Raising Our Game: Can We Sustain Globalization?

Depicts four alternate scenarios of the state of sustainable development and globalization in the year 2027, and looks at the associated environmental and societal wins and losses of each situation

Evaluation of IT Service Desk: A Case Study

Organisations rely heavily on Information Technology Services Management (ITSM) to provide efficient and quality services to all stakeholders. This research is an exploratory study conducted of the service desk operations model. The research explores simple metrics and a weighted requirement matrix for evaluating and selecting ITSM systems. Several data gathering tools which include brainstorming, interviewing, participantobservation and collaborative feedback document have been employed in this research for collecting requirements from stakeholders to ensure viability and robustness of the research. Prominent challenges to sound implementation of a suitable service desk suite have been identified and tabulated. The identified challenges, coupled with feedback from stakeholders enabled the researchers to arrive at a scaled section framework for selecting an ITSM system. A comparison of eleven state of the art service desk systems has also been completed as part of the research. This research also proposes a novel service desk process with specific emphasis on the roles played by various stakeholders in provision of an efficient service desk operation

Planning for Detroit's Tax-Reverted Properties: Possibilities fo rthe Wayne County Land Bank

http://deepblue.lib.umich.edu/bitstream/2027.42/110958/1/planning_for_detroit_s_tax_reverted_properties2006.pd

Contextual factors and programme theories associated with implementing blue prescription programmes: a systematic realist review

Nature-based social prescribing such as “blue prescription” promotes public health and health improvement of individuals with long-term health conditions. However, there is limited evidence explaining the relationship of contexts, mechanisms, and outcomes of implementing blue prescription programmes (BPPs) in health and social care settings that could inform policy and practice. We conducted a systematic realist review by searching PubMed, Web of Science, PsycInfo, Scopus, MEDLINE, and CINAHL for articles published in English between January 2000 and June 2022 about health and social care professionals providing referral to or prescription of blue space activities (e.g., swimming, fishing, surfing, etc.) with health-related outcomes. Components and descriptions of BPP implementation were extracted and used to develop themes of contextual factors used to develop programme theories and a logic model demonstrating the mechanisms of BPP implementation. Sixteen studies with adequate to strong quality were included from 8,619 records. After participating in BPPs referred to or prescribed by health and social care professionals, service users had improvements in their physical, cognitive (mental), social health, and proenvironmental knowledge. Service user-related contextual factors were referral information, free equipment, transportation, social support, blue space environments, and skills of service providers. Programme-related contextual factors were communication, multistakeholder collaboration, financing, and adequate service providers. Programme theories on service user enrolment, engagement, adherence, communication protocols, and programme sustainability explain the mechanisms of BPP implementation. BPPs could promote health and wellbeing if contextual factors and programme theories associated with service users’ characteristics and programme delivery are considered in the design, delivery, and evaluation of BPPs. Our study was registered with PROSPERO (CRD42020170660)

Evaluation of a Balloon Implant for Simultaneous Magnetic Nanoparticle Hyperthermia and High-Dose-Rate Brachytherapy of Brain Tumor Resection Cavities

Previous work has reported the design of a novel thermobrachytherapy (TBT) balloon implant to deliver magnetic nanoparticle (MNP) hyperthermia and high-dose-rate (HDR) brachytherapy simultaneously after brain tumor resection, thereby maximizing their synergistic effect. This paper presents an evaluation of the robustness of the balloon device, compatibility of its heat and radiation delivery components, as well as thermal and radiation dosimetry of the TBT balloon. TBT balloon devices with 1 and 3 cm diameter were evaluated when placed in an external magnetic field with a maximal strength of 8.1 kA/m at 133 kHz. The MNP solution (nanofluid) in the balloon absorbs energy, thereby generating heat, while an HDR source travels to the center of the balloon via a catheter to deliver the radiation dose. A 3D-printed human skull model was filled with brain-tissue-equivalent gel for in-phantom heating and radiation measurements around four 3 cm balloons. For the in vivo experiments, a 1 cm diameter balloon was surgically implanted in the brains of three living pigs (40–50 kg). The durability and robustness of TBT balloon implants, as well as the compatibility of their heat and radiation delivery components, were demonstrated in laboratory studies. The presence of the nanofluid, magnetic field, and heating up to 77 °C did not affect the radiation dose significantly. Thermal mapping and 2D infrared images demonstrated spherically symmetric heating in phantom as well as in brain tissue. In vivo pig experiments showed the ability to heat well-perfused brain tissue to hyperthermic levels (≥40 °C) at a 5 mm distance from the 60 °C balloon surface

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

A Case of Posterior Reversible Encephalopathy Syndrome Presenting as Obstructive Hydrocephalus

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiographic disorder classically consisting of subcortical edema bilaterally in the cerebral hemispheres. Extensive white matter hyperintensities are observed typically in the occipital and parietal regions on T2 weighted imaging without diffusion restriction (1). Cases of predominant brainstem involvement, without the classic aforementioned subcortical involvement, are uncommon (2,3) with one study estimating it to comprise 4% of those diagnosed with PRES (2). We present a rare case of brainstem PRES who presented with obstructive hydrocephalus and signs of raised intracranial pressure (4, 5)

Long Term Outcomes Following Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension

Optic nerve sheath fenestration (ONSF) is often used in the management of moderate to severe idiopathic intracranial hypertension (IIH). Prior studies have shown ONSF can both stabilize and reverse vision loss in patients with IIH. We sought to clarify the long-term stability of patient outcomes after undergoing ONSF by collecting data from multiple follow up visits

Institutional Analysis of Temporal Artery Biopsies based on Clinical Suspicion for Giant Cell Arteritis

Diagnosing Giant Cell Arteritis (GCA) is based on clinical symptoms, signs, labs and temporal artery biopsy (TAB) pathology.(1-4) Biopsies are the gold standard for confirming GCA.(1,3) Recently, a revised American College of Rheumatology (rACR) criteria was proposed with a more extensive set of criteria, which included biopsy.(2) A clinical tool without biopsy was created to stratify patients according to GCA risk.(1) The purpose of this study is to analyze our patient population with temporal artery biopsies according to the proposed rACR clinical criteria and to examine how (i)TABs and (ii) the final diagnosis regardless of biopsy correlated to this clinical suspicion