Spontaneous subarachnoid haemorrhage due to coarctation of aorta and intraspinal collaterals : a rare presentation

The occurrence of spontaneous subarachnoid haemorrhage (SAH) in association with coarctation of thoracic aorta and absence of intracranial aneurysm is a rare association. In spontaneous SAH, the predominant cause is intracranial aneurysmal rupture. This report describes a case of a 40 year-old male who presented with SAH and was incidentally diagnosed to have coarctation of aorta (CoA) with intraspinal collaterals on further work up. This case demonstrates the importance of detailed evaluation of patients with spontaneous SAH on whom common aetiologies have been ruled out.peer-reviewe

Warranties for Your Flat-Screen – Why Not for Your Bypass Surgery?

If Health Care Delivery is a business, and patients are consumers, what is the product they’re buying? Who is liable for that product’s quality? If someone purchases a television set, they get a warranty. That warranty is the manufacturer’s guarantee to the customer that their company will be responsible for repairing or replacing that product should it prove to be defective within a few days of purchase. Could medicine ever be treated the same way? The following article describes Geisinger Health System’s ProvenCareSM program, which establishes flat package pricing and a 90-day “warranty” for Coronary Artery Bypass Grafts (CABGs)

The Transformation of the U.S. Banking Industry: What a Long, Strange Trips It's Been

macroeconomics, Transformation, U.S. Banking Industry

Decarbonising urban transportation

18 p.The transportation sector is a major contributor to global greenhouse gas emissions, accounting for around one-quarter of current annual emissions. Surface transportation (passenger vehicles, buses, rail, and freight transportation) contributes 75% of total emissions, with the remaining 25% allocated equally between air and water transport. According to the recently released 5th Assessment Report of the IPCC (September 2013), the transportation sector is expected to grow significantly in future years, particularly in rapidly developing countries around the world, and will therefore be one of a few key drivers of increasing global warming. Unless there is a major political effort and consumer willingness to change current energy consumption patterns and travel modes over the next few decades, transport-related emissions are likely to double by 2050 relative to levels observed in 2010. Because of the contribution of transportation to climate change and its impact on urban air quality, a comparative assessment of potential carbon emission reductions and health benefits of reduced particulate matter emissions was undertaken considering several low carbon pathways for development of the urban road transport sector up to 2050. As a result, we conclude that aggressive changes will be needed to scale back future emissions by 20% (or more) compared to present day emissions. These changes will impact vehicle fuel economy (+50%), urban mobility patterns (lower private car demand and greater use of public transportation), choice of alternative fuels (less use of petroleum-based fuels and greater use of biofuels and electrons) and electricity generation mix (greater use of renewables, carbon capture technologies for limiting fossil fuel carbon emissions, and/or nuclear energy). Public acceptance is fundamental to bring about changes in consumer attitudes and behaviour. Given the long lead times required for research, development, demonstration and deployment of new technologies, the time to act is now if we are to limit the global mean surface temperature increase to within 2°C above preindustrial levels

The Theory of the Growth of the Firm, by Edith T. Penrose. Oxford: Blackwell, 1959 (Book Review)

[First paragraph] A review (in the pages of this journal) of a book published nearly fifty years ago may appear unusual; not unless the book has become a “classic”. Indeed, many organizational scholars (e.g, Pitelis, 2002) view it as a seminal text for the resource-based view of the firm - arguably one of the dominant theoretical perspectives in strategic management research today

BacillOndex: An Integrated Data Resource for Systems and Synthetic Biology

BacillOndex is an extension of the Ondex data integration system, providing a semantically annotated, integrated knowledge base for the model Gram-positive bacterium Bacillus subtilis. This application allows a user to mine a variety of B. subtilis data sources, and analyse the resulting integrated dataset, which contains data about genes, gene products and their interactions. The data can be analysed either manually, by browsing using Ondex, or computationally via a Web services interface. We describe the process of creating a BacillOndex instance, and describe the use of the system for the analysis of single nucleotide polymorphisms in B. subtilis Marburg. The Marburg strain is the progenitor of the widely-used laboratory strain B. subtilis 168. We identified 27 SNPs with predictable phenotypic effects, including genetic traits for known phenotypes. We conclude that BacillOndex is a valuable tool for the systems-level investigation of, and hypothesis generation about, this important biotechnology workhorse. Such understanding contributes to our ability to construct synthetic genetic circuits in this organism

Utility and applications of synoptic reporting in pathology

Background: Synoptic reports in routine pathology practice provide composite documents that include information from morphology and molecular technologies. It is clear and accurate structured information and developed by incorporating standardized data elements in the form of checklist for pathology reporting. This facilitates pathologists to document their findings and ultimately improve the overall quality of pathology reports.\ud \ud Objectives: The goal of this review article is to discuss (1) the importance of synoptic reporting in pathology, (2) utility and applications, (3) its impact on pathology reporting and patient care, and (4) the challenges and barriers of implementing synoptic reporting. Pertinent literature will also be reviewed.\ud \ud Design: The synoptic reporting system provides a complete set of data elements in the form of synoptic templates or “worksheets” for pathology tumor reporting based on the World Health Organization (WHO) Classification and the College of American Pathologists (CAP) Cancer Checklists. These standards provide most updated and supplemented classification scheme, specimen details, and staging as well as prognostic information. Data from synoptic reporting tool can be imported to a relational database where they are organized and efficiently searched and retrieved. Since search and retrieval are streamlined, synoptic databases enhance basic ­science, clinical, and translational cancer research.\ud \ud Conclusion: Synoptic reporting facilitates a standard based structured method for entering the diagnostic and prognostic information in accurate and consistent fashion for a particular ­pathology specimen, thus reducing transcription services, specimen turnaround time, and typographical and transcription errors. The structured data can be imported into the Laboratory Information Service (LIS) database, which facilitates swift data access and improved communication for cancer management. Finally, these synoptic templates act as a robust medium of high-quality data from the various biospecimens, which can be shared across multiple on-going research projects to enhance basic and translational research

Breaking the 400 ppm barrier: Physical and Social implications of the recent CO2 rise

6 p.The concentration of carbon dioxide (CO2) in the atmosphere has achieved its highest levels in the last 800,000 years, and probably even in the last 2.1 million years, recently topping briefly the atmospheric concentration target of 400 ppm. Whereas this mark does not set Earth’s climate in an apocalyptic mode, it does represent a grave global sociopolitical risk, because it highlights the inaction and indifference of government and society to our self-triggered climate changes and their consequences, especially for the poor and the weak. *Since pre-industrial times (i.e. since 1750), atmospheric CO2 concentrations have increased by over 40%, primarily from fossil fuel emissions and decondarily from net land use change emissions, at a rate unprecedented in the last 22,000 years, reaching an average of 2 ppm/ year in the last decade. About 30% of the emitted anthropogenic CO2 has been absorbed by the ocean, causing ocean acidification that poses serious risks to marine ecosystems, resources, and services. *Ice core paleoclimate records teach us that, under typical conditions, global surface temperature never changes much in the long term (of centuries) without a corresponding change in atmospheric CO2 concentration, and vice-versa. In order to explain the amount of warming observed in the temperature records, one must take into account the greenhouse effect caused by the corresponding Atmospheric CO2 concentrations in that period. This does not preclude, however, the occurrence of short-term (decadal) climate variability, which can enhance or counteract the prevailing temperature trend (e.g. the current 15-year hiatus in global temperature rise). *In a business as usual scenario, atmospheric CO2 concentrations by the middle of the 21st century would reach just over 500 ppm, a change of 25% above the present value, which would probably lead to an increase of more than 2ºC in the global mean surface temperature On the other hand, reducing emissions by 2% per year starting no later than 2020 would limit the global carbon dioxide concentration to below 450 ppm. Delaying emission cuts will only enhance the risks of dangerous, and potentially irreversible, climatic changes and increase the costs of future mitigation and adaptation measures