Cancer, the public, and the radiographer.

All radiographers can help bring about more cancer cures. In this context one's specialty--diagnosis or therapy--is less important than the fact that, because radiographers are seen by the public to be knowledgeable about health matters, they can exert an influence on how people think about the cancers. Why public attitudes to cancer adversely affect the number of patients cured and how radiographers might help improve the present lamentable situation is the subject of this paper.     

Morality, ethics, and radiologists' responsibilities.

The goal of this discussion was to address the matter and methodology of ethics and critical thinking and to ask several questions about the relationship between ethics and radiology. Questions about the nature of the moral and how ethics inform decision making raise our awareness and may provide new understanding about moral thinking. Why is medicine a moral endeavor? Overridingness, universalizability, and other-regarding virtues were discussed. How do ethics inform medical decision making? Ethical theories, including parentalism, autonomy, and the engagement model, were discussed. What are radiologists' ethical responsibilities? Our ethical responsibilities as radiologists entail seven briefly described elements: assessing the appropriateness of the imaging examination, participating in the informed consent process, protecting patient interests, providing excellent image interpretation, communicating effectively with physicians and patients, seeking continued learning, and continuously improving quality. Of these responsibilities, competence, loyal concern for the patient's well-being, and respect for his or her person provide the basis for trust in the patient-physician relationship. If the central paradox in medicine is the tension between self-interest and altruism, then responsibility to the patient in this trust has the greatest force and overrides other obligations. Finally, our challenge is to critically examine our and each other's professional role and the extent to which we achieve excellence in our contribution to patient care; to break out of comfortable habits and reflect on new, alternative ways of knowing as caregivers; to think about what we are doing in medicine and the consequences for the human mind and spirit of our patients, our colleagues, and ourselves; and to provide a forum for this important dialogue in our practices, residency programs, and continuing education curricula.     

Job stress, depression, work performance, and perceptions of supervisors in military personnel

OBJECTIVE: Recent studies have identified high levels of job stress in military personnel. This study examined the relationship among job stress, depression, work performance, types of stressors, and perceptions about supervisors in military personnel. METHODS: Eight hundred nine military personnel answered a 43-item survey on work stress, physical and emotional health, work performance, perceptions about leadership, job stressors, and demographics. RESULTS: More than one- quarter (27.4%) of this military population reported suffering from significant job stress. Both the report of work stress and depression were significantly related to impaired work performance, more days of missed work, poorer physical health, and negative perceptions about the abilities of supervisors and commanders. Depression and job stress were significantly and positively related to each other. CONCLUSIONS: These results support accumulating data indicating that work stress is a significant occupational health hazard in the routine military work environment. Targeting and eliminating sources of job stress should be a priority for the U.S. military to preserve and protect the mental health of military personnel.     

Emergency contraception knowledge, attitudes, practices, and barriers among providers at a military treatment facility

The safety and efficacy of postcoital administration of oral contraceptives, commonly called "emergency contraception pills" (ECPs), have been well documented; nonetheless, this method of preventing pregnancy is underused in the United States. Through the use of surveys, the current study assessed providers' knowledge, prescribing practices, attitudes, and barriers regarding ECPs at a military treatment facility in the southwest United States. Results showed a lack of knowledge of ECP provision, with 34% believing treatment had to be initiated in 48 or fewer hours, and 60% believing two doses must be taken within 24 hours or more of each other. Slightly more than one- half (54.4%) of the providers reported having prescribed an ECP; those who had prescribed had more positive attitudes about ECPs. Perceived barriers included women not asking for ECPs, concerns about safety of ECPs, and issues regarding liability. A discrepancy between providers' perceived and actual knowledge about ECPs supports the need for better education for all providers who care for women.     

Of Magic,Miracles, and Exercise Myths

Exercise physiologist James S. Skinner, PhD, scrutinizes some popular exercise myths end speculates about why they endure. His comments are enlightening, entertaining, and even a bit philosophical.     

Tattooed Army soldiers: examining the incidence, behavior, and risk

Primary prevention is a priority for medical personnel. Despite societal popularity and a long association of the military with tattooing, little is known about the tattooed Army soldier, which hampers primary health planning. Basic recruits and advanced individual training students (N = 1,835) at one mid-western military installation completed a questionnaire about any tattooing experiences. Almost half (48%) of the soldiers were serious/very serious about getting a tattoo, with 31% stating that there were "no reasons" to keep them from getting a tattoo. More than one-third (36%) were tattooed, with 22% possessing three or more tattoos. Many soldiers (64%) entered the military with the tattoos. Limited use (15%) of alcohol and/or drugs before tattooing was reported. Findings included a high incidence of tattooing, a strong determination to obtain tattoos, the possession of tattoos for self-identity reasons, and the supportive role of friends. Reported procedural bleeding (76%) documents the potential for blood-borne disease transmission. These results confirm the need for targeted health education regarding the safety and potential risks of tattooing.     

Nerve injury about the shoulder in athletes, part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome

Nerve injuries about the shoulder in athletes are being recognized with increasing frequency. Prompt and correct diagnosis of these injuries is important to treat the patient and to understand the potential complications and natural history, so as to counsel our athletes appropriately. This 2-part article is a review and an overview of the current state of knowledge regarding some of the more common nerve injuries seen about the shoulder in athletes, including long thoracic nerve, spinal accessory nerve, burners and stingers, and thoracic outlet syndrome. Each of these clinical entities will be discussed independently, reviewing the anatomy, mechanism of injury, patient presentation (history and examination), the role of additional diagnostic studies, differential diagnosis, and management.     

Risk factors for foot blisters during road marching: tobacco use, ethnicity, foot type, previous illness, and other factors

Three hundred thirty-nine freshmen participating in cadet basic training at the U.S. Military Academy completed a questionnaire that asked them about their previous military experience, gender, ethnicity, injuries and illness experienced in the last 12 months, foot type, cigarette smoking habits, smokeless tobacco use, alcohol consumption, and sleep habits. They then performed a 21-km road march in about 6.5 hours. Their feet were examined for blisters before and after the march. Univariate analysis showed that risk factors for foot blisters included ethnicity (blacks at lower risk than others), a sickness in the last 12 months, no previous active duty military experience, use of smokeless tobacco, and flat feet (pes planus). Logistic regression indicated that all of these were independent blister risk factors with the exception of no previous active duty military experience.     

Sustainability: Concept,implementation, economic implications

This paper defines environmental sustainability and draws attention to the aggregate unsustainability of current human lifestyles and economic activities. It lists a set of sustainability conditions which imply a fundamental transformation in patterns of production and consumption, and the ways in which government policies could help to bring this transformation about. The effects of such policies on macroeconomic quantities such as output, inflation, unemployment and the balance of payments are uncertain and depend to a large extent on whether new technologies or institutional arrangements will allow the transformation to be achieved at little or no net cost — a point of controversy between technological optimists and pessimists. Whether or not moves towards environmental sustainability will permit continuing economic growth, there is no likelihood of living standards collapsing under the challenge, but new approaches to unemployment will have to be developed. Finally, although economic growth may come about as a result of environmental sustainability becoming the dominant policy objective, the converse is unlikely to be true. Putting sustainability first is both the prudent and responsible policy orientation.     

67Ga-binding substances in stomach, small intestine, pancreas, and muscle

Normal male rats were injected with either gallium citrate Ga 67 or sodium sulfate S 35. After 24 h, the stomach, small intestine, pancreas, and muscle were excised and homogenized. After the removal of the nuclear fraction, each of these homogenates was digested with protease. After digestion, the supernatants of the reaction mixtures were applied to a Sephadex-G-100 column. The radioactivity was eluted with buffer solution. The resultant eluates were analyzed for radioactivity and the levels of proteins, uronic acids, and sialic acids. In all four organs, sizable amounts of 67Ga were bound to sulfated acid mucopolysaccharides with molecular masses of about 10,000 daltons and to sulfated acid mucopolysaccharides, a species whose molecular masses exceed 40,000 daltons. In the stomach, large amounts of 67Ga were bound to sulfated acid mucopolysaccharides with molecular masses of about 10,000 daltons. From these results, it is obvious that the main 67Ga-binding substances in these four organs are sulfated acid mucopolysaccharides, and that these acid mucopolysaccharides play the most important role in the concentration of 67Ga in these organs.     

Smoking-related attitudes, characteristics, and opinions in a group of young men with asthma.

The objective of this study was to examine the attitudes, characteristics, and opinions about smoking of a group of young asthmatic men. POPULATION AND METHODS: An anonymous, personal questionnaire was administered to 611 young male volunteers who had been diagnosed with asthma (according to the National Heart, Lung, and Blood Institute/World Health Organization Global Initiative for Asthma, 1995) in the respiratory disease and allergy clinics of the Burgos Military Hospital (Spain). This questionnaire contained items related to personal information, asthma characteristics, opinions about smoking, and information related to smoking habits. RESULTS: Six hundred patients with asthma completed the questionnaire. All were men, mean age 20.16 +/- 3.03 years; 189 (31.5%) were smokers and 16 (2.5%) were ex-smokers. Mean age at onset of regular smoking was 16.46 +/- 2 years. Sixty-five percent (65.07%) smoked fewer than 10 cigarettes per day. Most of the smoking asthmatics had mild asthma (58.9%). Eighty-eight percent (88.3%) had moderate dependence. Many of the smoking asthmatics were contemplating stopping smoking (54%), and 59% had tried before to stop. Concern about health was the main reason given for stopping smoking. Asthmatics who smoked had a higher percentage of smokers among family members, friends, and colleagues than nonsmoking asthmatics. Attitudes toward smoking were more permissive among smoking asthmatics. Only 36.64% of the total had received information about tobacco previously. In the sample group, 7% claimed that they did not smoke but their carbon monoxide concentration in exhaled air was 10 ppm or higher. CONCLUSIONS: There were no differences in the onset of the smoking habit between asthmatic and nonasthmatic young people. A large percentage of the smoking asthmatics were considering smoking cessation, motivated mainly by their asthma condition. The group as a whole had little previous information about tobacco.     

A device for rapid and reliable loading, with reduced radiation exposure, of Hodt applicators with Au-198 seeds

Thanks to the improved devices at the Royal Marsden gun the loading time for gold seeds has been reduced by about one third as well as the radiation exposure has been reduced to about one tenth, due to the fact that the fingers are not so long close to the seeds. The reliability and the manageability has been improved, too.     

Proton-decoupled, Overhauser-enhanced, spatially localized carbon-13 spectroscopy in humans

Spatially localized, natural abundance, carbon (13C) NMR spectroscopy has been combined with proton (1H) decoupling and nuclear Overhauser enhancement to improve 13C sensitivity up to five-fold in the human leg, liver, and heart. Broadhand-decoupled 13C spectra were acquired in 1 s to 17 min with a conventional 1.5-T imaging/spectroscopy system, an auxiliary 1H decoupler, an air-cooled dual-coil coplanar surface probe, and both depth-resolved surface coil spectroscopy (DRESS) and one-dimensional phase-encoding gradient NMR pulse sequences. The surface coil probe comprised circular and figure-eight-shaped coils to eliminate problems with mutual coupling of coils at high decoupling power levels applied during 13C reception. Peak decoupler RF power deposition in tissue was computed numerically from electromagnetic theory assuming a semi-infinite plane of uniform biological conductor. Peak values at the surface were calculated at 4 to 6 W/kg in any gram of tissue for each watt of decoupler power input excluding all coil and cable losses, warning of potential local RF heating problems in these and related experiments. The average power deposition was about 9 mW/kg per watt input, which should present no systemic hazard. At 3 W input, human 13C spectra were decoupled to a depth of about 5 cm while some Overhauser enhancement was sustained up to about 3 cm depth, without ill effect. The observation of glycogen in localized natural abundance 13C spectra of heart and muscle suggests that metabolites in the citric acid cycle should be observable noninvasively using 13C-labeled substrates.     

67Ga-Binding substances in stomach,small intestine,pancreas, and muscle

Normal male rats were injected with either gallium citrate Ga 67 or sodium sulfate S 35. After 24 h, the stomach, small intestine, pancreas, and muscle were excised and homogenized. After the removal of the nuclear fraction, each of these homogenates was digested with protease. After digestion, the supernatants of the reaction mixtures were applied to a Sephadex-G-100 column. The radioactivity was eluted with buffer solution. The resultant eluates were analyzed for radioactivity and the levels of proteins, uronic acids, and sialic acids. In all four organs, sizable amounts of ⁶⁷Ga were bound to sulfated acid mucopolysaccharides with molecular masses of about 10,000 daltons and to sulfated acid mucopolysaccharides, a species whose molecular masses exceed 40,000 daltons. In the stomach, large amounts of ⁶⁷Ga were bound to sulfated acid mucopolysaccharides with molecular masses of about 10,000 daltons. from these results, it is obvious that the main ⁶⁷Ga-binding substances in these four organs are sulfated acid mucopolysaccharides, and that these acid mucopolysaccharides play the most important role in the concentration of ⁶⁷Ga in these organs.     

Allograft update: the current status of tissue regulation, procurement, processing, and sterilization

Allografts are commonly used during sports medicine surgical procedures in the United States, and their frequency of use is increasing. Based on surgeon reports, it is estimated that more than 60 000 allografts were used in knee surgeries by members of the American Orthopaedic Society for Sports Medicine in 2005. In the United States, there are governmental agencies and other regulatory bodies involved in the oversight of tissue banks. In 2005, the Food and Drug Administration finalized its requirements for current good tissue practice and has mandated new rules regarding the "manufacture" of allogenic tissue. In response to well-publicized infections associated with the implantation of allograft tissue, some tissue banks have developed methods to sterilize allograft tissue. Although many surgeons have significant concerns about the safety of allografts, the majority believe that sterilized allografts are safe but that the sterilization process negatively affects tissue biology and biomechanics. However, most know very little about the principles of sterilization and the proprietary processes currently used in tissue banking. This article will review the current status of allograft tissue regulation, procurement, processing, and sterilization in the United States.     

Serum uric acid, body fatness, and heart rate response to exercise.

Serum uric acid was determined in 2298 males and 2237 females, age 10-64. Body fatness (sum of four skinfolds) and heart rate response to a modified Harvard Step Test were also measured in these subjects. Age and sex specific correlation coefficients between SUA and heart rate response to the standard exercise were low (about 0.15 on the average) but more than half were statistically significant. SUA was more closely related to body fatness than to heart rate response to exercise. Removing the effects of body fatness from the SUA - heart rate response correlations decreased these correlations so that only about one per cent of the variation in SUA among people is associated with one's physical fitness as reflected in heart rate response to exercise.     

MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls

OBJECTIVE: The purpose of this article is to review the technique of performing MR enterography examinations and to review the imaging findings suggestive of Crohn disease. This article will also allow the reader to self-assess and improve his or her skills in the performance and interpretation of MR enterography examinations. CONCLUSION: MRI plays a valuable role in providing accurate information about the severity of and complications related to Crohn disease and can help in guiding surgical or medical treatment.     

Posttraumatic stress, family adjustment, and treatment preferences among National Guard soldiers deployed to OEF/OIF

We used an anonymous self-reported questionnaire to assess posttraumatic stress disorder symptoms, relationship concerns, and treatment preferences including interest in family-focused interventions among 100 National Guard Soldiers who were recently redeployed from Iraq or Afghanistan. We found that the majority of married or partnered soldiers were concerned about getting along with their partners, while the majority of parents were concerned about their child-rearing practices. Posttraumatic stress disorder symptoms were significantly associated with the degree of relationship concerns. Soldiers showed a striking preference for family-based interventions over individual treatment, highlighting the importance of developing family-based interventions tailored to address post-deployment mental health and co-occurring family problems.     

Patient safety: a collaborative, blame-free, team approach

Establishing a comprehensive radiology patient safety program can help organize and focus patient safety efforts system-wide. This article highlights the process followed in creation of a comprehensive radiology patient safety program at Partners HealthCare System. The key to comprehensive patient safety is talking about errors that happen, learning from them and preventing them from happening again. At Partners, a collaborative, blame-free, team approach is the answer.     

Nuclear medicine exposure in the United States, 2005-2007: preliminary results

Medical radiation exposure of the U.S. population has not been systematically evaluated for almost 25 years. In 1982, the per-capita dose was estimated to be 0.54 mSv and the collective dose 124,000 person-Sv. The preliminary estimates of the National Council on Radiation Protection and Measurements Scientific Committee 6-2 medical subgroup are that, in 2006, the per-capita dose from all medical exposure (not including radiotherapy) had increased almost 600% to 3.0 mSv and the collective dose had increased more than 700% to approximately 900,000 person-Sv. >Nuclear medicine accounted for only about 2% of all procedures but 26% of the total collective dose from diagnostic studies in medicine. In 1982, the estimated number of nuclear medicine procedures was about 7.5 million. The per-capita effective dose from nuclear medicine was 0.14 mSv and the collective dose was 32,000 person Sv. By 2005, the estimated number of procedures had increased to about 19.6 million. The per-caput effective dose increased to about 0.75 mSv and the collective dose to about 220,000 person Sv. There also has been a marked shift in the type of procedures being performed with cardiac scanning accounting for about 70% of procedures.