The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus.

OBJECTIVE We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. METHODS An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* = 0 indicating excellent agreement and vr* = 1 indicating poor agreement). RESULTS The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019-0.033). CONCLUSIONS This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.

Leaving Home: Philo of Alexandria on the Exodus.

For Jewish-Hellenistic authors writing in Egypt, the Exodus story posed unique challenges. After all, to them Egypt was, as Philo of Alexandria states, their fatherland. How do these authors come to terms with the biblical story of liberation from Egyptian slavery and the longing for the promised land? In this chapter I am taking a close look at Philo’s detailed discussion of the Exodus and locate it within the larger context of Jewish-Hellenistic literature (Wisdom of Solomon, Ezekiel’s Exagoge). In Philo’s rewriting of the Exodus the destination of the journey is barely mentioned. Contrary to the biblical narrative, in the scene of the burning bush, as retold by Philo, God does not tell Moses where to go. Philo’s main concern is what happens in Egypt: both in biblical times and in his own days. The Exodus is nevertheless important to Philo: He reads the story allegorically as a journey from the land of the body to the realms of the mind. Such a symbolic reading permitted him to control the meaning of the Exodus and to stay, literally and figuratively, in Egypt.