The Mary Imogene Bassett Hospital (Bassett Medical Center) is a teaching hospital in Cooperstown, New York. The hospital opened in June 1922. The hospital has 180 beds. It is associated with Columbia University. It is home to the Bassett Cancer Institute.
This review aims to systematically evaluate the environmental impacts of key cardiac imaging modalities, identify current operational practices that disproportionately contribute to the carbon footprint, and propose evidence-based strategies to optimize imaging protocols for climate sustainability while preserving diagnostic accuracy and patient outcomes. There has been a significant increase in the utilization of cardiac magnetic resonance imaging (CMR), cardiac computed tomography (CT), cardiac positron emission tomography (PET) and single-photon emission computed tomography (SPECT) which comes with an unacknowledged cost to our environment with respect to carbon footprint, energy consumption and barriers to safe disposal of contrast agents. However, we are yet to incorporate environmental sustainability metrics in our major diagnostic guidelines. In CMR, protocol refinements such as limiting the number of localizing images, using specific faster mapping sequence and optimizing protocols such that cine SSFP can be moved into the contrast wait period can lower energy use and scan time. PET/SPECT/CT sustainability is enhanced by stress-first protocols, tailoring CT dose to clinical need, and promoting circular manufacturing of scanners and cyclotron components. In echocardiography, the major opportunity lies in redesigning ultrasound contrast agent packaging to enable multi-dose use, minimizing single-use plastic waste. Collectively, climate-conscious imaging is achievable by powering down devices, integrating the use of sustainability index, utilizing green data storage centers and optimizing protocols and machines both of the acquisition and vendor side. Future research should quantify the environmental savings of these strategies and support scalable implementation across diverse practice settings.
BACKGROUND:Logging consistently ranks among the most hazardous occupations in the United States, yet non-fatal injury patterns remain under-characterized. This study uses a novel time-series dataset of pre-hospital care records (PCRs) to identify trends in non-fatal injuries within the Maine forestry sector, with a focus on demographic and temporal changes in injury patterns in an increasingly mechanized occupational sector. METHODS:We identified 471 forestry-related injuries from a statewide dataset of PCRs from 2008 to 2022, excluding 2017 and 2018, and performed detailed injury coding using the Occupational Injury and Illness Classification (OIICS) coding system. We analyzed frequencies of OIICS subcodes for Primary Injury Source, Event/Exposure, Nature of Injury, and Body Part classifications. Injury characteristics and rates per year (per 1,000 at risk) were summarized across three periods: 2008-2011, 2012-2016, and 2019-2022, by age category and season. We used mixed-effects Poisson regression to assess the association between age category and injury counts per year, and quasi-Poisson models stratified by period to estimate mean injury counts and confidence intervals by age category and season. Chi-square tests were used to assess differences in injury source, event, nature and body part injured across age category, season, and period. RESULTS:A significant decline in the annual number of injuries and the overall injury rate was observed over the 15-year study period for all age categories. There is little consistent seasonality in injury rates across periods. Workers in prime working age category (ages 31 to 60) were most frequently injured, with older workers (ages 61+) also more frequently injured than the reference level (age 30 or less). The most common injury event was being struck by an object, with trees being the most frequent injury source and legs the most affected body part. CONCLUSION:Injury data classified and described from PCRs provides a valuable vehicle for injury surveillance in the forestry sector. Insights gained can guide the development of targeted safety interventions to protect this high-risk demographic.
Introduction:Rectal squamous cell carcinoma (rSCC) is exceedingly rare and lacks guidelines for staging or management. Prior radiation is a known risk factor for colorectal adenocarcinomas, but has rarely been reported with rSCC, with solid organ tumors generally arising after about 10 years following radiation. It poses a management dilemma as reradiation is associated with risks, but the outcome in patients without radiation therapy in rSCC is scarce. Case Description:We present a 76-year-old male with a past medical history of prostate adenocarcinoma treated with external beam radiotherapy 7 years prior, who presented with bright red bleeding per rectum and was diagnosed with tumor, node, and metastasis (TNM) stage IIIB rSCC. He underwent abdominal perineal resection (APR) and 4 cycles of adjuvant chemotherapy with carboplatin with paclitaxel. Radiotherapy was not done due to concern for complications with a history of prior radiation within the same region. On a 3-month follow-up, he was without recurrence, but passed away shortly after due to respiratory failure from severe mitral regurgitation. Conclusions:Radiation-associated rSCC and its management are rare and complex. Staging based on rADC as opposed to anal squamous cell carcinoma (aSCC) seems more intuitive based on location, but the choice of systemic treatment should be aSCC-based, given similar histology. A streamlined guideline on staging and management would be beneficial to track outcomes in rSCC, given its rarity, and would benefit from a consensus.
Abstract Introduction Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity syndrome characterized by rash, fever, hematologic abnormalities, and multi-organ involvement. Mortality approaches 10%, most often due to organ failure. While frequently reported in medical wards, severe cases requiring intensive care unit (ICU) management remain challenging, particularly when complicated by shock and multi-organ dysfunction. Emerging evidence suggests that genetic and mitochondrial factors may influence disease severity. Case Presentation A 61-year-old female with coronary artery disease, ischemic cardiomyopathy, and oxygen-dependent COPD presented with shock and a diffuse non-blanchable rash. She had recently undergone aortic valve replacement for Enterococcus faecium endocarditis and was completing a six-week vancomycin course. After five weeks, she developed confusion, dyspnea, and rash. In the emergency department, she was hypotensive and hypoxic, improving transiently with steroids and antihistamines. Despite antibiotic switch to Linezolid, she deteriorated with fever, hypotension, radiographic evidence of pneumonia, acute kidney injury, leukocytosis, and marked eosinophilia. She required ICU admission, vasopressors, and stress-dose steroids. Peripheral smear showed transient RBC membrane abnormalities (Fig.1). Work-up excluded infectious and autoimmune causes. Genetic testing revealed an SDHA mutation, and coenzyme Q10 was initiated. With continued steroids and supportive care, she improved and was transitioned to oral prednisone prior to discharge. Discussion This case highlights the potential role of mitochondrial dysfunction in amplifying the severity of DRESS. The SDHA gene encodes a succinate dehydrogenase subunit essential for oxidative phosphorylation [1, 2]. Pathogenic variants impair electron transport and increase reactive oxygen species (ROS). In DRESS, where immune activation and cytokine release are already heightened, excess ROS may drive immune dysregulation, cellular injury, and systemic inflammation. Such mechanisms could explain the disproportionate severity of our patient’s presentation and persistence of eosinophilia despite corticosteroids. Antibiotics with known mitochondrial toxicity (e.g., vancomycin, daptomycin) may exacerbate this vulnerability. Recognition of genetic predispositions like SDHA mutations could eventually guide antibiotic choice and support early consideration of adjunctive antioxidant therapy such as coenzyme Q10 in ICU settings. Conclusion We describe a severe case of DRESS complicated by shock and multi-organ dysfunction in a patient with an SDHA mutation. This raises the hypothesis that mitochondrial dysfunction and oxidative stress may predict more severe outcomes. Further study is warranted to evaluate whether genetic testing can inform prognosis, antibiotic selection, and targeted adjunctive therapy in DRESS, especially in ICU settings. This abstract is funded by: None
