Assessment of MR blood-oxygen-level-dependent (BOLD) cerebrovascular reactivity under general anesthesia in children with moyamoya.

Background: Moyamoya is a progressive, non-atherosclerotic cerebral arteriopathy that may present in childhood and currently has no cure. Early diagnosis is critical to prevent a lifelong risk of neurological morbidity. Blood-oxygen-level-dependent (BOLD) MRI cerebrovascular reactivity (CVR) imaging provides a non-invasive, in vivo measure of autoregulatory capacity and cerebrovascular reserve.

Should Detection Avoidance Be Criminalized?

Human nature being what it is, individuals engaging in unlawful activity will often seek to avoid having their misconduct detected by law enforcement. This article provides the first legal analysis of what are termed detection avoidance measures, and evaluates whether, and how, they should be subject to criminalization.

Predicting Ischemic Risk Using Blood Oxygen Level-Dependent MRI in Children with Moyamoya.

Background And Purpose: Moyamoya is a progressive steno-occlusive arteriopathy. MR imaging assessment of cerebrovascular reactivity can be performed by measuring the blood oxygen level-dependent cerebrovascular reactivity response to vasoactive stimuli. Our objective was to determine whether negative blood oxygen level-dependent cerebrovascular reactivity status is predictive of ischemic events in childhood moyamoya.

PANDAS/PANS in childhood: Controversies and evidence.

Since first defined in 1998, paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and its later, broader iteration, paediatric acute-onset neuropsychiatric syndrome (PANS), have garnered significant attention and controversy. The role of streptococcal infection in children with explosive onset obsessive-compulsive disorder and new onset tics, the natural history of this entity, and the role of symptomatic and disease-modifying therapies, including antibiotics, immunotherapy, and psychoactive drugs, are all issues that have yet to be definitively addressed. While definitive proof of the autoimmune hypothesis of PANDAS is lacking, given the heightened attention to this entity and apparent rise in use of this diagnostic category, addressing questions around diagnosis, treatment, and etiology is imperative.

The CHRS Data Portal, an easily accessible public repository for PERSIANN global satellite precipitation data.

The Center for Hydrometeorology and Remote Sensing (CHRS) has created the CHRS Data Portal to facilitate easy access to the three open data licensed satellite-based precipitation datasets generated by our Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks (PERSIANN) system: PERSIANN, PERSIANN-Cloud Classification System (CCS), and PERSIANN-Climate Data Record (CDR). These datasets have the potential for widespread use by various researchers, professionals including engineers, city planners, and so forth, as well as the community at large. Researchers at CHRS created the CHRS Data Portal with an emphasis on simplicity and the intention of fostering synergistic relationships with scientists and experts from around the world.

Breath-Hold Blood Oxygen Level-Dependent MRI: A Tool for the Assessment of Cerebrovascular Reserve in Children with Moyamoya Disease.

Background And Purpose: There is a critical need for a reliable and clinically feasible imaging technique that can enable prognostication and selection for revascularization surgery in children with Moyamoya disease. Blood oxygen level-dependent MR imaging assessment of cerebrovascular reactivity, using voluntary breath-hold hypercapnic challenge, is one such simple technique. However, its repeatability and reliability in children with Moyamoya disease are unknown.

Consistency of elemental and isotope-ratio patterns across multiple scales from individual fish.

Assays of elemental and stable-isotope ratios across growth increments of scales have the potential to provide a non-lethal alternative to otolith chemistry for identifying migration and ontogenetic trophic shifts. A central assumption when employing scales as otolith analogues is that any scale from an individual will provide equivalent information about the chemical history of that fish. This assumption was investigated with multiple scales from wild and captive euryhaline Atlantic tarpon Megalops atlanticus from the north-west Gulf of Mexico.

Cerebrovascular Reactivity and Intellectual Outcome in Childhood Stroke With Transient Cerebral Arteriopathy.

Background: Hypercapnic-challenge blood oxygen level-dependent magnetic resonance imaging cerebrovascular reactivity (CVR), measures the regional perfusion response to altered carbon dioxide. CVR correlates with the tissue-level microvascular dysfunction and ischemic risk. Among children with arterial ischemic stroke, transient cerebral arteriopathy (TCA) is a frequent, nonprogressive unilateral intracranial arteriopathy, which typically results in basal ganglia infarction and chronic cerebral artery stenosis.

MRI in the evaluation of localization-related epilepsy.

This article covers the MRI evaluation of patients with epilepsy, with a focus on neuroimaging in those with localization-related epilepsy who may be potential epilepsy surgery candidates. The article includes structural MRI to identify a lesion, functional MRI to identify the eloquent cortex and diffusion tensor imaging to identify the eloquent white matter tracts. We consider the equipment, protocol or procedures, and reporting of MRI in patients with epilepsy.

Mediators of the Age Effect in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).

Background And Purpose: There is higher combined risk of stroke or death (S+D) at older ages with carotid stenting. We assess whether this can be attributed to patient or arterial characteristics that are in the pathway between older age and higher risk.

Methods: Mediation analysis of selected patient (hypertension, diabetes mellitus, and dyslipidemia) and arterial characteristics assessed at the clinical sites and the core laboratory (plaque length, eccentric plaque, ulcerated plaque, percent stenosis, peak systolic velocity, and location) was performed in 1123 carotid artery stenting-treated patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).

Validating FMEA output against incident learning data: A study in stereotactic body radiation therapy.

Purpose: Though failure mode and effects analysis (FMEA) is becoming more widely adopted for risk assessment in radiation therapy, to our knowledge, its output has never been validated against data on errors that actually occur. The objective of this study was to perform FMEA of a stereotactic body radiation therapy (SBRT) treatment planning process and validate the results against data recorded within an incident learning system.

Methods: FMEA on the SBRT treatment planning process was carried out by a multidisciplinary group including radiation oncologists, medical physicists, dosimetrists, and IT technologists.

Prevalence of inherited neurotransmitter disorders in patients with movement disorders and epilepsy: a retrospective cohort study.

Background: Inherited neurotransmitter disorders are primary defects of neurotransmitter metabolism. The main purpose of this retrospective cohort study was to identify prevalence of inherited neurotransmitter disorders.

Methods: This retrospective cohort study does not have inclusion criteria; rather included all patients who underwent cerebrospinal fluid (CSF) homovanillic and 5-hydroxyindol acetic acid measurements.

Identical ATP1A3 mutation causes alternating hemiplegia of childhood and rapid-onset dystonia parkinsonism phenotypes.

Background: Alternating hemiplegia of childhood and rapid-onset dystonia parkinsonism are two separate movement disorders with different dominant mutations in the same sodium-potassium transporter ATPase subunit gene, ATP1A3.

Patient: We present a child with topiramate-responsive alternating hemiplegia of childhood who was tested for an ATP1A3 gene mutation.

Results: Gene sequencing revealed an identical ATP1A3 mutation as in three typical adult-onset rapid-onset dystonia parkinsonism cases but never previously described in an alternating hemiplegia of childhood case.

Continuous Electroencephalogram in Comatose Postcardiac Arrest Syndrome Patients Treated With Therapeutic Hypothermia: Outcome Prediction Study.

Purpose: Therapeutic Hypothermia (TH) is the only therapeutic intervention proven to significantly improve survival and neurologic outcome in comatose postcardiac arrest patients and is now considered standard of care. When we discuss prognostication with regard to comatose survivors postcardiac arrest, we should look for tools that are both reliable and accurate and that achieve a false-positive rate (FPR) equal to or very closely approaching zero.

Methods: We retrospectively reviewed data that were prospectively collected on all cardiac arrest patients admitted to our ICU.

An advanced course in long term care for geriatric medicine fellows.

Long term care deserves focused attention within a geriatric medicine fellowship curriculum to ensure that graduates are prepared not only for clinical care but also for the leadership, administrative, educational, quality improvement, and health policy aspects of their future roles. This report describes the curriculum development and program evaluation of an advanced course in long term care for geriatric medicine fellows and other graduate/post-graduate health professionals at Duke University. Course evaluation had 4 goals: (1) to determine how well the learning objectives were met; (2) to evaluate individual components of the course to improve subsequent offerings; (3) to determine whether additional topics needed to be added; and (4) to evaluate the effectiveness of the discussion forum component of the course.

Assessment of cerebrovascular reactivity using real-time BOLD fMRI in children with moyamoya disease: a pilot study.

Purpose: This pilot study aims to test the reliability and clinical validity of the assessment of cerebrovascular reactivity (CVR) with real-time blood-oxygen-level-dependent (BOLD) fMRI (rtCVR) in comparison with standard off-line processing in children with moyamoya disease.

Methods: Eight consecutive pediatric patients with moyamoya cerebral arteriopathy underwent BOLD fMRI CVR studies either on a 1.5-T or on a 3-T scanner with breath-holding techniques in six patients and under general anesthesia (GA) in three patients.

Cardiac transplantation in Friedreich ataxia.

In this article, we describe a 14-year-old boy with a confirmed diagnosis of Friedreich ataxia who underwent cardiac transplantation for left ventricular failure secondary to dilated cardiomyopathy with restrictive physiology. His neurological status prior to transplantation reflected early signs of neurological disease, with evidence of dysarthria, weakness, mild gait impairment, and limb ataxia. We review the ethical issues considered during the process leading to the decision to offer cardiac transplantation.

Physician knowledge, assessment, and reporting of older driver fitness.

ABSTRACT Physicians have the potential to serve as an important portal for information gathering, assessment, counseling, and reporting older driver fitness, as almost all older adults require medical care and have a primary care physician. However, there are few studies that have evaluated physician knowledge about, attitudes toward, and performance of older driver fitness assessment. Two pilot studies were conducted to assess physician knowledge and attitudes and aid understanding of physician knowledge of legal reporting requirements regarding older driver medical fitness.

Prospects for the international migration of U.S. sex offender registration and community notification laws.

Sex offender registration and community notification laws have proved enormously popular in the U.S. This is so even though the avowed sexual violence preventive benefits of the laws remain largely untested and unproven; indeed, it remains an open question whether the laws actually have anti-therapeutic and criminogenic effect.

Measurement of cerebrovascular reactivity in pediatric patients with cerebral vasculopathy using blood oxygen level-dependent MRI.

Background And Purpose: Cerebrovascular reactivity (CVR) is an indicator of cerebral hemodynamics. In adults with cerebrovascular disease, impaired CVR has been shown to be associated with an increased risk of stroke. In children, however, CVR studies are not common.

Toward a "smart" nightstand prototype: an examination of nightstand table contents and preferences.

Objective: Two studies were conducted to obtain an understanding of the types of items seniors keep in their nightstands and to understand how users feel about the possibility of "smart" furniture.

Background: To enable aging in place and universal design, it is vital to understand the needs of a broad range of aging individuals, especially since there is little research on nightstand usage and design.

Methods: Study 1 allowed for the development of a structured inventory of nightstand use today in assisted living and rehabilitation facilities.