Abstract PO-235: Choroid plexus papilloma: A report of a benign but rare entity

Choroid plexus papilloma (CPP) accounts for <1% of all the intracranial neoplasms and is a rare benign neoplasm with common sites being the fourth ventricle in adults and lateral ventricle in children. They are occasionally bilateral with associated hydrocephalus. A 28-year-old female with no past medical history presented to the emergency department with a fall and witnessed seizure. On her way to the bathroom, she felt dizzy and missed a step leading her to trip and fall hitting her headfirst. While on the floor she was witnessed a seizure and brought to the emergency department where she had postictal confusion, slow speech, and was unable to recall events after falling. She also complained about fatigue, lack of energy, sleepiness, loss of interest, sad mood, and suicidal thoughts. CT scan demonstrated a 2.6 cm fourth ventricular mass with internal calcifications. Posterior to the mass there was a subtle increased density which was favored as additional calcifications with moderate obstruction of the 4th ventricle and mild ventriculomegaly. Differential diagnosis included subependymoma, ependymoma as well as astrocytoma. Histopathological examination revealed CPP with appropriately controlled stains to be positive for S100 and Ki-67 to be approximately 3% and negative for p63. CPP is derived from neuroectoderm and is designated as Grade I neoplasms by WHO and Grade II is reserved for atypical CPP. The most optimal treatment strategy is resection which is curative with very little chance of recurrence after a gross-total resection in approximately 96% of the cases. One of the management challenges faced is the vascularity of the tumor which is due to the intraventricular location of tumor which has a rich anastomotic supply of choroidal blood vessels. Due to the rich vascularity of the tumor embolization is considered as an adjunct to reduce the intravascular blood loss intraoperatively with the overall mortality ranging from 0-25% and the mortality rate from the blood loss to be approximately 12%. Currently, the patient is doing well without any evidence of metastasis. Hence it is important to be aware of this rare and benign entity and endoscopic removal is recommended despite the intraoperative bleeding it might cause.

Citation Format: Hansini Laharwani, Vijay Kumar, James Neill. Choroid plexus papilloma: A report of a benign but rare entity [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-235.

Advancing oral health policy through persuasive messaging and effective research measures

Oral health is often excluded from broad health policy discussions, addressed only in a policy silo. There is a paucity of research to guide policymaking as it relates to oral health. In response, AcademyHealth's Oral Health Interest Group organized a meeting during the 2019 AcademyHealth Annual Research Meeting to promote transdisciplinary dialog on the current state of oral health policy and the steps necessary to improve the oral health of Americans. This article summarizes the two main themes that emerged from the proceedings of the Oral Health Interest Group meeting: a) recommendations for advocating the inclusion of oral health in policy discussions and b) critical research topics and measures needed for effective oral health policies in the future.

What future/s for outdoor and environmental education in a world that has contended with COVID-19?

This is an unusual article in that it brings together the perspectives of many on this journal’s editorial board, around the issue of contending with COVID-19. Twenty statements showcase a range of thoughts and experiences, highlighting the differences and similarities in the way the pandemic is impacting on the educational practice of outdoor and environmental education. The future is not yet written, of course, so it is worth thinking about how the current moment may impact on the months and years to come. The aim of this article is to influence and support such thinking.

Promoting student learning and increasing organizational capacity to host students in residential aged care: a mixed method research study

BACKGROUND

In Australia, the Federal government's agenda to increase clinical training places to address the forecast shortfall of nurses is driving innovation in clinical education. A student leadership model of clinical education, named the Student Nurse Led Ward model, was designed for the aged care context to provide a high number of clinical placements for pre-service Bachelor of Nursing students in an under-utilized clinical education setting.

OBJECTIVES

The research aimed to determine the viability of the innovation by (1) developing a preliminary understanding of what students were learning and (2) exploring stakeholders' perceptions about student learning.

DESIGN

A mixed methods design included an ageing knowledge test and ageing attitudes survey, both administered before and after the placement, student narratives of a learning event written after the placement, as well as focus group and individual interviews with stakeholders.

SETTING

Three residential aged care facilities partnering with one university in one Australian jurisdiction.

PARTICIPANTS

Included 35 of the 45 students who began placement in the aged care facilities during one semester, a convenience sample of 15 staff and each of the managers and educators from the three agencies.

METHODS

Descriptive statistical analysis of student pre-post knowledge test and attitude survey, hermeneutic analysis of student narratives, and content analysis of individual and group interview data.

RESULTS

There was an increase in student knowledge around sensory changes, delirium, and drug reactions in older people. There was a slight increase in students' expression of ageist attitudes following the clinical experience. The clinical educator position was considered to be critical to the success of the model.

CONCLUSIONS

This Student Nurse Led Ward model is a viable model to increase clinical placements, with preliminary evidence in this study suggesting that students benefit through increased knowledge, understanding and capacity to work with older people.

INFLUENCE OF TEMPERATURE AND HYDROGEN ION CONCENTRATION UPON THE SPORE CYCLE OF BACILLUS SUBTILIS

1. At 5 degrees C. no germination took place. 2. At 25 degrees C. and at 37 degrees C. germination occurs if the hydrogen ion concentration of the broth is kept between pH 5 and pH 10, but not at higher or lower pH values. 3. The completion of the spore cycle likewise requires a hydrogen ion concentration between pH 5 and pH 10. 4. The spores can germinate when the pH value is 10, although after germination the vegetative cells multiply only to a very slight extent and soon pass into spores. 5. The slight growth and multiplication of vegetative cells in broth of pH 10 suggest that the formation of endospores in this medium must be caused largely by the unfavorable reaction of the medium rather than by the accumulation of metabolic products. 6. Automatic adjustment of the medium seems to play a rôle in the completion of the spore cycle. 7. The results are not only of theoretical importance but they have a practical application to the preservation of food by canning and by other methods.

Using multimedia virtual patients to enhance the clinical curriculum for medical students

Changes in the environment in which clinical medical education takes place in the United States has profoundly affected the quality of the learning experience. A shift to out-patient based care, minimization of hospitalization time, and shrinking clinical revenues has changed the teaching hospital or "classroom" to a degree that we must develop innovative approaches to medical education. One solution is the Virtual Patient Project. Utilizing state-of-the-art computer-based multimedia technology, we are building a library of simulated patient encounters that will serve to fill some of the educational gaps that the current health care system has created. This project is part of a newly formed and unique organization, the Harvard Medical School-Beth Israel Deaconess Mount Auburn Institute for Education and Research (the Institute), which supports in-house educational design, production, and faculty time to create Virtual Patients. These problem-based clinical cases allow the medical student to evaluate a patient at initial presentation, order diagnostic tests, observe the outcome and obtain context-sensitive feedback through a computer program designed at the Institute. Multimedia technology and authoring programs have reached a level of sophistication to allow content experts (the teaching faculty) to design and create the majority of the program themselves and to allow students to adapt the program to their individual learning needs.

The effect of anonymous vs. nonanonymous rating conditions on patient satisfaction and motivation ratings in a population of substance abuse patients

Patient self-report in evaluations involving alcohol and other drug abuse has generally been found to be reliable and valid. However, little is known about the variables associated with greater or lesser degrees of reliability and validity. This study was conducted to determine how motivation and satisfaction ratings obtained under anonymous conditions would compare with ratings obtained under nonanonymous conditions. Over the course of 12 months, 1397 subjects in the Boston Target Cities Project were assigned to either confidential or fully anonymous data collection procedures in an interrupted time-series design. Anonymity had either no effect on ratings or accounted for < 1% of the variance. Satisfaction and motivation ratings obtained under confidential conditions are probably as reliable and valid as ratings obtained under fully anonymous conditions.

The business of education: a new paradigm

Business as usual is not the answer these days. But how do you create a new paradigm for academic educational and research endeavors? There is increasing pressure to separate the costs of providing care to patients from those of educating students and residents. It is evident already that we will not enjoy the flexibility of the past to cross-subsidize the academic effort. Presented here is a case study--a joint venture between Harvard Medical School and Beth Israel HealthCare created to sustain the academic mission, as distinct from its clinical business, and promote innovation in medical education and research through intellectual leadership, dedicated state-of-the-art facilities, and a focused development effort.

Whatever became of the schizophrenogenic mother?

From the late 1940s to the early 1970s, the concept of the "schizophrenogenic mother" was popular in the psychiatric literature. Research later confirmed that the mother who could cause schizophrenia in her offspring did not exist. Such a blame-levelling concept, which had no basis in scientific fact, may have caused a great deal of harm. Sociocultural factors, coupled with developments in psychiatric theory, contributed to the genesis of the concept. Implications of this episode in the history of psychiatry are discussed.

The impact of fine-needle aspiration biopsy on a diagnostic electron microscopy laboratory

We retrospectively reviewed the number and types of diagnostic electron microscopic specimens from a 4 1/2-year period. During this period, the number of fine-needle aspirate biopsy specimens processed increased in a linear fashion, from a relatively uncommon occurrence to the current level of activity, in which fine-needle aspiration specimens now represent 40% to 50% of the nonrenal diagnostic material examined by electron microscopy. This study documents the increasing importance of fine-needle aspirate-type specimens in the everyday operation of a diagnostic electron microscopy facility.

Nonamyloidotic fibrillary glomerulopathy

We describe a 28-year-old woman with nonamyloidotic fibrillary glomerulopathy. She had modest but stable renal insufficiency over a ten-year period, nephrotic-range proteinuria, sarcoidosis, and seven of the 25 signs of Down's syndrome. The rarity of the co-occurrence of these conditions suggests that they are not etiologically linked.

Captopril-associated acute interstitial nephritis

A 57-year-old male with mild impairment of renal function secondary to diabetic glomerulosclerosis developed acute renal failure (creatinine 32.4 mg/dl) associated with a generalized desquamative skin rash and peripheral eosinophilia shortly after initiation of antihypertensive therapy with captopril. An acute interstitial nephritis was demonstrated on renal biopsy, and improvement was temporally related to initiation of therapy with prednisone. A review of the literature revealed 5 similar cases in whom acute deterioration of renal function occurred following initiation of captopril and in whom there were features of a hypersensitivity reaction, including skin rash, fever, eosinophilia, azotemia, eosinophiluria, and a Coombs-positive hemolytic anemia. Renal biopsy, where available, revealed an acute interstitial nephritis. Observations from these cases suggest that, of the angiotensin-converting enzyme inhibitors, this syndrome appears to be specific for captopril, begins within the 1st month of therapy, is not dose-dependent, and generally resolves on cessation of therapy. Steroids may hasten recovery, but sufficient data are not available to confirm their efficacy.

Hydrosyringomyelia and its management in childhood

Syringomyelia, once regarded as a degenerative disease of adults, is now recognized to be a disorder usually associated with the Chiari malformation and occurring in patients of all ages. We have reviewed 47 patients with syringomyelia treated on the Neurosurgical Service at the Hospital for Sick Children during the years 1977 to 1985. Twelve of these patients had a Chiari I malformation, 30 had a Chiari II malformation, and 5 had an acquired Chiari malformation. Thirty-one of these patients were treated by decompression of the Chiari malformation and plugging of the obex, 5 were treated by a simple posterior fossa decompression, 9 were treated by shunting of the syringomyelic cavity, and 2 were treated by a combined decompression of the posterior fossa and shunting of the syrinx. The Gardner procedure (decompression of the Chiari malformation and plugging of the obex) was the procedure most commonly used in managing our group of patients and resulted in improvement in over 70% of patients.

Mediation of the discriminative stimulus properties of 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) by the putative 5-HT1A receptor

Male Sprague-Dawley rats were trained to discriminate the putative 5-HT1A receptor agonist, 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) from saline in a 2-lever operant drug discrimination paradigm. The 8-OH-DPAT cue was found to be highly selective; neither the 5-HT receptor agonists, quipazine, LSD, MK 212 and RU 24969, the 5-HT releasing agent, p-chloroamphetamine, nor the alpha 2-adrenoceptor agonist, clonidine, were able to substitute for 8-OH-DPAT in tests of generalization. In contrast, both buspirone and TVX Q 7821, which like 8-OH-DPAT have high affinity and selectivity for the 5-HT1A recognition site, generalized to the 8-OH-DPAT cue in a dose-dependent manner. The discriminative stimulus properties of 8-OH-DPAT were not antagonized by the 5-HT2 receptor antagonist, ketanserin, or the selective beta 1- and beta 2-adrenoceptor antagonists, betaxolol and ICI 118.551, indicating that neither 5-HT2 receptors, nor beta-adrenoceptors play a significant role in the behaviour. However, the 8-OH-DPAT cue was antagonized stereoselectively by pindolol and alprenolol, which have relatively high affinity and stereoselectivity for 5-HT1, but not 5-HT2, recognition sites. Similarly, the capacity of TVX Q 7821 to generalize to the 8-OH-DPAT cue could be blocked by pindolol. In view of the fact that 8-OH-DPAT has negligible affinity for the 5-HT1B site, the above results are consistent with its discriminative stimulus properties being mediated by the putative 5-HT1A receptor. Moreover, agonist activity at central 5-HT1A receptors may be an important mechanism contributing to the anxiolytic properties of buspirone and TVX Q 7821.

Pharmacological analysis of the behavioural and thermoregulatory effects of the putative 5-HT1 receptor agonist, RU 24969, in the rat

The roles of recognition sites for central neurotransmitters in the mediation of the behavioural effects of the putative 5-hydroxytryptamine (5-HT1) receptor agonist, RU 24969 [5-methoxy-3(1,2,3,6-tetrahydropyridin-4-yl)1H indole] in the rat have been examined. The drug RU 24969 was found to have high affinity for 5-HT1A and 5-HT1B recognition sites. Hyperlocomotion, induced by RU 24969, was enhanced in animals depleted of 5-HT with 5,7-dihydroxytryptamine, suggesting an involvement of 5-HT receptors in the mediation of this behaviour. However, results of experiments with 5-HT receptor antagonists argued against the receptors being of either the 5-HT1 or 5-HT2 type. Despite the negligible affinity of RU 24969 for catecholamine receptors, hyperlocomotion induced by RU 24969 was clearly dependent on intact catecholamine systems. When hyperlocomotion was blocked by treatment with reserpine, reciprocal forepaw-treading and a flat body posture, behavioural responses which are consistent with activation of the putative 5-HT1A receptor, became evident. When animals were restrained from moving, RU 24969 dose-dependently reduced body temperature, an effect that may also be associated with activation of the 5-HT1A recognition site. Thus, although the mechanism by which RU 24969 induces hyperlocomotion is not yet established, the agonist nevertheless can induce functional responses consistent with its high affinity for the 5-HT1A recognition site.

Group B streptococcal colonisation and the outcome of pregnancy

Vaginal colonisation of pregnant women with group B streptococci (GBS) was not related to age, parity or blood group. There were marked differences between racial groups, Asians having a low colonisation rate and Negroes a high rate. Vaginal GBS colonisation was associated with intrapartum pyrexia, but not with preterm labour, premature rupture of membranes or other complications in labour. Group B streptococci may be an important cause of bacteriuria in pregnancy and their effect on the outcome of pregnancy as urinary pathogens needs further evaluation.

Is group B streptococcal screening during pregnancy justified?

Twenty-eight per cent of women investigated during pregnancy were carriers of group B streptococci (GBS). The use of broth enrichment was the most significant factor in determining GBS carriage rates. GBS carriage decreased during pregnancy. Transmission of GBS from mother to baby was related to vaginal carriage but rectal carriage in pregnancy was the best predictor of maternal carriage at term. Rectal and vaginal swabs taken at 28 and 36 weeks correctly predicted 92% of intrapartum GBS carriage. Although accurate prediction of intrapartum GBS carriage is possible, mass screening for GBS in pregnancy is unlikely to be cost-effective in those countries with a low incidence of neonatal GBS sepsis.

Disruption in the temporal sequence of regional ventricular contraction. I. Characteristics and incidence in coronary artery disease

While spatial asynergy at end-systole has been well characterized in patients with coronary artery disease, assessment of regional asynchrony has been hampered by technical constraints. We developed a computer-assisted method for analyzing regional asynchrony from the equilibrium (ECG-gated) radionuclide ventriculogram. Twenty patients with normal contrast left ventriculograms (nine with a normal coronary arteriogram [group 1] and 11 with coronary artery disease [group 2]) and 20 patients with asynergy during contrast ventriculography (group 3) were studied. The earliest evidence of regional asynchrony occurred in early systole. Regional ejection fraction at one-third systole was 0.32 +/- 0.02 (mean +/- SEM) in group 1, 0.22 +/- 0.01 in group 2 (p less than 0.001) and 0.12 +/- 0.01 in asynergic regions in group 3 patients (p less than 0.001). In group 3, severe forms of regional asynchrony appeared in both early systole and early diastole: five patients (25%) had early systolic paradox, 13 (65%) had regional prolongation of peak ejection fraction and 16 (80%) had reduced percent peak ejection fraction at global end-systole. It appears, therefore, that there is progressively increasing regional asynchrony in patients with increasing severity of coronary artery disease.

Regional left ventricular function in acute myocardial infarction: evaluation with quantitative radionuclide ventriculography

Regional and global left ventricular performance was noninvasively assessed with quantitative gated equilibrium radionuclide ventriculography in 43 patients an average of 40 hours after the onset of a first acute transmural myocardial infarction. In all 16 patients with anterior infarction, regional ejection fraction, a quantitative measure of regional left ventricular performance, was uniformly depressed in the infarcted zone. In patients with inferior infarction the abnormalities of regional performance were less severe. Fourteen of 20 patients (70 percent) with inferior infarction had depressed performance in the infarcted zone. Function in noninfarcted zones was abnormal in only 6 of the 20 patients (30 percent) with inferior infarction, but it was abnormal in 11 of the 16 patients (69 percent) with anterior infarction, particularly in those with severe pump failure. As a consequence, global left ventricular ejection fraction was significantly lower in patients with anterior than in those with inferior infarction (mean +/- standard error of the mean 31 +/- 3 percent versus 51 +/- 3 percent, less than 0.005). Prognosis and clinical functional class were related to performance not only in infarcted zones, but also in noninfarcted zones as assessed with electrocardiography. It is concluded that depressed function in apparently noninfarcted left ventricular zones contributes significantly to left ventricular dysfunction after acute myocardial infarction, particularly in patients with anterior infarction.

The paradox image: a noninvasive index of regional left-ventricular dyskinesis

The paradox image, a functional image of regional dyskinesis derived from the equilibrium (gated) radionuclide ventriculogram, was constructed by subtracting the background-corrected end-diastolic frame from the background-corrected end-systolic frame. In 11 patients showing dyskinesis by contract ventriculography, the percentage of left-ventricular picture elements containing paradox ranged from 3.6 to 55.6% (21.44% +/- 4.45 s.e.m.). In 11 patients with normokinesis and in eight patients with hypokinesis by contract ventriculography, the left-ventricular picture elements demonstrating paradox were less than 1.1% in all cases. In nine patients with akinesis, the percentage of left-ventricular picture elements containing paradox was 2.05% +/- 0.96 s.e.m. and was less tha 2% in seven patients. There was also an excellent agreement between the location of dyskinesis on the paradox image and that by contrast ventriculography. The paradox image is a sensitive indicator of left-ventricular dyskinesis and should be useful in the evaluation of patients with suspected left-ventricular asynergy.

Precocious puberty, IQ and school acceleration

School acceleration was recommended in 20 of 45 cases of idiopathic sexual pre cocity, and carried through in 12 of those cases. The accelerated children all were academically successful.

School acceleration is recommended as part of a more general program of accel erating social development, in order to help the precocious child bridge the gap between chronologic age and physique age. A high IQ facilitates acceleration, but an average IQ does not necessarily forbid it.

The child's own effort to achieve and a favorable parental attitude are important. School authorities in some places do not understand the nature of the problem and refuse to cooperate.