Postmortem Demonstration of the Source of Pulmonary Thromboembolism: The Importance of the Autopsy

Periprostatic or paravaginal venous thromboses are rarely considered clinically as sites of clot origin in patients with pulmonary thromboembolism. The majority of emboli have been demonstrated to originate in the veins of the legs. This report raises awareness of pelvic vein thrombosis as a potential source of pulmonary embolism that is rarely considered or detected clinically, and which usually requires postmortem examination for recognition. It also reviews the possible routes emboli may take to reach the lungs

Preoperative spinal tumor embolization: an institutional experience with Onyx.

BACKGROUND: Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection. OBJECTIVE: We report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients. METHODS: A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution. RESULTS: Twenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell carcinomas. Fifty-four vessels were embolized using PVA, NBCA, Onyx, coils, or embospheres. Sixteen patients were treated with Onyx, 6 patients with PVA, 3 patients with embospheres, 2 patients with NBCA, and 3 patients with a combination of embolic agents. The average decrease in tumor blush was 97.8% with Onyx versus 92.7% with the rest of the embolic agents (p=0.08). The estimated blood loss was 1616ml (range 350-5000ml). Blood loss was 750cm(3) on average with Onyx versus 1844 with the rest of the embolic agents (p=0.14). The mean length of stay was 16 days. The mortality rate was zero. Pre- and post-operative modified Rankin Score (mRS) did not differ significantly in the series (3.12 versus 3.10, respectively, p=0.9). CONCLUSION: In our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is a safe and feasible option

Quantitative Risk Analysis With Qualitative Statements

Cybersecurity risk analysis is crucial for organizations to assess, identify, and prioritize possible threats to their systems and assets. Organizations seek to assess the potential costs of risks in order to determine how to invest in mitigating those risks. Risk analysts rely on qualitative methods to analyze risks. However, qualitative approaches do not produce a complete idea of the loss. The current methods lack efficacy in enabling analysts to make informed decisions. It is crucial to support analysts in their decision-making process by offering means to quantify risks. For this reason, recent studies introduced quantitative risk analysis (QRA) methods to assist organizations in determining risk mitigation strategies and resource allocation. Organizations must use QRA methods to identify and prioritize risks rather than relying on qualitative methods. However, risk analysts tend to prefer quantitative methods since they do not require precise probability estimations. This thesis proposes a spreadsheet-based QRA method based on verbal likelihoods. Our approach relies on tables constructed by experts that map linguistic likelihood to probability ranges. Using linguistic terms to estimate risk's probability of occurrence will help experts apply quantitative estimation. We eliminate the need to assign exact probabilities by providing a tool that accepts natural language words as input. In modern approaches, Monte Carlo simulation is an important step in QRA to estimate the total loss for risks. For each risk's probability, we will estimate a continuous distribution to use in the simulation. Users will define their own linguistic terms to use them in the risk estimation process. The key benefit of our tool lies in its adaptability across various industries, empowering risk analysts to apply it according to their distinct needs. The tool grants analysts the flexibility to define estimation terms, enhancing precision in their analyses. Finally, we conducted experiments with real examples to validate our approach's accuracy, statistical significance and reliability. We compared our results with those obtained from other methods in the literature. Also, we conducted tests to measure our model's performance and robustness. Our study demonstrates the effectiveness of our approach and its potential to apply it in real-world applications

Comparing Two Summer Camps with the Four Types of Fun Framework

Type 2 fun is a concept familiar to most outdoor educators (Cordes, 2024) but has yet to be rigorously examined by education science. ‚ÄãDr. Bradley Smith has developed a novel conceptual model that provides a theoretical framework for Type 2 fun and predicts four types of fun (Smith, 2024). ‚ÄãThe objective of this study is to operationalize and develop measures for the four proposed constructs of the 'Four Types of Fun' (4TF) framework. This study tests the 4TF model by comparing data collected from two summer camps with different intended emphases on types of fun: Teton Science Schools (TSS) designed to promote Type 2 fun and Camp LEAD in Texas designed to promote Type 1 fun .‚ÄãThis research should advance the scientific conceptualization and measurement of 'fun' in the context of child psychology and well-being.Psychological, Health, and Learning Sciences, Department ofHonors CollegePsychology, Department o

Preoperative Onyx Embolization of Vascular Head and Neck Tumors by Direct Puncture

Preoperative embolization of hypervascular head and neck tumors is frequently performed to reduce operative times and blood loss. While traditional transarterial embolization is commonly used, direct tumoral puncture has also been advocated as an alternative. We report our series of head and neck tumors embolized with onyx via direct tumoral puncture to ascertain the safety and efficacy of embolization using this technique. We prospectively collected data on all head and neck tumors embolized with onyx at our institution during a 24-month period. A total of 18 patients underwent preoperative embolization via direct tumoral puncture. Tumors included nine carotid body tumors, three glomus vagale tumors, five juvenile nasopharyngeal angiofibromas (JNAs), and one intracranial frontal parasagittal meningioma. All embolizations were completed in a single session. Mean fluoroscopy time was 40 minutes. The overall mean percent tumor devascularization was 87%. Inadvertent transtumoral migration of onyx into the superior sagittal sinus occurred during intraoperative embolization of the meningioma using single-plane fluoroscopy and resulted in a large postoperative hemorrhagic venous infarct. There were no other endovascular-related complications in the remaining patients embolized using biplanar fluoroscopy. Embolization of hypervascular head and neck tumors with onyx via direct tumoral puncture can be performed safely and efficiently. Tumor embolization by direct puncture may theoretically lower the risk of inadvertent migration of onyx through nontarget arterial vessels, but may increase the risk of inadvertent transtumoral embolization of venous structures. Caution should be exercised when using this technique for intracranial pathologies, and the importance of biplanar fluoroscopy to allow better visualization of the onyx migration cannot be overemphasized