Commentary: The History of Neurosurgery at Albany Medical College and Albany Medical Center Hospital, Albany, New York.

The origins of the Department of Neurosurgery at Albany Medical College closely parallel the development of early America and the establishment of modern health care.The tales of Washington Irving, the works of the Hudson River School of painters, and summers in the Catskill Mountains or Adirondacks are the stories that color the history of Upstate New York (Figure1). As a social, industrial, and political hub of the American colonies, New England’s need for centers providing structured medicine led to the creation of Albany Medical College in1839, one of the earliest such institutions in the young nation.1 Rapid progress in nearly every other realm of life required medical advancements as well, prompting subspecialization and the development of neurosurgery in the region

Rescue stenting for failed mechanical thrombectomy procedures

Background: Mechanical thrombectomy (MT) has dramatically changed the natural history of acute ischemic stroke. The disease that was associated with high morbidity, mortality, and significant cost on the health care system became a treatable disease. One of the most important variables to improve outcomes is time to revascularize the ischemic tissue. Rescue stenting (RS) is an option for patients who fail MT. Methods: A retrospective chart review for patients who underwent a MT procedure and either failed (defined as TICI 0-2a) or required a RS from 2015 – 2019 composed the study population. IRB approval was obtained and the consent was waived due to the study design. Medical charts and imaging were reviewed for baseline characteristics, stroke characteristics, complications, and functional outcome. Comparison was performed between the rescue group and the failed group to analyze outcomes. Results: From 2015-2019, 96 patients failed a MT procedure, and 26 patients required an intracranial stent. Initial NIHSS scores were comparable between the groups, (16.1 ± 7.2 vs. 15.2 ± 8.0, p = 0.552). Patients received comparable pre-procedure care as indicated by similar rate of tPA administration (38.5% vs. 34.6%, p = 0.804) and symptom onset to procedure time (1043.5 ± 3556 vs. 1505.3 ± 5183, p = 0.652). While receiving an intracranial stent led to a longer procedure time (66.1 ± 43.4 vs. 86.6 ± 36.2, p = 0.040), patients receiving a stent had a reduced mortality (32 (36.0%) vs. 3 (12.0%), p = 0.027) and NIHSS at discharge (23.0 ± 14.7 vs. 14.5 ± 13.6, p = 0.034). In the RS group, 4 patients had symptomatic intracranial hemorrhage as opposed to 2 in the non-RS group (3.6% vs 15.4%, p = 0.08). Conclusion: Rescue stenting was associated with good outcomes as indicated by decreased mortality and NIHSS at discharge

Abell 1451 and 1RXS J131423.6-251521: a multi-wavelength study of two dynamically perturbed clusters of galaxies

We present results from optical, X-ray and radio observations of two X-ray bright (L_X ~ 10^{45} erg/s) galaxy clusters. A1451 is at redshift z=0.1989 and has line-of-sight velocity dispersion sigma_v = 1330 km/s as measured from 57 cluster galaxies. It has regular X-ray emission without signs of substructure, a Gaussian velocity distribution, lack of a cooling flow region and significant deviations from the observed scaling laws between luminosity, temperature and velocity dispersion, indicating a possible merging shock. There is only one spectroscopically confirmed cluster radio galaxy, which is close to the X-ray peak. 1RXS J131423.6-251521 has z=0.2474 and sigma_v = 1100 km/s from 37 galaxies. There are two distinct galaxy groups with a projected separation of \~700 kpc. The velocity histogram is bi-modal with a redshift-space separation of ~1700 km/s, and the X-ray emission is double peaked. Although there are no spectroscopically confirmed cluster radio galaxies, we have identified a plausible relic source candidate.Comment: 16 pages, 12 figures, some in colour; A&A accepte

Stroke Centers of Excellence in the United States: Certification, Access and Outcomes

Introduction: Stroke is a leading cause of morbidity, mortality and healthcare costs in the United States. Evidence suggests that certified stroke centers have improved patient outcomes relative to non-certified hospitals. Our study explains the process, associated cost, quality and geographic proclivities of different certifying organizations. Methods: Data was collected from published literature, information on certifying organizations’ websites and through direct communication with representatives of The Joint Commission (TJC), Det Norske Veritas and Germanischer Lloyd (DNV-GL), and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of thrombectomy capable centers and comprehensive stroke centers was performed with the ArcGIS online tool. Results: Among the three certifying organizations, standards for recognition as acute, primary, thrombectomy capable and comprehensive stroke centers are not standardized. At the time of this review, there were 1406 TJC-certified stroke centers, 241 DNV-GL certified stroke centers and 66 HFAP-certified stroke centers in the United States. Cost for certification was similar with price scaled by complexity of capabilities. Quality metrics revealed a significantly higher rate of tPA administration and shorter door-to-needle time for TJC and DNV-GL centers than HFAP. All primary stroke centers exhibited improved in-hospital, 30-day and 1-year mortality when compared to non-stroke centers. Discussion: Despite lack of standardization of criteria between organizations, certification provides a mechanism for ensuring hospitals deliver higher standards of stroke care. Understanding variations in quality and scope of different organizations enables targeting of at-risk regions to maximize access and availability of care

Improving Serial Imaging Protocols in Spontaneous Intracerebral Hemorrhage

There is no universally agreed upon protocol to image patient presenting with intra-parenchymal hemorrhage of non-traumatic etiology (sICH). At our institution, it is common practice for a patient to have 3 CT’s done within 24 hours. They are often at onset of symptoms or presentation, 6 hours post onset of symptoms, and finally 24 hours post bleed onset. The goal of this project will be to assess the safety and efficacy of obtaining this repeat imaging in our patients in the hopes that limiting unnecessary CT head studies will decrease resource utilization, decrease patient radiation, expedite movement of stable patients out of the ICU and/or disposition

Pressure versus concentration tuning of the superconductivity in Ba(Fe(1-x)Cox)2As2

In the iron arsenide compound BaFe2As2, superconductivity can be induced either by a variation of its chemical composition, e.g., by replacing Fe with Co, or by a reduction of the unit-cell volume through the application of hydrostatic pressure p. In contrast to chemical substitutions, pressure is expected to introduce no additional disorder into the lattice. We compare the two routes to superconductivity by measuring the p dependence of the superconducting transition temperature Tc of Ba(Fe(1-x)Cox)2As2 single crystals with different Co content x. We find that Tc(p) of underdoped and overdoped samples increases and decreases, respectively, tracking quantitatively the Tc(x) dependence. To clarify to which extent the superconductivity relies on distinct structural features we analyze the crystal structure as a function of x and compare the results with that of BaFe2As2 under pressure.Comment: 14 pages, 4 figures, to be published in JPSJ Vol. 79 No. 12. The copyright is held by The Physical Society of Japa

Standardizing Postoperative Handoffs Using the Evidence-Based IPASS Framework Improves Handoff Communication for Postoperative Neurosurgical Patients in the Neuro-Intensive Care Unit

Aims for Improvement Within one year of initiation of the process improvement plan, we wanted to improve: Direct communication of airway and hemodynamic concerns Direct communication of operative events, complications, and perioperative management goals. Attendance at postoperative handoffs Confirmation of information by receiving teams Staff perceptions of handoff efficacy and teamwork

Coil Embolization with Subsequent Subacute Flow Diversion Before Hospital Discharge as a Treatment Paradigm for Ruptured Aneurysms

Subtotal coil embolization followed by subsequent flow diversion is often pursued for treatment of acutely ruptured aneurysms. Owing to the need for anti-platelet therapy, the optimal time of safely pursuing flow diversion treatment has not been fully elucidated. In this study, we aim to demonstrate the safety and feasibility of staged treatment of acutely ruptured aneurysms with early coil embolization followed by flow diversion prior to discharge. A retrospective study to evaluate clinical outcomes of patients who presented with aneurysmal subarachnoid hemorrhage and underwent coil embolization followed by subacute flow diversion treatment during the same hospitalization. A total of 18 patients are included in our case series. Eight patients presented with Hunt-Hess (H-H) grade 2 bleed, 6 patients with H-H grade 3, and 2 patients each with H-H grade 4 and H-H grade 1. Eight patients required placement of an external ventricular drain on admission. After initial coil embolization, 12 achieved Raymond-Roy grade 2 occlusion, and 6 attained grade 3a/b occlusion. The mean duration between coil embolization and subsequent flow diversion was 9.83 days (range: 1–30). There were no instances of re-hemorrhage between initial coil embolization and subsequent flow diversion treatment. Sixteen patients had a minimum of 6-month follow-up, of which 15 were found to have complete occlusion, and 1 required subsequent clipping. Subtotal coil embolization followed by definitive treatment using flow diversion during the same hospitalization is feasible and achieves excellent aneurysm occlusion rates while avoiding dual anti-platelet therapy during the initial hemorrhage period