Direct MR arthrography of the shoulder under axial traction: Feasibility study to evaluate the superior labrum-biceps tendon complex and articular cartilage.

PURPOSE: To assess the value of adding axial traction to direct MR arthrography of the shoulder, in terms of subacromial and glenohumeral joint space widths, and coverage of the superior labrum-biceps tendon complex and articular cartilage by contrast material. MATERIALS AND METHODS: Twenty-one patients investigated by direct MR arthrography of the shoulder were prospectively included. Studies were performed with a 3 Tesla (T) unit and included a three-dimensional isotropic fat-suppressed T1-weighted gradient-recalled echo sequence, without and with axial traction (4 kg). Two radiologists independently measured the width of the subacromial, superior, and inferior glenohumeral joint spaces. They subsequently rated the amount of contrast material around the superior labrum-biceps tendon complex and between glenohumeral cartilage surfaces, using a three-point scale: 0 = no, 1 = partial, 2 = full. RESULTS: Under traction, the subacromial (Δ = 2.0 mm, P = 0.0003), superior (Δ = 0.7 mm, P = 0.0001) and inferior (Δ = 1.4 mm, P = 0.0006) glenohumeral joint space widths were all significantly increased, and both readers noted significantly more contrast material around the superior labrum-biceps tendon complex (P = 0.014), and between the superior (P = 0.001) and inferior (P = 0.025) glenohumeral cartilage surfaces. CONCLUSION: Direct MR arthrography of the shoulder under axial traction increases subacromial and glenohumeral joint space widths, and prompts better coverage of the superior labrum-biceps tendon complex and articular cartilage by contrast material. J. Magn. Reson. Imaging 2013;37:1228-1233. © 2012 Wiley Periodicals, Inc.

Audit report on the City of Center Point, Iowa for the year ended June 30, 2007

Audit report on the City of Center Point, Iowa for the year ended June 30, 2007

Audit report on the City of Strawberry Point, Iowa for the year ended June 30, 2007

Audit report on the City of Strawberry Point, Iowa for the year ended June 30, 2007

Office of the State Long-Term Care Ombudsman Annual Report 2007, January 2008.

The State Long-Term Care Ombudsman program operates as a unit within the Office of Elder Rights at Iowa Department of Elder Affairs. Duties of all long-term care ombudsmen are mandated by the Older Americans Act. This office serves people living in nursing facilities, residential care facilities, elder group homes and assisted living programs. With the addition of 2 ombudsmen, regional offices were closed and 7 local programs were established in 2007. Local long-term care ombudsmen are becoming more aware of issues that need to be addressed, yet as evidenced by the tables included in this report, the increase in work load has been phenomenal, and is reaching the point of being unmanageable with the current staff.

Special investigation of the City of Center Point Library for the period January 1, 2006 through December 6, 2007

Special investigation of the City of Center Point Library for the period January 1, 2006 through December 6, 2007

Forecasting and turning point predictions in a Bayesian panel VAR model

We provide methods for forecasting variables and predicting turning points in panel Bayesian VARs. We specify a flexible model which accounts for both interdependencies in the cross section and time variations in the parameters. Posterior distributions for the parameters are obtained for a particular type of diffuse, for Minnesota-type and for hierarchical priors. Formulas for multistep, multiunit point and average forecasts are provided. An application to the problem of forecasting the growth rate of output and of predicting turning points in the G-7 illustrates the approach. A comparison with alternative forecasting methods is also provided.

Audit report on the Iowa Department of Human Services – Case Management Unit for the year ended June 30, 2007

Audit report on the Iowa Department of Human Services – Case Management Unit for the year ended June 30, 2007

Geoquímica das rochas magmáticas da Ilha Brava:implicações para a origem e variabilidade espaço-temporal do ponto quente de Cabo Verde

A Ilha Brava (64 km2) localiza-se no extremo oeste do alinhamento meridional do arquipélago de Cabo Verde, sendo constituída por três unidades vulcanoestratigráficas que testemunham uma história vulcânica de cerca de 3 Ma. Foi escolhida como objecto de estudo na tentativa de contribuir para a melhor compreensão da origem e local de residência de alguns dos componentes mantélicos, das relações genéticas entre magmas silicatados e carbonatíticos, dos processos de desgaseificação de magmas carbonatíticos e da origem do carbono neles contido, da variabilidade geoquímica espaço-temporal do ponto quente de Cabo Verde, e da profundidade de enraizamento da sua pluma mantélica. A Brava contrasta com as outras ilhas do arquipélago por definir dois grupos geoquímicos distintos. As amostras do Complexo Basal, sendo menos radiogénicas Sr e He e mais em Nd e Pb que a unidade mais recente, são idênticas às ilhas do norte e explicáveis pela mistura de um componente do tipo HIMU (crosta oceânica reciclada com 1.3 Ga) e manto inferior (3He/4He até 12.85 Ra), carreados para a “superfície” pela pluma mantélica. Tal como é usual nas ilhas do sul, a Unidade Superior sugere, em adição, o envolvimento de um componente com afinidade EM-1, aqui considerado representativo de fragmentos de litosfera subcontinental dispersos na astenosfera. Os carbonatitos definem dois grupos com assinaturas isotópicas semelhantes às das rochas silicatadas contemporâneas. Os calciocarbonatitos resultaram de imiscibilidade líquida produzindo magmas nefeliníticos e carbonatíticos, enquanto os magnesiocarbonatitos representam líquidos residuais após a fraccionação de calcite a partir de um magma carbonatítico. As muito baixas razões 4He/40Ar* (≈ 0.25) que caracterizam a fonte dos carbonatitos do Complexo Basal indicam uma evolução a partir de razões K/U muito mais elevadas que o conjunto dos reservatórios silicatados da Terra. Sendo estes valores, também incompatíveis com a reciclagem de componentes crostais, foram aqui interpretados como podendo reflectir a contribuição do “missing Ar reservoir” para a fonte mantélica dos carbonatitos.

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study.

OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use.