Severe pelvic injury: vascular lesions detected by ante- and post-mortem contrast medium-enhanced CT and associations with pelvic fractures.

The objectives of this study were to compare arterial and venous contrast medium extravasation in severe pelvic injury detected by ante- and post-mortem multi-detector CT (MDCT) and determine whether vascular injury is associated with certain types of pelvic fracture. We retrospectively included two different cohorts of blunt pelvic trauma with contrast medium extravasation shown by MDCT. The first group comprised 49 polytrauma patients; the second included 45 dead bodies undergoing multi-phase post-mortem CT-angiography (MPMCTA). Two radiologists jointly reviewed each examination concerning type, site of bleeding and pattern of underlying pelvic ring fracture. All 49 polytrauma patients demonstrated arterial bleeding, immediately undergoing subsequent angiography; 42 (85%) had pelvic fractures, but no venous bleeding was disclosed. MPMCTA of 45 bodies revealed arterial (n = 33, 73%) and venous (n = 35, 78%) bleeding and pelvic fractures (n = 41, 91%). Pelvic fracture locations were significantly correlated with ten arterial and six venous bleeding sites in dead bodies, with five arterial bleeding sites in polytrauma patients. In dead bodies, arterial haemorrhage was significantly correlated with the severity of pelvic fracture according to Tile classification (p = 0.01), unlike venous bleeding (p = 0.34). In severe pelvic injury, certain acute bleeding sites were significantly correlated with underlying pelvic fracture locations. MPMCTA revealed more venous lesions than MDCT in polytrauma patients. Future investigations should evaluate the proportional contribution of venous bleeding to overall pelvic haemorrhage as well as its clinical significance

Efficient Quantum Polar Coding

Polar coding, introduced 2008 by Arikan, is the first (very) efficiently encodable and decodable coding scheme whose information transmission rate provably achieves the Shannon bound for classical discrete memoryless channels in the asymptotic limit of large block sizes. Here we study the use of polar codes for the transmission of quantum information. Focusing on the case of qubit Pauli channels and qubit erasure channels, we use classical polar codes to construct a coding scheme which, using some pre-shared entanglement, asymptotically achieves a net transmission rate equal to the coherent information using efficient encoding and decoding operations and code construction. Furthermore, for channels with sufficiently low noise level, we demonstrate that the rate of preshared entanglement required is zero.Comment: v1: 15 pages, 4 figures. v2: 5+3 pages, 3 figures; argumentation simplified and improve

Working relationships between obstetric care staff and their managers: a critical incident analysis

Background Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi’s disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. Methods A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres’ providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Results Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers’ lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Conclusions Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers’ job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi

The Effects of Physical Activity on Health-Related Quality of Life Among Working Mothers Living in Amman: A Correlational Study

Aya Abu Aqab,1 Mahmoud AL-Hussami,2 Wafa Almegewly,3 Savvato Karavasileiadou3 1School of Medicine, the University of Jordan, Amman, Jordan; 2The University of Jordan, School of Nursing, Amman, 11942, Jordan; 3Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi ArabiaCorrespondence: Wafa Almegewly, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Email [email protected]: Jordan has a high prevalence of physical inactivity, a major risk factor for non-communicable diseases. Working mothers are a high-risk group who face significant barriers to physical activity and experience a decline in their quality of life.Purpose: This study aims to evaluate the potential impact of physical activity adherence on health-related quality of life and physical fitness among a sample of working mothers.Patients and Methods: A Correlational, retrospective analytical design, was employed among a sample of working mothers (n=120), from Amman and was divided into two comparison groups. Data collection included a self-reported questionnaire using a demographic questionnaire, a health perception scale, the International Physical Activity Questionnaire short form, the International Fitness Scale, and the Quality of Life Brief questionnaire. The statistical analysis was independent t-test analysis, analysis of variance (One-way ANOVA), Pearson r correlation and regression used to estimate the prediction of dependent variables based on independent variables.Results: The results found a significant positive relationship between physical activity and overall quality of life and its domains (physical, psychological, and environmental); however, there was no statistically significant difference in the social domain. Adherence to physical activity was a significant positive predictor of quality of life. Moreover, the health perception level was a significant positive predictor. A t-test revealed a statistically significant difference between the physically active group and a sedentary group of working mothers regarding changes in Health-Related Quality of Life; physically active mothers are more likely to have better physical (p < 0.024), psychological (p < 0.001), and overall quality of life (p < 0.011). Furthermore, Physical fitness significantly predicted physical activity in the study results.Conclusion: This study confirms the existence of positive correlations between physical activity and working women’s quality of life and physical fitness. Mothers with higher levels of physical activity are more likely to have better physical, psychological, and environmental domains of quality of life and better physical fitness.Keywords: physical activity, health-related quality of life, working mothers, physical fitness, Jorda

MRI of non-specific low back pain and/or lumbar radiculopathy: do we need T1 when using a sagittal T2-weighted Dixon sequence?

To show that for the MRI workup of non-specific low back pain and/or lumbar radiculopathy, the acquisition of T1-weighted sequences in the sagittal plane could be waived when using an FSE T2-weighted Dixon sequence. Three musculoskeletal radiologists retrospectively reviewed fifty lumbar spine MRI examinations performed for non-specific low back pain and/or lumbar radiculopathy. Two protocols were separately analyzed in the sagittal plane: a standard protocol (T1-weighted, in-phase, and water-only images of an FSE T2-weighted Dixon sequence) and a simplified protocol (fat-only, in-phase, and water-only images of an FSE T2-weighted Dixon sequence). Eight items usually assessed on T1-weighted sequences were analyzed for each of the vertebrae (n = 250), vertebral endplates (n = 500), vertebral corners (n = 1000), foramina (n = 500), lamina (n = 500), and facet joints (n = 500). Interchangeability of these protocols was tested using the individual equivalence index. A decrease in interobserver agreement of ≥ 5% when one reader used the simplified protocol compared with when both readers used the standard protocol was considered clinically significant. Interreader and intrareader agreement were assessed using kappa statistics. Rates of findings with each protocol were compared using odd ratios. The standard and simplified protocols were interchangeable (range of upper bound of the 95%CI of individual equivalence index = 0.25 to 1.38%). Intraprotocol and interprotocol interreader kappa values were similar (0.253-0.671 vs. 0.236-0.723, respectively). Rates of findings were not statistically significantly different (p ≥ 0.074), or were higher with the simplified protocol (p ≤ 0.036). In our target population, a single sagittal T2-weighted Dixon sequence may replace the recommended combination of T1-, T2-, and fat-suppressed T2-weighted sequences. • In patients with non-specific low back pain or lumbar radiculopathy, spine MRI in the sagittal plane could be limited to a single FSE T2-weighted Dixon sequence, hereby reducing the acquisition time. • A simplified protocol of spine MRI in the sagittal plane combining FSE T2-weighted Dixon sequence provides the same information as a standard protocol including T1-, T2-, and fat-suppressed T2-weighted sequences for the workup of degenerative lumbar spine lesions. • For some findings shown on the simplified protocol, such as focal bone marrow replacement lesions or signs of infection, additional sequences including pre- and post-contrast T1-weighted sequences may be required, as is currently the case when using the standard protocol

MRI T2 Mapping of the Knee Providing Synthetic Morphologic Images: Comparison to Conventional Turbo Spin-Echo MRI.

Background Use of a T2 mapping sequence in addition to the conventional knee MRI protocol increases sensitivity to early cartilage lesions but is time consuming. Purpose To test the in vitro validity of quantitative data from an accelerated parallel T2 mapping sequence (combined generalized autocalibrating partially parallel acquisition and model-based accelerated relaxometry by iterative nonlinear inversion [GRAPPATINI]) of the knee and to compare in vivo synthetic images generated with this sequence with those generated with conventional morphologic sequences. Materials and Methods T2 estimations with GRAPPATINI were validated in vitro in comparison with T2 estimations with routine multisection multiecho and reference standard single-section single-echo spin-echo T2 mapping sequences by using a Bland-Altman plot. Synthetic morphologic images (intermediate-weighted sequence, 34-msec echo time; T2-weighted sequence, 80-msec echo time) were compared in vivo with corresponding conventional morphologic turbo spin-echo 3-T sequences by three readers in consecutive patients recruited retrospectively from February to May 2018. Synthetic and conventional morphologic images were compared by using rates of interreader agreement, κ statistics, and rates of findings. Results T2 values with GRAPPATINI were accurate compared with those obtained with the reference single-section single-echo sequence, with slight T2 overestimation (2.7 msec). Sixty-one patients (mean age, 43 years ± 16 [standard deviation]; 32 men) were included. The rate of agreement when one reader used synthetic morphologic images and the other used conventional sequences was not inferior to the rate of agreement when all readers used conventional sequences (upper bounds of 95% confidence intervals of differences between rates of agreement ≤ 4.8%). Interreader agreement was similar for the conventional set alone, the synthetic set alone, and when readers used different sets (two-by-two differences between κ values for all items ≤ 0.15). The rates of findings were not different between synthetic and conventional image sets (all P ≥ .07) except for two items (femoral trochlear cartilage [3.0% vs 0.3%, P = .006] and joint effusion [0.3% vs 2.7%, P = .005]). Conclusion This T2 mapping sequence yields, in one acquisition, accurate T2 values and synthetic morphologic images that are comparable with those obtained with conventional turbo spin-echo sequences. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Fritz in this issue

Healthcare providers' intention to leave their jobs during COVID‐19 pandemic: A cross‐sectional study

Abstract Background and Aims During the coronavirus pandemic (COVID‐19), healthcare providers confronted risks of disease transmission to themselves and their family members, resulting in physical and psychological burdens. This might affect their decisions to leave their jobs temporarily or permanently, fearing infection and protecting their families. This study examined the factors related to the intention to leave a job among healthcare providers during the COVID‐19 pandemic in Jordan. Methods A cross‐sectional correlational design was used to collect data using a convenience sample of 557 healthcare providers working in different sectors across Jordan. Data were collected using a self‐administered questionnaire about the intention to leave jobs during the pandemic. Results The sample included 368 females (63.8%) and 209 males (36.6%) participants. The mean age of participants was 30.8 years (SD = 6.65). Differences found in intention to leave job during COVID‐19 in relation to age (t = 2.60, p < 0.05), gender (X2 = 4.25, p < 0.001), and marital status (X2 = 18.2, p < 0.001). Participants with a high risk of exposure to COVID‐19 and who experienced higher workloads had higher scores of intention to leave their job during COVID‐19, while being married had lower scores. Conclusions Policy‐makers need to pay attention to young and single healthcare providers during the COVID‐19 pandemic to prevent them leave their job. Crucial guidelines for managing workload during the COVID‐19 pandemic are needed. Policy‐makers during pandemics have to protect healthcare providers who feel they are at high risk of infection