Uniontown Hospital Radiation Oncology

Shoulder pain secondary to impingement of the rotator cuff tendons underneath the coracoacromial arch is a common problem seen in athletes who perform repetitive overhead activities. Shoulder impingement has been classified into primary and secondary types. Several factors contribute to impingement, including rotator cuff weakness, posterior capsule tightness, and subacromial crowding. Recently, it has been proposed that scapulothoracic muscle weakness could be a factor that contributes to impingement. Traditional rehabilitation protocols for shoulder impingement syndrome stress individualized rotator cuff strengthening. The authors propose that individualized scapulothoracic muscle strengthening should be a part of any protocol for nonoperative treatment of secondary shoulder impingement syndrome.

We recovered an unusual bacterial strain from blood or sputum of three patients with septicemia, endocarditis, and/or respiratory failure. The three isolates were thin, curved, gram-negative, light brown, pigment-producing bacilli with variable catalase activity. They were asaccharolytic, oxidase-negative, nonmotile, and fastidious. Identification was not possible on the basis of these characteristics alone or in combination with cellular fatty acid profiles. Nucleic acid amplification and sequence analysis of the 16S rRNA gene revealed that all three isolates were identical and most closely related to the emerging pathogen Bordetella holmesii, diverging from the published sequence at three nucleotide positions (99.8% similarity). Isolation of a B. holmesii-like pathogen from sputum suggests that, in addition to producing septicemia, the organism may inhabit the respiratory tract like other Bordetella species.

Patient, Miss G., aged forty-nine, white, weighing about ninety pounds, employed as a matron at city comfort station. Referred by Dr. J. G. Hemington for X-ray examination of chest, July 3, 1924. Chief complaint: Shortness of breath upon slight exertion or when in a crowd. First noticed this condition persisting following an attack of influenza and congestion of lungs in January, 1921. Had pleurisy of left side in March, 1924, and was sick about ten days. Had pleurisy of left side again in June, 1924, and was in bed this time about a week. There has been no loss of weight. Appetite always poor, tires very easily. No history of tuberculosis or malignancy in the family. Blood Wassermann negative. Patient was poorly nourished, of a sallow, muddy complexion, and slow in speech and movement. Roentgen-ray findings July 3, 1924: Dense, sharply outlined spherical mass, measuring about 12½ cm. in diameter, located at base of left posterior chest between the levels of the fifth rib and the eleventh interspace. It shows no evidence of invading the remaining parts of the chest and appears to be arising from the left side of the vertebral border of the chest cavity. Fluoroscopically it is fixed, does not move with respiration, does not pulsate, nor does it displace the heart shadow. The lung appears to glide about it with respiration. Conclusions: Cyst of left chest attached to left side of spinal column. Patient was re-examined July 14, 1924, eleven days after the first examination, and condition was unchanged. She was again examined on January 17, 1925, practically six months after the first examination, and there was no perceptible change in the size or shape of the mass. Following this third X-ray examination the patient was referred to Dr. F. S. Morris, of the Homeopathic Hospital, Pittsburgh, Pa., for operation. Pathological diagnosis made by Dr. J. G. Wurtz, Pathologist of the hospital: Sub-pleural fibrolipoma. This diagnosis was confirmed by members of the Clinical-Pathological Society of Pittsburgh, when the tumor, X-ray films, and microscopic sections were shown at a recent meeting. Six months following the operation, radiograms of the chest showed resection of the sixth, seventh, eighth and ninth ribs at the posterior angle on the left side, with no evidence of the previously existing tumor, lungs and mediastinum being normal. Patient, however, showed no increase in weight and her general physical appearance was unchanged. The writer wishes to express his appreciation to Dr. J. G. Hemington, of Uniontown, Pa., for the privilege of reporting this case, and also to Dr. E. H. Pond, Radiologist of the Pittsburgh Homeopathic Hospital, for supplying him with a copy of the pathological findings.

The surgical repair of transmalleolar fractures commonly involves reduction and internal fixation of the boney injuries. In the absence of extreme syndesmotic disruptions, little attention has been given in the recent literature to the role of the syndesmosis in general or to the anterior inferior tibiofibular ligament (AITFL) in particular in preserving the stability of the ankle mortise. In this paper, the author describes a surgical approach to evaluate and repair AITFL ligament injuries in transmalleolar ankle fractures. A significant portion of these injuries are associated with an avulsion of the tibial or fibular insertion resulting in an intra-articular fracture in the distal tibiofibular joint which may not be apparent on plain x-rays. Direct visualization of the injury allows accurate assessment of the injury pattern and obviates the need for more costly imaging studies such as computed tomography and magnetic resonance imaging scans. Anatomic repair of the AITFL injury restores the stability of the ankle mortise and improves the stability of the bone repair, allowing for early return to functional exercises and activities. Syndesmotic screw fixation of transmalleolar ankle fractures was not necessary when the AITFL was repaired directly by the techniques described.

The Specificity of the Test for Alcohol in Body Fluids Get access H. A. Heise H. A. Heise Uniontown Hospital, Uniontown, Pennsylvania Search for other works by this author on: Oxford Academic Google Scholar American Journal of Clinical Pathology, Volume 4, Issue 2, 1 March 1934, Pages 182–188, https://doi.org/10.1093/ajcp/4.2.182 Published: 01 March 1934

Extramedullary hematopoiesis associated with fibrosis is found frequently in the liver and spleen, but seldom in other organs. Acute abdomen due to extramedullary hematopoiesis has been reported in two patients with intestinal obstruction because of heavy infiltration of the terminal ileum. This report describes the case of a 71-year-old woman with myeloid metaplasia involving the gallbladder mimicking acute cholecystitis. As far as we know, involvement of the gallbladder by extramedullary hematopoiesis has never been reported before.

Journal Article Democracy and Catholicism in America, by Currin V. Shields Get access Democracy and Catholicism in America. By Currin V. Shields. New York, London, Toronto, McGraw-Hill Book Co., Inc., 1958.—ix, 310 pp. $5.00. Edward Dumbauld Edward Dumbauld Uniontown, Pa. Search for other works by this author on: Oxford Academic Google Scholar Political Science Quarterly, Volume 74, Issue 1, March 1959, Pages 140–142, https://doi.org/10.2307/2145954 Published: 15 March 1959

Abstract Understanding how entrepreneurs secure venture-related knowledge during the preoperational stage is a rarely studied aspect of entrepreneurship research. Our premise is that entrepreneurs will rely on discretion and use secrecy with advisors who are close friends and family. They will trust these advisors not to disclose shared knowledge with others. We also propose that they will use non-disclosure agreements(NDAs) with those they are not so familiar with, such as business associates and professional consultants. Drawing on the social capital perspective, we use interviews with 52 high-tech entrepreneurs to examine their use of NDAs with their advisors. Our results show that entrepreneurs’ trust in advisors significantly impact the choice of knowledge security mechanisms during the preoperational stage.

1Uniontown Hospital Uniontown, Pennsylvania Reprint requests and correspondence: T. C. Chauhan, MD, Unidade de Figado, Uniontown Hospital, Uniontown, PA 15401 Received April. 3, 1998; accepted March. 20, 1999

In 1902, Kinnicutt, after a careful search of the literature, was able to find only six cases in which a positive diagnosis of pancreatic lithiasis was made or suspected during life. Sistrunk, in 1921, reported four cases of pancreatic stone in which operation had been performed at the Mayo Clinic. Seeger, in 1925, after an extensive search of the literature, reported finding 100 cases, one of which was his own. He reviewed the literature and analyzed the symptoms in 22 of these cases. Pain was of a variable character, constant, intermittent or colicky, with radiation in various directions. Glycosuria occurred only twice, and, as others have found it more frequently, Seeger considered it a late complication. Jaundice was not uncommon. He emphasized the difficulty of making a diagnosis, even after exploration. In three cases the roentgen ray revealed the calculi. Hartman, in 1925, summarized the symptoms of the 22 cases abstracted by Seeger and Sistrunk as follows: Pain was not mentioned in three cases, was noted as absent in two, mentioned in six, called severe in ten. It radiated to the back in nine and was localized in the epigastrium or hypochondriac areas with one exception, when it occurred in the left lateral area, with downward radiation. Jaundice was not spoken of in six, absent in nine, very severe in three, and was noted as present in seven. Gallstones were not mentioned in five, were noted as absent in fourteen, and present in three. Glycosuria was present in two, noted as absent in fifteen, and not mentioned in five. Weight loss was not mentioned in fourteen, noted as moderate in five, and as marked in three. Vomiting occurred in only two cases. Since Sistrunk's report in 1921 there have been four cases of pancreatic stone demonstrated at operation at the Mayo Clinic. Five other cases were suspected clinically but were not confirmed by operation or X-ray. Case Report Patient was white male, aged 40, who was referred for X-ray examination of gastro-intestinal tract March 1, 1923, with the following history. Attacks of indigestion for past four or five years. These attacks consisted of very severe, sharp, cutting pains in the pit of the stomach, going through to the back and accompanied by vomiting and gaseous distention, the latter being especially distressing after eating. Bowels always regular. In the patient's past medical history he had had pneumonia in 1911, recovering with no complications. At the age of 19 he had had typhoid fever but made an uneventful recovery, with no sequelæ. As to his family history, his father and mother are living and well, one sister living and well; first wife died of pulmonary tuberculosis, leaving two children, who, although not robust looking are apparently healthy.

Abstract This article traces changing images of the prostitute in nineteenth-century Canada to show that the "prostitute" was always imaged as the rhetorical antithesis of the Ideal Woman. When the latter was constructed as "saint," the prostitute was a "fallen angel." Images of Ideal Woman as saint or coequal led to reconstruction of her antithesis as victim. Later redefinition of Ideal Woman as "protected wife" led to reframing of the prostitute as "white slave." Final reconstruction as "nurturing mother" encouraged redefinition of the prostitute as a "physiological pathology." Additional informationNotes on contributorsRichard A. Ball RICHARD A. BALL is currently Program Head of Administration of Justice at Penn State— Fayette. He received his Ph.D. from the Ohio State University and formerly chaired the Department of Sociology and Anthropology at West Virginia University, where he also served as Director of the Studies in Crime and Justice Program. His research interests include deviant behavior, white collar crime, sociology of law, and sociology of consciousness.

The Myelodysplastic Syndromes (MDS) are a group of hematologic disorders that resemble hematologic malignancies but are often treated much differently. These syndromes result from a clonal disorder of certain stem cells in the bone marrow. Treatment can range from simple supportive care to new and innovative approaches such as immunotherapy. In general, treatment is dictated by the severity of the presenting disease. Oncology nurses, because of their familiarity with the manifestations of cancer, are particularly qualified to intervene for the patient and family experiencing MDS. Nursing interventions, based on a firm understanding of the underlying disease, include patients and family education. In addition, emotional support and symptom management are important nursing roles.

Menopause: January 2009 - Volume 16 - Issue 1 - p 216 doi: 10.1097/gme.0b013e31818fc38f

Abstract Background: Pulmonary rehabilitation (PR) is a comprehensive intervention and essential component for integrated care with patients with chronic respiratory diseases, especially Chronic Obstructive Pulmonary Disease (COPD). American Thoracic Society (ATS) strongly recommends PR for patients with COPD after exacerbation. PR has been shown to reduce mortality, improve quality of life, and decrease hospital readmissions in patients with COPD. Despite these benefits, access to PR remains unevenly distributed, particularly among racial and ethnic minorities. This study explores racial and ethnic disparities in PR utilization among COPD patients with a history of exacerbations. Methods: Utilizing data from the TrinetX Research Network, we examined two cohorts of COPD patients. Cohort 1 (N=493) consisted of patients with COPD and prior exacerbations who received PR, while Cohort 2 (N=457,573) included similar patients who did not receive PR. Demographics, specifically, race and ethnicity, were statistically analyzed to assess the presence and significance of disparities, using chi-square tests and standardized mean differences (SMD) to provide a comparative framework.Results:493 patients were in the PR group and 457,573 patients in the non-PR group, comprising 458,066 patients across both cohorts. Among the 493 patients in the PR cohort, the largest group was categorized as Other Race (192 patients, 38.9%, p < 0.001, SMD = 1.040), followed by White patients (154 patients, 31.2%, p < 0.001, SMD = 0.899). Black or African American and Asian patients were both minimally represented, with 10 patients each (2.0%, p < 0.001, SMD = 0.319 and SMD = 0.034, respectively), while 137 patients (27.8%, p < 0.001, SMD = 0.349) were of Unknown Race. In contrast, the non-PR cohort, comprising 470,239 patients, had a substantially higher proportion of White patients (330,409 patients, 72.2%) and a significantly greater representation of Black or African American individuals (42,573 patients, 9.3%, p < 0.001, SMD = 0.319) and Hispanic or Latino individuals (13,709 patients, 3.0%, p < 0.001, SMD = 0.249) compared to the PR cohort. Conclusion: This study highlights significant disparities in the utilization of PR among COPD patients, with underrepresented racial and ethnic groups demonstrating lower access to this intervention. These findings highlight the need for targeted strategies to address potential barriers to PR, promoting equitable access across diverse populations. Further investigation into structural and socioeconomic factors influencing PR access will be crucial to fostering inclusive care and reducing healthcare disparities in COPD management.

Abstract Background Obesity contributes to worse symptoms and exacerbations in chronic obstructive pulmonary disease (COPD). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve weight and metabolic profiles and have emerging pulmonary benefits. However, their real-world impact on respiratory outcomes in patients with COPD and obesity is not well established. Research Question Among obese adults with COPD, is GLP-1 RA use associated with reduced risk of COPD exacerbations, acute respiratory failure, and all-cause mortality compared with those not receiving GLP-1 therapy? Methods We conducted a retrospective, propensity-matched cohort study using the TriNetX U.S. Collaborative Network. Adults aged ≥40 years with COPD (ICD-10 J44) and BMI ≥30 kg/m² were included. The exposed cohort comprised patients prescribed GLP-1 RAs (lixisenatide, albiglutide, dulaglutide, liraglutide, semaglutide, or exenatide), while comparators had no exposure. The index event was the first date meeting inclusion criteria. Outcomes were analyzed beginning 180 days after index to minimize reverse causation, excluding those with prior events. Propensity score matching (1:1) balanced demographics, comorbidities, laboratory data, and medication use, yielding 2,795 patients per group. Primary outcomes included the risk (≥1 event within window) of COPD exacerbation, acute respiratory hypoxic and/or hypercapnic failure leading to hospitalization, and all-cause mortality. Risk difference (RD), risk ratio (RR), and odds ratio (OR) were calculated; Kaplan-Meier and log-rank testing assessed time-to-event. Results After matching, baseline characteristics were well balanced. GLP-1 RA use was associated with significantly lower risk across all outcomes:COPD Exacerbation (J44.1): 18.2% (No GLP-1) vs 11.2% (GLP-1); RD 7.0%, RR 1.63 (95% CI 1.36-1.94); p = 0.042.Acute Hypoxic and/or Hypercapnic Respiratory Failure (J96.x): 19.2% vs 11.5%; RD 7.7%, RR 1.67 (1.42-1.96).All-Cause Mortality: 14.6% vs 7.6%; RD 7.0%, RR 1.92 (1.64-2.25); p = 0.010. Kaplan-Meier survival analysis demonstrated significantly improved survival in the GLP-1 group for mortality and COPD exacerbation outcomes. Conclusions In obese adults with COPD, GLP-1 RA therapy was associated with clinically and statistically significant reductions in COPD exacerbations, acute respiratory failure, and all-cause mortality. These findings suggest that GLP-1 RAs may offer dual metabolic and pulmonary benefits and warrant evaluation as adjunctive therapy in future prospective trials. This abstract is funded by: None

The Friedman (1939) test for pregnancy has the minor disadvantages that skill is required for the intravenous injection into the ear vein of the rabbit and that some 3 % (Albert, 1949; Evans and Krajian, 1944) of urine samples are toxic to the rabbit if injected intravenously. Ducey (1950) overcame some of these difficulties by injecting urine subcutaneously in doses of 20 to 30 ml. in the loose skin between the scapulae. Using this subcutaneous technique the large, subcutaneous bulge of injected urine, and the not inconsiderable amount of squirming of the test animal while the urine was being injected, were striking disadvantages. Toxic manifestations were not unknown with the subcutaneous technique, especially if the urine was old and some-what contaminated. Friedman and Lapham (1931) found that by doubling the minimum effective dose they could produce strongly positive results, i.e., more than six corpora haemor-rhagica in both ovaries. Ducey (1950) found, too, that the minimum effective dose by subcutaneous injection was twice that needed for positive results by intravenous injection.

Nurses working in union and community health clinics have pioneered the development of the independent nurse practitioner role. One of those pioneers offers her views on future directions for practice nurses.

Abstract Background and aims Routine post-intravenous thrombolysis (IVT) transfer of acute ischemic stroke patients to comprehensive stroke centers strains rural healthcare systems. A regional telestroke network may enable stroke-ready community hospitals to act as hubs for post-IVT monitoring of patients from smaller critical access facilities. Methods This retrospective cohort study evaluated transfer patterns before and after implementing a tiered retention protocol in a West Virginia telestroke network. Interventions included hub designation of community hospitals, evidence-based retention criteria for low-risk patients, staff education with 24/7 telestroke support, standardized monitoring, and explicit transfer triggers. Primary outcome was reduction in transfers to the comprehensive stroke center. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) and in-hospital mortality. Results Annual transfers to the comprehensive stroke center averaged 143.7 during the pre-intervention period (144 in 2022, 148 in 2023, 139 in 2024). Post-implementation, transfers decreased to 62 in 2025, representing a 56.8% reduction. Over the four-year study period (2022-2025), 297 patients received IVT and remained at community hospitals. Among retained patients, sICH occurred in 1/297 (0.34%), and in-hospital mortality was 1/297 (0.34%). Estimated direct cost savings were $3,000 per averted transfer, primarily from reduced air ambulance utilization. Additionally, an estimated $15,000 in revenue per retained patient remained within community hospitals, supporting local stroke program development and sustainability. Conclusions This regional hub-and-spoke model enabled selective retention of low-risk post-IVT patients, achieving a 57% reduction in transfers while maintaining exceptional safety outcomes. This approach kept care closer to home for rural patients, optimized limited resources, and is readily replicable in other rural systems. Conflict of interest None of the authors have anything to disclose.

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An introduction to the study of groups