Development of a TOPAS Monte Carlo (MC) model extension to simulate the automatic exposure control function of a C-arm CBCT.

Purpose: Accurate simulation of organ doses in C-arm CBCT is critical for estimating personalised patient dosimetry. However, system complexities such as automatic exposure control (AEC) and the incorporation of DICOM images into simulations are challenging. The aim of this study was to develop a model for mimicking the operation of an AEC system, which maintains a constant dose to the detector through mA modulation in order to facilitate more accurate MC dosimetry models for C-arm CBCT.

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders.

Purpose: Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring.

Methods: Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.

Relative response of dosimeters to variations in scattered X-ray energy spectra encountered in interventional radiology.

Purpose: The new lower eye lens dose limit is of relevance in interventional radiology, where higher dose procedures result in increased scattered radiation to staff. The eye lens dose may be monitored using the directional dose equivalent at 3 mm depth, H(3), or through H(10) or H(0.07) measurements and using conversion factors.

Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity.

The founding members of the Coalition for Psychotherapy Parity present Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. These guidelines support access to psychotherapy as prescribed by the clinician without arbitrary limitations on duration or frequency. The authors of the guidelines first review the evidence that psychotherapy is effective, cost-effective, and often provides a cost-offset in decreased overall medical expenses, morbidity, mortality, and disability.

The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program.

Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system.

The Contribution of Sidney Blatt's Two-Polarities Model to the Psychodynamic Diagnostic Manual.

This article reviews the theoretical and empirical contributions of Blatt's two-polarities model of personality development and psychopathology to the second edition of the Psychodynamic Diagnostic Manual (PDM-2). First, we briefly provide an overview of the manual's main features and describe the guiding principles of the revision process. We then discuss in more detail how Blatt's model, which is focused on the dialectic interaction between and dimensions in both normal and disrupted personality development, increases the PDM-2's theoretical and empirical comprehensiveness and clinical utility, especially concerning the classification and assessment of personality and overall mental functioning in adult populations.

Clinicians' emotional responses and Psychodynamic Diagnostic Manual adult personality disorders: A clinically relevant empirical investigation.

The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses.

Perceptions of private market landlords who rent to tenants of a Housing First program.

The rental of housing units by landlords to participants in Housing First (HF) programs is critical to the success of these programs. Therefore, it is important to understand the experiences of landlords with having these individuals as tenants. The paper presents findings of qualitative interviews with 23 landlords who rented to tenants from a HF program located in a small city and adjoining rural area in eastern Canada and in which approximately 75 % of tenants had been housed for at least six consecutive months at 2 years in the program.

The Relationship between Theoretical Orientation and Countertransference Expectations: Implications for Ethical Dilemmas and Risk Management.

Unlabelled: Countertransference (CT) awareness is widely considered valuable for differential diagnosis and the proactive management of ethical dilemmas. We predicted that the more practitioners' theoretical orientation (TO) emphasizes insight into the dynamics of subjective mental life, the better they will be at using their CT expectations in differential diagnosis with high-risk patients. To test this hypothesis, we compared psychodynamic therapy (PDT) practitioners who emphasize insight into subjective mental life with practitioners who do not emphasize this epistemology.

Impact of adding Level II and III trauma centers on volume and disease severity at a nearby Level I trauma center.

Background: As emergency care becomes increasingly regionalized, systems planners must determine how system expansion impacts existing system assets. We hypothesized that accrediting new Level II and III trauma centers impacted the trauma patient census and severity at a nearby Level I trauma center and estimated the magnitude of the impact.

Methods: We conducted an interrupted time series analysis using monthly patient counts during the past 10 years for five trauma centers located near one another in Pennsylvania.

Trauma registry reengineered.

A successful trauma registry balances accuracy of abstraction and timeliness of case submissions to achieve quality performance. Staffing to achieve quality performance is a challenge at times based on competitive institutional need. The aim of this performance improvement timing study was to identify trauma registry job responsibilities and redesign the responsibilities to create increased abstraction time and maintain accuracy of data abstraction.

Psychoanalysis and research: some reflections and opinions.

The author argues that existing research on the outcome of psychoanalysis and the psychoanalytic therapies is sufficient to claim a solid basis in scientific evidence for psychodynamically oriented clinical work. She explores sociocultural trends that increase the probability that analytic therapists and academic researchers will misunderstand one another, and she discusses the problematic status of the randomized controlled trial as the "gold standard" of research. She urges readers to educate themselves about what the outcome research actually shows, to support empirical investigations of psychoanalytic theories and practice, to make alliances with therapists of other orientations, and to try to contribute to changing the terms in which policymakers and the public frame their understanding of mental health and mental suffering.

Beyond traits: personality as intersubjective themes.

The author argues that research in the idiographic tradition is more conducive to effective clinical work than the uncritical adoption of specific "evidence-based therapies" for discrete symptomatic disorders. She views pressures on therapists to adopt evidence-based therapies without consideration of individual differences and personal subjectivity as the misapplication of a research paradigm to the clinical situation. Reviewing some recent empirical work on individuality and therapeutic process, she critiques efforts to formulate personality diagnosis on the basis of externally observable traits without attention to internal experience, and she contends that intrapsychic themes account for personality differences more powerfully than traits, even when traits are construed dimensionally.

Has TRISS become an anachronism? A comparison of mortality between the National Trauma Data Bank and Major Trauma Outcome Study databases.

Background: The Trauma and Injury Severity Score (TRISS) has been the approach to trauma outcome prediction during the past 20 years and has been adopted by many commercial registries. Unfortunately, its survival predictions are based upon coefficients that were derived from a data set collected in the 1980s and updated only once using a data set collected in the early 1990s. We hypothesized that the improvements in trauma care during the past 20 years would lead to improved survival in a large database, thus making the TRISS biased.

Epidemiological shifts in elderly traumatic brain injury: 18-year trends in Pennsylvania.

Older adults tend to have poorer outcomes compared to younger adults following moderate-to-severe traumatic brain injury (TBI). Currently, there is a need for research focusing on how elderly TBI has changed as the U.S.

The psychodynamic diagnostic manual: an effort to compensate for the limitations of descriptive psychiatric diagnosis.

This article describes, from the perspective of a participant in the process, the background of and rationale for the development of the Psychodynamic Diagnostic Manual (PDM), a classification system based on both long-standing clinical observation and recent empirical research. It was hoped that the PDM would compensate for some of the unintended negative consequences to practitioners and their clients of uncritical reliance on descriptive psychiatric taxonomies such as the Diagnostic and Statistical Manual of the American Psychiatric Association. A shared and motivating experience of the contributors to the PDM was dismay at how the dominance of a narrow, descriptive-psychiatry model has promoted the decline of the empirically sound and clinically valuable idiographic tradition, in which clients' difficulties are conceptualized in the context of their unique personalities, developmental challenges, and life contexts.

Coactivating signals for the hepatic lymphocyte gamma interferon response to Francisella tularensis.

The facultative intracellular bacterium Francisella tularensis is capable of causing systemic infections in various hosts, including mice and humans. The liver is a major secondary site of F. tularensis infection, but hepatic immune responses to the pathogen remain poorly defined.

Caveat medicus: consequences of federal investigations of marketing activities of pharmaceutical suppliers of prostate cancer drugs.

In the course of recent health care fraud investigations against TAP Pharmaceuticals (Lake Forest, IL) and AstraZeneca International (London, United Kingdom), each pled guilty to one violation of the Prescription Drug Marketing Act, settled claims related to alleged violations of the False Claims Act without admitting guilt, and paid fines, settlements for liabilities, and reimbursements of dollar 850 million and dollar 355 million, respectively. In a unique aspect of these cases, federal investigators brought criminal charges against 14 TAP employees and investigated the billing practices of several urologists. These investigations resulted in guilty pleas from both urologists and industry employees relative to the Prescription Drug Marketing Act or the False Claims Act and probationary sentences with payments of fines and restitution to the government for urologists who cooperated with federal investigations.

Opportunities for disease state management in prostate cancer.

In this paper, we examine how the management of prostate cancer lends itself to a disease state management (DSM)-based approach, and propose a framework that emphasizes the patient-provider-caregiver triad in managing the long-term implications of the condition. There is often no clearly superior approach to the management of patients with prostate cancer (eg, watchful waiting and hormonal therapy), and each option entails different trade-offs in quality of life. Ideally, the physician and patient discuss the options, issues, and patient preferences for treatment through the shared decision-making process.