Should A School Change Start Time For Sleep? Later School Start Times Improve Student Performance: Study

Public release date: 3-May-2012
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Contact: Samantha Schmidt
sschmidt@arrs.org
703-858-4316
American Roentgen Ray Society

Cervical spine CT examinations are unnecessary for emergency department (ED) patients who are a victim of "simple assault" or who have a "ground-level fall", unless the patient has a condition that predisposes the patient to spine fracture, a new study finds.

The study, conducted at Grady Memorial Hospital by researchers from the Department of Radiology and Imaging Sciences of the Emory University School of Medicine in Atlanta, found that out of 218 exams for simple assault, there were none that were positive, said Andrew Nicholson, MD, lead author of the study. In the series of 154 cervical spine CT scans that were obtained for ground-level fall, there was only one positive exam. This fracture was in a patient with ankylosing spondylitis, a condition that is known to increase the risk of fracture of the spine.

"The criteria that exist for cervical spine imaging can be vague in certain circumstances and lead to many patients receiving this exam who likely don't need it," said Dr. Nicholson. "At our level 1 trauma center in the past 12 months, there were 5,046 cervical spine CT examinations; in 2003, there were 2,091, an increase of 241%," he said.

"While this study looks at a relatively small subset of the CT exams ordered from the ED, we believe it can have a significant impact on radiation dose reduction at a population level," said Chad Holder, MD, senior author of the study. "These patients frequently have CT scans of the head and/or the face at the same time. The radiation dose to the lenses of the eyes, thyroid and lymph nodes from cervical spine CT is not insignificant; reducing unnecessary radiation exposure to these organs is important," he said. "Additionally, overutilization of high-cost imaging exams has contributed to the increase in healthcare expenditures. Efforts to contain these two aspects should be led by radiologists, who can be a driving force to reduce overutilization," said Dr. Nicholson.

The study will be presented on May 3 at the 2012 American Roentgen Ray Society Annual Meeting in Vancouver, Canada.

###

About ARRS

The American Roentgen Ray Society (ARRS) was founded in 1900 and is the oldest radiology society in the United States. Its monthly journal, the American Journal of Roentgenology, began publication in 1906. Radiologists from all over the world attend the ARRS Annual Meeting to take part in instructional courses, scientific paper presentations and scientific and commercial exhibits related to the field of radiology. The Society is named after the first Nobel Laureate in Physics, Wilhelm Rentgen, who discovered the X-ray in 1895.

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 3-May-2012
[ | E-mail | Share ]

Contact: Samantha Schmidt
sschmidt@arrs.org
703-858-4316
American Roentgen Ray Society

Cervical spine CT examinations are unnecessary for emergency department (ED) patients who are a victim of "simple assault" or who have a "ground-level fall", unless the patient has a condition that predisposes the patient to spine fracture, a new study finds.

The study, conducted at Grady Memorial Hospital by researchers from the Department of Radiology and Imaging Sciences of the Emory University School of Medicine in Atlanta, found that out of 218 exams for simple assault, there were none that were positive, said Andrew Nicholson, MD, lead author of the study. In the series of 154 cervical spine CT scans that were obtained for ground-level fall, there was only one positive exam. This fracture was in a patient with ankylosing spondylitis, a condition that is known to increase the risk of fracture of the spine.

"The criteria that exist for cervical spine imaging can be vague in certain circumstances and lead to many patients receiving this exam who likely don't need it," said Dr. Nicholson. "At our level 1 trauma center in the past 12 months, there were 5,046 cervical spine CT examinations; in 2003, there were 2,091, an increase of 241%," he said.

"While this study looks at a relatively small subset of the CT exams ordered from the ED, we believe it can have a significant impact on radiation dose reduction at a population level," said Chad Holder, MD, senior author of the study. "These patients frequently have CT scans of the head and/or the face at the same time. The radiation dose to the lenses of the eyes, thyroid and lymph nodes from cervical spine CT is not insignificant; reducing unnecessary radiation exposure to these organs is important," he said. "Additionally, overutilization of high-cost imaging exams has contributed to the increase in healthcare expenditures. Efforts to contain these two aspects should be led by radiologists, who can be a driving force to reduce overutilization," said Dr. Nicholson.

The study will be presented on May 3 at the 2012 American Roentgen Ray Society Annual Meeting in Vancouver, Canada.

###

About ARRS

The American Roentgen Ray Society (ARRS) was founded in 1900 and is the oldest radiology society in the United States. Its monthly journal, the American Journal of Roentgenology, began publication in 1906. Radiologists from all over the world attend the ARRS Annual Meeting to take part in instructional courses, scientific paper presentations and scientific and commercial exhibits related to the field of radiology. The Society is named after the first Nobel Laureate in Physics, Wilhelm Rentgen, who discovered the X-ray in 1895.

---

[ | E-mail | Share ]

?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

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Elder Scrolls Online turns Skyrim world into an MMO: report

Fans of the Elder Scrolls franchise will soon be able to trudge through Tamriel in a sweeping new MMO, according to a recent report.?

The Elder Scrolls, the long-running RPG franchise, is finally coming online, courtesy of Bethesda Softworks. According to Game Informer,?The Elder Scrolls Online will be developed by?ZeniMax Online Studios, and will hit Macs and PCs sometime early next year.?

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"It will be extremely rewarding finally to unveil what we have been developing the last several years," game director Matt Firor told the team at Game Informer. "The entire team is committed to creating the best MMO ever made ? and one that is worthy of The Elder Scrolls franchise."

Details about The Elder Scrolls MMO remain vague. Apparently the action takes place a?millennium before the events described in the recently-released ? and much-loved ? "The Elder Scrolls V: Skyrim." The bad guy is a daedric prince with the improbable name of?Molag Bal, who attempts to spread ruin across all of the land of Tamriel.?

Skyrim, Horizons readers will remember, launched last year to mostly rave reviews. "Other RPGs such as Disgaea and Final Fantasy XII may rival the total hours of gameplay one can derive from Skyrim," one critic wrote,?"but they can only do so through mass quantities of grinding. What they can?t rival is Skyrim?s incalculable amount of content and the sheer variety it has to offer."?

Can't wait for The Elder Scrolls MMO to arrive? Well, navigate over to the exhaustive Elder Scrolls Wiki, which has a long entry on Molag Bal. Sample: "Molag Bal resembles a large, bipedal crossbreed of a monkey and snake, and usually comes in a form adorned with horns, claws, and a long tail." Sounds like a handsome guy.?

For more tech news, follow us on?Twitter @venturenaut.

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Lower-Dose Radioiodine Effective Against Thyroid Cancer

WEDNESDAY, May 2 (HealthDay News) -- People with thyroid cancer are often given a radioactive iodine treatment to wipe out stray cancer cells, a treatment that comes with its own health risks.

Now, two new studies find that a safer, lower dose of radioactive iodine is just as effective as the higher dose at getting rid of any such cells that remain after surgery.

The research also found that patients were just as likely to have their thyroid shrunk away if they took a drug called Thyrogen (thyrotropin) as if they underwent thyroid hormone withdrawal -- which leads to fatigue, pain and weight gain -- before embarking on the radioiodine treatment.

The two studies, published in the May 3 issue of the New England Journal of Medicine, compared low- and high-dose radioactive iodine in a total of more than 1,000 patients. The participants, from Britain and France, also received either Thyrogen or thyroid hormone withdrawal as part of the therapy.

In either study, the researchers found that patients who received the low-dose (30 millicuries) of radioactive iodine in combination with Thyrogen were just as apt to have their remaining thyroid cells mopped up -- with fewer side effects -- than patients who received higher-dose (100 millicuries ) radioiodine along with either Thyrogen or hormone withdrawal.

However, the researchers say they plan on monitoring the patients for several years to see if rates of cancer recurrence are similar in the different groups.

"We try to give the lowest possible effective radiation dose so that we cure the current cancer, but we do not increase the risk of producing a second cancer resulting from the radiation itself," explained Dr. Ujjal Mallick, an oncologist at the Northern Centre for Cancer Care in Newcastle upon Tyne, in England, and lead author of the UK study.

Radioactive iodine has been associated with increased risk of a number of cancers, particularly leukemia, as well as short-term side effects such as nausea.

"Our study shows that clinicians can consider low-dose radioactive iodine in selected patients that have up to a four-centimeter tumor in the thyroid gland that has not spread outside the neck and have been operated on by expert surgeons," Mallick said.

The number of people diagnosed with thyroid cancer has been on the rise in the past decade, and there will be more than 56,000 new cases in the United States in 2012, according to the American Cancer Society's estimate. The disease, which is highly curable if caught early, affects more women than men, with patients tending to be diagnosed in their 40s and 50s.

The new studies suggest that, "we can spare a lot of young patients by using low-dose radioactive iodine," Mallick said.

However, Dr. David Cooper, an endocrinologist at Johns Hopkins School of Medicine in Baltimore, said that patients under 45 probably can probably avoid radioactive iodine altogether if their tumors are small (less than 2 centimeters) and the cancer has not spread to other parts of their body. Cooper was not involved in the new studies.

In fact, some of the low-risk patients in the current studies might not have needed radioactive iodine treatment at all, Cooper said.

"The chance that a person with low-risk thyroid cancer is going to come back in a year or two with recurrence is no different whether they got radioactive iodine or not," Cooper said.

In low-risk cases, the whole point of radiation treatment is more about getting rid of the normal tissue, which makes monitoring patients for recurrence easier, and less about wiping out disease, which surgery usually takes care of, Cooper said. However tests are usually sensitive enough to pick out recurrence even in patients who do not receive radiation to help eliminate their thyroid.

The research, led by Mallick and his colleagues, involved 421 patients at 29 centers in the U.K. who had thyroid cancer that had not spread outside the neck. The other study looked at 684 patients in France who had small thyroid tumors that had not metastasized (spread) beyond the neck.

All of the patients had undergone surgery to remove the bulk of their thyroid gland and were receiving thyroid hormone therapy to replace the natural thyroid hormone.

In both studies, researchers found that the rates of effective thyroid reduction in the months after treatment were similar in both the low- and high-dose groups.

Mallick and his colleagues found that about 84 percent of patients who received low-dose radioactive iodine along with Thyrogen had undetectable levels of thyroid tissue six to nine months later, compared with about 90 percent in the high-dose-plus-Thyrogen group and about 88 percent in the high-dose-plus-hormone-withdrawal group.

In addition, the rates of common side effects of radiation such as neck pain and nausea were higher in the high-dose group than in the low-dose group.

"These studies are not all that earth shattering" because smaller studies have shown that low-dose therapy is effective, Cooper said. "However these studies add something because they involve hundreds of people that were monitored carefully."

Many doctors in the United States are already using Thyrogen for thyroid ablation because patients feel awful during the weeks of thyroid hormone withdrawal leading up to radioactive iodine therapy, Cooper said.

However, a major problem with radioactive iodine treatment in the United States is that doctors use it in patients outside of the 2009 American Thyroid Association recommendations, which state that radioiodine should be used for certain people with tumors larger than 1 centimeter that have other properties, such as invasiveness, Cooper said. (Cooper was the lead author of these recommendations).

The current studies could help doctors at least see that a large dose of radioactive iodine is not necessary, Cooper said.

For his part, Mallick said, "In our hospital, we are going to start to implement the low-dose radioactive iodine for patients who match the criteria in the study."

He and his collaborators are about to start a new trial comparing low-dose with no radioiodine to see if radiation is necessary in selected low-risk patients after surgery. "This will answer a question that has plagued clinicians for several decades," he said.

More information

To learn more about radioactive iodine, visit the American Cancer Society.

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Sprint CEO Hesse cuts his pay by $3.25M

NEW YORK (AP) ? Sprint Nextel CEO Dan Hesse on Friday said he's cutting his 2012 pay by $3.25 million after shareholder complaints about how his 2011 pay was calculated.

Sprint's board bases the CEO's pay on the company's performance, but departed from its guidelines last year to exclude the cost of selling the iPhone. That boosted Hesse's pay.

"I do not want, nor does our Compensation Committee want, to penalize Sprint employees for the company's investment with Apple, so I will forego this adjustment to my compensation," Hesse said in a letter to the company.

The iPhone is expensive for phone companies, since Apple charges them hundreds of dollars more than the phones sell for in stores. The phone companies figure they'll make their money back in service fees over the run of a two-year contract. Sprint started selling the phone in October, incurring big upfront costs.

"We applaud Dan for his willingness to sacrifice personal compensation in order to reduce any distraction that could negatively affect the morale and performance of the company," said Sprint's board chairman, James Hance, in a statement.

Hesse's 2011 pay was $11.9 million, including stock and option awards. Hesse said he's reducing his salary by $346,223 this year to repay part of the iPhone bonus granted last year, and giving up $544,607 in future payments related to last year's performance. He's also cutting his bonus for this year, to set his bonus targets at 2010's level.

Hesse is also giving back $2 million in "performance units" that he was granted in February.

Sprint's annual shareholder meeting is May 15. The AFL-CIO has introduced a proposal for the meeting that would stop the company from awarding bonuses based on one year or less of the company's performance, and stretch the evaluation period to three years.

Associated Press

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