Primary cardiac neoplasms: do effective treatments exist

Primary cardiac neoplasms (PCNs) represent the rarest form of neoplastic growths worldwide with an incidence ranging from 0.001 - 0.3% in autopsy series (Yu et al., 2014) ("Primary Cardiac Neoplasms," 2014). The rarity of these tumors has contributed to the challenges associated with their diagnosis and treatment ("Primary Cardiac Neoplasms," 2014). Primary heart tumors are generally classified as benign or malignant based on whether or not the tumors cells invade their surrounding tissue. Primary benign heart tumors can be further sub-classified as non-complicated or complicated. Non-complicated tumors are those that are stable, occur alone, and do not invade the cardiac conduction system. Conversely, complicated primary benign cardiac neoplasms are those that tend to break off into systemic circulation increasing the risk for embolization, have multicentered origins within the heart and/ or invade the cardiac conduction system which may lead to heart block and sudden death ("Cardiac Tumors: Merck Manual Professional," n.d.). These distinctions have been shown to significantly impact the efficacy of treatment. Primary tumors in general tend to involve either the myocardium, i.e. the heart muscle itself, or the endocardium; i.e. the membrane that lines the heart cavities. In either case, the tumors most often appear in the left atrium (Roberts, 2001). Among primary cardiac neoplasms, myxomas (a type of non-cancerous heart tumor) are the most common accounting for approximately 40-50% of these growths ("Primary Cardiac Neoplasms," 2014). Clinicians tend to rely heavily on imaging procedures for the diagnosis of primary heart tumors because there are no characteristic clinical signs exclusive to primary cardiac neoplasms (Bartoloni & Pucci, 2013). Further, these growths have a tendency to mimic the symptomology of other better known conditions such as heart failure, stroke, and coronary artery disease ("Cardiac Tumors: Merck Manual Professional," n.d.). The mean age of diagnosis for these tumors is approximately 50 years of age but many PCNs have been identified in children (Bartoloni & Pucci, 2013; "Primary Cardiac Neoplasms," 2014). Further, sources disagree on the relative incidence of these neoplasms among men and women. Some report a higher prevalence in women while others hold that the frequencies are equal for both sexes and across all races (Bartoloni & Pucci, 2013; "Primary Cardiac Neoplasms," 2014). The standard of care for the treatment of primary cardiac neoplasms are; as with other neoplastic conditions; radiation therapy, chemotherapy, surgical resection, and; in some instances; cardiac transplantation. However, due to the differences in tumor histology, i.e. the structure and molecular characteristics of tumor cells, many of the current treatment options available to and considered curative in patients with non-complicated benign PCNs do not confer the same survival benefits in patients with complicated benign PCNs nor in patients with malignant PCNs. With treatment, the prognosis associated with primary cardiac neoplasms is heavily dependent upon the type of tumor. Primary benign non-complicated neoplasms tend to have very positive prognoses. Even with incomplete resection, reports have shown no evidence of recurrence in patients with this tumor type (Jr et al., 1987). On the other hand, primary malignant neoplasms of the heart are associated with the poorest prognoses. The longest reported median survival time is only 16.5 - 17 months after diagnosis and surgical excision of the primary tumor (Chahinian, Gutstein, & Fuster, 2000; Ostrowski, Marcinkiewicz, Kooemider, & Jaszewski, 2014; Simpson et al., 2008). In this thesis we examine the reported outcomes of the above four forms of treatment that are regarded as the standard of care for primary cardiac neoplasms. We do this by reviewing the currently available literature characterizing the results of these respective courses of therapy. We then evaluate the efficacy of these treatments relative the definition of effective treatments developed herein. Finally, based on the evidence, we conclude that effective treatments do exist for approximately 38% of people with PCNs. This minority represents the people with primary benign non-complicated cardiac neoplasms. We also regrettably conclude that for the other 62% (37% with benign complicated cardiac neoplasms and 25% with malignant cardiac neoplasms) of people with primary cardiac tumors effective treatments do not exist. For this reason, we propose the further investigation of two promising therapies. These are cardiac autotransplantation and targeted gene therapy. We believe that elucidating the possible advantages of these therapies in the heart will lead to treatments that can be deemed effective in treating complicated primary benign cardiac neoplasms as well as primary malignant cardiac neoplasms

From Dream to Reality: Conducting a Thorough Physical Exam With a Cell Phone

Background: The COVID-19 pandemic has prompted a surge in the utilization of telemedicine as physicians and patients attempt to protect themselves. The art of medicine is rooted in the ability to gather subjective and objective data from patients to make accurate diagnoses and recommendations. We must rely on creativity and innovation to gather this information in the new setting of telehealth in a manner with high consistency and reliability to maintain high-quality patient care. Case Presentation: After gathering a thorough history, we work with the patient’s guardian to systematically view the patient head to toe, perform cardiopulmonary auscultation, and assess exercise tolerance through a functional examination. This method of physical examination allows for teaching to be easily integrated as both attending physician and student are viewing and listening to the same thing at the same time. Just as importantly, this method of examination strengthens the doctor-patient relationship by creating a working partnership with parent and child to gather the information needed for a successful and reliable physical examination. The lack of training physicians have in performing a virtual physical examination is a concern. There is often a perceived barrier to what can be examined virtually, creating a potential disservice to the patient. Here, we present how mobile communication devices (i.e. cellular phones) can act as the sole peripheral device necessary to conduct a thorough history and physical examination as most of these devices now come equipped with a high-quality camera, microphone, and bright light allowing for a general head-to-toe visualization of the patient and auscultation. Conclusion: Technology will continually advance and become more accessible, but what is currently widely available for both the patient and clinician is the mobile communication device. Optimization of the use of technology that is currently available needs to be prioritized. We must also take advantage of the great opportunity we have been presented with to create unique partnerships between physician, guardian, and child that make them a part of their healthcare. These unique working relationships and the opportunity for improved medical teaching are drivers for high-quality healthcare

Prioritising energy efficiency measures in Maltese restaurants

The 2018 Energy Performance of Buildings Directive (EU) 2018/844, focuses on building energy renovation. With the increase in tourists and working opportunities in Malta, the restaurants’ sector is experiencing a business boom. Despite this sector being a major energy consumer, the energy performance of restaurants in Malta has been given little attention. This paper investigates the energy performance of four representative restaurants in Malta. Refrigeration accounted for the highest share of 40% electricity consumption, followed by kitchen exhaust ventilation, domestic hot water and space cooling, which accounted for about 50%, while lighting consumed only 6%. Energy saving potential was primarily identified for refrigeration, water heating and air-conditioning. Although, the fuel sources used for cooking equipment accounted for more than 50% of the overall energy used in these restaurants, electricity is the fuel of primary concern as on average it contributes to 70% of total carbon emissions and results in the highest operational cost. The total potential of carbon emission savings was found to be 17%, when the recommended energy efficiency measures are applied. A benchmark of 14.51 kWh primary energy per person served was established for energy-efficient restaurants. This paper provides evidence-based results that are useful for policy makers to introduce fiscal incentives to support the transition of Maltese restaurants to nearly-zero energy status.peer-reviewe

Subcommittee Report on Legislative Compensation

Currently, under Section 1-19-29.1 NMSA 1978 legislators may use campaign funds for expenditures \u2026 reasonably related to performing the duties of office held, including mail, telephone, and travel expenditures to serve constituents, but excluding personal and legislative session living expenses\u27. An unintended consequence of allowing campaign funds for performance of duties of the office may be that a legislator(s) may be dependent in some measures on funds given to them by third parties who have specific interests they are promoting or supporting. In addition to the perception that legislators may be receiving contributions for political consideration, there is an even greater issue of fairness to those who have chosen to serve the public in our \u27citizen legislatures\u27. This report presents three options for modifying rules governing legislative compensation and provides positives and negatives for each option.\u2

Subcommittee Report on Campaign Finance

New Mexico is one of a minority of 13 states that do not limit most campaign contributions. The United States Supreme Court has recognized that such limits may serve a states compelling interest in preventing corruption and the appearance of corruption in the political process. The Supreme Court has also concluded that reasonable contribution limits do not violate the United States Constitution. This report details several options for the Task Force\u27s consideration, as well as the subcommittee\u27s recommendations. In the 2005 Campaign Disclosure Project — Grading State Disclosure Report, New Mexico received a grade of F for its campaign disclosure law. It received an A for its electronic filing program, but accessibility of content and online usability received an F. While New Mexico has a campaign finance law that contains standard provisions found in other states, the results of this report suggest that there is much more that can be done to strengthen our existing legal framework in this area. This report provides some options for consideration.\u2

Photochemical Pump and NMR Probe to monitor the formation and kinetics of hyperpolarized metal dihydrides

On reaction of IrI(CO)(PPh 3) 21with para-hydrogen(p-H 2),Ir(H) 2I(CO)(PPh 3) 22 is formed which exhibits strongly enhanced 1H NMR signals for its hydride resonances. Complex 2 also shows similar enhancement of its NMR spectra when it is irradiated under p-H 2. We report the use of this photochemical reactivity to measure the kinetics of H 2 addition by laser-synchronized reactions in conjunction with NMR. The single laser pulse promotes the reductive elimination of H 2 from Ir(H) 2I(CO)(PPh 3) 22 in C 6D 6 solution to form the 16-electron precursor 1, back reaction with p-H 2 then reforms 2 in a well-defined nuclear spin-state. The build up of this product can be followed by incrementing a precisely controlled delay (τ), in millisecond steps, between the laser and the NMR pulse. The resulting signal vs. time profile shows a dependence on p-H 2 pressure. The plot of k obs against p-H 2 pressure is linear and yields the second order rate constant, k 2, for H 2 addition to 1 of (3.26 ± 0.42) × 10 2 M −1 s −1. Validation was achieved by transient-UV-vis absorption spectroscopy which gives k 2 of (3.06 ± 0.40) × 10 2 M −1 s −1. Furthermore, irradiation of a C 6D 6 solution of 2 with multiple laser shots, in conjunction with p-H 2 derived hyperpolarization, allows the detection and characterisation of two minor reaction products, 2a and 3, which are produced in such low yields that they are not detected without hyperpolarization. Complex 2a is a configurational isomer of 2, while 3 is formed by substitution of CO by PPh

The influence of managerial optimism and self-regulation on learning and business growth expectations within an emerging economic context

This paper examines psychological and behavioral mechanisms that underlie business growth expectations by examining how managerial optimism and self-regulatory focus influence learning behaviors. To empirically examine these relationships, the study situates in a resource-constrained business context by studying managers in two Pacific Island economies. Results indicate that a positive view toward gains encourages exploratory learning in unknown situations; whereas, a less optimistic disposition and avoidance are related to exploitative learning. This finding is consequential as managerial learning that leans toward development of new insights and possibilities is associated with greater business growth expectations versus learning that adheres to familiar and proven ideas and alternatives. The study results have implications for both practice and theory