BACKGROUND AND PURPOSE:

Hemangioblastoma is a rare vascular tumor that occurs within the central nervous system in children. Differentiating hemangioblastoma from other posterior fossa tumors can be challenging on imaging, and preoperative diagnosis can change the neurosurgical approach. We hypothesize that a "lightbulb sign" on the arterial spin-labeling (ASL) sequence (diffuse homogeneous intense hyperperfusion within the solid component of the tumor) will provide additional imaging finding to differentiate hemangioblastoma from other posterior fossa tumors.

BACKGROUND AND PURPOSE:

Periprocedural intracranial hemorrhage is one of common complications after stent placement for symptomatic intracranial atherosclerotic stenosis. This study was conducted to demonstrate predictors and long-term outcomes of periprocedural intracranial hemorrhage after stent placement for symptomatic intracranial atherosclerotic stenosis.

Rare genetic conditions are challenging for the primary care provider to manage without proper guidelines. This clinical review is designed to assist the pediatrician, family physician, or internist in the primary care setting to manage the complexities of 16p11.2 deletion syndrome. A multidisciplinary medical home with the primary care provider leading the care and armed with up-to-date guidelines will prove most helpful to the rare genetic patient population. A special focus on technology to fill gaps in deficits, review of case studies on novel medical treatments, and involvement with the educational system for advocacy with an emphasis on celebrating diversity will serve the rare genetic syndrome population well.

Metastatic porocarcinomas (PCs) are vanishingly rare, highly aggressive skin adnexal tumors with mortality rates exceeding 70%. Their rarity has precluded the understanding of their disease pathogenesis, let alone the conduct of clinical trials to evaluate treatment strategies. There are no effective agents for unresectable PCs. Here, we successfully demonstrate how functional precision medicine was implemented in the clinic for a metastatic PC with no known systemic treatment options. Comprehensive genomic profiling of the tumor specimen did not yield any actionable genomic aberrations. However, ex vivo drug testing predicted pazopanib efficacy, and indeed, administration of pazopanib elicited remarkable clinicoradiological response. Pazopanib and its class of drugs should be evaluated for efficacy in other cases of PC, and the rationale for efficacy should be determined when PC tumor models become available. A functional precision medicine approach could be useful to derive effective treatment options for rare cancers.

Pilocytic astrocytomas are the most common pediatric brain tumors, typically presenting as low-grade neoplasms. We report two cases of pilocytic astrocytoma with atypical tumor progression. Case 1 involves a 12-yr-old boy with an unresectable suprasellar tumor, negative for BRAF rearrangement but harboring a BRAF p.V600E mutation. He experienced tumor size reduction and stable disease following dabrafenib treatment. Case 2 describes a 6-yr-old boy with a thalamic tumor that underwent multiple resections, with no actionable driver detected using targeted next-generation sequencing. Whole-genome and RNA-seq analysis identified an internal tandem duplication in FGFR1 and RAS pathway activation. Future management options include FGFR1 inhibitors. These cases demonstrate the importance of escalating molecular diagnostics for pediatric brain cancer, advocating for early reflexing to integrative whole-genome sequencing and transcriptomic profiling when targeted panels are uninformative. Identifying molecular drivers can significantly impact treatment decisions and improve patient outcomes.

BackgroundThere has been significant investment in pharmacists working in UK general practice to improve the effective and safe use of medicines. However, evidence of how to optimise collaboration between GPs and pharmacists in the context of polypharmacy (multiple medication) is lacking.AimTo explore GP and pharmacist views and experiences of in-person, interprofessional collaborative discussions (IPCDs) as part of a complex intervention to optimise medication use for patients with polypharmacy in general practice.Design and settingA mixed-method process evaluation embedded within the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial conducted in Bristol and the West Midlands, between February 2021 and September 2023.MethodAudio-recordings of IPCDs between GPs and pharmacists, along with individual semi-structured interviews to explore their reflections on these discussions, were used. All recordings were transcribed verbatim and analysed thematically.ResultsA total of 14 practices took part in the process evaluation from February 2022 to September 2023; 17 IPCD meetings were audio-recorded, discussing 30 patients (range 1–6 patients per meeting). In all, six GPs and 13 pharmacists were interviewed. The IPCD was highly valued by GPs and pharmacists who described benefits, including: strengthening their working relationship; gaining in confidence to manage more complex patients; and learning from each other. It was often challenging, however, to find time for the IPCDs.ConclusionThe model of IPCD used in this study provided protected time for GPs and pharmacists to work together to deliver whole-patient care, with both professions finding this beneficial. Protected time for interprofessional liaison and collaboration, and structured interventions may facilitate improved patient care.

The usual challenges of conducting primary care research, including randomized trials, have been exacerbated, and new ones identified, during the COVID-19 pandemic. HOMER (Home versus Office for Medication Enhanced Recovery; subsequently, Comparing Home, Office, and Telehealth Induction for Medication Enhanced Recovery) is a pragmatic, comparative-effectiveness research trial that aims to answer a key question from patients and clinicians: What is the best setting in which to start treatment with buprenorphine for opioid use disorder for this patient at this time? In this article, we describe the difficult journey to find the answer. The HOMER study began as a randomized trial comparing treatment outcomes in patients starting treatment with buprenorphine via induction at home (unobserved) vs in the office (observed, synchronous). The study aimed to enroll 1,000 participants from 100 diverse primary care practices associated with the State Networks of Colorado Ambulatory Practices and Partners and the American Academy of Family Physicians National Research Network. The research team faced unexpected challenges related to the COVID-19 pandemic and dramatic changes in the opioid epidemic. These challenges required changes to the study design, protocol, recruitment intensity, and funding conversations, as well as patience. As this is a participatory research study, we sought, documented, and responded to practice and patient requests for adaptations. Changes included adding a third study arm using telehealth induction (observed via telephone or video, synchronous) and switching to a comprehensive cohort design to answer meaningful patient-centered research questions. Using a narrative approach based on the Greek myth of Homer, we describe here the challenges and adaptations that have provided the opportunity for HOMER to thrive and find the way home. These clinical trial strategies may apply to other studies faced with similar cultural and extreme circumstances.

PURPOSE

Meeting scholarly activity requirements continues to be a challenge in many family medicine (FM) residency programs. Studies comprehensively describing FM resident scholarship have been limited. We sought to identify institutional factors associated with increased scholarly output and meeting requirements of the Accreditation Council for Graduate Medical Education (ACGME).

PURPOSE

Despite being key to better health outcomes for patients from racial and ethnic minority groups, the proportion of underrepresented in medicine (URiM) physicians remains low in the US health care system. This study linked a nationally representative sample of family physicians (FPs) with Medicaid claims data to explore the relative contributions to care of Medicaid populations by FP race and ethnicity.

PURPOSE

Currently, 40% of counties in the United States do not have an obstetrician or midwife, and in rural areas the likelihood of childbirth being attended to by a family medicine (FM) physician is increasing. We sought to characterize the effect of the FM presence on unit culture and a key perinatal quality metric in Iowa hospital intrapartum units.

The respiratory literature, both written and in online formats, is growing exponentially. Capturing quality content, to meet the learning needs of those working in all fields of respiratory medicine and delivering it in a palatable, accessible format is challenging but paramount. In this article we discuss ways to determine the information content and review different methods of delivering this content to those who need it.

A rail service linking Scotland, Wales and England with one train journey is to start running for the first time. 

Sir Andy Murray will swap Centre Court for the stage next summer as he embarks on a tour discussing his illustrious tennis career.

Valve has announced Steam Deck OLED: Limited Edition White.

The handheld is a limited edition white version of the Steam Deck OLED that will be available in limited quantities for $679.

Pre-orders will open up on Steam on November 18 at 3:00 pm PT / 6:00 pm ET / 11:00 pm UK.

A life-long and avid gamer, William D'Angelo was first introduced to VGChartz in 2007. After years of supporting the site, he was brought on in 2010 as a junior analyst, working his way up to lead analyst in 2012 and taking over the hardware estimates in 2017. He has expanded his involvement in the gaming community by producing content on his own YouTube channel and Twitch channel. You can contact the author on Twitter @TrunksWD.

Full Article - https://www.vgchartz.com/article/463040/valve-announces-steam-deck-oled-limited-edition-white/

Sony Interactive Entertainment in a new video posted to YouTube revealed the PlayStation 5 Slim Digital Edition has been discounted by $70 and will be available for $379.99. The deal runs until December 24 "while supplies last."

No word yet if the standard PlayStation 5 or the recently released PlayStation 5 Pro will be discounted. The standard PS5 is priced at $499.99 and the PS5 Pro is priced at $699.99.

As of the time of writing, the discount isn't available yet at retailers or through PlayStation Direct.

A life-long and avid gamer, William D'Angelo was first introduced to VGChartz in 2007. After years of supporting the site, he was brought on in 2010 as a junior analyst, working his way up to lead analyst in 2012 and taking over the hardware estimates in 2017. He has expanded his involvement in the gaming community by producing content on his own YouTube channel and Twitch channel. You can contact the author on Twitter @TrunksWD.

Full Article - https://www.vgchartz.com/article/463046/ps5-slim-digital-edition-discounted-to-379-in-the-us-until-december-24/

WASHINGTON CROSSING, Pennsylvania—At a campaign rally in the most important swing state in the country, anti-Trump activist George Conway told the Daily Beast why he thinks Kamala Harris can win over Republicans.

“She’s kind of done it already,” he said. “Look at all those people who voted for [Nikki] Haley when she was already done. I actually think there’s kind of a hidden Harris vote for Republicans who are just exhausted by Donald Trump.”

Turnout is another factor that plays to Democrat’s advantage, Conway predicted. “I also think that even the people who are still for Trump and won’t vote for Harris, I don’t think the turnout’s going to be great for him.”

Read more at The Daily Beast.

MSNBC’s Chris Hayes called out Fox News for not showing the full context of Donald Trump’s “enemy within” comments during Vice President Kamala Harris’ interview on the network earlier Wednesday.

The anchor of All In opened his broadcast by calling attention to something that Harris herself did in the sit-down with Fox’s Bret Baier. The clip that the right-wing network showed to Harris as part of Baier’s question was of Trump during his all-female town hall event in Georgia—the one where Trump bizarrely argued he was the “father of IVF.”

In the clip that Fox aired directly to Harris during her interview, Trump wasn’t heard talking about how former House Speaker Nancy Pelosi or Rep. Adam Schiff are the “enemy within.” Instead, Fox made it so Harris had to react to him talking more mildly about “phony investigations.” The network omitted Trump’s line about “the enemy within.”

Read more at The Daily Beast.

I never completed the original Red Dead Redemption, but not for the usual reasons of being terrible at the game, or thinking that open worlds are too big and boring these days and I just want to lie down forever and watch anime. I never finished it because my Xbox 360 version was not, in practice, an open world game, but a lonely farm at the bottom of a vortex of butchered spacetime. In the prologue, reformed outlaw John Marston confronts an old bandit acquaintance and gets himself roundly shot to bits. He’s rescued by local rancher Bonnie MacFarlane, who nurses him back to health and gives him a few odd jobs to warm him up for the next plot point.

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Some days, I wonder if every word written before a trailer is actually superfluous. It’s a visual medium, after all. What can a description achieve save to clumsily gesture at the true shape of something; a dog-eared tour brochure for a thrilling weekend spelunking in Plato’s cave? I can usually shake this feeling, but gory zombie action game Showa American Story is my breaking point. There is nothing I can impart about this thing that will not be conveyed better by allowing its new trailer to wash over you like a tide of sheer videogame. Here’s it:

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Sunday is cancelled. Book for now!

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My brain is still thawing for the comment freeze, and thus there is sadly no cool industry person to talk to us about books this week. I'm currently reading Tony Tulathimutte’s Rejection. Jia Tolentino wrote about it for the New Yorker. Jia Tolentino also writes very good books. But enough about books, tell me about books! One's you've read, preferably, but I will also accept books you've formed opinions on based on their covers, as is good and proper. Book for now!

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Update:

The RPS 100 is our list of the best games to play on PC. It encompasses the full breadth and width of PC gaming stretching back to 1873, but focuses solely on those games that remain great to play today. It's updated yearly by our crack team of writers, and the first half of the 2024 edition is live now.

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The Steam Deck OLED – which is like a Steam Deck but better in almost every way – is getting a new, if potentially more smudge-susceptible Limited Edition. A successor to the translucent version that only went on sale in the US and Canada last year, the Steam Deck OLED: Limited Edition White offers both a snowy look and, for those of us outside North America, the chance to actually buy one. It’ll go on sale November 18th, in all the countries that the Steam Deck currently ships in.

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My strongest and most enduring memory of Grand Theft Auto will always be creasing into complete hysterics watching my mate pile into a crumpled police officer with a wooden baseball bat in GTA 3 after school one time. Young’uns these days just don’t appreciate how revolutionary it was to be able to hit a cop with a thing after he’d already fallen over. Suffice it to say I’ve got good memories of the open world series’ nascent forays into 3D, though never enough to tempt me into revisiting them, especially given the poor reception to Grand Theft Auto: The Trilogy - The Definitive Edition. I can sympathise. I’m annoyed just having to type a semicolon and a dash in the same game name.

If you’re in a similarly non-fussed position (I will never not be annoyed that ‘nonplussed’ doesn’t mean what it sounds like it should mean) I can’t imagine a lighting update that’s been available on the mobile versions for a while is enough to tempt you back. But what is a reporter's job if not pathetically treading water between chunklets of Grand Theft Auto news, upon the publishing of which Graham presses the button to release the nutritious pellets on which we all wholly subsist? I hope he doesn’t read that last sentence. I don’t get my pellet if the syntax becomes too convoluted. Moving swiftly on.

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Medically evacuating an astronaut from space is difficult and expensive, and a new model predicts that one in three long-duration moon missions may require it

The European Space Agency is sending a probe to get a closer look at the asteroid Dimorphos, which had its orbit altered by NASA’s DART mission in 2022

Combining two neural networks has helped researchers predict potentially disastrous collapses in complex systems, such as financial crashes or power blackouts

Between 2005 and 2021, Facebook, Twitter and YouTube were more likely to make policy changes in the weeks after negative stories in the media

A specialised algorithm could help autonomous vehicles track hidden objects, such as a pedestrian, a bicycle or another vehicle concealed behind a parked car

Just under 5 per cent of the Wikipedia pages in English that have been published since ChatGPT's release seem to include AI-written content

A pediatrician, author and co-inventor of a low-cost COVID-19 vaccine warns that the anti-vaccine movement has morphed into a political force that threatens the world's gains against deadly childhood infections like measles.

Stay up to date on the latest AI technology advancements and learn about the challenges and opportunities AI presents

LIVERPOOL midfielder Georginio Wijnaldum will be pivotal for Jurgen Klopp at Manchester City..