Radiation-associated sarcoma of the skull base after irradiation for pituitary adenoma

Secondary, radiation-induced neoplasms represent a significant long-term risk after radiation treatment, and radiation-induced sarcomas (RAS) have an especially poor prognosis. These have rarely been reported after irradiation for pituitary adenomas

Bayesian analysis of weak gravitational lensing and Sunyaev-Zel'dovich data for six galaxy clusters

We present an analysis of observations made with the Arcminute Microkelvin Imager (AMI) and the Canada-France-Hawaii Telescope (CFHT) of six galaxy clusters in a redshift range of 0.16--0.41. The cluster gas is modelled using the Sunyaev--Zel'dovich (SZ) data provided by AMI, while the total mass is modelled using the lensing data from the CFHT. In this paper, we: i) find very good agreement between SZ measurements (assuming large-scale virialisation and a gas-fraction prior) and lensing measurements of the total cluster masses out to r_200; ii) perform the first multiple-component weak-lensing analysis of A115; iii) confirm the unusual separation between the gas and mass components in A1914; iv) jointly analyse the SZ and lensing data for the relaxed cluster A611, confirming our use of a simulation-derived mass-temperature relation for parameterizing measurements of the SZ effect.Comment: 22 pages, 12 figures, 12 tables, published by MNRA

Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness: A Randomized Clinical Trial

For patients with limited prognosis, some medication risks may outweigh the benefits, particularly when benefits take years to accrue; statins are one example. Data are lacking regarding the risks and benefits of discontinuing statin therapy for patients with limited life expectancy

Ethical Issues and Palliative Care in the Cardiovascular Intensive Care Unit

Medical advances over the past 50 years have helped countless patients with advanced cardiac disease or who are critically ill in the intensive care unit (ICU), but have added to the ethical complexity of the care provided by clinicians, particularly at the end of life. Palliative care has the primary aim of improving symptom burden, quality of life, and the congruence of the medical plan with a patient’s goals of care. This article explores ethical issues encountered in the cardiac ICU, discusses key analyses of these issues, and addresses how palliative care might assist medical teams in approaching these challenges

What Makes a Catholic Hospital “Catholic” in an Age of Religious-Secular Collaboration? The Case of the Saint Marys Hospital and the Mayo Clinic

Mayo Clinic is recognized as a worldwide leader in innovative, high-quality health care. However, the Catholic mission and ideals from which this organization was formed are not widely recognized or known. From partnership with the Sisters of St. Francis in 1883, through restructuring of the Sponsorship Agreement in 1986 and current advancements, this Catholic mission remains vital today at Saint Marys Hospital. This manuscript explores the evolution and growth of sponsorship at Mayo Clinic, defined as “a collaboration between the Sisters of St. Francis and Mayo Clinic to preserve and promote key values that the founding Franciscan sisters and Mayo physicians embrace as basic to their mission, and to assure the Catholic identity of Saint Marys Hospital.” Historical context will be used to frame the evolution and preservation of Catholic identity at Saint Marys Hospital; and the shift from a “sponsorship-by-governance” to a “sponsorship-by-influence” model will be highlighted. Lastly, using the externally-developed Catholic Identity Matrix (developed by Ascension Health and the University of St. Thomas, Minnesota), specific examples of Catholic identity will be explored in this joint venture of Catholic health care institution and a secular, nonprofit corporation (Mayo Clinic)

Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein