Clubfoot

Clubfoot is a birth defect where one or both feet are rotated inward and downward. The affected foot and leg may be smaller in size compared to the other. Approximately 50% of cases of clubfoot affect both feet. Most of the time, it is not associated with other problems. Without treatment, the foot remains deformed, and people walk on the sides of their feet. This may lead to pain and difficulty walking.
The exact cause is usually not identified. Both genetic and environmental factors are believed to be involved. If one identical twin is affected, there is a 33% chance the other one will be as well. The underlying mechanism involves disruption of the muscles or connective tissue of the lower leg, leading to joint contracture. Other abnormalities are associated 20% of the time, with the most common being distal arthrogryposis and myelomeningocele. The diagnosis may be made at birth by examination or before birth during an ultrasound exam.
Initial treatment is most often with the Ponseti method. This involves moving the foot into an improved position followed by casting, which is repeated at weekly intervals. Once the inward bending is improved, the Achilles tendon is often cut, and braces are worn until the age of four. Initially, the brace is worn nearly continuously and then just at night. In about 20% of cases, further surgery is required. Treatment can be carried out by a range of healthcare providers and can generally be achieved in the developing world with few resources.
Clubfoot occurs in 1 to 4 of every 1,000 live births, making it one of the most common birth defects affecting the legs. About 80% of cases occur in developing countries where there is limited access to care. Clubfoot is more common in firstborn children and males. It is more common among Māori people, and less common among Chinese people.
Signs and symptoms.
In clubfoot, feet are rotated inward and downward. The affected foot and leg may be smaller than the other, while in about half of cases, clubfoot affects both feet. Most of the time clubfoot is not associated with other problems.
Without treatment the foot remains deformed and people walk on the sides or tops of their feet, which can cause calluses, foot infections, trouble fitting into shoes, pain, difficulty walking, and disability.
Cause.
Hypotheses about the precise cause of clubfoot vary, but genetics, environmental factors or a combination of both are involved. Research has not yet pinpointed the root cause, but many findings agree that "it is likely there is more than one different cause and at least in some cases the phenotype may occur as a result of a threshold effect of different factors acting together." The most commonly associated conditions are distal arthrogryposis or myelomeningocele.
Some researchers hypothesize, from the early development stages of humans, that clubfoot is formed by a malfunction during gestation. Early amniocentesis (11–13 wks) is believed to increase the rate of clubfoot because there is an increase in potential amniotic leakage from the procedure. Underdevelopment of the bones and muscles of the embryonic foot may be another underlying cause. In the early 1900s, it was thought that constriction of the foot by the uterus contributed to the occurrence of clubfoot.
Underdevelopment of the bones also affects the muscles and tissues of the foot. Abnormality in the connective tissue causes "the presence of increased fibrous tissue in muscles, fascia, ligaments and tendon sheaths".
Genetics.
If one identical twin is affected, there is a 33% chance the other one will be as well.
Mutations in genes involved in muscle development are risk factors for clubfoot, specifically those encoding the muscle contractile complex ("MYH3", "TPM2", "TNNT3", "TNNI2" and "MYH8"). These can cause congenital contractures, including clubfoot, in distal arthrogryposis (DA) syndromes. Clubfoot can also be present in people with genetic conditions such as Loeys–Dietz syndrome and Ehlers-Danlos syndrome.
Genetic mapping and the development of models of the disease have improved understanding of developmental processes. Its inheritance pattern is explained as a heterogenous disorder using a polygenic threshold model. The PITX1-TBX4 transcriptional pathway has become key to the study of clubfoot. PITX1 and TBX4 are uniquely expressed in the hind limb.
Diagnosis.
Clubfoot is diagnosed through physical examination. Typically, babies are examined from head-to-toe shortly after they are born. There are four components of the clubfoot deformity:
Factors used to assess severity include the stiffness of the deformity (how much it can be corrected by manually manipulating the foot), the presence of skin creases at the arch and heel, and poor muscle consistency.
Sometimes, it is possible to detect clubfoot before birth using ultrasound. Prenatal diagnosis by ultrasound can allow parents to learn more about this condition and plan ahead for treatment after their baby is born.
More testing and imaging is typically not needed, unless there is concern for other associated conditions.
Treatment.
Treatment is usually with some combination of the Ponseti method and French method. The Ponseti method involves a combination of casting, Achilles tendon release, and bracing. It is widely used and highly effective under the age of two. The French method involves realignment, taping, and long-term home exercises and night splinting. It is also effective but outcomes vary and rely on heavy involvement of caregivers. Generally, the Ponseti method is preferred. Another technique, the Kite method, does not appear to be as effective. In about 20% of cases, additional surgery is required after initial treatment.
Ponseti method.
The Ponseti method corrects clubfoot over the course of several stages.
The Ponseti Method is highly effective with short-term success rates of 90%. However, anywhere from 14% to 41% of children experience a recurrence of the deformity. The most common reason for this is inadequate adherence to bracing, such as not wearing the brace properly, not keeping it on for the recommended length of time, or not using it every day. Children who do not follow proper bracing protocol have up to 7 times higher recurrence rates than those who follow bracing protocol, as the muscles around the foot can pull it back into the abnormal position. Recurrence is more common when there is poor compliance with the bracing, because the muscles around the foot can pull it back into the abnormal position. Low parental education level and failure to understand the importance of bracing is a major contributor to non-adherence. Relapses are managed by repeating the casting process. Relapsed feet may also require additional, more extensive surgeries and have a reduced chance of achieving subsequent correction.
Another reason for recurrence is a congenital muscle imbalance between the muscles that invert the ankle (tibialis posterior and tibialis anterior muscles) and the muscles that evert the ankle (peroneal muscles). This imbalance is present in approximately 20% of infants successfully treated with the Ponseti casting method, and makes them more prone to recurrence. After 18 months of age, this can be addressed with a surgery to transfer the tibialis anterior tendon from its medial attachment (on the navicula) to a more lateral position (on the lateral cuneiform). The surgery requires general anesthesia and subsequent casting while the tendon heals, but it is a relatively minor surgery that rebalances the muscles of the foot without disturbing any joints.
French method.
The French method is a conservative, non-operative method of clubfoot treatment that involves daily physical therapy for the first two months followed by thrice-weekly physical therapy for the next four months and continued home exercises following the conclusion of formal physical therapy. During each physical therapy session the feet are manipulated, stretched, then taped to maintain any gains made to the feet's range of motion. Exercises may focus on strengthening the peroneal muscles, which is thought to contribute to long-term correction. After the two month mark, the frequency of physical therapy sessions can be weaned down to three times a week instead of daily, until the child reaches six months. After the conclusion of the physical therapy program, caregivers must continue performing exercises at home and splinting at night in order to maintain long-term correction.
Compared to the Ponseti method which uses rigid casts and braces, the French method uses tape which allows for some motion in the feet. Despite its goal to avoid surgery, the success rate varies and surgery may still be necessary. The Ponseti method is generally preferred over the French method.
Surgery.
If non-operative treatments are unsuccessful or achieve incomplete correction of the deformity, surgery is sometimes needed. Surgery was more common prior to the widespread acceptance of the Ponseti Method. The extent of surgery depends on the severity of the deformity. Usually, surgery is done at 9 to 12 months of age and the goal is to correct all the components of the clubfoot deformity at the time of surgery.
For feet with the typical components of deformity (cavus, forefoot adductus, hindfoot varus, and ankle equinus), the typical procedure is a Posteromedial Release (PMR) surgery. This is done through an incision across the medial side of the foot and ankle, that extends posteriorly, and sometimes around to the lateral side of the foot. In this procedure, it is typically necessary to release (cut) or lengthen the plantar fascia, several tendons, and joint capsules/ligaments. Typically, the important structures are exposed and then sequentially released until the foot can be brought to an appropriate plantigrade position. Specifically, it is important to bring the ankle to neutral, the heel into neutral, the midfoot aligned with the hindfoot (navicula aligned with the talus, and the cuboid aligned with the calcaneus). Once these joints can be aligned, thin wires are usually placed across these joints to hold them in the corrected position. These wires are temporary and left out through the skin for removal after 3–4 weeks. Once the joints are aligned, tendons (typically the Achilles, posterior tibialis, and flexor halluces longus) are repaired at an appropriate length. The incision (or incisions) are closed with dissolvable sutures. The foot is then casted in the corrected position for 6–8 weeks. It is common to do a cast change with anesthesia after 3–4 weeks, so that pins can be removed and a mold can be made to fabricate a custom AFO brace. The new cast is left in place until the AFO is available. When the cast is removed, the AFO is worn to prevent the foot from returning to the old position.
For feet with partial correction of deformity with non-operative treatment, surgery may be less extensive and may involve only the posterior part of the foot and ankle. This might be called a posterior release. This is done through a smaller incision and may involve releasing only the posterior capsule of the ankle and subtalar joints, along with lengthening the Achilles tendon.
Surgery leaves residual scar tissue and typically there is more stiffness and weakness than with nonsurgical treatment. As the foot grows, there is potential for asymmetric growth that can result in recurrence of foot deformity that can affect the forefoot, midfoot, or hindfoot. Many patients do fine, but some require orthotics or additional surgeries. Long-term studies of adults with post-surgical clubfeet, especially those needing multiple surgeries, show that they may not fare as well in the long term. Some people may require additional surgeries as they age, though there is some dispute as to the effectiveness of such surgeries, in light of the prevalence of scar tissue present from earlier surgeries.
Developing world.
Despite effective treatments, children in LMICs face many barriers such as limited access to equipment (specifically casting materials and abduction braces), shortages of healthcare professionals, and low education levels and socioeconomic status amongst caregivers and families. These factors make it difficult to detect and diagnose children with clubfoot, connect them to care, and train their caregivers to follow the proper treatment and return for follow-up visits. It is estimated that only 15% of those diagnosed with clubfoot receive treatment.
In an effort to reduce the burden of clubfoot in LMICs, there have been initiatives to improve early diagnosis, organize high-volume Ponseti casting centers, utilize mid-level practitioners and non-physician health workers, engage families in care, and provide local follow-up in the person’s community.
Epidemiology.
Club foot occurs in 1 to 4 of every 1,000 live births. It is one of the most common birth defects affecting the legs. Clubfoot is more common in firstborn children and males, who are twice as likely to be affected as females. It is more common among Māori people, and less common among Chinese people.
Clubfoot disproportionally affects those in low and middle-income countries (LMICs). About 80% of those with clubfoot, or approximately 100,000 children per year as of 2018, are born in LMICs.
History.
Pharaohs Siptah and Tutankhamun had clubfoot, and the condition appeared in Egyptian paintings. Indian texts () and Hippocrates () described treatment.


Hector MacLennan

Sir Hector MacLennan FRCP FRCPGlas FRCOG (1 November 1905 – 6 January 1978) was a Scottish gynaecologist, knighted in the 1965 Birthday Honours.
He was President of the Royal Society of Medicine from 1967 to 1969.
His son, Robert was ennobled as Baron Maclennan of Rogart. His daughter was the acclaimed Elizabeth MacLennan.


Roscoe Conkling Giles

Dr Roscoe Conkling Giles (1890–1970) was the first African American to earn a degree from Cornell University Medical College. He worked as a surgeon at Provident Hospital, and served as the hospital's Chairman of the Division of General Surgery. He was elected President of the National Medical Association in 1935.
Early life and education.
Dr. Giles was born on May 6, 1890 in Albany, New York to the Reverend Francis F. Giles and Laura Caldwell Giles. He graduated from Boys High School in Brooklyn, New York in 1907 and won a scholarship to attend Cornell University in Ithaca, New York. He became one of four students to be initiated into the second class of Alpha Phi Alpha, drafting their fraternity ritual and assisting in drafting their constitution. He became treasurer of the national fraternity while at Cornell and was elected the first president of the Alpha Alumni Chapter while attending Cornell University Medical College in New York City in 1913.
He graduated from Cornell University Medical College in 1915 as the first African American graduate of the program. Dr. Giles reportedly received death threats and was asked to leave the institution due to the color of his skin, though he stayed and graduated with honors.
Career.
Between 1915 to 1917 Dr. Giles interned at Provident Hospital in Chicago, Illinois. He passed the exam for Junior Physician at the Municipal Tuberculosis Sanitarium and at the Oak Forest Infirmary at the top of the Civil Service list; while certification was obtained eventually, his appointment was denied due to the color of his skin. In 1917 Dr. Giles was appointed a supervisor of the Health Department by Mayor William Hale Thompson. He was associated with Dr. U.G. Dailey from 1917 to 1925. Dr. Giles became Assistant Attending Surgeon (1917-1925), Attending Surgeon (1925-1955) and Honorary Attending Surgeon (1956-1970) at Provident Hospital. He was affiliated with a number of professional organizations and involved in professional activities throughout his life, including serving as President of the National Medical Association (NMA). He is known within the NMA for chairing what came to be called the "Giles Committee" that successfully lobbied the American Medical Association (AMA) for the removal of the abbreviation "col." after the names of African-American physicians listed in AMA Directory of physicians. The Committee continued as a "Special Liaison Committee" between the NMA and the AMA.
Dr. Giles volunteered for service in the Medical Corps of the Army of the United States and entered as a Major, June 13, 1942. He was promoted to Lieutenant Colonel in 1944 and became Chief of the Medical Services at the Thousand Bed Station and Regional Hospital in Fort Huachuca, Arizona. Following World War II, he became a Lieutenant Colonel in the Organized Reserves of the U.S. Army until his death. In 1946 he was also appointed a Consultant in Surgery to the Secretary of War through the Surgeon General.
Personal life.
Dr. Giles married Miss Francis Reeder and had two sons: Oscar DePriest Giles and Roscoe Conkling Giles, Jr.


Leopold Augustus Leo

Leopold Augustus Leo (born April 19, 1794, died June 19, 1868 in Warsaw) was a Polish ophthalmologist of Jewish origin.
The son of Zygmunt and Zofia Hertz, Leopold August Leo graduated from the University of Königsberg in East Prussia and received his doctorate of medicine. Around 1815 he moved to Warsaw, where he practiced medicine. In the years 1838-1841 he was head of 'Instytut Oftalmiczny' (the Ophthalmic Institute) in Warsaw. He published numerous scientific papers.
He married Julianna Levy-Lyon (1801-1861), with whom he had five children: Josepha Amalie (1824-1902, wife of Stanisław Solomon Kronenberg), Ernestine Rozalie (1826-1893, wife of Leopold Stanisław Kronenberg), Edward Wiktor (1828-1901, lawyer and publicist), Anna (1829-1830), and Ludwik Filip (born 1831).
He was buried in the cemetery of the Evangelical-Augsburg Church in Warsaw.


George Washington Crile

George Washington Crile (November 11, 1864 – January 7, 1943) was an American surgeon. Crile is now formally recognized as the first surgeon to have succeeded in a direct blood transfusion. He contributed to other procedures, such as neck dissection. Crile designed a small hemostatic forceps which bears his name; the Crile mosquito clamp. He also described a technique for using opioids, regional anesthesia and general anesthesia which is a concept known as balanced anesthesia. He is also known for co-founding the Cleveland Clinic in 1921.
Early life and education.
Crile was born in Chili, Ohio. He graduated from Ohio Northern University in 1885, and in 1887 received his M.D. from Wooster Medical College which merged to form modern day Case Western Reserve University School of Medicine.
Career.
He did further study at Vienna, London and Paris. He taught at Wooster from 1889 to 1900. He was professor of clinical medicine at Western Reserve University from 1900 to 1911, and was then made professor of surgery. He was chair of surgery at University Hospitals Case Medical Center from 1910 to 1924, and established its Lakeside Hospital. Crile was responsible for whole blood transfusion, in 1906, and he spurred the use of the new X-ray machines.
During the Spanish–American War, he was made a member of the Medical Reserve Corps and served in Puerto Rico (1898). He was made an honorable F.R.C.S. (London) in 1913. After America entered World War I, he became a major in the medical O.T.C., and professional director (1917–18). He served with the British Expeditionary Force (B.E.F.) in France and was senior consultant in surgical research (1918–19). He was made lieutenant-colonel in June 1918, and colonel later in the year.
He made important contributions to the study of blood pressure and of shock in operations. Realizing that any strong emotion, such as fear before operation, produced shock, he attempted to allay dread by psychic suggestion, also endeavouring to prevent the subjective shock which affects the patient, even when under general anaesthesia, by first anaesthetizing the operative region with cocaine for several days, if necessary, before operating. Thus nerve communication between the affected part and the brain was already obstructed when the general anaesthetic was administered. For his work in shockless surgery he received a gold medal from the National Institute of Social Sciences in 1914.
When he retired from the Medical School at age 65, Crile went into private practice and worked with those establishing the new Cleveland Clinic.
Crile was the author of "A Mechanistic View of War and Peace", published in 1917. He also wrote "Surgical Shock" (1897), "On the Blood Pressure in Surgery" (1903), "Hemorrhage and Transfusion" (1909), "Surgical Anemia and Resuscitation" (1914), "The Origin and Nature of the Emotions" (1915), "Man an Adaptive Mechanism" (1916), "The Fallacy of the German State Philosophy" (1918), "The Surgical Treatment of Hypertension" (1938)
Legacy.
 The U.S. Army's Crile General Hospital in Cleveland, Ohio was named in his honor on 21 April 1944. The lunar crater Crile is also named after him.
Personal life.
His son George Crile, Jr. was also a surgeon. His grandson George Crile III was a journalist, author, and CBS producer. His wife, Grace Elizabeth (McBride) Crile (1876–1948), was a descendant of Lydia (Reed) McBride, sister of David Reed.
Death.
He died on January 7, 1943, in Cleveland. It was the same day that Nikola Tesla died in New York City, the famed inventor of electrical and mechanical devices, promotor of alternating current, among other achievements.
He is buried in Lake View Cemetery in Cleveland, Ohio.


Souhel Najjar

Souhel Najjar () is a Syrian-American neurologist whose story with Susannah Cahalan turned into an American drama film. He was the first physician in New York University history to identify the mechanism of interaction between the immune system and the central nervous system. He is considered an expert in the field of encephalopathy, specifically the treatment of encephalitis.
He was selected as a recipient of 2020 Ellis Island Medal of Honor.


List of questionable diagnostic tests

This is a list of medical diagnostic tests that are considered questionable, unverified or refuted.


Medical education in the United Kingdom

Medical education in the United Kingdom includes educational activities involved in the education and training of medical doctors in the United Kingdom, from entry-level training through to continuing education of qualified specialists. A typical outline of the medical education pathway is presented here. However training schemes vary and different pathways may be available.
Medical school.
Assessments.
Like many other university degrees, UK medical schools design and deliver their own in-house assessments. This practice is different from, for example, the United States, where a national licensing examination has been in place for over 20 years. Each UK undergraduate summative assessment in medicine is subject to the scrutiny of a formally appointed external examiner.
In 2003 a number of UK medical schools began to work together to increase quality assurance activities in the area of assessment as part of the Universities Medical Assessment Partnership (UMAP). UMAP is a collaborative item banking project seeking to build a quality assured written assessment item bank suitable for high-stakes examinations at all UK medical schools.
Qualities assurance of the undergraduate medical education.
The UK General Medical Council (GMC) has the ability to reverse its endorsement of any medical undergraduate training course as part of its regular visiting schedule should a course fall short of the expected standards.
Due to the UK code for higher education, first degrees in medicine comprise an integrated programme of study and professional practice spanning several levels. The final outcomes of the qualifications typically meet the expectations of a higher education qualification at level 7 (the UK Master's degree). These degrees may retain, for historical reasons, "Bachelor of Medicine, Bachelor of Surgery" and are abbreviated to MBChB or MBBS.
Specialty training and postgraduate studies.
Following completion of medical school, junior doctors then enter a vocational training phase. In the UK a doctor's training normally follows this path:
Newly qualified doctors enter a two-year Foundation Programme, where they undertake terms in a variety of different specialities. These must include training in General Medicine and General Surgery but can also include other fields such as Paediatrics, Anaesthetics or General Practice.
Following completion of the Foundation Programme a doctor can choose to specialise in one field. All routes involve further assessment and examinations.
To train as a general practitioner (GP), after completing the Foundation Programme, a doctor must complete eighteen months of posts in a variety of hospital specialities - often including paediatrics, psychiatry, geriatrics and obstetrics & gynaecology. The trainee also has to spend eighteen months as a General Practice Speciality Registrar - a trainee based in a GP practice. After completing this training and the membership exams of the Royal College of General Practitioners, the doctor can become a GP and can practise independently.
Hospital doctors are promoted after sitting relevant postgraduate exams within their chosen speciality (e.g. Member of the Royal College of Physicians MRCP, Member of the Royal College of Surgeons MRCS) and a competitive interview selection process from SHO to Specialty Registrar (StR) and eventually Consultant on completion of the CCT (Certificate of Completion of Training), which is the highest level in a speciality (with the exception of university-linked professors).
The competition is significant for those who wish to attain consultant level and many now complete higher degrees in research such as a Doctorate of Medicine (MD), which is a thesis-based award based on at least two years full-time research; or PhD which involves at least three years of full-time research. The time taken to get from medical school graduation to becoming a consultant varies from speciality to speciality but can be anything from 7 to over 10 years.
In the United Kingdom, doctors' training has been evolving, for example, with the introduction of run-through training programmes. These offer direct entry to a typically longer training programme after foundation training (providing a pathway to consultant without an additional application step after the first 2-3 years). These changes were proposed in accordance with the government-instituted plan for Modernising Medical Careers. They formed part of a drive to offer streamlined training pathways, although in light of the COVID-19 pandemic of 2020, some have argued that current training frameworks are now too inflexible. In UK trauma and orthopaedics, for instance, one study reported that trainees experienced a 43% reduction in surgical training activities due to the pandemic and all trainees in the study had their final examinations cancelled - a situation incompatible with fixed, time-limited training pathways. Issues with training frameworks across all medical specialties had been identified previously and high-profile calls are now being made to change the system in favour of individualised training tailored to each trainee.
Continuing medical education.
Continuing medical education is now mandatory for all doctors, under guidelines from the General Medical Council and Clinical governance.


Chiari malformation

Chiari malformation (CM) is a structural defect in the cerebellum, characterized by a downward displacement of one or both cerebellar tonsils through the foramen magnum (the opening at the base of the skull). CMs can cause headaches, difficulty swallowing, vomiting, dizziness, neck pain, unsteady gait, poor hand coordination, numbness and tingling of the hands and feet, and speech problems. Less often, people may experience ringing or buzzing in the ears, weakness, slow heart rhythm, or fast heart rhythm, curvature of the spine (scoliosis) related to spinal cord impairment, abnormal breathing, such as central sleep apnea, characterized by periods of breathing cessation during sleep, and, in severe cases, paralysis.
This can sometimes lead to non-communicating hydrocephalus as a result of obstruction of cerebrospinal fluid (CSF) outflow. The cerebrospinal fluid outflow is caused by phase difference in outflow and influx of blood in the vasculature of the brain. The malformation is named for Austrian pathologist Hans Chiari. A type II CM is also known as an Arnold–Chiari malformation in honor of Chiari and German pathologist Julius Arnold.
Signs and symptoms.
Findings are due to brain stem and lower cranial nerve dysfunction. Onset of symptoms are less likely to be present during adulthood in most patients. Younger children generally have a substantially different presentation of clinical symptoms from older children. Younger children are more likely to have a more rapid neurological degeneration with profound brain stem dysfunction over several days.
The blockage of cerebrospinal fluid (CSF) flow may also cause a syrinx to form, eventually leading to syringomyelia. Central cord symptoms such as hand weakness, dissociated sensory loss, and, in severe cases, paralysis may occur.
Syringomyelia.
Syringomyelia is a chronic progressive degenerative disorder characterized by a fluid-filled cyst located in the spinal cord. Its symptoms include pain, weakness, numbness, and stiffness in the back, shoulders, arms or legs. Other symptoms include headaches, the inability to feel changes in the temperature, sweating, sexual dysfunction, and loss of bowel and bladder control. It is usually seen in the cervical region but can extend into the medulla oblongata and pons or it can reach downward into the thoracic or lumbar segments. Syringomyelia is often associated with type I Chiari malformation and is commonly seen between the C-4 and C-6 levels. The exact development of syringomyelia is unknown but many theories suggest that the herniated tonsils in type I Chiari malformations cause a "plug" to form, which does not allow an outlet of CSF from the brain to the spinal canal. Syringomyelia is present in 25% of patients with type I Chiari malformations.
Pathophysiology.
The most widely accepted pathophysiological mechanism by which Chiari type I malformations occur is by a reduction or lack of development of the posterior fossa as a result of congenital or acquired disorders. Congenital causes include hydrocephalus, craniosynostosis (especially of the lambdoid suture), hyperostosis (such as craniometaphyseal dysplasia, osteopetrosis, erythroid hyperplasia), X-linked vitamin D-resistant rickets, and neurofibromatosis type I. Acquired disorders include space occupying lesions due to one of several potential causes ranging from brain tumors to hematomas.
Traumatic brain injury may cause delayed acquired Chiari malformation, but the pathophysiology of this is unknown. Additionally, ectopia may be present but asymptomatic until a whiplash injury causes it to become symptomatic.
Diagnosis.
Diagnosis is made through a combination of patient history, neurological examination, and medical imaging. Magnetic resonance imaging (MRI) is considered the preferred imaging modality for Chiari malformation. The MRI visualizes neural tissue such as the cerebellar tonsils and spinal cord as well as bone and other soft tissues. CT and CT myelography are other options and were used prior to the advent of MRI, unfortunately the resolution of CT based modalities do not characterize syringomyelia and other neural abnormalities as well.
By convention, the cerebellar tonsil position is measured relative to the basion-opisthion line, using sagittal T1 MRI images or sagittal CT images. The selected cutoff distance for abnormal tonsil position is somewhat arbitrary, as not every person will be symptomatic at a certain amount of tonsil displacement, and the probability of symptoms and syrinx increases with greater displacement; however, greater than 5 mm is the most frequently cited cutoff number, though some consider 3–5 mm to be "borderline,"; pathological signs and syrinx may occur beyond that distance. One study showed little difference in cerebellar tonsil position between standard recumbent MRI and upright MRI for patients without a history of whiplash injury. Neuroradiological investigation is used to first rule out any intracranial condition that could be responsible for tonsillar herniation. Neuroradiological diagnostics evaluate the severity of crowding of the neural structures within the posterior cranial fossa and their pressure against the foramen magnum. Chiari 1.5 is a term used when both brainstem and tonsillar herniation through the foramen magnum are present.
The diagnosis of a Chiari II malformation can be made prenatally, through ultrasound.
Classification.
In the late 19th century, Austrian pathologist Hans Chiari described seemingly related anomalies of the hindbrain, the so-called Chiari malformations I, II and III. Later, other investigators added a fourth (Chiari IV) malformation. The scale of severity is rated I – IV, with IV being the most severe. Types III and IV are very rare. Since Dr. Chiari's original descriptions Chiari 0, 1.5, 3.5, and 5 have been described in the medical literature.
Types of Chiari malformation.
Other conditions sometimes causally associated with Chiari malformation include hydrocephalus, syringomyelia, spinal curvature, tethered spinal cord syndrome, and connective tissue disorders such as Ehlers-Danlos syndrome and Marfan syndrome.
Chiari malformation is the most frequently used term for this set of conditions. The use of the term "Arnold–Chiari malformation" has fallen somewhat out of favor over time, although it is used to refer to the type II malformation. Current sources use "Chiari malformation" to describe its four specific types, reserving the term "Arnold-Chiari" for type II only. Some sources still use "Arnold-Chiari" for all four types.
Chiari malformation or Arnold–Chiari malformation should not be confused with Budd-Chiari syndrome, a hepatic condition also named for Hans Chiari.
In Pseudo-Chiari Malformation, leaking of CSF may cause displacement of the cerebellar tonsils and similar symptoms sufficient to be mistaken for a Chiari I malformation.
Treatment.
While there is no current cure, the treatments for Chiari malformation are surgery and management of symptoms, based on the occurrence of clinical symptoms rather than the radiological findings. The presence of a syrinx is known to give specific signs and symptoms that vary from dysesthetic sensations to algothermal dissociation to spasticity and paresis. These are important indications that decompressive surgery is needed for patients with Chiari Malformation Type II. Type II patients have severe brain stem damage and rapidly diminishing neurological response.
Decompressive surgery involves removing the lamina of the first and sometimes the second or third cervical vertebrae and part of the occipital bone of the skull to relieve pressure. The flow of spinal fluid may be augmented by a shunt. Since this surgery usually involves the opening of the dura mater and the expansion of the space beneath, a dural graft is usually applied to cover the expanded posterior fossa.
A small number of neurological surgeons believe that detethering the spinal cord as an alternate approach relieves the compression of the brain against the skull opening (foramen magnum), obviating the need for decompression surgery and associated trauma. However, this approach is significantly less documented in the medical literature, with reports on only a handful of patients. The alternative spinal surgery is also not without risk.
Complications of decompression surgery can arise. They include bleeding, damage to structures in the brain and spinal canal, meningitis, CSF fistulas, occipito-cervical instability and pseudomeningeocele. Rare post-operative complications include hydrocephalus and brain stem compression by retroflexion of odontoid. Also, an extended CVD created by a wide opening and big duroplasty can cause a cerebellar "slump". This complication needs to be corrected by cranioplasty.
In certain cases, irreducible compression of the brainstem occurs from in front (anteriorly or ventral) resulting in a smaller posterior fossa and associated Chiari malformation. In these cases, an anterior decompression is required. The most commonly used approach is to operate through the mouth (transoral) to remove the bone compressing the brainstem, typically the odontoid. This results in decompressing the brainstem and therefore gives more room for the cerebellum, thus decompressing the Chiari malformation. Arnold Menzes, MD, is the neurosurgeon who pioneered this approach in the 1970s at the University of Iowa. Between 1984 and 2008 (the MR imaging era), 298 patients with irreducible ventral compression of the brainstem and Chiari type 1 malformation underwent a transoral approach for ventral cervicomedullary decompression at the University of Iowa. The results have been excellent resulting in improved brainstem function and resolution of the Chiari malformation in the majority of patients.
Epidemiology.
Congenital Chiari I malformation, defined as tonsilar herniations of 3 to 5 mm or greater, was previously believed to be in the range of one per 1000 births, but is likely much higher. Women are three times more likely than men to have a congenital Chiari malformation. Type II malformations are more prevalent in people of Celtic descent. A study using upright MRI found cerebellar tonsillar ectopia in 23% of adults with headache from motor-vehicle-accident head trauma. Upright MRI was more than twice as sensitive as standard MRI, likely because gravity affects cerebellar position.
Cases of congenital Chiari malformation may be explained by evolutionary and genetic factors. Typically, an infant's brain weighs around 400g at birth and triples to 1100-1400g by age 11. At the same time the cranium triples in volume from 500 cm3 to 1500 cm3 to accommodate the growing brain. During human evolution, the skull underwent numerous changes to accommodate the growing brain. The evolutionary changes included increased size and shape of the skull, decreased basal angle and basicranial length. These modifications resulted in significant reduction of the size of the posterior fossa in modern humans. In normal adults, the posterior fossa comprises 27% of the total intracranial space, while in adults with Chiari Type I, it is only 21%. H. neanderthalensis had platycephalic (flattened) skulls. Some cases of Chiari are associated with platybasia (flattening of the skull base).
History.
The history of Chiari malformation is described below and categorized by the year:
Society and culture.
The condition was brought to the mainstream on the series "" in the tenth-season episode "Internal Combustion" on February 4, 2010.
Chiari malformation was briefly mentioned on the medical drama "House M.D." in the fifth-season episode "House Divided", It was the focus of the sixth-season episode "The Choice." It is also the focus of "Private Practice" Season 4 episode 4, where a pregnant woman is diagnosed with it. It was the a cause of death on the reality television series "Dr. G: Medical Examiner" in the sixth-season episode "Bruised and Battered". It was also mentioned in the medical drama "A Gifted Man", in the first-season episode "In Case of Separation Anxiety".
It is also featured in the 3rd and 4th episode of the 7th season of the series "Rizzoli & Isles" where Dr. Maura Isles is diagnosed with the condition.


William James Mayo

William James Mayo (June 29, 1861 – July 28, 1939) was a physician and surgeon in the United States and one of the seven founders of the Mayo Clinic. He and his brother, Charles Horace Mayo, both joined their father's private medical practice in Rochester, Minnesota, US, after graduating from medical school in the 1880s. In 1919, that practice became the not-for-profit Mayo Clinic.
Augustus Stinchfield was also asked to join the medical practice in 1892 by William Worrall Mayo. Once Stinchfield was hired, W. W. Mayo retired at age 73. Others who were invited to be part of the enterprise were C. Graham, E. Starr Judd, Henry Stanley Plummer, Melvin Millet and Donald Balfour.
Early years.
Will Mayo was born to William Worrall Mayo and his wife Louise in Le Sueur, Minnesota in his parents' home. As a child, William and his brother Charles frequently accompanied their father as he went about his business as a pioneer physician. They began by helping out with very menial tasks, and were gradually given more responsibility. Eventually, the boys were administering anesthesia and tying off blood vessels.
One night at the age of 16, Will accompanied his father to an abandoned hotel where one of the elder Mayo's patients worked as the caretaker. The patient had just died and Mayo was going to perform an autopsy. Will stood by and watched the procedure and after about an hour, it was time to go to another patient's home. Mayo asked his son to stay behind and clean up. "Sew up the incisions and then tuck the sheet around the corpse. When you finish, go right home." Will nervously began to stitch up the incisions on the body and recounted the incident many years later saying, "I'm about as proud of the fact that I walked out of there, instead of ran, as of anything else I ever made myself do".
Education and career.
Mayo earned his medical degree at the University of Michigan Medical School in 1883, where he became a founder of Nu Sigma Nu Medical Fraternity. Afterwards he returned to Rochester to practice medicine alongside his father and his brother Charles.
On August 21, 1883, a tornado struck Rochester, killing 29 people and seriously injuring over 55 others. One-third of the town was destroyed, but young Will and his family escaped serious harm. The relief efforts began immediately with a temporary hospital being established at the town's dance hall. The Mayo brothers were extensively involved in treating the injured who were brought there for help. Mother Alfred Moes and the Sisters of Saint Francis were called in to act as nurses (despite the fact they were trained as teachers and had little if any medical experience).
After the crisis had subsided, Mother Alfred Moes approached William Worrall Mayo about establishing a hospital in Rochester. On September 30, 1889, Saint Mary's Hospital opened. W.W. Mayo, 70 years old, became the consulting physician and surgeon at the hospital, and his two sons began seeing patients and performing surgery with the assistance of the Sisters of Saint Francis.
Personal life and death.
William J. Mayo married Hattie Marie Damon (1864-1952) in 1884. They had 5 children, two of whom survived infancy. Carrie born in 1887 and Pheobe in 1897 both married physicians at the Mayo clinic.
He died in July 1939 of gastric carcinoma (stomach cancer) in Rochester, Minnesota. That type of tumor had been a major focus of his surgical practice. Mayo is buried with his family members near his parents and brother at Oakwood Cemetery in Rochester.
The United States Postal Service printed a stamp depicting him and his brother, Charles Horace Mayo, on September 11, 1964.
Both William J. Mayo and his brother Charles H. Mayo were prominent Freemasons of the Grand Lodge of Minnesota, and members of Rochester Lodge #21.
The Dr. William J. Mayo House in Rochester is listed on the U.S. National Register of Historic Places.
Military service.
William J. Mayo served in World War I at the rank of Colonel (O6), as chief adviser for U.S. Army surgical services in the office of the U.S. Army Surgeon General. His brother Charles was also a Colonel in the U.S. Army Medical Corps and alternated with William as the associate chief adviser for surgical care of U.S. Army soldiers. When President Woodrow Wilson organized the Committee of American Physicians for Medical Preparedness in 1916, William was named its chairman and Charles as one of its members. That committee subsequently became the General Medical Board of the Council for National Defense. William was made a member of its executive committee and Charles was his alternate.
During World War I, the Mayo Clinic continued to be busy. Many draftees were examined and war training classes were conducted for new physicians in the medical corps. William and Charles designed courses to educate military doctors on the latest scientific and surgical developments. The two brothers divided their time between Rochester and their duties in Washington, D.C. so that one of them would always be at the Clinic. This schedule took a toll on their health; Charles contracted pneumonia during one of his stints in Washington, and William developed hepatitis while in Rochester in 1918.
After hostilities ended in November 1918, both of the Mayo brothers were promoted to the rank of Brigadier General (O7) in the U.S. Army Reserve. In addition, they both received the U.S. Distinguished Service Medal for their wartime service to the country.
Predictions.
In September 1931, Mayo and other prominent individuals of the time were invited by "The New York Times" to make a prediction concerning the world in eighty years time in the future, in 2011, to celebrate the paper's hundred-and-sixtieth anniversary since its establishment in 1851. Mayo's prediction was that the life expectancy of developed countries would reach 70 years, compared to less than sixty years in 1931.
"Three-score and ten" means 70 years. The average life expectancy in the United States was approximately 78 years as of 2010, and it exceeded 80 years in other countries such as Japan.


Blue Ridge Institute for Medical Research

The Blue Ridge Institute for Medical Research is an independent, non-profit, scientific research institute located in Horse Shoe, North Carolina. The Institute was founded by Robert Roskoski Jr. and he is the only full-time employee.
Mission.
The general goals of the Institute are to explore the interrelationships of fundamental biological science, clinical science, and clinical care.
Research.
Research at BRIMR focuses on the structure and regulation of protein kinases, their downstream signaling pathways, and therapeutic drugs that inhibit these enzymes. Protein kinases regulate the activity of their substrate targets by adding phosphate groups in a reaction known as protein phosphorylation. The United States Food and Drug Administration has approved the use of about 50 protein kinase inhibitors for the treatment of several cancers including those of breast, kidney, and lung and inflammatory diseases such as rheumatoid arthritis and ulcerative colitis. An average of two to three new drugs of this type is approved annually.
An important component of the Institute's fundamental research involves the study of the nature of the interaction of these anticancer and anti-inflammatory agents with their target protein kinase enzyme. Institute studies are based upon the X-ray crystallographic results that are in the public domain as well as in-house computer-generated models of drugs binding to their targets. The Institute functions as a scientific think tank and performs no actual laboratory work. However, the Institute uses results from the research areas of biochemistry and molecular, chemical, structural and cancer biology in an effort to understand the mechanisms of action of protein kinase inhibitors and the aberrations that result in neoplastic growth.
The results of these studies have been published.
NIH funding data.
The Blue Ridge Institute for Medical Research has monitored NIH funding to Medical Schools as well as other health science schools and organizations since 2006. BRIMR generates an annual ranking of NIH funding for US Medical Schools and their Departments and the BRIMR data is considered to be the gold standard for medical school research metrics. These data are used throughout the biomedical community for the analysis of medical research and educational activities


United States Army Nurse Corps

The United States Army Nurse Corps (AN or ANC) was formally established by the U.S. Congress in 1901. It is one of the six medical special branches (or "corps") of officers which – along with medical enlisted soldiers – comprise the Army Medical Department (AMEDD) .
The ANC is the nursing service for the U.S. Army and provides nursing staff in support of the Department of Defense medical plans. The ANC is composed entirely of Registered Nurses (RNs).
Mission.
The mission of the ANC is "To provide responsive, innovative, and evidence-based nursing care integrated on the Army Medicine Team to enhance readiness, preserve life and function, and promote health and wellness for all those entrusted to our care. Preserving the strength of our Nation by providing trusted and highly compassionate care to the most precious members of our military family—each Patient."
Creed.
The Army Nursing Team Creed was written by Lt. Col. Leigh McGraw in December 2009:
"I am a member of the Army Nursing Team.
My patients depend on me and trust me to provide compassionate and proficient care always. I nurture the most helpless and vulnerable and offer courage and hope to those in despair. I protect the dignity of every individual put in my charge.
I tend to the physical and psychological wounds of our warriors and support  the health, safety, and welfare of every retired Veteran. I am an advocate for family members who support and sustain their Soldier during times of War. It is a privilege to care for each of these individuals and I will always strive to be attentive and respectful of their needs and honor their uniquely divine human spirit.
We are the Army Nursing Team.
We honor our professional practice standards and live the Soldier values. We believe strength and resilience in difficult times is the cornerstone of Army Nursing. We embrace the diversity of our team and implicitly understand that we must maintain a unified, authentically positive culture and support each other's physical, social, and environmental well-being. We have a collective responsibility to mentor and foster the professional growth of our newest Team members so they may mentor those who follow.
We remember those nursing professionals who came before us and honor their legacy, determination, and sacrifice. We are fundamentally committed to provide exceptional care to past, present, and future generations who bravely defend and protect our Nation."
Qualifications.
To qualify for the Army Nurse Corps, you need a Bachelor of Science in Nursing (BSN) from an accredited program (Active and Reserve). AR 135-100, AR 135-101, AR 601-100, and applicable ANC circulars in the DA Circular 601-FY-X series list qualifications for entry.
The ANC consists entirely of commissioned officers. Nurses who wish to serve as an Army Nurse are required to hold an unrestricted Registered Nurse (RN) license prior to receiving a commission.
Leadership.
As of 2019, the Chief of the Army Nurse Corps is Brig. Gen. Jack M. Davis.
Specialties – Area of Concentration (AOC).
Public Health Nurse – 66B
Psychiatric-Mental Health Nurse – 66C
Peri-Operative Nurse – 66E
Certified Registered Nurse Anesthetist (CRNA) – 66F
Obstetrics-Gynecological Nurse – 66G
Medical-Surgical Nursing – 66H
Generalist Nurse – 66N; this is used to designate positions on organizational documents but is not held by the individual.
Family Nurse Practitioner (FNP) – 66P
Additional Skill Identifiers (ASIs); these designate additional areas of expertise or experience and are in addition to a basic nursing specialty.
History.
Pre-1901.
Nurses served in Washington's Army during the Revolutionary War. Although the women who tended the sick and wounded during the Revolutionary War were not nurses as known in the modern sense, they blazed the trail for later generations when, in 1873, civilian hospitals in America began operating recognized schools of nursing.
After the Revolutionary War, Congress drastically reduced the size of the medical service. Patient care was performed by soldiers detailed from the companies. There was no centralized medical direction by a formally organized medical department until the War of 1812. The Army Medical Department was reestablished by Congress under the direction of a Surgeon General, Dr. Joseph Lovell. The Army Reorganization Act of 1818 marked the beginning of the modem Medical Department of the United States Army.
Two months after the Civil War began on 12 April 1861, the Secretary of War Simon Cameron appointed Dorothea Lynde Dix as superintendent of women nurses for the Union Army. Some of the women, before reporting for assignment, received a short course in nursing under the direction of Dr. Elizabeth Blackwell, the first woman to receive a medical degree in the United States.
Some of the nurses who worked in the Union hospitals were not on the Army payroll but were sponsored by the United States Sanitary Commission or by volunteer agencies. Their work was largely limited to preparing diets, supervising the distribution of supplies furnished by volunteer groups, and housekeeping details.
During the 1898 Spanish–American War, the Army hired female civilian nurses to help with the wounded. Dr. Anita Newcomb McGee was appointed Acting Assistant Surgeon in the U.S. Army. After the war ended, McGee pursued the establishment of a permanent nurse corps. She wrote the section of the Army Reorganization Act legislation pertaining to nursing and is now known as the founder of the Army Nurse Corps. In all, more than 1,500 women nurses worked as contract nurses during that 1898 conflict.
Race and sex played central roles. The ANC was for white women only, and fought hard to exclude or minimize the numbers of black women until 1947. They excluded all men until the Korean war when male doctors began to emphasize the need for nurses in the front lines, and this meant male nurses.
1901–1917.
Professionalization was a dominant theme during the Progressive Era, because it valued expertise and hierarchy over ad-hoc volunteering in the name of civic duty. The Army Nurse Corps (female) became a permanent corps of the Medical Department under the Army Reorganization Act (31 Stat. 753) on 2 February 1901. Nurses were appointed in the Regular Army for a three-year period, although nurses were not actually commissioned as officers in the Regular Army until forty-six years later-on 16 April 1947. Dita H. Kinney, was officially appointed the first Superintendent of the Corps on 15 March 1901. Kinney served as superintendent until she resigned on 31 July 1909.
The number of nurses on active duty hovered around 100 in the years after the creation of the corps, with the two largest groups serving at the general hospital at the Presidio in San Francisco and at the First Reserve hospital in Manila.
World War I.
In World War I (American participation from 1917–18) the military recruited 20,000 registered nurses (all women) for military and navy duty in 58 military hospitals; they helped staff 47 ambulance companies that operated on the Western Front. More than 10,000 served overseas, while 5,400 nurses enrolled in the Army's new School of Nursing. Key decisions were made by Jane Delano, director of the Red Cross Nursing Service, Mary Adelaide Nutting, president of the American Federation of Nurses, and Annie Goodrich, dean of the Army School of Nursing.
Interwar period.
Demobilization reduced the two corps to skeleton units designed to be expanded should a new war take place. Eligibility at this time included being female, white, unmarried, volunteer, and a graduate from a civilian nursing school.
In 1920, Army Nurse Corps personnel received officer-equivalent ranks and wore Army rank insignia on their uniforms. However, they did not receive equivalent pay and were not considered part of the US Army.
Flikke remained in the Army after the war. After 12 years at Walter Reed Army hospital in Washington, D.C., she was promoted to captain and became the Assistant Superintendent of Nurses. She succeeded in creating new billets for occupational therapists and dieticians. Flikke became Superintendent, with the rank of Major, in 1938.
World War II.
At the start of the war in December 1941, there were fewer than 1,000 nurses in the Army Nurse Corps and 700 in the Navy Nurse Corps. All were women.
Colonel Flikke's small headquarters in 1942, though it contained only 4 officers and 25 civilians, supervised the vast wartime expansion of nurses, in cooperation with the Red Cross. She only took unmarried women age 22–30 who had their RN training from civilian schools. They enlisted for the war plus six months, and were discharged if they married or became pregnant.
Due to the Japanese attack of Pearl Harbor on 7 December 1941, the United States entered the Pacific part of World War II. Along with this military effort was the work of the Flying Tigers in Kunming, China, under Claire Chennault. Nurses were thus needed in China to serve the U.S. Army. These nurses were recruited among the Chinese nurses residing in China, particularly the English-speaking nurses that fled Hong Kong (a British colony) to free China due to the Japanese invasion of Hong Kong on 8 December 1941. The Hong Kong nurses were trained by the Department of Medical Services (directed by Dr. Percy Selwyn Selwyn-Clarke) of the Government of Hong Kong. They took up Nursing positions at the Flying Tigers (Rebecca Chan Chung 鍾陳可慰, Daisy Pui-Ying Chan 陳培英), U.S. Army (Rebecca Chan Chung 鍾陳可慰, Daisy Chan 陳培英, Cynthia Chan 陳靜渝), Chinese Red Cross (Elsie Chin Yuen Seetoo, Irene Yu 余秀芬) and China National Aviation Corporation (Rebecca Chan Chung 鍾陳可慰, Irene Yu 余秀芬). Cynthia Chan 陳靜渝 is the elder sister of Anna Chan 陳香梅 (Mrs. Chennault).
Only a few African American nurses were admitted to the Army Nurse Corps. Mabel Keaton Staupers, who worked for the National Association of Colored Graduate Nurses with help from Eleanor Roosevelt, pressured the Army to admit African American nurses in 1941. The first black nurse admitted to the program was Della H. Raney who was commissioned as a second lieutenant in April 1941. The limit on black nurses was 48 in 1941 and they were mostly segregated from white nurses and soldiers. In 1943, the Army set a limit on black nurses to 160. That same year, the first African American medical unit, the 25th Station Hospital Unit, was deployed overseas to Liberia. Later, nurses were deployed to Burma, where they treated black soldiers. African American nurses also served in China, Australia, New Guinea, the Philippines, England and in the US where they treated prisoners of war. By the end of the war, there were 476 serving in the corps.
On 26 February 1944 Congress passed a bill that granted Army and Navy Nurses actual military rank, approved for the duration of the war plus 6 months.
With over 8 million soldiers and airmen, the needs were more than double those of World War I. Hundreds of new military hospitals were constructed for the expected flow of casualties. Fearing a massive wave of combat casualties once Japan was invaded in late 1945, President Franklin D. Roosevelt called on Congress early in 1945 for permission to draft nurses. However, with the rapid collapse of Germany early in 1945, and the limitation of the war in the Pacific to a few islands, the draft was not needed and was never enacted.
By the end of the war, the Army and Army Air Forces (AAF) had 54,000 nurses and the Navy 11,000—all women.
Some 217 black nurses served in all-black Army medical units. The AAF was virtually autonomous by 1942, and likewise its Nurse Corps. Much larger numbers of enlisted men served as medics. These men were in effect practical nurses who handled routine care under the direction of nurse officers. Likewise many enlisted Wacs and Wafs served in military hospitals. Medical advances greatly increased survival rates for the wounded: 96% of the 670,000 wounded soldiers and sailors who made it to a field hospital staffed by nurses and doctors survived their injuries. Amputations were seldom necessary to combat gangrene. Penicillin and sulfa drugs proved highly successful in this regard. Nurses were deeply involved with post-operative recovery procedures, air evacuation, and new techniques in psychiatry and anesthesia.
Upon Flikke's retirement in 1943, she was succeeded by Florence A. Blanchfield, who successfully promoted new laws in 1947, that established the Army, Navy and Air Force Nurse Corps on a permanent basis, giving the nurses regular commissions on exactly the same terms as male officers. A month before she retired in 1947, Blanchfield became the first women to hold a regular Army commission.
Korea.
During the Korean War, Army nurses would once again treat the wounded. Nurses would staff MASH units and standard emplaced hospitals in Japan and Korea. Nurses were on the forefront of battlefield medicine during the conflict, playing a major role in the treatment of the wounded U.N. forces within mere minutes or hours of the wounds being inflicted.
In September 1955, President Eisenhower suffered a heart attack while on vacation near Denver. He was hospitalized at Fitzsimons Army Medical Center. During his six weeks of recovery, Ike talked to his Army nurses. He discovered their quarters were substandard, that nurses rotated overseas more often than other soldiers and they were forced to leave the military at age fifty-five. Nurses were also promoted more slowly than other soldiers. Ike directed the corps be led by a brigadier general and that the other issues be corrected.
Vietnam.
The Army Nurse Corps stopped being all-female in 1955; that year Edward L.T. Lyon was the first man to receive a commission in the Army Nurse Corps. During the Vietnam War many Army nurses would see deployment to South East Asia. Army nurses would staff all major Army hospitals in the theatre, including: Cam Ranh Bay, Da Nang, and Saigon. Vietnam would be the first major deployment of men as nurses into the combat theater, as men could be located in more hazardous locations than what was considered safe for females. Many Army nurses faced enemy fire for the first time due to the unconventional nature of the conflict, and several nurses would die from direct enemy fire. On at least one occasion the US Army hospital at Cam Ranh Bay was assaulted and severely damaged, with a loss of both patient and staff life.
Currently.
Army Nurses are deployed all over the world, participating in humanitarian missions, and supporting the Global War on Terror.
Modern Nurse Corps.
The Nurse Corps continues as a significant part of the Army Medical Department. Most training is conducted at Fort Sam Houston, Texas.
Insignia and badges.
The Nurse Corps has a distinctive insignia, a gold color metal caduceus, bearing an 'N' in black enamel.
Superintendents and Directors.
From its founding in 1901 until after World War II in 1947, the Army Nurse Corps was led by a superintendent. Its nurses had no permanent commissioned rank. The Army-Navy Nurses Act took effect on 16 April 1947, establishing the Army Nurse Corps as a staff corps, with officers holding permanent commissioned rank from second lieutenant to lieutenant colonel. The corps was to be led by a director holding the rank of colonel while in that position.


Transmission of plant viruses

Problems associated with viral transmission.
Viruses are known to infect both plant cells and animal cells. Since viruses are obligate intracellular parasites they must develop direct methods of transmission, between hosts, in order to survive. The mobility of animals increases the mechanisms of viral transmission that have evolved, whereas plants remain immobile and thus plant viruses must rely on environmental factors to be transmitted between hosts.
Natural transmission between plant hosts.
The structural differences between plant and animal cells have resulted in a variety of transmission routes being exploited, enabling the virus to be passed between different host plants. The main difference, from the point of view of a virus, is the cell wall. This forms a tough barrier between the intracellular components and the extracellular environment, which has to be penetrated. These differences, combined with the fact that plants are immobile, have resulted in plant viruses relying on the wind and soil to transmit seeds as well as vectors. Vectors either transmit the virus propagative transmission, which results in an amplification of the virus by replication within the cells of the vector, or non-propagative transmission which simply carries the virus between the plants without viral replication. Common vectors include Bacteria, Fungi, Nematodes, arthropods and arachnids.
Furthermore, human intervention, including grafting and experimental mechanical damage, physically damages the cell wall, contributes to the array of transmission routes. The virus commonly uses these methods to be passed from one host to another. However, the virus is dependent upon physical damage, generated naturally by the wind and feeding of vectors or by human intervention.
Transmission between plant cells.
Viral infections often develop into systemic infections as a means of transmission. The virus often infects many tissues, if not the whole plant, where it can continue to replicate. There are a variety of methods the virus can use to spread throughout the organism but the most common route use the vascular system, otherwise known as the xylem and phloem, and the plasmodesmata, which interconnect adjacent cells.
Nevertheless, the rigidity of the cell wall of plant cells, not only poses a problem for transmission of the viruses between different plant hosts, but also acts to prevent viral transmission between cells. Consequently the virus must modify the plasmodesmata as they, themselves, are too large to fit through the small and tightly regulated plant structure. There are again a variety of mechanisms used for this, which have evolved for different viruses. The main mechanisms involve expressing proteins which coat the virus and interact with the structure of the plasmodesmata. The array of proteins expressed by the different viruses may act differently but all achieve a similar goal, passage between adjacent cells.


Suporn Watanyusakul

Suporn Watanyusakul is a Thai plastic and reconstructive surgeon. He is considered by some to be a world leader in surgical procedures for transgender individuals. He performs facial feminization surgery and male-to-female (MTF) sex reassignment surgery (SRS).
Suporn's method differs from most MTF SRS in that he does not use the penile inversion method. He instead constructs the vaginal canal with scrotal skin and uses the penile tissues for the labia, clitoral hood, and other external features. A full thickness inguinal (groin crease) skin graft is used for the vaginal lining in cases where inadequate scrotal skin is available. In some cases, small parts of the urethra have been used, along with other body parts. Dr. Suporn's method generally yields a deeper neovagina than the more standard penile inversion technique and positions the areas of greatest sensitivity at the same locations as on cisgender women. Suporn's form of vaginoplasty has been referred to as the "Suporn technique". Dr. Suporn always retains the Cowper's gland or bulbourethral gland. In transgender females this bulbourethral gland is responsible for the thin, colourless lubricating fluid that is secreted during sexual arousal, which also adds to the natural lubrication.


Heinrich Obersteiner

Heinrich Obersteiner (13 November 1847 – 19 November 1922) was an Austrian neurologist born in Vienna.
In 1870 earned his doctorate from the University of Vienna, where he worked in the laboratory of Ernst Wilhelm von Brücke (1819–1892). In 1873 he earned his habilitation for pathology and anatomy of the nervous system at the University of Vienna, becoming an associate professor in 1880, and receiving the title of "full professor" in 1898. He was also director of a private mental institution at Oberdöbling, outside of Vienna. In 1882 he established an internationally known neurological institute in Vienna.
The eponymous Obersteiner–Redlich line is named after him, along with Emil Redlich (1866–1930). This zone is where the central nervous system and peripheral nervous system meet, as well as the place where Schwann cells meet oligodendroglia cells.


European Psychiatric Association

The European Psychiatric Association (EPA) is the main association representing psychiatry in Europe.
History.
The EPA was founded in October 1983 as the Association of European Psychiatrists (AEP), at the University of Strasbourg, by twelve French- and English-speaking university psychiatrists. The objective of the new organization was to "promote European Psychiatry in the fields of research, treatment and teaching, three axes considered to be unequivocally complementary." An inauguration symposium was held in May 1984. In 1989, the AEP was granted consultant status at the Council of Europe. In 2003, participatory status was gained. In 2008, the name was changed to the present one.
Journal.
"European Psychiatry" is the association's official journal.
European Brain Council.
The EPA is a member of the European Brain Council.


Paul Bucy

Paul Bucy (; November 13, 1904 – September 22, 1992) was an American neurosurgeon and neuropathologist who was a native of Hubbard, Iowa. He is known both for his part in describing the Klüver–Bucy syndrome, his academic life as a teacher in the neurosciences, and for his founding in 1972 and editing "Surgical Neurology" – An International Journal of Neurosurgery and Neuroscience" from 1972 to 1987.
Academic Life.
Bucy grew up and was educated in Iowa. He received his bachelor's degree, a master's in neuropathology and his doctorate from the University of Iowa. He interned and trained at Ford Hospital in Detroit. He was an assistant to neurosurgeon Percival Bailey (1892–1973) at the University of Chicago. In the early 1930s he traveled to Europe, and studied with Gordon Morgan Holmes (1876–1965) in London and Otfrid Foerster (1874–1941) in Breslau. In 1941, he became Professor of Neurology and Neurological Surgery at the University of Illinois in Chicago, where he spent 13 years. During World War II he was a medical consultant to the U.S. Army.
From 1954 to 1972, he was Professor of Neurosurgery and taught neurosurgical residents at Northwestern University and at Chicago Memorial Hospital. During his long career, Bucy wrote more than 400 papers and books on neurological and neurosurgical subjects. He trained 65 neurosurgeons who went on to practicing neurosurgery worldwide. Bucy served as publisher for 13 years on the Journal of Neurosurgery. In 1972. after moving to Tryon, North Carolina, he was appointed Clinical Professor of Neurology and Neurological surgery at Bowman Gray School of Medicine in Winston-Salem. That same year (1972) Bucy became Founding Editor of Surgical Neurology, a new neurosurgical journal, which he edited until 1987 along with Robert J. White.
He was past president of the American Neurological Association, The Society of Neurological Surgeons and The World Federation of Neurosurgical Societies. Bucy died in 1993 at his home in Tryon, where he had lived with his wife Evelyn, who died a year later in St. Louis.
Paul Bucy is remembered for his work with experimental psychologist Heinrich Klüver (1897-1979) involving the eponymous Klüver-Bucy syndrome, defined as a behavioral disorder caused by malfunction of the left and right medial temporal lobes of the brain. The two men were able to clinically reproduce this disorder in rhesus monkeys by performing bilateral temporal lobectomies. He will also be remembered, along with Percival Bailey, for performing important research of brain tumors, in particular oligodendrogliomas and meningiomas.


University of Barcelona

The University of Barcelona (; ; ) is a public university located in the city of Barcelona, Catalonia in Spain. With 63,000 students, it is one of the biggest universities in Spain. It is one of the oldest universities in Catalonia, established in 1450.
It is considered one of the best universities in Spain. It has 106 departments and more than 5,000 full-time researchers, technicians and research assistants, most of whom work in the 243 research groups as recognized and supported by the Government of Catalonia. In 2010 the UB was awarded 175 national research grants and 17 European grants and participated in over 500 joint research projects with the business sector, generating an overall research income of 70 million euros. The work of these groups is overseen by the UB's research centres and institutes which collaborate with leading research institutions and networks in Spain and abroad. The UB is also home to three large research foundations: the Barcelona Science Park Foundation (PCB), which includes the Institute of Biomedical Research of Barcelona (IRBB); the August Pi i Sunyer Biomedical Research Institute (IDIBAPS); and the Bellvitge Institute for Biomedical Research (IDIBELL). The UB is also a degree-awarding body of the Institut Barcelona d'Estudis Internacionals (IBEI).
History.
The University was founded under the royal prerogative granted by King Alfonso V of Aragon, in Naples, on 3 November 1450. For forty-nine years prior to this, however, the city had a fledgling medical school (or "Estudi General", as the universities were known at that time), founded by King Martin of Aragon, but neither the "Consell de Cent" (Barcelona's Council of One Hundred) nor the city's other leading institutions had given it their official recognition, considering it an intrusion on their respective jurisdictions. Alphonse the Magnanimous’ prerogative, though, was granted at the petition of the "Consell de Cent", and so the council was always to consider the "Estudi General" created in 1450 as the city's true university, since it was very much under its control and patronage.
The process that culminated in the foundation of the "Estudi General" of Barcelona can be traced back to the end of the fourteenth century, with the opening of a number of schools under the patronage of the City Hall, the cathedral schools and the Dominican convent of Santa Caterina, which established itself as a major cultural centre. It was King Martín the Humane who set in motion the process that would result in the foundation of the University of Barcelona. In his letter written 23 January 1398 and addressed to the councillors of Barcelona, he informed them that he had sought the Pope's permission to found a university in the city by Juan Carlos IX.
Despite the "Consell de Cent's" refusal to accept the concession issued by the King to found an "estudi general", on 10 January 1401, Martín founded the "Estudi General" of Medicine in Barcelona under his royal prerogative, granting it the same privileges as those enjoyed by the University of Montpellier. In another document, signed in Valencia on 9 May 1402, King Martin sought to promote the "Estudi General" of Medicine with the appointment of a number of teachers of the liberal arts, without which the study of medicine was virtually useless. From that day forth, the "Estudi" was known as the "Estudi" of Medicine and the Arts.
The prerogative granted by King Alphonse the Magnanimous in 1450, authorizing the "Consell de Cent" to found a university in Barcelona, was the culmination of the process initiated in 1398.
For a number of reasons, in particular the civil war that raged during the reign of John II and the subsequent conflicts involving the peasant farmers, the official "Estudi General" of Barcelona did not begin to develop until the reign of Fernando the Catholic; but it was under Charles I, in 1536, that the foundation stone was laid for the new university building at the top end of La Rambla. From that moment on the university began to carry out its work as normal despite financial difficulties and in-fighting between university teachers, though this was not to stop some illustrious professors from making their mark in their respective fields and creating their own schools of academic followers.
The 1596 Ordinances once more showed the need for reform. These followed hard on the heels of earlier Ordinances passed in 1539 and 1559, in which the competitive examination system for the appointment of professors had been introduced.
This period was brought to a close with the Decree issued on October 23, 1714, by the Royal High Commission for Justice and Government of Catalonia – created by the Duke of Berwick – ordering the immediate transfer of the Faculties of Philosophy, Law and Canon Law to Cervera. Barcelona was to keep its Faculty of Medicine and the Cordelles School of Humanities, governed by the Jesuits. Plans to open the University of Cervera did not get underway until 1715 and it did not start its academic work until 1717, as the successor to the six Catalan universities closed down by Philip V. The first statutes of the new University of Cervera were passed in 1725.
"The University of Barcelona was closed by the Bourbon dynasty after the War of the Spanish Succession from 1714 until 1837". The university was restored to Barcelona during the liberal revolution during the reign of Isabella II. In 1837, the University of Cervera was transferred to Barcelona, the capital of the principality. From that moment forth it was recognized as the cultural home of the four Catalan provinces.
On its return the University was housed initially in the Convent of Carme, which had been disestablished a few years earlier. Here the Faculties of Canon Law, Law and Theology were provisionally installed. The Faculty of Medicine took up residence in the Royal Academy of Medicine, next door to the Hospital of Santa Creu. Thus, all the Faculties were now located in just two streets – Hospital and del Carme.
The inadequate nature of these premises soon gave rise to the need to construct a larger home for the University, and in 1863 work began on Elies Rogent's new building, though it would not be fully completed until 1882. Its construction was to have major repercussions for the city, since it was one of the first buildings to be raised outside the ancient city walls.
Work on the building lasted for more than twenty years, although by 1871 the first lectures were being given there. The clock and the iron bell housed in the tower in the "Pati de Lletres"— the "Patio of the Arts"— were installed in 1881. Complementing the building work, sculptures and paintings were commissioned either directly from artists of repute or awarded in open competition.
Medical sciences continued to be taught at the former Hospital of Santa Creu i Sant Pau. In 1879 the Faculty of Medicine was presented with a project for a new hospital, and after many changes in the plans and suggested locations, it was eventually installed in the Hospital Clinic on the eastern side of the city's Eixample district in 1900. Today, Medicine is also taught on the Bellvitge Campus and at the Hospital of Sant Joan de Déu.
The natural growth of the University of Barcelona has given rise to the need to undertake large-scale building work to meet the growing demands made by student numbers that were unthinkable in the nineteenth century. In response to this growth, the university district of Pedralbes was begun in 1952. The first building to be completed on this new city campus was the Faculty of Pharmacy in 1956 alongside the Sant Raimond de Penyafort and the Verge de Montserrat Halls of Residence.
This was followed by the Faculty of Law in 1958, the University School of Business Studies in 1961, and the Faculty of Economics between 1957 and 1968. Today this district is known as the Pedralbes Campus, while in the nineties the university added the Campus Mundet, housed in some of the buildings of the Llars Mundet. In 2006, the Faculties of History and Geography and the Faculty of Philosophy were moved from the Pedralbes Campus to the historic centre of the city (Ciutat Vella district), in the El Raval neighborhood, and just a short walk from the Historic Building of the University.
The University of Barcelona was the only university in Catalonia until 1971, when the Universitat Politècnica de Catalunya, comprising the more technical Faculties and University Schools, became an independent entity. In 1968 the Universitat Autònoma of Barcelona became the first of several new universities to be set up in Catalonia.
Faculties.
As of 2013, the University of Barcelona comprises 100 departments grouped in 18 faculties and two university schools, one school and eight attached schools.
The UB offers 74 undergraduate programs, 349 graduate programs and 48 doctorate programs to 63,000 students. It also has 30 research centers.
Library.
The library holds about 2,000,000 volumes, and is the second-biggest university library in Spain.
International rankings.
In 2020, QS World University Rankings by Subject placed the UB in the top 50 for the following subjects: Anatomy and Physiology (14th), Library Science and Information Management (43rd), Philosophy (45th) and Archaeology (47th), while the ShanghaiRanking's Global Ranking of Academic Subjects (ARWU) placed it 48th for Clinical Medicine.
THE Europe Teaching Rankings 2019 ranked the UB 29th and THE 2020 Impact Rankings ranked it 91th overall, with 14th for Quality Education and 43th for Partnerships for the Goals. The QS Graduate Employability Rankings 2020 ranked it 80th.


Fever Nurses Association

The Fever Nurses Association was established in London in 1908.
The governing body had 39 members: 20 doctors and 19 matrons and assistant matrons, mostly from fever hospitals and some from the hospitals run by the Metropolitan Asylums Board. Nurse Susan Villiers was a member.
It was associated with the campaign for nurse registration led by Ethel Bedford-Fenwick, and was represented on the Central Committee for the State Registration of Nurses which was established in 1908.
A scheme for training fever nurses was established after it was set up.


Joseph Charles Aub

Joseph Charles Aub (1890-1973) was an American endocrinologist and professor then chair of medicine at Harvard University. He graduated from Harvard College and Harvard Medical School.


Cardiac rehabilitation

Cardiac rehabilitation (CR) is defined by the World Health Organization (WHO) as "The sum of activity and interventions required to ensure the best possible physical, mental, and social conditions so that patients with chronic or post-acute cardiovascular disease may, by their own efforts, preserve or resume their proper place in society and lead an active life". CR is a comprehensive model of care including established core components, including structured exercise, patient education, psychosocial counselling, risk factor reduction and behaviour modification, with a goal of optimizing patient's quality of life while helping to reduce the risk of future heart problems.
CR is delivered by a multi-disciplinary team, often headed by a physician such as a cardiologist. Nurses support patients in reducing medical risk factors such as high blood pressure, high cholesterol and diabetes. Physiotherapists or other exercise professionals develop an individualized and structured exercise plan, including resistance training. A dietitian helps create a healthy eating plan. A social worker or psychologist may help patients to alleviate stress and address any identified psychological conditions; for tobacco users, they can offer counseling or recommend other proven treatments to support patients in their efforts to quit. Support for return-to-work can also be provided. CR programs are very patient-centered.
Based on the benefits summarized below, CR programs are recommended by the American Heart Association / American College of Cardiology and the European Society of Cardiology, among other associations. Patients typically enter CR in the weeks following an acute coronary event such as a myocardial infarction (heart attack), with a diagnosis of heart failure, or following percutaneous coronary intervention (such as coronary stent placement), coronary artery bypass surgery, a valve procedure, or insertion of a rhythm device (e.g., pacemaker, implantable cardioverter defibrillator). CR services can be provided in hospital, in an outpatient setting such as a community center, or remotely at home using the phone and other technologies.
CR Phases.
Inpatient program (phase I).
Where available, patients receiving CR in the hospital after surgery are usually able to begin within a day or two. First steps include simple motion exercises that can be done sitting down, such as lifting the arms and legs. Heart rate is monitored and continues being monitored as the patient begins to walk.
Outpatient program (phase II).
It is recommended patients begin outpatient CR within 2–7 days following a percutaneous intervention, or 4–6 weeks after cardiac surgery. In order to participate in an outpatient program, the patient generally must first obtain a physician's referral.
Participation typically begins with an intake evaluation that includes measurement of cardiac risk factors such as lipid measures, blood pressure, body composition, depression / anxiety, and tobacco use. An exercise stress test is usually performed both to determine if exercise is safe and to allow for the development of a customized exercise program.
Risk factors are addressed and patients goals are established; a "case-manager" who may be a cardiac-trained Registered Nurse, Physiotherapist, or an exercise physiologist works to help patients achieve their targets. During exercise, the patient's heart rate and blood pressure may be monitored to check the intensity of activity.
The duration of CR varies from program to program, and can range from six weeks to several years. Globally, a median of 24 sessions are offered, and it is well-established that the more the better.
After CR is finished, there are long-term maintenance programs (phase III) available to interested patients, as benefits are optimized with long-term adherence; unfortunately however patients generally have to pay out-of-pocket for these services.
Under-use.
CR is significantly under-used globally. Rates vary widely.
Under-use is caused by multi-level factors. At the health system level, this includes lack of available programs. At the provider level, there are low referral rates by physicians, who often focus more attention on better reimbursed cardiac intervention procedures than on long-term lifestyle treatments. At the patient level, factors such as transportation, distance, cost, competing responsibilities, lack of awareness and other health conditions are responsible, but most can be mitigated. Women, ethnocultural minorities, older patients, those of lower socio-economic status, with comorbidities, and living in rural areas are less likely to access CR, despite the fact that these patients often need it most. Cardiac patients can assess their CR barriers here, and receive suggestions on how to overcome them: https://globalcardiacrehab.com/For-Patients.
Strategies are now established on how we can mitigate these barriers to CR use. It is important for inpatient units treating cardiac patients to institute automatic/systematic or electronic referral to CR. It is also key for healthcare providers to promote CR to patients at the bedside.
Benefits.
Participation in CR is associated with many benefits. A Cochrane review of 147 studies demonstrated that for myocardial infarction and heart failure patients, CR reduces cardiovascular mortality by 25% and readmission rates by 20%. However, there was no benefit in all-cause mortality. A more recent network meta-analysis however, where the complex components of CR are better considered, showed significant reductions in all-cause mortality with CR.
CR is also associated with improved quality of life, as well as better psychosocial well-being, and functional capacity. CR is cost-effective.
There appears to be no difference in outcomes between supervised and home-based CR programs, and both cost about the same.
Another Cochrane review of six randomised controlled trials in adults with atrial fibrillation found that CR may improve physical exercise capacity, but there was no effect on quality of life. Due to the limited number of trials, the authors could not estimate the impact on mortality or serious adverse events. There are also Cochrane reviews on effects in valve patients, among others.
CR Societies.
CR professionals work together in many countries to optimize service delivery and increase awareness of CR. The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), a member of the World Heart Federation, is composed of formally-named Board members of CR societies globally. Through cooperation across most CR-related associations, ICCPR seeks to promote CR in low-resource settings, among other aims outlined in their Charter.


John Anderson Strong

Dr. John Anderson Strong (18 February 1915 – 15 December 2012) was a Scottish physician/internist and academic, who served as Professor of Medicine at the University of Edinburgh and the President of the Royal College of Physicians of Edinburgh.
Born in Ireland, he was educated at Monkton Combe School in Bath, and then studied medicine at Trinity College, Dublin. Shortly after graduating, he entered the Royal Army Medical Corps at the outbreak of the Second World War, and served in the UK and in the Far East throughout the war. He was awarded the MBE in 1942 for his military work, and mentioned in despatches in 1945 for his service in Burma; after the war, he was given the honorary rank of Lieutenant-Colonel in the RAMC.
He then began to teach medicine, and was appointed to the post of Senior Lecturer at the University of Edinburgh in 1949, along with the position of honorary consulting physician at the Western General Hospital. In 1959 he was appointed as an honorary physician in the Medical Research Council Clinical and Population Cytogenetics Unit, and in 1966 was appointed to a Chair of Medicine at the University of Edinburgh. He retired from the latter two posts in 1980, at the age of 65, and was appointed Professor Emeritus the following year.
In 1979 he was appointed President of the Royal College of Physicians of Edinburgh, holding the position until 1982. Other medical work in his later career included sitting as a member of the Medicines Commission from 1976 to 1983, and as the chair of the Scottish Health Education Co-Ordinating Committee from 1986 to 1988.
He was a Fellow of the Royal College of Physicians, the Royal College of Physicians of Edinburgh, and the Royal Society of Edinburgh, as well as an honorary fellow of the American College of Physicians (1980), the Royal College of Physicians of Ireland (1980), the College of Physicians of Philadelphia, Trinity College, Dublin, the College of Physicians of South Africa, the Royal College of General Practitioners, and a member of the Academy of Medicine, Singapore. He was appointed CBE in 1978.
He married Moira Heaney in 1939, with whom he had one son and two daughters: she died in 1997.
He was cited by professor Bryan Sykes in "Adam's Curse: A Future Without Men"


Cuvierian tubules

Cuvierian tubules are clusters of fine tubes located at the base of the respiratory tree in some sea cucumbers in the genera "Bohadschia", "Holothuria" and "Pearsonothuria", all of which are included in the family Holothuriidae. The tubules can be discharged through the anus when the sea cucumber is stressed. They lengthen when they come into contact with seawater and become adhesive when they encounter objects so that they function as a defence against potential predators. They are named after the French zoologist Georges Cuvier, who first described them.
Mode of action.
There may be several hundred Cuvierian tubules which are attached to the left respiratory tree and lie freely in the coelomic fluid in the body cavity. When stressed, the sea cucumber faces away from the attacker and contracts its body wall muscles sharply. This causes the wall of the cloaca to tear and the anus to gape and the free ends of some of the tubes to be ejected. Water from the respiratory tree is forced into these tubules causing a rapid expansion and they elongate by up to 20 times their original length. They have great tensile strength and become sticky when they encounter any object. The adhesive is unique among marine invertebrates and a firm grip is obtained in under ten seconds. The mass of threads can entangle and immobilize potential predators such as small fish or crabs. The threads become detached from the sea cucumber which crawls away. The tubules are readily regenerated, a process that takes about 17 days in "Holothuria leucospilota" and five weeks in "Holothuria forskali". The tubules contain a toxic saponin called holothurin, which is also present in the body wall in some sea cucumber species.


Cuthbert Leslie Cope

Cuthbert Leslie Cope (1903–1975) was an English physician and endocrinologist.
He graduated in 1924 BA from the University of Oxford. He studied medicine at University College Hospital Medical School. He qualified MRCS, LRCP in 1927 and MRCP in 1930. He graduated BM BCh in 1927 and DM in 1932. He held his residency appointments at University College Hospital.
On his return to the UK he held appointments successively at St Thomas' Hospital, University College Hospital, and the Radcliffe Infirmary.
Cope was elected FRCP in 1939. In 1940 he published his paper "The Diagnostic Value of Pregnandiol Excretion in Pregnancy Disorders". He became in 1942 a lieutenant-colonel in the RAMC; he served from 1944 to 1945 in France and Holland and then in the postwar-era in Norway. He was director of human problems research for the UK's National Coal Board from 1947 to 1949. He was then appointed to the Royal Postgraduate Medical School. By applying chromatography and isotopes he developed methods for measuring urine levels, blood levels, and production rates for cortisol and aldosterone.
In 1954 Cope and J. García-Llauradó published evidence of excess secretion of aldosterone in a case of potassium-losing nephropathy, occurring in a 41-year-old patient with a renal tube anomaly associated with a chronic pyelonephritis. Cope, García-Llauradó, and M. D. Milne were among the first researchers to identify primary aldosteronism, also known as Conn's syndrome.
In 1958 Cope and E. Black introduced a new method for measuring the production rate of cortisol. In their method, the patient first empties the bladder and drinks a small test dose of 14C-labelled cortisol. The patient's urine is then collected over the next 24 hours. From the urine sample, a measurement is made of the sample's total 14C content, and a measurement is also made of the specific activity of the sample's tetrahydrocortisol, a metabolite of cortisol.
In 1959 Cope and Black published their paper "The Reliability of Some Adrenal Function Tests". In 1964 Cope was the President of the Section of Endocrinology at the annual meeting of the Royal Society of Medicine. In 1966 he gave the Lumleian Lectures on "The Adrenal Cortex in Internal Medicine". He retired at age 65 but continued his laboratory work. In 1972 he was awarded the Royal College of Physicians' Moxon Medal.
Family.
Zachary Cope was his uncle. On 9 July 1937 in Totnes, Devon, Cuthbert Leslie Cope married Eileen Gertrude Putt. They had two sons, Jonathan Leslie (b. 1940) and David Robert (b. 1944). The older son became a member of the medical profession, and the younger son became an outstanding headmaster.


Royal Society of Tropical Medicine and Hygiene

The Royal Society of Tropical Medicine and Hygiene, more commonly known by its acronym RSTMH, was founded in 1907 by Sir James Cantlie and George Carmichael Low. Sir Patrick Manson, the Society's first President (1907–1909), was recognised as "the father of tropical medicine" by his biographer. He passed the post on to Sir Ronald Ross (president 1909–1911), discoverer of the role of mosquitoes in the transmission of malaria.
The objectives of RSTMH are "to promote and advance the study, control and prevention of diseases in man and other animals in the tropics and sub-tropics, facilitate discussion and exchange of information among those who are interested in tropical diseases and international health, and generally to promote the work of those interested in these objectives".
In 1920, King George V gave his permission for RSTMH to use the Royal prefix. Queen Elizabeth II is patron of the society and the Princess Royal is an Honorary Fellow.
Location.
In 2011 the Society moved from Manson House, 26 Portland Place, London, to its current premises in Northumberland House, 303-306 High Holborn, London, WC1V 7JZ
Journals.
RSTMH publishes two peer reviewed journals, "Transactions of the Royal Society of Tropical Medicine and Hygiene" and "International Health".
Awards and medals.
RSTMH awards the Chalmers Medal and Donald Mackay Medal annually and the Manson Medal, the George MacDonald Medal and the Sir Rickard Christophers Medal triennially.
Five special Centenary Medals were awarded in 1907, two for lifetime achievement and three for special achievement by an under-45 year old.
Presidents.
A complete list of presidents and their inaugural presidential addresses can be found on the "Transactions" website.


Corona radiata (embryology)

The corona radiata is the innermost layer of the cells of the cumulus oophorus and is directly adjacent to the zona pellucida, the inner protective glycoprotein layer of the ovum. Its main purpose in many animals is to supply vital proteins to the cell. It is formed by follicle cells adhering to the oocyte before it leaves the ovarian follicle, and originates from the squamous granulosa cells present at the primordial stage of follicular development. The corona radiata is formed when the granulosa cells enlarge and become cuboidal, which occurs during the transition from the primordial to primary stage. These cuboidal granulosa cells, also known as the granulosa radiata, form more layers throughout the maturation process, and remain attached to the zona pellucida after the ovulation of the Graafian follicle. For fertilization to occur, sperm cells rely on hyaluronidase (an enzyme found in the acrosome of spermatozoa) to disperse the corona radiata from the zona pellucida of the secondary (ovulated) oocyte, thus permitting entry into the perivitelline space and allowing contact between the sperm cell and the nucleus of the oocyte.


Thomasia de Mattio


Grapevine yellow speckle viroid

Grapevine yellow speckle viroid can refer to two different species of viroid, both in the genus "Apscaviroid":