The Mobile Thriving Respite With and for the Street Community

We report on our work with the street community of Pittsburgh, specifically, a community-based action initiative we call the Mobile Thriving Respite (Institutional Review Board approval was obtained from our university). For 5 years, student advocate ethnographers from Point Park University have gathered data (e.g., long- and short-term interviews, participant-observations generating fieldnotes). The data revealed and supported the need for thriving beyond surviving homelessness. The data endorsed the creation of the mobile thriving respite. In the first part of this work, we will discuss some critical concepts regarding homelessness as a phenomenon and then argue that while surviving as enduring is necessary, there are some for whom survival is a perpetual, lethal state of being. We will discuss the theoretical foundations to the respite and offer researchers’ ethnographic accounts of the respite’s process and progress (We had to temporarily end the respite during the Covid-19 pandemic. To date, the respite has returned with “pop up” events outside at various locations). We will outline how the mobile thriving respite is a praxis as site of resistance as well as an emergent strategy, and an instantiation of communitas. We will then revisit surviving as collectively bearing witness and testifying to the lived experiences of those living outside.

The Utility of Gallbladder Absence on Ultrasound for Children With Biliary Atresia

Background: Biliary Atresia (BA) is congenital condition, where infant intra- and extrahepatic bile ducts become obliterated, leading to cholestasis, and cirrhosis if untreated. This study aims to assess the predictive measure of absent gallbladder on ultrasounds (US) performed in infants with cholestasis for diagnosing BA.Method: After Institutional Review Board approval, retrospective chart reviews of 61 infants with cholestasis found 43 (70.5%) were diagnosed with BA. A pediatric radiologist provided interpretations of all ultrasounds in a blinded fashion. Statistical analysis was used to assess the utility of absence of gallbladder on US in predicting BA, confirmed intraoperatively.Results: Absent gallbladder on US predicts absent gallbladder with 77% accuracy, 92% sensitivity, 73% specificity, PPV 43%, and NPV 97% (P < 0.001, Fisher exact test). To diagnose BA, absent gallbladder on US has 66% accuracy, 53% sensitivity, 94% specificity, 96% PPV, and 46% NPV (P < 0.001, Fisher exact test).Conclusion: Sonographic gallbladder absence has high specificity and PPV, indicating utility for BA diagnosis; however, it is not useful for ruling out BA given its low sensitivity.

The Savvy Survey #9: Gaining Institutional Review Board Approval for Surveys

Getting IRB approval for your survey can seem like a daunting task to many people in academia and Extension. This new 4-page publication of the UF/IFAS Department of Agricultural Education and Communication discusses what the IRB is, when and how to get IRB approval for a survey, getting informed consent, and where to get help for Extension professionals wanting to perform research or publish findings from surveys they have completed. Written by Colleen E. Gariton and Glenn D. Israel.

Hepatic Artery Variations Analyzed in 1141 Patients Undergoing Digital Subtraction Angiography

Background: The hepatic artery has several variations that can be observed by digital subtraction angiography (DSA). In recent years, clinical studies have continued to explore its diversity, leading to the discovery of rare variations and the development of new classifications.Methods: Institutional Review Board approval was attained. This retrospective study was based on analysis of DSA images in 1141 patients who were pathologically or clinically diagnosed with liver tumor from May 2015 to December 2019. All patients involved in this study had undergone hepatic arteriography at our hospital. The study aimed to complete angiographic assessments of the left gastric artery (LGA), superior mesenteric artery (SMA) and HA, which supply the liver parenchyma. Results: It was worth mentioning that we found five new cases of hepatic artery variations. The four major types of hepatic artery anatomy were identified. Normal hepatic artery anatomy was pointed in 871 (76.3%) of 1141 patients, and the incidence of hepatic artery variation was 270 (23.7%) cases. Variation in hepatic artery origin was identified in 240 (21.1%) cases. Variation in bifurcation was identified in 18 (1.6%) cases. Three (0.5%) cases had synchronized bifurcate and variation of origin, which has not been reported previously. Conclusion: Hepatic artery variation have diversity and complexity. The known and newly is covered variations were thoroughly analyzed in detail, which has important clinical significance for hepatobiliary surgeries and interventional operations.

Video assisted thoracoscopy as a therapeutic modality in evacuating retained or clotted haemothoraces

Objective: To determine the role of VATS (Video Assisted Thoracoscopy) for evacuating retained / clotted haemothorax resulting in minimising the duration of chest tube drainage and length of hospital stay. Methods: From July 2019 to February 2020, 160 consecutive patients underwent VATS for retained or clotted haemothoraces at the Department of Thoracic Surgery, Jinnah Postgraduate Medical Centre. Institutional review board approval and consent from all patients taken. Outcome was measured as partial or complete lung expansion and relapse of collection. Results: There were 128 (80%) male and 32 (20%) female. 103 (64.37%) patients underwent VATS in first week (2-7) and 57 (35.63%) in second week (8-14 days). Of 103 patients who underwent VATS the first week, (71.9%) had complete lung expansion which was significantly higher compared to those who underwent VATS in second week (28,1%). Ninety-nine participants had chest tube removed in first week of VATS. Participants who underwent VATS in first week had shorter duration of stay (p=0.000). Conclusion: VATS is a safe, reliable and effective technique for the evacuation of retained haemothorax in haemodynamically stable patients. Early intervention within first week of injury not only is associated with better outcome but shorter duration of hospital stays. Keywords: VATS, blunt trauma, Clotted haemothoraces, Continuous...

Mammary and extramammary myofibroblastoma: multimodality imaging features with clinicopathologic correlation, management and outcomes in a series of 23 patients

Objective: The purpose of this study was to describe the imaging appearance, diagnosis, and management of mammary and extramammary myofibroblastoma (MFB) in a series of 23 patients. Methods and materials: Following institutional review board approval, cases were identified by searching for “myofibroblastoma” in radiology reports. Multimodality imaging and pathological features were assessed. Results: 23 cases of myofibroblastoma were identified in 15 males and 8 females. Most cases were in the breast (20/23, 87%), presenting as a palpable mass or discovered incidentally on mammography in females or chest CT in males. Extramammary MFB lesions (3/23, 13%) presented with symptoms related to mass effect. At imaging, MFB most often demonstrated an oval or irregular mass that was hypoechoic or heterogeneously echogenic with variable margins. MRI showed T2 hyperintensity, diffusion restriction, and plateau kinetics. Extramammary MFB appeared as an enhancing mass with variable fat content and T2 intensity. Conclusion: Here we describe imaging and clinicopathological features of mammary and extramammary myofibroblastoma. Advances in knowledge: Imaging description of this rare tumor is limited in the literature, and to date this is the largest case series describing the imaging findings.

State of the Art: Evaluation and Management of Patients with Cardiac Papillary Fibroelastoma

Objective: To review the current literature on the state of the art of evaluation and management of cardiac papillary fibroelastoma (PFE). Methods: A literature review was performed on the topic of evaluation and management of PFE. PubWeb, Web of Science, Google Scholar, Scopus search engines were used. Key search terms included: “Cardiac papillary fibroelastoma,” “papillary fibroelastoma,” “Surgical resection of papillary fibroelastoma,” “Minimally invasive resection of papillary fibroelastoma,” “Thoracoscopy and PFE.” Relevant articles were archived and synthesized in an EndNote database. Particular attention was focused on identifying cases of minimally invasive resection of PFE and the use of thoracoscopic adjuncts to assist with cavitary PFE removal. Institutional Review Board approval was waived. Results: A total of 119 articles were identified and archived. Forty seven articles were used to compose this paper. 8 articles detailed minimally invasive resection of PFE. The largest series of minimally invasive PFE resection summed 4 patients. There are currently no guidelines to direct care of patients with PFE. General consensus is that the presence of left sided PFE should prompt evaluation for surgery. Conclusions: PFE is a rare tumor, more common in children than adults. Lesions are typically left sided and are at risk for embolization. Minimally invasive surgery is feasible and safe. Long-term outcomes with complete resection are very good.

Influence of Pharmaceutical Direct-to-Consumer Advertisement on Medical Treatment of Inflammatory Bowel Disease—An Outpatient Survey-Based Study

Background The management of inflammatory bowel disease (IBD) has become much more complex as our understanding of the disease pathology has improved and as new novel therapeutic options come into play. A factor that has not been studied in the management of this disease is the role that Direct-To-Consumer Advertisement (DTCA) plays in patients’ decisions regarding their treatment options. Here we investigate the very role this mode of television advertisement has on influencing our patients. Methods Following formal institutional review board approval, we devised a prospective, single institution, survey-based study in our university-based outpatient gastroenterology clinic. Surveys included major demographic features along with questions pertaining to patients’ interactions with various advertisements. Surveys were collected over a 3-month period. Results Overall, 103 surveys were collected. The data were not normally distributed. Fifty-three patients were female, and 40 patients were male. Eighty-one percent of patients with IBD were not affected in any way by advertisements with regard to influencing their decision to start new therapies. A subgroup analysis revealed that various parameters including age, sex, and marital status played a role in how DTCA influences patients with regard to their IBD treatments. Discussion This study demonstrates that overall patients are not significantly influenced by DTCAs; however, some cohorts are influenced in more ways than others. This study highlights the importance of understanding the role DTCA plays in influencing our patients with IBD and sets the foundation for further inquiry into this very interesting relationship.

Pressure-based Compression Guidance of the Breast in Digital Breast Tomosynthesis Using Flexible Paddles Compared to Conventional Compression

Objective We investigated the effect of introducing a pressure-based flexible paddle on compression parameters and user and patient experience of digital breast tomosynthesis (DBT) combined with patient-assisted compression or technologist compression. Methods After institutional review board approval, women with a DBT appointment who gave informed consent received pressure-based flexible paddle breast compression. Eight lights on the paddle were illuminated (1.9 kPa per light) as pressure was applied, aiming for an 8–13.9 kPa target range. The compression level was applied by the technologist or the participant utilizing a remote control device. The participant’s and technologist’s experiences were assessed by a questionnaire. Compression parameters were compared to previous examinations. Comparative statistics were performed using t-tests. Results Pressure-based compression (PBC) was judged to be similar or more comfortable compared with previous traditional exams (80%, 83/103), and 87% (90/103) of participants would recommend PBC to friends. Pressure variability decreased for craniocaudal (CC) views (-55%, P < 0.001) and mediolateral oblique (MLO) views (-34%, P < 0.0001). Subgroup analysis showed a similar glandular dose for CC views, while breast thickness was reduced (-3.74 mm, P < 0.0001). For MLO views, both glandular dose (-0.13 mGy, P < 0.0001) and breast thickness were reduced (-6.70 mm, P < 0.0001). Mean compression parameters were similar for technologist compression and patient-assisted examinations. Conclusion Use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.