Heatherwood Hospital

Primary nonmalignant brain tumors, such as meningiomas, are the most commonly diagnosed type of primary brain tumor; however, limited research explores their neurologic and psychological effects. Existing literature on survivorship following a meningioma diagnosis and treatment is scarce. This article aims to raise awareness about the unique needs of individuals living with primary nonmalignant brain tumors, particularly meningiomas. In addition, this article calls for greater recognition of the ongoing challenges for these patients, and advocates for research and the development of education and support systems to assist survivors throughout their trajectory. This review synthesizes current literature on nonmalignant brain tumors, focusing on their prevalence, clinical presentation, and associated neurocognitive effects. Particular emphasis is placed on meningiomas and the neurologic and psychological impacts of the tumors and their treatment. Meningiomas are a major cause of long-term disability. Although typically not fatal, meningiomas often leave patients with lasting physical and psychosocial effects. These psychosocial impacts are frequently overlooked, highlighting the need for more comprehensive and sustained patient support.

Late last year, the news of Elsevier’s acquisition of bepress, the provider of the popular Digital Commons repository platform, sent a shockwave throughout the library community. Hundreds of institutions that use Digital Commons to support their open access repositories quite literally woke up to the news that their repository services are now owned and managed by a company that is well known for its obstruction of open access in the repository space.

Permanent vascular catheterization for intravascular access is one of the most commonly applied techniques used on rodents in pharmacology studies. However, use of the intravascular catheters is complicated by nontolerance due to thromboembolic disease and sepsis. We have undertaken an extensive pathologic and clinical analysis of an intravascular catheterization model in Wistar Han and Sprague-Dawley rats, with a particular focus on carotid artery catheterization with or without jugular vein catheterization, in order to define the pathologic mechanisms behind nontolerance and define clinical end points to ensure maximal animal welfare. Further, we have explored various potential solutions to increase the tolerance of the procedure. In these studies, indwelling catheters were found to cause a high degree of thromboembolic disease with infarction in the brain, cecal tip, and kidneys being the primary causes of nontolerance. Loss of greater than 10% body weight was determined to be the most sensitive indicator of nontolerance and was closely correlated with degree of renal parenchymal loss. Sepsis was noted as a very rare complication, indicating that routine aseptic surgical techniques are adequate for preventing this complication.

Introduction: Electronic health records (EHRs) represent an opportunity for real-time early risk prediction. EHR records were used to determine the extent to which machine learning tools and a purely data driven approach to modeling (DDM) could detect heart failure subtypes, i.e., preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF), 12 months before a clinical diagnosis. Methods: Incident HF cases were identified from Geisinger Clinic primary care patients age 50-85, diagnosed between 2001 and 2010 and further defined as HFrEF if LVEF≤40 and HFpEF if LVEF>50. Controls were chosen to match HF cases by age, gender, location and primary care physician. EHR data were extracted on demographics, ICD-9 codes, medication orders, clinical and behavioral measures. Modeling was completed to detect HF using data from a 24-month observation window 12 months before the HF diagnosis. Patient feature vectors were generated from the data and summarized by one or more aggregation functions (e.g., counts, means). For the HF endpoint, modeling was done with and without patients who had an acute coronary syndrome (ACS) event within 12 months of the diagnosis. Regularized logistic regression was applied using information gain feature selection and 10-fold cross validation. Model performance was assessed by the area under the ROC curve (AUC) and complexity by the number of selected features. Results: Performance for HFpEF is better than for HFrEF. The HFpEF model is more complex than the HFrEF model as indicated by more EHR information that was needed to discriminate the HFpEF cases from controls. Performance with and without ACS cases is similar though models including ACS cases are more complex than models excluding them (Table). Conclusions: Purely data driven approaches to modeling can be used to detect HF 12 months before clinical diagnosis. Model performance and complexity varies with the HF subtypes indicating differences in the complexity of modeling the HF subtypes.

The technique of double first metatarsal osteotomies was first developed in response to the high frequency of recurrence noted in the treatment of severe adolescent congruent hallux valgus deformities. The concept behind the use of this technique is that it allows the individual correction of each component of the deformity. We have modified the technique for use in adult hallux valgus where the majority of deformities are incongruent deformities and the distal chevron osteotomy is used primarily for its additional translational properties rather than purely to correct the distal metatarsal articular angle (DMAA). We report on a series of double first metatarsal osteotomies (basal opening wedge and distal chevron osteotomy) with Akin osteotomy in the treatment of moderate to severe adult hallux valgus deformity. All patients presenting to our institution with a hallux valgus deformity and treated with this procedure between 2008 and 2013 with a minimum of 1 year of follow-up were identified. Data were obtained through review of case notes, electronic charts, and digital imaging. A total of 50 feet in 48 patients underwent double first metatarsal osteotomy with Akin osteotomy. Three patients were excluded due to loss to follow-up, leaving 47 feet in 45 patients with a mean follow-up of 45 months (range, 14-60 months). Of these 43 (96%) were female and the mean age was 56 years (range, 35-70 years). The mean preoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, sesamoid position, and lateral first metatarsotalar angle were 42 degrees (range, 32-52 degrees), 18 degrees (range, 6-26 degrees), 12 degrees (range, 4-26 degrees), stage 6 (range, 4-7), and 2 degrees of dorsiflexion (range, 20 degrees of dorsiflexion to 4 degrees of plantar flexion), respectively. The mean postoperative HVA, IMA, DMAA, sesamoid position, and lateral first metatarsotalar angle were 7 degrees (range, 2 to 24 degrees), 4 degrees (range, 4-14 degrees), 6 degrees (range, 10-22 degrees), stage 2 (range, 1-5) and 6 degrees of plantar flexion (range, 8 degrees of dorsiflexion to 18 degrees of plantar flexion), respectively. The osteotomies consolidated at a mean of 7 weeks (range, 5-9 weeks). There were no cases of delayed union or nonunion. Of the cohort, 45 (96%) stated that they were satisfied overall with the results of their surgery and would have it again. The mean postoperative summary index Manchester-Oxford Foot Questionnaire (MOXFQ) score was 12.9 (range, 0-60.9) out of 100 at a mean follow-up of 45 months (range, 14-60 months). For the minority of cases, 8 (17%), that had preoperative scoring, the summary index MOXFQ score was 73.7 (range, 29.7-100). The double first metatarsal osteotomy (basal opening wedge and distal chevron osteotomy) with Akin osteotomy provides powerful correction and facilitates correction of the individual components of the hallux valgus deformity. The individual osteotomies that make up this procedure are familiar to the majority of foot and ankle surgeons, thus limiting the associated learning curve. Level IV, retrospective case series.

Gerard Wainwright recounts how his team supported an older resident during the final stages of her life and won a palliative care award

Four thousand years is a fair old time for chickens to have been domesticated. They originate from the Red Jungle Fowl (Gallus gallus, a small pheasant of Asia) and have provided us with eggs, fresh meat and feathers, plus some truly horrible traditional medicines. Recent publicity given to the welfare conditions of laying hens has resulted in many people keeping chickens in their backyards. For this reason, it is now commonplace to have chickens in the waiting room. This article aims to arm the reader with some basic facts to help with advising owners and nursing these birds.

Abstract Recent developments in national and international legislation encourage the submission of computer predictions to support chemical registration, in order to reduce dependency on animal experiments. The Organisation for Economic Cooperation and Development (OECD) has issued guidelines for describing and evaluating such prediction models. This paper suggests that operating procedures and guidelines are needed for good practice in their development and application. Illustrative examples are provided of the sorts of issues that need to be considered and the possible rules that might be drawn up. Copyright © 2010 John Wiley & Sons, Ltd.

To review the cases of placenta previa/accreta and its management. The records of all patients with the diagnosis of placenta previa/accreta during the 6 year period 1997–2005 were reviewed. We had seven cases of placenta accreta during the 6 year period. Case 1: 35 yrs, P3, Previous 1 Cesarean, major placenta previa. Had emergency LSCS at 34 weeks for APH followed by subtotal hysterectomy. Case 2: 24 yrs, P3, Previous 3 Cesareans, major placenta previa. Had emergency LSCS at 29 weeks for APH. Subsequently had total abdominal hysterectomy due to uncontrolled bleeding. Case 3: 30 yrs, P5, previous 1 Cesarean, major placenta previa. Had elective LSCS at term. Had uncontrolled bleeding and intrauterine balloon was tried followed by total hysterectomy. Case 4: 29 yrs, P2, Previous 2 Cesareans, major placenta previa. Had elective LSCS at term. Placenta found invading the bladder. Uncontrolled bleeding leading to total abdominal hysterectomy and repair of bladder. Case 5: 35 yrs, P3 + 2, previous 2 Cesareans. Placenta previa accreta was diagnosed antenatally. Elective Cesarean section with planned Cesarean hysterectomy was done at 36 weeks. Case 6: 37 yrs, P2 + 1. Had spontaneous vaginal delivery. Following delivery placenta was retained and a diagnosis of placenta accreta made on examination under anesthesia and managed conservatively. She was followed by serial scans and β-hCG. Case 7: P1 + 1. Had spontaneous vaginal delivery followed by retained placenta. Manual removal was tried and 1/3rd of placenta could be removed. As she was not bleeding decision was made to treat conservatively. She was followed by serial scans and β-hCG. She had a vaginal delivery at term in 2006. With the ultrasound diagnosis of placenta accreta elective Cesarean/Cesarean hysterectomy can be planned which has less morbidity (Case 5). Cases 1–4 had massive transfusion and ITU admission. Also conservative management has a role with or without the use of methotrexate.