Computed tomographic angiography for the evaluation of aneurysmal subarachnoid hemorrhage.

OBJECTIVES: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. METHODS: Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient\u27s history. RESULTS: A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false-positive CTA. Follow-up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm. CONCLUSIONS: In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results

Developing Literacy Learning Model Based on Multi Literacy, Integrated, and Differentiated Concept at Primary School

The main issue addressed in this research is the low writing skills of primary school students. One of the reasons for this condition is that the existing model of writing literacy learning is not appropriate. The purpose of this study is to explain MID-based literacy teaching model and the impact of the model in increasing primary school students\u27 writing skills. This study used combined methods of exploratory type. The samples were elementary school students coming from six schools with three different characteristics. Based on the data analysis, it can be concluded that the implementation of MID-based literacy learning model has proven to signi cantly contribute to the improvement of students\u27 writing skills. Taking place in all sample schools, the improvement may suggest that the model ts not only to students with high- ability but also those with low-ability. Therefore, the MID-based literacy learning model is needed to improve the ability to write various text types appropriately

Breast cancer treatment patterns of Asian-American women in an equal access system

589 Background: Treatment patterns of breast cancer in Asian-American women have not been well studied. Existing studies suggest higher mastectomy rates compared to Whites, but have been unable to control for differences in access to healthcare. The objective was to describe primary and adjuvant treatment patterns of Asian women in an equal-access healthcare system. Methods: Data were extracted from the tumor registry to include women diagnosed with T1-T2, M0 breast cancer between 1989 and 2004 and treated at the Naval Medical Center San Diego, an equal-access system. Self-reported data was used to classify race. Military rank was used as a proxy for socioeconomic status and education level. Characteristics and treatment patterns of Asian and White women were compared by the two-sided Fisher’s exact test and multiple logistic regression with consideration of covariates. Results: 574 non-Hispanic White and 226 Asian-American women resulted from the query. Asian women received mastectomy more often than Whites. From 1989 to 2004, mastectomy rates declined for both groups at an equal rate until 1997. On secondary analysis based on the initial results, differences in mastectomy rates existed only until 1997, which was coincident with the opening of a multidisciplinary Breast Health Center. Asians were much less likely to receive breast reconstruction. There was no difference in rates of adjuvant radiation or chemotherapy, but a suggestion of higher hormone therapy rates in Asians. Conclusions: Even in the setting of an equal-access healthcare system, Asian-American women were more likely to receive mastectomy than Whites, suggesting that barriers to healthcare access do not explain these treatment disparities. This difference disappeared in recent years. The contrasting reconstruction rates suggest a difference in cultural attitudes regarding the significance of the breast in the setting of cancer treatment. The multidisciplinary Breast Health Center may have ameliorated factors leading to higher mastectomy rates in Asians. [Table: see text] No significant financial relationships to disclose. </jats:p

Single Versus Multiple Hyperbaric Sessions for Carbon Monoxide Poisoning in a Murine Model.

Hyperbaric oxygen (HBO) has been advocated for treatment of acute carbon monoxide (CO) poisoning. There exists considerable debate as to whether HBO prevents delayed neurologic sequelae (DNS) due to CO poisoning. Additionally, existing data in the literature supporting HBO efficacy do not identify an optimal number of HBO treatments. We sought to determine in a mouse model whether there is a difference between one versus multiple HBO sessions for the prevention of DNS. Fifty mice were randomized into five groups of ten mice each: (1) control, receiving no CO exposure or treatment; (2) CO poisoned, receiving no treatment (CO group); (3) CO poisoned, receiving normobaric oxygen for 58&nbsp;min following the end of exposure (CO + NBO group); (4) CO poisoned, followed by one session of HBO(CO + HBO1); and (5) CO poisoned, followed by three HBO treatment sessions, one every 6&nbsp;h (CO + HBO3). Prior to poisoning, all animals were trained in step-down latency (SDL) and step-up latency (SUL) tasks. One week after exposure and treatment, all five groups were retested to evaluate the retention of this training. There was no difference detected among groups in SDL (p&nbsp;=&nbsp;0.67 among all groups) when evaluated using a Kruskal-Wallis test. There was a significant difference among groups in SUL (p&nbsp;=&nbsp;0.027 among all groups) when evaluated using a Kruskal-Wallis test. When individual groups were compared using a Wilcoxon signed-rank test with Bonferroni correction, there were no statistically significant differences in either SDL or SUL. There was no difference between groups treated with either one or three HBO sessions. One possibility to explain this might be that HBO sessions administered some time after a CO exposure may enhance the lipid peroxidation cascade and worsen neurologic outcomes; alternatively, HBO may simply impart no benefit when compared to NBO