Search

and medication utilization among older patients with hypertension to gauge opportunity for service redesign. STUDY DESIGN: Data came from 1,880,331 Medicare Advantage members with hypertension who had a primary care visit and a pharmacy claim for an antihypertensive, antidiabetic, or antilipemic medication. To determine activities associated with a primary care visit, we analyzed 43,258,454 medical claims, 245 procedure codes, and medication management associated with those visits. Models for predicting both hypertension visits and medication management were evaluated and applied. METHODS: Logistic regression was used to identify which features were predictive of a medication change or a provider visit. RESULTS: Almost 40% of visits were consultation only, not associated with a procedure, and 26.5% of individuals had no medication change in a year. For prescription changes, 75% were a return to a previously prescribed medication or a medication discontinuation. Twenty percent of the population accounted for 47.9% of visits. Type 2 diabetes and a prior medication change were the strongest predictors of a medication change. A previous medication change was also the strongest predictor of a subsequent provider visit. CONCLUSIONS: Our analysis suggests that a significant portion of care--consultation-only visits--may be relatively low value. Further, much of medication management may not require an office-based visit. Finally, utilization behavior of patients with hypertension and predictive models are likely to allow informed provisioning of new service models to specific population segments. [ABSTRACT FROM AUTHOR]

Optimising the conduct of clinical trials for diffuse intrinsic pontine glioma involves use of consistent, objective disease assessments and standardised response criteria. The Response Assessment in Pediatric Neuro-Oncology working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. A working group was formed specifically to address response assessment in children and young adults with diffuse intrinsic pontine glioma and to develop a consensus on recommendations for response assessment. Response should be assessed using MRI of brain and spine, neurological examination, and anti-inflammatory or antiangiogenic drugs. Clinical imaging standards are defined. As with previous consensus recommendations, these recommendations will need to be validated in prospective clinical trials. [ABSTRACT FROM AUTHOR]

The article highlights the improvements in health care outcomes and reduction in total cost of care demonstrated by the Optimal Care ambulatory care delivery system of the Optum Care network. It cites the cause of excess cost in the U.S. health care system including administrative overhead and pharmaceutical pricing. One of the goals of the program is the rapid transition of high-quality evidence-based medicine into daily practice. Also cited are challenges in Optimal Care implementation.

Lesbian, gay, and bisexual (LGB) young people experience a variety of developmental trajectories that consist of milestones, the sequence and timing of which differ across individuals. They include early feelings of being different from peers, the onset of same-sex attraction, questioning one's sexuality, first same-sex sexual experience, recognition and self-labelling, disclosure to others, first romantic relationship, and self-acceptance. The invention of ‘gay youth’ during the 1970s and 1980s is briefly reviewed with an emphasis on the ways in which the portrait created by early research fails to capture the developmental trajectories of millennial young people. Although some young people struggle with mental health problems as they navigate these milestones, research documents the complexity, variety, and normative nature of the vast majority of LGB young people. A growing chorus of developmental, behavioural, and social scientists now emphasize that many contemporary young people forego sexual confusion, recognize the sex or gender to which they are attracted to and love, and believe they are as mentally healthy as heterosexual young people. [ABSTRACT FROM PUBLISHER]

Maculopathies affect point-to-point foveal correspondence causing diplopia. The effect that the maculopathies have on the interaction of central sensory fusion and peripheral fusion are different th an the usual understanding of treatment for diplopia. This paper reviews the pathophysiology of macular diplopia, describes the binocular pathology causing the diplopia, discusses the clinical evaluation, and reviews the present treatments including some newer treatment techniques. [ABSTRACT FROM AUTHOR]

The article focuses on the influence of Daoist master Zhao Bichen on martial arts and qigong in China. The consideration of Bichen's teachings in the formation of the spiritual core of several Chinese martial arts and many contemplative arts among Chinese is noted. Reasons why Bichen's teaching is not that influencing in the West are provided including title, writing style and limited Daoism view.

Abstract: Background: Adult survivors of childhood cancer have an increased risk of cerebrovascular disease; little is known about early stroke risk in childhood cancer. Our objectives were to assess stroke prevalence in children with cancer, to establish cancer and stroke type, and to determine if modifiable risk factors for stroke were present. Methods: Children with stroke and cancer were compared with all children seen for cancer at a single institution between 2000 and 2009. An International Classification of Disease, 9th version, code search and search of existing pediatric oncology and stroke databases identified children <18 years with ischemic stroke, intracerebral hemorrhage, and cerebral sinovenous thrombosis. Results: Of 1411 children with cancer, 15 had a stroke (1.1%, 95% CI: 0.6-1.7%). Stroke classifications were seven intracerebral hemorrhages, five ischemic strokes (one of which was followed by intracerebral hemorrhage), and three sinovenous thromboses. Stroke occurred at a median of 5 months after cancer diagnosis. Ten children with strokes had hematologic malignancies and five had brain tumors. Thirteen patients died poststroke, eight because of withdrawal of care. White blood cell count ≥48,000/mm3 was found in four children, all with intracerebral hemorrhage. Five of seven children with intracerebral hemorrhage had platelets <50,000/mm3. Conclusions: Stroke has a prevalence of approximately 1% in children with cancer. Hemorrhagic stroke and ischemic stroke occur with approximately equal frequency; children with leukemia and brain tumors are at greatest risk. [Copyright &y& Elsevier]

Purpose: Improvements in cancer outcomes for adolescents and young adults with cancer lag behind those of other age groups, and few psychosocial interventions have been developed specifically for this population. This study sought to explore both adolescent cancer patients' interest in engaging in a participatory study and their perceived coping needs. Methods: Applying a grounded theory and participatory action approach, cancer patients aged 13-19 years who were at least 3 months post-diagnosis at a tertiary pediatric oncology service were invited for group discussions and activities involving a t-shirt design and blog. Inductive coding and thematic analysis were applied to session transcripts. Results: Four themes were elicited regarding coping with cancer as an adolescent: adjustments related to physical and social participation, social perceptions, physical effects, and health-related communication needs. Peer-to-peer messages aligned with shared coping strategies, particularly featuring elements of humor and resilience while connecting to culture and redefining one's individual and group identity. Conclusion: Participatory methods can be effective in eliciting perceptions and needs in adolescents with cancer, and warrant further attention in research efforts to define and assess interventions and patient-reported outcomes for adolescents with chronic disease. [ABSTRACT FROM AUTHOR]

An essay is presented on the relationship between gambling and social, political, and business networks in early America. According to the author, public gambling provided a site for political mobilization and helped to shape a nationwide culture of masculine risk. It is suggested that while wealthy white men created and held hegemonic power, it was constructed through vertical social networks and benefited white men across class and region. Horse racing and reputation are also discussed.

This presentation will develop the concept of metapsychological capacity and describe the convergence of Systemic, Self, Intersubjective and Horneyan theory that integrates into the metapsychological construct. The traditional concepts of repetition compulsion and projective identification are expanded from their mechanistic roots towards a more real, existential, iterative force that influences the therapeutic process. Metapsychological capacity creates a therapeutic presence enabling greater emotional awareness and psychological growth for both the therapist and the patient. The foundations of repetition compulsion, Horneyan character splits and projective identification serve to frame the intersubjective space from which real self emerges. Focused on subjective/relationship-near immersion, real self emergence and resonating character splits, Horney clearly understood the metapsychological capacity required for emotional growth. Deconstruction of other more classic historical and mechanistic theoretical legacies is required to comprehend and experience this therapeutic presence. [ABSTRACT FROM AUTHOR]

This article describes the history, development, and principles of the two major Taiji Ruler lineages: one associated with the Song Dynasty (960-1279 CE) imperial family, and the other lesser known, Daoist lineage, transmitted by Hu Yaozhen and his successors, including the well known Chen Style Taijiquan teacher, Feng Zhiqiang. The Taiji Ruler is a traditional system of health-enhancing qigong that is attributed to the Song Dynasty Daoist recluse Chen Xiyi and was first taught publicly in the 1950s. The exercises may be practiced while holding a foot-long wooden object, the Ruler, or with a variety of training devices, such as a wooden or stone ball. Mr. Cohen began studying Taji Ruler with various teachers more than 30 years ago, but also bases his research on works in Chinese and English. Both the teachers and literature agree that the ultimate goal of the Ruler is to blend with the original qi of the universe and, in the process, to achieve vitality and longevity. [ABSTRACT FROM AUTHOR]

Purpose: To describe and identify unknown opaque material between the optic of an AR40 intraocular lens (IOL) injected with the Emerald Series implantation system (both AMO, Inc.) and the posterior capsule at the conclusion of routine phacoemulsification to prevent an outbreak of toxic anterior segment syndrome (TASS). Setting: Ambulatory care center operating room, University of North Carolina Hospitals and Department of Ophthalmology, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina, USA. Methods: After coaxial phacoemulsification in multiple patients, opaque material was present between the optic of a posterior chamber IOL and the posterior capsule. Although there was no TASS, the material was removed from 2 eyes and analyzed with scanning electron microscopy (SEM) and x-ray microanalysis (XRM). Similarly, crystalline lens, Klenzyme (Steris Corp.), Viscoat (sodium hyaluronate 3.0%–chondroitin sulfate 4.0%), and Provisc (sodium hyaluronate 1.0%) were analyzed. Results: On SEM, the material had an irregular undulating surface similar to that of Provisc. Viscoat and the crystalline lens had smoother surfaces. On XRM, the material contained sodium, chlorine, and calcium, like Viscoat and Provisc, and phosphorous and sulfur, like Viscoat. The material also contained silicone, magnesium, aluminum, titanium, iron, and zinc. Klenzyme had smaller peaks of sodium, chlorine, and calcium and a higher carbon background than the unknown material. Conclusions: The material was likely ophthalmic viscosurgical device that was chemically and structurally altered by the cleaning and sterilization process. The silicone and metallic elements were probably from the Emerald Series implantation system as the disposable cartridge is coated with silicone and the reusable injector is metal. [Copyright &y& Elsevier]

The article discusses the growth of the thoroughbred industry in the Chesapeake region in Maryland from 1790 to 1850. The emergence of the thoroughbred industry in the region tells a story about the significance of investment in sporting activities in early America. Understanding the social and economic mechanics of horse racing in the early national Chesapeake requires familiarity with its colonial predecessor.

From stills to marijuana crops, our public lands have historically been the home of illicit activity. Methamphetamine production can now be added to the list. However, methamphetamine production presents unique threats and challenges that remain understudied. Methamphetamine production is highly toxic, and the disposal of this waste on forestlands represents a serious and growing environmental crime in the United States. This article examines three forms of collateral damage that the meth threat poses: the environmental consequences of meth production on public lands, the threats to people recreating on public lands, and the potential for impact to gateway and resource-dependent communities. These three interrelated points of impact are documented as ways to understand the scope of this problem on public lands. In light of these findings, we also seek to understand the reasons behind the disparate institutional responses to the threat. We end with recommendations for research and management. [ABSTRACT FROM AUTHOR]

Purpose: To quantify changes in areas of hyperfluorescence of the macula, perifovea, and optic disc after phacoemulsification in patients with diabetes mellitus and evaluate relationships between hyperfluorescence, macular thickness, diabetic retinopathy (DR), and logMAR best corrected visual acuity (BCVA). Setting: Ophthalmology Clinic and Operating Room, Ambulatory Care Center, University of North Carolina at Chapel Hill, School of Medicine, and the University of North Carolina Hospitals, Chapel Hill, North Carolina, USA. Methods: This prospective case-control study comprised 30 eyes of 24 subjects with cataracts and diabetes mellitus with different levels of DR. Preoperatively and 2 months postoperatively, BCVA was recorded, digital retinal photography and fluorescein angiography were performed, macular thickness was measured (optical coherence tomography), and DR and hyperfluorescence of the optic disc, macula, and perifovea were quantified. Results: Postoperatively, BCVA improved in surgical eyes but was unchanged in nonsurgical eyes. Preoperatively, between eyes, there was no difference in hyperfluorescence. Postoperatively, hyperfluorescence of the optic disc, macula, and perifovea increased in surgical eyes and was unchanged in nonsurgical eyes. Macular thickness increased in surgical eyes, although DR was unchanged in surgical and nonsurgical eyes. Although there was no correlation between hyperfluorescence and macular thickness in surgical eyes, increased hyperfluorescence of the perifovea was associated with less improvement in BCVA. Conclusions: After phacoemulsification, hyperfluorescence and macular thickness increased in the eyes of diabetic subjects. These short-term changes are more likely an effect of the surgery than a worsening of DR. [Copyright &y& Elsevier]

Objective: Hyperpolarization modulates Ca 2+ influx during agonist stimulation in many endothelial cells, but the effects of hyperpolarization on Ca 2+ influx in freshly isolated arteriolar endothelial cells are unknown. Therefore, the purpose of the present study was to characterize agonist-induced Ca 2+ transients in freshly isolated arteriolar endothelial cells and to test the hypothesis that membrane hyperpolarization augments agonist-induced Ca 2+ influx into these cells. Methods: Arterioles were removed from hamster cremaster muscles and arteriolar endothelial cells were enzymatically isolated. Endothelial cells were loaded with Fura 2-AM and the Fura 2 ratio measured photometrically as an index of intracellular Ca 2+ . The cells were then stimulated with the muscarinic, cholinergic agonist, methacholine, and the resulting Ca 2+ transients were measured. Results: Methacholine (1 µ M) increased the endothelial cell Fura 2 ratio from a baseline of 0.81 &PlusMinus; 0.02 to an initial peak of 1.17 &PlusMinus; 0.05 (n = 17) followed by a sustained plateau of 1.12 &PlusMinus; 0.07. The plateau phase of the Ca 2+ transient was inhibited by removal of extracellular Ca 2+ (n = 12, p .05). The initial peak of methacholine-induced Ca 2+ transients was inhibited by the IP 3 -receptor antagonist xestospongin D (10 µ M, n = 5, p .05). Conclusions: Freshly isolated arteriolar endothelial cells display agonist-induced Ca 2+ transients. For the muscarinic agonist, methacholine, these Ca 2+ transients result from release of Ca 2+ from intracellular stores through IP 3 receptors, followed by sustained influx of extracellular Ca 2+ . While these changes in intracellular Ca 2+ are associated with endothelial cell hyperpolarization, the methacholine-induced, sustained increase in intracellular Ca 2+ appears to be independent from this change in membrane potential. These data suggest that arteriolar endothelial cells may possess a novel Ca 2+ influx pathway, or that the relationship between intracellular Ca 2+ and Ca 2+ influx is more complex than that observed in other endothelial cells. [ABSTRACT FROM AUTHOR]

Purpose: To measure macular thickness using the Retinal Thickness Analyzer (RTA) (Talia Technologies, Ltd.) before and after routine phacoemulsification.Setting: Ophthalmology Clinic, Ambulatory Care Center, University of North Carolina at Chapel Hill, School of Medicine, and the University of North Carolina Hospitals, Chapel Hill, North Carolina, USA.Methods: Thirty-five nonconsecutive patients scheduled for phacoemulsification and posterior chamber intraocular lens implantation were recruited. The best corrected visual acuity (BCVA) and macular thickness in the surgical and nonsurgical eyes were measured with the RTA prior to surgery and 1 and 6 weeks after surgery. Wilcoxon signed rank tests were used to evaluate each index of macular thickness—the mean posterior pole, perifoveal, and foveal thicknesses—over the 3 time periods and to compare the indices before surgery in surgical and nonsurgical eyes. Spearman correlations were computed for each index and the BCVA. Significance was assessed at the 5% level.Results: Preoperatively, all indices were higher in nonsurgical eyes than in surgical eyes. In surgical eyes, all indices decreased from preoperatively to 6 weeks after surgery. In nonsurgical eyes, there was no change. The BCVA in surgical eyes improved from before surgery to 1 week and 6 weeks after surgery. In surgical eyes, there were nonsignificant negative correlations between each index and the BCVA before surgery and 1 and 6 weeks after surgery. In nonsurgical eyes, there were nonsignificant negative correlations between each index and the BCVA preoperatively and 6 weeks after surgery, except for a significant negative correlation for the foveal index at 6 weeks.Conclusions: Measurements by the RTA indicate that the decrease in macular thickness indices in surgical eyes from before surgery to 6 weeks after routine phacoemulsification is an artifact of imaging the retina through hazy media. Therefore, the results must be interpreted in the context of the clinical situation. [Copyright &y& Elsevier]

Objective: The mechanism by which elevated extracellular potassium ion concentration ([K+]o) causes dilation of skeletal muscle arterioles was evaluated. Methods: Arterioles (n = 111) were hand-dissected from hamster cremaster muscles, cannulated with glass micropipettes and pressurized to 80 cm H2O for in vitro study. The vessels were super-fused with physiological salt solution containing 5 mM KCl, which could be rapidly switched to test solutions containing elevated [K+]o) and/or inhibitors. The authors measured arteriolar diameter with a computer-based diameter tracking system, vascular smooth muscle cell membrane potential with sharp micropipettes filled with 200 mM KCl, and changes in intracellular Ca2+ concentration ([Ca2+]i) with Fura 2. Membrane currents and potentials also were measured in enzymatically isolated arteriolar muscle cells using patch clamp techniques. The role played by inward rectifier K+ (KIR) channels was tested using Ba2+ as an inhibitor. Ouabain and substitution of extracellular Na+ with Li+ were used to examine the function of the Na+/K+ ATPase. Results: Elevation of [K+]o from 5 mM up to 20 mM caused transient dilation of isolated arterioles (27 ± 1 μm peak dilation when [K+]o was elevated from 5 to 20 mM, n = 105, p < .05). This dilation was preceded by transient membrane hyperpolarization (10 ± 1 mV, n = 23, p < .05) and by a fall in [Ca2+]i as indexed by a decrease in the Fura 2 fluorescence ratio of 22 ± 5% (n = 4, p < .05). Ba2+ (50 or 100 μM) attenuated the peak dilation (40 ± 8% inhibition, n = 22) and hyperpolarization (31 ± 12% inhibition, n = 7, p < .05) and decreased the duration of responses by 37 ± 11% (n = 20, p < 0.05). Both ouabain (1 mM or 100 μM) and replacement of Na+ with Li+ essentially abolished both the hyperpolarization and vasodilation. Conclusions: Elevated [K+]o causes transient vasodilation of skeletal muscle arterioles that appears to be an intrinsic property of the arterioles. The results suggest that K+-induced dilation involves activation of both the Na+/K+ ATPase and KIR channels, leading to membrane hyperpolarization, a fall in [Ca2+]i, and culminating in vasodilation. The Na+/K+ ATPase appears to play the major role and is largely responsible for the transient nature of the response to elevated [K+]o, whereas KIR channels primarily affect the duration and kinetics of the response. [ABSTRACT FROM AUTHOR]

Presents an excerpt from the book 'Honoring the Medicine: The Essential Guide to Native American Healing.'

OBJECTIVE:: We tested the hypothesis that hypoxia inhibits currents through L-type Ca2+ channels and inhibits norepinephrine-induced rises in intracellular Ca2+ in cremasteric arteriolar muscle cells, thus accounting for the inhibitory effect of hypoxia on norepinephrine-induced contraction of these cells. METHODS:: Single smooth muscle cells were enzymatically isolated from second-order and third-order arterioles from hamster cremaster muscles. The effects of hypoxia (partial pressure of oxygen: 10-15 mm Hg) were examined on Ba2+ (10 mM) currents through L-type Ca2+ channels by use of the perforated patch clamp technique. Also, the effect of hypoxia on norepinephrine-induced calcium changes was studied using Fura 2 microfluorimetry. RESULTS:: Hypoxia inhibited the norepinephrine-induced (10 uM) contraction of single arteriolar muscle cells by 32.9 ± 5.6% (mean ± SE, n = 4). However, hypoxia had no significant effect on whole-cell currents through L-type Ca2+ channels: the peak current densities measured at +20 mV were -3.83 ± 0.40 pA/pF before hypoxia and -3.97 ± 0.36 pA/pF during hypoxia (n = 15; p > 0.05). In addition, hypoxia did not inhibit Ca2+ transients in arteriolar muscle cells elicited by 10 uM norepinephrine. Instead, hypoxia increased basal Ca2+ (13.8 ± 3.2%) and augmented peak Ca2+ levels (29.4 ± 7.3%) and steady-state Ca2+ levels (15.2 ± 5.4%) elicited by 10 uM norepinephrine (n = 21; p < 0.05). CONCLUSIONS:: These data indicate that hypoxia inhibits norepinephrine-induced contraction of single cremasteric arteriolar muscle cells by a mechanism that involves neither L-type Ca2+ channels nor norepinephrine-induced Ca2+ mobilization. Instead, our findings suggest that hypoxia must inhibit norepinephrine-induced contraction by affecting a component of the signaling pathway that... [ABSTRACT FROM AUTHOR]

We have cloned and characterized the cDNA, expression pattern, and subcellular localization of the human and murine orthologs of the centrosomal colon cancer autoantigen protein (CCCAP). We identified both the transcriptional start site of murine CCCAP (mCCCAP) and its TATA-less promoter within BAC genomic clones of the mCCCAP 5′ region. The mCCCAP transcript is ubiquitously present in mouse tissues, but at very low copy number. The 2151 bp open reading frame of mCCCAP encodes an 83 kDa protein that possesses a large C-terminal coiled-coil domain, which is able to homo-oligomerize in the yeast 2-hybrid system. Endogenous mCCCAP localizes to the centrosomes of murine BALB/c 3T3 fibroblasts during both interphase and mitosis. This centrosomal localization was not disrupted by nocodazole-induced depolymerization of the microtubule cytoskeleton, suggesting that mCCCAP is an integral component of the centrosome rather than simply a microtubule-associated protein. We also cloned human CCCAP (hCCCAP). The 2139 bp open reading frame of hCCCAP encodes an 82.5 kDa protein that is 71% identical to mCCCAP at the amino acid level and has the same predicted secondary structure. Ectopically expressed full-length hCCCAP in human U2-osteosarcoma cells also displayed centrosomal localization during interphase and mitosis. This pattern of localization was abolished by truncations of the N- and C-terminus of the protein. We further discovered that the C-terminal portion of hCCCAP is identical to the human colon cancer autoantigen NY-CO-8 (Human Gene Nomenclature symbol SDCCAG8). [Copyright &y& Elsevier]

Moderate support was obtained in a sample of 101 gay, bisexual, and heterosexual males for the perinatal hormone theory, which hypothesizes that attenuated levels of androgens during critical periods of male fetal development fail to masculinize and defeminize the brain. Affected individuals develop female-typical sexual orientation (assessed here by a pie chart) and cerebral organization, reflected in visual-spatial abilities and gender nonconformity. Handedness, also thought to reflect in utero hormone exposure, was evaluated. Gay and bisexual males reported greater femininity and lesser masculinity than heterosexuals, with bisexuals intermediate in masculinity, suggesting a common biological mediator for homoeroticism and sex atypicality. Among bisexual males, increased masculinity was related to enhanced performance on all spatial tasks. Group mean differences in spatial ability and handedness were not found; however, among bisexuals, poorer visual-spatial performance predicted increased homoeroticism and right-handedness positively correlated with all spatial tasks. If perinatal hormones contribute to a generalized feminization of the brain, the current data indicate that it is most apparent among bisexual males. Sexing of their brains may involve several sexually dimorphic regions that are related in a continuous manner. Inferred cerebral feminization was more circumscribed among gay and heterosexual males, for whom childhood sex atypicality was most highly-distinguishing. Unspecified mechanisms responsible for homoeroticism in them may differ from those that produce same-sex attractions in bisexuals and thus have relatively little impact on other components of cerebral feminization. [ABSTRACT FROM AUTHOR]

Presents readings of four different episodes of the cross-cultural play 'The Middle Ground,' and its portrayal of Native Americans and Europeans. Value of the play as a tool for cultural investigation; Discussion on the episode at Fort Michilimackinac and the question of why the Chippewa used lacrosse as a guise for their attack; Analysis of the performance of two Iroquois boys in front of a band of Europeans near Niagara Falls.

Discusses the role of capillaries on coupling blood flow with metabolism. Control of capillary blood flow and recruitment at the capillary level; Capable of sensing and responding to vasoactive stimuli; Contraction of skeletal muscle fibers underneath the capillaries.

Examines remote arteriolar dilations in response to muscle contraction under capillaries. Dilation of upstream arterioles in response to remote muscle contraction during application of gap junction inhibitors; diameter changes of module inflow arterioles with application of halothane and 18-beta-glycyrrhetinic acid during remote muscle stimulation.

Presents a study which characterized the mechanism underlying the remote dilation in two arteriolar generations upstream from capillaries. Methodology; Results and discussion; Conclusion.

Pediatric gliomas span a spectrum of neoplasms ranging from the well-circumscribed, slowly growing lesions that can be totally removed by surgery to highly infiltrating, nonexcisable, rapidly growing tumors that resist any form of postoperative therapy. As part of this symposium, we discuss selected members of this group in the diencephalon, where lesions of both extremes are common in children. The report illustrates and contrasts the clinical, radiographic and pathological features of the two classic regional astrocytomas, pilocytic and fibrillary, as well as two less common but distinctive lesions, pilomyxoid astrocytoma and bithalamic astrocytoma.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

VISUAL ABSTRACT. [ABSTRACT FROM AUTHOR]

Examines local coupling between blood flow and metabolism by using micropipettes to stimulate muscle fibers running underneath specified capillary modules. Increase in capillary erythrocyte flow; Preparation and muscle fiber stimulation; Arteriolar responses and application of high-osmolar sucrose or tetrodotoxin.

Examines the connection between capillary blood flow and metabolism by observing the flow in both the module capillaries the module inflow arteriole when the muscle fibers under a single capillary module were simulated. Impact of tissue simulation on the red blood cell.

Outlines some ways in which counsellors and psychotherapists in England and Wales may incur legal liability. Legal liability for negligence; Councellor's duty of care; Providing a safe physical environment; Compensating psychological harm; Compensating financial loss; More.

A letter to the editor is presented in response to the article "Depressive symptoms among same-sex oriented young men: Importance of reference group," by R. C. Savin-Williams and colleagues.

In this article, the author discusses the potential therapeutic role of angiogenic biomarkers in multiple myeloma patients who undergo autologous stem cell transplant (ASCT). He mentions a study by G. T. Sucak and colleagues on the prognostic importance of bone marrow microvessel density (MVD) which shows no correlation between the levels of angiogenic cytokines and MVD and progression-free survival. Furthermore, bone marrow MVD and angiogenic cytokines do not provide prognostic data.

A letter to the editor is presented in response to the article about depressive symptoms among same-sex oriented young men.

Presents a case in which surgical trauma was the underlying mechanism for the development of transient thyroiditis with mild clinical thyrotoxis. Cause for thyroiditis; Impact on the clinical outcome.

Girlhood (It's complicated) is an exhibition at the National Museum of American History (NMAH), part of the Smithsonian Institution, which opened in October of 2020. Created with federal funding as part of the American Women's History Initiative (AWHI), the exhibition commemorates the centennial of women's suffrage. To put a fresh spin on this anniversary and draw attention to larger, intertwining issues of gender and politics in the United States, the exhibition team chose to explore the history of girlhood and girls as political actors as the focus of the show. Drawing on the rich, interdisciplinary literature of girlhood studies and inspired by zines as a form of identity creation and political self-expression, the show aims to create a public history of girlhood that unveils the public lives of girls in the past and showcases the many ways in which they, even without the vote or formal political power, have had a political voice in American history. The exhibition is open at the NMAH from October 2020 to January 2023, and will travel with the Smithsonian Institution Traveling Exhibition Service through 2026. [ABSTRACT FROM AUTHOR]

Background Although the relationship between radiation and neurocognition has been extensively studied in the pediatric brain tumor population, it is increasingly recognized that neurocognitive impairment is multifactorial. Therefore, we quantified the effect of socioeconomic status (SES) and chemotherapy on neurocognitive impairment and decline post-treatment. Methods Eligible patients included those diagnosed with a brain tumor at < 22 years of age with ≥1 neurocognitive assessment. Neurocognitive impairment was defined as performance 1.5 standard deviations below the normative mean using age-standardized measures of intellectual function. Neurocognitive decline was defined as a negative slope. Neurocognitive outcomes included Wechsler indices of Full-Scale Intelligence Quotient (IQ). Logistic regression identified variables associated with neurocognitive impairment. Longitudinal data was analyzed using linear mixed models. Results Eligible patients (n  = 152, median age at diagnosis = 9.6 years) had a mean neurocognitive follow-up of 50.2 months. After accounting for age and receipt of craniospinal irradiation, patients with public insurance had 8-fold increased odds of impaired IQ compared to private insurance (odds ratio [OR]: 7.59, P  < .001). After accounting for age, change in IQ was associated with chemotherapy use (slope: −0.45 points/year with chemotherapy vs. 0.71 points/year without chemotherapy, P  = .012). Conclusions Public insurance, an indicator of low SES, was associated with post-treatment impairment in IQ, highlighting the need to incorporate SES measures into prospective studies. Chemotherapy was associated with change in IQ. Further work is needed to determine whether impairment associated with low SES is secondary to baseline differences in IQ prior to brain tumor diagnosis, brain tumor/therapy itself, or some combination thereof. [ABSTRACT FROM AUTHOR]

BACKGROUND: Detection of the BRAF V600E mutation in pediatric low-grade glioma has been associated with a lower response to standard chemotherapy. In previous trials, dabrafenib (both as monotherapy and in combination with trametinib) has shown efficacy in recurrent pediatric low-grade glioma with BRAF V600 mutations, findings that warrant further evaluation of this combination as first-line therapy. METHODS: In this phase 2 trial, patients with pediatric low-grade glioma with BRAF V600 mutations who were scheduled to receive first-line therapy were randomly assigned in a 2:1 ratio to receive dabrafenib plus trametinib or standard chemotherapy (carboplatin plus vincristine). The primary outcome was the independently assessed overall response (complete or partial response) according to the Response Assessment in Neuro-Oncology criteria. Also assessed were the clinical benefit (complete or partial response or stable disease for >24 weeks) and progression-free survival. RESULTS: A total of 110 patients underwent randomization (73 to receive dabrafenib plus trametinib and 37 to receive standard chemotherapy). At a median follow-up of 18.9 months, an overall response occurred in 47% of the patients treated with dabrafenib plus trametinib and in 11% of those treated with chemotherapy (risk ratio, 4.31; 95% confidence interval [CI], 1.7 to 11.2; PcO.OOl). Clinical benefit was observed in 86% of the patients receiving dabrafenib plus trametinib and in 46% receiving chemotherapy (risk ratio, 1.88; 95% CI, 1.3 to 2.7). The median progression-free survival was significantly longer with dabrafenib plus trametinib than with chemotherapy (20.1 months vs. 7.4 months; hazard ratio, 0.31; 95% CI, 0.17 to 0.55; PcO.001). Grade 3 or higher adverse events occurred in 47% of the patients receiving dabrafenib plus trametinib and in 94% of those receiving chemotherapy. CONCLUSIONS: Among pediatric patients with low-grade glioma with BRAF V600 mutations, dabrafenib plus trametinib resulted in significantly more responses, longer progression-free survival, and a better safety profile than standard chemotherapy as first-line therapy. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about admissions in medical school.