bluuebunny/crossref_metadata_2025 huggingface dataset:
Secretary, Colleague, and Friend of Jean-Martin Charcot
Authors: Walusinski Olivier
Published: January 2019

The unpublished letters presented in this chapter, from Georges Gilles de la Tourette’s teacher Jean-Martin Charcot to Gilles de la Tourette, provide insight into the daily workings of Charcot’s famous La Salpêtrière department in the famous Parisian hospital. Charcot engaged a secretary to help him in his practice, and in 1887 he selected Gilles de la Tourette for this coveted post. By providing evidence of an exchange between the teacher and his student regarding hypnotism and hysteria, these letters also elucidate the quarrel between the Nancy and Salpêtrière Schools, especially during a famous trial, the Gouffé affair. Charcot’s esteem for and trust in Gilles de la Tourette are manifest.
Glimpses of Gilles de la Tourette’s Personality
Authors: Walusinski Olivier
Published: January 2019

Using unpublished letters as well as press excerpts, the author examines Gilles de la Tourette’s relationships with hospital administrators and journalists, which provide insight into his personality. Responding to an unfortunate case sensationalized by the press, Gilles de la Tourette aggressively defended his reputation while also revealing cognitive difficulties that would worsen over time. Starting in 1893, Gilles de la Tourette’s behavior gradually changed, a sign of syphilitic general paralysis. The chapter presents previously unpublished letters that he sent to the administrators of his hospital, where he was in charge of a department and describes his reaction to a slanderous press campaign. In addition to Gilles de la Tourette’s condition, the new documents elucidate the state of Parisian hospitals and the challenges of hospital physicians at the end of the nineteenth century.
Hypnotism and Analogous States
Authors: Walusinski Olivier
Published: January 2019

Among the many writings of Gilles de la Tourette, his book L’hypnotisme et les états analogues was the most successful, with two editions and translations in German and Italian. After brilliantly introducing the history of the discovery of this trance state, Gilles de la Tourette described the studies undertaken by the Salpêtrière School on hypnotism and its use for hysteria. Supporting his arguments with evidence, he claimed it was necessary to consider the practice of hypnosis as a medical therapy and to prohibit its uncontrolled use by non-physicians, notably healers and entertainers. A few of the clinical cases covered are analyzed parallel to the writings of other alienists at that time, such as Paul Sollier and Alfred Maury. Gilles de la Tourette’s hidden debt to Alexandre Cullere is at last brought to light.
The Pediatric Airway
Authors: Clark Lowell , Tomek Stephen
Published: January 2019

The practice of procedural sedation involves the use of medications that alter upper airway function and patency because of myoneural suppression of anatomic airway elements. It is the specific responsibility of the sedationist to ensure upper airway patency during conditions induced by pharmaceuticals in which the airway is almost certain to be threatened, if not totally obstructed. Soft tissue collapse during inspiration is modeled by the Starling resistor. Airway protective reflexes may be profoundly disturbed during deep sedation. The sedationist’s knowledge of the anatomy and physiology of the upper airway and proficiency in clinical application of airway supportive principles are essential.
Presedation Preparation
Authors: Mack Elizabeth , Vidrine Rhea
Published: January 2019

Procedural sedation is associated with potential complications generally involving airway obstruction or hypoxemia that if not properly managed may lead to temporary or permanent harm to the patient. Equipment necessary to deal with these common complications and a checklist approach to ensuring the presence of this equipment are discussed here.
Urgent Sedation (Unscheduled Procedural Sedation) in the Emergency Department
Authors: Jackson Benjamin F. , Pifko Elysha
Published: January 2019

The emergency department (ED) commonly manages patients who require urgent/emergent painful or anxiety-provoking diagnostic or therapeutic procedures. Safe, appropriate, high-quality procedural sedation/analgesia (PSA) is an essential aspect of ED care of pediatric patients that increases the likelihood of procedural success and improves overall patient satisfaction. Emergency Medicine physicians are trained to stratify the risks and benefits of PSA and to manage any complications. Important factors to consider prior to PSA in the ED include patient selection, procedural complexity, procedural urgency, necessary personnel, and pharmacologic options. In general, performing simple procedures with few anticipated complications on patients with favorable cardiorespiratory anatomy and physiology without prior sedation complications is the ideal situation for PSA in the ED.
Intravascular Access
Authors: Fine Jenna , Nwokorie Ndidi , Lowrie Lia H.
Published: January 2019

Vascular access is necessary for routine and emergent care of patients for delivery of fluids and medications. The vascular access devices (VADs) discussed here include peripheral intravascular catheters, intraosseous needles, peripherally inserted central catheters (PICC lines), and central venous catheters. VAD insertion can be painful and frightening for children, and their inherently smaller anatomy may also make the procedure more challenging. Children often require behavioral modification as well as medications to control pain and anxiety in order to tolerate placement of VADs. The sedationist must have a good knowledge of the demands of the procedure, the patient’s level of cooperation and cognitive ability, and pharmacologic resources available to aid in the performance of the procedure.
Regulatory Issues
Authors: Sturm Jesse J. , Connors Jerard (Mick)
Published: January 2019

Under current Center for Medicare and Medicaid Services (CMS) regulations, hospitals are responsible for establishing policies and procedures that differentiate anesthesia from analgesia/sedation. They are also responsible for determining the qualifications for practitioners who administer sedation based on nationally recognized guidelines. CMS regulations require the anesthesia service in CMS-certified hospitals to develop hospital policies and procedures governing the provision of all categories of anesthesia services, including specifying the minimum qualifications for practitioners permitted to provide procedural sedation. Additional regulatory bodies such as state survey agencies, which may include departments of health and accrediting organizations, follow CMS interpretive guidelines to determine a facility’s compliance with the Medicare Conditions of Participation. State laws, health department requirements, professional boards, accrediting organization standards, and facility bylaws and policy may exceed CMS requirements.
Management of the Difficult Airway in the MRI Suite
Authors: Mathews Letha , Lane Jason
Published: January 2019

Management of the difficult airway is common problem anesthesiologists experience every day. From management of the morbidly obese patient, to the patient with severe facial trauma, anesthesiologists are the go to physicians in a hospital when it comes to airway management. With the expansion of nonoperating room anesthesia case volume throughout the world, airway management now brings unique challenges never before experienced by the anesthesiologist. This chapter uses the case study of a 67-year-old morbidly obese male with obstructive sleep apnea, claustrophobia, and known difficult airway who is scheduled to undergo brain magnetic resonance imaging for evaluation of new-onset seizures.
Anesthesia for Mastectomy with Autologous Flap
Authors: Nada Eman
Published: January 2019

Mastectomy is performed for treatment of breast cancer or for prophylaxis of high-risk patients. The procedure is usually done under general anesthesia with or without regional analgesia. Reconstructive flap surgery is done to improve the quality of life. Autologous flaps provide better cosmetic and better longer term results than synthetic grafts. Common autologous flaps are transversus abdominis myocutaneous, deep inferior perforator epigastric perforator, and latissimus dorsi flap. Anesthesia plays an important role in the success of surgery. The procedure is long and needs meticulous attention to hemodynamics and maintenance of the flap perfusion which can be challenging. Chronic pain is common after mastectomy procedures; regional anesthesia together with other pharmacological analgesic therapy helps to reduce the development of chronic pain.
Acute Intraoperative Blood Loss in a Jehovah’s Witness—Medical, Ethical, and Legal Issues
Authors: Kcomt Myrna
Published: January 2019

The objective of this chapter is to explore the medical, ethical, and legal problems that arise when providing an anesthetic to a Jehovah’s Witness (JW) patient. The first part of the chapter consists of a stem case and key questions. The second part provides an overview of ethical principles, legal history, and considerations that a physician anesthesiologist should have knowledge of to give optimal patient care. Techniques that anesthesiologists may use on a JW patient who refuses blood transfusion are clearly delineated in the chapter. The remainder of the chapter consists of board type questions. Medical, ethical, and legal issues challenge the anesthesia treatment of a JW. It is to the advantage of both the JW patient and everyone in the medical community to be better informed and educated about the latest therapies and help available for JW patients.
Preeclampsia Problem-Based Learning Discussion
Authors: Reddy Shamantha , Spitzer Yelena
Published: January 2019

This chapter is a problem based learning discussion about the hypertensive diseases in pregnancy and describes incidence, risk factors, etiology, prevention and treatment of the disease. The chapter discusses risk factors for preeclampsia, the etiology and pathogenesis of preeclampsia; prevention of preeclampsia; management of preeclamptic patients; treatment of hypertension in pregnancy; eclampsia prevention and treatment; anesthetic management, including general anesthesia, of the preeclamptic patient; invasive monitoring in the preeclamptic patient; and management of HELLP syndrome. The chapter uses the case study of a 32-year-old woman at 39 weeks gestation who presents to the labor floor with headache, blurry vision, and abdominal pain for 1 day.
Integrative Nursing Management of Sleep
Authors: Cuellar Norma G.
Published: January 2019

Sleep, either too much or not enough, has been shown to increase mortality and morbidity when associated with chronic health conditions. The importance of sleep assessment and management in acute and chronic health conditions has been highly underrepresented and ignored as a health indicator. This chapter describes an integrative approach to sleep assessment, including commonly used measures and biomarkers. Evidence supports the use of integrative approaches to facilitate restful, high-quality sleep that can not only improve health outcomes but can also improve quality of life in persons across the lifespan.
Integrative Nursing Management of Intestinal Disturbances
Authors: Lacasse Cheryl , Mueller Kelly
Published: January 2019

Disturbances of the intestinal system are common across all populations and range from short term, self-limiting alterations in normal function to long-term alterations that have a major impact on overall health and wellbeing. This chapter reviews two of the most common intestinal disturbances—constipation and diarrhea. A comprehensive overview of each symptom provides a physiologic basis for understanding constipation and diarrhea. The discussion of each symptom includes key assessment data that provides a person-centered view of the symptom. In addition, in-depth, evidence-informed information on interventions is discussed. Both key assessment data and interventions are based on an integrative nursing approach to care. The chapter concludes with a complex case study that applies principles of integrative nursing and evidence-informed principles to assessment and treatment of an individual with intestinal disturbances.
Integrative Nursing in Germany
Authors: Ammende Rainer , Tewes Renate
Published: January 2019

This chapter focuses on the practice of integrative nursing in Germany. The rich heritage of integrative nursing concepts is highlighted, and the present use of several of these modalities is described. Hildegard von Bingen experimented in medieval times with herbs and developed many recipes and special diets to treat illnesses. Rosen Bodywork is a treatment and relaxation method that includes bodywork, breathing, and movement. Another method is aromatherapy, in which scents and essential oils are used for room ventilation, massage, bed baths, applications, and herbal packs. Other methods discussed are Kneipp hydrotherapy, basal stimulation, Neuro-Development Treatment by Bobath, Anthroposophical Nursing, and Therapeutic Touch. A short statement of expected developments ends the chapter.
Controversies About Rates of Post-Traumatic Stress Disorder in U.S. Vietnam Veterans
Authors: Dohrenwend Bruce P. , Turner J. Blake , Turse Nick , Adams Ben G. , Koenen Karestan C. , Marshall Randall
Published: January 2019

This chapter reexamines past estimates that 30.9% of veterans had developed PTSD during their lifetimes and that 15.2% were currently suffering from PTSD. The 1988 National Vietnam Veterans Readjustment Study (NVVRS) of a representative sample of 1,200 male veterans also found a strong dose–response relationship: as retrospective reports of combat exposure increased, PTSD occurrence increased. Skeptics have argued that these results are inflated by recall bias and other flaws. This chapter uses military records to construct a new exposure measure and to cross-check exposure reports in rigorous diagnoses of a subsample of 260 veterans. It finds little evidence of falsification, an even stronger dose–response relationship, and psychological costs that were lower than previously estimated but still substantial: 18.7% of the veterans had developed war-related PTSD during their lifetimes, and 9.1% were currently suffering from PTSD 11–12 years after the war.
The Value of Statistical and Logical Thinking
Authors: Montgomery Erwin B.
Published: January 2019

There is a perception that intuition, held important in some forms of medical reasoning, is somehow different from “scientific” medical reasoning. Such intuitions are arrived at quickly, suggesting no need to think about it as one might do in a logical deduction. Furthermore, intuitions typically are qualitative or ordinal in nature rather than cardinal if numbers are applied. Consequently, there is the presumption that statistics are not applicable in this form of medical reasoning, perhaps because numerical rules cannot be applied. However, the rules that guide statistical reasoning are not only numerical, they also arise from having to deal with necessary logical fallacies, such as the partial syllogism. Efforts to mitigate the risks of having to use logical fallacies find their way into the rules of statistical inference. However, these same efforts can be applied to nonnumeric analysis, such as intuition itself: hence their value.
The Role of Metaphor
Authors: Montgomery Erwin B.
Published: January 2019

Metaphor use in medical decisions and research is ubiquitous. Use of treatments for “off-label” indications follows as a metaphor to approved indications. Fundamentally, reasoning from a sample of patients in a clinical study to an individual patient is a form of metaphor. Hypothesis generation for hypothetico-deduction medical decisions and for the scientific method often arises from metaphors. However, metaphors are the Fallacy of Pseudotransitivity, which risks the Fallacy of Four Terms. The associated risks can be estimated from the epistemic risk in terms of epistemic distance and epistemic degrees of freedom. Metaphors can be nonlinguistic, and a particular form is the process metaphor. The source domain to explicate the target domain is a process that may never be fully realized, and thus the certainty of the metaphor stems from the process itself. Examples of process metaphors include allopathic reductionism, scientific reductionism, the Large Number Theorem of statistics, and others.
Choices of illness narratives in practice
Authors: Meyer Thorsten , Xyländer Margret
Published: January 2019

This chapter examines how which cases and parts of illness narratives are selected for a specific use in practice. It takes the perspective of qualitative researchers and apply ideas of sampling and generalizability to this question. It discusses the different types of sampling strategies in qualitative research and the relevance of each towards making generalization statements. It then reflects on the different roles that qualitative researchers might take in using illness narratives in practice, including the roles of agency or that the media might take. In light of these perspectives this chapter argues that decisions on how illness narratives are selected should be guided by the same rigour used in the conduct of a qualitative study. In short, criteria for their selection should be explicit and transparent.
Narratives in decision aids
Authors: Shaffer Victoria A. , Zikmund-Fisher Brian J.
Published: January 2019

This chapter maintains that while narratives should be used carefully in health communication, arguments in favour of their use outweigh concerns. The use of narratives in patient decision aids is controversial because of their persuasive power, ability to bias medical decisions, and tendency to proliferate the spread of misinformation. However, this chapter argues that: 1) didactic and statistical information alone are not enough to combat major public health issues; 2) narratives are also an important way that people make sense of data; and 3) narratives provide important contextual information that is essential for decision making. This chapter provides a blueprint for how narratives should be used in public health communications and discusses which narratives would be most efficacious. Finally, this chapter makes the case for a new, integrative model that respects the complementary roles of both data and narrative communications in the design of health communications.
Illness narratives as evidence for healthcare policy
Authors: Law Susan , Ormel Ilja , Loutfi David , Lavis John
Published: January 2019

Individual narratives about patient/family experiences of illness, and needs for information and support, can exert a powerful influence on policy formulation, particularly when a sensational story captures the attention of the media or general public. In this chapter, we situate the use and potential value of the narrative evidence within the messy world of policy making when trying to privilege evidence that brings diversity of voice and experiences on a topic, rather than individual stories. We explore the challenges associated with this type of experiential evidence, and the gap in translating such evidence to decision makers. We argue that both researchers and policy makers would benefit from a deeper understanding of each other’s worlds, and present examples of strategies to bridge this gap. We conclude by offering advice for policy makers regarding communication of their needs for experiential evidence, and advice for qualitative researchers regarding the translation of narrative-based findings for policy.
Collecting information
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Collecting accurate and comprehensive information both direct from the participants, or indirectly from records or other data is one of the major challenges to a successful epidemiological study. Epidemiological information comes from a variety of sources. These may be conveniently divided into those that are available from previously documented data and those that require the gathering of new information. Examples of the former include extracting information about individuals from their medical records, occupational records, and similar data sources. Design and choice of delivery of patient data capture forms by direct interview or telephone, by post, email, or other electronic means all require considerable thought and pilot testing. Attention to the specific wording of certain questions is crucial. This chapter therefore focuses on the issues surrounding the collection of information that otherwise would not be available: primary data collection.
Feasibility and pilot studies
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

Designing a study ‘on paper’ is no guarantee it will work; for example, individuals agree to be recruited or the method of data acquisition is acceptable and provides the data in the format and quality required. For this reason it is, especially when planning large/expensive studies, to test the feasibility of the different components in separate small-scale studies. Alternatively, or in addition it may be useful to do a pilot study, which reproduces the planned methods for the proposed full study, to test ‘the whole system’. A successful pilot study enhances the likelihood of grant success; indeed, grant-awarding bodies will often expect to see evidence that they have been conducted.
Reviews of evidence
Authors: Silman Alan J. , Macfarlane Gary J. , Macfarlane Tatiana
Published: January 2019

The preceding chapters have focused on the generation of scientific evidence using epidemiological studies. Here the emphasis is on bringing together evidence (evidence synthesis) to inform future research and health policies. The chapter considers levels and quality of scientific evidence and describes in detail how to conduct a systematic review. It reviews the ways of summarizing and evaluating evidence from epidemiological studies. Summary of evidence is needed in everyday clinical practice and for public health. We live in a time of information overload, and it is impossible to read all the available scientific journals, even on a narrow scientific topic. Simply using search terms such as ‘cancer’ will result in millions of results in Google Scholar or PubMed (a service of the US National Library of Medicine®) database. Given the ever-increasing volume of medical literature and time constraints, summary of evidence plays a big role in decision-making.
Meningitis and Encephalitis
Authors: Jha Ruchira
Published: January 2019

Central nervous system infections are frequently neurological emergencies with high rates of morbidity and mortality depending on the underlying etiology. They warrant rapid diagnosis and treatment. This chapter focuses on clinical aspects of meningitis and encephalitis including the epidemiology of common pathogens (bacterial, viral, fungal), diagnostic tools, clinical presentations, risk factors, and management. Atypical organisms such as Borrelia burgdoferi and Mycobacterium tuberculosis are also presented. General management principles for intracranial abscesses and subdural empyemas are briefly discussed. While there is exciting molecular research regarding genetic susceptibilities for various infections, as well as new microbiological techniques (such as MALDI-TOF, 16S-PCR) facilitating more rapid, sensitive and specific diagnoses, these details are beyond the scope of this chapter since they are not yet standard clinical tools and the reader is referred to additional references.
Management of Intracranial Hypertension in Fulminant Hepatic Failure
Authors: Kadir Sajid , Murugan Raghavan
Published: January 2019

Fulminant hepatic failure (FHF) leads to a spectrum of pathophysiologic derangements including multisystem organ failure, cerebral edema, intracranial hypertension, and cerebral herniation with associated high mortality. Orthotopic liver transplantation is currently the only definitive therapy that can improve outcome. The critical care physician must be familiar with the various monitoring tools and therapeutic strategies to support patients with FHF who develop intracranial hypertension. Methods of monitoring include electroencephalography, transcranial doppler, jugular venous oximetry, and intracranial pressure monitoring. Therapies to manage intracranial hypertension include propofol sedation, hypertonic saline, induced therapeutic hypothermia, and barbiturate coma. This chapter reviews the pathophysiology of intracranial hypertension including the multimodal neuromonitoring techniques and therapeutic strategies that are currently available in managing these patients in the critical care setting.
Brain Death, Organ Donation, and Transplantation
Authors: Wang Hilary H. , Greer David M.
Published: January 2019

This chapter reviews the history of brain death determination, current guidelines for performing the brain death examination including the apnea test, details of apnea testing, the role of brain dead donors in organ donation, physiologic changes seen in brain dead patients, and the relevant challenges in intensive care unit management of such patients for donor organ optimization. The goal of this chapter is to provide clear guidance for a critical care provider to perform an accurate and thorough brain death examination and to further the reader’s understanding of the historical and legal context surrounding brain death and organ donation in the United States.
Fungal immunology in clinical practice: Magical realism or practical reality?
Authors: Chang Christina C , Levitz Stuart M
Published: January 2019

Invasive fungal infections (IFIs) occur predominantly in immunocompromised individuals but can also be seen in previously well persons. The human innate immune system recognizes key components of the fungal cell wall as foreign resulting in a myriad of signaling cascades. This triggers release of antifungal molecules as well as adaptive immune responses, which kill or at least contain the invading fungi. However, these defences may fail in hosts with primary or secondary immunodeficiencies resulting in IFIs. Knowledge of a patient's immune status enables the clinician to predict the fungal infections most likely to occur. Moreover, the occurrence of an opportunistic mycosis in a patient without known immunocompromise usually should prompt a search for an occult immune defect. A rapidly expanding number of primary and secondary immunodeficiencies associated with mycoses has been identified. An investigative approach to determining the nature of these immunodeficiencies is suggested to help guide clinicians encountering patients with IFI. Finally, promising adjunctive immunotherapy measures are currently being investigated in IFI.
Lessons from the curious case of the ‘fastest’ star in Gaia DR2
Authors: Boubert D , Strader J , Aguado D , Seabroke G , Koposov S E , Sanders J L , Swihart S , Chomiuk L , Evans N W
Published: January 2019

Gaia DR2 5932173855446728064 was recently proposed to be unbound from the Milky Way based on the $-614.3\pm 2.5\, \mathrm{km}\, \mathrm{s}^{-1}$ median radial velocity given in Gaia DR2. We obtained eight epochs of spectroscopic follow-up and find a very different median radial velocity of $-56.5 \pm 5.3\, \mathrm{km}\, \mathrm{s}^{-1}$. If this difference were to be explained by binarity, then the unseen companion would be an intermediate-mass black hole; we therefore argue that the Gaia DR2 radial velocity must be in error. We find it likely that the spectra obtained by Gaia were dominated by the light from a star $4.3\, \mathrm{arcsec}$ away, and that, due to the slitless, time delay integration nature of Gaia spectroscopy, this angular offset corresponded to a spurious $620\, \mathrm{km}\, \mathrm{s}^{-1}$ shift in the calcium triplet of the second star. We argue that such unanticipated alignments between stars may account for 105 of the 202 stars with radial velocities faster than $500\, \mathrm{km}\, \mathrm{s}^{-1}$ in Gaia DR2 and propose a quality cut to exclude stars that are susceptible. We propose further cuts to remove stars where the colour photometry is suspect and stars where the radial velocity measurement is based on fewer than four transits, and thus produce an unprecedentedly clean selection of Gaia radial velocities for use in studies of Galactic dynamics.
Stereotactic Lesion in the Forel's Field H: A 2-Years Prospective Open-Label Study on Motor and Nonmotor Symptoms, Neuropsychological Functions, and Quality of Life in Parkinson Disease
Authors: Godinho Fabio , Magnin Michel , Filho Paulo Terzian , Reis Paul , Moraes Osmar , Nascimento Marivaldo , Costa Carlos , de Oliveira Maira Okada , Rocha Maria Sheila
Published: January 2019

BACKGROUND

Stereotactic lesion in the Forel's field H (campotomy) was proposed in 1963 to treat Parkinson disease (PD) symptoms. Despite its rationale, very few data on this approach have emerged. Additionally, no study has assessed its effects on nonmotor symptoms, neuropsychological functions and quality of life.

OBJECTIVE

To provide a prospective 2-yr assessment of motor, nonmotor, neuropsychological and quality of life variables after unilateral campotomy.

METHODS

Twelve PD patients were prospectively evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), the Dyskinesia Rating Scale and the Parkinson's disease quality of life questionnaire (PDQ39) before campotomy, and after 6 and 24 mo. Nonmotor, neuropsychiatric, neuropsychological and quality of life variables were assessed. The impact of PD on global health was also rated.

RESULTS

A significant reduction in contralateral rest tremor (65.7%, P < .001), rigidity (87.8%, P < .001), bradykinesia (68%, P < .001) and axial symptoms (24.2%, P < .05) in offmedication condition led to a 43.9% reduction in UPSDRS III scores 2 yr after campotomy (P < .001). Gait improved by 31.9% (P < .05) and walking time to cover 7 m was reduced by 43.2% (P < .05). Pain decreased by 33.4% (P < .01), while neuropsychiatric and neuropsychological functions did not change. Quality of life improved by 37.8% (P < .05), in line with a 46.7% reduction of disease impact on global health (P < .001).

CONCLUSION

A significant 2-yr improvement of motor symptoms, gait performance and pain was obtained after unilateral campotomy without significant changes to cognition. Quality of life markedly improved in parallel with a significant reduction of PD burden on global health.
Management of Iatrogenic Internal Carotid Artery Dissection and Middle Cerebral Artery Restenosis during Endovascular Treatment of Acute Stroke: Video Case
Authors: Vakharia Kunal , Waqas Muhammad , Munich Stephan A , McPheeters Matthew J , Levy Elad I
Published: January 2019

Iatrogenic dissection of the internal carotid artery (ICA) during endovascular approaches is challenging. This video illustrates a case of iatrogenic ICA dissection at the skull base during mechanical thrombectomy for M1 occlusion. This case was further complicated by post-thrombectomy M1 restenosis that did not improve with submaximal angioplasty. ICA dissection occurred while navigating the guide catheter into the distal cervical ICA over a 0.38 inch Glidewire (MicroVention-Terumo, Aliso Viejo, California). The dissection flap was crossed with a SofiaPlus intermediate catheter (MicroVention-Terumo), Velocity microcatheter (Penumbra, Alameda, California), and double-ended 0.18 inch wire. The M1 occlusion was crossed and treated with Solumbra technique by pulling a Solitaire stent-retriever (Medtronic, Dublin, Ireland) through a SofiaPlus aspiration catheter (MicroVention). Post-recanalization M1 stenosis was noted, which was believed to be due to underlying intracranial atherosclerotic disease because of the appearance of platelet aggregation instead of a typical vasospasm response to a stent-retriever. A noncompliant Gateway 2 × 12 mm balloon catheter (Stryker Neurovascular, Kalamazoo, Michigan) was used to cross the lesion and perform submaximal angioplasty. Next, the dissection was treated by advancing a NeuronMAX guide catheter (Penumbra) over the SofiaPlus into the vertical petrous carotid artery beyond the dissection flap and unsheathing a Wallstent (Stryker Neurovascular) across the flap. Because of progressive M1 restenosis, a Wingspan stent (Stryker Neurovascular) was deployed. Final runs demonstrated Thrombolysis in Cerebral Infarction 2C recanalization. Pre-stenting thrombectomy was chosen because the duration of symptoms was >48 h; thus, determining the risk of reperfusion hemorrhage by evaluating intracranial shunting before stenting was prudent. Reperfusion hemorrhage would complicate the antiplatelet agent therapy necessary for stent placement.

 Consent was obtained from the patient prior to performing the procedure. Institutional review board approval is not required for the report of a single case.
Professionalizing Criminal Investigation—An Examination of an Early Attempt to Support Specialization in Criminal Investigation
Authors: Tong Stephen , O’Neill Martin
Published: January 2019

This article explores perceptions of individuals involved in an early attempt to professionalize detective work in Kent, UK. In 2000, Kent Police developed a Strategic Policing Doctrine incorporating a learning and development strategy. These ideas resulted in a partnership between Kent Police and Canterbury Christ Church University producing the Advanced Detective Training (ADT) programme including a university qualification, the BSc (Hons) in Applied Criminal Investigation delivered between 2001 and 2006. This research, conducted in 2016, used semi-structured interviews with 27 participants including: trainers, academic staff, students, and the Chief Constable. The research revealed that there were challenges in the selection of candidates, use of the term ‘advanced’ in the programme title and the abstraction of ADT trainees. A very high proportion of ADT officers valued the ‘training’ part of the programme with the majority valuing the ‘academic input’. This research provides a useful analysis of previous attempts to develop detective professionalization and accredited learning relevant for programme designers responding to the introduction of the Police Education Qualification Framework and direct entry and fast track detective training.
Response to Conservative Treatment for Thumb Carpometacarpal Osteoarthritis Is Associated With Conversion to Surgery: A Prospective Cohort Study
Authors: Tsehaie Jonathan , Porsius Jarry T , Rizopoulos Dimitris , Slijper Harm P , Feitz Reinier , Hovius Steven E R , Selles Ruud W
Published: January 2019

Background

The current guidelines for treatment of carpometacarpal osteoarthritis recommend starting with conservative treatment before a surgical procedure is considered.

Objective

The objective was to investigate how response to conservative treatment, in terms of pain and hand function, influences the hazard that patients convert to surgical treatment.

Design

This was a multicenter, prospective cohort study.

Methods

Participants comprised 701 patients who received 3 months of hand therapy and an orthosis. Pain and function were measured with the Michigan Hand Questionnaire (MHQ) at baseline and at 6 weeks and 3 months follow-up. Conversion to surgical treatment was recorded from clinical records. Joint modeling (a statistical method of combining prediction models) was used to perform the analysis and to calculate hazard ratios (HRs).

Results

The joint analytical model showed that both MHQ pain score at a certain point (HR = 0.93; 95% confidence interval [CI] = 0.92–0.94) and change in MHQ pain score (HR = 1.07; 95% CI = 1.06–1.09) during conservative treatment was significantly associated with conversion to surgical treatment. The joint analytical model between functional outcome and conversion to surgical treatment showed only a significant association between MHQ function at a certain point (HR = 0.97; 95% CI = 0.95–0.99), and no significant association between the change in MHQ score for function (HR = 1.0; 95% CI = 1.0–1.0) and conversion to surgical treatment.

Limitations

Missing data might have resulted in biased estimates.

Conclusions

Self-reported pain and function, as well as change in self-reported pain during treatment, were associated with the hazard of conversion to surgical treatment, whereas change in self-reported functioning was not associated with conversion. Because a reduction in pain during conservative treatment appears to decrease the rate of conversion to surgical treatment, it is advised to structurally monitor pain levels during treatment.

Listen to the author interview at  https://academic.oup.com/ptj/pages/podcasts
Pain and fatigue in primary Sjögren’s syndrome
Authors: Omdal Roald , Mellgren Svein Ivar , Norheim Katrine Brække
Published: January 2019

Chronic fatigue, pain and depression are common in patients with primary Sjögren’s syndrome. These phenomena mutually affect each other and have a considerable impact on the patients’ quality of life. While pain is usually regarded as a fairly somatic phenomenon, both fatigue and depression have traditionally been regarded as more-or-less of psychological origin. There is an increasing understanding that this picture is multifaceted; that there is a genetic foundation, and that biological mechanisms regulate the clinical expression through activation of evolutionary, deeply conserved neuronal pathways in the brain. This pattern is evident not only in primary Sjögren’s syndrome, but also in other systemic inflammatory autoimmune diseases, in cancer and in neurodegenerative diseases like Parkinson’s disease. This article will mainly focus on the biology of pain and fatigue. We describe how these factors influence each other, and act with the overarching purpose of defending the organism against harm and danger.
Muscle fluorodeoxyglucose uptake assessed by positron emission tomography–computed tomography as a biomarker of inflammatory myopathies disease activity
Authors: Matuszak Julien , Blondet Cyrille , Hubelé Fabrice , Gottenberg Jacques-Eric , Sibilia Jean , Bund Caroline , Geny Bernard , Namer Izzie Jacques , Meyer Alain
Published: January 2019

Objective

To devise a simple PET-CT score for measurement of muscle disease activity in patients with inflammatory myopathies (IMs) and to assess its validity.

Methods

A total of 44 PET-CT examinations in 34 IM patients (performed during cancer screening) and 20 PET-CT examinations in matched controls (investigated for pulmonary nodules with a conclusion of benignity) were analysed. Maximal standardized uptake values (SUVmax) were recorded bilaterally in eight proximal muscles. The muscle SUVmax (mSUVmax) was defined as the average of the 16 muscle SUVmax values, normalized on the liver mean SUV. Reliability, validity and responsiveness were evaluated.

Results

The mSUVmax was increased in IM patients compared with controls. This index allowed the identification of patients with high vs low muscle disease activity using the myositis intention to treat activity index as the gold standard. In patients with subsequent examinations, our method showed good accuracy to detect changes in muscle disease activity [area under the curve 0.96 (95% CI 0.84, 1)]. Responsiveness was strong. Interrater reliability was excellent.

Conclusion

PET-CT, a non-invasive tool useful for cancer screening, is also valuable to measure muscle disease activity and its evolution in IM patients.
The Legacy of Disadvantaged Origins: Blocked Social Mobility of Descendants of Nobi Great-Grandfathers in Korea (1765–1894)
Authors: Park Hyunjoon , Kim Kuentae
Published: January 2019

Despite the emerging literature on multigenerational stratification beyond two-generation models, our understanding of how disadvantages are transmitted over multiple generations at the bottom of the socioeconomic hierarchy is limited, with the lack of data on the extremely disadvantaged. We fill this research gap by investigating the legacy of the nobi system, a system by which individuals were treated as property and owned by the government or private individuals, upon social mobility across four generations. The formal abolition of the nobi system in 1801 provides an opportunity to assess the extent to which nobi great-grandfathers still mattered for great-grandsons’ upward mobility, more than six decades after the dismantling of the system. Korean household registers, which were compiled every three years during 1765–1894 in two villages on Jeju Island and incorporated a variety of individual demographic and social status information, allow us to link families across generations. We identify the social status of adult males recorded in 1864–94 registers as well as that of their fathers, grandfathers, and great-grandfathers. Logistic regression results show that the odds of attaining high status were substantially lower for adult males whose great-grandfathers were nobis than for those whose great-grandfathers held high- or middle-status positions, even after controlling for the social statuses of fathers and grandfathers. Despite the abolition of the nobi system and the rapid expansion of high-status positions throughout the nineteenth century, the upward mobility of descendants of nobi great-grandfathers was considerably restricted, revealing the continuity of disadvantages over multiple generations.
Etiology of Alternaria Leaf Spot of Cotton in Southern New Mexico
Authors: Zhu Yi , Lujan Phillip , Dura Srijana , Steiner Robert , Zhang Jinfa , Sanogo Soum
Published: January 2019

Alternaria leaf spot (caused by Alternaria spp.) is one of the most common foliar diseases of cotton (Gossypium spp.) and occurs in most cotton-growing regions of the world. In surveys of commercial cotton fields, Alternaria leaf spot has increased in prevalence and incidence in southern New Mexico due to favorable environmental conditions in recent years. Incidence, severity, and etiology of leaf spot of cotton in southern New Mexico were determined. Fourteen cotton fields with plants exhibiting leaf spot symptoms were evaluated in October and November 2016, when plants were at late growth stage. Disease incidence was 100% in 13 of the fields, and averaged 70% in the 14th field. Average disease severity index for all fields ranged from 21.5 to 87.0. For identification of the causal agent, 14 isolates (one from each field) were characterized based on morphological features and PCR using universal primers ITS4/ITS5 and primers targeting the plasma membrane ATPase gene. Colonies of all 14 isolates were olive green with distinct white margins and relatively small spores when compared with reference isolates of large-spored species. All 14 isolates were identified as A. alternata. The fungus grew on potato dextrose agar from 5 to 35°C, and optimum growth occurred at temperatures between 20 and 30°C. Cotton plants inoculated with selected isolates of A. alternata displayed symptoms similar to those observed under field conditions. This is the first report of A. alternata as a causal agent of Alternaria leaf spot on cotton in southern New Mexico.
Epidemiology of Exobasidium Leaf and Fruit Spot of Rabbiteye Blueberry: Pathogen Overwintering, Primary Infection, and Disease Progression on Leaves and Fruit
Authors: Ingram R. J. , Ludwig H. D. , Scherm H.
Published: January 2019

Epidemiological field studies utilizing disease monitoring, spore trapping, and trap plants were conducted on rabbiteye blueberry (Vaccinium virgatum) between 2014 and 2017 to shed light on the epidemiology of Exobasidium leaf and fruit spot, an emerging disease in the southeastern United States caused by the fungus Exobasidium maculosum. Wash plating of field-collected blueberry tissue from the late dormant season through bud expansion showed that the pathogen overwintered epiphytically on blueberry plants in the field, most likely in its yeast-like conidial stage. Agrichemical applications during the dormant season altered epiphytic populations of the pathogen, which correlated directly with leaf spot incidence later in the spring. Disease monitoring of field plants and weekly exposure of potted trap plants revealed that young leaves at the mouse-ear stage were most susceptible to infection, that disease incidence on leaves progressed monocyclically, and that infection periods were associated with rainfall variables such as the number of days per week with ≥1.0 mm of rain or cumulative weekly rainfall. Weekly spore trapping with an Andersen sampler showed that airborne inoculum was detected only after sporulating leaf lesions producing basidiospores were present in the field, suggesting that the primary inoculum is not airborne. The first symptoms on young, green fruit were observed soon after petal fall (requiring removal of the waxy fruit layer to visualize lesions), and visible disease progress on fruit was delayed by 1 to 3 weeks relative to that on leaves. Fruit infection of field plants and trap plants occurred before airborne propagules were detected by spore trapping and before sporulating leaf lesions were present in the field. Hence, this study showed that fruit infections are initiated by the same initial inoculum as leaf infections but it was not possible to conclusively exclude the possibility of a contribution of basidiospore inoculum from leaf lesions to disease progress on later developing fruit. This is one of only a few studies addressing the epidemiology and disease cycle of an Exobasidium sp. in a pathosystem where artificial inoculation has not been possible to date.
A Scanning Electron Microscopy Technique for Viewing Plant−Microbe Interactions at Tissue and Cell-Type Resolution
Authors: Caldwell Denise , Iyer-Pascuzzi Anjali S.
Published: January 2019

Observing pathogen colonization and localization within specific plant tissues is a critical component of plant pathology research. High-resolution imaging, in which the researcher can clearly view the plant pathogen interacting with a specific plant cell, is needed to enhance our understanding of pathogen lifestyle and virulence mechanisms. However, it can be challenging to find the pathogen along the plant surface or in a specific cell type. Because of the time-consuming and expensive nature of high-resolution microscopy, techniques that allow a researcher to find a region of pathogen colonization more quickly at low resolution and subsequently move to a high-resolution microscope for detailed observation are needed. Here we present paraffin scanning electron microscopy (PSEM), a technique in which paraffin-embedded samples are first sectioned to identify a region of interest. Subsequently the same block is recut, deparaffinized, and used in scanning electron microscopy (SEM) to generate high-resolution images of plant-pathogen interactions in specific plant cell types. This method has several additional advantages over traditional SEM techniques, including reduced noise and better image quality. Here we use this technique to show that Fusarium oxysporum f. sp. lycopersici colonization is restricted in resistant Solanum pimpinellifolium and that PSEM works well in additional pathosystems, including maize leaves and Clavibacter michiganensis subsp. nebraskensis and Arabidopsis leaves and Pseudomonas syringae.