Definition Of Sign Research Articles

Clinical, Aetiological, Anatomical and Pathological Classification (Ceap): Gold Standard and Limits

The first CEAP (clinical, aetiological, anatomical and pathological elements) consensus document was published after a consensus conference of the American Venous Forum, held at the sixth annual meeting of the AVF in February 1994 in Maui, Hawaii. In the following years the CEAP classification was published in many international journals and books which has led to widespread international use of the CEAP classification since 1995. The aim of this paper is to review the benefits and limits of CEAP from the available literature. In an actual Medline analysis with the keywords 'CEAP' and 'venous insufficiency', 266 publications using the CEAP classification in venous diseases are available. The CEAP classification was accepted in the venous community and used in scientific publications, but in most of the cases only the clinical classification was used. Limitations of the first version including a lack of clear definition of clinical signs led to a revised version. The CEAP classification is the gold standard of classification of chronic venous disorders today. Nevertheless for proper use some facts have to be taken into account: the CEAP classification is not a severity classification, C2 summarizes all kinds of varicose veins, in C3 it may be difficult to separate venous and other reasons for oedema, and corona phlebectatica is not included in the classification. Further revisions of the CEAP classification may help to overcome the still-existing deficits.

Philosophy and linguistics in Sava Mrkalj's writings

In this paper, the author critically discusses the philosophical presuppositions of Sava Mrkalj's language reform. Mrkalj's reflections on the origin of language and his definition of sign and language are analyzed in detail. In doing so, the author tries to find out whose philosophical influence played the major role in Mrkalj's grammatical writings.

Semiotic Insights into Aristotle’s Theory of Being: Definition and Model of Sign

This paper is aimed to develop a model of the sign as homomorphism (i.e. similarity of form) as the initial part of a strict and fundamental theory of sign. Many various signs—photographs, pictures, sculptures, diagrams, surface maps, etc.—might be viewed in terms of homomorphism. The proposed model of sign as a homomorphism is derived using Aristotle’s theory of being. Two principles of Aristotle’s theory—form and matter—are used as elementary ideas in the model of sign. The main peculiarity of the undertaken approach to semiotics is treating a sign and a signified object as derivative ideas; they are constructed as compounds of form and matter. To achieve more strictness, the model of sign is treated in terms of the system of Cartesian coordinates modified for the articulation of being. Intentionality is viewed as the key idea in the model of sign. The approach to the definition of sign presented in this paper can be viewed as an ontological alternative to Peirce’s one.Keywords: sign as homomorphism, Aristotle, hylomorphism, Cartesian coordinate system, ontology.Aristotelio esaties teorijos semiotinės įžvalgosAlgirdas BudrevičiusSantraukaPagrindinis šio straipsnio tyrimo dalykas yra ženklas kaip žymimojo objekto homomorfizmas – tai yra ženklas kaip formos panašumas. Pagrindinis tikslas – sukurti ženklo kaip homomorfizmo modelį, kuris būtų griežtos, pamatinės ženklo teorijos pradinė dalis. Daug įvairių ženklų gali būti nagrinėjami kaip homomorfizmai: fotografijos, paveikslai, skulptūros, diagramos, žemėlapiai ir kt. Pasiūlytas homomorfinio ženklo modelis išvestas naudojant Aristotelio esaties teoriją. Kaip elementariosios sąvokos jame naudojami du Aristotelio esaties teorijos principai – forma ir materija (medžiaga). Dėstomo požiūrio ypatumas semiotikos atžvilgiu yra tas, kad ženklas ir žymimasis objektas traktuojami kaip išvestinės sąvokos; jos konstruojamos kaip formos ir materijos junginiai. Siekiant, kad modelis būtų griežtesnis, jam sudaryti naudojama Dekarto koordinačių sistema, pritaikyta esaties artikuliavimui. Homomorfinio ženklo apibrėžimo kertine laikoma intencionalumo sąvoka. Straipsnyje pateiktas požiūris į ženklo apibrėžimą gali būti laikomas ontologine alternatyva Peirce’o požiūriui.

The place of ultrasonography in knee joint osteoarthritis: an update

Ultrasound is gaining ground over conventional imaging methods in the assessment of musculoskeletal changes in osteoarthritis. Systematic ultrasound scanning following established guidelines enables the detection of even minimal and early abnormalities of cartilage, synovial tissue and subchondral bone. Thus far, ultrasound has shown to be extremely sensitive in the detection of soft tissue changes in knee osteoarthritis, including synovial proliferation and synovial fluid. Such abnormalities are correlated with symptomatic flares and have associated prognostic implications. Although there has been some progression, there is still a lack of standardization and validation over the definition and scoring of ultrasound signs that are thought to reflect structural damage affecting different joint structures. Meanwhile, exciting developments are expanding the applications of ultrasound in the musculoskeletal field; the application of technologies such as sonoelastography, imaging coupling, 3D ultrasound and ul...

S. Karcevskij on the asymmetrical dualism of the linguistic sign1

"This paper aims to highlight the figure of S. Karcevskij, a Russian linguist usually mentioned by historians of linguistics for having introduced Saussure’s theory to the Russians, but who was not appreciated enough for his own linguistic achieve- ments. Karcevskij, who studied in Geneva from the beginning of 1900 as a pupil of Saussure, Bally and Sechehaye, not only adopted Saussure’s method, applying it to the analysis of the Russian language, but also developed one of the basic concepts of the Cours de linguistique générale: the definition of sign. Karcevskij analyses the relationship between the signifiant and the signifié from a dynamic point of view. He observes that they are linked in a sort of unstable balance, which gives the signifiant the possibility to shift towards other signifiés, creating homonyms of the given sign, while the signifié has the possibility to acquire new signifiants, creating synonyms of the given sign. Karcevskij calls the precarious balance between«form» and «function» an «asymmetrical dualism of the linguistic sign». Karcevskij emphasizes that this asymmetrical dualism paves the way to linguistic changes. This concept was already present in Saussure’s Cours but was not analysed to thesame extent as in Karcevskij’s work."

Diagnostic accuracy of clinical signs used to identify electrolyte disturbances in children with diarrhoea

No studies have assessed the diagnostic accuracy of clinical signs of electrolyte disturbances in children with dehydrating diarrhoea. To assess the diagnostic accuracy and reliability of clinical signs previously reported to be associated with plasma sodium and potassium disturbances in children. A cross-sectional analytical study of 476 children aged 6 weeks to 2 years, admitted to a rehydration unit in Cape Town, South Africa. The clinical signs were elicited on admission by one of 58 junior doctors. Operational definitions of clinical signs were provided, but no additional training was given. Admission plasma electrolyte levels were the reference standard. Likelihood ratios were the primary measures of diagnostic accuracy, with reliability expressed as weighted Kappa scores. Inter-observer agreement was generally poor, and confidence intervals were wide. None of the 18 signs studied had clinically meaningful diagnostic accuracy even for severe plasma sodium and potassium abnormalities. None of the clinical signs assessed were useful in clinical practice. Additional training would improve the accuracy of the signs.

„Społeczne ramy kultury” czterdzieści lat później. Pięć modeli komunikacji kulturowej

Forty years ago Antonina Kłoskowska built up a universal paradigm of three social frames of culture. They included: frame one, i.e. local production of symbolic processes, close to folk culture; frame two — understood as a network of local institutions of culture; frame three — involving a radiation of pan-local centers, in particular a reception of contents transmitted by mass media. A basic sociological criterion of differentiating between these categories includes a type of contact, and adjacency of sender and recipient of symbolic communication. Currently, following years of development of digital means of communication, computer networks and fiber optic technologies, audio-visual systems, mobile telephones, etc. a proposal of frames of culture must be examined again. New media shape new vehicles of expression (e.g. hypertext), but most importantly they inspire specific social relations. Discussion over cultural framework is also triggered by accelerated processes of economic and social transformation, advanced globalization, increase of living standards and dissemination of consumption attitudes, changes in leisure activities of the middle class. In more narrowly understood domain of institutional and professional culture one witnessed the processes of European deregulation and release of culture from state, which in Eastern Europe was accompanied by abolition of censorship and a different model of culture distribution, which is controlled by market and cultural (creative) industry rather than by central government. As a result, the nature of direct communication among people is subject to ongoing transformation. We witness more and more indirect cultural communication (off-line and on-line). Modified and broadened proposal of social frames of culture includes five rather than three paradigms, namely: the culture of indirect communication, the culture of associations and volunteers; the culture of local institutions (public and private), mass culture versus pop culture, cyber-culture, culture of network community. One has to underline that in the new reality of our civilization we can still use analytic principles of Kłoskowska’s typology. First, we can treat spiritual culture as a phenomenon of autotelic semiosis with pragmatic definition of sign; second, while describing social functioning of culture we can use a sociological criterion of contact and adjacency.

Some properties and applications of the Riemann and Green-Hadamard functions for linear second-order hyperbolic equations

We study some properties of the Riemann and Green-Hadamard functions for linear second-order hyperbolic equations of general form. We consider their sign definiteness and symmetry in a certain sense and prove a comparison type theorem. Some applications are presented.

Regards croisés sur les signes précoces de rechute des sujets schizophrènes

The question of the course of schizophrenia relapses, is of considerable interest in different clinical and social areas such as prognosis, quality of life, therapeutic relationship, psychoeducation, rehabilitation and so on. The more the schizophrenic relapses, the higher the level of handicap. Although there is a widespread agreement that it is essential to detect early signs of relapses in order to prevent them, there still remain theoretical and methodological difficulties in identifying these signs because they are personal, heterogeneous and not always specific to psychosis. That is why the notion of "relapse signature" seems relevant by taking into account differentiated and personal assessment of early signs of relapse. This implies the consideration of the different visions of relapse given by patients, parents and caregivers. We propose a qualitative study of the joint appraisal of patients, patients' parents and medical staff. The aim of this study is to regroup the expertises in order to further our understanding of the early signs of relapse. We assume that patients and parents are able to describe signs that are not considered as pathological symptoms, but refer to a personal manner of initiating the relapse process. This should then help in designing early intervention and provide reinforced therapeutic alliance and more positive responses to psychoeducation programs. We have interviewed 30 subjects divided in three groups: 10 schizophrenic patients, 10 caregivers (including physicians, psychologists and nurses) and 10 parents of schizophrenics. The patients met the following criteria: patients with a diagnosis of schizophrenia (DSM IV criteria), under neuroleptic treatment, and stabilized. The mean duration of illness was 15 years. The patients as well as caregivers were recruited in two external hospital structures. All the subjects gave their written consent for this study and its methods. We did not recruit parents who were not living with their schizophrenic child or who did not see or have frequent contact with him or her for this study. We conducted a semistructured interview and analysed the transcripts of the narratives provided by our three groups on the definition of relapse and early signs of relapse. Recorded interviews were processed using the Alceste Method, a computer program of textual analysis that identifies the word patterns most frequently used by the subjects. Alceste creates classes of words using a hierarchical descending classification. The description of each class is presented in the form of a word list (with the value of the word's Chi(2) association in this class). We assessed the awareness of problems using the 8-Q. The three groups described relapses as a distressed, even traumatic experience. This experience is shared by the patients' siblings who sometimes mention violent situations and difficulties at home. The analysis showed that each group uses a compartmentalized universe of speech. This raises the question of the communication and the sharing of information between the different groups. Parents who didn't live the relapse of their children and the caregivers gave prepsychotic or psychotic symptoms of relapse. Conversely, parents who had lived relapse(s) of their children gave nonspecific and very personalized signs of relapse (e.g., "When she relapses, our daughter eats much more cheese than usually"). The patients with a low level of awareness of his/her problem were able to describe early signs of relapse. They described mood and sleep disturbances. This is an unexpected result and calls for a debate on the need or not to have good insight in order to follow a psychoeducation program. This study insists on the complementarity of different conceptions of all persons involved in schizophrenic relapse in order to identify as accurately as possible the "relapse signature" of patients. According to us, and in order to promote suitable subjective data to increase insight, compliance and therapeutic alliance, psychoeducation programs should rely on these personal criteria rather than propose systematic programs. Then the relapse signature could be the first step to the appropriation of the course of illness and control of psychotic symptoms by schizophrenic patients.

Analysis of a quadratic functional with a partly degenerate legendre condition

The question of nonnegativity of a quadratic functional such that its matrix at the square of control is degenerate in part of controls is studied. After some transformation of the phase variables, the “degenerate” part of controls disappears, while its role passes to new phase variables. The obtained quadratic functional can have a non-degenerate matrix at the square of new control variables, allowing us to study its sign definiteness by standard methods.

Varicose veins and chronic venous insufficiency

Varicose veins are a very frequent disorder with prevalence in our adult population between 14% for large varices and 59% for small teleangiectasias. Subjective symptoms may be very non-specific. The term "chronic venous insufficiency (CVI)" defines functional abnormalities of the venous system producing advanced symptoms like oedema, skin changes or leg ulcers. Both entities, varicose veins and CVI, may be summarized under the term "chronic venous disorders" which includes the full spectrum of morphological and functional abnormalities of the venous system. A classification system to describe chronic venous disorders regarding clinical appearance, etiology, anatomical distribution and pathophysiology has been proposed under the acronym of CEAP. The revised version of the CEAP classification contains also definitions of clinical signs and suggests three levels of apparative investigations adjusted to the clinical stage. Concerning the etiology of venous disorders controversial theories exist leading to different therapeutic concepts. As a matter of fact there is a vicious circle between structural changes in valves and venous wall and hemodynamic forces leading to reflux and venous hypertension. Different methods for treating varicose veins are available producing satisfactory early outcome in most cases, but followed by a high recurrence rate after years. Chronic venous insufficiency requires "chronic management". Compression therapy by bandages for initial treatment of severe stages and maintenance therapy using medical compression stockings is essential. In addition correction of venous refluxes by surgery or endovenous procedures including echo-guided foam sclerotherapy should be considered in every single case.

The importance of early symptom recognition in the context of early detection and cancer survival

Since there is evidence that stage is an important prognostic factor in cancer, interventions aimed at ‘down-staging’ are part of a comprehensive cancer control approach. Besides organised screening programmes, raising awareness of detectable signs and symptoms is recommended. A precise definition of early cancer signs and symptoms, however, is lacking and there has also been no systematic review regarding the impact of awareness raising interventions on cancer outcomes. We reviewed the scientific medical literature to assess the consistency and availability of a definition for early cancer symptoms as well as to assess the impact of early cancer diagnosis on survival. Although early diagnosis is an important factor for cancer survival, other considerations such as the cancer profile of a country, the characteristics of cancer types and the availability of devices for diagnosis should be taken into account in promoting early cancer detection. There is a clear need for research to categorise cancer types according to early symptoms in order to increase comparability of studies in this field and to provide guidance for health personnel in primary care settings in low income regions.

Complex-valued support vector classifiers

In this paper, we present a family of complex-valued support vector classifiers (CSVCs) based on the definition of the complex sign inspired by the modulation in digital communications and the complex-valued kernel functions. We also propose a theorem to construct the complex-valued Mercer kernels and the corresponding kernel function groups. CSVC algorithms include binary (2-state) CSVC (BCSVC), quadrature (4-state) CSVC (QCSVC) and some multi-state CSVCs. In this paper, we focus on QCSVC. For a quadrature complex-valued classification problem, QCSVC is identical to the 4-quadrature amplitude modulation demodulation methods in digital communications. Finally, the simulated experiments confirm the validity and the efficiency of CSVCs.

International Criteria for the Diagnosis of Ocular Sarcoidosis: Results of the First International Workshop on Ocular Sarcoidosis (IWOS)

Aim: To report criteria for the diagnosis of intraocular sarcoidosis, taking into account suggestive clinical signs and appropriate laboratory investigations and biopsy results. Design: Concensus workshop of an international committee on nomenclature. Methods: An international group of uveitis specialists from Asia, Africa, Europe, and America met in a concensus conference in Shinagawa, Tokyo on October 28–29, 2006. Based on questionnaires that had been sent out prior to the conference, the participants discussed potential intraocular clinical signs eligible for a diagnosis of ocular sarcoidosis. A refined definition of clinical signs, which received two-thirds majority of votes, was included in the list of signs consistent with ocular sarcoidosis. Laboratory investigations were similarly discussed and those tests reaching a two-thirds majority were retained for the diagnosis of ocular sarcoidosis. Finally diagnostic criteria were proposed based on ocular signs, laboratory investigations, and biopsy results. Results: The concensus conference identified seven signs in the diagnosis of intraocular sarcoidosis: (1) mutton-fat keratic precipitates (KPs)/small granulomatous KPs and/or iris nodules (Koeppe/Busacca), (2) trabecular meshwork (TM) nodules and/or tent-shaped peripheral anterior synechiae (PAS), (3) vitreous opacities displaying snowballs/strings of pearls, (4) multiple chorioretinal peripheral lesions (active and/or atrophic), (5) nodular and/or segmental peri-phlebitis (± candlewax drippings) and/or retinal macroaneurism in an inflamed eye, 6) optic disc nodule(s)/granuloma(s) and/or solitary choroidal nodule, and (7) bilaterality. The laboratory investigations or investigational procedures that were judged to provide value in the diagnosis of ocular sarcoidosis in patients having the above intraocular signs included (1) negative tuberculin skin test in a BCG-vaccinated patient or in a patient having had a positive tuberculin skin test previously, (2) elevated serum angiotensin converting enzyme (ACE) levels and/or elevated serum lysozyme, (3) chest x-ray revealing bilateral hilar lymphadenopathy (BHL), (4) abnormal liver enzyme tests, and (5) chest CT scan in patients with a negative chest x-ray result. Four levels of certainty for the diagnosis of ocular sarcoidosis (diagnostic criteria) were recommended in patients in whom other possible causes of uveitis had been excluded: (1) biopsy-supported diagnosis with a compatible uveitis was labeled as definite ocular sarcoidosis; (2) if biopsy was not done but chest x-ray was positive showing BHL associated with a compatible uveitis, the condition was labeled as presumed ocular sarcoidosis; (3) if biopsy was not done and the chest x-ray did not show BHL but there were 3 of the above intraocular signs and 2 positive laboratory tests, the condition was labeled as probable ocular sarcoidosis; and (4) if lung biopsy was done and the result was negative but at least 4 of the above signs and 2 positive laboratory investigations were present, the condition was labeled as possible ocular sarcoidosis. Conclusion: Various clinical signs, laboratory investigations, and biopsy results provided four diagnostic categories of sarcoid uveitis. The categorization allows prospective multinational clinical trials to be conducted using a standardized nomenclature, which serves as a platform for comparison of visual outcomes with various therapeutic modalities.

Clinical Predictors of Psychogenic Nonepileptic Seizures

Psychogenic nonepileptic seizures (PNES) are often disabling and usually associated with psychiatric disorders and reduced quality of life. Although often suspected based on historical and clinical features, the gold standard for diagnosis of PNES is video electroencephalography. Identification of clinical features that reliably distinguish PNES from ES would be valuable in acute care settings, for patients that have coexisting disorders, and those with multiple event types. To determine the diagnostic value of putative clinical symptoms or signs of PNES against the gold standard of video electroencephalography. We addressed the objective through development of a structured critically appraised topic that included a clinical scenario, structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of epileptology. There were wide variations in the rates of coexisting PNES and epilepsy and study methodology. Ictal stuttering and the "teddy bear" sign were associated with moderate specificity for PNES. However, the presence of pelvic thrusting or ictal eye closure did not accurately distinguish PNES from ES. The presence of either ictal stuttering or the teddy bear sign is moderately specific but poorly sensitive for PNES. Pelvic thrusting and ictal eye closure are not reliable indicators of PNES. Future studies should establish more precise and reliable definitions of clinical signs and evaluate combinations of such signs in a broad spectrum of patients with PNES and ES spell phenotypes that may be difficult to distinguish, such as spells of unresponsiveness with motor manifestations. Because PNES and ES may coexist, analysis of diagnostic accuracy of clinical features should be performed for individual spells.

Diagrams, Formalism, and Structural Homology in Beckett’s Come and Go

C.S. Peirce’s definition of the iconic sign (within his second trichotomy of signs) has received special emphasis and widespread application in semiotic analysis of the theatre. However, one important type of icon, the diagram (Peirce subdivided icons into three types: images, diagrams, and metaphors), has received little attention in these studies and, to my knowledge, no attention at all as far as the message of the performance as a whole is concerned. In this essay I suggest a way of broadening the “classical” semiotics of theatre to include diagrams within the scope of application of the icon to this art. This is to be realized by emphasizing the explanatory power latent in diagrams to explicate the way the message of the performance as a whole is created and conveyed. In doing so, I attempt to address another lacuna in theatre semiotics concerning an important feature of the icon. Peirce emphasized the inherent ability of the icon to reveal new insights into its object, “for a great distinguishing property of the icon is that by the direct observation of it, other truths concerning the object can be discovered than those which suffice to determine its construction.”1 This property of the icon, which appears to have been neglected in semiotic analyses of theatre, is best exemplified in the functioning of diagrams. Accordingly, an analysis of the way diagrams function in this art may throw new light on the cognitive aspect of the theatrical enterprise. The performance of Beckett’s play Come and Go (filmed as part of the Beckett on Film project2) will serve here as a representative of a class of theatrical works whose semiotic mechanism is based on diagrammatic iconicity. According to Peirce, the resemblance between diagrams and their objects consists in structural homologies and not in “sensuous resemblance.” The icon includes, suggests Peirce, “every diagram, even though there be no sensuous resemblance between it and its object, but only an analogy between the relations of the parts of each.”3 Elsewhere he indicates that “many diagrams resemble their objects not at all in looks; it is only in respect to the relations of their parts that their likeness consists.”4 Structural homology is, thus, a kind of similarity based on analogous relations and as such is different in kind from sensuous similarity and more abstract. As Noth indicates in Handbook of Semiotics, “iconicity includes

Through the prism of linguistic sign

This paper shortly presents some observations on a sign in general in order to, through Saussure’s definition of linguistic sign as a synthesis of signifiant and signifié, draw attention to the importance of language, and recognize semiotic nature of some Qur’an ayats. Ideas and aconstic images like the units of linguistic sign are inseparable. Their relationship is automatic for they require each other. The processes af relating ideas and aconstic images and realting signs are the processes of thinking Language and mind form a unity. Some Qur’an verses can be related to the issues of sign. In those verses it is said tha Adem, s.a.w.a, was taught the names of things. After he had learned the names, he could relate ideas and aconstic images. That way he could identify and use them in the processes of thinking. Key words: sign, linguistic sign, notion, acoustic presentation, thinking

Definition of the Target Sign and Its Use for the Diagnosis of Schwannomas

The target sign is one of the characteristic imaging findings in schwannomas that distinguishes it from other soft tissue tumors, but its definition has varied in past studies. We defined the characteristic target sign on MRI and clarified its sensitivity and specificity based on histology. Of the 199 schwannomas reviewed, 162 (81%) showed biphasic macroscopic and microscopic patterns of central Antoni A and peripheral Antoni B cells; 118 (59%) also showed a biphasic pattern on MRI. Gadolinium-enhanced T1-weighted images showed central high intensity and peripheral low intensity, whereas T2-weighted images showed peripheral high intensity and central low intensity. Seventy-eight cases had cystic, hemorrhagic, or necrotic degeneration, which corresponded to high intensity on T2-weighted images and low intensity on gadolinium-enhanced T1-weighted images. Nine cases in which the degenerative area was only in the central portion of Antoni A showed a triphasic pattern. We defined the target sign as the biphasic or triphasic pattern on MRI, and the sign correlated with macroscopic and microscopic findings. The specificity of the target sign in schwannoma was 100% and the sensitivity was 59%; therefore, the target sign was characteristic of and helpful for the diagnosis of schwannomas. Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Visible, Yet Secret: Images as Signs of Friendship in Seuse

This article focuses on one aspect of the presentation of friendship within the writings of the Dominican Heinrich Seuse: the importance accorded to visible signs and images as tokens or manifestations of friendship. Seuse's Horologium sapientiae contains his most developed statement on the nature of friendship, as well as a complex definition of signs as markers that mediate between inner and outer, the secret and the manifest. The materiality of gifts and other tokens parallels an awareness of the legibility of the body itself: the notion of 'the body as an image' serving as the corollary of 'the image as a body'. To that extent, all gifted images represent an incarnation of sorts, reflecting not only the fact that for Seuse, friendship itself constitutes a gift, but also that friendship is made manifest on the model of the Incarnation.

Recommended reporting standards for endovenous ablation for the treatment of venous insufficiency: Joint Statement of the American Venous Forum and the Society of Interventional Radiology

Sanjoy Kundu, MD, FRCPC, FCIRSE, FASA, Fedor Lurie, MD, Steven F. Millward, MD, FRCPC, FSIR, Frank Padberg Jr, MD, Suresh Vedantham, MD, Steven Elias, MD, Neil M. Khilnani, MD, William Marston, MD, John F. Cardella, MD, FSIR, FACR, Mark H. Meissner, MD, Michael C. Dalsing, MD, Timothy W.I. Clark, MD, FSIR, and Robert J. Min, MD, MBA, FSIR, Toronto and Peterborough, Ontario, Canada; Honolulu, Hawaii; Newark and Englewood, NJ; Saint Louis, Mo; New York, NY; Chapel Hill, NC; Springfield, Mass; Seattle, Wash; and Indianapolis, Ind