Could there be light at the end of the tunnel? Mesocaval shunting for refractory esophageal varices in patients with contraindications to transjugular intrahepatic portosystemic shunt.

Cirrhotic patients with recurrent variceal bleeds who have failed prior medical and endoscopic therapies and are not transjugular intrahepatic portosystemic shunt candidates face a grim prognosis with limited options. We propose that mesocaval shunting be offered to this group of patients as it has the potential to decrease portal pressures and thus decrease the risk of recurrent variceal bleeding. Mesocaval shunts are stent grafts placed by interventional radiologists between the mesenteric system, most often the superior mesenteric vein, and the inferior vena cava. This allows flow to bypass the congested hepatic system, reducing portal pressures. This technique avoids the general anesthesia and morbidity associated with surgical shunt placement and has been successful in several case reports. In this paper we review the technique, candidate selection, potential pitfalls and benefits of mesocaval shunt placement

Metastatic Pancreatic Adenocarcinoma During Pregnancy.

We present a rare case of metastatic pancreatic adenocarcinoma diagnosed antepartum. A high index of suspicion must be maintained to diagnose pancreatic cancer during pregnancy. We recommend a thorough history and physical and aggressive pursuit of sensitive imaging in patients with persistent symptoms. If pancreatic adenocarcinoma is diagnosed, a multidisciplinary approach that focuses on patient goals should be undertaken. The effect of pregnancy on tumor growth rates is unknown

Tackling the Monday Morning Quarterback: Applications of Hindsight Bias in Decision-Making Settings

Extant research has focused largely on what causes hindsight distortion. In contrast, this work examines applied aspects related to the bias in decision-making environments. A conceptual framework is provided and recent real–world examples are presented to outline how decision makers—and those who observe them—show hindsight effects. Then, both negative and positive consequences of the bias are outlined. Strategies are presented to reduce negative effects that occur when decision makers show hindsight distortion. Finally, because it is often not possible to avoid or to correct others\u27 hindsight–tainted evaluations, suggestions for coping with the bias are discussed

Production and income statistics for certain specialty farm products Oregon - 1936

Published September 1938. Facts and recommendations in this publication may no longer be valid. Please look for up-to-date information in the OSU Extension Catalog: http://extension.oregonstate.edu/catalo

The Role of Life Satisfaction in Predicting Youth Violence and Offending: A Prospective Examination

Life satisfaction in adolescence has been shown to protect against numerous negative outcomes (e.g., substance use, sexual risk-taking), but limited work has directly explored the relationship between life satisfaction and youth violence and offending. As such, we conducted a prospective assessment to explore this relationship among community (n = 334) and at-risk youth (n = 99). Findings suggest life satisfaction is significantly associated with decreased offending and violence within both samples and adds incremental value above established risk factors in predicting violent and total offending among community youth. Furthermore, moderation analyses indicate that the protective value of life satisfaction is greater for youth with high callous–unemotional traits. Mediation analyses suggest that youth who are unsatisfied with their lives may seek out substance use, in turn elevating risk of offending. Together, these findings indicate that efforts to improve overall life satisfaction may help prevent adolescent offending. However, future research is needed

Measurement of Sibling Violence: A Two-Factor Model of Severity

The measurement of violence is a major challenge in aggression research. Because of the heterogeneous nature of violent behavior, problems arise when applying blanket measures to inherently distinct subtypes of aggression. Incidents of intersibling violence (ISV) exacerbate these problems because siblinghood represents a unique offender–victim situation. This research explored whether an existing two-factor model for severe violence found in a sample of 250 adult offenders (age M = 26.8, SD = 5.9) could be generalized to deliberate severe ISV in a sample of 111 young offenders (age M = 14.83, SD = 1.45). Exploratory factor analysis revealed a two-factor model encompassing severe ISV perpetration with weapon use (Factor 1) and severe ISV perpetration without weapon use (Factor 2). The results provide strong empirical support for the two-factor model of violence severity previously established with adult offenders. This analysis demonstrates construct validity of the severity measures among the different types of offenders studied and provides support for generalization across populations

Low incidence of new biochemical and clinical hypogonadism following hypofractionated stereotactic body radiation therapy (SBRT) monotherapy for low- to intermediate-risk prostate cancer

<p>Abstract</p> <p>Background</p> <p>The CyberKnife is an appealing delivery system for hypofractionated stereotactic body radiation therapy (SBRT) because of its ability to deliver highly conformal radiation therapy to moving targets. This conformity is achieved via 100s of non-coplanar radiation beams, which could potentially increase transitory testicular irradiation and result in post-therapy hypogonadism. We report on our early experience with CyberKnife SBRT for low- to intermediate-risk prostate cancer patients and assess the rate of inducing biochemical and clinical hypogonadism.</p> <p>Methods</p> <p>Twenty-six patients were treated with hypofractionated SBRT to a dose of 36.25 Gy in 5 fractions. All patients had histologically confirmed low- to intermediate-risk prostate adenocarcinoma (clinical stage ≤ T2b, Gleason score ≤ 7, PSA ≤ 20 ng/ml). PSA and total testosterone levels were obtained pre-treatment, 1 month post-treatment and every 3 months thereafter, for 1 year. Biochemical hypogonadism was defined as a total serum testosterone level below 8 nmol/L. Urinary and gastrointestinal toxicity was assessed using Common Toxicity Criteria v3; quality of life was assessed using the American Urological Association Symptom Score, Sexual Health Inventory for Men and Expanded Prostate Cancer Index Composite questionnaires.</p> <p>Results</p> <p>All 26 patients completed the treatment with a median 15 months (range, 13-19 months) follow-up. Median pre-treatment PSA was 5.75 ng/ml (range, 2.3-10.3 ng/ml), and a decrease to a median of 0.7 ng/ml (range, 0.2-1.8 ng/ml) was observed by one year post-treatment. The median pre-treatment total serum testosterone level was 13.81 nmol/L (range, 5.55 - 39.87 nmol/L). Post-treatment testosterone levels slowly decreased with the median value at one year follow-up of 10.53 nmol/L, significantly lower than the pre-treatment value (<it>p </it>< 0.013). The median absolute fall was 3.28 nmol/L and the median percent fall was 23.75%. There was no increase in biochemical hypogonadism at one year post-treatment. Average EPIC sexual and hormonal scores were not significantly changed by one year post-treatment.</p> <p>Conclusions</p> <p>Hypofractionated SBRT offers the radiobiological benefit of a large fraction size and is well-tolerated by men with low- to intermediate-risk prostate cancer. Early results are encouraging with an excellent biochemical response. The rate of new biochemical and clinical hypogonadism was low one year after treatment.</p

Identifying Causal Risk Factors for Violence among Discharged Patients

This study was funded by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0407-10500)