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Concept: Boston

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In November 2015, a neurologist in the Boston, Massachusetts, area reported four cases of an uncommon amnestic syndrome involving acute and complete ischemia of both hippocampi, as identified by magnetic resonance imaging (MRI), to the Massachusetts Department of Public Health (MDPH) (1). A subsequent e-mail alert, generated by the Massachusetts Board of Registration in Medicine and sent to relevant medical specialists (including neurologists, neuroradiologists, and emergency physicians), resulted in the identification of 10 additional cases that had occurred during 2012-2016. All 14 patients (mean and median age = 35 years) had been evaluated at hospitals in eastern Massachusetts. Thirteen of the 14 patients underwent routine clinical toxicology screening at the time of initial evaluation; eight tested positive for opioids, two for cocaine, and two for benzodiazepines. Apart from sporadic cases (2-6), this combination of clinical and imaging findings has been reported rarely. The apparent temporospatial clustering, relatively young age at onset (19-52 years), and associated substance use among these patients should stimulate further case identification to determine whether these observations represent an emerging syndrome related to substance use or other causes (e.g., a toxic exposure).

Concepts: Medicine, Brain, Hospital, Medical imaging, Nuclear magnetic resonance, Physician, Magnetic resonance imaging, Boston

15

Health care consumers won a significant victory when Massachusetts Suffolk County Superior Court Judge Janet Sanders blocked a settlement that would have allowed Partners HealthCare, the system that dominates the Boston area, to acquire three additional health care providers in eastern Massachusetts. Sanders concluded that the acquisitions “would cement Partners' already strong position in the health care market and give it the ability, because of this market muscle, to exact higher prices from insurers for the services its providers render.” If this decision is not overturned on appeal, consumers will now be spared those projected price increases. But there is . . .

Concepts: Health care, Health care provider, Healthcare, Health, Massachusetts, Boston, New York, Greater Boston

12

To examine maternal folic acid supplementation and plasma folate concentrations in the Boston Birth Cohort, a predominantly urban, low-income, minority population in Boston, Massachusetts.

Concepts: Cohort study, Vitamin, Folic acid, Folate deficiency, Mother, Massachusetts, Boston

10

Many patients even those with health insurance pay out-of-pocket for medicines. We investigated the availability and prices of essential medicines in the Boston area.

Concepts: Health care, Health insurance, Pharmacy, Price, Massachusetts, New England, Boston, Greater Boston

6

Our aim was to identify the factors influencing the selection of a model of acute stroke service centralization to create fewer high-volume specialist units in two metropolitan areas of England (London and Greater Manchester). It considers the reasons why services were more fully centralized in London than in Greater Manchester.

Concepts: England, New York City, London, Boston, Manchester United F.C., Greater Manchester, Manchester, Metropolitan county

6

We discuss the strengths of the medical response to the Boston Marathon bombings that led to the excellent outcomes. Potential shortcomings were recognized, and lessons learned will provide a foundation for further improvements applicable to all institutions.

Concepts: Marathon, Boston, Atomic bombings of Hiroshima and Nagasaki, Bomb, Boston Marathon, Robert Kipkoech Cheruiyot, World Marathon Majors, Bobbi Gibb

4

The Boston Marathon bombing was the first major, modern US terrorist event with multiple, severe lower extremity injuries. First responders, including trained professionals and civilian bystanders, rushed to aid the injured. The purpose of this review was to determine how severely bleeding extremity injuries were treated in the prehospital setting in the aftermath of the Boston Marathon bombing.

Concepts: Massachusetts, Marathon, Boston, Boston Marathon, Robert Kipkoech Cheruiyot, World Marathon Majors, Bobbi Gibb

4

Earlier this year, Boston Children’s Hospital was targeted in a sustained cyberattack purportedly instigated by the hacker group known as Anonymous - an event that may carry lessons for other health care organizations that now rely heavily on electronic systems.

Concepts: Health care, Health insurance, Electronics, Massachusetts, Boston, Children's Hospital Boston, The Hacker

3

Older adults are highly vulnerable to the detriment of extreme weather. The rapid non-linear increase in heat-related morbidity is difficult to quantify, hindering the attribution of direct effects of exposure on severe health outcomes. We examine the effects of ambient temperatures on heat-related hospitalizations (HH) among the elderly in presence of strong seasonality and by assessing the effects caused by the first and subsequent seasonal heatwaves. We empirically derived the thresholds for a heatwave episode in Boston MSA based on 16 years of daily observations. We compared the health risks of heatwaves using the proposed and four alternative definitions. 701 cases of HH in older residents of Boston area were examined using harmonic regression models, designed to capture the non-linear effects of ambient temperatures and heatwave episodes when the night-time temperature is above 65.5 °F for 3 consecutive nights. The overall relative risk of HH associated with a heatwave episode was 6.9 [95%CI:4.8-9.8]. The relative risk of HH associated with the first heatwave increases up to 13.3 [95%CI:7.4-24.0]. The risk declined to 3.7 [95%CI:2.4-5.8] for the subsequent heatwave. Four other commonly used heatwave definitions confirmed these findings. Public health actions have to target the first heatwave to maximize the impact of preventive measures.

Concepts: Epidemiology, Middle age, Fundamental physics concepts, Weather, Gerontology, Old age, Boston, Greater Boston

3

The role of repeated exposure to collective trauma in explaining response to subsequent community-wide trauma is poorly understood. We examined the relationship between acute stress response to the 2013 Boston Marathon bombings and prior direct and indirect media-based exposure to three collective traumatic events: the September 11, 2001 (9/11) terrorist attacks, Superstorm Sandy, and the Sandy Hook Elementary School shooting. Representative samples of residents of metropolitan Boston (n = 846) and New York City (n = 941) completed Internet-based surveys shortly after the Boston Marathon bombings. Cumulative direct exposure and indirect exposure to prior community trauma and acute stress symptoms were assessed. Acute stress levels did not differ between Boston and New York metropolitan residents. Cumulative direct and indirect, live-media-based exposure to 9/11, Superstorm Sandy, and the Sandy Hook shooting were positively associated with acute stress responses in the covariate-adjusted model. People who experience multiple community-based traumas may be sensitized to the negative impact of subsequent events, especially in communities previously exposed to similar disasters.

Concepts: New York City, Massachusetts, Boston, Metropolitan area, New York, Philadelphia, World Trade Center, Acute stress reaction