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BackgroundDuring the Coronavirus disease (COVID-19) pandemic, countries implemented border control and quarantine measures to reduce transmission. The Alberta Border Testing Pilot Program (ABTPP) allowed international travellers entering Alberta to reduce their quarantine period following two negative COVID-19 tests. We evaluated participant experiences with the ABTPP and implementation.MethodWe used a parallel convergent mixed-methods design to explore participant experiences through electronic web-based questionnaires (n = 21,089; n = 13,839) and semi-structured telephone interviews (n = 30). We evaluated implementation through three staff focus groups (n = 11). We analysed questionnaires using descriptive statistics and analysed interviews using inductive and deductive thematic analysis. We deductively coded focus group data using the 2009 Consolidated Framework for Implementation Research (CFIR).ResultsQuestionnaires indicated minimal issues with registration forms (91.7%), symptom reports (95.5%), and COVID-19 testing (95.7%). Most respondents (95.1%) expressed willingness to participate in the ABTPP again. Interviews revealed three themes related to participant experience: program efficiency, clarity of information, and requisite effort. Focus groups identified key implementation facilitators including the single health information system, strong stakeholder partnerships, and good communication across partnerships. Barriers included program complexity, implementation timeline, and evolving external context.DiscussionParticipants reported high satisfaction with the ABTPP. Border testing programs should have high efficiency, require low effort, and use messaging that is clear and consistent. The effective implementation of border testing programs may be facilitated by strong leadership, adaptability, automated components, good communication, and simple technology. Learnings from participants and staff may help improve the implementation of border control programs for future pandemics or other emergencies.ConclusionsThe ABTTP was a novel border control measure during the COVID-19 pandemic. Our evaluation of both participant and staff experiences demonstrated high levels of traveller satisfaction and identified areas for improvement that can inform the development of future border control measures.

A distinction is often made between two traditions of British Conservative thought: the paternalist “one nation/middle way” tradition, and the more libertarian one that is associated with Margaret Thatcher. Typically, this distinction is mapped onto the ideas that Conservatives hold about equality. While “one nation” Conservatives condone some forms of redistribution, their libertarian counterparts, it is argued, do not. This article reassesses this distinction by comparing the political thinking of two representatives of the two traditions: Harold Macmillan and Margaret Thatcher. Comparing Macmillan and Thatcher’s views on equality, it is argued, is inappropriate as a way of distinguishing between their respective ideologies. Instead, we should draw a distinction between the way that Macmillan and Thatcher arrived at their views about equality. On his part, Macmillan adopted a triadic logic. By conceiving of a “middle way”, he defined his conservatism in relation to the dangerous “extremes” of free market capitalism and state socialism. Thatcher, by contrast, adopted a dyadic logic. Instead of locating herself between two “extremes”, she employed a series of binary distinctions to establish her conception of conservatism. Freedom was preferred to equality; the market was preferred to the state, and so on. The article explores the implications of these differing logics, and it concludes if we are to identify different variants of conservatism, we should be just as concerned with their modes of negation as we are with the affirmative claims they make about concepts like equality.

Abstract Background Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning. Methods Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning. Results Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737). Conclusions To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.

The axis deer (Axis axis) was imported from Germany and introduced into Brijuni in 1911. Brijuni are a group of islands in the Adriatic Sea along the western coast of the southern peak of the Istrian Peninsula in the Republic of Croatia. In 1983 the area was declared a National Park. The objective of this paper was to research the adaptation of the axis deer to living conditions on the islands. Observation has shown that on the Brijuni islands the axis deer lives in herds comprising 10 to 30 individuals. The youngest male deer seeking access to does was four years old, while at the age of fi ve they started roaring. Deer fi ghts are not frequent during roaring period. The natural grazing rhythm is disturbed by the vast number of tourists. The calving periods of the axis deer during the year indicate three well-pronounced ruts, namely January to February, July-August and October-November. They also show that oestrus occurs soon after calving in most of the females. Gestation period of does is 7 to 7.8 months. 85% of the does on the Brijuni Islands produce their offspring in the warmer part of the year, between 1 March and 31 September. The population of the axis deer in the area of the Brijuni National Park is stable, rather numerous (about 100 individuals) and well acclimatized, and as such it presents reproductive material suitable to populate enclosed hunting grounds and big game farms.

Dean Blevins1,2,3, Bridget Morton4, Rene McGovern5,61South Central Mental Illness Research, Education, and Clinical Center (SC-MIRECC), Central Arkansas Veterans Healthcare System; 2University of Arkansas for Medical Sciences; 3University of Phoenix, Little Rock Campus, Little Rock, AR; 4Northeast Missouri Health Network, Kirksville, MO; 5A.T. Still University/Kirksville College of Osteopathic Medicine, Kirksville, MO; 6Case Western Reserve University, Cleveland, OHAbstract: The purpose of this evaluation was to explore the collaborative nature of partners in a rural mental health program for the elderly, and to test an adapted method of assessing the collaborative process. Sixteen collaborative partners were interviewed to explore ratings of collaboration across 6 domains identified as critical to participatory research. Results indicate that the context of rural Missouri and uniqueness of the program necessitated an approach to collaboration that began with a top-down approach, but greater community responsibility developed over time. Partners recognized the efforts of the program’s directors to seek input. Most were satisfied with their roles and the degree of success achieved by the program, although several wanted to have more input in the future in some domains, but not in others. Interviews revealed numerous barriers to achieving sustainability. Methods to improve the assessment of collaboration are discussed and areas for improvement are offered.Keywords: community-based participatory research, elderly, mental health, older adults, rural

We report the imaging features of 4 cases of patients with papillary tumor of the pineal region, a tumor newly recognized in the 2007 World Health Organization "Classification of Tumors of the Nervous System." In each case, the tumor was intrinsically hyperintense on T1-weighted images with a characteristic location in the posterior commissure or pineal region. The pathologic hallmarks of the tumor are discussed, including a possible explanation for the MR imaging characteristics in our cases.

Background and Purpose: Dissection and retraction of the sylvian fissure can cause venous insufficiency and may be an important contributor to postoperative edema or hemorrhage after clipping of a middle cerebral artery (MCA) aneurysm. The incidence of changes in the superficial middle cerebral vein (SMCV) and adjacent veins and whether such changes increase the amount of edema or hemorrhage on postoperative CT is the focus of this study., Methods: Pre- and postoperative angiograms of 100 consecutive patients with MCA aneurysms treated by craniotomy and clipping were compared to determine the postoperative incidence of changes involving the SMCV. CTs from the normal and abnormal postoperative venous groups were compared to determine the amount of edema or presence of parenchymal hemorrhage., Results: Postoperatively, 31 (31%) SMCVs were altered, 20 to a minor or moderate degree. Eleven cases were pronounced. In 9 (9%) cases, the SMCV was completely obscured or failed to fill on postoperative angiography. More edema (observer 1, P < .0002; observer 2, P < .0006) and small brain parenchymal hemorrhages (observer 1, P < .00003; observer 2, P < .00001) were found on the postoperative CT images of the group whose SMCVs were altered than those that were unchanged., Conclusions: Neurosurgeons and neuroradiologists should be attentive to changes in the SMCV and adjacent venous structures to optimize outcomes of procedures involving the sylvian fissure.

An 18-year-old female patient with unilateral hearing loss underwent evaluation with CT and MR imaging. A partially ossified, enhancing lesion in the bony labyrinth, with replacement of adjacent structures, was identified. Surgical biopsy revealed a meningioma arising primarily within the bony labyrinth. To our knowledge, this entity has not been previously described.

Facial and skull base trauma can cause clinically significant epistaxis. Optimal evaluation and treatment require knowledge of the pertinent vascular and skull base anatomy. We describe a patient with extensive skull base injury and epistaxis in whom CT revealed a fracture through the roof of the nasopharynx and arteriography showed injury to the pterygovaginal (pharyngeal) artery. The fracture was successfully treated with transarterial particulate embolization.

Purpose: To evaluate the results of balloon angioplasty of 17 stenoses resulting from intracranial atherosclerosis and vasculitis., Methods: Seventeen skull-base and intracranial lesions were dilated with a microballoon angioplasty catheter., Results: Initially, 16 of the 17 stenoses showed improvement at angiography. Moderate residual stenosis was found in 2 of 12 atherosclerotic lesions, both in the distal vertebral artery. Angioplasty in 1 of 12 atherosclerotic lesions caused worsening of the stenotic site, also in the distal V4 region of the vertebral artery. All but one of the patients improved clinically. However, all five lesions caused by acute vasculitis progressed to occlusion after initial improvement., Conclusion: Intracranial percutaneous transluminal angioplasty is a viable nonsurgical option for the treatment of atherosclerotic vascular insufficiency, but it may not be as successful in treating lesions caused by vasculitis in the acute phase.

We report a case of a carotid-cavernous fistula through a persistent trigeminal artery with endovascular treatment, and discuss the Saltzman classification of persistent trigeminal artery anatomy and its importance in treatment of this lesion.

Purpose: To evaluate the clinical efficacy, cost-effectiveness, and safety of presurgical devascularization of meningiomas., Methods: Matched samples of embolized and nonembolized groups of meningiomas were compared. The study variables for clinical efficacy were estimated blood loss, number of transfusions, surgical resection time, and length of hospitalization. The cost-effectiveness was evaluated by adjusting all hospital costs to 1991 dollar amounts, and adding additional embolization costs and fees to the hospital cost totals for the embolized group. A qualitative comparison of complications was made., Results: All dependent variables evaluating the clinical efficacy of the procedure (estimate blood loss, 533 cc versus 836 cc; number of transfusions, 0.39 units versus 1.56 units; surgical resection time, 305.8 minutes versus 337.5 minutes; and length of hospitalization, 10.6 days versus 15.0 days) displayed trends of higher means in the nonembolized group; however, only the estimated blood loss and number of transfusions variables were significant. The cost-effectiveness of the procedure was not statistically significant. The mean cost was $29,605 for the embolized group and $38,449 for the nonembolized group. There were three major and nine minor complications in the nonembolized group and zero major and six minor complications in the embolized group. There were four additional minor complications caused by the embolization procedure., Conclusion: Endovascular devascularization of meningiomas is beneficial for large meningiomas because it diminishes the necessity of intraoperative transfusions and decreases blood loss. The additional day of hospitalization, emolization costs, and costs of complications do not conversely increase treatment costs. There were no major complications or adverse long-term effects caused by the embolization procedure.

Purpose: To examine the incidence of neurologic complications associated with modern cerebral angiography and to assess patient characteristics associated with an increased risk of complications., Methods: One thousand consecutive cerebral angiographic procedures were evaluated prospectively. Examinations were performed using transfemoral catheterization and film-screen methods. For purposes of this trial, a neurologic complication was defined as any new focal neurologic deficit or change in mental status occurring during the angiogram or within the following 24 hours. Patients were evaluated during and at the completion of angiography. Follow-up evaluations were performed on the day of and the day after angiography., Results: There were a total of 10 neurologic complications within 24 hours of angiography, 5 of which were persistent. Onset of 5 of the deficits occurred during angiography, the other 5 (3 persistent) were delayed. All complications occurred in patients being evaluated for stroke/transient ischemic attack or (in one case) asymptomatic bruit. A higher average age, longer average procedure time, and greater volume of radiographic contrast was noted in these patients than in the study population., Conclusion: Cerebral angiography was associated with a 1% overall incidence of neurologic deficit and a 0.5% incidence of persistent deficit. All complications occurred in patients presenting with a history of stroke/transient ischemic accident or carotid bruit, which may reflect the difficulty of performing angiography in this population at risk for atherosclerotic changes.

Purpose: To compare the clinical efficacy of a dual-echo fast spin-echo imaging technique, SHARE (share-view acquisition using repeated echoes), with conventional long-repetition-time spin-echo imaging., Methods: Conventional spin-echo and SHARE fast spin-echo MR images of the brain were acquired in 50 randomized patients and interpreted separately in conjunction with the T1-weighted images. All images were reviewed independently by two neuroradiologists who were blinded to the clinical history and previous interpretations., Results: The diagnoses rendered for the spin-echo and SHARE images were concordant in 48 of the 50 subjects (96%) by the first reader and in all 50 cases (100%) by the second reader. SHARE images were acquired in one-fourth of the imaging time yet image contrast, quality, and sensitivity to long T2 lesions were comparable. The SHARE technique was less sensitive to hemorrhagic residua., Conclusions: SHARE is a viable time-saving alternative to the conventional long-repetition-time pulse sequence. Although SHARE images are not as sensitive to magnetic susceptibility effects, the time saved using this technique could be used to perform a gradient-echo sequence when indicated.

Purpose: To assess the degree and regional pattern of first-pass brain enhancement using dynamic MR imaging., Materials and Methods: Ultrafast MR imaging (1.06-second acquisition time per image) was performed in 19 healthy subjects following a bolus IV injection of a gadolinium contrast agent; 36 patients with suspected pathology were studied using the same protocol., Results: Calculated percent blood volumes were 4.9% for right cortical gray matter, 4.8% for left cortical gray matter, and 2.6% for white matter. Subtraction images were obtained that depicted the first pass "blood pool" pattern of enhancement (gray and white matter) which was significant., Conclusion: Preliminary evidence suggests utility for cerebral "blood pool" imaging, especially if reduced image acquisition times can be achieved.

We describe a rapid MR imaging technique, applying functional analysis to images obtained during the tissue transit of injected contrast material into the cerebral circulation, which has potential for assessment of the altered hemodynamics in cerebral ischemia. This technique utilized turbo-FLASH imaging maximizing the T1 relaxivity properties of gadopentetate dimeglumine with positive contrast enhancement.