Coronary Sinus to Left Atrial Communication

Congenital coronary sinus anomalies are rare in clinical practice, partly due to the lack of symptoms. We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia. In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation. In conclusion, further investigations revealed a communication between the coronary sinus (CS) and left atrium (LA)

Malpractice Suits and Physician Apologies in Cancer Care

Conside the following case: The patient is a 44-year-old woman who presents for radiation treatment of an isolated locoregional recurrence of breat cancer in her chest wall, 3 years after undergoing masectomy. At the time of diagnosis, she had T2N2M0 disease, with four of 15 lymph nodes involved with tumor. She received a masectomy with negative margins and appropriate chemotherapy, but none of her physicians talked to her about postmasectomy radiation therapy, which would clearly have been indicated to reduce her risk of locoregional failure and would have been expected to improve her likelihood of survival. She asks the radiation oncologist who sees her whether this recurrence could have been prevented, and she notes that when she was diagnosed with the recurrence, a nurse asked her why she had not received radiation before. She states that she is thinking of retaining an attorney. The radiation oncologist says, Dwelling on what could have been isn\u27t productive - let\u27s just focus on how we can fight this cancer now. This case reveals some of the dilemmas oncologists face when treating patients who have suffered from substandard medical care. It also highlights some of the shortcomings of the existing tort systm, both in addressing the legitimate claims of the patient who has been harmed by negligent care and in promoting quality improvement. In this article, we survey the US medical malpractice system and assess the effectiveness of tort law at achieving its goals. We then consider how physicians and health care organizations could better assist negligently harmed patients and simultaneously reduce future mistakes. Specifically, we describe how the hypothetical case presented might have been handled if if had occurred at our own institution, which has adopted a noevl approach to promote transparency and remedy through disclosure and apology by negligent providers to injured patients. This program was designed to compensate patients swiftly and fairly when there is evidence of harm caused by unreasonable care, as well as to decrease future errors through continuous quality improvement and an open exchange with injured patients about medical mistakes

Marginalization of social work practice with ethno-racial minorities in mainstream human service organizations in a Canadian setting : a critical exploratory study of systemic issues

The thesis is a qualitative study from critical theory perspectives to enhance understanding of how systemically mainstream organizations marginalize social work practice with ethno-racial minorities. It also explores strategic implications for systemic change based on field research findings. Ten social workers from Edmonton – the provincial capital city of Alberta, Canada - participated in investigative dialogues for the thesis field research. These research participants’ workplace stories lend themselves to explore three questions: what does marginalization of practice with ethno-racial minorities look like in mainstream organizational settings; what is there to understand about it as a systemic issue and what the research findings imply for change strategies. A critical analysis of dialogic data thematically identifies everyday work issues that describe how practice with ethno-racial minorities is kept at the operational and service-delivery fringe of individual workplaces. These thematic findings point to broader issues of the mainstream human service organization sector. These broader issues further highlight how the practice marginalization of concern in this thesis is a systemically constructed issue. These broader issues are mainstream benevolence, social work as an employment regime, multicultural service delivery as a thrill and clientization of ethno-racial minorities. In consideration of these sector-wide issues, implied change strategies reveal three thematic directions for systemic transformational change: (i) continued dialoguing involving concerned social workers and ethno-racial minority community leaders, (ii) community social work to build and foster coalitionary activist work and organizations, and (iii) participatory research involving a community sharing concern of the practice marginalization issue so as to build a strong knowledge-base to support and empower broad-base activist endeavour to effect change about mainstream human service organizations.Social WorkD. Phil. (Social Work

Grand Rounds: Asbestos-Related Pericarditis in a Boiler Operator

Context: Occupational and environmental exposures to asbestos remain a public health problem even in developed countries. Because of the long latency in asbestos-related pathology, past asbestos exposure continues to contribute to incident disease. Asbestos most commonly produces pulmonary pathology, with asbestos-related pleural disease as the most common manifestation. Although the pleurae and pericardium share certain histologic characteristics, asbestos-related pericarditis is rarely reported. Case presentation: We present a 59-year-old man who worked around boilers for almost 30 years and was eventually determined to have calcific, constrictive pericarditis. He initially presented with an infectious exacerbation of chronic bronchitis. Chest radiographs demonstrated pleural and pericardial calcifications. Further evaluation with cardiac catheterization showed a hemodynamic picture consistent with constrictive pericarditis. A high-resolution computerized tomography scan of the chest demonstrated dense calcification in the pericardium, right pleural thickening and nodularity, right pleural plaque without calcification, and density in the right middle lobe. Pulmonary function testing showed mild obstruction and borderline low diffusing capacity. Discussion: Based on the patient’s occupational history, the presence of pleural pathology consistent with asbestos, previous evidence that asbestos can affect the pericardium, and absence of other likely explanations, we concluded that his pericarditis was asbestos-related. Relevance to clinical practice: Similar to pleural thickening and plaque formation, asbestos may cause progressive fibrosis of the pericardium

DAP5 enables main ORF translation on mRNAs with structured and uORF-containing 5' leaders.

Half of mammalian transcripts contain short upstream open reading frames (uORFs) that potentially regulate translation of the downstream coding sequence (CDS). The molecular mechanisms governing these events remain poorly understood. Here, we find that the non-canonical initiation factor Death-associated protein 5 (DAP5 or eIF4G2) is required for translation initiation on select transcripts. Using ribosome profiling and luciferase-based reporters coupled with mutational analysis we show that DAP5-mediated translation occurs on messenger RNAs (mRNAs) with long, structure-prone 5' leader sequences and persistent uORF translation. These mRNAs preferentially code for signalling factors such as kinases and phosphatases. We also report that cap/eIF4F- and eIF4A-dependent recruitment of DAP5 to the mRNA facilitates main CDS, but not uORF, translation suggesting a role for DAP5 in translation re-initiation. Our study reveals important mechanistic insights into how a non-canonical translation initiation factor involved in stem cell fate shapes the synthesis of specific signalling factors

DAP5 enables main ORF translation on mRNAs with structured and uORF-containing 5' leaders

Half of mammalian transcripts contain short upstream open reading frames (uORFs) that potentially regulate translation of the downstream coding sequence (CDS). The molecular mechanisms governing these events remain poorly understood. Here, we find that the non-canonical initiation factor Death-associated protein 5 (DAP5 or eIF4G2) is required for translation initiation on select transcripts. Using ribosome profiling and luciferase-based reporters coupled with mutational analysis we show that DAP5-mediated translation occurs on messenger RNAs (mRNAs) with long, structure-prone 5' leader sequences and persistent uORF translation. These mRNAs preferentially code for signalling factors such as kinases and phosphatases. We also report that cap/eIF4F- and eIF4A-dependent recruitment of DAP5 to the mRNA facilitates main CDS, but not uORF, translation suggesting a role for DAP5 in translation re-initiation. Our study reveals important mechanistic insights into how a non-canonical translation initiation factor involved in stem cell fate shapes the synthesis of specific signalling factors

Signatures of Electronic Nematic Phase at Isotropic-Nematic Phase Transition

The electronic nematic phase occurs when the point-group symmetry of the lattice structure is broken, due to electron-electron interactions. We study a model for the nematic phase on a square lattice with emphasis on the phase transition between isotropic and nematic phases within mean field theory. We find the transition to be first order, with dramatic changes in the Fermi surface topology accompanying the transition. Furthermore, we study the conductivity tensor and Hall constant as probes of the nematic phase and its transition. The relevance of our findings to Hall resistivity experiments in the high-$T_c$ cuprates is discussed.Comment: 5 pages, 3 figure