Automatic exposure control

Automatic Exposure Control (AEC) is an X-ray exposure termination device. A medical radiographic exposure is always initiated by a human operator but an AEC detector system may be used to terminate the exposure when a predetermined amount of radiation has been received. The intention of AEC is to provide consistent x-ray image exposure, whether to film, a digital detector or a CT scanner. AEC systems may also automatically set exposure factors such as the X-ray tube current and voltage in a CT.
Operation.
Projectional Radiography.
In projectional radiography an AEC system uses one or more physically thin radiation ionization chambers (the "AEC detector") which is positioned between the X-ray source and the x-ray receptor. Where low energy x-rays are used such as in mammography the AEC detector is placed behind the image receptor to avoid creating a shadow.
In early radiographic AEC systems, a large paddle (17" x 17") of transparent lucite was sandwitched between rare earth screens, which emitted photons when excited by X-rays. The individual lucite sections were open on one end, and a solenoid was used to select one of three, or a combination of shutters that allowed the generated light into a photomultiplier tube Photomultiplier_tube. The output of the PMT was then converted to a signal, which ramped in the positive direction until a preprogrammed threshold was reached. At this point, the X-ray generator terminated the exposure. This method is no longer used, and has been replaced by the iontomat.
In an iontomat, a weak ionization signal resulting from the radiographic X-rays passing through it are integrated as a ramp shaped voltage waveform. This ramp signal rises until it matches a pre-set threshold. At this point the x-ray exposure is terminated by the X-ray generator.
AEC devices are calibrated to ensure that similar exams have linearity in optical density.
Computed Tomography.
Modern computed tomography (CT) scanners have AEC systems which aim to maintain image quality for patients of varying sizes, whilst keeping doses as low as reasonably practicable. The systems are also designed to maintain quality with the varying size and attenuation of an individual patient over their length. Implementations vary between manufacturers, some systems are based on a desired noise level in the image, while others are based on a specified reference output (milliampere second, mAs).
CT AEC systems use the initial "scanogram", a fixed angle planning view, to determine the relative size of the patient, and variation over their length. The tube output is then adjusted for overall size. The output is also typically modulated for each rotation in response to changes in attenuation over patient length. Some systems adjust output during each rotation, which is known as rotational modulation, based on measured attenuation in the previous rotation.
Advantages.
Because patients vary in size and shape, an AEC device is very useful in achieving consistent x-ray film densities, which can be difficult when manually setting exposure factors without AEC.
Disadvantages.
AEC devices are susceptible to operator error (usually due to mispositioned anatomy or having the incorrect AEC chamber selected). Prosthetic devices such as total hip hardware can also cause the selected ionization chamber to overexpose the image receptor. This is due to the absorption of the x-ray beam into the metal of the hardware as opposed to exposing the ionization chamber.


White cerebellum sign

The white cerebellum sign, also known as reversal sign or dense cerebellum sign, is a radiological sign denoting the relatively white appearance of the cerebellum due to a generalized decrease in density of the supratentorial brain structures caused by extensive edema.
Causes.
White cerebellum sign can be associated with raised intracranial pressure that occurs due to anoxic or ischemic changes in the brain. It can be found in:
Pathophysiology.
Diffuse brain edema is the likely cause of this radiological change observed in CT or MRI.
Prognosis.
It was considered to indicate a bad prognosis. However, evidence suggests that it could be a non-specific indicator of diffuse brain edema which might not be as ominous as previously thought.


David J. Francis (academic)

David J. Francis is an American psychologist, focusing in statistical models for longitudinal data, multi-level models, latent variable models, psychometrics, reading acquisition and the early identification and prevention of reading disabilities and developmental disabilities, currently the Hugh Roy and Hugh Roy and Lillie Cranz Cullen Distinguished University Chair at University of Houston.


Independent Reconfiguration Panel

The Independent Reconfiguration Panel (IRP) is the independent expert on National Health Service (NHS) service change in England. Set up in 2003, the IRP advises the Secretary of State for Health on contested proposals for health service change in England. The IRP also offers informal support and guidance to the NHS and other organisations on achieving successful change.
The IRP is made up of experienced clinicians, managers and lay members who have wide-ranging expertise in clinical healthcare, NHS management, involving the public and patients, and handling and delivering successful changes to the NHS. The panel is led by the IRP Chair and supported by the Secretariat.


Hector Charles Cameron

Hector Charles Cameron (17 July 1878, Glasgow – 1 April 1958) was a British physician and paediatrician.
Biography.
Hector Charles Cameron, the younger son of Sir Hector Clare Cameron, was known as Charles Cameron. He was educated at Clifton College and then at the University of Glasgow, before he became in 1898 a Foundation Scholar in Science at St John's College, Cambridge. He graduated there B.A. (Nat. Sci. Trip., 1st Class) in 1901 and won a university scholarship to Guy's Hospital.
At Guy's Hospital he held a variety of posts, including demonstrator of physiology, out-patients officer, house-physician, anaesthetist, and medical registrar, before being appointed assistant physician in 1910, medical school sub-dean in 1911, and medical school dean in 1912. In 1920 he chose to become a paediatric specialist instead of appointment as a full physician. For many years he was editor of the "Guy's Hospital Gazette".
Cameron delivered the Lumleian Lectures ("Some Forms of Vomiting in Infancy") in 1925. He was Chief Medical Officer for the Motor Union and United British Insurance Co. From the University of Glasgow, he received an M.A. in 1906 and an honorary LL.D. in 1956.
Cameron married in 1908. The marriage produced two daughters.


Dust mite allergy

Dust mite allergy, also known as house dust allergy, is a sensitization and allergic reaction to the droppings of house dust mites. The allergy is common and can trigger allergic reactions such as asthma, eczema or itching. It is the manifestation of a parasitosis. The mite's gut contains potent digestive enzymes (notably Peptidase 1) that persist in their feces and are major inducers of allergic reactions such as wheezing. The mite's exoskeleton can also contribute to allergic reactions. Unlike scabies mites or skin follicle mites, house dust mites do not burrow under the skin and are not parasitic.
The symptoms can be avoided or alleviated by a number of measures. In general, cutting down mite numbers may reduce these reactions while others say efforts to remove these mites from the environment have not been found to be effective. Immunotherapy may be useful in those affected. Subcutaneous injections have better evidence than under the tongue dosing. Topical steroids as nasal spray or inhalation may be used.
Severe dust mite infestation in the home has been linked to atopic dermatitis, and epidermal barrier damage has been documented.
Symptoms.
Dust mite allergy symptoms include:
If the dust mite allergy contributes to asthma:
Cross-reactivity to shellfish allergy.
Tropomyosin, the major allergen in dust mites, is also responsible for shellfish allergy. Exposure to inhaled tropomyosins from dust mites is thought to be the primary sensitizer for shellfish allergy, an example of inhalant-to-food cross-reactivity. Epidemiological surveys have confirmed correlation between shellfish and dust mite sensitizations. An additional confirmation was seen in Orthodox Jews with no history of shellfish consumption, in that skin tests confirming dust mite allergy were also positive for shellfish tropomyosin. In addition to tropomyosin, the proteins arginine kinase and hemocyanin seem to have a role in cross-reactivity to dust mites.


David Xavier Cifu

David Xavier Cifu (born July 17, 1962, New York City, New York) is an American physiatrist, researcher, and medical educator. He is the Associate Dean for Innovation and System Integration in the School of Medicine at Virginia Commonwealth University School of Medicine, the chairman and Herman J. Flax M.D. Professor of the Department of Physical Medicine and Rehabilitation (PM&R) at Virginia Commonwealth University (VCU) in Richmond, Virginia, staff physiatrist at the Hunter Holmes McGuire Veterans Administration Medical Center (HHM-VAMC), founding director of the VCU-Center for Rehabilitation Science and Engineering and senior TBI specialist in the Department of Veterans Affairs' Veterans Health Administration.
Early life and education.
Cifu graduated from Boston University with an M. D. in 1986. He began post-graduate training at the Baylor College of Medicine in July 1986. He began his internship in Transitional Medicine in July 1986 and residency in Physical Medicine and Rehabilitation from 1986-1990. He joined the faculty of the BCM (Departments of PM&R and Restorative Neurology) as a staff physiatrist at the Houston VAMC in July 1990.
Career.
In 2005, Cifu was instrumental in developing the VCU Center for Rehabilitation Science and Engineering, a research consortium. He was CERSE's Executive Director from 2005-2013. He has also been a volunteer member of the American Academy of Physical Medicine and Rehabilitation since 1988 AAPM&R, and a member of its board of governors from 2000–2009 and president from 2007-8. He joined the Veterans Health Administration as Chief of PM&R services at the Hunter Holmes McGuire VAMC in 2006, became Deputy Director of the PM&R Program Office of the Department of Veterans Affairs in 2009, was National Director of the PM&R Program Office of the Department of Veterans Affairs from 2010–14 and is Senior TBI Specialist for the Department of Veterans Affairs. In 2014, he received the Commonwealth of Virginia's Outstanding Faculty Award from the State Council of Higher Education of Virginia SCHEV.
Cifu has published five books, co-authored more than 25 book chapters and published more than 220 scientific journal articles. In 2009 and again in 2016, he co-led the development and publication of the joint Departments of Veterans Affairs and Defense Clinical Practice Guidelines for The Management of Concussion/Mild TBI. In 2010, he authored "Traumatic Brain Injury", a guide for specialists, as part of the Demos Rehabilitation Medicine Quick Reference Series. In 2011, he co-authored, with Cory Blake, the patient self-help book "Overcoming Post-Deployment Syndrome: A Six Step Mission to Health" to help returning service members and Veterans from the Afghanistan and Iraq wars. In 2013, he released "Handbook of Polytrauma Care and Rehabilitation Handbook of Polytrauma Care and Rehabilitation" as a portable guide for everyday clinicians and health care providers. In 2015, he served as the editor-in-chief of the 5th edition of the "Braddom's Physical Medicine and Rehabilitation," and in 2017 he served as co-editor in chief of the "Braddom's Handbook of Rehabilitation Medicine."


Craniosynostosis

Craniosynostosis is a condition in which one or more of the fibrous sutures in a young infant's skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull. Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures. Sometimes the resulting growth pattern provides the necessary space for the growing brain, but results in an abnormal head shape and abnormal facial features. In cases in which the compensation does not effectively provide enough space for the growing brain, craniosynostosis results in increased intracranial pressure leading possibly to visual impairment, sleeping impairment, eating difficulties, or an impairment of mental development combined with a significant reduction in IQ.
Craniosynostosis occurs in one in 2000 births.
Craniosynostosis is part of a syndrome in 15% to 40% of affected patients, but it usually occurs as an isolated condition. The term is from "cranio", cranium; + "syn", together; + "ost", relating to bone; + "osis", denoting a condition.
Signs and symptoms.
Children born with craniosynostosis have a distinct phenotype, i.e., appearance—observable traits caused by the expression of a condition's genes. The features of craniosynostosis' particular phenotype are determined by which suture is closed. The fusion of this suture causes a certain change in the shape of the skull; a deformity of the skull.
Virchow's law dictates that, when premature suture closure occurs, growth of the skull typically is restricted perpendicularly to the fused suture and enhanced in a plane parallel to it, thus trying to provide space for the fast-growing brain. Using this law, the pattern of skull deformity in craniosynostosis often may be predicted.
Scaphocephaly.
An illustrative example of this phenomenon is scaphocephaly; the name providing a direct hint regarding the deformity of the skull. The literal meaning of the Greek derived word 'scaphocephaly' is boat-head. A synonymous term is 'dolichocephaly' (the prefix dolicho- means elongated).
Premature sagittal suture closure restricts growth in a perpendicular plane, thus the head will not grow sideways and will remain narrow. This is best seen in a view standing above the child looking downward at the top of the head. Compensatory growth occurs forward at the coronal suture and backward at the lambdoid suture giving respectively a prominent forehead, called frontal bossing, and a prominent back portion of the head, called coning.
Trigonocephaly.
Trigonocephaly is a result from the premature closure of the metopic suture. Using Virchow's law again to predict the resulting deformity, this fusion will result in a narrow forehead, which is even further emphasized by ridging of the suture. Compensatory growth occurs at both the coronal sutures, thereby pushing the forehead forwards.
The resulting shape can best be assessed from a top view again, which will reveal a somewhat triangular form of the head. Trigonocephaly is also a Greek-derived word, which can be translated as triangular-shaped head. A facial feature of metopic synostosis is hypotelorism; in the frontal view, it can be seen that the width between the eyes is smaller than usual.
Plagiocephaly.
The Greek word πλάγιος "plágios" means "skew". Plagiocephaly can be subclassified as anterior plagiocephaly or posterior plagiocephaly.
Anterior plagiocephaly.
Anterior plagiocephaly is a clinical description of unilateral coronal synostosis. Children born with unilateral coronal synostosis develop due to compensatory mechanisms a skew head; a plagiocephaly.
The sagittal suture 'divides' the coronal suture in two halves; unilateral meaning that either the right side or the left side to the sagittal suture is fused. This fact immediately raises an important point. Unlike closure of the sagittal or the metopic suture, right and left are not the same in unilateral coronal synostosis. This asymmetry shows in the skull deformity, as well as in the facial deformity and the complications.
This time, the skull deformity can only partly be predicted using Virchow's law. Growth is arrested in the plane perpendicular to the fused suture and the forehead is flattened, but only at the ipsilateral side of the head. Ipsilateral indicates the same side of the head as where the suture is closed.
Compensatory growth occurs in a parallel plane, as well as in a perpendicular plane. An increase in growth at the metopic and the sagittal suture accounts for the parallel plane and will result in bulging at the temporal fossa. Compensatory growth in the perpendicular plane occurs on the side of the head with the patent coronal suture, the contralateral side. Half of the forehead will bulge forwards.
Assessment of the skull from a top view shows asymmetry of the frontal bones, an increased width of the skull and a forward displacement of the ear at the ipsilateral side of the head. Assessment of the skull from a frontal view will show asymmetrical features of the face, including a displacement of the chin point of the jaw and a deviation of the tip of the nose. The chin point is located more to the contralateral side of the head, due to the ipsilateral forward displacement of the temporomandibular joint together with the ear. The tip of the nose will also point towards the contralateral side. Complications based on the skull deformation include malocclusion of the jaw, in as many as 90%; a subtle form of strabismus, caused by the asymmetrical placement of the orbits; and refractive error, particularly astigmatism, due to asymmetrical development of the orbits.
Posterior plagiocephaly.
Unilateral lambdoid synostosis is also called posterior plagiocephaly, indicating that this gives, just like unilateral coronal synostosis, a 'skew head'. The difference is that this time, the deformity mostly shows at the occiput.
By Virchow's law, restriction of growth will occur at the ipsilateral side of the head; compensatory growth will occur at the contralateral side of the head. This growth pattern exerts an effect at the base of the skull, which is not even when the child is assessed from a point of view standing behind the child, as well as on the cervical spine, which shows a curvature. In addition, from a point of view standing behind the child, a bulging of the mastoid can be seen.
Minimal forehead asymmetries are typically seen.
Brachycephaly.
Brachycephaly, or a 'short head', is the result of a closure of both the coronal sutures. Following Virchow's law, this will result in a child's head with a restriction of growth in the forward direction and in the backward direction: recessed frontal bones and a flattened occiput. Compensatory growth will occur sideways, due to the sagittal suture, and upwards, due to the lambdoid sutures.
Oxycephaly.
Oxycephaly, also known as turricephaly and high-head syndrome, is a type of cephalic disorder. This is a term sometimes used to describe the premature closure of the coronal suture plus any other suture, like the lambdoid suture,
Pansynostosis.
The word pansynostosis is also Greek derived and can be translated as 'all one bone', indicating that all of the sutures are closed. In general practice, the term is used to describe the children with three or more cranial sutures closed.
Pansynostosis can present in several ways. The appearance can be the same as that seen with primary microcephaly: a markedly small head, but with normal proportions. However, pansynostosis can also appear as a Kleeblattschädel (cloverleaf skull), which presents with bulging of the different bones of the cranial vault.
The condition is associated with syndromes caused by mutations in fibroblast growth factor receptor genes (FGFR), including thanatophoric dwarfism type 2 ("FGFR3") and Pfeiffer syndrome type 2 ("FGFR2").
Complications.
Not all cranial abnormalities seen in children with craniosynostosis are solely a consequence of the premature fusion of a cranial suture. This is especially true in the cases with syndromic craniosynostosis. Findings include elevation of the intracranial pressure; obstructive sleep apnea (OSA); abnormalities in the skull base and neurobehavioral impairment.
Elevated intracranial pressure.
When the ICP is elevated the following symptomes may occur: vomiting, visual disturbance, bulging of the anterior fontanel, altered mental status, papilledema and headache.
The main risks of prolonged elevated intracranial pressure may include cognitive impairment and impaired vision through prolonged papilledema and subsequent optic atrophy. These are the main reasons why fundoscopy should be performed during the physical examination of children with craniosynostosis.
The causes of an elevation of the intracranial pressure are best understood using the Monro-Kellie doctrine. The Monro-Kellie doctrine reduces the cranial vault to a box with rigid walls. This box contains three elements: brain, intracranial blood and cerebrospinal fluid. The sum of volumes of these three elements is constant. An increase in one should cause a decrease in one or both of the remaining two, thereby preventing an elevation of the intracranial pressure.
A compensatory mechanism involves the movement of cerebrospinal fluid from the cranial vault towards the spinal cord. The volume of blood in the cranial vault is auto-regulated by the brain, and will therefore not decrease that easily.
Intracranial pressure will rise as a result of continued brain growth within the rigid skull. It appears that in children with craniosynostosis, the expected decrease of intracranial blood is probably not occurring as it should according to the Monro-Kellie hypothesis. This is shown when the brain expands in the fixed skull, which gives a faster rise in intracranial pressure than would be expected.
Obstructive sleep apnea.
The short stops in breathing during the sleep are the mainstay of OSA. Other symptoms can be difficulty in breathing, snoring, day-time sleepiness and perspiration.
The main causative agent of OSA is the [midface hypoplasia], which also poses a risk to the eyes that can be seen bulging out of the eye sockets. Other factors, such as a micrognathism and adenoid hypertrophy, are likely to contribute in causing OSA.
The most common syndromic forms of craniosynostosis; i.e. Apert, Crouzon and Pfeiffer, have an increased risk of developing OSA. The children have nearly 50% chance of developing this condition.
A theory regarding the involvement of OSA as a causative agent for elevated intracranial pressure suggests an association with the auto-regulation of blood flow in the brain.
Certain cells in the brain respond specifically to an increase of CO2 in the blood. The response involves vasodilatation of the cranial vault blood vessels, increasing the volume of one of the elements in the Monro-Kellie doctrine. The increase of CO2 concentration in the blood is a consequence of impaired breathing, especially seen when the child suffering from OSA is sleeping. It is well documented that the highest spikes in intracranial pressure often occur during sleep.
Abnormalities in the skull base.
Impaired venous outflow is often caused by a hypoplastic jugular foramen. This causes an increase in the intracranial blood volume, thereby causing an increase in intracranial pressure.
This can be further complicated with a possible Arnold–Chiari malformation, which can partially obstruct the flow of cerebro-spinal fluid from the neurocranium to the spinal cord. The Chiari malformation may be asymptomatic or present with ataxia, spasticity or abnormalities in breathing, swallowing or sleeping.
Due to the impaired venous outflow, which may be further complicated with an Arnold–Chiari malformation, there is often a clinical image of hydrocephalus present. Hydrocephalus is seen in 6.5 to 8% of patients with Apert's syndrome, 25.6% in patients with Crouzon's syndrome and 27.8% of those with Pfeifer's syndrome.
Ventriculomegaly is a usual finding in children with the Apert syndrome.
Neurobehavioural impairment.
Neurobehavioural impairment includes problems with attention and planning, processing speed, visual spatial skills, language, reading and spelling. A decreased IQ may also be part of the problems.
It has been suggested that these problems are caused by a primary malformation of the brain, rather than being a consequence of the growth restriction of the skull and elevated intracranial pressure. Some evidence for this statement has been provided by studies using computed tomographic (CT) scans and magnetic resonance imaging (MRI) to identify differences between the structures of the brains of healthy children and those affected with craniosynostosis.
It has been found that corrective surgery of the cranial vault alters the morphology of the brain compared with the situation before surgical intervention. However the structure was still abnormal in comparison to children without craniosynostosis.
Causes.
Advances in the fields of molecular biology and genetics, as well as the use of animal models have been of great importance in expanding our knowledge of suture fusion. Research in animal models has led to the idea that the dura mater plays an important role in determining closure or patency of the suture. In contrast to the dura mater it appears that the periosteum is not essential in causing closure or patency.
Instead of describing the abnormalities in structure and form, research focuses nowadays at decoding the molecular interactions that underlie them.
Despite the progress that has been made, many things are still not understood about the suture biology and the exact causative pathways remain yet to be completely understood.
Multiple potential causes of premature suture closure have been identified, such as the several genetic mutations that are associated with syndromic craniosynostosis.
The cause of nonsyndromic craniosynostosis however, is still greatly unknown.
Most likely, a role is played by biomechanical factors, as well as environmental, hormonal and genetical factors.
New insights have given fuel to a debate whether there might be an intrinsic factor causing the premature fusion of the sutures. Brain structures of children with craniosynostosis were evaluated using magnetic resonance imaging. Differences were seen compared with the brain structures of normal children. The question now is whether these differences are caused by the craniosynostosis, or are the cause of craniosynostosis.
Biomechanical factors.
Biomechanical factors include fetal head constraint during pregnancy. It has been found by Jacob et al. that constraint inside the womb is associated with decreased expression of Indian hedgehog protein and noggin. These last two are both important factors influencing bone development.
Environmental factors.
Environmental factors refer for example to maternal smoking and the maternal exposure to amine-containing drugs. Several research groups have found evidence that these environmental factors are responsible for an increase in the risk of craniosynostosis, likely through effects on fibroblast growth factor receptor genes.
On the other hand, a recent evaluation of valproic acid (an anti-epilepticum), which has been implicated as a causative agent, has shown no association with craniosynostosis.
Certain medication (like amine-containing drugs) can increase the risk of craniosynostosis when taken during pregnancy, these are so-called teratogenic factors.
Hormonal factors.
Hyperthyroid induced craniosynostosis is a hormone mediated premature closure. It is thought that the bone matures faster due to high levels of thyroid hormone.
Genetic factors.
In 6 to 11% of the children born with coronal synostosis, more often involving the bilateral cases than unilateral, other members of the family have been reported that were also born with the same condition. This finding is highly suggestive of a genetic cause, which has possibly been found in the fibroblast growth factor receptor 3 (FGFR3) and TWIST genes.
Fibroblast growth factor and fibroblast growth factor receptors regulate fetal bone growth and are expressed in cranial sutures during pregnancy.
The transcription factor gene TWIST is thought to decrease the function of FGFR, thus also indirectly regulating fetal bone growth. A relation between the mutations in these genes and craniosynostosis is therefore possible.
Moloney et al. observed a FGFR3 mutation in as many as 31% of the cases with nonsyndromic coronal synostosis, thus showing that FGFR abnormalities play an important role in nonsyndromic craniosynostosis.
In terms of syndromic craniosynostosis not only do FGFR3 and TWIST genes feature, but also FGFR1 and in particular FGFR2, which has been reported in 90% of the syndromic craniosynostoses such as Apert, Crouzon, Peiffer and Jackson–Weiss. The mutations can be divided into mutations that lead to gain of function (in FGFR genes) and mutations that lead to loss of function (in TWIST genes). Craniosynostosis is therefore likely the result of a disturbance in the fine balance that regulates the multiplication and maturation of the precursor bone cells in the cranial sutures.
The familial rate, which is different for nonsyndromic and syndromic cases, provides an important clue. In the nonsyndromic cases, a positive family history is found in 2% of the cases with sagittal suture closure and in 6% to 11% of the cases with coronal suture closure.
Cranial sutures.
The mesenchyme above the meninges undergoes intramembranous ossification forming the neurocranium. The neurocranium consists of several bones, which are united and at the same time separated by fibrous sutures. This allows movement of the separate bones in relation to one another; the infant skull is still malleable. The fibrous sutures specifically allow the deformation of the skull during birth and absorb mechanical forces during childhood They also allow the necessary expansion during brain growth.
In the very first years of life the sutures serve as the most important centers of growth in the skull.
The growth of the brain and the patency of the sutures depend on each other. Brain growth pushes the two sides of the patent sutures away from each other, thereby enabling growth of the neurocranium. This means that the neurocranium can only grow if the sutures remain open.
The neurocranium will not grow when the forces induced by brain growth are not there.
This will occur for example when the intracranial pressure drops; the sutures do not experience stretching anymore causing them to fuse.
Diagnosis.
The evaluation of a child suspected to have craniosynostosis is preferentially performed in a craniofacial center. The three main elements of analysis include medical history, physical examination and radiographic analysis.
Medical history should in any case include questions about risk factors during pregnancy, the familial rate and the presence of symptoms of elevated intracranial pressure (ICP).
Physical examination.
Fundoscopy should always be performed in children with craniosynostosis. It is used to find papilledema which is sometimes the only symptom of elevated intracranial pressure shown in these children.
Other parts of the physical examination include the measurement of the head circumference, the assessment of the skull deformity and the search for deformities affecting other parts of the body. The head circumference and the growth curve of the head provide important clues into making a differentiation between craniosynostosis, primary microcephaly and hydrocephalus. This differentiation has an important influence on the further treatment of the child.
In a recent article Cunningham et al. described several steps in which a pediatrician should observe the patient to assess skull deformity:
The implications of the deformities that are seen are extensively discussed under 'phenotype'.
Syndromal craniosynostosis presents with a skull deformity as well as deformities affecting other parts of the body. Clinical examination should in any case include evaluation of the neck, spine, digits and toes.
Medical imaging.
Radiographic analysis by performing a computed axial tomographic scan is the gold standard for diagnosing craniosynostosis.
Plain radiography of the skull may be sufficient for diagnosing a single suture craniosynostosis and should therefore be performed, but the diagnostic value is outweighed by that of the CT-scan. Not only can the sutures be identified more accurately, thus objectively demonstrating a fused suture, but also evaluation of the brain for structural abnormalities and excluding other causes of asymmetric growth are possible at the same time. In addition to this, CT-scanning can visualize the extent of skull deformity, thereby enabling the surgeon to start planning surgical reconstruction.
Classification.
There are several ways to classify craniosynostosis.
In addition, the following syndromes have been identified:
Differential diagnosis.
Deformational plagiocephaly.
The main difference between plagiocephaly based on craniosynostosis and deformational plagiocephaly is that there is no suture fusion in the latter one. The malleability of the neonatal skull allows the skull to change shape due to extrinsic forces.
With the tests a pediatrician should perform, as explained above, the difference is quite easy to make.
In deformational plagiocephaly the skull does not show a bulging of the mastoid and in these patients the skull base and position of the ears is level, all in contrary with plagiocephaly due to craniosynostosis. Displacement of one ear to the front is characteristic for deformational plagiocephaly.
Primary microcephaly.
Primary microcephaly shows a clinical image of craniosynostosis, but due to a different cause. The primary failure is the absence of growth of the brain, rendering the sutures of the cranial vault useless. As a consequence, the sutures close, presenting a pansynostosis like image.
A differentiation between these two conditions can be made with a computed tomography (CT) scan. The subarachnoid spaces are typically enlarged with primary microcephaly, whereas they are reduced or absent in true pansynostosis.
Treatment.
The primary goal of surgical intervention is to allow normal cranial vault development to occur. This can be achieved by excision of the prematurely fused suture and correction of the associated skull deformities. If the synostosis goes uncorrected, the deformity will progressively worsen not only threatening the aesthetic aspect, but also the functional aspect. This is especially prevalent with asymmetric conditions, such as unilateral coronal synostosis, with compromised function of the eyes and the jaw.
In addition, signs of compromised neurodevelopment have been seen amongst all the synostoses, although this may also be caused by primary maldevelopment of the brain and can thus not be prevented by surgical intervention.
There are a few basic elements involved in surgical intervention which is aimed at normalization of the cranial vault:
Timing of surgery.
The prevention of post-surgical complications, including those mentioned above, plays an important role in discussions over the timing of potential surgery. The general consensus is to perform surgery in late infancy, i.e. between six and twelve months. Within this time frame the efficacy of surgery will be enhanced for several reasons:
Most surgeons will not intervene until after the age of six months due to the heightened risk which blood loss poses before this age. It is generally preferable to wait until after three months of age when anaesthetic risks will also be decreased.
Surgery is not performed in early childhood in every country; in some countries surgical intervention can take place in the late teens.
It is important that families seek out a Pediatric Craniofacial Physician who has experience with craniosynostosis for proper diagnosis, surgical care, and followup.
Specific sutures.
Sagittal craniosynostosis/scaphocephaly.
There are two surgical procedures which are commonly used to treat sagittal synostosis. The matter of which procedure is superior is still heavily debated amongst the surgeons treating this condition, however it is generally agreed upon that the cephalic index should be used to assess the efficacy of the preferred surgical intervention.
Retrospective analysis has given an indication that the use of total cranial vault remodelling provides children with a better cephalic index than does the extended strip craniectomy.
An approach that is currently being evaluated involves the use of springs. This intervention is likely most effective when used in the time frame between three and six months of age.
Metopic synostosis/trigonocephaly.
The main elements of metopic suture closure involve a low volume of the anterior cranial fossa, the metopic ridging and hypotelorism. These problems are all addressed during the surgical intervention.
The volume is increased by placing the frontal bones and the supraorbital rim further forward. This is done by excision of the bones after which they are reshaped with greenstick fracturing. Replacement of the bones provides a possibility for the correction of the hypotelorism at the same time. A bone graft is placed in between the two halves of the supraorbital bars, thereby increasing the width between the orbits. The metopic ridge can then be corrected with a (simple) burring.
Unilateral coronal synostosis/anterior plagiocephaly.
The treatment of unilateral coronal synostosis is typically performed in two parts: the forward advancement of the supraorbital bar and the correction of the orbital asymmetry.
The supraorbital bar is the rim just above the eye socket; as discussed under phenotype, the supraorbital and the frontal bone are typically recessed at the ipsilateral side of the head. The goal of treatment is to position this bar together with the frontal bone in a plane three millimetres further forwards than the vertical plane of the cornea.
A two-dimensional sagittal image is used to pre-operatively determine the extent of movement, which can vary between seven and fifteen millimetres depending on the severity of the deformity.
The orbital asymmetry exists typically of a narrower and taller orbit at the ipsilateral side of the head. The contralateral orbit, however, is wider than usual. Symmetry is restored by extracting a small piece of bone from the supraorbital bar at the contralateral side, thereby reducing the width. This bone fragment is then introduced into the supraorbital bar on the ipsilateral side, thereby increasing width. The height of the orbit is altered at the ipsilateral side only, by extracting a piece of bone.
Any correction of the nasal tip, which points towards the contralateral side, will not be performed during childhood.
Unilateral lambdoid synostosis/posterior plagiocephaly.
An excision of the flattened occipital bone with release of the fused suture tends to correct the cranial vault deformity.
Bilateral coronal synostosis/brachycephaly.
The treatment of bilateral coronal synostosis shows a high degree of overlap with treatment of unilateral coronal synostosis; in both surgical interventions is the forward advancement of the supraorbital rim together with the frontal bones is an important part of the procedure. Again, the plane three millimetres further forwards than the vertical plane of the [cornea] is the appropriate position to place the bone. The increased height of the skull is addressed in the same procedure. Parts of the flattened occiput are extracted and given a rounder shape by greenstick fracturing them.
Pansynostosis/kleeblattschädel.
The treatment of pansynostosis comprises the expansion of the anterior cranial vault, as well as the posterior cranial vault. Whilst this may be accomplished in one procedure it is generally performed in two stages.
Complications.
The most common complications of uncorrected craniosynostosis include increased intracranial pressure, asymmetry of the face, and malocclusion. Asymmetry of the orbits often leads to strabismus.
Epidemiology.
It is estimated that craniosynostosis affects 1 in 1,800 to 3,000 live births worldwide. 3 out of every 4 cases affect males. Sagittal synostosis is the most common phenotype, representing 40% to 55% of nonsyndromic cases, whilst coronal synostosis represents between 20% to 25% of cases. Metopic synostosis is a factor in 5% to 15% of cases, and lambdoid synostosis is seen in 0% to 5% of nonsyndromic cases.
5% to 15% of the time more than one suture is involved; this is referred to as 'complex craniosynostosis' and is typically part of a syndrome.


Eugene Curnow

Eugene Curnow (8 February 1925 – 9 April 2010) was a retired veterinarian who pioneered the Mobile Pet Clinic concept in Portland, Oregon. He served as a medical corpsman with the Fourth Marine Division during World War II and survived the invasion and battle for Iwo Jima. His autobiography, "Life the Hard Way: Up from Poverty Flat", was published in 2007.
Early life.
Dr. Curnow was born on February 8, 1925, in Lake City, Minnesota. He grew up in various towns in California, including a gold mining claim in the small settlement of Poverty Flat, population 12. In 1942, he graduated from Shasta Union High School in Redding, California. He then moved to Seattle where he enlisted in the Navy. He attended one quarter at Seattle College as a pre-med student before the Navy sent him to the University of New Mexico in Albuquerque, where he continued his pre-med studies for the rest of the year. In December 1943, he was assigned to the Hospital Corps School in San Diego, California, for a six-week training course. In February 1944, he was sent to Mare Island Navy Hospital at Imola, California, where he cared for returning combat veterans who were suffering from post-traumatic stress disorder (PTSD). He was transferred in October 1944 to Astoria, Oregon, and was assigned to the USS Sanborn, APA 193 as a member of the ship’s crew.
World War II service.
His first overseas assignment was as a medical corpsman with the Fourth Marine Division, and he was sent to Iwo Jima. On February 19, 1945, he was part of a contingent of 36 medical corpsmen and 2,500 combat Marines that landed there. Their objective was Blue Beach Number 2. Of that group, only six corpsmen and 88 Marines were still alive when they left the island 10 days later. He came close to death twice during that time. He witnessed the famous American flag raising atop Mount Suribachi on Iwo Jima.
He returned to San Diego in November 1945 and was honorably discharged in January 1946. He married Glenora M. Murray on January 9, 1948, in Seattle, Washington. He went back to college and earned a Bachelor of Science degree in chemistry from Seattle University in 1950, a master’s degree in biological sciences from Washington State University in 1952, and a Doctor of Veterinary Medicine (DVM) in 1955 from Washington State University. He attended Mt. Hood Community College from the spring of 1988 to the fall of 1999, auditing an advanced writing class. During this time, he wrote his autobiography, "Life the Hard Way: Up From Poverty Flat".
Veterinary career.
He began veterinary practice in 1955 in Portland, Oregon. He had to give up hospital practice after having extensive intestinal surgery in 1973. He was told he could no longer stand for long periods of time, work more than six hours a day, or lift anything over 10 pounds. As he was deciding what to do next for a living, he said, "I recalled that during my years of hospital practice, I would receive at least five phone inquiries a week asking if any veterinarian in the Portland area made house calls," he stated in a 1975 interview.
He made the decision to establish a mobile practice. He converted an 18-foot-long mini-motor home into a Mobile Pet Clinic. It was equipped with a 110-volt auxiliary electrical generator, roof air-conditioning, thermostatically controlled propane heat, refrigerator, sink with hot and cold water, cooking range and oven, counter space, surgical and medical tables, bathroom with a shower, seating for four, and storage space for a well-stocked pharmacy, equipment, and supplies. The seven-foot windows on each side gave it a roomy feel. He would drive to a client’s home, park at the curb, and treat the pet in the mobile unit. Dr. Curnow’s wife, Glenora, assisted him in his practice. Because of his physical limitation, his practice was 90 percent cats and the rest small dogs.
This innovative idea earned him an article in "National Geographic World" magazine in January 1985. Because of this, he received letters from veterinarians from all over the world wanting to learn how to do the same thing. He wrote a 25-page "how-to" monograph and sold more than 6,000 copies by putting a small advertisement in the Journal of the American Veterinary Medical Association. He retired from his practice in 2006 after more than 50 years of work.
Later life.
Dr. Curnow didn't talk about his war experiences with anyone for nearly 60 years, when he suddenly began experiencing violent nightmares. He discovered that after a lifetime of internalizing the war, he was suffering from post-traumatic stress disorder (PTSD). After getting help from the Veteran’s Administration, he used his experience to counsel other Marines suffering from PTSD through the VFW’s Veterans Helping Veterans program. He did this for more than three years, also helping them obtain cash awards and medical help for their disabilities. Dr. Curnow and his wife had two daughters, Berniece and Yvonne, and two grandsons.
He died on 9 April 2010 in Portland, Oregon.
Bibliography.
"Life the Hard Way: Up from Poverty Flat" (2007)


Ternopil National Medical University

Ternopil National Medical University ("Ivan Horbachevsky Ternopil National Medical University" is the Government university Run by-Ministry of Health of Ukraine ; ) is a medical university located in the city of Ternopil in Ukraine.
History.
TNMU was founded on 12 April 1957 as a Ternopil Medical Institute. On July 1, 1992, the institute was named after Ivan Horbachevsky. On December 30, 1997, it received the status of State Medical Academy, and on 17 November 2004, after reorganization, the institution became Ivan Horbachevsky Ternopil State Medical University.
The first rector of the medical institute was Petro Ohii, and the vice-rector Arsen Martyniuk. The regional administration transferred ownership of two buildings to the institute for the use as academic and laboratory facilities, and two dormitories. University clinic facilities were located in the municipal hospital. At the same time, the Morphology Building, a dormitory, and the Regional Hospital were being built.
The institute had 19 departments, and employed 66 instructors, among them Kostiantyn Kovanov, Rostyslav-Yurii Komarovskyi, Anatolii Lokai, Ivan Sytnyk, Mykola Skakun, and Yevhen Honcharuk. The first class consisted of 210 students.
The institute steadily developed programs and facilities, but the biggest change took place after Ukraine has gained its independence in 1991, when the school started moving towards the European system of education. In 1994, the Institute received IV level of institutional accreditation. In 1995 TSMU added the specialty of Nursing, and in 2000 Pharmacy.
As of 2016, the university offers Bachelor's level programs in Physical rehabilitation and Nursing; Master's level programs in Medicine, Pharmacy, Dentistry and Nursing; and Ph.D. level programs in specialties Medicine, Pharmacy, Dentistry and Biology.
According to the Decree of the President of Ukraine No. 146/2019 from the 17-th of April, 2019, I.Horbachevsky Ternopil State Medical University received the status of a national university.
The document states that “taking into account national and international recognition of the results of the activity of the State Higher Educational Institution ” I.Ya.Horbachevsky Ternopil State Medical University of the Ukrainian Ministry of Public Health”, its significant contribution to the development of national medical and pharmaceutical education and science, I resolve to give the State Higher Educational Institution “I.Ya.Horbachevsky Ternopil State Medical University of the Ukrainian Ministry of Public Health” the status of national and to continue naming it – ” I.Ya.Horbachevsky Ternopil National Medical University of the Ukrainian Ministry of Public Health”.
Rankings and reputation.
Ukraine Ministry of Health consistently ranks under top 4000 university's over world wide and 1st in whole ukraine in 2021
 Ternopil national Medical University one among the top medical university's in world by .
Academics.
Teaching staff.
The teaching staff includes over 600 professors, among them 102 Doctors of Science and full professors, and 460 associate professors. The staff includes two Corresponding and one Full Members of the National Academy of Medical Sciences, 11 Merited Scientists of Ukraine, 3 Merited Inventors of Ukraine, 2 Merited Teachers of Ukraine and 4 Merited Doctors of Ukraine.
Student body and teaching process.
Over 6530 students are currently enrolled in Ternopil State Medical University, including more than 1977 international students from 53 countries. As of 2016, there are over 700 students from African countries (48% of the total number of international students, including 351 from Nigeria). Students from Asia comprise 21%, and Europe 15% of the total number of international students. The language of instruction for the majority (90%) of international students is English.
Lectures typically take place in one of the 10 large lecture-halls equipped with modern audio-visual systems. Practical and laboratory classes usually consist of 8-12 persons. Clinical training takes place in affiliated hospitals. Since 2006 students in their first years learn clinical aspects together with theoretical subjects. Academic departments are located in different buildings around the central part of Ternopil, while clinical departments are situated in the affiliated hospitals.
Classes usually take place from 9 to 3 pm.
Languages of instruction are Ukrainian, English, and Russian.
Qualifications.
Ternopil State Medical University is listed in the FAIMER (International Medical Education) directory under ECFMG and the WHO (World Health Organization) directory of Medical Universities/Schools. TSMU's degree is recognized by WHO, US Education Department, General Medical Council of England, and in EU countries.
Since 2005 students are assessed according to the European Credit Test System (ECTS) credit-module system, which will allow the diplomas granted by the University to be converted in all countries of the European Union.
Faculties.
The university contains the following faculties: Medicine (6 years – MD program), Dentistry (5 years), Pharmacy (5 years), and Nursing (2–4 years). Postgraduate programs are also offered in different fields.
The theoretical departments of the faculty occupy four educational scientific institutes, which are independent structural-functional subdivisions of the University: Institute of Morphology, Institute of Biomedical Problems, Institute of Modeling and Pathologic Processes Analyzing, and M. Skakun Institute of Pharmacology, Hygiene and Medical Biochemistry. There are 12 clinical departments, based at city and regional medical establishments in Ternopil.
Postgraduate education.
Postgraduates can study for a Master's Degree or a PhD.
Other continuing education includes a Training Internship Program, and provision for clinical specialization.
Vacation activities.
International summer schools have involved students from the University of South Carolina, Moscow State University, Kazakh Medical Academy, Shlyonsk Medical Academy (Poland), National Pharmaceutical University (Kharkiv).
The university also offers students a chance to travel abroad for student exchange programs during summer.
Foreign students.
More than 1500 international students from 53 different countries are studying in Ternopil National Medical University.
The University collaborates with a number of foreign institutions.
Ternopil National Medical University is the first university in Ukraine to adopt the American Nursing Program. In the American Nursing School and International Nursing School, teaching follows the American Nursing School curriculum. TSMU collaborates with the University of South Carolina Upstate (USA) to exchange academic programs for nursing students. The Nursing School offers two degrees:
After graduation students are eligible to take the National Council License Examination (NCLEX) and Commission on Graduates of Foreign Nursing Schools (CGFNS) for registered nurses to start working and living in USA. After obtaining associate degree, students can transfer to USA for bachelor's degree.


Yoonew

yoonew, Inc. was a start-up based in New York City, USA, that ran an online exchange specializing in championship sports tickets and ticket derivatives. Since being founded in 2004, Yoonew provided tickets and ticket derivatives for large sporting events such as the Super Bowl, the World Series, the Stanley Cup, the UEFA European Football Championship, the Final Four and the US Open.
History.
yoonew Inc. was founded in September 2004 by MIT Sloan students Gerry Wilson and Hagos Mehreteab in hopes of creating a method by which die-hard fans without thousands of dollars to spare could get their hands on cheap tickets to major sporting events. The idea was born when Wilson was unable to obtain affordable tickets to the 2003 World Series. After the idea fared well in a couple of business-plan competitions, Wilson and Mehreteab, a longtime friend, launched the company.
The company experienced difficulties early as co-founder Wilson was forced to liquidate his 401(k) in order to provide customers with 2005 NCAA Final Four college basketball tickets in 2005. After struggling initially, Yoonew was able to raise $2 million in investments and began to grow. In October 2007, yoonew changed its interface to provide real-time price plotting similar to that seen on Yahoo! and Google. A point of contention raised regarding the new interface was that it was too heavily geared towards traders, which reduces usability for the average user.
To make the site more accessible for the average user, yoonew launches on July 2008, "yoonew direct" a new interface in Adobe Flash which complements the existing interface ("yoonew exchange"). Users having an account on "yoonew exchange" can use the same account to log in yoonew direct and vice versa. In addition, products purchased on "yoonew direct" can be traded on the "yoonew exchange".
At the same time, yoonew launched a new feature which allows users to place orders for exact seat (defined by a section, row and seat) unlike the other events where users can only choose the seating category (usually five). At the moment, this feature is only available for the US Open 2008. This company is now out of business.
How it worked.
If a fan believes his favorite team will reach the championship game, he can purchase ticket futures months in advance at a low prices which are market-based. If the team actually makes it to the big game, the fan is guaranteed tickets. If the team is eliminated and the holder has not re-sold their contract, they lose their investment.
yoonew offers three types of contracts:
If Matchup Fantasy Seat are riskier than Team Fantasy Seat, they are also much cheaper.
During the playoff, the Fantasy Seats of eliminated teams get expired and are removed from their owner's portfolios. When a team becomes a finalist, the Team Fantasy Seat for the team is converted into a ticket. When both teams of a matchup become finalist, the Matchup Fantasy Seats are converted into tickets. The owners of such Fantasy Seats can choose either to sell the ticket on the exchange for a profit or keeps it to go to the game.
For example, in 2006, sports fan Joe Kocott bought 18 futures contracts for the Pittsburgh Steelers making the Super Bowl at an average of $185 each. When the Steelers eventually made it to the Super Bowl, he was delivered the tickets, which were selling at around $2,500 each at the time.
In 2007, a systems analyst paid $537 apiece for two futures contracts for the New England Patriots for upper-deck seats at University of Phoenix Stadium in Arizona. Since the Patriots made it to the Super Bowl, he ends up with two tickets for the Super Bowl XLII.
For Super Bowl XLII, a consumer could have had got a ticket for only $86 had he bought a team fantasy seat for the Giants one month before the big game.
More recently in 2008, Craig Cox, an associate professor at Texas Tech's School of Pharmacy bought two Matchup Fantasy Seats for the Steelers and Cardinals at the lower level for the Super Bowl XLIII for only $29.70 apiece one month before the NFL playoff. As both teams made it to the big game, he received two tickets and went to the game with his brother.
On the other hand, if a trader believes that a team will unlikely make it to the championship game, he can short the Fantasy Seat. To make sure that the short is covered, yoonew required that the trader owns a ticket. With one ticket to the Super Bowl for instance, the trader can short up to 16 Team Fantasy Seats (one for each team of the AFC conference or one for each team of the NFC conference). If the trader shorts a Team Fantasy Seat for a team which gets eliminated, she earns the amount at which she shorted the Fantasy Seat. However, in the "unfortunate" case the team makes it to the final, she loses her ticket.
End of business.
On February 1, 2010 Yoonew ceased operations. Yoonew personally called its users on 1/31/2010 to make the announcement and notify customers that Yoonew would not be able to deliver Super Bowl 2010 tickets to customers who owned valid futures for that event. In the phone call, Yoonew indicated that they could not fulfill Super Bowl tickets because the macroeconomic crisis forced the bank responsible for its merchant account to go bankrupt and they had not paid Yoonew the money it was owed for its credit card deposits. Yoonew also indicated that they were in litigation with The Ticket Reserve. In understanding that by not delivering the tickets to its customers that there would be no hope for repairing market confidence, Yoonew was forced to end its business. Yoonew promised to return the money its customers paid for their winning Super Bowl 2010 Fantasy Seats. On January 31, 2010 Yoonew decommissioned its forum and blog and directed all inquiries to service[at]yoonew.com.


Hydranencephaly

Hydranencephaly is a condition in which the brain's cerebral hemispheres are absent to a great degree and the remaining cranial cavity is filled with cerebrospinal fluid.
Hydranencephaly is a type of cephalic disorder.
These disorders are congenital conditions that derive from either damage to, or abnormal development of, the fetal nervous system in the earliest stages of development in utero. Cephalic is the scientific term for "head" or "head end of body". These conditions do not have any definitive identifiable cause factor; instead generally attributed to a variety of hereditary or genetic conditions, but also by environmental factors such as maternal infection, pharmaceutical intake, or even exposure to high levels of radiation.
This should not be confused with hydrocephalus, which is an accumulation of excess cerebrospinal fluid in the ventricles of the brain.
In hemihydranencephaly, only half of the cranial cavity is affected.
Signs and symptoms.
An infant with hydranencephaly may appear normal at birth or may have some distortion of the skull and upper facial features due to fluid pressure inside the skull. The infant's head size and spontaneous reflexes such as sucking, swallowing, crying, and moving the arms and legs may all seem normal, depending on the severity of the condition. However, after a few weeks the infant sometimes becomes irritable and has increased muscle tone (hypertonia). After several months of life, seizures and hydrocephalus may develop, if they did not exist at birth. Other symptoms may include visual impairment, lack of growth, deafness, blindness, spastic quadriparesis (paralysis), and intellectual deficits.
Some infants may have additional abnormalities at birth including seizures, myoclonus (involuntary sudden, rapid jerks), limited thermoregulation abilities, and respiratory problems. Still other infants display no obvious symptoms at birth, going many months without a confirmed diagnosis of hydranencephaly. In some cases severe hydrocephalus, or other cephalic condition, is misdiagnosed.
Causes.
Hydranencephaly is an extreme form of porencephaly, which is characterized by a cyst or cavity in the cerebral hemispheres.
Although the exact cause of hydranencephaly remains undetermined in most cases, the most likely general cause is by vascular insult such as stroke or injury, intrauterine infections, or traumatic disorders after the first trimester of pregnancy. In a number of cases where intrauterine infection was determined the causing factor, most involved toxoplasmosis and viral infections such as enterovirus, adenovirus, parvovirus, cytomegalic, herpes simplex, Epstein-Barr, and syncytial viruses. Another cause factor is determined to be monochorionic twin pregnancies, involving the death of one twin in the second trimester, which in turn causes vascular exchange to the living twin through placental circulation through twin-to-twin transfusion, causing hydranencephaly in the surviving fetus. One medical journal reports hydranencephaly as an autosomal inherited disorder with an unknown mode of transmission, where an unknown blockage of the carotid artery where it enters the cranium causes obstruction and damage to the cerebral cortex.
Genetic.
As a recessive genetic condition, both parents must carry the asymptomatic gene and pass it along to their child, a chance of 25 percent. Genetic hydranencephaly afflicts both males and females in equal numbers.
Post-natal brain injury.
Though hydranencephaly is typically a congenital disorder, it can occur as a postnatal diagnosis in the aftermath of meningitis, intracerebral infarction, and ischemia (stroke), or other traumatic brain injury.
Diagnosis.
Diagnosis may be delayed for several months because the infant's early behavior appears to be relatively normal. Transillumination, an examination in which light is passed through body tissues, can be used to diagnose hydranencephaly. An accurate, confirmed diagnosis is generally impossible until after birth, though prenatal diagnosis using fetal ultrasonography (ultrasound) can identify characteristic physical abnormalities that exist. Through thorough clinical evaluation, via physical findings, detailed patient history, and advanced imaging techniques, such as angiogram, computerized tomography (CT scan), magnetic resonance imaging (MRI), or more rarely transillumination after birth are the most accurate diagnostic techniques. However, diagnostic literature fails to provide a clear distinction between severe obstructive hydrocephalus and hydranencephaly, leaving some children with an unsettled diagnosis.
Preliminary diagnosis may be made in utero via standard ultrasound, and can be confirmed with a standard anatomy ultrasound. This sometimes proves to provide a misdiagnosis of differential diagnoses including bilaterally symmetric schizencephaly (a less destructive developmental process on the brain), severe hydrocephalus (cerebrospinal fluid excess within the skull), and alobar holoprosencephaly (a neurological developmental anomaly). Once destruction of the brain is complete, the cerebellum, midbrain, thalami, basal ganglia, choroid plexus, and portions of the occipital lobes typically remain preserved to varying degrees. Though the cerebral cortex is absent, in most cases the fetal head remains enlarged due to the continued production by the choroid plexus of cerebrospinal fluid that is inadequately reabsorbed causing increased intracranial pressure.
Prognosis.
There is no standard treatment for hydranencephaly. Treatment is symptomatic and supportive. An accompanying diagnosis of hydrocephalus may be treated with surgical treatment of a shunt, which often grants a much better prognosis and greater quality of life.
The prognosis for children with hydranencephaly is generally quite poor. Death is reported to often occur within the first year of life, but many children live several years, even in to adulthood (with one reported case dying at 19).
Occurrence.
This condition affects under 1 in 10,000 births worldwide. Hydranencephaly is a rare disorder in the United States, which is defined as affecting fewer than 1 in 250,000.


Channel Islands Practical Shooting Association

Channel Islands Practical Shooting Association (CIPSA) is the Channel Islands region for practical shooting under the International Practical Shooting Confederation.


Michael Arthur (physician)

Michael James Paul Arthur FMedSci (born 3 August 1954) was the tenth provost and president of University College London between 2013 and January 2021. Arthur had previously been chairman of the Russell Group of UK universities and the vice-chancellor of the University of Leeds between September 2004 and 2013.
Early life.
Arthur was born in Purley, London, England. He attended Burnt Mill School in Harlow, Essex, at a similar time to Bill Rammell. His father was a cabinet maker and his mother was a student liaison officer at an agricultural college. He went to the University of Southampton, where he graduated as a Bachelor of Medicine in 1977 and became a Doctor of Medicine in 1986. From 1987 to 1989 he studied at the University of California, San Francisco.
Career.
Arthur's academic career began at Southampton, where he was appointed research fellow and lecturer in medicine in 1982, senior lecturer in 1989 and, at the age of 37, to a chair of medicine in 1992. He became director of research at Southampton in 1995, head of the school of medicine in 1998 and dean of the Faculty of Medicine, Health and Life Sciences in 2003. From 1 September 2004 he was vice-chancellor of the University of Leeds. At the time of his appointment, he was the first vice-chancellor of a Russell Group university to have attended a comprehensive school. According to the Yorkshire Post, his salary was £253,000.
Arthur was appointed president and provost of University College London (UCL) on 10 December 2012, starting in September 2013, to succeed Sir Malcolm Grant. He stepped down on 10 January 2021, replaced by Michael Spence.
Controversy.
In 2009, during his time as Vice Chancellor of the University of Leeds, Arthur was subject to a motion of no confidence from the Leeds branch of University and College Union (UCU) due to his proposed 10% cut in academic staff. Earlier in the next year, UCU voted to strike after 54 staff at the University lost their jobs, in the midst of plans for 700 more to suffer the same fate. This strike was supported by a record turnout (64%) with 78% voting in favour of the strike.
In 2015, Arthur accepted the resignation of Professor Tim Hunt, after a controversy surrounding reported comments made by Hunt regarding women in science.
As of 2019, Arthur was faced with continuing controversy in his role as Provost of UCL, with 94% of the academics present at an informal meeting in 2018 voting no confidence in the college’s governance. Numerous faculty complaints were directed towards an alleged lack of democracy and transparency regarding plans to expand UCL with a new site, "UCL East", inadequate teaching facilities, and a perceived decline in academic standards.
Research.
Arthur first developed his interests in the cell and molecular pathogenesis of liver fibrosis on a two-year Fogarty International Travelling Fellowship at the University of California, San Francisco (1988–1990). In 2002, he took up a Fulbright distinguished scholar award to conduct cell biology research at Mount Sinai School of Medicine in New York City.
His contribution to research has been acknowledged with the award of the American Liver Foundation Research Prize (1987) and the Linacre Medal of the Royal College of Physicians, London (1994), a year after becoming a Fellow. He became a Fellow of the Academy of Medical Sciences in 1998 and Fellow of the Royal Society of Arts, Manufactures and Commerce in 2006.
Arthur has been on the editorial boards of several academic journals, including "Journal of Hepatology", "Comparative Hepatology", "Gut" and "Clinics in Gastroenterology".
Other roles.
He has chaired the cell and molecular panel at the Wellcome Trust (2003–2004). He was a member of HEFCE’s Research Assessment Exercise panel for 2001 for hospital-based medicine and HEFCE’s strategic research committee (2003–2005). Other roles have included membership of the Department of Health’s advisory group on hepatitis (1998–2004) and President of the British Association for the Study of the Liver (2001–2003). He was chair of the board of trustees of the British Liver Trust (2003–2006) and now vice president (2007-). Arthur has also chaired the national steering group for the National Student Survey (2005–2008). Arthur was chair of the Russell Group of universities (2009-2012).
Current roles and public appointments include commissioner for the US/UK Fulbright Commission (2008-), membership of the Council of the Medical Research Council (UK) (2008-) and chair of the Advisory Group for National Specialised Services (NHS)(2010-). He is a council member of the Council for Industry and Higher Education (CIHE) (2012-). Arthur is a board member of Opera North (2006-). He is a trustee of Centre for London.
Personal life.
He is married to consultant paediatrician, Elizabeth S. McCaughey (married 1979), and they have two daughters (born 1983 and 1985) and one son (born 1987). He enjoys sailing.


American Clinical and Climatological Association

The American Clinical and Climatological Association (ACCA) is a society for the study of climatology, balneology, and the diseases of the respiratory and circulatory organs. It was organized in New York City in 1884, and is composed of physicians residing in the United States and Canada.
Membership is limited to 250 physicians. It had 133 members in 1901.


Very low cerebral blood volume

Very low cerebral blood volume (VLCBV) is a measurement of hemorrhagic transformation degree in the tissue surrounding the lesion in the strokes. It is counted as one of the penumbral imaging procedures along with less commonly used methods such as diffusion-weighted imaging (DWI). These are used to predict if there is going to be a hemmorrhage after the treatment by tPA. In advanced centers, this measurement helps with using tPA beyond the standard time limit (4.5 hours) without risk of hemorrhage.


Apollo Hospitals, Visakhapatnam

Apollo Hospitals, Visakhapatnam is a branch of the Apollo Group of Hospitals located in Visakhapatnam, Andhra Pradesh, India. The hospital serves the health needs of north coastal Andhra Pradesh and adjacent Odisha.
History.
The multi-specialty 350 bedded hospital at Health City, Arilova, Visakhapatnam has been operational since 2016. The hospital has a Trauma Care Team and Respiratory Rehabilitation Unit. The institute covers different branches of health care including neurosciences, orthopedics, cosmetic and plastic surgery, gastroenterology and liver clinics. Departments include cardiology, cardiovascular surgery, neurosurgery including thrombectomy, bariatric surgery, plastic surgery, critical care, obstetrics and gynecology, nephrology, urology, orthopedics, radiology, ENT, and organ transplant.
Services.
Out patient clinic.
Out patient clinics are available from 8:00 am to 8:00 pm from Monday to Saturday .
Apollo pharmacy.
One Apollo pharmacy outlet is attached to the main hospital. It is a part of Apollo Hospitals.
Education and research.
AHERF hosts academic courses coupled with research in the field of healthcare.


Center for BrainHealth

The Center for BrainHealth, part of The University of Texas at Dallas' school of Behavioral and Brain Sciences, is a research institute focused exclusively on brain health that combines brain research with clinical interventions. Founded by Dr. Sandra Bond Chapman in 1999, the Center for BrainHealth houses 125 researchers, postdoctoral research fellows, doctoral students, master's students, and research clinicians who work on 60 privately and federally funded research projects. The Center provides academic training and houses specialists in, among many others, Alzheimer's disease, traumatic brain injury (TBI), healthy brain aging, multiple sclerosis, autism, attention deficit hyperactivity disorder (ADHD), stroke, and posttraumatic stress disorder (PTSD). To help raise awareness of and funding for research underway at the Center for BrainHealth, a number of proponent groups have formed. These include the Think Ahead Group (TAG) of young professionals and Friends of BrainHealth.
Research.
Researchers work side-by-side with clinicians. Brain scientists at the Center use technologies to elucidate how brain networks can be strengthened and reconnected, including electroencephalography (EEG) to record the brain's electrical rhythms during cognitive task performance, functional MRI (fMRI) scans to measure brain blood flow during cognitive tasks, an indicator of brain activity and brain morphometrics to measure size and shape differences of brain regions to millimeter accuracy. The Center houses specialists in various fields of neuroscience, and has produced publications from members of the BrainHealth Team. Research initiatives include:
History.
The Center for BrainHealth, part of The University of Texas at Dallas (UTD), was established in 1999 under the direction of Dr. Sandra Bond Chapman, UT Dallas' Dee Wyly Distinguished Chair in Brain Health. Originally located at UT Dallas' Callier Center for Communication Disorders, in 2004 the Texas Higher Education Coordinating Board approved the purchase and renovation of a nearby building at 2200 Mockingbird Lane in Dallas to be the Center's own facility. This facility is adjacent to the UT Southwestern North Campus. The Center's virtual lab is part of the National Pediatric Acquired Brain Injury Plan, and in 2004 the BrainHope Program was established for children with traumatic brain injuries. Also in 2004, Dee and Charles Wyly endowed the $2-million Dee Wyly Distinguished Chair at the Center and a $1.5-million gift from Sallie and Frederic B. Asche, Jr., to enable the establishment of the Sallie and Frederic B. Asche Jr. Advanced Treatment Wing at the Center for BrainHealth.
In 2005 the Center received a $2-million gift to endow a chair for the Center's medical science director. The Center's memory research initiatives were expanded in 2006 with $1 million to establish the Berman Laboratory for Learning and Memory and the Berman Scholars Program for young researchers doing postdoctoral training in memory. In 2007, businessman and philanthropist T. Boone Pickens donated $5 million to the Center for BrainHealth to fund educational and research initiatives in the area of brain science. In 2008, the Center's Middle School Brain Years project conducted the pilot study of its Strategic Memory and Reasoning Training (SMART) Program, an experimental curriculum designed to improve strategic reasoning skills in teens. The pilot study's success led to a $6 million grant from Texas Legislature for the project's expansion.
Facilities.
The Center for BrainHealth is located in a building designed by Kyley Harvey of HKS, Inc., on a site near the UT Dallas' Callier Center for Communication Disorders and the University of Texas Southwestern Medical Center in the city of Dallas. In 2004, UT Dallas purchased a building with a $5 million donation from Dianne Cash. The new building was named the Frances and Mildred Goad Building in honor of Cash's mother and grandmother, both of whom had benefited from the Center's efforts. Originally constructed in 1970, the redesign and remodel was an extensive undertaking that began in June 2005, completed in September 2006, with the building formally dedicated on January 26, 2007. Each floor of the facility is dedicated to carrying out one aspect of BrainHealth's mission and includes an auditorium, virtual classrooms, the T. Boone Pickens Virtual Learning Center, and a reception hall. The second floor contains computers and data analysis tools, as well as an outlet for brain scientists, engineers, and technology experts to explore data. The third floor houses clinically based research projects, including a facility for individuals to undergo brain fitness checkups for discovering ways to prevent memory decline and a place for adults and children to participate in research aimed at learning more about how to strengthen brain function after injury or disease. The Center for BrainHealth houses electroencephalography labs, data analysis tools, MRI machines, an rTMS (Repetitive Transcranial Magnetic Stimulation) lab, and brain morphometric laboratories.
Think Ahead Group.
Think Ahead Group (TAG) is a young professionals group based in Dallas, Texas, that raises awareness of brain health and funds for research taking place at the Center for BrainHealth.
The Think Ahead Group, founded in October 2009, now includes over 300 members. All contributions support the cause of brain health and the Center's many research focus areas-Alzheimer's disease, traumatic brain injury (TBI), autism, attention deficit hyperactivity disorder (ADHD), stroke, posttraumatic stress disorder (PTSD), addiction, BrainHealth physical, dementia, exercise and the brain, healthy brain aging, and virtual brain training.


Adam Finn

Adam Hugh Roderick Finn is professor of paediatrics at the University of Bristol and head of the Bristol Children's Vaccine Centre. He has been chairman of the WHO European Technical Advisory Group of Experts (ETAGE) on Immunization since 2011 and is an ex-officio member of the WHO Strategic Advisory Group of Experts.
He is a member of the British Department of Health Joint Committee on Vaccination and Immunisation (JCVI) and in 2015 was elected president of the European Society for Paediatric Infectious Diseases (ESPID).


Biopharma LLC

Biopharma (Ukrainian: ТОВ «Біофарма плазма») is the Ukrainian pharmaceutical company focused on the development and production of drugs based on human plasma.
History.
Foundation and early history.
In 1895, the Association for the Control of Infectious Diseases was created, and in 1896 the Bacteriological Institute was founded in Kyiv. In 1897, a shelter for vaccination of the population was opened opposite the building.
20th century.
In 1920, with the opening of epidemiological, microbiological, parasitological and sanitary-hygienic departments, it was renamed to the "Sanitary and Bacteriological Institute."
In 1938, the Institute was divided into two parts: scientific and manufacturing. It was renamed to the "Ukrainian Institute of Epidemiology and Microbiology." At this time, the staff consisted of 250 employees.
During World War II, the Institute was evacuated to Kuybyshev and continued the research.
After the war, manufacturing returned to Kyiv. In 1955, the manufacturing expanded to 12 bacterial drugs. The institute begins to export to Europe, the Middle East, and India.
21st century.
In 2005, the company implemented the technology of the virus inactivation by the solvent/detergent method in the production of immunoglobulins.
In 2005, at the International Forum of Quality, the enterprise received the ISO 9001 certificate.
In 2009, after a series of changes, reorganizations, and renamings (in 1965, 1978, 1992), PrJSC Biopharma was formed.
In 2012, Horizon Capital and FMO invested in Biopharma for building a new biopharmaceutical production factory equipped with a quality control laboratory.
In 2014, the first phase of the Biopharmaceutical Research and Manufacturing Complex was launched in Bila Tserkva. It includes a pharmaceutical plant for the production of medicines, center for research, development and technology, laboratory building for quality control of drugs, warehouses for raw materials and finished products, housing for power systems.
The official opening of the Biopharmaceutical NSC "Biopharma" took place on June 16, 2015. On this occasion, the company handed over medicines worth 1 million UAH, for the needs of the Ministry of Defense and the treatment of military personnel.
In September 2018 company joined The European Business Association (EBA).
2019 (September 19–20) Biopharma jointly with the Ministry of Health of Ukraine held an international forum on blood components and preparations - "Actual issues of industrial production of blood products". Within the framework of the forum, the official opening ceremony of the plasma fractionation plant was held, which became the first such plant in Ukraine and can process up to one million liters of plasma per year.
Construction of a new complex.
At the end of 2016, Biopharma started the third stage of the construction – the plant for blood plasma fractionation. In October 2017, after the construction of a new building, the installation of technical equipment was started. At the new facilities, the company will produce Albumin, Bioven, and Immunoglobulin that help treat diseases caused by immunodeficiency.
The opening of the new complex took place in summer 2018 Vasyl Khmelnytsky and his partners invested $42 million in the research and production facility.
2019 — opening and launch of the first plasma fractionation plant in Ukraine which became the first such plant in Ukraine that can process up to one million liters of plasma per year. This technology enables to extract life-saving drugs, requires advanced research and development, GMP-certified equipment and facilities. $75 million was raised to build the plant.
In December 2019, Biopharma sold part of the company to the German pharmaceutical manufacturer STADA. This decision was made in view of the fact that STADA will be able to bring investment and new expertise in the production and promotion of medicines. Biopharma's shareholders maintained the production of donor plasma drugs and focused on its development both in Ukraine and abroad.
Currently, the company is focused on combating the COVID-19 pandemic and is working in two main areas:
Social activities.
Biopharma is involved in solving the problem of hemophilia and combating the AIDS epidemic and hepatitis C in Ukraine.
In 2017, as part of a public-private partnership, Biopharma invested over $3.5 million in the reconstruction and modernization of the Sumy Regional Blood Service Center. It is the first blood center in Ukraine certified according to the international standard ISO 9001: 2015.
In 2017, Biopharma launched an all-Ukrainian social program "We do care. We are together", aimed at improving the quality of life of patients with hemophilia in Ukraine. In the same year, the company provided charitable assistance to medical institutions of Kyiv region in the amount of UAH 1 million. The company also intends to build 10 modern donor plasma collection centers throughout Ukraine.
In March 2018, Biopharma initiated public discussions and held a series of meetings with representatives of the All-Ukrainian Hemophilia Society, the World Hemophilia Federation, and the Children with Hemophilia Charitable Foundation. As a result, a Memorandum of Cooperation was concluded and signed, which makes it possible to implement a system of public control over the production of the drug for patients with hemophilia "BioClot A".
At the end of July 2020, the first Biopharma Plasma center was opened in Cherkasy. The company leased the obsolete regional blood center and turned it into a high-tech progressive European institution. They installed modern equipment and created the most comfortable conditions for both donors and employees.
Activities during the COVID-19 pandemic.
At the end of March 2020, Biopharma helped the laboratory of the Center for Public Health of Ukraine of the Ministry of Healthcare to establish a national reference laboratory for the detection of coronavirus. In March 2020, the laboratory has already analyzed hundreds of samples and thus became a flagship in the fight against the spread of coronavirus in Ukraine.
In April 2020, Biopharma started collecting plasma from people who had recovered from COVID-19. Free tests for the presence of antibodies to coronavirus are conducted for all donors. Plasma is collected from donors by hardware plasmapheresis.
In September 2020 Biopharma has completed clinical trials of immunoglobulin (Bioven) in the complex therapy of patients with pneumonia caused by coronavirus infection COVID-19.


Steven T. DeKosky

Steven T. DeKosky (born 1947) is the Aerts-Cosper Professor of Alzheimer's Research at the University of Florida (UF) College of Medicine, deputy director of UF’s Evelyn F. and William L. McKnight Brain Institute (MBI) and associate director of the 1Florida Alzheimer’s Disease Research Center.
Education and Career.
After receiving his bachelor's degree from Bucknell University, DeKosky attended UF for graduate studies in neuroscience and psychology. He then graduated from the UF College of Medicine and completed an internship in internal medicine at The Johns Hopkins Hospital and a three-year residency in neurology at UF. DeKosky completed a postdoctoral fellowship in neurochemistry at the University of Virginia (UVA).
Before returning to UF in 2015, DeKosky co-founded the Alzheimer’s Disease Center at the University of Kentucky College of Medicine; was division chief of geriatric psychiatry at the University of Pittsburgh and then chair of the department of neurology for eight years. He directed the Alzheimer Disease Research Center at the University of Pittsburgh for 14 years, and served as vice president and dean of University of Virginia School of Medicine.
Research Interests.
DeKosky’s basic research has centered on structural and neurochemical changes in human brain in aging and dementia, and the effects of traumatic brain injury (TBI). His clinical and translational research have focused on understanding the genetics, neuropsychiatric symptoms, neuroimaging and treatment and prevention of Alzheimer’s disease (AD). He and his colleagues were first to correlate synapse number in the cortex with cognitive performance in AD patients.
He was an author of the first reports of dementia pugilistica, now termed Chronic Traumatic Encephalopathy (CTE) in American professional football players. In 2015, DeKosky was portrayed by Eddie Marsan in the movie, Concussion.
DeKosky was also a principal investigator in the clinical application of the breakthrough amyloid-imaging agent Pittsburgh Compound B (PiB). He directed an eight-year NIH-funded national multicenter trial to assess whether Ginkgo biloba can prevent or delay onset of dementia in normal elderly adults, the first large study of prevention of dementia/AD.
Honors and Other Roles.
DeKosky has served on and led numerous NIH review and advisory committees, and taught and mentored in clinical research training programs sponsored by the National Institute on Aging (NIA) and the National Institute of Neurological Disorders and Stroke (NINDS).
DeKosky is a frequent commentator on AD and brain aging for the press and is a frequent lecturer on AD nationally. He has testified multiple times before U.S. Senate Committees for greater research funding for AD, and has met with government officials in other countries as a consultant and advocate for programs and support for people with dementia.
A fellow of the American College of Physicians, the American Neurological Association and the American Academy of Neurology, DeKosky was elected to the American Board of Psychiatry and Neurology (ABPN) in 2003, and served in various capacities, including revamping the ABPN certification examination of neurologists. He served as the board’s vice president and president of the Neurology Council in 2010.
DeKosky has published over 500 peer-reviewed articles and book chapters and was named among Clarivate Analytics’ 2018 Highly Cited Researchers, recognizing those with the top 1 percent most-cited works in their field between 2006 and 2016.
He serves on the editorial boards of several leading neurology and AD journals and is a reviewer for multiple other journals. DeKosky served two eight-year terms on the Alzheimer’s Association’s Board of Directors, with one term as vice president and five years as chair of their Medical and Scientific Advisory Council. He served a similar role as chair of Alzheimer’s Disease International’s Medical and Scientific Advisory Panel. He has received numerous awards including the Rita Hayworth Award; the Ronald and Nancy Reagan Research Institute Award for outstanding contributions to research, care and advocacy on behalf of Alzheimer’s patients and their caregivers; the NIH Great Teacher Lecturer; the Alzheimer’s Association Zaven Khachaturian Award for contributions to AD research, and the Alzheimer’s Association's Lifetime Achievement Award in 2020.


Thomas Baffes

Thomas G. Baffes (April 3, 1923 – June 15, 1997) was an American surgeon and attorney noted for developing a surgical procedure to repair a heart defect known as transposition of the great vessels, which often caused "blue baby" deaths.
Early life and education.
Baffes was born in New Orleans, Louisiana, to Greek immigrant parents, Gustave "Gus" Baffes (1893-) (English attribution for the Greek name Konstantinos) and Tina (née Bores) (1905-). They came from Tripoli, Greece. Thomas had one younger sister, Bessie and one younger brother, Christian. He received his M.D. from Tulane University Medical School.
Career.
Baffes was chairman of the surgery department at Mt. Sinai Hospital Medical Center in Chicago. He was also a partner in a Chicago law firm, Pierce Daley Baffes and O'Sullivan, and taught classes at DePaul University Law School.


National Care Group

The National Care Group is a social care provider based in Accrington. It was established in March 2016 by Jamil Mawji and Faisal Lalani. They previously helped set up 99p Stores. It provides support services for people with complex needs arising from learning disability, mental health and acquired brain injury.
It was third in the Sunday Times Fast Track 100 league table in December 2020. Sales grew by an average 183% a year to £60.8 million in 2020. It has acquired 36 other providers. 650 new staff were recruited between March and December 2020. It has 2,400 staff who support over 1230 people. James Allen is the chief executive officer.
It bought the Rotherham-based company Steps Residential Care, which was established in 1999, in November 2020 with funding provided by Allied Irish Bank with which it has an ongoing relationship. It provides residential care for up to 26 adults with learning disabilities.
The property management and compliance company, Velway, has a contract to support their 47 properties.
The company has, like the rest of the sector, recruitment and staff turnover issues, but in 2018 said that staff turnover was comfortably below the industry average of 28%.


Thomas C. Butler

Thomas Campbell Butler is an American scientist specializing in infectious diseases including cholera and bubonic plague at Texas Tech University since 1987. He is credited with making oral hydration the standard treatment for diarrhea.
Butler was arrested in 2003 and prosecuted by the United States Justice Department for, among many other charges, illegal transportation of plague samples, tax evasion, fraud, and embezzlement. He was convicted of 47 out of 69 charges and served a two-year jail term ending in December 2005, having rejected a plea bargain offer.
Early life and education.
Butler received his MD degree from Vanderbilt University in 1967 and served in the U.S. Naval Medical Research Unit studying infectious disease, attaining the rank of lieutenant commander.
Arrest.
In January 2003, Butler reported 30 vials of plague missing from his laboratory to safety officers at Texas Tech University. The missing vials apparently triggered a bioterrorism response plan. Sixty law enforcement officers were sent to investigate, and they arrested Butler after questioning him. The Justice Department accused Butler of illegal transportation of plague samples, tax evasion, fraud, and embezzlement, among other charges. Butler pleaded not guilty in September 2003, turning down a plea-bargain offer for a six-month sentence in exchange for a guilty plea.
Conviction.
He was convicted on December 1, 2003 of 47 of the 69 charges filed against him. Of the convictions, three were for improper shipment of plague samples to research collaborators in Tanzania and forty-four were related to what prosecutors called "shadow contracts" for his research at Texas Tech, whereby "part of the payment for clinical trials went directly to Dr. Butler instead of through university accounts."
Prosecution.
The prosecution of Butler was met with disapproval by many groups of scientists, including colleagues, the National Academy of Sciences, several Nobel Prize winners, and the Federation of American Scientists. Critics of the prosecution suggested that the aggressive prosecution of a prominent scientist would make other scientists reluctant to carry out research in dangerous diseases for fear of similar prosecutions.


Margaret Clark (psychologist)

Margaret Sydnor Clark is an American psychologist.
Clark graduated from Franklin and Marshall College in 1973, and obtained a doctorate at the University of Maryland in 1977. She joined the faculty of Carnegie Mellon University upon completing her studies, and taught there until moving to Yale University in 2005. At Carnegie Mellon she served as chair of the faculty of Humanities and Social Sciences for a year, received the Elliot Dunlop Smith Award for excellence in teaching in that college and received the Ryan Award for excellence in teaching across all colleges at the University. At Yale, Clark has served first as master, a position subsequently renamed as head, of Trumbull College since 2013, and was named John M. Musser Professor of Psychology in 2015. She has served as the president of the Society for Personality and Social Psychology of the Society of Experimental Social Psychology. In 2015, Clark was elected to membership of the American Academy of Arts and Sciences.


Neuroendocrine hyperplasia

Neuroendocrine hyperplasia is rare and poorly understood lung condition which causes abnormal growth pulmonary neuroendocrine cells in the lungs. It is a progressive hyperplastic process that ultimately results in obliterative fibrosis of predominantly the pulmonary tree (the lungs). It is characterized by tachypnea, hypoxemia, and retractions. It is predominantly found in infants and children younger than 2 years of age. There is no currently recognized treatment for the relentless progression of this disorder.
Signs and Symptoms.
People with this diagnosis may have no obvious symptoms, they may present with shortness of breath or wheezing.Infants and children present with symptoms of heavy breathing at a rate greater than 20 breath/min. Oxygen levels are lower due to hypoxia, and chest x-rays show signs of pneumonia. NEHI typically presents in otherwise healthy infants during the first months to year of life. Severe cases may risk permanent damage to the lungs and death from severe tachypnea.
Causes.
There is not cause of Neuroendocrine hyperplasia, however some known causes are a rapid increase of pulmonary endocrine cells in the lungs in children under the age of 2. An increase in pulmonary endocrine cells is usually seen in adults with a history of smoking, COPD, or cystic fibrosis. Children under the age of 2 may present with signs of interstitial lung disease and be diagnosed with NEH following severe progression.
Mechanism.
Neuroendocrine hyperplasia is a rare condition amongst chILD. This condition is characterized as an overgrowth of pulmonary endocrine cells in the lungs. These cells receive signals from neurons to produce hormones. With this rapid increase of PNC (pulmonary endocrine cells), this can affect the airways of children. Furthermore, this increase can be a precursor of pulmonary carcinoid tumors.
Diagnosis.
To diagnose neuroendocrine hyperplasia after a referral is made for fast breathing (tachypnea) or need for extra oxygen. There are several tests that are commonly performed to confirm the diagnosis. Chest CT gives a better look at the lungs to see signs of pneumonia. With a bronchoscopy, a scope (small camera) is passed from the mouth or nose, through the windpipe, and into the lungs to check for other causes of breathing problems. A lung biopsy may be the only way to diagnose the disease if the chest CT does not show the characteristic findings. In a biopsy, a small portion of lung tissue is removed to determine if lung disease is present.
Treatment.
There is no consensus on the therapy for NEHI, and management generally consists of supportive care: supplemental oxygen for chronic hypoxemia, adequate nutrition, proper immunization, avoidance of environmental pollutants, and treatment of recurrent infections . To relieve symptoms of NEH, there are not any methods yet proven effective in infants. Supportive care and adequate nutrition may be considerate in improve quality of life as NEH in most cases is not treatable.
Prognosis.
Most outcomes in neuroendocrine hyperplasia leads to failure to thrive due to the restrictions of oxygen flow in lungs. The long-term outcome of NEHI is generally favourable with most patients gradually improving over time, although persistent airway obstruction mimicking severe asthma and relapse with respiratory infection.
Epidemiology.
The incidence and prevalence of NEHI are unknown, but it is clearly rare. Available data derive from small to moderate sized case series. The original report of this disorder in 2005 included 15 cases. A study from a large referral center identified 19 cases (14 percent) from among 138 lung biopsy cases accrued over a 10-year period. Twenty-three NEH cases were included in a separate study testing chest CAT scan. The largest report to date includes 37 cases in a manuscript focusing on infant pulmonary function testing (PFT)
Current Research.
The research being done on neuroendocrine hyperplasia consists of a criterion to distinguish its characteristics from similar cHILD cases. A recent study in November, 2020 helped identify pathologic features of NEH, and used clinical patients to support their data. Another study reviewed the various supplemental oxygen use in NEH patients. They identified factors in NEH to help in clinical course. As well as, reviewed failure to thrive patients who would have an increased use of supplemental oxygen. Other than its associations with chILD, researchers do not know much about this condition.