Notes

Folding-controlled assembly involving ortho-phenylene-based macrocycles.
Under the same conditions, the PCEs of reference MAPbI3 devices reduced to 43% of their initial value in 480 h.Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by subcortical vasogenic edema presenting with acute neurological symptoms. Common precipitating causes include renal failure, pre-eclampsia/eclampsia, post-organ transplant and cytotoxic drugs. Hypercalcemia is a rare cause of PRES; most cases occur in the setting of severe hypercalcemia secondary to malignancy or iatrogenic vitamin D/calcium overdose. Primary hyperparathyroidism (PHPT), as a cause of PRES, is an oddity. We report two cases of adolescent PHPT presenting with generalized tonic-clonic seizures and altered sensorium. On evaluation, both had hypertension, severe hypercalcemia (serum calcium 14.1 mg/dl and 14.5 mg/dl, respectively) and elevated parathyroid hormone levels. Magnetic resonance imaging revealed T2/FLAIR hyperintensities located predominantly in the parieto-occipital regions, suggestive of PRES. Localization and excision of parathyroid adenoma led to restoration of normocalcemia. see more Neurological symptoms and MRI changes improved subsequently. Extensive literature search revealed only four cases of PHPT-associated PRES; none of them being in the pediatric/adolescent age group. The predominant clinical manifestations were seizures and altered sensorium. All had severe hypercalcemia; three had hypertension at presentation while one was normotensive. Parathyroid adenomectomy led to normalization of serum calcium and resolution of neurological symptoms and radiological changes. Thus, severe hypercalcemia, although rare in PHPT, can lead to hypercalcemic crisis precipitating acute hypertension that can result in cerebral endothelial dysfunction with breakdown of blood-brain barrier, culminating in PRES. We therefore recommend that serum calcium levels should be checked in all patients with PRES and PHPT be regarded as a differential diagnosis in those with underlying hypercalcemia.BACKGROUND Some authors have hypothesized that the initial kinetics of the primary melanoma (MM) growth could reflect its biologic aggressiveness. The aim of this study was to pilot a measure of the horizontal vs vertical growth of superficial spreading melanomas (SSM). METHODS The dermoscopic images of twenty-three consecutive MMs (17 SSMs and 6 MMs in situ), excised after digital sequential dermoscopy, were reviewed. We built up two indexes 1) dROG (digital Rate of Growth) defined as Breslow thickness/(t1-tR), where t1 was the reported time of the first dermoscopic image acquisition and tR was the reported time of the acquisition before the lesion excision; 2) lHGR (linear Horizontal Growth Rate) took into account the greater axis of the lesion at two time points, at the time (t1) of the first image acquisition (D1) and before (tR) lesion excision (DR). The index was computed as (DR- D1)/(t1-tR). We built up the Composite Rate of Growth index (cROG) calculated as dROG/lHRG. If the value of cROG is 1 the vertical growth is prevalent on the superficial growth. RESULTS In 82.6% of lesions the horizontal growth was prevalent on the vertical growth, and in 17.4% of cases the vertical growth was equal or prevalent on the superficial growth. CONCLUSIONS A small proportion of SSMs with a slow horizontal growth could have a precocious vertical growth. Other larger studies are needed to confirm this observation.The Royal Commission into Institutional Responses to Child Sexual Abuse estimated 60,000 people were sexually abused as children in Australian Institutions during the period it examined and recommended the Australian Government establish a single National Redress Scheme. The National Redress for Institutional Child Sexual Abuse Act 2018(the NRS Act) commenced on 1 July 2018 enacting some, but not all, of the recommendations of the Royal Commission, including the implementation of the three elements of redress, the use of a matrix to determine monetary payments, and the provision of an internal review scheme. Redress under the NRS Act includes a "direct personal response by the institution", "counselling and psychological care" and "monetary payments". All States and Territories were required to respond to the NRS Act by referring relevant powers to the Commonwealth in order to facilitate the operation of the national scheme. In addition each jurisdiction enacted particular responses to the NRS having regard to the existing victims of crime legislation in each State or Territory. This article surveys the NRS Act and the approach adopted by Western Australia and the other sub-national jurisdictions in responding to the NRS Act.Medical experts play a central role in establishing the standard of care in medical litigation and whether the duty of care has been breached. There has long been criticism of them and their performance of this function. They are subject to biases including partisanship and cognitive biases. They may idealise the standard of care or fail to take adequately into account the context in which care was delivered. As a group, they are unrepresentative of the profession in age, gender, location and type of practice. Recent changes to how expert evidence is managed by courts is addressing some of these issues but may have raised other problems. This article discusses the strengths and weaknesses of medical expert evidence, both as delivered traditionally and in the recent innovations of expert conclaves and concurrent evidence, and discusses potential further improvements including increased accountability and refinements to the conclave processes.Expert evidence in medical imaging claims has the potential for well-recognised biases. Informational biases occur from the distorted context when an expert witness knows which specific finding is present and the severity of the injury sustained as a result of the undiagnosed finding. Systemic litigation biases occur from the selection and undersampling of opinions and issues with compensation and affiliation between the expert and parties to litigation. Blinding the expert witness to outcomes holds potential for mitigating these biases and may act as a screening tool to evaluate civil claims. The more complex strategies of blinding the expert to both the legal case and the commissioning legal party, by providing a "library of imaging" for review to imitate a normal day's work, are unlikely to be practical for Australian legal practice. The persuasiveness of blinded expert evidence in mediation, concurrent evidence and court decisions in Australia is still uncertain.
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