHOA. Therefore, we evaluated the facilitators and barriers of intermediate care for KHOA. Methods: General practitioners (GPs), orthopaedists, and healthcare managers from two intermediate care projects in the Netherlands were invited to participate in this qualitative study through convenience sampling. Patients with KHOA who had at least one consultation in intermediate care were invited for participation by GPs from these two projects. Semi-structured interviews with open-ended questions were conducted by one researcher (IA). The interview guide of the patients covered the following pre-determined themes: barriers and facilitators regarding the patient-healthcare provider relationship, the accessibility of healthcare, the differences between usual (primary and secondary care) and intermediate care, their expectations of intermediate care, recommendations for improvement of intermediate care, and others. The interview guide for healthcare providers covered the same topics, but with the added following topics: barriers and facilitators with the start, content, and financial structure of the intermediate care project. Interviews were transcribed verbatim into written form and read by the interviewer (IA) to increase the validity. Transcripts of the interviews were analysed in the qualitative analysis software program MAXqda Version 2018, guided by a six-phased thematic analysis approach of Braun and Clarke (2006). Interviews were deductively coded based on pre-determined themes, and inductively coded based on additional topics that emerged from the open-ended questions. The first two interviews were coded independently by two researchers (IA and DS). All other interviews were coded by one researcher (IA). Results: In total, ten interviews were conducted with patients (n=4), orthopaedists (n=2), GPs (n=4), and a healthcare manager (n=1). Five facilitators of intermediate care were identified: 1) better communication between GPs and orthopaedists compared to usual care, 2) better access to healthcare for the patient compared to usual care due to lower out of pocket costs, short travel distances, and short waiting times, 3) increase in knowledge of healthcare providers about management of KHOA, including indications of patients’ referral to secondary care due to intensive collaboration between GPs and orthopaedists, resulting in a decrease of patients’ referral to secondary care, 4) high patient satisfaction due longer duration of consultation, the involvement of an orthopaedist, and receiving the healthcare in a trusted environment (the general practice). Table 1 presents examples of quotes of the identified facilitators and participants who reported them. Although patients did not experience any barriers, GPs and orthopaedists pointed out three barriers of intermediate care: 1) the cultural differences between healthcare providers of primary and secondary care, resulting in difficulties for starting intermediate care projects, 2) less access to additional diagnostic facilities for orthopaedists (e.g. MRI or X-ray) compared to secondary care, resulting in uncertainties for orthopaedists about the diagnosis of the patient, 3) the experienced higher workload of the orthopaedists in secondary care due to a better selection of patients with more severe KHOA. Table 2 presents examples of quotes of the identified barriers and participants who reported them. Conclusions: This study showed many advantages of intermediate care for patients with KHOA and for the healthcare providers involved, such as better access to healthcare for patients with KHOA and increase in knowledge for healthcare providers. The barriers provided relevant input to improve the experiences with intermediate care on the access to additional diagnostic facilities for orthopaedists and the experienced heavier workload in secondary care due to a better selection of patients with more severe KHOA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Bladder Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on the clinical presentation and workup of suspected bladder cancer, treatment of non-muscle-invasive urothelial bladder cancer, and treatment of metastatic urothelial bladder cancer because important updates have recently been made to these sections. Some important updates include recommendations for optimal treatment of non-muscle-invasive bladder cancer in the event of a bacillus Calmette-Guérin (BCG) shortage and details about biomarker testing for advanced or metastatic disease. The systemic therapy recommendations for second-line or subsequent therapies have also been revised. Treatment and management of muscle-invasive, nonmetastatic disease is covered in the complete version of the NCCN Guidelines for Bladder Cancer available at NCCN.org. Additional topics covered in the complete version include treatment of nonurothelial histologies and recommendations for nonbladder urinary tract cancers such as upper tract urothelial carcinoma, urothelial carcinoma of the prostate, and primary carcinoma of the urethra.

So You Want to Image Myelin Using MRI: An Overview and Practical Guide for Myelin Water Imaging

Myelin water imaging (MWI) is an MRI imaging biomarker for myelin. This method can generate an in vivo whole-brain myelin water fraction map in approximately 10 minutes. It has been applied in various applications including neurodegenerative disease, neurodevelopmental, and neuroplasticity studies. In this review we start with a brief introduction of myelin biology and discuss the contributions of myelin in conventional MRI contrasts. Then the MRI properties of myelin water and four different MWI methods, which are categorized as T2 -, T2 *-, T1 -, and steady-state-based MWI, are summarized. After that, we cover more practical issues such as availability, interpretation, and validation of these methods. To illustrate the utility of MWI as a clinical research tool, MWI studies for two diseases, multiple sclerosis and neuromyelitis optica, are introduced. Additional topics about imaging myelin in gray matter and non-MWI methods for myelin imaging are also included. Although technical and physiological limitations exist, MWI is a potent surrogate biomarker of myelin that carries valuable and useful information of myelin. Evidence Level: 5 Technical Efficacy: 1 J. MAGN. RESON. IMAGING 2021;53:360-373.