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•Anterior cervical osteophytectomy successful for DISH related dysphagia.•Early referral for DISH related dysphagia to neurosurgical-multidisciplinary review.•DISH - an important differential in obstructive dysphagia and airway obstruction. This study reviews the management pathway and surgical outcomes of patients referred to and operated on at a tertiary neurosurgical centre, for dysphagia associated with anterolateral cervical hyperostosis (ACH) in diffuse idiopathic skeletal hyperostosis (DISH). Electronic patient records for 6 patients who had undergone anterior cervical osteophytectomy for dysphagia secondary to ACH were reviewed. ACH diagnosis was made by an Ear, Nose and Throat (ENT) specialist and patients were referred to a neurosurgical-led multidisciplinary team (MDT) for review. A senior radiologist performed imaging measurements and vertebral level localization was confirmed via barium-swallow video-fluoroscopy. Speech and language therapists (SLTs) determined the suitability of pre-operative conservative management. Patients were followed-up post-operatively with clinical and radiological assessments. 6 patients (Male to female ratio, 6:0; mean age, 59 years) were referred to a tertiary neurosurgical centre with DISH related dysphagia, an average of 25 months after ENT review (range, 14–36 months) between 2005 and 2016. The vertebral levels implicated in dysphagia ranged from C2 to T1 with a median of 4 vertebral levels involved. The most frequently affected vertebral levels were C4-6 (all 6 patients). The average antero-posterior height (as measured on axial images) of the most prominent osteophyte was 15.9 mm (range 12.0–20.0 mm). Patients underwent elective cervical osteophytectomy on average 10.8 months after neurosurgical review (range, 3–36 months). One patient had a post-operative haematoma needing evacuation and prolonged hospital stay. The average duration of follow-up was 42.3 months. All our patients maintained good symptomatic resolution without osteophyte recurrence. All our patients experienced significant and sustained clinical improvement. Anterior cervical osteophytectomy consistently leads to improvement in symptomatic ACH patients without recurrence. Early referral to a neurosurgical multi-disciplinary team (MDT) is indicated in ACH related dysphagia, once conservative management has failed.

Consistent with the deinstitutionalization-of-marriage thesis, studies report a decline in support for marital conventions and increased approval of other relationship types. Generalizations are limited by the lack of cross-national research for a broad domain of attitudes on marriage and alternative arrangements, and by the lack of consensus on what counts as evidence. Acknowledging the conceptual distinction between expectations for behavior inside and outside marriage, we address the deinstitutionalization debate by testing whether support for marital conventions has declined for a range of attitudes across countries. Based on eleven International Social Survey Program items replicated between the late 1980s and the 2000s, OLS regressions evaluate attitude changes in up to 21 countries. Consistent with the deinstitutionalization argument, disapproval declined for marital alternatives (cohabitation, unmarried parents, premarital and same-sex sex). For attitudes on the behavior of married people and the nature of marriage the results are mixed: despite a shift away from gender specialization, disapproval of extramarital sex increased over time. On most items, most countries changed as predicted by the deinstitutionalization thesis. Attitude changes on 'new relationships' and marital alternatives are compatible with the deinstitutionalization of marriage. Beliefs arguably more central to the marital institution do not conform as neatly to this thesis. Because results are sensitive to the indicators used, the deinstitutionalization of marriage argument merits greater empirical and conceptual attention.

Abstract BACKGROUND Idiopathic spinal cord herniation is usually repaired by releasing the spinal cord and inserting a dural patch to close the herniated segment of dura. However, reherniation is a potential limitation of this standard technique. OBJECTIVE To describe early results of a novel technique that utilizes the dentate ligament to hitch the spinal cord and prevent reherniation. METHODS Two patients underwent dural hernia repair and the dentate hitch technique was performed. RESULTS Restored lower limb power and mobility, and satisfactory reduction of spinal cord herniation on magnetic resonance imaging in 2 patients at 6- and 24-mo follow-ups, respectively. CONCLUSION The dentate hitch technique can achieve repair of spinal cord herniation, with satisfactory postoperative results and minimizes the risk of reherniation.

IntroductionMyelopathy arising due to dorsal herniation of the spinal cord is a rare phenomenon, particularly so in the thoracic region. Where cases of thoracic dorsal cord herniation have been reported, the aetiology has typically been non-iatrogenic.Case presentationWe report the case of a paediatric oncology patient who presented with neurological deterioration secondary to thoracic dorsal spinal cord herniation, manifesting three months after laminectomy for biopsy of a spinal medulloblastoma lesion. We repaired the dural defect using non-penetrating titanium clips to create a secure expansile duraplasty, resulting in radiologically evident reduction of the cord herniation as well as corresponding clinical improvement.DiscussionThoracic dorsal spinal cord herniation is an extremely rare occurrence after spinal surgery. Non-penetrating titanium clips can be used to form a secure expansile duraplasty following reduction of the cord herniation. Successful repair of the dural defect re-anteriorises the cord and can confer neurological benefit.

Modern marriage has been characterized as a “greedy institution” where couples disengage from their social networks and community to devote their undivided attention to each other. I compare the co-presence patterns, that is, who people surround themselves with and how much time is spent with them, of cohabiters and married individuals to determine whether marriage is a uniquely “greedy institution” or whether co-residential romantic relationships lead to similar social worlds. I also compare divorcees and never-married individuals to determine whether experiencing marital dissolution influences the time that is allocated to others. Pooling data from the American Time Use Survey (ATUS) from 2003 to 2013, this study finds little differences in how cohabiters and married persons manage their relationships outside of their own union. Although cohabitation may be no less “greedy” of social ties than marriage, cohabiting couples spend more time alone together than marital couples. Divorcees and persons who have yet to marry also have similar social worlds. Household composition and demographic characteristics play a large role in the differences in time allocation. The findings suggest that marriage is no “greedier” than informal co-residential unions, and social networks appear to recover post-marriage.

Exercise training is effective at promoting physical fitness, cardiovascular outcomes, and quality of life amongst persons with chronic kidney disease. To our knowledge, no published data exist to date on the prevalence of exercise programs offered to Canadians undergoing dialysis. The study purpose was to characterize existing exercise programs in hemodialysis centres in the province of Ontario. An online survey was created and distributed to 95 dialysis facilities across Ontario. There was a 61% survey response rate. Only eight facilities offered exercise programs, which included intradialytic and cardiac rehabilitation programs. Lack of funding (n = 22), lack of human resources (n = 18), and lack of equipment (n = 17) were reported as the most commonly perceived barriers of offering an exercise program. Although exercise has been shown to be effective, prevalence of programs is low. Work is underway to administer the online survey tool to dialysis programs across Canada.

Many corporations across the world are experiencing growing pressure to incorporate environmental issues into their strategic decision‐making process. This pressure characterizes the increased global significance of the environment. Examines the extent to which the issue is recognized by UK corporations, and how the environment affects corporate business planning. Additionally, reflects on the key motivational factors leading to the adoption of environmental policies, and comments on the nature of those influences. The key findings show that UK companies recognize the environment is an issue, but that the degree of importance attached is based on a variety of factors, resulting from unique corporate perceptions of opportunity and threat. Companies are generally concerned with meeting legal compliance levels and obtaining cost saving, without undertaking high levels of investment. Some companies are, however, seeking to become “environmental managers”, having identified the existence of opportunities for achieving competitive advantage.

Many corporations across the world are experiencing growing pressure to incorporate environmental issues into their strategic decision-making process. This pressure characterizes the increased global significance of the environment. Examines the extent to which the issue is recognized by UK corporations, and how the environment affects corporate business planning. Additionally, reflects on the key motivational factors leading to the adoption of environmental policies, and comments on the nature of those influences. The key findings show that UK companies recognize the environment is an issue, but that the degree of importance attached is based on a variety of factors, resulting from unique corporate perceptions of opportunity and threat. Companies are generally concerned with meeting legal compliance levels and obtaining cost saving, without undertaking high levels of investment. Some companies are, however, seeking to become \"environmental managers\", having identified the existence of opportunities for achieving competitive advantage.

Many corporations across the world are experiencing growing pressure to incorporate environmental issues into their strategic decisionmaking process. This pressure characterizes the increased global significance of the environment. Examines the extent to which the issue is recognized by UK corporations, and how the environment affects corporate business planning. Additionally, reflects on the key motivational factors leading to the adoption of environmental policies, and comments on the nature of those influences. The key findings show that UK companies recognize the environment is an issue, but that the degree of importance attached is based on a variety of factors, resulting from unique corporate perceptions of opportunity and threat. Companies are generally concerned with meeting legal compliance levels and obtaining cost saving, without undertaking high levels of investment. Some companies are, however, seeking to become environmental managers, having identified the existence of opportunities for achieving competitive advantage.

Background Long non-coding RNAs (lncRNAs) comprise a diverse class of transcripts that can regulate molecular and cellular processes in brain development and disease. LncRNAs exhibit cell type- and tissue-specific expression, but little is known about the expression and function of lncRNAs in the developing human brain. Furthermore, it has been unclear whether lncRNAs are highly expressed in subsets of cells within tissues, despite appearing lowly expressed in bulk populations. Results We use strand-specific RNA-seq to deeply profile lncRNAs from polyadenylated and total RNA obtained from human neocortex at different stages of development, and we apply this reference to analyze the transcriptomes of single cells. While lncRNAs are generally detected at low levels in bulk tissues, single-cell transcriptomics of hundreds of neocortex cells reveal that many lncRNAs are abundantly expressed in individual cells and are cell type-specific. Notably, LOC646329 is a lncRNA enriched in single radial glia cells but is detected at low abundance in tissues. CRISPRi knockdown of LOC646329 indicates that this lncRNA regulates cell proliferation. Conclusion The discrete and abundant expression of lncRNAs among individual cells has important implications for both their biological function and utility for distinguishing neural cell types.