Letter from Albert Cabbad and David Brickman, President and Executive Director of the Park Slope Fifth Avenue Local Development Corporation to Frederick Schwartz, Chairman of the Charter Revision Commission

This letter from the President and the Executive Director of the Park Slope Fifth Avenue Local Development Corporation to Frederick Schwartz, Chairman of the Charter Revision Commission, urges Schwartz to maintain an effective role for the Borough Presidents in the budget process. The letter is dated April 17, 1989

Letter from Albert Cabbad and David Brickman, President and Executive Director of the Park Slope Fifth Avenue Local Development Corporation to Frederick Schwartz, Chairman of the Charter Revision Commission

This letter from the President and the Executive Director of the Park Slope Fifth Avenue Local Development Corporation to Frederick Schwartz, Chairman of the Charter Revision Commission, urges Schwartz to maintain an effective role for the Borough Presidents in the budget process. The letter is dated April 17, 1989

Transverse Cerebellar Diameter On Cranial Ultrasound Scan In Preterm Neonates In An Australian Population

Objective: Fetal measurement of transverse cerebellar diameter (TCD) has been shown to correlate well with gestational age (GA), even in the presence of growth retardation. The aim of this study was to define the normal range of TCD in preterm neonates in an Australian population between 23 and 32 weeks GA. Methodology: Infants admitted to the Royal Women's Hospital, Melbourne, having routine cranial ultrasound scans (< 1500 g and/or of gestational age 32 weeks at birth) had their TCD measured on a cranial scan performed during the first 3 days of life. The posterior fossa was examined through the asterion using a General Electric LOGIQ 500 scanner (GE Medical Systems, Waukesha, USA) and TCD measurement was taken in the coronal plane. Results: 106 infants < 1500 g and/or of GA 32 weeks at birth had their TCD measured between 1 January 1997 and 30 November 1997. Transverse cerebellar diameter and associated 95% confidence intervals are described for infants between 23 and 32 weeks GA. The linear regression equation relating TCD and GA was: TCD (mm) = 12.9 + 1.61 GA (weeks). R2 = 0.80, P< 0.001. Conclusion: This is the only study of TCD measurement using cranial ultrasound in a group of preterm newborns, and forms the basis for nomograms of TCD which can be used as a tool to assist in the assessment of GA, even in growth-retarded preterm newborns, and in the diagnosis of cerebellar hypoplasia

Trauma Team Oversight Of Patient Management Improves Efficiency Of Care And Augments Clinical And Economic Outcomes

Introduction: The purpose of this study was to determine whether trauma team oversight of patient management would positively affect efficiency of care as defined by improved patient throughput, with augmentation of both clinical and economic outcomes. Methods: All patients activating the trauma team at a Level I trauma center over two time periods (last six months of 2005 and 2006) were reviewed. Trauma team activation criteria remained constant across the two time periods. During period one, patients were admitted to multiple services depending on injury pattern, while in period two, most patients were admitted to the trauma service for trauma team oversight of their management. In period two, improved documentation and appropriate coding was encouraged. Data are reported as mean ± SD, and median. Results: Patient demographics and payer mix were similar over the two time periods. The number of full-time trauma surgeons remained constant. Trauma activations increased from 407 to 651 (p\u3c0.05). The percentage of patients admitted to the trauma service also increased (68% vs. 86%, p\u3c0.001). The mean injury severity score decreased (15 ± 15 vs. 12 ± 11, p\u3c0.0001) although 3 the median ISS score remained stable at 9. Linear regression analysis identified ISS and admission during the later time period as significant predictors of decreased length of stay. Hospital length of stay also decreased significantly. Changes in billings and coding practices resulted in statistically significant increases in trauma surgeon work relative value units (182% increase), charges (360% increase) and collections (280% increase). The increased system efficiency resulted in significant decreases in the actual hospital costs per patient and led to the generation of an overall net positive hospital contribution margin per patient. Conclusions: Implementation of trauma team oversight of patient care resulted in increased efficiency of care delivery, with shorter hospital lengths of stay despite increased patient volume. This paradigm change, coupled with improved documentation and coding, resulted in improved reimbursement for the physician, and lower cost per discharge for the hospital

Fetal and Maternal Inflammatory Response in the Setting of Maternal Intrapartum Fever With and Without Clinical and Histologic Chorioamnionitis

BACKGROUND: Both infectious and noninfectious causes of maternal fever have been linked to adverse neonatal outcomes including low Apg0ar scores, respiratory distress, hypotonia, and neonatal seizures. Even in the absence of infection, the occurrence of intrapartum fever is a strong risk factor for poor long-term neonatal developmental outcomes, including encephalopathy, cerebral palsy, and neonatal death. OBJECTIVE: The primary objective of this study was to compare intrapartum and postpartum maternal and fetal umbilical cord serum levels of cytokines RANTES, interferon-ɣ, interleukin-1β, interleukin-2, interleukin-4, interleukin-6, interleukin-8, interleukin-10, interleukin-13, and tumor necrosis factor-α among nonfebrile patients, febrile patients without clinical chorioamnionitis, and febrile patient with clinical chorioamnionitis. STUDY DESIGN: This study was conducted at the Richmond University Medical Center from May 15, 2020 to July 16, 2019. During this time, we recruited 30 nonfebrile patients at \u3e36 gestational weeks who were in labor and collected umbilical cord and pre- and postdelivery maternal serum samples to evaluate the cytokine levels. Placentas were collected for pathologic review and to evaluate the histopathologic findings. These results were compared with 121 patients who developed a fever of \u3e38°C during labor. The febrile patients were further divided based on the presence or absence of clinical chorioamnionitis. A secondary analysis was performed based on the presence of absence of histologic chorioamnionitis. Statistical analysis was performed using IBM Statistical Package for the Social Sciences version 25.0. For the 3 group comparisons, a P value of \u3c.017 was considered statistically significant after application of a Bonferroni correction. RESULTS: A total of 151 patients were included in the study; 30 were nonfebrile patients, 46 were febrile patients with a diagnosis of clinical chorioamnionitis, and 75 were febrile patients without clinical chorioamnionitis. Compared with nonfebrile patients, umbilical cord serum interferon-ɣ, interleukin-1β, interleukin-6, interleukin-8, RANTES, and tumor necrosis factor-α levels were elevated in the presence of maternal hyperthermia irrespective of the diagnosis of clinical chorioamnionitis. Interleukin-6 umbilical cord levels were more than doubled from 63.60 pg/mL (6.09-1769.03 pg/mL) in febrile patients with no clinical chorioamnionitis to 135.77 pg/mL (1.86-6004.78 pg/mL) in febrile patients with clinical chorioamnionitis, making it the only cytokine that was significantly different between these 2 groups. When comparing the intrapartum maternal serum, we found a significant elevation in the interleukin-10, RANTES, and tumor necrosis factor-α levels in the febrile group irrespective of the presence of clinical chorioamnionitis when compared with the nonfebrile group. In the postpartum maternal blood evaluations, tumor necrosis factor-α was the only cytokine that was significantly higher in febrile patients than in nonfebrile controls. CONCLUSION: In the setting of intrapartum fever, maternal cytokine profiles were similar irrespective of the diagnosis of clinical chorioamnionitis. Even in the absence of clinical or histologic chorioamnionitis, maternal hyperthermia induced elevations in fetal cytokines