Publications by authors named "Carl Flink"

12 Publications

  • Page 1 of 1

NCI's publication affiliation conundrum: Reframing innovation to incentivize an equitable path for advocate representation.

Transl Oncol 2022 Feb 30;16:101325. Epub 2021 Dec 30.

Beckman Research Institute, City of Hope, Duarte, CA 91010, United States.

Advocacy engagement has been at the forefront of National Cancer Institute (NCI) efforts to advance scientific discoveries and transform medical interventions. Nonetheless, the journey for advocates has been uneven. Case in Point: NCI publication affiliation rules of engagement pose unique equity challenges while raising questions about structural representation in biomedical research. Abiding by the core rationale that publication affiliation should be tailored to employment status, the NCI has systematically denied research advocate volunteers the opportunity to specifically list NCI as an institutional affiliation on academic publications. Unpacking advocate NCI publication affiliation restrictions and its links with advocacy heritage preservation and convergent science goals poses unique diversity, equity, and inclusion challenges and opportunities. Improving the quality of structural representation in biomedical research requires new theories of action and flexible planning to advance, promote and build capacity for strategic advocacy inclusion and equity within publication affiliation initiatives. Here we highlight several opportunities for how leadership might formulate a radically different vision for NCI's approach. This perspective interrogates the best way forward for ensuring that biomedical employee and volunteer advocate workforce publication affiliation intersections are characterized by increased creativity and representation parity. Imbuing the scientist and clinical researcher archetype with social dimensions, we join NCI critical thinkers in urging employees, funded academics, and volunteer citizen scientists to collectively assume the role as paladins of science and integrity who view the triumphs of making a difference in science alongside the social responsibility of promoting transdisciplinary professionalism and the democratization of science.
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http://dx.doi.org/10.1016/j.tranon.2021.101325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728534PMC
February 2022

Imaging review of penile pathologies encountered in the emergency department.

Emerg Radiol 2022 Feb 1;29(1):147-159. Epub 2021 Oct 1.

Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267-0761, USA.

While penile pathology is uncommon, prompt diagnosis and treatment of emergent and urgent penile pathology are necessary to prevent complications. This paper will review the imaging findings of the most common critical penile pathologies, including traumatic, vascular, infectious, foreign body-related, and urethral pathology, in addition to penile prosthesis complications. Each entity will be discussed in the context of presentation and treatment and complications of each pathology will be discussed.
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http://dx.doi.org/10.1007/s10140-021-01988-1DOI Listing
February 2022

American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings.

Radiology 2021 04 2;299(1):122-130. Epub 2021 Feb 2.

From the Departments of Radiology (J.T.L.) and Biostatistics (E.S., A.D.), University of Kentucky, 800 Rose St, Room HX 315A, Lexington, KY 40536-0293; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (J.U.); Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Ind (S.D.S.); Department of Radiology, University of Michigan, Ann Arbor, Mich (S.T.C.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.T., D.R.); Department of Radiology, University of Washington, Seattle, Wash (K.F.L.); Department of Diagnostic and Interventional Imaging, University of Texas Health Sciences Center at Houston, Houston, Tex (N.R.C.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Md (M.P.D.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (Arthur Baghdanian, Armonde Baghdanian); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (C.F.); Department of Radiology, Boston University, Boston, Mass (C.A.L.).

Background Treatment of blunt splenic trauma (BST) continues to evolve with improved imaging for detection of splenic vascular injuries. Purpose To report on treatments for BST from 11 trauma centers, the frequency and clinical impact of splenic vascular injuries, and factors influencing treatment. Materials and Methods Patients were retrospectively identified as having BST between January 2011 and December 2018, and clinical, imaging, and outcome data were recorded. Patient data were summarized descriptively, both overall and stratified by initial treatment received (nonoperative management [NOM], angiography, or surgery). Regression analyses were used to examine the primary outcomes of interest, which were initial treatment received and length of stay (LOS). Results This study evaluated 1373 patients (mean age, 42 years ± 18; 845 men). Initial treatments included NOM in 849 patients, interventional radiology (IR) in 240 patients, and surgery in 284 patients. Rates from CT reporting were 22% (304 of 1373) for active splenic hemorrhage (ASH) and 20% (276 of 1373) for contained vascular injury (CVI). IR management of high-grade injuries increased 15.6%, from 28.6% (eight of 28) to 44.2% (57 of 129) (2011-2012 vs 2017-2018). Patients who were treated invasively had a higher injury severity score (odds ratio [OR], 1.04; 95% CI: 1.02, 1.05; < .001), lower temperature (OR, 0.97; 95% CI: 0.97, 1.00; = .03), and a lower hematocrit (OR, 0.96; 95% CI: 0.93, 0.99; = .003) and were more likely to show ASH (OR, 8.05; 95% CI: 5.35, 12.26; < .001) or CVI (OR, 2.70; 95% CI: 1.64, 4.44; < .001) on CT images, have spleen-only injures (OR, 2.35; 95% CI: 1.45, 3.8; < .001), and have been administered blood product for fewer than 24 hours (OR, 2.35; 95% CI: 1.58, 3.51; < .001) compared with those chosen for NOM, after adjusting for key demographic and clinical variables. After adjustment, factors associated with a shorter LOS were female sex (OR, 0.84; 95% CI: 0.73, 0.96; = .009), spleen-only injury (OR, 0.72; 95% CI: 0.6, 0.86; < .001), higher admission hematocrit (OR, 0.98; 95% CI: 0.6, 0.86; < .001), and presence of ASH at CT (OR, 0.74; 95% CI: 0.62, 0.88; < .001). Conclusion Contained vascular injury and active splenic hemorrhage (ASH) were frequently reported, and rates of interventional radiologic management increased during the study period. ASH was associated with a shorter length of stay, and patients with ASH had eight times the odds of undergoing invasive treatment compared with undergoing nonoperative management. © RSNA, 2021 See also the editorial by Patlas in this issue.
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http://dx.doi.org/10.1148/radiol.2021202917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997613PMC
April 2021

Reflection on the Evaluation of Radiologists' Performance during Off-Hours Shifts.

Radiology 2021 03 19;298(3):E165. Epub 2021 Jan 19.

Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pa.

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http://dx.doi.org/10.1148/radiol.2021203771DOI Listing
March 2021

Education and Outreach in Physical Sciences in Oncology.

Trends Cancer 2021 01 7;7(1):3-9. Epub 2020 Nov 7.

Department of Biochemistry and Molecular Biology, Mayo Clinic, Jacksonville, FL, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Jacksonville, FL, USA; Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA; Center for Immunotherapeutic Transport Oncophysics, Houston Methodist Research Institute, Houston, TX, USA. Electronic address:

Physical sciences are often overlooked in the field of cancer research. The Physical Sciences in Oncology Initiative was launched to integrate physics, mathematics, chemistry, and engineering with cancer research and clinical oncology through education, outreach, and collaboration. Here, we provide a framework for education and outreach in emerging transdisciplinary fields.
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http://dx.doi.org/10.1016/j.trecan.2020.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895467PMC
January 2021

Gut wrenching: cases of missed gastrointestinal tumors and their mimics on computed tomography.

Emerg Radiol 2021 Apr 6;28(2):389-399. Epub 2020 Oct 6.

Department of Radiological Sciences, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.

Computed tomography (CT) of the abdomen and pelvis is one of the most common imaging studies ordered through the emergency department (ED). Because these studies are ordered for the detection of acute abnormalities and due to the relatively low incidence in patients presenting through the ED, gastrointestinal tumors are commonly missed. Moreover, many CT findings of malignant tumors overlap with benign entities, which can present a diagnostic challenge. This review article will describe the common CT findings of gastric, small bowel, colon, and appendiceal cancer as well as some of the common benign gastrointestinal conditions with similar imaging findings.
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http://dx.doi.org/10.1007/s10140-020-01832-yDOI Listing
April 2021

Emergent MRI for acute abdominal pain in pregnancy-review of common pathology and imaging appearance.

Emerg Radiol 2020 Apr 5;27(2):205-214. Epub 2020 Jan 5.

Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267, USA.

Acute abdominal pain in pregnancy remains a clinically challenging presentation, often requiring imaging. The threat of morbidity and mortality to both mother and fetus necessitates quick and accurate imaging diagnosis, often via ultrasound. However, many of the common causes of acute abdominal pain are not readily diagnosed with sonography, and magnetic resonance imaging (MRI) is increasingly favored in this setting. The purpose of this review is to familiarize the reader with common pathologies which may be encountered in pregnant females presenting with acute abdominal pain requiring emergent MRI.
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http://dx.doi.org/10.1007/s10140-019-01747-3DOI Listing
April 2020

Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: An Updated Series.

J Urol 2019 05;201(5):1005-1011

Department of Urology, Northwestern University , Chicago , Illinois.

Purpose: Reoperative pyeloplasty is commonly used in children with recurrent obstruction after pyeloplasty. We previously reported on reoperative robot-assisted laparoscopic repair for failed pyeloplasty in 16 children and concluded that short-term and intermediate outcomes were comparable to open reoperative repair. In this updated series we describe longer term outcomes from an extended study.

Materials And Methods: We retrospectively reviewed outcomes of consecutive children with prior failed primary pyeloplasty who underwent robot-assisted laparoscopic reoperative repair at a single institution from January 2008 to June 2018.

Results: Overall, 36 children 0.6 to 15.2 years old (median 3.7) underwent robot-assisted laparoscopic reoperative repair (pyeloplasty in 31, ureterocalicostomy in 5) at a median of 24.3 months (range 3.9 to 136.7) after primary repair. Median reoperative time was 285.0 minutes (range 207 to 556) and median length of stay was 1 day (1 to 8). Crossing vessels were present in 8 of 30 children (26.7%) with prior open repair and in 0 of 6 with prior minimally invasive repair. Clavien-Dindo grade 1 to 2 perioperative complications occurred in 4 children (11.1%) and grade 3 to 5 complications in 2 (5.6%). Median followup was 35.3 months (range 1.4 to 108.3), with 18 children (50.0%) being followed for more than 3 years. Postoperative ultrasound in 34 children revealed improvement in 31 (91.2%), stability in 2 (5.9%) and worsening hydronephrosis in 1 (2.9%). All 11 children undergoing preoperative and postoperative diuretic renography demonstrated stable or improved differential renal function. All children were symptom-free at last followup.

Conclusions: To our knowledge, this is the largest series of robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children. Our results indicate the feasibility, efficacy, safety and durability of this procedure.
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http://dx.doi.org/10.1016/j.juro.2018.10.021DOI Listing
May 2019

The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis.

J Urol 2018 08 6;200(2):440-447. Epub 2018 Apr 6.

Division of Pediatric Urology, Department of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address:

Purpose: While serial renal ultrasound is often used as an alternative to functional renal imaging in children followed for hydronephrosis, it is unclear whether a lack of hydronephrosis progression safeguards against loss of renal function. In this study we characterize the association between findings on serial renal ultrasound and diuretic renography in children with severe unilateral hydronephrosis.

Materials And Methods: We retrospectively reviewed imaging among patients younger than 18 years old with a history of severe unilateral hydronephrosis, 2 renal ultrasounds and 2 diuretic renograms. Each pair of renal ultrasounds was interpreted by an independent blinded diagnostic radiologist and compared to a contemporaneous diuretic renogram. Change in hydronephrosis was considered as 1) a change in hydronephrosis grade or 2) any change by radiologist interpretation. A 5% or greater change in split differential function was considered significant. Chi-square and Spearman correlation analyses were performed.

Results: A total of 85 children were evaluated. Increased hydronephrosis was noted in 11.8% of children by grade and 32.9% by radiologist interpretation. Split differential renal function worsened by 5% or more in 17.6% of children. Overall, 13.3% of children with stable or decreased hydronephrosis demonstrated worsening split differential function at an average of 11.8 months. When renal ultrasound and diuretic renograms were directly compared, the Spearman correlation was poor (r = 0.24, 95% CI 0.03 to 0.43).

Conclusions: The overall correlation between imaging modalities was poor, and 13.3% of children with stable or decreased hydronephrosis had worsening of split differential renal function. These findings are important to consider when counseling nonoperatively managed children followed without diuretic renography.
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http://dx.doi.org/10.1016/j.juro.2018.03.126DOI Listing
August 2018

Science + dance = bodystorming.

Trends Cell Biol 2012 Dec 31;22(12):613-6. Epub 2012 Oct 31.

Department of Theatre Arts & Dance, University of Minnesota, Minneapolis, MN 55455, USA.

In everyday life, gravity and inertial forces often dominate our movements; in the cell, these forces pale in comparison to thermal forces. The violent, collisional world of the cell, where water moves faster than a jet airliner, can be difficult to imagine. To develop our intuitive understanding of cellular and molecular processes, we are exploring the concept of 'bodystorming', where human 'movers' act as molecules that diffuse, undergo reactions, and generate/absorb forces.
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http://dx.doi.org/10.1016/j.tcb.2012.10.005DOI Listing
December 2012

Impact of resident call eligibility on major discrepancy rate.

Acad Radiol 2010 Oct 22;17(10):1299-301. Epub 2010 Jul 22.

Department of Radiology, Allegheny General Hospital, Pittsburgh PA 15212, USA.

Rationale And Objectives: The Resident Review Committee (RRC) recently changed the policy concerning first-year resident call. Our study is intended to evaluate whether the additional 6 months of training before a resident's first call made a significant difference in the resident's ability to provide patient care. To evaluate this, we assessed the discrepancy rates between preliminary interpretations made by residents and final reports by attendings.

Materials And Methods: All cross-sectional imaging interpreted by on-call residents (5 PM to 8 AM) during the first 6 months of call duties was reviewed for discrepant findings between the preliminary resident report and the final interpretation by an attending. Only major discrepancies were evaluated. A major discrepancy was defined as a change made to the resident preliminary report by an attending radiologist where a delay in communicating that finding had the potential to negatively affect clinical outcomes. Major discrepancy rates between groups were then compared.

Results: During the second 6 months of the 2008-2009 academic year, first-year residents interpreted 3331 studies. Fifty-nine of those were declared to be discrepancies after an attending over-read, a rate of 1.8%. During the first 6 months of the 2009-2010 academic year, second-year residents interpreted 4649 studies with 49 discrepancies, a rate of 1.0%. This difference is statistically significant (P = .008).

Conclusions: The recent RRC policy change requiring 6 additional months of training before assuming independent on-call responsibilities has significantly decreased the major discrepancy rate at our institution.
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http://dx.doi.org/10.1016/j.acra.2010.05.018DOI Listing
October 2010
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