Arterial-portal fistula treated with hepatic arterial embolization and portal venous aneurysm stent-graft exclusion complicated by type 2 endoleak.

Intrahepatic arterioportal fistulas may be complicated by portal hypertension. An associated portal venous aneurysm (PVA) may impinge upon adjacent structures or rupture. We present a 65-year-old man with an intrahepatic Intrahepatic arterioportal fistula and 6.4 × 5.8 cm right portal vein aneurysm extending within 0.4 cm of the hepatic margin, associated with pain concerning for impending rupture. The PVA was refractory to transarterial embolization due to recruitment of arterial collaterals. Therefore, it was additionally excluded from the portal vein with a 12 mm × 9.5 cm venous stent graft. Although endovascular therapy thrombosed the aneurysm and improved symptoms, it was complicated by a type 2 endoleak into the PVA

Physical modelling of lime stabilisation in soft soils around deep excavations

Bored concrete piles have been used widely on commercial developments in London for about the last 50 years. The life of a commercial building is between 25 – 30 years and, as each building is demolished and rebuilt, the piles from the previous buildings remain in the ground causing obstruct ions to the new foundations. This paper describes a preliminary study to explore the viability of sheet piled foundations as a genuine alternative to cast in situ concrete piles and all of the complications inherent in their construction and the obstruction they create to subsequent foundations. If it is possible to u se steel piles as foundations they can be easily removed, recycled and will not cause obstructions for future developments. However, individual sheet piles have relatively low capacity when axially loaded and it is therefore necessary to consider a sheet p ile grou p in conjunction with a pilecap, which can be considered a hybrid foundation; a combination of shallow (pilecap) and deep (sheet pile). A short series of centrifuge tests is reported in which model sheet pile groups in over - consolidated clay were l oaded axially whilst vertical displacements were measured. Equivalent cast in place piles were similarly tested alongside the sheet pile groups by way of comparison

Starbursts versus Truncated Star Formation in Nearby Clusters of Galaxies

We present long-slit spectroscopy, B and R bandpass imaging, and 21 cm observations of a sample of early-type galaxies in nearby clusters which are known to be either in a star-forming phase or to have had star formation which recently terminated. From the long-slit spectra, obtained with the Blanco 4-m telescope, we find that emission lines in the star-forming cluster galaxies are significantly more centrally concentrated than in a sample of field galaxies. The broadband imaging reveals that two currently star-forming early-type galaxies in the Pegasus I cluster have blue nuclei, again indicating that recent star formation has been concentrated. In contrast, the two galaxies for which star formation has already ended show no central color gradient. The Pegasus I galaxy with the most evident signs of ongoing star formation (NGC7648), exhibits signatures of a tidal encounter. Neutral hydrogen observations of that galaxy with the Arecibo radiotelescope reveal the presence of ~4 x 10^8 solar masses of HI. Arecibo observations of other current or recent star-forming early-type galaxies in Pegasus I indicate smaller amounts of gas in one of them, and only upper limits in others.Comment: to be published in Astronomical Journa

Putting Like a Pro: The Role of Positive Contagion in Golf Performance and Perception

Many amateur athletes believe that using a professional athlete's equipment can improve their performance. Such equipment can be said to be affected with positive contagion, which refers to the belief of transference of beneficial properties between animate persons/objects to previously neutral objects. In this experiment, positive contagion was induced by telling participants in one group that a putter previously belonged to a professional golfer. The effect of positive contagion was examined for perception and performance in a golf putting task. Individuals who believed they were using the professional golfer's putter perceived the size of the golf hole to be larger than golfers without such a belief and also had better performance, sinking more putts. These results provide empirical support for anecdotes, which allege that using objects with positive contagion can improve performance, and further suggest perception can be modulated by positive contagion

Impact of SARS-CoV-2 on training and mental well-being of surgical gynecological oncology trainees

Introduction: The SARS-CoV-2 global pandemic has caused a crisis disrupting health systems worldwide. While efforts are being made to determine the extent of the disruption, the impact on gynecological oncology trainees/training has not been explored. We conducted an international survey of the impact of SARS-CoV-2 on clinical practice, medical education, and mental well-being of surgical gynecological oncology trainees. Methods: In our cross-sectional study, a customized web-based survey was circulated to surgical gynecological oncology trainees from national/international organizations from May to November 2020. Validated questionnaires assessed mental well-being. The Wilcoxon rank-sum test and Fisher's exact test were used to analyse differences in means and proportions. Multiple linear regression was used to evaluate the effect of variables on psychological/mental well-being outcomes. Outcomes included clinical practice, medical education, anxiety and depression, distress, and mental well-being. Results: A total of 127 trainees from 34 countries responded. Of these, 52% (66/127) were from countries with national training programs (UK/USA/Netherlands/Canada/Australia) and 48% (61/127) from countries with no national training programs. Altogether, 28% (35/125) had suspected/confirmed COVID-19, 28% (35/125) experienced a fall in household income, 20% (18/90) were self-isolated from households, 45% (57/126) had to re-use personal protective equipment, and 22% (28/126) purchased their own. In total, 32.3% (41/127) of trainees (16.6% (11/66) from countries with a national training program vs 49.1% (30/61) from countries with no national training program, p=0.02) perceived they would require additional time to complete their training fellowship. The additional training time anticipated did not differ between trainees from countries with or without national training programs (p=0.11) or trainees at the beginning or end of their fellowship (p=0.12). Surgical exposure was reduced for 50% of trainees. Departmental teaching continued throughout the pandemic for 69% (87/126) of trainees, although at reduced frequency for 16.1% (14/87), and virtually for 88.5% (77/87). Trainees reporting adequate pastoral support (defined as allocation of a dedicated mentor/access to occupational health support services) had better mental well-being with lower levels of anxiety/depression (p=0.02) and distress (p<0.001). Trainees from countries with a national training program experienced higher levels of distress (p=0.01). Mean (SD) pre-pandemic mental well-being scores were significantly higher than post-pandemic scores (8.3 (1.6) vs 7 (1.8); p<0.01). Conclusion: SARS-CoV-2 has negatively impacted the surgical training, household income, and psychological/mental well-being of surgical gynecological oncology trainees. The overall clinical impact was worse for trainees in countries with no national training program than for those in countries with a national training program, although national training program trainees reported greater distress. COVID-19 sickness increased anxiety/depression. The recovery phase must focus on improving mental well-being and addressing lost training opportunities

Autosomal dominant inheritance with variable penetrance in primary familial and congenital polycythemia: A family tree

Primary familial and congenital polycythemia is a rare congenital disorder with only one case ever reported from Indian Subcontinent. Here, we are reporting an entire family inflicted with primary familial and congenital polycythemia, first ever of its kind from Indian subcontinent. We are of firm belief that our report would create awareness among medical fraternity in India about this under reported disorder

Economic Evaluation of Population-Based BRCA1/BRCA2 Mutation Testing across Multiple Countries and Health Systems

Clinical criteria/Family history-based BRCA testing misses a large proportion of BRCA carriers who can benefit from screening/prevention. We estimate the cost-effectiveness of population-based BRCA testing in general population women across different countries/health systems. A Markov model comparing the lifetime costs and effects of BRCA1/BRCA2 testing all general population women ≥30 years compared with clinical criteria/FH-based testing. Separate analyses are undertaken for the UK/USA/Netherlands (high-income countries/HIC), China/Brazil (upper–middle income countries/UMIC) and India (low–middle income countries/LMIC) using both health system/payer and societal perspectives. BRCA carriers undergo appropriate screening/prevention interventions to reduce breast cancer (BC) and ovarian cancer (OC) risk. Outcomes include OC, BC, and additional heart disease deaths and incremental cost-effectiveness ratio (ICER)/quality-adjusted life year (QALY). Probabilistic/one-way sensitivity analyses evaluate model uncertainty. For the base case, from a societal perspective, we found that population-based BRCA testing is cost-saving in HIC (UK-ICER = $−5639/QALY; USA-ICER =$−4018/QALY; Netherlands-ICER = $−11,433/QALY), and it appears cost-effective in UMIC (China-ICER =$18,066/QALY; Brazil-ICER = $13,579/QALY), but it is not cost-effective in LMIC (India-ICER =$23,031/QALY). From a payer perspective, population-based BRCA testing is highly cost-effective in HIC (UK-ICER = $21,191/QALY, USA-ICER =$16,552/QALY, Netherlands-ICER = $25,215/QALY), and it is cost-effective in UMIC (China-ICER =$23,485/QALY, Brazil−ICER = $20,995/QALY), but it is not cost-effective in LMIC (India-ICER =$32,217/QALY). BRCA testing costs below $172/test (ICER =$19,685/QALY), which makes it cost-effective (from a societal perspective) for LMIC/India. Population-based BRCA testing can prevent an additional 2319 to 2666 BC and 327 to 449 OC cases per million women than the current clinical strategy. Findings suggest that population-based BRCA testing for countries evaluated is extremely cost-effective across HIC/UMIC health systems, is cost-saving for HIC health systems from a societal perspective, and can prevent tens of thousands more BC/OC cases

Attitude towards and factors affecting uptake of population based BRCA testing in the Ashkenazi Jewish population: a cohort study

Objective To evaluate factors affecting unselected‐population‐based‐BRCA‐testing in Ashkenazi‐Jews (AJ). Design Cohort‐study set within recruitment to the GCaPPS‐trial (ISRCTN73338115). Setting North‐London AJ‐population. Population or Sample AJ women/men >18‐years, recruited through self‐referral. Methods AJ‐women/men underwent pre‐test counselling for BRCA‐testing through recruitment clinics (clusters). Consenting individuals provided blood‐sample for BRCA‐testing. Socio‐demographic/family‐history/knowledge/psychological well‐being data along‐with benefits/risks/cultural‐influences (18‐item‐questionnaire measuring ‘attitude’) were collected. 4‐item likert‐scales analysed initial ‘interest’ and ‘intention‐to‐test’ pre‐counselling. Uni‐&‐multivariable logistic‐regression‐models evaluated factors affecting uptake/interest/intention‐to undergo BRCA‐testing. Statistical inference was based on cluster robust standard‐errors and joint Wald‐tests for significance. Item‐Response‐Theory and graded‐response‐models modelled responses to 18‐item questionnaire. Main Outcome Measures Interest, intention, uptake, attitude towards BRCA‐testing. Results 935 (women=67%/men=33%; mean‐age=53.8(S.D=15.02) years) individuals underwent pre‐test genetic‐counselling. Pre‐counselling 96% expressed interest but 60% indicated clear intention‐to undergo BRCA‐testing. Subsequently 88% opted for BRCA‐testing. BRCA‐related knowledge (p=0.013) and degree‐level education(p=0.01) were positively and negatively (respectively) associated with intention‐to‐test. Being married/cohabiting had four‐fold higher‐odds for BRCA‐testing uptake (p=0.009). Perceived benefits were associated with higher pre‐counselling odds for interest and intention‐to undergo BRCA‐testing. Reduced uncertainty/reassurance were the most important factors contributing to decision‐making. Increased importance/concern towards risks/limitations (confidentiality/insurance/emotional‐impact/inability to prevent cancer/marriage‐ability/ethnic‐focus/stigmatization) were significantly associated with lower‐odds of uptake‐of BRCA‐testing, and discriminated between acceptors and decliners. Male‐gender/degree‐level‐education (p=0.001) had weaker, while having children had stronger (p=0.005) attitudes towards BRCA‐testing. Conclusions BRCA‐testing in the AJ‐population has high acceptability. Pre‐test counselling increases awareness of disadvantages/limitations of BRCA‐testing, influencing final cost‐benefit perception and decision‐making on undergoing testing. This article is protected by copyright. All rights reserved

Multiple Merging Events in the Double Cluster A3128/A3125

Multi-fiber spectroscopy has been obtained for 335 galaxies in the field of the double cluster A3128/A3125, using the 2dF multi-fiber positioner on the AAT. A total of 532 objects in the double cluster now have known redshifts. We have also obtained a 20 ks Chandra ACIS-I image of A3128 and radio imaging with the MOST and the ATCA. The spatial-kinematic distribution of redshifts in the field of A3128/A3125, when combined with the Chandra image of A3128, reveals a variety of substructures present in the galaxy distribution and in the hot ICM. The most striking large-scale feature in the galaxy distribution is an underpopulated redshift zone ~4000 km/s on either side of the cluster velocity at ~17500 km/s. We attribute this depletion zone to the effect of the extensive Horologium-Reticulum Supercluster (HRS), within which A3128/A3125 is embedded. In addition, numerous smaller groups of galaxies are identified, particularly in the underpopulated region within +-4000 km/s of the cluster redshift. Due to the large gravitational influence of the HRS, these groups arrive at A3128 with a very high (hypersonic) infall velocity. Two of these groups appear as elongated filaments in position-velocity diagrams, indicating that they are tidally distended groups which have been disrupted after a close passage through A3128. We have identified a primary NE-SW merger axis connecting A3128 with A3125, along which the filaments are also oriented. In addition, the Chandra image reveals that the X-ray emission is split into two components, each with very small core radii, that are separated by ~1 Mpc along the NE-SW axis. We propose that the complex X-ray morphology is likely the result of the hypersonic infall of a relatively small group into A3128. The group produces a major disruption in the ICM due to its high infall velocity.Comment: 52 pages, 27 figures, accepted for publication in the Astronomical Journal. A more easily down-loaded version with full resolution figures is available at http://www.physics.unc.edu/~jim/a3128/LANL