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Background Vessel perforation during thrombectomy is a severe complication and is hypothesized to be more frequent during medium vessel occlusion (MeVO) thrombectomy. The aim of this study was to compare the incidence and outcome of patients with perforation during MeVO and large vessel occlusion (LVO) thrombectomy and to report on the procedural steps that led to perforation. Methods In this multicenter retrospective cohort study, data of consecutive patients with vessel perforation during thrombectomy between January 1, 2015 and September 30, 2022 were collected. The primary outcomes were independent functional outcome (ie, modified Rankin Scale 0--2) and all-cause mortality at 90 days. Binomial test, chi-squared test and t-test for unpaired samples were used for statistical analysis. Results During 25 769 thrombectomies (5124 MeVO, 20 645 LVO) in 25 stroke centers, perforation occurred in 335 patients (1.3%; mean age 72 years, 62% female). Perforation occurred more often in MeVO thrombectomy (2.4%) than in LVO thrombectomy (1.0%, p<0.001). More MeVO than LVO patients with perforation achieved functional independence at 3 months (25.7% vs 10.9%, p=0.001). All-cause mortality did not differ between groups (overall 51.6%). Navigation beyond the occlusion and retraction of stent retriever/aspiration catheter were the two most common procedural steps that led to perforation. [ABSTRACT FROM AUTHOR]

In an ageing world, age equality is critical for securing the future of work. Yet workplaces have not been designed with demographic ageing in mind, and age discrimination remains prevalent. This article offers a provocation to encourage the use of an age lens when considering the future of work and workplace change. It puts forward suggestions for future research and scholarship, to reframe equality law, and to build a research agenda that helps advance workplace equality for people of all ages. [ABSTRACT FROM AUTHOR]

This paper continues the analysis of the management of urban waterways in Greater Melbourne, Australia, commenced with our first paper. We focus first on the increasing emphasis on waterways and their corridors as part of Melbourne's liveability, and then on the future management of waterways and their corridors in the face of the three most pressing future challenges – climate change, population increase, and urban expansion and densification. The long history of the development of parks, gardens and open spaces in Melbourne is reviewed. These open-spaces initially occurred with quite strong linkage to the waterways, enabled by the city's unique institutional arrangements, but were substantially weakened as a result of policy and governance reforms in the 1990s. Melbourne will need to substantially improve the integration of the management of urban waterways and their corridors with the planning, development and management of the city's associated green spaces if it is to achieve the expected community liveability standards in the face of the above three future challenges. Additionally, if waterway management remains with the existing agency (Melbourne Water), the authorising environment and the culture and mindset of this agency will need to change its focus from the current 'city servicing' institutional model to a 'city shaping' model. [ABSTRACT FROM AUTHOR]

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There is a growing need for empirical legal research, and for lawyers and judges who are empirically literate. In this article, I consider the role legal education can and should play in achieving this empirical literacy, to enable law students and staff to be both skilled consumers and producers of empirical legal research. Drawing on a case study of initiatives at Melbourne Law School, I consider how empirical legal research could be embedded into law teaching, to better support the future of empirical legal scholarship. [ABSTRACT FROM AUTHOR]

This document, published in the journal Clinical Neuroradiology, discusses the Quattro Technique for treating medium distal vessel occlusion (MDVO) stroke. The technique involves using a combination of a stent retriever and aspiration catheter to remove blood clots in the cerebral vasculature. The authors report their preliminary experience with the technique and discuss its potential advantages and pitfalls. The document includes illustrations and a case presentation to provide further context. The article provides detailed instructions on how to perform the procedure and highlights the importance of avoiding certain pitfalls. The authors suggest that further research is needed to explore the effectiveness of the quattro technique in prospective studies and randomized trials. [Extracted from the article]

Endovascular therapy (EVT) is the standard treatment for ischemic stroke caused by a large vessel occlusion (LVO). The effectiveness of EVT for distal medium vessel occlusions (MDVOs) is still uncertain, but newer, smaller devices show potential for EVT in MDVOs. The new Solitaire X 3 mm device offers a treatment option for MDVOs. Our study encompassed consecutive cases of primary and secondary MDVOs treated with the Solitaire X 3 mm stent-retriever as first-line EVT device between January and December 2022 at 12 European stroke centers. The primary endpoint was a first-pass near-complete or complete reperfusion, defined as a modified treatment in cerebral infarction (mTICI) score of 2c/3. Additionally, we examined reperfusion results, National Institutes of Health Stroke Scale (NIHSS) scores at 24 h and discharge, device malfunctions, complications and procedural technical parameters. Sixty-eight patients (38 women, mean age 72 ± 14 years) were included in our study. Median NIHSS at admission was 11 (IQR 6–16). In 53 (78%) cases, a primary combined approach was used as the frontline technique. Among all enrolled patients, first-pass mTICI 2c/3 was achieved in 22 (32%) and final mTICI 2c/3 in 46 (67.6%) patients after a median of 1.5 (IQR 1–2) passes. Final reperfusion mTICI 2b/3 was observed in 89.7% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR 0–4), and no symptomatic intracranial hemorrhages were reported. Based on our analysis, the utilization of the Solitaire X 3 mm device appears to be both effective and safe for performing EVT in cases of MDVO stroke. [ABSTRACT FROM AUTHOR]

Background and Purpose: COVID‐19 infections caused by SARS‐CoV‐2 disseminated through human‐to‐human transmission can evoke severe inflammation. Treatments to reduce the SARS‐CoV‐2‐associated inflammation are needed and are the focus of much research. In this study, we investigated the effect of N‐ethyl‐N′‐[(3β,5α)‐17‐oxoandrostan‐3‐yl] urea (NEOU), a novel 17α‐ketosteroid derivative, on the severity of COVID‐19 infections. Experimental Approach: Studies were conducted in SARS‐CoV‐2‐infected K18‐hACE2 mice. Key Results: SARS‐CoV‐2‐infected K18‐hACE2 mice developed severe inflammatory crises and immune responses along with up‐regulation of genes in associated signalling pathways in male more than female mice. Notably, SARS‐CoV‐2 infection down‐regulated genes encoding drug metabolizing cytochrome P450 enzymes in male but not female mice. Treatment with NEOU (1 mg·kg−1·day−1) 24 or 72 h post‐viral infection alleviated lung injury by decreasing expression of genes encoding inflammatory cytokines and chemokines while increasing expression of genes encoding immunoglobins. In situ hybridization using RNA scope™ probes and immunohistochemical assays revealed that NEOU increased resident CD169+ immunoregulatory macrophages and IBA‐1 immunoreactive macrophage‐dendritic cells within alveolar spaces in the lungs of infected mice. Consequentially, NEOU reduced morbidity more prominently in male than female mice. However, NEOU increased median survival time and accelerated recovery from infection by 6 days in both males and females. Conclusions and Implications: These findings demonstrate that SARS‐CoV‐2 exhibits gender bias by differentially regulating genes encoding inflammatory cytokines, immunogenic factors and drug‐metabolizing enzymes, in male versus female mice. Most importantly, we identified a novel 17α‐ketosteroid that reduces the severity of COVID‐19 infection and could be beneficial for reducing impact of COVID‐19. [ABSTRACT FROM AUTHOR]

According to laboratory federalism, federal systems can promote governmental innovation and experimentation, while containing the risks of innovation to only one jurisdiction. However, it is unclear whether these benefits are realised in practice and whether states are actually effective 'laboratories'. This article evaluates the extent to which laboratory federalism is occurring in practice, focusing on a case study of age discrimination law in Australia. Drawing on related ideas of democratic experimentalism; legal doctrinal analysis of age discrimination law in the Australian states and territories, and at the federal level; and qualitative expert interviews with 66 Australian respondents, I map the potential and limits of laboratory federalism in advancing age equality. I argue that, in this particular context, the benefits of experimentation may be outweighed by the resulting difficulties of enforcing age discrimination law, exacerbating inequality in practice. The federal structure has led to a confused and confusing patchwork of legal regulation. There is therefore a need for stronger federal structures to facilitate mutual learning and better realise the benefits of laboratory federalism. [ABSTRACT FROM AUTHOR]

Forest School provision is a growing phenomenon in the UK due to its perceived impact on participant learning and wellbeing. This study sought to understand the impact of Forest School provision on the social and emotional development of participants using practitioner's reflections. Semi-Structured interviews with six qualified Forest School Leaders explored practitioner experiences working with children and young people. A thematic analysis with a social-constructionist epistemology revealed three interrelated themes, which are inherent in the Forest School ethos. These themes show Forest Schools to be micro-communities constructed by participants. The study concluded that Forest School micro-communities are established by each Forest School that is formed. These micro-communities contribute to the social and emotional development of children and young people through the construction of a shared space, fostering a sense of community and a shared power paradigm between leaders and participants. [ABSTRACT FROM AUTHOR]

Endovascular embolization techniques are showing an extraordinary potential to treat patients suffering from complex neurovascular malformations. The embolization with liquid embolic agents via Onyx is a prominent approach to treat arteriovenous malformation (AVM). However, intraoperative reflux of the liquid agents can be very challenging and, thus, is impairing full success of endovascular treatment. A possible technique to prevent intraoperative endovascular reflux is the pressure-cooker technique (PCT) utilizing coils to build a wedge proximal to the AVM. Few modifications of the PCT have been developed in the recent years to improve effectiveness of embolization procedure. Hereby, we present a novel PCT modification utilizing extra-soft Kaneka coils and glue to build well-fitting wedges. After the application of extremely soft bare coils with high trackability, flexibility and crossability, liquid agents can be injected with reduced reflux. We think the pressure-cooker technique with extra-soft Kaneka coils enables more efficient embolization in even farther, tinier and more tortuous target vessels. This technical note presents two illustrative patient cases with treatment-refractory, high-grade cerebral arteriovenous malformations which were successfully treated via embolization with PCT in which the plug was formed with Kaneka coils. [ABSTRACT FROM AUTHOR]

Discrimination law primarily relies on individual enforcement for addressing discrimination at work; yet those who are most impacted by discrimination are likely the least able to enforce their rights. The question then becomes: what role should individual enforcement play in discrimination law? Can we effectively abandon individual enforcement as part of the legislative model? Drawing on a mixed method, multi-year comparative study of the enforcement of age discrimination law in the UK, Australia and Sweden, this paper considers the gaps, limits and risks of the individual enforcement model in discrimination law. Integrating doctrinal analysis; statistical analysis of claims and cases, and data from the EU and OECD; qualitative expert interviews; and a survey of legal practitioners, this paper argues that while individual enforcement is inherently limited as a tool for achieving systemic change, it must remain part of any legislative model. Reflecting on the experience in Sweden, where individual enforcement of discrimination law is significantly curtailed, the paper posits that individual rights and individual enforcement remain important complements to other regulatory tools, particularly in jurisdictions with strong enduring age norms. Abandoning or severely restricting individual enforcement is unlikely to support either the macro or micro effectiveness of age discrimination law. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is common and adversely impacts quality‐of‐life and healthcare cost. In Australia, less than 10% of bariatric surgeries are performed in the public sector. This study reports our 10‐year experience from a high volume public bariatric service which delivers multi‐disciplinary care for primary and revisional procedures with mid‐ to long‐term follow‐up. Methods: A prospectively maintained database of all patients who underwent bariatric surgery from January 2010 to January 2020 at a tertiary metropolitan hospital was analysed. We analysed patient demographics, comorbidities, perioperative outcomes, 2‐ and 5‐year weight loss as well as comorbidities reduction. Results: A total of 995 patients underwent 1086 (674 primary and 412 revisional) bariatric procedures with mean age of 46.9 years, mean BMI of 49.6 ± 9.1 kg/m2 and 92% patients with ≥1 obesity‐related co‐morbidity. Length‐of‐stay was longer for revisional than primary surgery (5.6 vs. 3.5 days). Major complication rate was 4.2%. Overall, % Total body weight loss (%TBWL) for primary surgeries at 2 years was 26.2%, and for revision surgery was 17.4%. At 2 years follow‐up, treatment was ceased or reduced in 65% of diabetics, 29% of hypertensive patients and 69% of sleep apnoea patients. Conclusion: This study confirms that bariatric surgery in Australia can be delivered effectively in resource constrained public health system with outcomes similar to private sector. [ABSTRACT FROM AUTHOR]

Spinal fractures are the third most common traumatic injury in older people, of which cervical spine injuries make up around 15%. They are predominantly seen in people living with frailty who fall from standing height. Spinal fractures in this patient group are associated with substantial morbidity and mortality (over 40% at 1 year). For many older people who survive, their injuries will be life changing. Practice between EDs varies significantly, with no universally accepted guidelines on either assessment, investigation or management specific to older people experiencing trauma. This expert practice review examines the current evidence and emergency management options in this patient group through clinical scenarios, with the aim of providing a more unified approach to management. [ABSTRACT FROM AUTHOR]

Introduction: While intracranial aneurysms are common lesions affecting between 1 and 5% of the general population, the prevalence in professional athletes remains unknown. The result is uncertainty and lack of guidelines on appropriate treatment of these patients. Case Presentation: A 29-year-old professional soccer player presented in our hospital with an incidentally found intracranial aneurysm. After detailed depiction of the aneurysm and interdisciplinary discussion, endovascular treatment using a flow diverter was chosen to be the best treatment modality. Postinterventional medication consisted of dual antiplatelet therapy with aspirin and clopidogrel. The main challenge in managing the case of our patient was the combination of the dual antiplatelet treatment regime with his professional career in a contact sport. Conclusion: Due to lack of literature or similar reports regarding the management of professional athletes with intracranial aneurysms, the optimal treatment strategy remains unclear. Even though decisions should be made dynamically and case-adapted to each situation, developing a registry could help provide guidance and new ideas for similar cases in the future. [ABSTRACT FROM AUTHOR]

Purpose: The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications. Materials and methods: This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis. Results: Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred. Conclusion: Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications. [ABSTRACT FROM AUTHOR]

Background: The performance of laparoscopic sleeve gastrectomy has increased markedly to become the single-most performed bariatric surgical procedure globally. To date, a means of standardized trainee teaching has not been developed. The aim of this study was to design a laparoscopic curriculum for trainees of bariatric surgery utilizing modified Delphi consensus methodology. Methods: A panel of surgeons was assembled to devise an academic framework of technical, non-technical and cognitive skills utilized in the performance of laparoscopic sleeve gastrectomy. The panel invited 18 bariatric surgeons experienced in laparoscopic gastrectomy from 11 countries to rate the items for inclusion in the curriculum to a predefined level of agreement. Results: A consensus of experts was achieved for 24 of the 30 proposed elements for inclusion within the first round of the curriculum Delphi panel. All components pertaining to anatomical knowledge, peri-operative considerations and non-technical items were accepted. A second round further examined six statements, of which three were accepted. Agreement of the panel was reached for 27 of the cognitive, technical and non-technical components after two rounds. Three statements found no consensus. Conclusions: Utilizing modified Delphi methodology, a curriculum outlining the most important components of teaching the procedure of laparoscopic sleeve gastrectomy, has been determined by a consensus of international experts in bariatric surgery. The curriculum is suggested as a standard in proficiency-based training of this procedure. It forms a generic template which facilitates individual jurisdictions to perform content validation, adapting the curriculum to local requirements in teaching the next generation of bariatric surgeons. [ABSTRACT FROM AUTHOR]

The online publication of employment tribunal (ET) decisions in England, Wales and Scotland marks a watershed moment, opening up new innovative avenues for legal research, and promoting transparency in labour law decision-making. Drawing on this 'dataset', and using age discrimination decisions as a lens to facilitate analysis, this paper reflects on the advantages and limitations of using online ET decisions as a data source to support labour law research. By considering matters of time in age discrimination decisions – both in relation to time limits for bringing a claim, and ET delays – this paper uses innovative empirical findings to map the limits of the individual enforcement model adopted by discrimination laws, and illustrates some of the barriers to successfully bringing a claim for discrimination. [ABSTRACT FROM AUTHOR]

Background: The application of a new coating to the delivery wire of the Trevo retriever has the potential to improve its handling. We therefore report our initial experience with this new stent retriever for mechanical thrombectomy of large and medium vessel occlusions. Methods: We pooled data of four high-volume European stroke centers over the time period from October 2020 to February 2021. Patients were included in our study if the Trevo NXT stent retriever was used as a first-line device. Primary endpoints were first-pass near-complete or complete reperfusion, defined as mTICI score of ≥2c. Secondary endpoints were final reperfusion, National Institutes of Health Stroke Scale (NIHSS) at 24 h and discharge, device malfunctions, complications during the procedure, and subjective ratings of the interventionalists regarding device functionality. Results: Eighty patients (39 women, mean age 74 ± 14 years) were eligible for our study. Median NIHSS at admission was 15 (IQR, 8–19), and median Alberta Stroke Program Early CT Score at baseline was 9 (IQR, 8–10). In 74 (93%) patients a primary combined approach was used as first-line technique. First-pass near-complete reperfusion was achieved in 43 (54%) and first-pass complete reperfusion in 34 (43%) patients. Final near-complete reperfusion was achieved in 66 (83%) patients after a median of 1.5 (1–3) passes, while final successful reperfusion was observed in 96% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR, 0–5), and 3 patients (4%) suffered a symptomatic intracranial hemorrhage. Conclusions: Based on our initial data, we conclude that the Trevo NXT is an effective and safe tool for mechanical thrombectomy especially when used for combined approaches. [ABSTRACT FROM AUTHOR]

Purpose: The global rise in obesity has been accompanied by widespread uptake of the procedure of laparoscopic sleeve gastrectomy. Despite this, the key components for performance assessment have not been standardized for this procedure. The aim of this study was to develop and demonstrate the validity of a Sleeve Objective Structured Assessment of Technical Skill (SOSATS) scale for learning the procedure of laparoscopic sleeve gastrectomy (LSG). Materials and Methods: The SOSATS evaluation tool was based upon critical steps of the LSG procedure. Both the SOSATS and the Global Rating Scale (GRS) component of the Objective Structured Assessment of Technical Skill (OSATS) tools were utilized in a prospective single-blinded observational study design of 26 video recordings of surgeons performing sleeve gastrectomies using a novel simulation. The surgeons were allocated into "novice" or "experienced" groups dependent on case-volume criteria. Surgical performance was assessed using both the GRS and SOSATS scales by blinded assessors of the video recordings. Results: Face and content validity were demonstrated for key components of the simulated model. An overall positive correlation was established inferring concurrent validity between the accepted OSATS Global Rating Scale against the SOSATS procedural scale. Construct validity was established for a number of areas of the SOSATS scale. Conclusion: The SOSATS scale is shown to exhibit construct and concurrent validity in the simulated setting for the procedure of sleeve gastrectomy. Utilizing this scale to review surgical performance is potentially feasible and reliable but would require further research prior to use in high-stakes assessment processes such as credentialing. [ABSTRACT FROM AUTHOR]

The article offers information on chasing elimination through lockdowns is stamping out livelihoods and lives. Topics include the life similar to pre-COVID-19 depends on the development of an effective vaccine which faces the serious problem of antibody induced enhancement, and the vaccine has developed it is unlikely to achieve elimination and since cases continue despite has widespread immunisation.

Precarious work is becoming increasingly prevalent in academe, as tenured opportunities diminish and university employment practices adapt to a volatile and internationalised funding context. This article explores the notion of precarious work as it applies to academic work, particularly in the context of legal education. It analyses available statistical evidence to map and unpack the prevalence of precarious work in higher education in the United Kingdom and Australia. Drawing on an original empirical survey of law academics in the UK and Australia, the article examines the implications of increasing employment precarity for legal education. [ABSTRACT FROM AUTHOR]

Judicial incapacity, while under-researched, presents unique challenges for supporting and responding to issues of judicial performance. In this article, we argue for a reconceptualisation of this topic based on contemporary theories of socially-constructed disability and principles of anti-discrimination law. While assisting and supporting judicial officers who are attempting to work with a disability or ongoing health issue will always be complex, this reconceptualisation offers heads of jurisdiction, conduct commissions and parliamentarians, who retain the ultimate sanction of removal, the opportunity to craft a surer guide for handling cases of incapacity. This will not only better serve the individual concerned, affording them greater agency and dignity than has traditionally been the case, but also protect the principle of judicial independence. [ABSTRACT FROM AUTHOR]

Soft tissue sarcomas are common neoplasms accounting for 1% of all adult malignancies; however, soft tissue sarcomas infrequently arise from the abdominal viscera. Many case reports discuss gastric and esophageal neoplasms. In the group of gastrointestinal liposarcomas, primary duodenal liposarcomas are among the rarest, with only three previous cases reported in the literature. Herein, we discuss a case of primary duodenal liposarcoma. A 59-year-old woman presented with symptoms consistent with anemia raising suspicion for an upper gastrointestinal bleed. Upper endoscopy revealed an ulcerated mass in the first portion of the duodenum. The patient underwent a segmental duodenal resection and distal gastrectomy with Roux-en-Y reconstruction. A diagnosis of dedifferentiated liposarcoma was rendered on the resected specimen. At 16 months' follow-up, the patient remains without evidence of disease recurrence. We have presented a case of primary duodenal liposarcoma, which is among the rarest locations for gastrointestinal sarcomas with only three previous reports in the literature. Liposarcomas should be included in the differential for submucosal masses of the duodenum. [ABSTRACT FROM AUTHOR]

Employment age discrimination cases are notoriously unsuccessful in Australia. While it is arguable that most strong cases are settled through conciliation, serious questions remain: are those cases that proceed to the courts particularly weak? Or are there procedural or substantive legal hurdles that operate as barriers to the success of claims? As the first rigorous study of age discrimination case law across all Australian jurisdictions, this article evaluates these two questions, drawing on employment age discrimination case law at federal, state and territory level up to 2017. This article interrogates and maps, both qualitatively and quantitatively, potential legal barriers to age discrimination claims. It offers original and innovative insights into the cases that proceed to court, and why they fail. It argues that while some cases may be weak, there appear to be procedural and substantive hurdles that limit the success of age discrimination cases. This article offers compelling evidence of the need for legal reform, or for a more sympathetic interpretation of existing statutes by the courts, if individual enforcement is to be used as a means of addressing age discrimination. [ABSTRACT FROM AUTHOR]

Experimentalism is a theory of regulation in which change is achieved via a process of 'directly deliberative polyarchy' within an experimentalist architecture. This paper argues that experimentalism offers a normatively desirable model for legal interventions relating to the ageing workforce, and age equality law in particular, and offers new insights into existing UK scholarship on reflexive law. Drawing on qualitative and quantitative data from UK universities, this article considers the extent to which reforms to retirement ages have promoted a form of experimentalism among UK universities. This paper offers concrete suggestions and reforms for how an experimentalist framework could be adopted in this context to enhance regulatory reform. [ABSTRACT FROM AUTHOR]

We present a case of a 54-year-old man with primary angiitis of the central nervous system (PACNS) who was initially admitted to a psychiatric clinic with a diagnosis of delirium. We discuss the difficulty in establishing the diagnosis of PACNS and provide the reader with some recommendations on how to promptly and correctly diagnose this disease in order to avoid potentially lethal outcomes. [ABSTRACT FROM AUTHOR]

Human dignity is often cited as a justification and foundation for equality law. However, it is also used in some contexts to justify detracting from equal treatment, including in relation to mandatory retirement ages in the UK. Drawing on interdisciplinary scholarship from legal theory and industrial relations, this article argues case law on retirement ages adopts a limited approach to the notion of 'dignity', which is grounded in age stereotypes. It considers how a re-conceptualisation of 'dignity' might inform the future development of the law on retirement ages and proposes alternative ways to secure individual dignity in employment that do not depend on mandatory retirement ages. [ABSTRACT FROM AUTHOR]

Kartagener syndrome is a rare autosomal recessive condition. Approximately 25% of those with situs inversus totalis suffer the syndrome. With the rising overall number and indications for bariatric surgery, this condition will be increasingly recognised. We present a case of a 25-year-old woman with SIT and Kartagener syndrome who underwent a laparoscopic sleeve gastrectomy. As with all bariatric surgery, a multidisciplinary team approach was important in managing such a case. There were considerable cognitive challenges for the surgical team both preoperatively and during the procedure. The patient tolerated the operation well and was discharged 2 days after the surgery. At 12-months follow-up, the patient had achieved 125% excess weight loss. This case illustrates that an experienced surgeon can safely perform a laparoscopic sleeve gastrectomy on a patient with situs inversus totalis. [ABSTRACT FROM AUTHOR]

Background: Gallstones are a common cause of acute pancreatitis. The proposed mechanism by which choledocholithiasis induces pancreatitis is mechanical obstruction of the ampulla leading to the reflux of bile into the pancreatic duct or edema resulting from a gallstone's passage. To our knowledge, there are no previously reported cases of gallbladder adenocarcinoma as a potential cause of acute pancreatitis. Herein, we describe a patient who presented with acute necrotizing pancreatitis, without other associated risk factors, who was found to have a fragmented friable polypoid gallbladder adenocarcinoma. Case Report: A 55-year old Hispanic female with prediabetes presented to the Emergency Department with severe epigastric abdominal pain radiating to her back. The patient's clinical presentation, laboratory tests and computed tomography imaging were suggestive of acute necrotizing pancreatitis and a gallbladder lesion concerning for neoplasm. After clinical resolution of her pancreatitis, the patient was brought to the operating room for a cholecystectomy. Final pathology revealed a stage T1aN0 gallbladder adenocarcinoma. Conclusions: We have presented a patient with acute necrotizing pancreatitis in the absence of alcohol abuse, gallstones, biliary sludge, hypertriglyceridemia, hypercalcemia, or hereditary predisposition. Without evidence of other etiologies, we hypothesize that the friable tumor fragments of the gallbladder adenocarcinoma might be the underlying cause of pancreatitis in this patient. [ABSTRACT FROM AUTHOR]

Background and purpose: Aneurysms of the posterior inferior cerebellar artery (PICA) are relatively uncommon and evidence is sparse about patients presenting with ruptured PICA aneurysms. We performed an analysis of the Swiss SOS national registry to describe clinical presentation, treatment pattern, and neurological outcome of patients with ruptured PICA aneurysms compared with other ruptured posterior circulation (PC) aneurysms. Methods: This was a retrospective analysis of anonymized data from the Swiss SOS registry (Swiss Study on Aneurysmal Subarachnoid Hemorrhage; 2009–2014). Patients with ruptured PC aneurysms were subdivided into a PICA and non-PICA group. Clinical, radiological, and treatment-related variables were identified, and their impact on the neurological outcome was determined in terms of modified Rankin score at discharge and at 1 year of follow-up for the two groups. Results: Data from 1864 aneurysmal subarachnoid hemorrhage patients were reviewed. There were 264 patients with a ruptured PC aneurysm. Seventy-four PICA aneurysms represented 28% of the series; clinical and radiological characteristics at admission were comparable between the PICA and non-PICA group. Surgical treatment was accomplished in 28% of patients in the PICA group and in the 4.8% of patients in the non-PICA group. No statistically significant difference was found between the two groups in terms of complications after treatment. Hydrocephalus requiring definitive shunt was needed in 21.6% of PICA patients (p = 0.6); cranial nerve deficit was present in average a quarter of the patients in both PICA and non-PICA group with no statistical difference (p = 0.3). A more favorable outcome (66.2%) was reported in the PICA group at discharge (p < 0.05) but this difference faded over time with a similar neurological outcome at 1-year follow-up (p = 0.09) between both PICA and non-PICA group. The Kaplan-Meyer estimation showed no significant difference in the mortality rate between both groups (p = 0.08). Conclusions: In the present study, patients with ruptured PICA aneurysms had a favorable neurological outcome in more than two thirds of cases, similar to patients with other ruptured PC aneurysms. Surgical treatment remains a valid option in a third of cases with ruptured PICA aneurysms. [ABSTRACT FROM AUTHOR]

Judges fulfil a fundamental constitutional role in democratic systems. Most research on judges, though, focuses on the public and constitutional significance of the judicial role, not the needs of individual judges. This article applies a labour law lens to help reconceive the judicial role in a way that balances the individual and collective needs of judges with the institutional and constitutional needs of the third arm of government, drawing on comparative analysis of Australia and the United Kingdom, and examples from common law countries. I argue that, while some progress has been made towards using labour law to structure and inform judicial roles, labour law offers new insights into how judges and judicial work might be supported. This may both assist judges in their individual capacity and support the judiciary as an institution. It therefore has significance for judges as individuals and the judiciary's fundamental constitutional role. [ABSTRACT FROM AUTHOR]

Background: Choroid plexus papillomas (CPPs) are infrequently encountered brain tumors with the majority originating in the ventricular system. Rarely, CPP occurs outside of the ventricles. Case Description: We report the case of a recurrent CPP that initially originated within the fourth ventricle, though years later it recurred in the left middle cerebellar peduncle. Conclusion: Patients with cerebellar plexus papilloma need long-term follow-up comprising regular magnetic resonance imagings since, in patients with a history of CPP, any new mild symptomatology, even years after the initial presentation, may be an early sign of tumor recurrence. [ABSTRACT FROM AUTHOR]

Background: The treatment of ruptured posterior circulation aneurysms remains challenging despite progresses in the endovascular and neurosurgical techniques.Objective: To provide epidemiological characterization of subjects presenting with ruptured posterior circulation aneurysms in Switzerland and thereby assessing the treatment patterns and neurological outcomes.Methods: This is a retrospective analysis of the Swiss SOS registry for patients with aneurysmal subarachnoid hemorrhage. Patients were divided in 3 groups (upper, lower, and middle third) according to aneurysm location. Clinical, radiological, and treatment-related variables were identified and their impact on the neurological outcome was determined.Results: From 2009 to 2014, we included 264 patients with ruptured posterior circulation aneurysms. Endovascular occlusion was the most common treatment in all 3 groups (72% in the upper third, 68% in the middle third, and 58.8% in the lower third). Surgical treatment was performed in 11.3%. Favorable outcome (mRS ≤ 3) was found in 56% at discharge and 65.7% at 1 year. No significant difference in the neurological outcome were found among the three groups, in terms of mRS at discharge (p = 0.20) and at 1 year (p = 0.18). High WFNS grade, high Fisher grade at presentation, and rebleeding before aneurysm occlusion (p = 0.001) were all correlated with the risk of unfavorable neurological outcome (or death) at discharge and at 1 year.Conclusions: In this study, endovascular occlusion was the principal treatment, with a favorable outcome for two-thirds of patients at discharge and at long term. These results are similar to high volume neurovascular centers worldwide, reflecting the importance of centralized care at specialized neurovascular centers. [ABSTRACT FROM AUTHOR]

Young workers occupy a particularly vulnerable position in the contemporary labour market. While this may partly be attributable to structural trends, it is also related to age discrimination, which is embedded in labour law and organisational practices. Age discrimination against younger workers raises many of the same tensions as age discrimination against older workers. This article therefore calls for a reconsideration of how we frame and conceive age discrimination law. [ABSTRACT FROM AUTHOR]

Grading scales yield objective measure of the severity of aneurysmal subarachnoid hemorrhage and serve as to guide treatment decisions and for prognostication. The purpose of this cohort study was to determine what factors govern a patient’s disease-specific admission scores in a representative Central European cohort. The Swiss Study of Subarachnoid Hemorrhage includes anonymized data from all tertiary referral centers serving subarachnoid hemorrhage patients in Switzerland. The 2009-2014 dataset was used to evaluate the impact of patient and aneurysm characteristics on the patients’ status at admission using descriptive and multivariate regression analysis. The primary/co-primary endpoints were the GCS and the WFNS grade. The secondary endpoints were the Fisher grade, the presence of a thick cisternal or ventricular clot, the presence of a new focal neurological deficit or cranial nerve palsy, and the patient’s intubation status. In our cohort of 1787 consecutive patients, increasing patient age by 10 years and low pre-ictal functional status (mRS 3-5) were inversely correlated with “high” GCS score (GCS ≥ 13) (OR 0.91, 95% CI 0.84-0.97 and OR 0.67, 95% CI 0.31-1.46), “low” WFNS grade (grade VI-V) (OR 1.21, 95% CI 1.04-1.20 and OR 1.47, 95% CI 0.66-3.27), and high Fisher grade (grade III-IV) (OR 1.08, 95% CI 1.00-1.17 and OR 1.54, 95% CI 0.55-4.32). Other independent predictors for the patients’ clinical and radiological condition at admission were the ruptured aneurysms’ location and its size. In sum, chronological age and pre-ictal functional status, as well as the ruptured aneurysm’s location and size, determine the patients’ clinical and radiological condition at admission to the tertiary referral hospital. [ABSTRACT FROM AUTHOR]