Parents' Withdrawal from Treatment at a Child Guidance Clinic: A Study of Fifteen Cases at the Worcester Youth Guidance Center.

Thesis (M.S.)--Boston Universit

Successful Surgical Outcome after Traumatic Diaphragmatic Intra-Pericardial Herniation from Blunt Abdominal Injury

Intrapericardial diaphragmatic hernia (IPDH) is a rare manifestation of non-hiatal diaphragmatic hernias (NHDH). Intrapericardial diaphragmatic hernia is defined as the prolapse of the abdominal viscera into the pericardium through the diaphragm. Their incidence has increased over the last 50-60 years, secondary to high-speed transport, and constitutes 5% of major thoracic and abdominal trauma today. These injuries can present during the initial workup or months after the initiating injury. These hernias can be caused by both blunt and penetrating trauma with concomitant central tendon rupture and pericardial laceration. We report an interesting case of intrapericardial diaphragmatic hernia with delayed presentation that was successfully reduced via open surgical repair after a laparoscopic repair attempt failed. We present a 77-year-old female admitted to the hospital after a motor vehicle crash. On hospital day 9, the patient developed shortness of breath, which prompted a chest x-ray. The chest x-ray revealed bowel in the patient’s chest. The patient was taken to the operating room, where they underwent an attempted laparoscopic diaphragmatic hernia repair and, ultimately, open repair of the diaphragmatic hernia. The patient did well after surgery and was discharged on post-injury day 22

Surgery for Esophageal Adenocarcinoma: Three field open McKeown procedure has a role in assessment and treatment of extensive locally advanced esophageal adenocarcinoma with a favorable clinical and pathological outcome.

Esophageal adenocarcinoma has seen an increased incidence due to gastroesophageal reflux disease , smoking and obesity. There are no established guidelines for screening of esophageal cancer and many patients present late in their disease process. Most early stage adenocarcinoma of the esophagus is treated with neoadjuvant chemotherapy and radiation follow by surgical resection in suitable operative candidates. We describe a case of locally advanced esophageal cancer, where the patient had a relatively insignificant response to neoadjuvant chemotherapy and radiation, who was then treated by open direct resection of the esophagus and proximal stomach (three field McKeown approach) with lymphadenectomy. The patient did well after surgery apart from pneumonia and increased secretions that required tracheostomy. There were no surgical complications such as anstomotic leak or chylothorax. Pathology showed T2N0 disease. Locally advanced esophageal cancer in the mediastinum occasionally requires an open direct approach for direct assessment of resectability and full mobilization of the esophagus and subsequent complete cancer free surgical outcome. We felt that this was a necessary procedure under these circumstances due to the large mass effect of the tumor, and a preoperative staging of T2N3. The mainstay of esophageal resection continues to be minimally invasive procedures for early stage esophageal malignancy where assessment of resectability and direct mobilization from the mediastinum are typically not an issue

Delineating Anaplasma phagocytophilum Ecotypes in Coexisting, Discrete Enzootic Cycles

Genetically distinct subpopulations have adapted to different niche

Diversity decoupled from ecosystem function and resilience during mass extinction recovery

The Chicxulub bolide impact 66 million years ago drove the near-instantaneous collapse of ocean ecosystems. The devastating loss of diversity at the base of ocean food webs probably triggered cascading extinctions across all trophic levels and caused severe disruption of the biogeochemical functions of the ocean, and especially disrupted the cycling of carbon between the surface and deep sea. The absence of sufficiently detailed biotic data that span the post-extinction interval has limited our understanding of how ecosystem resilience and biochemical function was restored; estimates of ecosystem ‘recovery’ vary from less than 100 years to 10 million years. Here, using a 13-million-year-long nannoplankton time series, we show that post-extinction communities exhibited 1.8 million years of exceptional volatility before a more stable equilibrium-state community emerged that displayed hallmarks of resilience. The transition to this new equilibrium-state community with a broader spectrum of cell sizes coincides with indicators of carbon-cycle restoration and a fully functioning biological pump. These findings suggest a fundamental link between ecosystem recovery and biogeochemical cycling over timescales that are longer than those suggested by proxies of export production, but far shorter than the return of taxonomic richness. The fact that species richness remained low as both community stability and biological pump efficiency re-emerged suggests that ecological functions rather than the number of species are more important to community resilience and biochemical functions

NRF2 regulates HER2 and HER3 signaling pathway to modulate sensitivity to targeted immunotherapies

NF-E2 related factor-2 (NRF2) is an essential transcription factor for multiple genes encoding antioxidants and detoxification enzymes. NRF2 is implicated in promoting cancer therapeutic resistance by its detoxification function and crosstalk with proproliferative pathways. However, the exact mechanism of this intricate connectivity between NRF2 and growth factor induced proliferative pathway remains elusive. Here, we have demonstrated that pharmacological activation of NRF2 by tert-butylhydroquinone (tBHQ) upregulates the HER family receptors, HER2 and HER3 expression, elevates pAKT levels, and enhances the proliferation of ovarian cancer cells. Preactivation of NRF2 also attenuates the combined growth inhibitory effects of HER2 targeting monoclonal antibodies, Pertuzumab and Trastuzumab. Further, tBHQ caused transcriptional induction of HER2 and HER3, while SiRNA-mediated knockdown of NRF2 prevented this and further caused transcriptional repression and enhanced cytotoxicity of the HER2 inhibitors. Hence, NRF2 regulates both HER2 and HER3 receptors to influence cellular responses to HER2 targeting monoclonal antibodies. This deciphered crosstalk mechanism reinforces the role of NRF2 in drug resistance and as a relevant anticancer target

Automatic detection of one-on-one tackles and ruck events using microtechnology in rugby union

Objectives To automate the detection of ruck and tackle events in rugby union using a specifically-designed algorithm based on microsensor data. Design Cross-sectional study. Methods Elite rugby union players wore microtechnology devices (Catapult, S5) during match-play. Ruck (n = 125) and tackle (n = 125) event data was synchronised with video footage compiled from international rugby union match-play ruck and tackle events. A specifically-designed algorithm to detect ruck and tackle events was developed using a random forest classification model. This algorithm was then validated using 8 additional international match-play datasets and video footage, with each ruck and tackle manually coded and verified if the event was correctly identified by the algorithm. Results The classification algorithm’s results indicated that all rucks and tackles were correctly identified during match-play when 79.4 ± 9.2% and 81.0 ± 9.3% of the random forest decision trees agreed with the video-based determination of these events. Sub-group analyses of backs and forwards yielded similar optimal confidence percentages of 79.7% and 79.1% respectively for rucks. Sub-analysis revealed backs (85.3 ± 7.2%) produced a higher algorithm cut-off for tackles than forwards (77.7 ± 12.2%). Conclusions The specifically-designed algorithm was able to detect rucks and tackles for all positions involved. For optimal results, it is recommended that practitioners use the recommended cut-off (80%) to limit false positives for match-play and training. Although this algorithm provides an improved insight into the number and type of collisions in which rugby players engage, this algorithm does not provide impact forces of these events

Self-Enforcing Trade Agreements: Evidence from Time-Varying Trade Policy

The Bagwell and Staiger (1990) theory of cooperative trade agreements predicts new tariffs (i) increase with imports, (ii) increase with the inverse of the sum of the import demand and export supply elasticities, and (iii) decrease with the variance of imports. We find US import policy during 1997-2006 to be consistent with this theory. A one standard deviation increase in import growth, the inverse of the sum of the import demand and export supply elasticity, and the standard deviation of import growth changes the probability that the US imposes an antidumping tariff by 35%, by 88%, and by -76%, respectively

Surgery for Esophageal Adenocarcinoma: Three field open McKeown procedure has a role in assessment and treatment of extensive locally advanced esophageal adenocarcinoma with a favorable clinical and pathological outcome

Esophageal adenocarcinoma has seen an increased incidence due to gastroesophageal reflux disease , smoking and obesity. There are no established guidelines for screening of esophageal cancer and many patients present late in their disease process. Most early stage adenocarcinoma of the esophagus is treated with neoadjuvant chemotherapy and radiation follow by surgical resection in suitable operative candidates. We describe a case of locally advanced esophageal cancer, where the patient had a relatively insignificant response to neoadjuvant chemotherapy and radiation, who was then treated by open direct resection of the esophagus and proximal stomach (three field McKeown approach) with lymphadenectomy. The patient did well after surgery apart from pneumonia and increased secretions that required tracheostomy. There were no surgical complications such as anstomotic leak or chylothorax. Pathology showed T2N0 disease. Locally advanced esophageal cancer in the mediastinum occasionally requires an open direct approach for direct assessment of resectability and full mobilization of the esophagus and subsequent complete cancer free surgical outcome. We felt that this was a necessary procedure under these circumstances due to the large mass effect of the tumor, and a preoperative staging of T2N3. The mainstay of esophageal resection continues to be minimally invasive procedures for early stage esophageal malignancy where assessment of resectability and direct mobilization from the mediastinum are typically not an issue