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Abstract Background Many health professions learners report feeling uncomfortable and underprepared for professional interactions with inner city populations. These learners may hold preconceptions which affect therapeutic relationships and provision of care. Few tools exist to measure learner attitudes towards these populations. This article describes the development and validity evidence behind a new tool measuring health professions learner attitudes toward inner city populations. Methods Tool development consisted of four phases: 1) Item identification and generation informed by a scoping review of the literature; 2) Item refinement involving a two stage modified Delphi process with a national multidisciplinary team (n = 8), followed by evaluation of readability and response process validity with a focus group of medical and nursing students (n = 13); 3) Pilot testing with a cohort of medical and nursing students; and 4) Analysis of psychometric properties through factor analysis and reliability. Results A 36-item online version of the Inner City Attitudinal Assessment Tool (ICAAT) was completed by 214 of 1452 undergraduate students (67.7% from medicine; 32.3% from nursing; response rate 15%). The resulting tool consists of 24 items within a three-factor model – affective, behavioural, and cognitive. Reliability (internal consistency) values using Cronbach alpha were 0.87, 0.82, and 0.82 respectively. The reliability of the whole 24-item ICAAT was 0.90. Conclusions The Inner City Attitudinal Assessment Tool (ICAAT) is a novel tool with evidence to support its use in assessing health care learners’ attitudes towards caring for inner city populations. This tool has potential to help guide curricula in inner city health.

Before the advent of tomographic imaging, it was postulated that decay of 90Y to the 0+ excited state of 90Zr may result in emission of a positron-electron pair. While the branching ratio for pair production is small (~32x10-6), PET has been successfully used to image 90Y in numerous recent patient and phantom studies. 90Y PET imaging has been performed on a variety of PET/CT systems, with and without time-of-flight (TOF) and/or resolution recovery capabilities as well as on both BGO and L(Y)SO based scanners. On all systems, resolution and contrast superior to bremsstrahlung SPECT has been reported. The intrinsic radioactivity present in L(Y)SO-based PET scanners is a potential limitation associated with accurate quantification of 90Y. However, intrinsic radioactivity has been shown to have a negligible effect at the high activity concentrations common in 90Y radioembolization. Accurate quantification is possible on a variety of PET scanner models, with or without TOF, although TOF improves accuracy at lower activity concentrations. Quantitative 90Y PET images can be transformed into 3D maps of absorbed dose based on the premise that the 90Y activity distribution does not change after infusion. This transformation has been accomplished primarily with the use of 3D dose point-kernel convolution. From a clinical standpoint, 90Y PET provides a superior post-infusion evaluation of treatment technical success owing to its improved resolution. Absorbed dose maps generated from quantitative PET data can be used to predict treatment efficacy and manage patient follow-up. For patients who receive multiple treatments, this information can also be used to provide patient-specific treatment planning for successive therapies, potentially improving response. The broad utilization of 90Y PET has the potential to provide a wealth of dose-response information, which may lead to development of improved radioembolization treatment-planning models in the future.

Angiography plays an important role in both diagnosis and treatment of gastrointestinal (GI) bleeding; however, the sensitivity is low for diagnosis. We report a case of a 38-year-old woman who presented with recurrent upper GI bleeding following central pancreatectomy. Multiple selective arteriograms failed to reveal any active bleeding or other common signs of bleeding. There was an abrupt occlusion of the right gastroepiploic artery initially interpreted to be a surgical ligation. Upon direct superselective injection near the occlusion, an area of frank contrast extravasation was demonstrated immediately beyond the occlusion. The underlying vessel was embolized with n-butyl cyanoacrylate without recurrent bleeding up to 3-month follow-up.

Before the advent of tomographic imaging, it was postulated that decay of 90Y to the 0C excited state of 90Zr may result in emission of a positron-electron pair. While the branching ratio for pair-production is small (∼32 × 10-6), PET has been successfully used to image 90Y in numerous recent patients and phantom studies. 90Y PET imaging has been performed on a variety of PET/CT systems, with and without time-of-flight (TOF) and/or resolution recovery capabilities as well as on both bismuth-germanate and lutetium yttrium orthosilicate (LYSO)-based scanners. On all systems, resolution and contrast superior to bremsstrahlung SPECT has been reported. The intrinsic radioactivity present in LYSO-based PET scanners is a potential limitation associated with accurate quantification of 90Y. However, intrinsic radioactivity has been shown to have a negligible effect at the high activity concentrations common in 90Y radioembolization. Accurate quantification is possible on a variety of PET scanner models, with or without TOF, althoughTOF improves accuracy at lower activity concentrations. Quantitative 90Y PET images can be transformed into 3-dimensional (3D) maps of absorbed dose based on the premise that the 90Y activity distribution does not change after infusion. This transformation has been accomplished in several ways, although the most common is with the use of 3D dose-point-kernel convolution. From a clinical standpoint, 90Y PET provides a superior post-infusion evaluation of treatment technical success owing to its improved resolution. Absorbed dose maps generated from quantitative PET data can be used to predict treatment efficacy and manage patient follow-up. For patients who receive multiple treatments, this information can also be used to provide patientspecific treatment-planning for successive therapies, potentially improving response. The broad utilization of 90Y PET has the potential to provide a wealth of dose-response information, which may lead to development of improved radioembolization treatment-planning models in the future. [ABSTRACT FROM AUTHOR]

Focuses on the haunting figures in French discourses and popular culture. Details on clandestines; Portrayal of voodoo as a threat; Representation of perversion of high culture through zombies; Use of cannibalism as metaphor for conflicts; Issue on the representation of national identity.

Abstract Background This study evaluates preliminary results of image-guided percutaneous direct pancreatic duct intervention in the management of pancreatic fistula after surgery or pancreatitis when initially ineligible for surgical or endoscopic therapy. Methods Between 2001 and 2018 the medical records of all patients that underwent percutaneous pancreatic duct intervention for radiographically confirmed pancreatic fistula initially ineligible for surgical or endoscopic repair were reviewed for demographics, clinical history, procedure details, adverse events, procedure related imaging and laboratory results, ability to directly catheterized the main pancreatic duct, and whether desired clinical objectives were met. Results In 10 of 11patients (6 male and 5 female with mean age 60.5, range 39–89) percutaneous pancreatic duct cannulation was possible. The 10 duct interventions included direct ductal suction drainage in 7, percutaneous duct closure in 3 and stent placement in 1. Pancreatic fistulas closed in 7 of 10, 2 were temporized until elective surgery, and 1 palliated until death from malignancy. The single patient with failed duct cannulation resolved the fistula with prolonged catheter drainage of the peri-pancreatic cavity. There were no major adverse events related to intervention. Conclusion In patients with pancreatic fistulas initially ineligible for endoscopic therapy or elective surgery, direct percutaneous pancreatic duct interventions are possible, can achieve improvement without major morbidity or mortality, and can improve and maintain the medical condition of patients in preparation for definitive surgery.

Ablative treatment for hepatocellular carcinoma is standard of care in selected settings and is endorsed by international societal guidelines. Centrally located hepatocellular carcinoma are difficult to treat due to their proximity to vasculature and central bile ducts. Irreversible electroporation is a nonthermal ablation modality that has been shown to preserve the extracellular matrix and is less likely to damage structures such as bile ducts and is not susceptible to vascular heat sink. Successful irreversible electroporation requires the parallel placement of probes which can be prevented by ribs or the sternum. This case report describes the use of the coaxial bone biopsy system to enable transchondral access and facilitate parallel placement of probes during irreversible electroporation IRE for the treatment of hepatocellular carcinoma. Keywords: Irreversible electroporation, Hepatocellular carcinoma, Bonopty needle device, Transchondral access