Appreciating cultural diversity through clinical supervision

Abstract: Structured supervision techniques encourage service providers to increase their knowledge, skills, and selfawareness in providing multicultural services. Structured techniques are described and illustrated

Arachnoid cysts - common and uncommon clinical presentations and radiological features

Arachnoid cysts are benign, extra axial, cystic lesions, formed due tocongenital splitting of the arachnoid layer. They are often discovered incidentally, either by fetal cranial ultrasound or as an asymptomatic finding on subsequent neuroimaging studies in adulthood. In this article, we present a pictorial review demonstrating the typical imaging features for arachnoid cysts and also include imaging appearances of more atypical arachnoid cysts and their potential complications. We also discuss the epidemiology, pathogenesis, imaging features, differential diagnosis and clinical presentation of arachnoid cysts according to their location and present a brief outline of treatment options

The ROAM/EORTC-1308 trial: Radiation versus Observation following surgical resection of Atypical Meningioma: study protocol for a randomised controlled trial

BACKGROUND Atypical meningiomas are an intermediate grade brain tumour with a recurrence rate of 39-58 %. It is not known whether early adjuvant radiotherapy reduces the risk of tumour recurrence and whether the potential side-effects are justified. An alternative management strategy is to perform active monitoring with magnetic resonance imaging (MRI) and to treat at recurrence. There are no randomised controlled trials comparing these two approaches. METHODS/DESIGN A total of 190 patients will be recruited from neurosurgical/neuro-oncology centres across the United Kingdom, Ireland and mainland Europe. Adult patients undergoing gross total resection of intracranial atypical meningioma are eligible. Patients with multiple meningioma, optic nerve sheath meningioma, previous intracranial tumour, previous cranial radiotherapy and neurofibromatosis will be excluded. Informed consent will be obtained from patients. This is a two-stage trial (both stages will run in parallel): Stage 1 (qualitative study) is designed to maximise patient and clinician acceptability, thereby optimising recruitment and retention. Patients wishing to continue will proceed to randomisation. Stage 2 (randomisation) patients will be randomised to receive either early adjuvant radiotherapy for 6 weeks (60 Gy in 30 fractions) or active monitoring. The primary outcome measure is time to MRI evidence of tumour recurrence (progression-free survival (PFS)). Secondary outcome measures include assessing the toxicity of the radiotherapy, the quality of life, neurocognitive function, time to second line treatment, time to death (overall survival (OS)) and incremental cost per quality-adjusted life year (QALY) gained. DISCUSSION ROAM/EORTC-1308 is the first multi-centre randomised controlled trial designed to determine whether early adjuvant radiotherapy reduces the risk of tumour recurrence following complete surgical resection of atypical meningioma. The results of this study will be used to inform current neurosurgery and neuro-oncology practice worldwide. TRIAL REGISTRATION ISRCTN71502099 on 19 May 2014

Sudden onset headache in a post-partum young female

 We present the case of a 33 year old female presenting with acute neurological signs including right sided neglect and confusion four days postpartum. The original non-contrast CT brain demonstrated an acute left temporal intraparenchymal hemorrhage. A cerebral catheter angiogram was performed and demonstrated the typical appearances of RCVS (Reversible cerebral vasoconstriction syndrome)

College Student Mental Health: An Evaluation of the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure

© 2018 American Psychological Association. The DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure was developed to aid in clinical decision-making for clients seeking psychiatric services and to facilitate empirical investigation of the dimensional nature of mental health issues. Preliminary evidence supports its utility with clinical samples. However, the brief, yet comprehensive structure of the DSM-5 Level 1 measure may benefit a high-risk population that is less likely to seek treatment. College students have high rates of hazardous substance use and co-occurring mental health symptoms, yet rarely seek treatment. Therefore, the current study evaluated the psychometric properties (i.e., construct and criterion-related validity) of the DSM-5 Level 1 measure with a large, diverse sample of non-treatment-seeking college/university students. Data from 7,217 college students recruited from 10 universities in 10 different states across the United States evidenced psychometric validation of the DSM-5 Level 1 measure. Specifically, we found acceptable internal consistency across multi-item DSM-5 domains and moderate to strong correlations among domains (internal validity). Further, several DSM-5 domains were positively associated with longer, validated measures of the same mental health construct and had similar strengths of associations with substance use outcomes compared to longer measures of the same construct (convergent validity). Finally, all DSM-5 domains were negatively associated with self-esteem and positively associated with other theoretically relevant constructs, such as posttraumatic stress (criterion-related validity). Taken together, the DSM-5 Level 1 measure appears to be a viable tool for evaluating psychopathology in college students. Several opportunities for clinical application and empirical investigation of the DSM-5 Level 1 measure are discussed

CIRSE Vascular Closure Device Registry

The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters

Reduced ovarian reserve relates to monocyte activation and subclinical coronary atherosclerotic plaque in women with HIV

Objective: To investigate differences in subclinical coronary atherosclerotic plaque and markers of immune activation among HIV-infected and non-HIV-infected women categorized by degree of ovarian reserve and menopause status. Design: Cross-sectional evaluation. Methods: Seventy-four women (49 HIV-infected, 25 non-HIV-infected) without known cardiovascular disease (CVD) were classified as premenopausal, premenopausal with reduced ovarian reserve, or postmenopausal based on menstrual history and anti-Mü llerian hormone (AMH) levels. Participants underwent contrast-enhanced coronary computed tomography angiography and immune phenotyping. Comparisons in coronary atherosclerotic plaque burden and immune markers were made between the HIV-infected and non-HIV-infected women overall and within the HIV-infected and non-HIV-infected women by reproductive classification group. Results: Among the overall group of HIV-infected women, the women with reduced ovarian reserve (undetectable AMH) had a higher prevalence of coronary atherosclerotic plaque (52 versus 6%, P ¼ 0.0007) and noncalcified plaque (48 versus 6%, P ¼ 0.002), as well as higher levels of log sCD163 (P ¼ 0.0004) and log MCP-1 (P ¼ 0.006), compared with the premenopausal women with measurable AMH. Furthermore, reduced ovarian reserve in the HIV-infected group related to noncalcified plaque, controlling for traditional CVD risk factors (P ¼ 0.04) and sCD163 (P ¼ 0.03). Conclusion: HIV-infected women with reduced ovarian reserve have increased subclinical coronary atherosclerotic plaque compared with premenopausal women in whom AMH is measurable. This relationship holds when controlling for CVD risk factors (including age) and immune activation. Our findings demonstrate that reduced ovarian reserve may contribute to CVD burden in HIV-infected women and support a comprehensive assessment of CVD risk prior to completion of menopause in this population

An exhibition of work by the Victorian tapestry workshop

An exhibition of work by the Victorian tapestry workshop Fine Arts Gallery, University Centre, Churchill Ave., Sandy Bay 24 April - 10 Ma