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In late 2016, 21 American and Canadian diplomatic personnel stationed in Havana, Cuba, experienced unusual and unexplained health problems. Although symptoms varied among those affected, the onset of illness was [...]

Despite workplaces having policies on fire evacuation, many employees still fail to evacuate when there is a fire alarm. The Reasoned Action Approach is designed to reveal the beliefs underlying people's behavioral decisions and thus suggests causal determinants to be addressed with interventions designed to facilitate behavior. This study is a uses a Reasoned Action Approach salient belief elicitation to identify university employees' perceived advantages/disadvantages, approvers/disapprovers, and facilitators/barriers toward them leaving the office building immediately the next time they hear a fire alarm at work.

Our findings demonstrate substantial variation in the diagnosis of cervical precancerous lesions by colposcopists, pathologists, and particularly between laboratory facilities across the United States.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2008.08.003 Byline: James L. Ebaugh (a)(b), David Gagnon (c)(d), Christopher D. Owens (a)(b), Michael S. Conte (b), Joseph D. Raffetto (a)(b) Keywords: Hybrid; Healthcare costs; Utilization; Vascular surgery; Percutaneous transluminal angioplasty and stent; Lower extremity bypass Abstract: Hybrid procedures combine endovascular and open surgical techniques. We examined utilization rates and ways of performing them more efficiently. Author Affiliation: (a) Boston VA Healthcare System, Surgical Service (112), 1400 VFW Pkwy, West Roxbury, MA 02132, USA (b) Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (c) Massachusetts Veterans Epidemiology Research and Information Center, VA Cooperative Studies Program, Boston, MA, USA (d) Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA Article History: Received 21 May 2008; Revised 11 August 2008

Abstract We describe what we believe is the first reported case of simultaneous highly invasive cutaneous and laryngopharyngeal zygomycosis in a non-neutropenic, nondiabetic but immunosuppressed patient with prostate cancer. An [...]

Because of the high rates of false-negative or nondiagnostic ureteral Piranha microbiopsies associated with low cellularity, we assessed the effect of processing these using cytology.

The September 2002 publication of The National Security Strategy of the United States of America represents for the Bush administration a significant departure from previous strategies, particularly the stated willingness [...]

The article discusses the disagreement between the Navy and Marine Corps over the sustainment requirements for the Light Amphibious Warship (LAW) and the larger issue of how the Corps will sustain remotely deployed units under its latest operating concept.

Objective:To evaluate evidence regarding 25-hydroxyvitamin D (25(OD)D) levels during pregnancy and its association with postpartum depression (PPD). Data Sources:Primary literature was accessed through MEDLINE, Google Scholar, and International Pharmaceutical Abstracts searches through January 2015. Data from published trials were retrieved for analysis using the following search terms: vitamin D, 25-hydroxyvitamin D, 25(OH)D, postpartum, pregnancy, and depression. Data Extraction:Inclusion criteria were human subjects, English language, vitamin D as the sole micronutrient under study, and measurement of vitamin D level during pregnancy. Studies measuring vitamin D levels after delivery were excluded. Also any antenatal or prepartum depression was excluded. Data Synthesis:Although a variety factors may contribute to the likelihood and severity of PPD, there are 3 published prospective cohort studies specifically evaluating the relationship between vitamin D and PPD. The results are conflicting: 2 of these studies found a significant correlation between patients with low vitamin D level and PPD, but the third found that high vitamin D levels are associated with a greater incidence of PPD. Conclusion:Available evidence suggests a possible correlation between vitamin D levels at midpregnancy and PPD. Women with risk factors for PPD should be educated on this potential association and ways to maintain normal vitamin D levels. Further study is needed to determine the benefit of vitamin D supplementation in preventing PPD.

"How to Handle His Flare-Ups' was right. Women need to wait for guys to calm down. Then we'll let you know if we want to talk. But I agree that […]

Cytopathologist's review of Papanicolaou tests (PTs) screened by cytotechnologists as negative for intraepithelial lesion or malignancy (NILM) that are positive for high-risk human papillomavirus (hrHPV+) may be a useful quality control measure.

The goal of Barrett esophagus surveillance is to identify high-grade dysplasia (HGD) for eradication. Surveillance programs currently rely on limited histologic sampling; however, the role of cytology in this setting is not well studied.

Renal toxicity from conventional, iodinated, intravenous contrast agents is a common complication in patients with peripheral artery disease (PAD). Similarly, the potential for serious side effects prevents the use of gadolinium-based agents in many patients with depressed renal function. Ferumoxytol-enhanced magnetic resonance angiography (Fe-MRA) is a novel technique that uses an intravenous, ultrasmall, superparamagnetic, iron oxide preparation, currently approved by the Food and Drug Administration for the treatment of iron deficiency anemia in adults with chronic kidney disease. Our objective was to determine the feasibility of Fe-MRA for clinical decision making in PAD patients.

Low-grade intraductal papillary mucinous neoplasms (IPMN) are challenging to diagnose because of an absence of reliable morphologic or immunohistochemical features to distinguish them from contaminating gastric foveolar epithelium. After noting intranuclear cytoplasmic inclusions (ICIs) in some cases of IPMN, we investigated whether ICIs could be used as a specific feature to distinguish IPMN from gastric foveolar epithelium.

Endovascular interventions on peripheral arteries are limited by high rates of restenosis. Our hypothesis was that adventitial injection of rapamycin nanoparticles would be safe and reduce luminal stenosis in a porcine femoral artery balloon angioplasty model.

The article discusses the author's efforts in constructing a map that would accurately display the various tracts of land on U.S. President James Monroe's Highland estate in Albemarle County, Virginia. The author describes his historical research process, in which he analyzed Monroe's deeds land titles.

Atherosclerosis is a chronic inflammatory disease of the vessel wall. Recent evidence suggests that chronic vascular inflammation ensues as an imbalance between pro- and anti-inflammatory mediators. Recently identified lipid mediators (eg, lipoxins and resolvins) play active roles in promoting the resolution of inflammation. Alterations in vascular smooth muscle cell (VSMC) phenotype, which manifest as a loss of contractile protein expression and increased proliferation and migration, are prominent mechanistic features of both atherosclerosis and restenosis following various interventions (eg, angioplasty and bypass grafting). We sought to determine whether human atherosclerosis is associated with a “resolution deficit” and whether lipoxins and resolvins influence VSMC phenotype. Here we report that plasma levels of aspirin-triggered lipoxin are significantly lower in patients with symptomatic peripheral artery disease than in healthy volunteers. Both aspirin-triggered lipoxin and resolvin E1 block platelet-derived growth factor-stimulated migration of human saphenous vein SMCs and decrease phosphorylation of the platelet-derived growth factor receptor-β. Importantly, receptors for aspirin-triggered lipoxin and resolvin E1 (ALX and ChemR23, respectively) were identified in human VSMCs. Overall, these results demonstrate that stimulatory lipid mediators confer a protective phenotypic switch in VSMCs and elucidate new functions for these mediators in the regulation of SMC biology. These results also suggest that peripheral artery disease is associated with an inflammation-resolution deficit and highlight a potential therapeutic opportunity for the regulation of vascular injury responses.

Purpose The maturation of an arteriovenous fistula (AVF) requires remodeling of the arterial inflow and the venous outflow limbs to sustain flows sufficient to support hemodialysis. However, factors influencing remodeling of AVF are poorly understood. We hypothesized that AVF remodeling was an endothelium-dependent process.Methods This is a prospective cohort study of patients (n=25) undergoing autologous AVF formation. Brachial artery vasoreactivity studies were performed pre-operatively to assess endothelium-dependent, flow-mediated vasodilation (FMD). High-resolution ultrasound was used to assess venous and arterial diameters intraoperatively, and at 3 months.Results The mean age was 64.5 ± 13.6 yrs. Twelve patients (48%) had diabetes. The mean FMD for the entire cohort was (mean ± SEM) 5.82 ± 0.9%, (range) 0–17.3%. The vein increased in size 3.19 ± .28 to 6.11 ± .41 mm, 108.4 ± 17.9%, p=.0001, while the artery increased from 3.29 ± .14 to 4.48 ± .30 mm, 20.47 ± 10.8%, p=.013. There was a significant positive correlation between the degree of arterial and venous remodeling, r=.52, p=.023. Brachial artery FMD most strongly correlated with the magnitude of arterial remodeling, r=.47, p=.038. Patients with diabetes failed to undergo venous remodeling to the same extent as did those without diabetes, 59.2 ± 24.4% vs. 141.5 ± 25.4%, p=.04.Conclusion Impairment of endothelial function is associated with decreased arterial remodeling and final venous lumen diameter attained at 3 months. Further investigation is needed to determine whether modulation of endothelial function in this cohort can improve AVF maturation.

To assess and compare the attitudes of primary care physicians and midlevel providers toward community pharmacists by surveying the frequency and perceived helpfulness of practitioner-pharmacist interactions, as well as attitudes toward traditional and expanded functions.

BACKGROUND:ThinPrep liquidbased cytology TP preparations are being used increasingly in nongynecologic specimens. To the authors knowledge, few studies to date have evaluated TP cytology in the setting of small cell carcinoma of the lung SCCL. Accurately differentiating SCCL from other lung tumors has important clinical and therapeutic implications. Herein, the authors evaluated the diagnostic utility and cytomorphology of TP in the setting of SCCL.METHODS:All cases of SCCL with prior or concurrent TP cytologic specimens were identified via computer search. The cytodiagnoses were tabulated. When available, cytologic material was reviewed. Performance parameters of the various cytologic modalities processed with TP were calculated.RESULTS:In 121 patients with SCCL, 261 TP specimens were identified. The cytodiagnoses were: SCCL 119 specimens, suspicious for SCCL 45 specimens, atypical cellsnot otherwise specified 22 specimens, negativenondiagnostic 63 specimens, and nonsmall cell carcinoma 4 specimens. During the same period of time, 3 cases of falsepositive diagnoses of SCCL were identified. The positive predictive value for a cytodiagnosis of SCCL on TP was 97.5, and the sensitivity was 62.8. Bronchial brush was the most sensitive cytologic modality 78.3. Immunostaining was found to be contributory to the diagnosis in 10 of the 11 cases in which it was attempted.CONCLUSIONS:TP is a sound alternative to conventional preparations for the cytodiagnosis of SCCL. Cytomorphology of SCCL is altered in TP with less molding, less cell fragility, more discohesion, and tumor cell shrinkage artifact. Immunohistochemical staining of cellblocks is a useful adjunct in challenging cases. A positive cytodiagnosis of SCCL on TP can be used to initiate definitive therapy when biopsy is not possible. Cancer Cancer Cytopathol 2009. © 2009 American Cancer Society.

Compared with standard donors, kidneys recovered from donors after cardiac death (DCD) exhibit higher rates of delayed graft function (DGF), and DCD livers demonstrate higher rates of biliary ischemia, graft loss, and worse patient survival. Current practice limits the use of these organs based on time from donor extubation to asystole, but data to support this is incomplete. We hypothesized that donor postextubation parameters, including duration and severity of hemodynamic instability or hypoxia might be a better predictor of subsequent graft function.

Background:An isolated injury to the calcaneocuboid joint is frequently unrecognized clinically. The possibility of an injured dorsal calcaneocuboid ligament (DCC) should be considered in all acutely swollen feet after trauma involving supination. Despite its significance, there is much confusion in the literature regarding nomenclature, morphology, and location. Materials and Methods:To determine morphometric dimensions, dissection was performed on the feet of 30 adult preserved cadaveric limbs. Results:The DCC was consistently present in all specimens in the form of either a solitary structure (66.6%) or 2 components (33.3%). For the solitary structures, the superior and inferior borders measured 18.6 ± 2.8 mm and 17.3 ± 2.5 mm, respectively. The widths of the calcaneal and cuboid sides were 13.8 ± 2.2 mm and 12.4 ± 2.1 mm, respectively. In the 2 component ligaments, the superior component had a superior and inferior length that averaged 16.9 ± 2.1 mm and 16.4 ± 2.8 mm, respectively. Its calcaneal and cuboid borders were 9.3 ± 1.2 mm and 10.6 ± 1.4 mm, respectively. The inferior component had superior and inferior sides that were 12.9 ± 2.9 mm and 13.8 ± 3.0 mm, respectively. The widths of the calcaneal and cuboid sides were 8.3 ± 1.4 mm and 7.2 ± 1.0 mm, respectively. Conclusion:We have demonstrated variations in the morphology of the DCC along with its morphometric dimensions. Clinical Relevance:Knowledge of the morphologic variations and dimensions of the DCC can be of aid when planning for surgical management of the ruptured ligament.

Deep fibromatosis or desmoid tumor (DF/DT) is a low‐grade, soft tissue lesion that is notable for its infiltration and local recurrence and its inability to metastasize. Although the histologic features of DF/DT are well described, there is a paucity of literature regarding cytologic findings.The surgical pathology files of The Johns Hopkins Hospital revealed 17 patients with a diagnosis of DF/DT with prior cytology in a 16‐year period (1989–2005). The clinicoradiologic findings were noted, and the fine‐needle aspiration (FNA) slides were available for review in 8 patients. In patients with archived tissue, an immunohistochemical panel was performed that included β‐catenin, desmin, CD‐34, and c‐kit.There was a wide age range and a wide range of anatomic distribution for DF/DT in this series. Eleven patients (65%) had a prior history of surgery at or near the site of DF/DT. Radiologically, 5 of 11 patients (45%) who had in‐house studies available and no history of DF/DT were diagnosed as suspicious for malignancy. Predominantly bland spindled cells with long, fusiform nuclei and metachromatic matrix material were present in most tumors. The tumor cells were present both singly and as fragments embedded in the matrix. Nine patients had paraffin‐embedded tissue samples available for immunohistochemical staining. Six of those samples demonstrated nuclear β‐catenin reactivity, and all 9 samples were negative for desmin, CD‐34, and c‐kit.The current results indicated that clinical history in patients with suspected DF/DT is important. Because of the infiltrative nature of DF/DT, the radiographic impression often is over‐called as suspicious for malignancy. The cytomorphology is nonspecific, often resulting in descriptive diagnoses. Immunohistochemical stains increase the yield of FNA. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.

Passage of a nonpathogenic simian-human immunodeficiency virus (SHIV-HXBc2) in monkeys resulted in changes in the viral envelope glycoproteins that are responsible for a dramatic increase in replication and pathogenicity in vivo. Here, we show that the envelope glycoproteins of the pathogenic SHIV-HXBc2P 3.2 mediate virus entry into rhesus monkey peripheral blood mononuclear cells (PBMC) more efficiently than the parental SHIV-HXBc2 envelope glycoproteins, and study the basis for this increase. Both parental and pathogenic SHIVs exclusively use CXCR4 as a coreceptor. The determinants of the increased entry associated with the SHIV-HXBc2P 3.2 envelope glycoproteins are located in both the gp120 and gp41 subunits. Changes in the gp120 V3 variable loop specify a decreased sensitivity to SDF-1, consistent with an increase in the affinity of the HXBc2P 3.2 gp120 glycoprotein for CXCR4. Thus, multiple changes in the gp120 variable loops and the gp41 ectodomain of a pathogenic SHIV cooperate to allow enhanced replicative capacity, which in part results from increased chemokine receptor binding.

OBJECTIVE: To evaluate the clinical utility of oral conjugated equine estrogen in postmenopausal women with Alzheimer disease.DATA SOURCES: Literature was identified through MEDLINE (1997–January 2002). Key search terms included Alzheimer disease, estrogen replacement therapy, and treatment.DATA SYNTHESIS: Estrogen has been identified as a neuroprotective agent with possible application in degenerative disorders. Observational studies have demonstrated an association between estrogen replacement therapy and decreased incidence of Alzheimer disease. Two recent, controlled clinical trials have evaluated the role of oral conjugated estrogen in the treatment of Alzheimer disease.CONCLUSIONS: Clinical trials indicate that oral conjugated equine estrogen is not an effective treatment for Alzheimer disease in postmenopausal women.

Purpose:The purposes of this study were to evaluate the long-term results of different autogenous conduits used for infrainguinal bypass when ipsilateral greater saphenous vein (IGSV) is absent or inadequate and to determine the impact on the contralateral lower extremity. Methods:The study was performed as a retrospective evaluation of a prospective vascular registry together with review of patient records and telephone follow-up. Results:From January 1990 to June 2000, 226 autogenous infrainguinal reconstructions were performed in 203 patients without adequate IGSV. The patients consisted of 128 men and 98 women, with a mean age of 69 years. Prevalent risk factors included diabetes (51%) and prior coronary bypass (46%). Limb salvage was the predominant indication (93%), and 59% of the procedures were secondary reconstructions. All bypasses were completed with autogenous vein, which included contralateral greater saphenous vein (CGSV; 31%), single-segment lesser saphenous vein (5%), single-segment arm vein (19%), and autogenous composite vein (45%). Bypasses were performed to the tibial and pedal arteries in 84% of the cases. The 30-day mortality and graft occlusion rates were 1% and 9%, respectively. The overall postoperative morbidity rate was 24%, with a 7% rate of major complications. Follow-up was complete in 95% of patients over a mean period of 24 months (range, 0.1 to 106 months). The 5-year primary patency rates were significantly better for CGSV compared with autogenous composite vein grafts (61% ± 7% versus 39% ± 6%; P<.009). The 5-year secondary patency (60% to 73%) and limb salvage (78% to 81%) rates did not differ significantly between the three groups. Follow-up of the contralateral lower limb revealed that nine of 226 limbs (4%) were amputated at a mean of 36 months after the ipsilateral bypass. The overall 5-year contralateral limb preservation rate was 90% ± 3%. Contralateral vein harvest and the presence of diabetes did not affect the need for bypass or amputation of the contralateral limb. Conclusion:For most patients with inadequate IGSV, the CGSV is the alternative conduit of choice because of its length, superior performance, ease of harvest, and minimal risk to the donor limb. (J Vasc Surg 2002;35:1085-92.)

Reasoning from prior cases or abstractions requires that a system identify relevant similarities between the current situation and objects represented in memory. Often, relevance depends upon abstract, thematic, costly-to-infer properties of the situation. Because of the cost of inference, a case-retrieval system needs to learn which descriptions are worth inferring, and how costly tht inference will be. This article outlines the properties that make an abstract thematic feature valuable to a case-based reasoner, and recasts the problem of case retrieval into a framework under which a system can explicitly and dynamically reason about the cost of acquiring features relative to their information value.

Several letters to the editor are presented in response to articles in previous issues including John Cook's essay on countering 'science denial,' and an article by Ian Maxwell on qualified scientists in the March 2016 issue; and "Improving laboratory learning" by Kieran Lim in February 2016 issue.

We have used a multimodality imaging approach to assess the inflammatory component of a growing iliac artery aneurysm in a 53-year-old man who presented with related ureteral obstruction. Research suggests that episodic and heterogeneous inflammatory processes are important for the progression of aneurysms. The combined PET and MRI evaluation of inflammation that we present here is a novel approach to vascular imaging that is well suited for emerging hybrid PETMRI systems.

The article discusses the author's experience as an exercise scientist researching in the field of mental health services. He relates some of the issues and challenges he has come up against, such as securing an ethics approval from the National Health Service. He states that he is using the computer software package NVivo 7 to manage the qualitative data he has collected. He plans to present his research at university research seminars.