Model-supported decision-making at a contaminated sediment site: Post-audit and site closure.

Computer simulation models have been used to support decision-making at contaminated sediment sites for decades. Nonetheless, their reliability in remedial decision-making has been questioned, and there is a need for retrospective studies of the accuracy of model predictions, that is, post-audits. The Neal's Landfill site near Bloomington, Indiana, provides an example of the successful use of a mathematical simulation model in the selection of a remedy for a site that includes streams with polychlorinated biphenyl (PCB)-affected sediment, water, and fish.

Otolaryngology Surgical Activity in Tertiary Care Center During the Covid-19 Lockdown.

Corona virus disease (COVID 19) is an infectious respiratory disease caused by the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With many countries implementing lockdown the surgical activities in the division of otolaryngology across the world has been affected with many hospital confining themselves to only emergency or essential surgeries. The aim of this work is to report and discuss the in the surgical activity of the otolaryngology unit of the St John's National Academy of Health Sciences, Bangalore (India) during the pandemic.

Emergence, Seasonality, and Hybridization of Laricobius nigrinus (Coleoptera: Derodontidae), an Introduced Predator of Hemlock Woolly Adelgid (Hemiptera: Adelgidae), in the Tennessee Appalachians.

From 2010 through 2013, adult emergence and seasonality of Laricobius nigrinus Fender, an introduced predatory species native to western North America, as well as hybridization with the native species Laricobius rubidus (LeConte), were evaluated using emergence traps and beat-sheet sampling in areas of previous release against hemlock woolly adelgid, Adelges tsugae Annand. The shortest emergence period of adult L. nigrinus was 7 wk beginning 22 October 2010, and the longest emergence was 15 wk beginning 17 October 2012.

A Qualitative Study of US Clinical Ethics Services: Objectives and Outcomes.

The quality of clinical ethics services in health care organizations is increasingly seen as an important aspect of the overall quality of care. But measuring this quality is difficult because there is a lack of clarity and consensus regarding the objectives of clinical ethics and the best outcome domains to measure. The aim of this qualitative study is to explore the views of experts about the objectives and outcomes of clinical ethics services in the US.

Fitness and physiology of Adelges tsugae (Hemiptera: Adelgidae) in relation to the health of the eastern hemlock.

The hemlock woolly adelgid, Adelges tsugae Annand is an invasive insect that frequently causes hemlock (Tsuga spp.) mortality in the eastern United States. Studies have shown that once healthy hemlocks become infested by the adelgid, nutrients are depleted from the tree, leading to both tree decline and a reduction of the adelgid population.

Influence of body habitus and use of oral contrast on reader confidence in patients with suspected acute appendicitis using 64 MDCT.

The purpose of this study is to evaluate how body habitus affects reader confidence in diagnosing acute appendicitis and appendiceal visualization using 64 MDCT technology with and without oral contrast. We conducted a HIPAA compliant, IRB approved study of adult patients presenting to the Emergency Department with nontraumatic abdominal pain. Subjects were randomized to two groups: 64 MDCT scans performed with oral and intravenous contrast or scans performed solely with intravenous contrast.

Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only.

Objective: The objective of our study was to compare the diagnostic accuracy of IV contrast-enhanced 64-MDCT with and without the use of oral contrast material in diagnosing appendicitis in patients with abdominal pain.

Materials And Methods: We conducted a randomized trial of a convenience sample of adult patients presenting to an urban academic emergency department with acute nontraumatic abdominal pain and clinical suspicion of appendicitis, diverticulitis, or small-bowel obstruction. Patients were enrolled between 8 am and 11 pm when research assistants were present.

Pelvic CT angiography in blunt trauma: imaging findings and protocol considerations. [corrected].

The evolution of multi-row detector computed tomography (MDCT) technology has resulted in evolving applications of CT angiography (CTA) in the trauma setting. In patients with significant blunt pelvic injuries, the immediate diagnosis and characterization of vascular injuries are of significant import given their morbidity and mortality in this patient population. The application of MDCT technology, specifically 64MDCT, to pelvic CTA is useful in evaluating for potential vascular injuries and may be integrated into admission trauma imaging in order to triage patients with blunt pelvic trauma to appropriate emergent intervention.

Use of 64-row multidetector CT angiography in blunt and penetrating trauma of the upper and lower extremities.

Computed tomographic (CT) angiography is rapidly becoming the preferred imaging test for the initial evaluation of patients suspected to have arterial injuries after blunt and penetrating trauma to the extremities. The increasingly widespread use of 64-row multidetector CT technology offers considerable benefits in extremity CT angiography in the trauma setting. These include the ability to generate isotropic data sets of long vascular territories, with the acquisition performed in a short time (10 seconds or less).

Imaging colorectal trauma using 64-MDCT technology.

Computed tomography has evolved to become the principal imaging modality in the evaluation of colorectal trauma. Direct signs of colorectal trauma are usually highly specific but relatively insensitive and, therefore, indirect signs are important in the diagnostic of colorectal injuries. In addition, prompt recognition of colorectal injury is crucial as even short delays in its diagnosis have been shown to significantly increase both morbidity and mortality.

Imaging of blunt pancreatic trauma.

Blunt pancreatic trauma is an exceedingly rare but life-threatening injury with significant mortality. Computed tomography (CT) is commonly employed as the initial imaging modality in blunt trauma patients and affords a timely diagnosis of pancreatic trauma. The CT findings of pancreatic trauma can be broadly categorized as direct signs, such as a pancreatic laceration, which tend to be specific but lack sensitivity and indirect signs, such as peripancreatic fluid, which tend to be sensitive but lack specificity.

CT of blunt abdominal and pelvic vascular injury.

Computed tomography (CT) has been shown to be increasingly useful in the evaluation of blunt trauma patients with suspected abdominopelvic vascular injuries. CT findings of abdominopelvic vascular insult may be broadly characterized as end-organ abnormalities or direct evidence of vascular injury. End-organ abnormalities implying an underlying vascular insult include identifying an area of relative hypoperfusion in solid organ injury.

Extremity CT angiography: application to trauma using 64-MDCT.

Evolving multi-row detector computed tomography (MDCT) technology has resulted in increasing utility of CT angiography (CTA) in extremity vascular trauma diagnosis and characterization. Given the widespread availability as well as the ease of acquiring CTA in the trauma setting, CTA is increasingly being used as the initial diagnostic evaluation in extremity vascular trauma, replacing digital subtraction angiography in many institutions. One of the significant advantages of the application of 64-MDCT to extremity vascular trauma is the ability to integrate CTA into routine trauma torso protocols.

Active extravasation of the abdomen and pelvis in trauma using 64MDCT.

The objective of this study was to determine the clinical and management implications of the finding of active extravasation in blunt or penetrating trauma patients evaluated with abdomino-pelvic computed tomography (CT) using 64MDCT technology. This HIPAA compliant, retrospective study was IRB-approved, and the need for consent was waived. All adult patients scanned with 64MDCT who sustained blunt or penetrating abdomino-pelvic trauma and had findings of active extravasation at our Level I trauma center during a 30-month period were included.

Detection of vascular injuries in patients with blunt pelvic trauma by using 64-channel multidetector CT.

Vascular injuries are a major source of morbidity and mortality in patients with blunt pelvic trauma. Digital subtraction angiography (DSA) has traditionally been used to detect pelvic arterial injuries and to treat active arterial hemorrhage. Improvements in the technology of computed tomography (CT) have facilitated the implementation of CT angiography, which is beginning to replace DSA in the evaluation of patients with acute trauma.

MDCT evaluation of blunt abdominal trauma: clinical significance of free intraperitoneal fluid in males with absence of identifiable injury.

Objective: The purpose of our study was to determine the clinical significance of the isolated finding of free intraperitoneal fluid on 64-MDCT in male patients who have undergone blunt trauma.

Materials And Methods: A retrospective study was performed of 669 consecutive male patients, ranging in age from 15 to 85 years, who underwent CT evaluation of the abdomen and pelvis at our level 1 trauma center over a 17-month period. Two radiologists evaluated the images for the presence of free intraperitoneal fluid and for an underlying cause.

Blunt trauma: feasibility and clinical utility of pelvic CT angiography performed with 64-detector row CT.

Purpose: To retrospectively evaluate the integration of pelvic computed tomographic (CT) angiography into the thoracoabdominal CT examination of blunt trauma by using 64-detector row CT to differentiate active arterial from active venous hemorrhage.

Materials And Methods: This study was institutional review board approved and HIPAA compliant; the requirement for informed patient consent was waived. Fifty-three patients (30 male, 23 female; mean age, 42 years) with multiple blunt trauma underwent pelvic CT angiography with 64-detector row CT at admission.

64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation.

The finding of active hemorrhage on computed tomography (CT) in trauma patients has been shown to have significant clinical implications and has been incorporated into numerous CT grading schema. As CT technology has advanced, the sensitivity for detection of active hemorrhage in the trauma population has significantly improved. Currently, with the improved spatial and temporal resolution afforded by 64 multidetector computed tomography (64 MDCT) technology, the clinical implications of the CT findings of active extravasation may need to be reconsidered.

Emergency department abdominal computed tomography for nontraumatic abdominal pain: optimizing utilization.

Objectives: To identify predictors of positive computed tomographic (CT) yield and to measure the impact of CT yield on the disposition of patients referred for computed tomography after presenting to an emergency department with nontraumatic abdominal pain.

Materials And Methods: Computed tomographic reports, laboratory data, and emergency department and hospital records were retrospectively analyzed in 604 consecutive patients undergoing CT examinations. Computed tomographic yield was correlated to age, gender, leukocyte count, specified precomputed-tomography clinical diagnosis, and patient disposition.

Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting.

Purpose: To retrospectively review the authors' experience with multi-detector row computed tomography (CT) for detection of aortic dissection in the emergency setting.

Materials And Methods: The investigation was institutional review board approved, did not require informed patient consent, and was HIPAA compliant. In 373 clinical evaluations in the emergency setting, 365 patients suspected of having aortic dissection and/or other aortic disorders underwent multidetector CT.

Acute epiploic appendagitis in hernia sac: CT appearance.

We describe an unusual cause of acute abdomen due to acute epiploicappendagitis located within an incisional hernia sac. The contrast-enhanced CT showed an oval fat density structure with surrounding inflammation in the transverse mesocolon. The contrast-enhanced CT findings of the inflammation of appendices epiploicae of the transverse colon were diagnostic in this case.

The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients.

Objective: Appendiceal CT was introduced at our hospital in 1996 and now is used in most patients. The use of appendiceal CT has generated controversy and mixed results in various investigations. Our purpose was to determine the percentage of patients for whom CT was performed, incidence of appendicitis, accuracy of CT, percentage of equivocal interpretations, and negative appendectomy rates for those patients who did and did not undergo CT.

How to simplify the CT diagnosis of Le Fort fractures.

Objective: The numerous components seen in the Le Fort fractures make classification difficult. Our objective is to simplify the task of classifying Le Fort fractures.

Conclusion: Each of the Le Fort fractures has at least one unique component that is easily recognizable: I, the anterolateral margin of the nasal fossa; II, the inferior orbital rim; and III, the zygomatic arch.

CT appearance of acute appendagitis.

Objective: Our aim was to describe the spectrum of CT findings in patients with acute epiploic appendagitis and also to evaluate the changes seen with this condition.

Materials And Methods: Fifty patients diagnosed with acute epiploic appendagitis seen on contrast-enhanced CT were included in this study. The CT scans of the epiploic appendagitis were evaluated for the presence of colon wall thickening, a focal fatty center, inflammatory changes, location in relationship to the colon, size, and presence or absence of central high density within the fat.