Sea-level rise in Hawaii: Implications for future shoreline locations and Hawaii coastal management

Management of coastal development in Hawaii is based on the location of the certified shoreline, which is representative of the upper limit of marine inundation within the last several years. Though the certified shoreline location is significantly more variable than long-term erosion indicators, its migration will still follow the coastline's general trend. The long-term migration of Hawaii’s coasts will be significantly controlled by rising sea level. However, land use decisions adjacent to the shoreline and the shape and nature of the nearshore environment are also important controls to coastal migration. Though each of the islands has experienced local sea-level rise over the course of the last century, there are still locations across the islands of Kauai, Oahu, and Maui, which show long- term accretion or anomalously high erosion rates relative to their regions. As a result, engineering rules of thumb such as the Brunn rule do not always predict coastal migration and beach profile equilibrium in Hawaii. With coastlines facing all points of the compass rose, anthropogenic alteration of the coasts, complex coastal environments such as coral reefs, and the limited capacity to predict coastal change, Hawaii will require a more robust suite of proactive coastal management policies to weather future changes to its coastline. Continuing to use the current certified shoreline, adopting more stringent coastal setback rules similar to Kauai County, adding realistic sea-level rise components for all types of coastal planning, and developing regional beach management plans are some of the recommended adaptation strategies for Hawaii. (PDF contains 4 pages

Diagnosis and evaluation of intracranial arteriovenous malformations

BACKGROUND: Ideal management of intracranial arteriovenous malformations (AVMs) remains poorly defined. Decisions regarding management of AVMs are based on the expected natural history of the lesion and risk prediction for peritreatment morbidity. Microsurgical resection, stereotactic radiosurgery, and endovascular embolization alone or in combination are all viable treatment options, each with different risks. The authors attempt to clarify the existing literature's understanding of the natural history of intracranial AVMs, and risk-assessment grading scales for each of the three treatment modalities. METHODS: The authors conducted a literature review of the existing AVM natural history studies and studies that clarify the utility of existing grading scales available for the assessment of peritreatment risk for all three treatment modalities. RESULTS: The authors systematically outline the diagnosis and evaluation of patients with intracranial AVMs and clarify estimation of the expected natural history and predicted risk of treatment for intracranial AVMs. CONCLUSION: AVMs are a heterogenous pathology with three different options for treatment. Accurate assessment of risk of observation and risk of treatment is essential for achieving the best outcome for each patient

Anterior communicating artery complex aneurysms: anatomic characteristics as predictors of surgical outcome in 300 cases

OBJECTIVE Anterior communicating artery (ACoA) complex aneurysms are challenging to treat microsurgically. The authors report their experience with microsurgical treatment of ACoA aneurysms and examine the anatomic characteristics of these aneurysms as predictors of outcome. METHODS The authors queried their institution’s aneurysm database for records of consecutive patients treated for ACoA aneurysms via microsurgical clip ligation. Data included patient demographics and clinical/radiographic presentation characteristics as well as operative techniques. Glasgow outcome scores (GOS) at hospital discharge and 6-month as well as 1-year follow-up were analyzed. RESULTS Of 319 ACoA aneurysms that underwent treatment, 259 were ruptured and 60 were unruptured. Average GOS at 1-year follow-up for all patients was 4.6. Average GOS for patients with ruptured aneurysms correlated with Hunt and Hess grade at presentation, presence of frontal hemorrhages, and need for multiple clips during surgery. Notably, 142 (44.5%) of aneurysms originated mainly from the ACoA artery; 12 (3.8%) primarily from the A1 branch; 3 (0.9%) from the A2 branch; and 162 (50.8%) from the A1/A2 junction. Aneurysm projection was superior in 118 (37%), inferior in 106 (33.2%), anterior in 88 (27.6%), and posterior in 7 (2.2%). Patients with aneurysms originating from the A1 segment had worse outcomes. Posteriorly-projecting aneurysms were more likely to be unruptured and larger than other aneurysm configurations. CONCLUSIONS The aneurysm’s exact location in relation to the adjacent neurovascular structures is potentially predictive of outcomes in the microsurgical treatment of ACoA aneurysms

Clinical, Pathological, and Surgical Outcomes for Adult Pineoblastomas

Introduction Pineoblastomas are uncommon primitive neuroectodermal tumors that occur mostly in children; they are exceedingly rare in adults. Few published reports have compared the various aspects of these tumors between adults and children. Methods The authors report a series of 12 pineoblastomas in adults from 2 institutions over 24 years. The clinical, radiologic, and pathologic features and clinical outcomes were compared with previously reported cases in children and adults. Results Patient age ranged from 24 to 81 years, and all but 1 patient exhibited symptoms of obstructive hydrocephalus. Three patients underwent gross total resection, and subtotal resection was performed in 3 patients. Diagnostic biopsy specimens were obtained in an additional 6 patients. Pathologically, the tumors had the classical morphologic and immunohistochemical features of pineoblastomas. Postoperatively, 10 patients received radiotherapy, and 5 patients received chemotherapy. Compared with previously reported cases, several differences were noted in clinical outcomes. Of the 12 patients, only 5 (42%) died of their disease (average length of survival, 118 months); 5 patients (42%) are alive with no evidence of disease (average length of follow-up, 92 months). One patient died of unrelated causes, and one was lost to follow-up. Patients with subtotal resections or diagnostic biopsies did not suffer a worse prognosis. Of the 9 patients with biopsy or subtotal resection, 4 are alive, 4 died of their disease, and 1 died of an unrelated hemorrhagic cerebral infarction. Conclusions Although this series is small, the data suggest that pineoblastomas in adults have a less aggressive clinical course than in children

Population Frequencies of the Triallelic 5HTTLPR in Six Ethnicially Diverse Samples from North America, Southeast Asia, and Africa

Genetic differences between populations are a potentially an important contributor to health disparities around the globe. As differences in gene frequencies influence study design, it is important to have a thorough understanding of the natural variation of the genetic variant(s) of interest. Along these lines, we characterized the variation of the 5HTTLPR and rs25531 polymorphisms in six samples from North America, Southeast Asia, and Africa (Cameroon) that differ in their racial and ethnic composition. Allele and genotype frequencies were determined for 24,066 participants. Results indicated higher frequencies of the rs25531 G-allele among Black and African populations as compared with White, Hispanic and Asian populations. Further, we observed a greater number of ‘extra-long’ (‘XL’) 5HTTLPR alleles than have previously been reported. Extra-long alleles occurred almost entirely among Asian, Black and Non-White Hispanic populations as compared with White and Native American populations where they were completely absent. Lastly, when considered jointly, we observed between sample differences in the genotype frequencies within racial and ethnic populations. Taken together, these data underscore the importance of characterizing the L-G allele to avoid misclassification of participants by genotype and for further studies of the impact XL alleles may have on the transcriptional efficiency of SLC6A4

Career adaptability and perceived overqualification: Testing a dual-path model among Chinese human resource management professionals

Based on career construction theory, the current research examined the relationship between career adaptability and perceived overqualification among a sample of Chinese human resource management professionals (N = 220). The results of a survey study showed that career adaptability predicted perceived overqualification through a dual-path model: On the one hand, career adaptability positively predicted employees' perceived delegation, which had a subsequent negative effect on perceived overqualification. At the same time, career adaptability also positively predicted career anchor in challenge, which in turn positively predicted overqualification. This dual-path mediation model provides a novel perspective to understand the mechanisms through which career adaptability affects perceived overqualification, and demonstrates the coexistence of opposite effects in this process. In addition, the results also showed that the effects of perceived delegation and career anchor in challenge on perceived overqualification were stronger among employees with a higher (vs. lower) level of organizational tenure. These findings carry implications for both career development theories and organizational management practices

A Historiometric Examination of Machiavellianism and a New Taxonomy of Leadership

Although researchers have extensively examined the relationship between charismatic leadership and Machiavellianism (Deluga, 2001; Gardner & Avolio, 1995; House & Howell, 1992), there has been a lack of investigation of Machiavellianism in relation to alternative forms of outstanding leadership. Thus, the purpose of this investigation was to examine the relationship between Machiavellianism and a new taxonomy of outstanding leadership comprised of charismatic, ideological, and pragmatic leaders. Using an historiometric approach, raters assessed Machiavellianism via the communications of 120 outstanding leaders in organizations across the domains of business, political, military, and religious institutions. Academic biographies were used to assess twelve general performance measures as well as twelve general controls and five communication specific controls. The results indicated that differing levels of Machiavellianism is evidenced across the differing leader types as well as differing leader orientation. Additionally, Machiavellianism appears negatively related to performance, though less so when type and orientation are taken into account.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Endovascular and microsurgical treatment of cerebral arteriovenous malformations: Current recommendations

BACKGROUND: Cerebral arteriovenous malformations (AVMs) can be a heterogeneous pathological entity whose management requires a complex decision-making process due to the risks associated with their treatment and natural history. Despite the recently published conclusions of the aborted Randomized Trial of Brain Unruptured AVMs (ARUBA) trial, the authors of this article believe multimodality intervention in general and microsurgical resection in particular continue to play a major role in the management of carefully selected ruptured or unruptured AVMs. METHODS: The authors provide an overview of their methodology for endovascular intervention and microsurgical resection and share their technical nuances for successful embolization and microsurgical resection of AVMs with special emphasis on complication avoidance. RESULTS: The authors have achieved successful outcomes in embolization and resection of cerebral AVMs when using their methodology. CONCLUSIONS: These lesions are among the most technically difficult pathological entities handled by the cerebrovascular specialist, and an overview of technical concepts to help systematize this challenging and variable endeavor can improve the safety of their treatment