Disclosing incidental findings in brain research: The rights of minors in decision‐making

MRI is used routinely in research with children to generate new knowledge about brain development. The detection of unexpected brain abnormalities (incidental findings; IFs) in these studies presents unique challenges. While key issues surrounding incidence and significance, duty of care, and burden of disclosure have been addressed substantially for adults, less empirical data and normative analyses exist for minors who participate in minimal risk research. To identify ethical concerns and fill existing gaps, we conducted a comprehensive review of papers that focused explicitly on the discovery of IFs in minors. The discourse in the 21 papers retrieved for this analysis amply covered practical issues such as informed consent and screening, difficulties in ascertaining clinical significance, the economic costs and burden of responsibility on researchers, and risks (physical or psychological). However, we found little discussion about the involvement of minors in decisions about disclosure of IFs in the brain, especially for IFs of low clinical significance. In response, we propose a framework for managing IFs that integrates practical considerations with explicit appreciation of rights along the continuum of maturity. This capacity‐adjusted framework emphasizes the importance of involving competent minors and respecting their right to make decisions about disclosure. J. Magn. Reson. Imaging 2013;38:1009–1013. © 2013 Wiley Periodicals, Inc.     

Atmospheric Pollutants and the Pathogenesis

Influenza-infected mice exposed continuously to 20 ppm of sulfur dioxide (SO₂) for seven days after virus exposure developed more pneumonia than virus control mice. Dose-response experiments suggested that the post virus SO₂-induced increase in influenzal pneumonia began at about 7 to 10 ppm. The increase in pneumonia was not influenced by altering the virus dosage within a 5 to 100 mouse infectious dose range. A similar increase (15% to 20%) in influenzal pneumonia was observed when mice were exposed to 25 ppm of SO₂ prior to initiation of virus infection. The SO₂ exposure had no effect on the growth of influenza virus in the lungs of mice. Rather, the increase in She amount of pneumonia was associated with SO₂ concentrations which induced low-grade, inflammatory lesions in the lung.     

Angioleiomyoma in a Rare Location: A Case Report

A case report of a 38-year-old man with a 10 year history of left buttock mass associated with pain and numbness. A computed tomography scan showed a subcutaneous enhancing 1cm lesion that was not communicating with surrounding structures to include neurovascular structures. The mass was removed without complication and sent to pathology for extensive review. This case report signifies the importance of maintaining a broad differential with a subcutaneous mass presentation and includes thorough histology and pathology for angioleiomyoma.     

1975 Interstate postgraduate medical assembly 60TH Program

Observed platelet changes in women known to be taking oral contraceptives prompted a study to see whether estrogen users could be identified solely by examination of Wright-stained blood smears. The examiner correctly identified as estrogen users all of a group of 26 women who were taking an oral contraceptive containing estrogen and progesterone.     

Establishing biennial paramedic experience benchmarks

Objective. Since stroke symptoms are often vague, and acute therapies for stroke are more recently available, it has been hypothesized that stroke patients may not be treated with the same urgency as myocardial infarction (MI) patients by emergency medical services (EMS). To examine this hypothesis, EMS transport times were examined for both stroke and MI patients who used a paramedic-level, county-based EMS system for transportation to a single hospital during 1999. Methods. Patients were first identified by their hospital discharge diagnosis as stroke (ICD-9 430–436, n = 50) or MI (ICD-9 410, n = 55). Trip sheets with corresponding transport times were retrospectively obtained from the 911 center. A separate analysis was performed on patients identified by dispatchers with a chief complaint of stroke (n = 85) or MI (n = 372). Results. Comparing stroke and MI patients identified by ICD-9 codes, mean EMS transport times in minutes did not meaningfully differ with respect to dispatch to scene arrival time (8.3 vs 8.9, p = 0.61), scene time (19.5 vs 21.4, p = 0.23), and transport time (13.7 vs 16.2, p = 0.10). Mean total call times in minutes from dispatch to hospital arrival were similar between stroke and MI patients (41.5 vs 46.4, p = 0.22). Results were similar when comparing patients identified by dispatchers with a chief complaint indicative of stroke or MI. Conclusion. In this single county, EMS response times were not different between stroke and MI patients. Replication in other EMS settings is needed to confirm these findings.