Endoscopic endonasal management of recurrent petrous apex cholesterol granuloma.

Petrous apex cholesterol granulomas (PACG) are uncommon lesions. Recurrence following transcranial or endonasal approaches to aerate the cyst occurs in up to 60% of cases. We describe the technical nuances pertinent to the endonasal endoscopic management of a recurrent symptomatic PACG and review the literature. A 19-year-old woman presented with a recurrent right abducens nerve paresis. Four months prior, she underwent an endonasal transsphenoidal surgery (TSS) for drainage of a symptomatic PACG. Current imaging documented recurrence of the right PACG. Transsphenoidal and infrapetrous approaches were performed to obtain a wider bony opening along the petrous apex and drain the cyst. A Doyle splint was inserted into the cyst's cavity and extended out into the sphenoid, maintaining patency during the healing process. Three months after surgery, the splint was removed endoscopically, allowing visualization of a patent cylindrical communication between both aerated cavities. The patient remains symptom- and recurrence-free. Endoscopic endonasal surgery must be adapted to manage recurrent PACG. A TSS may not be sufficient. An infrapetrous approach with wider bony opening, extensive removal of the cyst's anterior wall, and use of a stent are indicated for the treatment of recurrent PACG and to prevent recurrences

Teaching the Use of Systems Dynamics for Strategic Decision Making in Healthcare

Having worked in the healthcare system and taught healthcare MBAs for over a decade, we have observed that healthcare systems and departments operate in independent silos. This paper shows how to use systems dynamics as a method to help students examine the big picture of how components fit together to form a system. We demonstrate the application of this approach and provide an example from one of our healthcare professional graduate student teams

Finding the Path to Innovation – Part 2

Industry leaders have been put on the defensive in their need to address mounting financial and operational concerns. In a previous, companion paper, it was suggested that healthcare managers need to balance financial challenges with innovative programming that enhances their strategic mix to find new ways to counter the disruption from the ACA. This paper illustrates a practical example of the applications of this innovation model which touches on three activities: (1) aligning the organization’s purpose with its markets, (2) piloting ideas, and (3) learning from a variety of stakeholders in and outside of the traditional healthcare domain. United HealthGroup (UHG) has developed a new program in the area of health literacy (Just Plain Clear) that illustrates these principles. Based on the organization’s mission of “helping people live healthier lives” it was clear that there was a need to more effectively communicate with their customers. As part of their effort to pilot ideas UHG developed a tool to analyze documents to determine the reading levels needed to understand the documents used by their customers and how to modify then for easier reading. They then decided that a glossary of medical terms in English and Spanish would be a good way to begin addressing health literacy issues among its customers. Learning from stakeholders the UHG staff consulted with the Institute of Medicine; America’s Health Insurance Plans; medical schools at Northwestern University, Boston University, and the University of Missouri; the RAND Corporation; and the Center for Plain Language. In addition, UHG staff reviewed more than 800 journal articles on health literacy. In 2014, the Just Plain Clear website had 22,600 visitors and its use continues to grow. UHG considers this pilot program a success

Thinking Beyond the Affordable Care Act

Health care leaders are currently focused on implementing the many aspects of the Affordable Care Act. Although these initiatives are necessary, they are not sufficient to succeed strategi­cally in the healthcare reform environment. Success occurs with an organizational strategy that focuses on new processes and services that meet the healthcare and financial needs of the customer while disrupt­ing the status quo. Three strategic principles are recommended that can be used in helping organizations address disruptions or create their own. These three principles are: test a new business model against the needs of our customers; pilot test one or two new ideas to disrupt or counter disruption; look across disciplines for ideas and encouragement. Change management is far more difficult to enact than is communicated in books, lectures, and case studies. However, in this high-pressure healthcare environment, it is becoming imperative for managers to find a path to participate in positive disruptive solutions, or risk becoming victims of other organizations solutions

Interstellar X-Ray Absorption Spectroscopy of Oxygen, Neon, and Iron with the Chandra LETGS Spectrum of X0614+091

We find resolved interstellar O K, Ne K, and Fe L absorption spectra in the Chandra X-Ray Observatory Low-Energy Transmission Grating Spectrometer (LETGS) spectrum of the low-mass X-ray binary X0614+091. We measure the column densities in O and Ne and find direct spectroscopic constraints on the chemical state of the interstellar O. These measurements probably probe a low-density line of sight through the Galaxy, and we discuss the results in the context of our knowledge of the properties of interstellar matter in regions between the spiral arms

Impacts of agriculture on the parasite communities of northern leopard frogs (Rana pipiens) in southern Quebec, Canada

Given that numerous amphibians are suffering population declines, it is becoming increasingly important to examine the relationship between disease and environmental disturbance. Indeed, while many studies relate anthropogenic activity to changes in the parasitism of snails and fishes, little is known of the impact on the parasites of amphibians, particularly from agriculture. For 2 years, the parasite communities of metamorphic northern leopard frogs from 7 agricultural wetlands were compared with those from 2 reference wetlands to study differences in parasite community diversity and abundance of various species under pristine conditions and 3 categories of disturbance: only agricultural landscape, only pesticides, and agricultural landscape with pesticides. Agricultural (and urban) area was negatively related to species richness, and associated with the near absence of adult parasites and species that infect birds or mammals. We suggest that agriculture and urbanization may hinder parasite transmission to frogs by limiting access of other vertebrate hosts of their parasites to wetlands. The only parasite found at all localities was an unidentified echinostome infecting the kidneys. This parasite dominated communities in localities surrounded by the most agricultural land, suggesting generalist parasites may persist in disrupted habitats. Community composition was associated with dissolved organic carbon and conductivity, but few links were found with pesticides. Pollution effects may be masked by a strong impact of land use on parasite transmission

mmView: a web-based viewer of the mmCIF format

<p>Abstract</p> <p>Background</p> <p>Structural biomolecular data are commonly stored in the PDB format. The PDB format is widely supported by software vendors because of its simplicity and readability. However, the PDB format cannot fully address many informatics challenges related to the growing amount of structural data. To overcome the limitations of the PDB format, a new textual format mmCIF was released in June 1997 in its version 1.0. mmCIF provides extra information which has the advantage of being in a computer readable form. However, this advantage becomes a disadvantage if a human must read and understand the stored data. While software tools exist to help to prepare mmCIF files, the number of available systems simplifying the comprehension and interpretation of the mmCIF files is limited.</p> <p>Findings</p> <p>In this paper we present mmView - a cross-platform web-based application that allows to explore comfortably the structural data of biomacromolecules stored in the mmCIF format. The mmCIF categories can be easily browsed in a tree-like structure, and the corresponding data are presented in a well arranged tabular form. The application also allows to display and investigate biomolecular structures via an integrated Java application Jmol.</p> <p>Conclusions</p> <p>The mmView software system is primarily intended for educational purposes, but it can also serve as a useful research tool. The mmView application is offered in two flavors: as an open-source stand-alone application (available from <url>http://sourceforge.net/projects/mmview</url>) that can be installed on the user's computer, and as a publicly available web server.</p

Aerobic capacity, activity levels and daily energy expenditure in male and female adolescents of the kenyan nandi sub-group

The relative importance of genetic and socio-cultural influences contributing to the success of east Africans in endurance athletics remains unknown in part because the pre-training phenotype of this population remains incompletely assessed. Here cardiopulmonary fitness, physical activity levels, distance travelled to school and daily energy expenditure in 15 habitually active male (13.9±1.6 years) and 15 habitually active female (13.9±1.2) adolescents from a rural Nandi primary school are assessed. Aerobic capacity ([Formula: see text]) was evaluated during two maximal discontinuous incremental exercise tests; physical activity using accelerometry combined with a global positioning system; and energy expenditure using the doubly labelled water method. The [Formula: see text] of the male and female adolescents were 73.9±5.7 ml(.) kg(-1.) min(-1) and 61.5±6.3 ml(.) kg(-1.) min(-1), respectively. Total time spent in sedentary, light, moderate and vigorous physical activities per day was 406±63 min (50% of total monitored time), 244±56 min (30%), 75±18 min (9%) and 82±30 min (10%). Average total daily distance travelled to and from school was 7.5±3.0 km (0.8-13.4 km). Mean daily energy expenditure, activity-induced energy expenditure and physical activity level was 12.2±3.4 MJ(.) day(-1), 5.4±3.0 MJ(.) day(-1) and 2.2±0.6. 70.6% of the variation in [Formula: see text] was explained by sex (partial R(2) = 54.7%) and body mass index (partial R(2) = 15.9%). Energy expenditure and physical activity variables did not predict variation in [Formula: see text] once sex had been accounted for. The highly active and energy-demanding lifestyle of rural Kenyan adolescents may account for their exceptional aerobic fitness and collectively prime them for later training and athletic success