What Clinicians Think About When They Think About Sepsis: Results From a Survey Across the University of Maryland Medical System.

Importance: Sepsis, a leading cause of death in the hospital, is a heterogeneous syndrome without a defined or specific set of symptoms.

Objectives: We conducted a survey of clinicians in practice to understand which clinical findings they tend to associate with sepsis.

Design, Setting, And Participants: A survey was distributed to physicians and advanced practice providers across a multihospital health system during April 2022 and May 2022 querying likelihood of suspecting sepsis and initiating sepsis care in response to various normal and abnormal clinical findings.

Long term results with medpor reconstruction of the anterior skull base at a single institute.

Objectives: To evaluate a technique of multi-layered CSF repair following endonasal anterior skull base surgery using medpor graft.

Design: Retrospective review of consecutive case series from a single centre.

Subjects: 68 cases of repair of CSF leaks utilising medpor identified from a larger prospectively maintained database of endonasal endoscopic procedures at our centre.

Radiological cervical foraminal stenosis severity and morphology as a predictor of pre-operative function and functional surgical outcome.

Background: Cervical foraminal stenosis on MRI may be assessed using the Kim, modified Kim or Siller methods. This study aimed to investigate which morphological features of cervical foraminal stenosis in patients with cervical radiculopathy correlated best with pre-operative and post-operative surgical outcome following Anterior Cervical Discectomy (ACD) or a Posterior Cervical Foraminotomy (PCF).

Methods: Pre-operative MRIs of adults with cervical radiculopathy were assessed by six raters.

Home Pulse Oximetry Monitoring during the COVID-19 Pandemic: An Assessment of Patient Engagement and Compliance.

Objectives: Patients with suspected COVID-19 remain at risk for clinical deterioration after discharge and may benefit from home oxygen saturation (SpO) monitoring using portable pulse oximeter devices. Our study aims to evaluate patient engagement and compliance with a home SpO monitoring program.

Methods: This is a single center, prospective pilot study of patients being discharged from the ED or urgent care after evaluation of symptoms consistent with COVID-19.

Appropriateness of antibiotic prescribing for patients with sepsis in rural hospital emergency departments.

Design/participants: This was a multicentre retrospective cohort study of adult patients (≥18 years) presenting with a process associated International Classification of Diseases code (ICD-AM-10) pertaining to sepsis between January 2017 and July 2020 to rural Emergency Departments.

Main Outcome Measures: Our primary outcome was antibiotic appropriateness as defined by the Australian Therapeutic Guidelines (for antibiotic selection relative to infecting source) and the National Antimicrobial Prescribing Survey tool. Our secondary outcome was in-hospital mortality.

Overcoming stagnant flow: A scoping review of vertical movement in the emergency department.

Objectives: Improving emergency department (ED) patient flow has plagued many hospitals worldwide. "Vertical" flow improves throughput by maximizing use of chairs and waiting areas instead of beds. This process, however, is inconsistently described in the literature.

Consistency of Radiological Grading of Cervical Foraminal Stenosis.

Background: The degree of cervical foraminal stenosis on MRI scans may be measured and categorised using the Kim or modified Kim methods. These grading scales have not previously been validated in a cohort of patients awaiting surgery.

Objectives: To establish the normal foraminal and root diameters as well as the consistency of inter and intra-rater grading using the Kim and modified Kim grading systems in pre-operative surgical patients.

The Winchcombe meteorite, a unique and pristine witness from the outer solar system.

Direct links between carbonaceous chondrites and their parent bodies in the solar system are rare. The Winchcombe meteorite is the most accurately recorded carbonaceous chondrite fall. Its pre-atmospheric orbit and cosmic-ray exposure age confirm that it arrived on Earth shortly after ejection from a primitive asteroid.

Clinical outcomes and echocardiographic characteristics between African American and Caucasian patients with acute pulmonary embolism.

Background: Despite socioeconomic disparities, no association between clinical presentation and poor outcomes explains a higher mortality in African Americans with pulmonary embolism (PE). The objective is to identify the co-morbidities and echocardiographic characteristics associated with increased mortality in African American patients.

Methods: This is a cross-sectional study of Caucasian or African American patients with PE diagnosed between October 2015 and December 2017 at University of Maryland Medical Center.

Ruptured intra-cranial arachnoid cysts: a case series from a single UK institution.

Introduction: Intracranial arachnoid cysts are a common incidental finding; however presentation with cyst rupture is a recognised complication. Patients are advised to avoid contact sports to reduce the risk of cyst rupture but the risk of rupture is not currently known. The aim of this study is to describe a single institution's experience of managing ruptured intra-cranial arachnoid cysts.

Two pulmonary emboli in a psych pod.

Background: A female patient known to have schizoaffective disorder self-presented to an emergency department in a state of acute agitation and paranoia shortly after a 35-day inpatient stay at a psychiatric facility.

Case Report: The patient exhibited no signs or complaints of dyspnea or hypoxia, but later collapsed and became hypoxic after sleeping comfortably with sedation for 12 h in the psychiatric unit. She was intubated and a computed tomography angiogram revealed bilateral lobar pulmonary emboli and right heart strain.

Enhanced recovery and accelerated discharge after endoscopic transsphenoidal pituitary surgery: safety, patient feedback, and cost implications.

Background: Enhanced recovery after surgery (ERAS) is a constant motivation. There is growing evidence that an endoscopic (rather than microscopic) transsphenoidal approach to pituitary tumours can play a role, facilitating faster recovery and a commensurate reduction in length of stay (LOS). Reducing LOS is beneficial to both patients and healthcare systems.

Prenatal diagnosis of arachnoid cysts: a case series and systematic review.

Introduction: Primary cysts are believed to arise from the splitting of the arachnoid membrane during prenatal development and can be diagnosed in utero. Prenatal diagnosis is uncommon; therefore, the evidence base for counselling expectant mothers is limited. The purpose of this article is to present a case series and review the current literature on prenatally diagnosed arachnoid cysts.

An Evaluation of an Extended Intervention to Reduce Plagiarism in Bachelor of Nursing Students.

Pre- and postintervention surveys of first-year nursing students were undertaken to establish the students' knowledge of plagiarism following implementation of an online library-based Academic Integrity Module and the use of plagiarism detection software. Knowledge and understanding of plagiarism improved, but students' ability to paraphrase remained poor. Students entering postsecondary educational institutions require ongoing support and learning opportunities to improve their skills in paraphrasing and referencing to avoid plagiarism.

Natural History of Intracranial Arachnoid Cysts.

Background: Intracranial arachnoid cysts are a common incidental finding. Most of these remain asymptomatic with surgical intervention being reserved for those cysts causing symptoms from mass effect or hydrocephalus. It is not properly understood why cysts enlarge nor is it possible to predict in which cysts this will occur.

Clinical and radiological outcomes following surgical treatment for intra-cranial arachnoid cysts.

Objectives: Intra-cranial arachnoid cysts are benign lesions which are usually incidental, however can produce neurological symptoms due to mass effect as they enlarge. Controversy still exists regarding the optimal option for the surgical management of these cysts. These options are neuroendoscopic fenestrations, microsurgical fenestrations +/- marsupialisation and insertion of a cysto-peritoneal shunt.

Management of incidental aneurysms: comparison of single Centre multi-disciplinary team decision making with the unruptured incidental aneurysm treatment score.

Objective: To compare multidisciplinary team (MDT) decision making at our centre with the suggested management from the recently published Unruptured Intracranial Aneurysm Treatment Score (UIATS), with particular focus on disagreements between the two bodies of expert opinion.

Design: A retrospective audit of local practice.

Subjects: Adult patients with incidental cerebral saccular aneurysms referred to The National Hospital for Neurology and Neurosurgery Neurovascular MDT.

Intractable Nausea Due to the Area Postrema Syndrome of Neuromyelitis Optica: An Uncommon Cause of a Common Symptom.

Background: Nausea and vomiting are common emergency department (ED) complaints. Neuromyelitis optica, a demyelinating disorder, has a predilection for the area postrema, the central nausea and vomiting center. Demyelinating lesions in this region cause intractable nausea and vomiting.

Intraparenchymal intracranial pressure monitoring for hydrocephalus and cerebrospinal fluid disorders.

Background: Elective intraparenchymal intracranial pressure (ICP) monitoring is useful for the diagnosis and treatment of hydrocephalus and cerebrospinal fluid (CSF) disorders. This retrospective study analyzes median ICP and pulse amplitude (PA) recordings in neurosurgically naïve patients undergoing elective ICP monitoring for suspected CSF disorders.

Methods: Retrospective review of prospectively collated database of neurosurgically naïve patients undergoing elective ICP monitoring for suspected hydrocephalus and CSF disorders.

Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel.

Perioperative communication between surgeons and caregivers is an important aspect of patient care, with postoperative conversations (POCs) being critical. Literature suggests current communication practices may be suboptimal. Identifying barriers and opportunities could improve patient and caregiver satisfaction and increase surgeon efficiency.

Sir FMR Walshe (1885-1973): what a neurologist can teach us about the neurosurgeon.

Sir Francis Martin Rouse Walshe (1885-1973) was a decorated neurologist, but he also commented widely on neurosurgery. Many of his comments and his overall approach to medicine remain highly relevant to the practicing neurosurgeon. His focus on the paramount importance of the core principles of clinical medicine, as well as his passion for basic clinical research are values which remain key to neurosurgery to this day.

A potential hidden layer of meteorites below the ice surface of Antarctica.

Antarctica contains some of the most productive regions on Earth for collecting meteorites. These small areas of glacial ice are known as meteorite stranding zones, where upward-flowing ice combines with high ablation rates to concentrate large numbers of englacially transported meteorites onto their surface. However, meteorite collection data shows that iron and stony-iron meteorites are significantly under-represented from these regions as compared with all other sites on Earth.

A modeling approach to determine how much UV radiation is available across the UK and Ireland for health risk and benefit studies.

A detailed map of the available UV across the UK from 2003 to 2012 is provided. A suite of data derived from climatologies and satellite observations are used to calculate spectral UV irradiance and related weighted doses (erythema, DNA damage, vitamin D). The result is a well-validated tool that has two advantages: (i) the output is simulated spectral UV irradiance that can be weighted with any action spectrum for use in any research studies that require ambient UV data, (ii) reliance on instruments with planned operational lives of at least several years that ensures data and method homogeneity for extension to future studies.

Colour as a signal for entraining the mammalian circadian clock.

Twilight is characterised by changes in both quantity ("irradiance") and quality ("colour") of light. Animals use the variation in irradiance to adjust their internal circadian clocks, aligning their behaviour and physiology with the solar cycle. However, it is currently unknown whether changes in colour also contribute to this entrainment process.

An intervention aimed at reducing plagiarism in undergraduate nursing students.

Plagiarism is a current and developing problem in the tertiary education sector where students access information and reproduce it as their own. It is identified as occurring in many tertiary level degrees including nursing and allied health profession degrees. Nursing specifically, is a profession where standards and ethics are required and honesty is paramount.