Publications by authors named "Margaret Hall"

68 Publications

Natural recovery of a marine foundation species emerges decades after landscape-scale mortality.

Sci Rep 2021 Mar 26;11(1):6973. Epub 2021 Mar 26.

Center for Marine Science, University of North Carolina at Wilmington, Wilmington, NC, 28403, USA.

Globally, the conditions and time scales underlying coastal ecosystem recovery following disturbance remain poorly understood, and post-disturbance examples of resilience based on long-term studies are particularly rare. Here, we documented the recovery of a marine foundation species (turtlegrass) following a hypersalinity-associated die-off in Florida Bay, USA, one of the most spatially extensive mortality events for seagrass ecosystems on record. Based upon annual sampling over two decades, foundation species recovery across the landscape was demonstrated by two ecosystem responses: the range of turtlegrass biomass met or exceeded levels present prior to the die-off, and turtlegrass regained dominance of seagrass community structure. Unlike reports for most marine taxa, recovery followed without human intervention or reduction to anthropogenic impacts. Our long-term study revealed previously uncharted resilience in subtropical seagrass landscapes but warns that future persistence of the foundation species in this iconic ecosystem will depend upon the frequency and severity of drought-associated perturbation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-86160-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997892PMC
March 2021

Midline and Mediolateral Episiotomy: Risk Assessment Based on Clinical Anatomy.

Diagnostics (Basel) 2021 Feb 2;11(2). Epub 2021 Feb 2.

College of Graduate Studies, Midwestern University, Glendale, AZ 85308, USA.

Episiotomy is the surgical incision of the vaginal orifice and perineum to ease the passage of an infant's head while crowning during vaginal delivery. Although episiotomy remains one of the most frequently performed surgeries around the world, short- and long-term complications from the procedure are not uncommon. We performed midline and mediolateral episiotomies with the aim of correlating commonly diagnosed postepisiotomy complications with risk of injury to perineal neuromuscular and erectile structures. We performed 61 incisions on 47 female cadavers and dissected around the incision site. Dissections revealed that midline incisions did not bisect any major neuromuscular structures, although they did increase the risk of direct and indirect injury to the subcutaneous portion of the external anal sphincter. Mediolateral incisions posed greater risk of iatrogenic injury to ipsilateral nerve, muscle, erectile, and gland tissues. Clinician discretion is advised when weighing the potential risks to maternal perineal anatomy during vaginal delivery when episiotomy is indicated. If episiotomy is warranted, an understanding of perineal anatomy may benefit diagnosis of postsurgical complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics11020221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913006PMC
February 2021

Situating dementia in the experience of old age: Reconstructing legal response.

Int J Law Psychiatry 2019 Sep - Oct;66:101468. Epub 2019 Jul 17.

Thompson Rivers University Faculty of Law, Canada. Electronic address:

This paper examines the intersection of dementia with the physiological processes and social contexts of old age; assesses the current legal response to problems arising through that intersection; and considers the potentially transformative effect of re-thinking legal response with those contextualised problems in mind. Two distinctive problems are identified: a heightened risk of exploitation, and an increasingly intense need for care coinciding with a decreasing ability to recognise and respond to that need. These problems require a social (rather than medical) response, of which law is an integral part. Several areas of law (including adult guardianship, legislation and common law doctrine relating to health care consent/refusal, and the body of law relating to decision-making about agreements, transactions, and bequests) provide for that response through the medico-legal construct of mental capacity. This legal idea of mental capacity has survived extensive critique, particularly in relation to interpretation and implementation of Article 12 of the Convention on the Rights of Persons With Disabilities. The survival of the mental capacity construct can be attributed to its usefulness as a theoretical mechanism that provides both a justification for over-ruling choice and preference (locating autonomy in the mentally capable decision) and a process for doing so (the mental capacity assessment and determination). This ambit of usefulness is particularly relevant to the problems (arising in the context of dementia in old age) identified in this paper. Both problems engage the public interest, together with the fundamental legal principle of fairness, in ways that call for legal response of some kind. Supported decision-making, as the suggested replacement for mental capacity based legal response, applies awkwardly in these contexts; as far as the individual is concerned, her decision has been made (and she does not need assistance in making one). This paper concludes that the mental capacity construct is problematic both for the reasons identified in the CRPD discourse (in which the experience of dementia in old age has been largely invisible) and because of the complicated intersections between mental capacity, dementia, and old age. The paper concludes by setting out an alternative conceptual basis and framework for legal response, including over-ruling expressed choice and preference, constructed around a principled theory of vulnerability as an alternative to and replacement for the mental capacity construct.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijlp.2019.101468DOI Listing
May 2020

Long-term performance of seagrass restoration projects in Florida, USA.

Sci Rep 2019 10 29;9(1):15514. Epub 2019 Oct 29.

Department of Integrative Biology, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.

Seagrass restoration is a common tool for ecosystem service enhancement and compensatory mitigation for habitat loss. However, little is known about the long-term performance of these projects. We identified seagrass restoration projects by reviewing historic permitting documents, monitoring reports, and studies conducted in Florida, USA, most of which have not been cited previously in peer-reviewed literature. We then revisited 33 seagrass restorations ranging in age from 3 to 32 years to compare seagrass percent cover, species diversity, and community structure in restored and contemporary reference seagrass beds. We found that 88% of restoration projects continued to support seagrass and, overall, restored percent cover values were 37% lower than references. Community composition and seagrass percent cover differed from references in projects categorized as sediment modification and transplant restorations, whereas all vessel damage repair projects achieved reference condition. Seagrass diversity was similar between restored and reference beds, except for sediment modification projects, for which diversity was significantly lower than in reference beds. Results indicate that restored seagrass beds in Florida, once established, often exhibit long-term persistence. Our study highlights the benefit of identifying and surveying historic restorations to address knowledge gaps related to the performance and long-term fate of restored seagrass beds.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-019-51856-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820728PMC
October 2019

Appearance of Florid Cemento-Osseous Dysplasia on SPECT/CT.

Clin Nucl Med 2019 May;44(5):e357-e359

From the Departments of Nuclear Medicine, and.

Florid cemento-osseous dysplasia, a benign fibro-osseous condition, is diagnosed based on characteristic radiographic appearances of multifocal round or lobulated sclerotic lesions associated with the teeth in multiple quadrants of the jaws. We report a case of a 73-year-old woman who presented with a painless sharp bony area on the right side of her maxilla. SPECT/CT of facial bones demonstrated multifocal intense increased uptake in both the maxilla and mandible, corresponding to ill-defined florid sclerotic periapical lesions seen on CT, in keeping with a classical appearance of florid cemento-osseous dysplasia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RLU.0000000000002512DOI Listing
May 2019

Male and female anatomical homologies in the perineum of the dog (Canis familiaris).

Vet Med Sci 2019 02 21;5(1):39-47. Epub 2019 Jan 21.

Department of Anatomy, College of Graduate Studies, Midwestern University, Glendale, Arizona, USA.

Understanding the homologies between male and female perineal structure helps both evolutionary biologists and clinicians better understand the evolution and anatomy of canines. Domestic dogs (Canis familiaris) play an important role in human society, and canine perineal anatomy is important for maintaining dogs' reproductive health for successful breeding and a wide variety of pathologies. Here, we investigate homologies between male and female perineal structure, identifying structures based on common function, anatomical relationships and attachments. In this investigation we dissected 21 male and female large-breed dogs. We find broad structural homologies between male and female dogs related to erection, micturition and defecation, including muscles, fasciae and erectile tissue. Using these homologies will help anatomists and clinicians interpret the anatomical organization of the perineum, a notoriously difficult area of anatomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/vms3.128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376168PMC
February 2019

Artificial intelligence and nuclear medicine.

Authors:
Margaret Hall

Nucl Med Commun 2019 01;40(1):1-2

Royal Free Hospital, London, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MNM.0000000000000937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282665PMC
January 2019

Multivariate Analysis of Water Quality and Benthic Macrophyte Communities in Florida Bay, USA Reveals Hurricane Effects and Susceptibility to Seagrass Die-Off.

Front Plant Sci 2018 8;9:630. Epub 2018 May 8.

Florida Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, FL, United States.

Seagrass communities, dominated by , form the principal benthic ecosystem within Florida Bay, Florida USA. The bay has had several large-scale seagrass die-offs in recent decades associated with drought and hypersaline conditions. In addition, three category-5 hurricanes passed in close proximity to the bay during the fall of 2005. This study investigated temporal and spatial trends in macrophyte abundance and water quality from 2006 to 2013 at 15 permanent transect sites, which were co-located with long-term water quality stations. Relationships, by year and by transect location (basin), between antecedent water quality (mean, minimum and maximum for a 6-month period) and benthic macrophyte communities were examined using multivariate analyses. Total phosphorus, salinity, pH, turbidity, dissolved inorganic nitrogen (DIN), DIN to phosphate ratio (DIN: ), chlorophyll , and dissolved oxygen correlated with temporal and spatial variations in the macrophyte communities. Temporal analysis (MDS and LINKTREE) indicated that the fall 2005 hurricanes affected both water quality and macrophyte communities for approximately a 2-year period. Spatial analysis revealed that five basins, which subsequently exhibited a major seagrass die-off during summer 2015, significantly differed from the other ten basins in macrophyte community structure and water quality more than 2 years before this die-off event. High total phosphorus, high pH, low DIN, and low DIN: , in combination with deep sediments and high seagrass cover were characteristic of sites that subsequently exhibited severe die-off. Our results indicate basins with more mixed seagrass communities and higher macroalgae abundance are less susceptible to die-off, which is consistent with the management goals of promoting more heterogeneous benthic macrophyte communities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpls.2018.00630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952043PMC
May 2018

Grossly Abnormal Ventilation/Perfusion SPECT Study in Idiopathic Pulmonary Arterial Hypertension Without Thromboembolism.

Heart Lung Circ 2018 Nov 31;27(11):e101-e104. Epub 2018 Jan 31.

Royal Free London NHS Foundation Trust, London, United Kingdom. Electronic address:

Pulmonary hypertension is a serious condition with multiple underlying aetiologies which require different treatment strategies. We present a case of severe idiopathic pulmonary arterial hypertension in a 20-year-old patient with ongoing breathlessness. She was initially diagnosed with asthma and panic attacks in community care. As the symptoms became progressively worse, she was referred for pulmonary hypertension clinic assessment. Ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) showed grossly abnormal perfusion defects which were mismatched to the ventilation scan, suggestive of chronic thromboembolic disease. However, corroborating computed tomographic (CT) pulmonary angiogram and invasive pulmonary angiography showed no thromboembolic disease. Histological examination of the pulmonary arteries post-mortem showed changes consistent with idiopathic pulmonary arterial hypertension. This case highlighted the clinical challenges in interpreting the investigation results and phenotyping pulmonary hypertension. V/Q SPECT might have a role in visualising the extent of vasculopathies in pulmonary arterial hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hlc.2018.01.001DOI Listing
November 2018

Emergency Department Visits by Patients Aged 45 and Over With Diabetes: United States, 2015.

NCHS Data Brief 2018 02(301):1-8

An estimated 30 million Americans have diabetes, of whom 26 million are aged 45 and over (1). Healthy eating and exercise can prevent diabetes progression (1,2). Around 12 million emergency department (ED) visits in 2015 were by patients aged 45 and over with diabetes, representing 24% of ED visits by patients aged 45 and over and 80% of diabetes ED visits by patients of all ages (3). This report presents data on ED visits by patients aged 45 and over with diabetes, defined as visits for which diabetes is mentioned as either a diagnosis or as one of a set of conditions that the patient is reported to have.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2018

Extraocular muscle architecture in hawks and owls.

Vet Ophthalmol 2018 Nov 6;21(6):595-600. Epub 2018 Feb 6.

Department of Anatomy, Arizona College of Osteopathic Medicine, Glendale, AZ, USA.

Objective: A complete and accurate understanding of extraocular muscle function is important to the veterinary care of the avian eye. This is especially true for birds of prey, which rely heavily on vision for survival and yet are prone to ocular injury and disease. To better understand the function of extraocular muscles in birds of prey, we studied extraocular muscle architecture grossly and histologically.

Animals Studied: This sample was composed of two each of the following species: red-tailed hawk (Buteo jamaicensis), Harris's hawk (Parabuteo unicinctus), great horned owl (Bubo virginianus), and barn owl (Tyto alba).

Procedures: All extraocular muscles were dissected and weighed. To analyze muscle fiber architecture, the superior oblique and quadratus muscles were dissected, weighed, and sectioned at 5 μm thickness in the transverse plane. We calculated the physiologic cross-sectional area and the ratio of muscle mass to predicted effective maximum tetanic tension.

Results And Conclusions: Hawk and owl extraocular muscles exhibit significant physiological differences that play roles in ocular movements and closure of the nictitating membrane. Owls, which do not exhibit extraocular movement, have muscle architecture suited to stabilize the position of a massive, tubular eye that protrudes significantly from the orbit. Hawks, which have a more globose eye that is largely contained within the orbit, do not require as much muscular stability and instead have muscle architecture that facilitates rapid eye movement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/vop.12553DOI Listing
November 2018

Pulmonary Arterial Hypertension With Abnormal V/Q Single-Photon Emission Computed Tomography.

JACC Cardiovasc Imaging 2018 10 18;11(10):1487-1493. Epub 2017 Oct 18.

Royal Free NHS Foundation Trust, London, United Kingdom. Electronic address:

Objectives: This study aimed to evaluate the incidence and clinical outcomes of abnormal ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) without thromboembolism, especially in patients with group I pulmonary arterial hypertension (PAH).

Background: American Heart Association/American College of Cardiology and European Society of Cardiology guidelines recommend V/Q scan for screening for chronic thromboembolic pulmonary hypertension. The significance of patients with abnormal V/Q SPECT findings but no thromboembolism demonstrated in further investigations remained unclear. A distinct pattern of global patchy changes not typical of thromboembolism is recognized, but guidelines for reporting these in the context of PAH are lacking.

Methods: A total of 136 patients who underwent V/Q SPECT and right-sided heart catheterization showing mean pulmonary arterial pressure ≥25 mm Hg were included. V/Q SPECT findings were reported using European Association of Nuclear Medicine criteria for pulmonary embolism followed by computed tomography pulmonary angiography screening for positive thromboembolism and further invasive pulmonary angiography for distal thromboembolism. The abnormal V/Q SPECT images were further analyzed according to perfusion pattern into focal or global perfusion defects.

Results: V/Q SPECT showed thromboembolic disease in 44 patients, but 19 of these patients had no thromboembolism demonstrated by pulmonary angiography. Among these patients, 15 of 19 (78.9%) had group I PAH, and the majority had diffuse, patchy perfusion defects. After redefining V/Q SPECT images according to the perfusion pattern, those patients with global perfusion defects had higher mean pulmonary arterial pressure compared with patients with focal perfusion defects and normal scans (mean difference +13.9 and +6.2 mm Hg, respectively; p = 0.0002), as well as higher pulmonary vascular resistance (mean difference +316.6 and +226.3 absolute resistance units, respectively; p = 0.004). Among patients with PAH, global perfusion defects were associated with higher all-cause mortality with a hazard ratio of 5.63 (95% confidence interval: 1.11 to 28.5) compared with patients with focal or no perfusion abnormalities.

Conclusions: There is a high incidence of abnormal V/Q SPECT scans in nonthromboembolic PAH. Further studies are needed to investigate the poor outcome associated with abnormal V/Q SPECT findings in the context of PAH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcmg.2017.07.026DOI Listing
October 2018

Reorganization of mammalian body wall patterning with cloacal septation.

Sci Rep 2017 08 23;7(1):9182. Epub 2017 Aug 23.

Department of Anatomy, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, 85308, USA.

Septation of the cloaca is a unique mammalian adaptation that required a novel reorganization of the perineum-the caudal portion of the trunk body wall not associated with the hindlimb. Fish, the basal vertebrates, separate ventrolateral body wall musculature of the trunk into two discrete layers, while most tetrapods expand this pattern in the thorax and abdomen into four. Mammals, the only vertebrate group to divide the cloaca into urogenital and anorectal portions, exhibit complex muscle morphology in the perineum. Here we describe how perineal morphology in a broad sample of mammals fits into patterning of trunk musculature as an extension of the four-layer ventrolateral muscular patterning of the thorax and abdomen. We show that each perineal muscle layer has a specific function related to structures formed by cloacal septation. From superficial to deep, there is the subcutaneous layer, which regulates orifice closure, the external layer, which supplements both erectile and micturition function, the internal layer, which provides primary micturition and defecation regulation, and the transversus layer, which provides structural support for pelvic organs. We elucidate how the four-layer body wall pattern, restricted to the non-mammal tetrapod thorax and abdomen, is observed in the mammalian perineum to regulate function of unique perineal structures derived from cloacal septation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-017-09359-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569103PMC
August 2017

Histological study of white rhinoceros integument.

PLoS One 2017 25;12(4):e0176327. Epub 2017 Apr 25.

Department of Anatomy, Midwestern University, Glendale, Arizona, United States of America.

In this study, we report findings from a microscopic analysis of the white rhinoceros (Ceratotherium simum) integumentary ultrastructure. Skin samples from the cheek, shoulder, flank and rump were taken from a 46-year-old female southern white rhinoceros and examined using H&E and elastic histological stains. The epidermis was thickest in the flank (1.003 mm) followed by the rump, cheek and shoulder. The stratum corneum comprised more than half the epidermal thickness. Numerous melanin granules were found in the basal and spinosum layers. The epidermal-dermal junction was characterized by abundant papillary folds increasing surface contact between integument layers. Most of the dermal thickness consisted of organized collagen bundles with scattered elastic fibers. Collagen fiber bundles were thickest in the flank (210.9 μm) followed by shoulder, rump and cheek. Simple coiled sweat glands were present in the dermis, but hair and sebaceous glands were absent. Together, these data suggest the white rhinoceros has a unique integumentary system among large terrestrial herbivores.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176327PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404766PMC
September 2017

Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010.

Natl Health Stat Report 2017 Feb(102):1-15

Objectives-This report presents national estimates of surgical and nonsurgical ambulatory procedures performed in hospitals and ambulatory surgery centers (ASCs) in the United States during 2010. Patient characteristics, including age, sex, expected payment source, duration of surgery, and discharge disposition are presented, as well as the number and types of procedures performed in these settings. Methods-Estimates in this report are based on ambulatory surgery data collected in the 2010 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS has collected outpatient department and emergency department data since 1992 and began gathering ambulatory surgery data from both hospitals and ASCs in 2010. Sample data were weighted to produce annual national estimates. Results-In 2010, 48.3 million surgical and nonsurgical procedures were performed during 28.6 million ambulatory surgery visits to hospitals and ASCs combined. For both males and females, 39% of procedures were performed on those aged 45-64. For females, about 24% of procedures were performed on those aged 15-44 compared with 18% for males, whereas the percentage of procedures performed on those under 15 was lower for females than for males (4% compared with 9%). About 19% of procedures were performed on those aged 65-74, while about 14% were performed on those aged 75 and over. Private insurance was listed as the principal expected source of payment for 51% of ambulatory surgery visits, Medicare for 31% of visits, and Medicaid for 8% of visits. The most frequently performed procedures included endoscopy of large intestine (4.0 million), endoscopy of small intestine (2.2 million), extraction of lens (2.9 million), insertion of prosthetic lens (2.6 million), and injection of agent into spinal canal (2.9 million). Only 2% of visits with a discharge status were admitted to the hospital as an inpatient.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2017

A Prospective Pilot Study on the Systemic Absorption of Oral Vancomycin in Children With Colitis.

J Pediatr Pharmacol Ther 2016 Sep-Oct;21(5):426-431

Divisions of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.

Oral vancomycin is used to treat refractory colitis due to Clostridium dificile infection. Traditionally, oral vancomycin was thought to not be absorbed systemically, but recent adult studies have demonstrated detectable serum levels in over half of patients with severe colitis. This has not been studied in children. To determine the absorption of oral vancomycin and the renal safety profile of oral vancomycin in children hospitalized with colitis. We performed a prospective, observational, pilot proof of principle study at the North Carolina Children's Hospital in patients 2 years to 18 years of age receiving oral vancomycin for the treatment of C dificile colitis. Severity of disease was determined using a validated scoring system. Serial serum vancomycin levels and renal function tests were performed during the administration of oral vancomycin. All patients enrolled (n = 8) had mild to moderate C dificile colitis and varying severity of underlying systemic diseases; 7 with inflammatory bowel disease and 1 with acute kidney injury following renal transplantation. No enrolled patients had detectable levels of serum vancomycin. Additionally, no adverse renal outcomes were attributed to oral vancomycin, and no cases of "Red Man" syndrome were observed. Unlike studies in adult patients, oral vancomycin is likely not absorbed in children with mild to moderate colitis. Further study is needed to determine the pharmacokinetics in severe colitis and those with severe illness in a critical care setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5863/1551-6776-21.5.426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5103650PMC
November 2016

A functional and clinical reinterpretation of human perineal neuromuscular anatomy: Application to sexual function and continence.

Clin Anat 2016 Nov 21;29(8):1053-1058. Epub 2016 Sep 21.

Department of Anatomy, Arizona College of Osteopathic Medicine, Midwestern, University, 19555 N 59th Ave, Glendale, Arizona, 85308.

Modern anatomical and surgical references illustrate perineal muscles all innervated by branches of the pudendal nerve but still organized into anatomically distinct urogenital and anal triangles with muscles inserting onto a central perineal body. However, these conflict with the anatomy commonly encountered during dissection. We used dissections of 43 human cadavers to characterize the anatomical organization of the human perineum and compare our findings to standard references. We found bulbospongiosus and the superficial portion of the external anal sphincter (EAS) were continuous anatomically with a common innervation in 92.3% of specimens. The superficial transverse perineal muscle inserted anterior and lateral to the midline, interdigitating with bulbospongiosus. The three EAS subdivisions were anatomically discontinuous. Additionally, in 89.2% of our sample the inferior rectal nerve emerged as a branch of S3 and S4 distinct from the pudendal nerve and innervated only the subcutaneous EAS. Branches of the perineal nerve innervated bulbospongiosus and the superficial EAS and nerve to levator ani innervated the deep EAS. In conclusion, we empirically demonstrate important and clinically relevant differences with perineal anatomy commonly described in standard texts. First, independent innervation to the three portions of EAS suggests the potential for functional independence. Second, neuromuscular continuity between bulbospongiosus and superficial EAS suggests the possibility of shared or overlapping function of the urogenital and anal triangles. Clin. Anat. 29:1053-1058, 2016. © 2016 Wiley Periodicals, Inc.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ca.22774DOI Listing
November 2016

Coding in nuclear medicine, from examination to tariff: an iterative process.

Nucl Med Commun 2016 Nov;37(11):1113-5

aDepartment of Nuclear Medicine, Royal Free London NHS Foundation Trust bNuclear Medicine Department, Guys and St Thomas NHS Foundation Trust, London cDepartment of Radiology, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich dNational Casemix Office, Health and Social Care Information Centre, Leeds, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MNM.0000000000000581DOI Listing
November 2016

Rural residents who are hospitalized in rural and urban hospitals: United States, 2010.

NCHS Data Brief 2014 Jul(159):1-8

In 2010, 17% of the U.S. population lived in rural (nonmetropolitan) areas. Many rural areas are medically underserved due to physician (especially specialist) shortages. Rural hospitals often are small, with a low volume of services, and have difficulty remaining financially viable under the regular hospital prospective payment system. Special Medicare hospital payment categories have been established so that rural residents have access to hospital care without traveling to urban areas. The share of rural residents' hospitalizations that take place in urban (metropolitan) compared with rural hospitals has been of interest for a number of years. Those who go to urban hospitals have been described as "bypassing" rural hospitals. This data brief compares characteristics of rural residents who stay in rural areas with those who travel to urban areas for their inpatient care.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2014

Utility and limitations of 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy in systemic amyloidosis.

Eur Heart J Cardiovasc Imaging 2014 Nov 16;15(11):1289-98. Epub 2014 Jun 16.

National Amyloidosis Centre, UCL Medical School (Royal Free Campus), Rowland Hill Street, London NW3 2PF, UK

Aims: Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid ((99m)Tc-DPD) is a sensitive method for imaging cardiac transthyretin (ATTR) amyloid. We report utility and limitations of (99m)Tc-DPD scintigraphy in 321 patients with suspected cardiac amyloidosis.

Methods And Results: The cohort included wild-type ATTR (ATTRwt) amyloidosis in 94 (29%), ATTR-Val122Ile amyloidosis in 38 (12%), hereditary ATTR (ATTRmt) amyloidosis in 46 (14%), primary light-chain (AL) amyloidosis in 44 (14%), secondary (AA) amyloidosis in three (1%), other hereditary amyloidosis types in nine (3%), undetermined types in two (0.5%), and 85 (26.5%) patients in whom systemic amyloidosis was ultimately excluded. All 158 patients with ATTR amyloidosis with clinical cardiac involvement had cardiac (99m)Tc-DPD uptake, with median Grade 2 intensity. Thirteen further ATTR amyloidosis patients without clinical evidence of cardiac involvement also demonstrated (99m)Tc-DPD cardiac uptake. Eighteen of 35 (51%) AL patients with cardiac involvement had (99m)Tc-DPD cardiac uptake (median Grade 1 intensity). SPECT imaging indicates that the apparent reciprocal reduction in bone uptake is due to masking of bone uptake by extensive soft-tissue uptake in ATTR amyloidosis, especially ATTRwt, and ATTR-Val122Ile types.

Conclusion: (99m)Tc-DPD scintigraphy is a highly sensitive technique for imaging cardiac ATTR amyloidosis and is an important investigation in the diagnostic pathway of patients with cardiac amyloidosis. It is not specific for ATTR in isolation but must be interpreted in a broad clinical context to avoid dangerous diagnostic errors. Diffuse skeletal muscle uptake identifies muscle as a hitherto unrecognized site that merits investigation as a target organ in ATTR amyloidosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjci/jeu107DOI Listing
November 2014

Abdominopelvic splenosis--an unusual cause of tenesmus.

J Gastrointest Surg 2014 Aug 29;18(8):1543-5. Epub 2014 May 29.

Department of Nuclear Medicine, Royal Free Hospital, London, UK,

Splenosis is a rare condition defined as seeding and autotransplantation of splenic tissue, typically after blunt abdominal trauma (e.g. from road traffic collision). Sites of splenosis ranging from intrathoracic to intrapelvic have been reported, and symptoms vary greatly depending on the site and size of lesions. We present the use of Tc-99m sulphur colloid SPECT/CT in diagnosing a case of multiple abdominopelvic splenosis as the cause of new-onset tenesmus and constipation, which was initially thought to be due to colorectal malignancy, 47 years following the initial abdominal trauma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11605-014-2548-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094653PMC
August 2014

Rural and urban hospitals' role in providing inpatient care, 2010.

NCHS Data Brief 2014 Apr(147):1-8

Key Findings: Data from the National Hospital Discharge Survey, 2010. In 2010, 12% of the 35 million U.S. hospitalizations were in rural hospitals. A higher percentage of inpatients in rural hospitals were aged 65 and over (51%) compared with inpatients in urban hospitals (37%). The average number of diagnoses for rural and urban inpatients was similar, as was the average length of stay. Sixty-four percent of rural hospital inpatients, compared with 38% of urban hospital inpatients, had no procedures performed while in the hospital. Following their hospitalization, a higher percentage of rural inpatients (7%) than urban inpatients (3%) were transferred to other short-term hospitals, and a higher percentage of rural (14%) than urban (11%) inpatients were discharged to long-term care institutions.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2014

An alternate dissection approach to the female urogenital triangle.

Clin Anat 2013 Sep 3;26(6):751-4. Epub 2013 Jul 3.

Department of Anatomy, Midwestern University, Glendale, AZ 85308, USA.

Traditional dissections of the female urogenital (UG) triangle can lead to early destruction of the erectile tissues, associated musculature, and neurovascular structures. Here, we present an alternate dissection of the female UG triangle. Rather than begin the female UG triangle dissection with the fatty tissue of the labia majora, we utilize an early identification of the suspensory ligament of the clitoris to organize the dissection. The suspensory ligament leads to the body of the clitoris, which can be palpated from distal to proximal to find the crura of the clitoris with overlying ischiocavernosus muscles. Once the crura have been defined, the bulbs of the vestibule with overlying bulbospongiosus muscles can be palpated medially and posteriorly. This dissection approach results in a clean dissection that well demonstrates homologies between male and female external genitalia. Through the use of this method, most student dissection attempts are able to demonstrate the erectile tissues and associated musculature that comprise the female UG triangle. This technique can also be used for male UG triangle dissections, encouraging identification of male and female homologies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ca.22287DOI Listing
September 2013

Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000-2010.

NCHS Data Brief 2013 Mar(118):1-8

Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Care Statistics, Hyattsville, MD 20782, USA.

In 2000, there were 2.4 million deaths in the United States, and in 2010 there were 2.5 million (1,2). In both years, about one-third of these deaths occurred in short-stay, general hospitals (3), despite research that found that most Americans prefer to die in their own homes (4-6). This report presents National Hospital Discharge Survey (NHDS) data from 2000 through 2010 on patients who died during hospitalization.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2013

A novel method for comparative analysis of retinal specialization traits from topographic maps.

J Vis 2012 Nov 20;12(12):13. Epub 2012 Nov 20.

Dept. of Biological Sciences, Purdue Univ., West Lafayette, IN, USA.

Vertebrates possess different types of retinal specializations that vary in number, size, shape, and position in the retina. This diversity in retinal configuration has been revealed through topographic maps, which show variations in neuron density across the retina. Although topographic maps of about 300 vertebrates are available, there is no method for characterizing retinal traits quantitatively. Our goal is to present a novel method to standardize information on the position of the retinal specializations and changes in retinal ganglion cell (RGC) density across the retina from published topographic maps. We measured the position of the retinal specialization using two Cartesian coordinates and the gradient in cell density by sampling ganglion cell density values along four axes (nasal, temporal, ventral, and dorsal). Using this information, along with the peak and lowest RGC densities, we conducted discriminant function analyses (DFAs) to establish if this method is sensitive to distinguish three common types of retinal specializations (fovea, area, and visual streak). The discrimination ability of the model was higher when considering terrestrial (78%-80% correct classification) and aquatic (77%-86% correct classification) species separately than together. Our method can be used in the future to test specific hypotheses on the differences in retinal morphology between retinal specializations and the association between retinal morphology and behavioral and ecological traits using comparative methods controlling for phylogenetic effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1167/12.12.13DOI Listing
November 2012

Evaluation of image enhancement software as a method of performing half-count bone scans.

Nucl Med Commun 2013 Jan;34(1):78-85

Department of Anaesthesia, Hadassa Hebrew University School of Medicine, Hadassah University Hospital, Jerusalem, Israel.

Reducing the radiation dose and scanning time of diagnostic tests is often desirable. One method uses image enhancement software such as Pixon, which processes lower-count scans and aims to produce high-quality images. However, it is essential that diagnostic accuracy is not compromised. We compared the level of agreement between clinicians using standard scans, with half-count and Pixon-enhanced half-count scans. Bone scans from 150 patients referred to diagnose metastatic disease were degraded by a process of Poisson-preserving binomial resampling to generate equivalent half-count scans and then processed by Pixon software to recreate 'original' high-quality scans. Two experienced clinicians reported the scans in a randomized, blinded manner for metastatic disease (yes/no) and assigned a confidence level to this diagnosis. Levels of agreement between clinicians were calculated for the full-count, half-count, and Pixon-enhanced half-count scans and between scanning methods for each clinician. Agreement between clinicians for standard full-count scans was 92% (±4%, κ=0.80), compared with 92% (±4%, κ=0.79) for half-count scans and 87% (±5%, κ=0.70) for Pixon-processed half-count scans. Agreement for a single clinician viewing full-count versus half-count scans was 95% (±2%, κ=0.88), similar to the agreement for a single clinician viewing full-count versus Pixon-processed half-count scans (95%, ±2%, κ=0.88). With respect to confidence in diagnosis, 127 full-count scans were scored in the highest category, compared with 98 half-count and 88 Pixon-processed half-count scans. Switching to half-count scanning does not introduce more diagnostic disagreement than is already present between clinicians. However, clinicians feel less confident reporting half-count scans. The Pixon enhancement step improved neither objective diagnostic agreement nor clinician confidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MNM.0b013e32835afb45DOI Listing
January 2013

Hospitalization for congestive heart failure: United States, 2000-2010.

NCHS Data Brief 2012 Oct(108):1-8

Centers for Disease Control and Prevention National Center for Health Statistics, Hyattsville, Maryland 20782, USA.

Congestive heart failure (CHF) is a serious medical condition in which the heart cannot pump enough blood to meet the body's needs. CHF is often caused by hypertension, diabetes, or coronary heart disease. It is estimated that 5.8 million people in the United States have CHF (1). CHF is one of the most common reasons those aged 65 and over are hospitalized (2). This report presents National Hospital Discharge Survey (NHDS) data from 2000 through 2010 on hospitalizations for CHF.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2012

Eye shape and the nocturnal bottleneck of mammals.

Proc Biol Sci 2012 Dec 24;279(1749):4962-8. Epub 2012 Oct 24.

Department of Anatomy, Arizona College of Osteopathic Medicine, Midwestern University, 19555 N 59th Avenue, Glendale, AZ 85308, USA.

Most vertebrate groups exhibit eye shapes that vary predictably with activity pattern. Nocturnal vertebrates typically have large corneas relative to eye size as an adaptation for increased visual sensitivity. Conversely, diurnal vertebrates generally demonstrate smaller corneas relative to eye size as an adaptation for increased visual acuity. By contrast, several studies have concluded that many mammals exhibit typical nocturnal eye shapes, regardless of activity pattern. However, a recent study has argued that new statistical methods allow eye shape to accurately predict activity patterns of mammals, including cathemeral species (animals that are equally likely to be awake and active at any time of day or night). Here, we conduct a detailed analysis of eye shape and activity pattern in mammals, using a broad comparative sample of 266 species. We find that the eye shapes of cathemeral mammals completely overlap with nocturnal and diurnal species. Additionally, most diurnal and cathemeral mammals have eye shapes that are most similar to those of nocturnal birds and lizards. The only mammalian clade that diverges from this pattern is anthropoids, which have convergently evolved eye shapes similar to those of diurnal birds and lizards. Our results provide additional evidence for a nocturnal 'bottleneck' in the early evolution of crown mammals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1098/rspb.2012.2258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497252PMC
December 2012

Hospitalization for stroke in U.S. hospitals, 1989-2009.

NCHS Data Brief 2012 May(95):1-8

Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road, Hyattsville, Maryland 20782, USA.

Stroke remains one of the most significant U.S. health problems (6). Although the stroke hospitalization rate has declined, in 2009 there were still almost 1 million hospitalizations for stroke. Many stroke patients, upon discharge, went to another short-stay hospital or a long-term care institution. In addition, outpatient or in-home services (including rehabilitation) are often provided to those who have had a stroke, to prevent future strokes and to restore functioning (6,7). In 2011, the U.S. Department of Health and Human Services announced its "Million Hearts" campaign, which aims to prevent 1 million heart attacks and strokes over the next 5 years (8). Efforts like this are especially important because the baby boomer population is aging into the years when strokes are more common. It is important to continue to track the number and rate of stroke hospitalizations, in order to gauge the effects of campaigns like Million Hearts as well as the effectiveness of provisions in health care legislation (including the Patient Protection and Affordable Care Act) that promote preventive care and coordination of care.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2012