bluuebunny/crossref_metadata_2025 huggingface dataset:
China’s Water Pricing Policies
Authors: Ma Zhong , Chang Dunhu , Zhou Fang
Published: June 2017

In order to address the water contamination and supply problems in China, a number of water pricing policies have been introduced. They include water resource fees, water supply charges, wastewater treatment fees, and water pollution levies. The purposes of China’s water pricing policies are to protect and conserve water resources, encourage reasonable utilization of water resources, control pollution, and protect the environment. However, concern about the affordability of China’s water pricing for users has resulted in generally low tariffs. Moreover, as a result of poor supervision, China’s actual revenues from water pricing are far less than receivables. Consequently, wastewater discharges still produce pollution, while the polluters achieve environmental dividends by bearing relatively low pollution control costs. China’s water pricing policies should be improved through application of the polluter-pays principle and full-cost pricing. It is also necessary to strengthen environmental laws by specifying environmental standards on the basis of environmental non-degradation.
Victim Selection
Authors: Averdijk Margit
Published: June 2017

This chapter reviews what is known about victim selection—that is, the question of why offenders select some people, but not others, to be victims of crime. It first addresses theoretical perspectives on victim selection, namely the structural–choice model of victim selection, social interactionism, and target congruence. It then describes three data sources that have been used in prior research to study victim selection: police reports, victimization surveys, and offender interviews. Subsequently, empirical findings on victim selection are reviewed and organized into nine subsections: victims’ demographic characteristics, psychological characteristics, physical characteristics, behavior, biological characteristics, prior victimization, relationship to the offender, behavior during the offense, and the role of randomness. The final section discusses research gaps and potential future directions in the field, including an emphasis on theoretical explanations and mediators, cross-cultural studies, methodological innovation and diversity, interactions between victim and offender characteristics, and generality across crime types and subpopulations.
Informal Guardians and Offender Decision Making
Authors: Reynald Danielle M.
Published: June 2017

Research has demonstrated that informal guardians affect offender decision making in a variety of crime contexts. This chapter highlights what can be learned from empirical research about the way offenders perceive informal guardianship and how it affects criminal choices. Focusing specifically on studies that elucidate the offenders’ perspective on guardians, this chapter reviews what is known from studies on burglars, armed robbers, and sex offenders about how guardianship factors into their criminal decision making. Based on these offender accounts, the chapter reveals the patterns that emerge around (a) the stages of the crime event process in which guardianship is most likely to influence various types of offenders and (b) what form of guardianship is most effective in discouraging different offenders at different stages of the crime event.
Observational Methods of Offender Decision Making
Authors: Lindegaard Marie Rosenkrantz , Copes Heith
Published: June 2017

The strength of ethnography is that it combines the insights of what people say about crime with what they do when they make the decision to commit crime. Participant observation has played a key role in ethnographic research on crime, but it has become rare in criminology. This chapter argues that despite this development, new types of camera-based observations are emerging that can potentially bring new life into ethnographic research on crime. The chapter distinguishes between three types of observational methods (participant, researcher, and camera), and it discusses insights that have been gained from each method. Camera observations offer exciting possibilities of gaining insights into what offenders do as criminal events unfold. Although these types of observations may replace researcher observations because of higher detail and reliability, participant observations remain most suitable for the study of the socioeconomic circumstances of offenders and their experiences with committing crimes.
Self-Determination and Ideality in Hegel’s Logic of Being
Authors: Bowman Brady
Published: June 2017

Hegel’s project in the Science of Logic is to generate a demonstrably complete list of categories and forms of thought while arguing that these are products of thought’s own self-determining (autonomous) activity. The chapter offers a compact introduction to the work’s first section, ‘Quality (Determinateness),’ without assuming prior knowledge. Key background sources in Kant (the table of categories, the table of nothing, the transcendental ideal) and Spinoza (monism, nihilism, and the principle omnis determinatio est negatio) are discussed in order to cast light on the specifics of Hegel’s approach. Analysis focuses on the main stations of Hegel’s exposition: the opening dialectic of being–nothing–becoming, the relation of the finite to ‘bad infinity’ and the ‘true infinite’, the concept of being-for-self in its relation to self-consciousness (apperception), and the transition from quality to quantity. The final section draws conclusions about the nature of Hegelian ‘idealism’ and its essentially practical character.
Hegel’s Philosophy of Law
Authors: Brooks Thom
Published: June 2017

Hegel was neither a lawyer nor primarily a legal theorist, but his writings make a significant influence to the understanding of legal philosophy. Nevertheless, there is disagreement about where Hegel’s importance lies. This chapter argues that Hegel’s philosophy of law is best understood as a natural law theory. But what is interesting about Hegel’s view is that it represents a distinctive alternative to how most natural law theories are traditionally conceived. Hegel’s philosophy is remarkable for providing an entirely new way of thinking about the relation between law and morality than had been considered before. It is the distinctiveness of his legal philosophy that has rendered so difficult a categorization into standard jurisprudential schools of thought. There is little that is standard in Hegel’s innovative understanding of law. This has importance for other areas of his thinking, such as his novel theory of punishment and understanding of the common law.
Equatorial Africa
Authors: de Maret Pierre
Published: June 2017

Numerous wood, clay, and ivory figurines have been used for various purposes throughout Central Africa for many centuries. Unfortunately, only a few figurines in clay have so far been recovered by archaeologists. In Uganda, a pottery head and a cylindrical figurine, both dated probably to the late first millennium ad were found in two instances near Kampala. In Lower Congo, small stone statues were placed on tombs, while much further upstream, figurines in the shape of cylindrical bottles have been recovered among Kisalian grave goods (ninth to thirteenth centuries). From the same period, caprine and antelope metapodia were used as dolls for young girls and probably as fertility figures for young women. Throughout Africa, similar bones have had the same uses in recent times. Similar metapodia found in an archaeological context from various time periods in the Near East and in Europe may thus also have been perceived as figurines.
North America—Southwest
Authors: Schaafsma Polly
Published: June 2017

This broad overview considers the long discontinuous and diverse history of anthropomorphic figurine production in the ancient American Southwest. While the primary focus is on the Hohokam, Fremont, and Ancestral Pueblos, other cultural contexts are considered. Numerous figurine styles are described, as are close stylistic relationships between certain figurine traditions and rock art. Stylistic trends in the graphic rock art may have influenced the aesthetics of figurine production and vice versa. Discarded in refuse mounds, cached in association with burials and cremations or in crypts within architectural confines, figurines and their roles were diverse between cultures and changed through time. Regarded as active agents within their respective cultural frameworks, the chapter proposes that they functioned as social mediators, promoted fertility, increase, and community well-being, and as they served as conduits to the ancestors and cosmological entities.
Figurines and Figural Art of the Northwest Coast
Authors: Carlson Roy L.
Published: June 2017

Similarities between the earliest Northwest Coast art and ethnographic art are traced regionally from 2000 bc into the late nineteenth century. The earliest known figural art is in the Fraser River–Gulf Islands region and consists of human and animal images with ribs and backbones, joint marks, and protruding tongues, and masks. These motifs are present on ritual spoons used for feeding the dead, probably as part of an early form of the memorial potlatch, and are related to beliefs in human–animal transformation, regeneration from bone, spirit power, and shamanism. These same motifs are found later in adjacent regions as parts of ritual objects, tools, and utensils. Art declined in the late pre-contact period in the region where it is known earliest, but fluoresced later on the lower Columbia River, particularly on the northern Northwest Coast where the late classic interlocked style developed and has continued to evolve today.
South America—Andes
Authors: Lau George F.
Published: June 2017

This chapter details major figurine developments in the ancient Andes and discusses new understandings based on figurine form, function, and imagery. Great formal diversity characterizes the long history of their use. The most active traditions occurred along the coast, while data from the highlands and eastern slopes are more limited. Certain regions, especially the north coast, show longevity in the use of figurines, especially in household, funerary, and offering contexts. Figurines were important for their role in embodying identity (e.g. gender, fertility, status) as well as alterity. Production and ritual embued them with divine powers and agency. Figurine use and imagery also show dual structures, often manifested in gendered pairs or object sets. Finally, Andean figurines were important for their interactions with other contexts and things, including other figurine-like items: they inspired their own small worlds of sociality.
Palaeolithic Western and North Central Europe
Authors: Pettitt Paul
Published: June 2017

Since their initial discovery in the nineteenth century, human figurines have formed a noticeable part of the artistic record of the 30,000 years of the European Upper Palaeolithic. Some figurines—particularly the ‘Venuses’ of the Mid-Upper Palaeolithic (Gravettian sensu lato)—have long served as icons of Upper Palaeolithic cultural achievement. This chapter reviews our current understanding of figurines of western and North Central Europe. Their first manifestation is with a few enigmatic examples during the Early Upper Palaeolithic (Aurignacian) of southwest Germany. A far more visible and geographically widespread manifestation comes with the Mid-Upper Palaeolithic Venus figurines, and a similarly widespread occurrence comes with the highly schematic side-profile outlines of the Gönnersdorf type, which belong to the Middle and Late Magdalenian. The history of interpretation and current thinking of these figurine horizons is discussed in this chapter, which should be read in conjunction with Chapter 30 (Farbstein).
The Duty to Retreat in Self-Defense Law and Violence against Women
Authors: Gruber Aya
Published: June 2017

This article explores the complicated relationship between the duty to retreat in self-defense law and violence against women. It first provides an overview of self-defense law in the United States, with particular emphasis on the duty to retreat, before discussing the feminists’ position regarding self-defense law in the context of battered women who kill abusers, along with the so-called “no-retreat” rules. It then traces the history of no-retreat in U.S. law and argues that it is a complex doctrine, both liberationist and discriminatory. It also examines the tension in feminist theorizing on retreat by focusing on recent stand-your-ground controversies. The article concludes by proposing distributional analysis as a framework for feminists and other theorists to resolve the persistent tensions between the duty to retreat and gender justice.
Diabetic ketoacidosis
Authors: Alois Corinne I. , Rizzolo Denise
Published: June 2017

Despite advances in diabetes management, diabetic ketoacidosis (DKA) continues to be a leading cause of morbidity and mortality. Up to one-third of children may present with DKA as the original presentation of type 1 diabetes. These children develop clinical manifestations of DKA including hyperglycemia, acidosis, and ketosis. Clinicians must be able to identify those patients at risk, recognize common signs and symptoms, and start prompt management.
No shortcuts: new findings reinforce why nuance is the rule in genetic autoinflammatory syndromes
Authors: Tsoukas Paul , Canna Scott W.
Published: June 2017

Purpose of review

Practitioners dazed by the evolving concept of autoinflammation are in good company. Despite the clinical challenges autoinflammatory patients present, their study has been fundamental to our understanding of basic human inflammation. This review will focus on the ways in which recent discoveries in genetically mediated autoinflammation broaden and refine the concept.

Recent findings

Major developments in pyrin inflammasome biology, defective ubiquitination, and the hyperferritinemic syndromes will be highlighted.

We offer a brief discussion of discordance, convergence, genotype, and phenotype in autoinflammation. Additionally, we introduce the concepts of mutation dose effect and hybrid nomenclature. Overall, we hope to provide an update on developments in the field of autoinflammation, some conceptual tools to help navigate the rising tide of discovery, and some encouragement that keeping up with developments in autoinflammation is both exciting and necessary.
Risk Factors and Prognosis for Acute Progression of Myelopathic Symptoms in Patients Ossification of the Posterior Longitudinal Ligament After Minor Trauma
Authors: Jung Jong-myung , Chung Chun Kee , Kim Chi Heon , Choi Yunhee
Published: June 2017

Study Design.

A retrospective cohort study.

Objective.

The aim of this study was to identify the risk factors for acute progression of myelopathic symptoms (PMS) associated with ossification of the posterior longitudinal ligament (OPLL) after minor trauma and to compare the prognosis between an acute PMS group and a chronic PMS group.

Summary of Background Data.

Although the prevalence of OPLL among patients with cervical myelopathy is high, few studies have been published regarding the risk factors for acute PMS associated with OPLL after minor trauma.

Methods.

Patients with OPLL who had histories of minor trauma and had undergone surgery were divided according to clinical course into an acute (within 48 hours, n = 38) and a chronic PMS group (n = 32). The type of trauma and the clinical and radiologic characteristics were compared. The clinical outcomes were also compared at admission and at 1 and 2 years postoperatively.

Results.

The types of trauma were significantly different between the two groups (P < 0.05). Univariate analysis revealed that older age, a narrower space available for the cord, and a higher rate of stenosis in the spinal canal were associated with acute PMS after minor trauma (P = 0.014, 0.020, and 0.006, respectively). However, the rate of stenosis in the spinal canal was the only risk factor that was identified in a multivariate analysis (P = 0.023; odds ratio, 0.872; 95% confidence interval, 0.774–0.982). The Japanese Orthopedic Association scores at the initial visit and at postoperative years 1 and 2 were significantly lower in the acute PMS group than in the chronic PMS group (P < 0.001, P < 0.001, and P < 0.001, respectively).

Conclusion.

One risk factor for acute PMS in patients with OPLL after minor trauma is a higher rate of stenosis of the spinal canal. Patients with acute PMS exhibited unfavorable neurologic outcomes. Preventive surgical treatment may be recommended for patients with significant OPLL with mild cervical myelopathy.

Level of Evidence: 3
A Microstructural Investigation of Disc Disruption Induced by Low Frequency Cyclic Loading
Authors: Schollum Meredith L. , Wade Kelly R. , Robertson Peter A. , Thambyah Ashvin , Broom Neil D.
Published: June 2017

Study Design.

Microstructural investigation of low frequency cyclic loading and flexing of the lumbar disc.

Objective.

To explore micro-level structural damage in motion segments subjected to low frequency repetitive loading and flexing at sub-acute loads.

Summary of Background Data.

Cumulative exposure to mechanical load has been implicated in low back pain and injury. The mechanical pathways by which cyclic loading physically affects spine tissues remain unclear, in part due to the absence of high quality microstructural evidence.

Methods.

The study utilized seven intact ovine lumbar spines and from each spine one motion segment was used as a control, two others were cyclically loaded. Ten motion segments were subjected to 5000 cycles at 0.5 Hz with a peak load corresponding to ∼30% of that required to achieve failure. An additional small group of segments subjected to 10,000 or 30,000 cycles was similarly analyzed. Following chemical fixation and decalcification samples were cryosectioned along one of the oblique fiber angles and imaged in their fully hydrated state using differential interference contrast optical microscopy. Structural damage obtained from the images was organized into an algebraic shell for analysis.

Results.

At 5000 cycles the disc damage was limited to inner wall distortions, evidence of stress concentrations at bridging-lamellae attachments, and small delaminations. The high-cycle discs tested exhibited significant mid-wall damage. There was no evidence of nuclear material being displaced.

Conclusion.

At this low frequency and without the application of sustained loading or a more severe loading regime, or maintaining a constant flexion with repetitive loading, it seems unlikely that actual nuclear migration occurs. It is possible that the inner-annular damage shown in the low dose group could disrupt pathways for nutrient diffusion leading to earlier cell death and matrix degradation, thus contributing to a cascade of degeneration.

Level of Evidence: N/A
Further Standardization in the Aneurysm Clip
Authors: Rong Hui , Liu Yue , Zhao Zhibin , Feng Jiying , Sun Rao , Ma Zhengliang , Gu Xiaoping
Published: June 2017

Study Design.

Experimental study.

Objective.

To evaluate the relationship between clip occlusal depth and functional and histological outcome measures in a rat model of thoracic spinal cord injury (SCI).

Summary of Background Data.

Aneurysm clip compression is a proven model of contusion-compression SCI, but the relationship between clip depth and outcomes in thoracic SCI is unknown.

Methods.

A single aneurysm clip was applied to the spinal cord at thoracic vertebra 10 for 1 minute with an occlusal depth of 2, 6, or 10 mm. The actual compression force was measured using a self-made pulling method. Locomotor function was assessed for 28 days using Basso, Beattie, and Bresnahan (BBB) and inclined plane test (IPT) scores. We then used hematoxylin-eosin and Luxol fast blue staining to histologically quantify cavitation formation, preserved white matter, and preserved grey matter.

Results.

Greater occlusal compression depths caused greater actual compression forces and worsened functional and histological recovery. The 2- and 10-mm clip injury groups had significantly different BBB and ITP scores; cavitation, preserved white matter, and preserved grey matter volumes; and actual force measures (P < 0.05).

Conclusion.

Our findings show that the occlusal depth of clip compression correlates with actual compression force and recovery impairment.

Level of Evidence: 1
Immune-related Neurological Symptoms in an Adolescent Patient Receiving the Checkpoint Inhibitor Nivolumab
Authors: Tchapyjnikov Dmitry , Borst Alexandra J.
Published: June 2017

Immune checkpoint inhibitors are a novel group of immunotherapeutic agents for the treatment of cancer. Immune-related adverse events, including neurological symptoms, have been associated with these agents. We present the case of an adolescent with refractory Hodgkin lymphoma treated with nivolumab, a PD1 inhibitor, who developed Hashimoto thyroiditis, posterior reversible encephalopathy syndrome causing seizures, as well as urinary retention, truncal/appendicular spasticity, dysphagia, and a progressive encephalopathy that was clinically consistent with a diagnosis of progressive encephalopathy with rigidity and myoclonus, a stiff-person-syndrome spectrum disorder. He showed response and ultimately full recovery to a combination of intravenous steroids, intravenous immunoglobulin, and plasma exchange. To our knowledge, this is the first documented report of an immune-related neurological reaction to nivolumab in an adolescent patient and expands the spectrum of known nivolumab-associated toxicities.
Spirituality As a Coping Mechanism for Individuals with Parkinson's Disease
Authors: Reynolds Diane
Published: June 2017

Parkinson's disease (PD) is a chronic neurodegenerative disease that can render individuals totally disabled. Spiritual practices can help mitigate stress and provide a source of strength in PD. This article demonstrates a gap that exists between PD and spiritual coping specific research; discusses existing spiritual coping research in chronic illness; and explores the use of spirituality in managing PD care. Healthcare providers need to provide holistic care and explore mechanisms to assist individuals to manage the demands of living with PD.
Increasing Cervical Cancer Screening in Underserved Populations
Authors: Dorsainvil Merlyn A.
Published: June 2017

The incidence of cervical cancer has declined dramatically due to Papanicolaou smear testing. However, some minority populations continue to suffer with high incidences and/or death rates of cervical cancer, due to lack of screening. This article updates on cervical cancer screening and prevention and discusses cultural impacts on screening. Knowledge deficits disproportionately affect ethnic minority groups and contribute to cancer incidence, whereas lack of healthcare coverage and low socioeconomic status contribute to screening disparities. Although minority women have cultural beliefs and practices that influence screening, recommendation and/or education from a provider often lead to screening.
Analysis of the Variables Influencing Valproic Acid Concentration in the Serum and Cerebrospinal Fluid of Chinese Patients After Craniotomy
Authors: Li Zhihong , Gao Weiqi , Liu Guifen , Chen Weihong
Published: June 2017

Background:

Valproic acid (VPA) has been widely used in Chinese patients after craniotomy. Many studies have focused on the influencing factors of VPA serum concentration, but conclusions are sometimes paradoxical. Furthermore, the concentration of VPA in the cerebrospinal fluid (CSF) has been rarely reported. In the present study, VPA CSF concentrations were measured, and the potential factors influencing serum concentration and CSF distribution of VPA were investigated. In addition, the functional relationship between serum and CSF concentration was explored.

Methods:

Subjects were patients who underwent craniotomy and were administrated with VPA and had a lumbar puncture. Serum and CSF VPA concentrations were measured by use of the Abbott i1000 system. CYP2C9 (430 C>T, 1075 A>C, 1076 T>C, 1080 C>G), UGT1A6 (541 A>G, 552 A>C), UGT2B7 (211 G>T, 802 C>T), and ABCB1 (1236 C>T, 2677 G>T/A, 3435 C>T) genotypes were determined by direct sequencing. Information, such as age, gender, and height, was collected, and their effect on serum and CSF VPA concentrations was investigated by univariate analysis and multiple linear regression analysis.

Results:

First, the concomitant use of carbapenems (β′ = −0.422) and UGT1A6 (552 AA → AC) (β′ = −0.249) had a significant negative correlation with the weight-adjusted VPA serum concentration (C:W ratio), whereas CYP2C9 (1075 AA → AC) (β′ = 0.186) and gender (female compared with male) (β′ = 0.322) showed a positive correlation with VPA serum C:W ratio. The coefficient of determination (R
2) was only 0.348. Second, the relationship between the serum concentration and the CSF square root of the concentration (R
2 = 0.705) had a better linear fit. Third, serum VPA concentration (β′ = 0.810), concomitant use of glycerol fructose (β′ = 0.160), and age (≥65 compared with <65) (β′ = 0.118) showed a positive correlation (R
2 = 0.748) with the variability of square root of the concentration of the CSF.

Conclusions:

In Chinese patients, after craniotomy, female patients with 1 or more of CYP2C9 (1075 AC) and UGT1A6 (552 AA) genotypes required a lower VPA dosage compared with male patient. There was a better-fitted linear relationship between VPA serum and the square root of CSF concentrations. CSF VPA concentrations were relatively stable, with only age and the use of glycerol fructose having a small influence.
Impact of CYP2C19 Genotype and Liver Function on Voriconazole Pharmacokinetics in Renal Transplant Recipients
Authors: Li Zi-Wei , Peng Feng-Hua , Yan Miao , Liang Wu , Liu Xiao-Lei , Wu Yan-Qin , Lin Xiao-Bin , Tan Sheng-Lan , Wang Feng , Xu Ping , Fang Ping-Fei , Liu Yi-Ping , Xiang Da-Xiong , Zhang Bi-Kui
Published: June 2017

Background:

Invasive fungal infection (IFI) is one of the leading causes of early death after renal transplantation. Voriconazole (VRC) is the first-line drug of IFI. Because of the large inter- and intraindividual variability in VRC plasma concentrations and the narrow therapeutic window for treating patients with IFIs, it is crucial to study the factors which could influence pharmacokinetic variability. We performed a population pharmacokinetics (PPK) study of VRC for personalized medicine.

Methods:

A total of 125 trough concentrations (Cmin) from 56 patients were evaluated, retrospectively. Nonlinear mixed effect model was used to describe a PPK model that was internally validated by bootstrap method. Potential covariates included demographic characteristics, physiological and pathological data, concomitant medications, and CYP2C19 genotype.

Results:

A 1-compartment model with first-order absorption and elimination was fit to characterize the VRC pharmacokinetics in renal transplant recipients (RTRs). Aspartate aminotransferase (AST) had a significant influence on clearance (CL) while CYP2C19 genotype had a major impact on the volume of distribution (V). The parameters of CL and V were 4.76 L/h and 22.47 L, respectively. The final model was V (L) = 22.47 × [1 + 2.21 × (EM = 1)] × [1 + 4.67 × (IM = 1)] × [1 + 3.30 × (PM = 1)] × exp (0.96); CL (L/h) = 4.76 × (AST/33)^(−0.23) × exp (0.14). VRC Cmin in intermediate metabolizers was significantly higher than in extensive metabolizers.

Conclusions:

Liver function and CYP2C19 polymorphism are major determinants of VRC pharmacokinetic variability in RTRs. Genotypes and clinical biomarkers can determine the initial scheme. Subsequently, therapeutic drug monitoring can optimize clinical efficacy and minimize toxicity. Hence, this is a feasible way to facilitate personalized medicine in RTRs. In addition, it is the first report about PPK of VRC in RTRs.
HIGH-DOSE HIGH-FREQUENCY AFLIBERCEPT FOR RECALCITRANT NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: You Qi Sheng , Gaber Raouf , Meshi Amit , Ramkumar Hema L. , Alam Mostafa , Muftuoglu Ilkay Kilic , Freeman William R.
Published: June 2017

Purpose:

To determine the efficacy of monthly (0.1 mL/4 mg) aflibercept for refractory neovascular age-related macular degeneration (wet age-related macular degeneration).

Methods:

This was a retrospective interventional case series in which patients with wet age-related macular degeneration were treated with stepwise dose escalation. Nonvitrectomized patients resistant to monthly (Q4W) ranibizumab/bevacizumab were switched to 2 mg aflibercept every 8 weeks. With resistance, they were escalated to Q4W 2 mg aflibercept, then Q4W 4 mg (high dose high frequency, 4Q4W) aflibercept. Resistance was defined as ≥2 recurrences after being dry following ≥3 injections or persistent exudation on treatment of ≥5 injections.

Results:

Thirty-three eyes of 28 patients were treated with 4Q4W aflibercept and followed for a mean of 16 months. A dry retina (no intraretinal or subretinal fluid) was achieved after initiating 4Q4W aflibercept treatment at a mean of 3.8 months. Central foveal thickness, maximum foveal thickness, intraretinal fluid, subretinal fluid, and retinal pigment detachment height decreased significantly at 1 month after initiating the 4Q4W aflibercept, and the morphologic therapeutic effect was sustained until the last visit. Forty-five percent of eyes had one or more lines of vision improvement. New geographic atrophy developed in 9% of eyes during follow-up. No ocular or systemic adverse events occurred after initiating 4Q4W aflibercept.

Conclusion:

Intravitreal high-dose high-frequency aflibercept is an effective treatment for patients with refractory wet age-related macular degeneration.
Subjective Visual Vertical in Idiopathic Bilateral Vestibular Hypofunction: Enhanced Role of Vision, Neck, and Body Proprioception
Authors: Toupet Michel , Van Nechel Christian , Hautefort Charlotte , Duquesne Ulla , Heuschen Sylvie , Bozorg Grayeli Alexis
Published: June 2017

Introduction:

We aimed to study the participation of proprioceptive and visual inputs in subjective visual vertical (SVV) in bilateral vestibular hypofunction and in normal subjects.

Study Design:

Prospective case-control study.

Setting:

Tertiary referral center.

Materials and Methods:

SVV (six replicates) was measured on a tiltable rehabilitation seat in 26 adult patients with idiopathic bilateral vestibular hypofunction (IBVH) and 33 adult controls. Subjects were asked to place vertically a 45 degrees-tilted red line on a screen (three replicates to left and three to right alternatively) using a remote control in total darkness and in seven body positions: vertical, head, and body left- and right-tilts to 12 and 24 degrees, and then body left- and right-tilt to 24 degrees with the head upright.

Results:

In the vertical position, SVV did not differ between IBVH and controls. Patients with IBVH were more sensitive to body tilt than controls (SVV: −8.1 ± 4.66 degrees for IBVH versus −0.2 ± 3.23 for control at 24 degrees body and head left-tilt, p < 0.0001, unpaired t test). The visual attraction effect defined by a deviation of the SVV to the side of the initial line presentation appeared to be higher in the IBVH than in controls suggesting higher visual dependence in IBVH. Placing the head upright while the body was still tilted significantly reduced this difference. Similar results were observed for the right-tilts.

Conclusion:

Not only otolithic function but also visual plus body and neck proprioceptive entries participate in SVV. The influence of vision and proprioception appears to be enhanced in case of IBVH.
Drill-induced Cochlear Injury During Otologic Surgery: Intracochlear Pressure Evidence of Acoustic Trauma
Authors: Banakis Hartl Renee M. , Mattingly Jameson K. , Greene Nathaniel T. , Farrell Nyssa F. , Gubbels Samuel P. , Tollin Daniel J.
Published: June 2017

Hypothesis:

Drilling on the incus produces intracochlear pressure changes comparable to pressures created by high-intensity acoustic stimuli.

Background:

New-onset sensorineural hearing loss (SNHL) following mastoid surgery can occur secondary to inadvertent drilling on the ossicular chain. To investigate this, we test the hypothesis that high sound pressure levels are generated when a high-speed drill contacts the incus.

Methods:

Human cadaveric heads underwent mastoidectomy, and fiber-optic sensors were placed in scala tympani and vestibuli to measure intracochlear pressures (P
IC). Stapes velocities (V
stap) were measured using single-axis laser Doppler vibrometry. P
IC and V
stap were measured while drilling on the incus. Four-millimeter diamond and cutting burrs were used at drill speeds of 20k, 50k, and 80k Hz.

Results:

No differences in peak equivalent ear canal noise exposures (134–165 dB SPL) were seen between drill speeds or burr types. Root-mean-square P
IC amplitude calculated in third-octave bandwidths around 0.5, 1, 2, 4, and 8 kHz revealed equivalent ear canal (EAC) pressures up to 110 to 112 dB SPL. A statistically significant trend toward increasing noise exposure with decreasing drill speed was seen. No significant differences were noted between burr types. Calculations of equivalent EAC pressure from V
stap were significantly higher at 101 to 116 dB SPL.

Conclusion:

Our results suggest that incidental drilling on the ossicular chain can generate P
IC comparable to high-intensity acoustic stimulation. Drill speed, but not burr type, significantly affected the magnitude of P
IC. Inadvertent drilling on the ossicular chain produces intense cochlear stimulation that could cause SNHL.
How to Avoid a Learning Curve in Stapedotomy: A Standardized Surgical Technique
Authors: Kwok Pingling , Gleich Otto , Dalles Katharina , Mayr Elisabeth , Jacob Peter , Strutz Jürgen
Published: June 2017

Objective:

To evaluate, whether a learning curve for beginners in stapedotomy can be avoided by using a prosthesis with thermal memory-shape attachment in combination with a standardized laser-assisted surgical technique.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Fifty-eight ears were operated by three experienced surgeons and compared with a group of 12 cases operated by a beginner in stapedotomy.

Intervention:

Stapedotomy.

Main Outcome Measures:

Difference of pure-tone audiometry thresholds measured before and after surgery.

Results:

The average postoperative gain for air conduction in the frequencies below 2 kHz was 20 to 25 dB and decreased for the higher frequencies. Using the Mann-Whitney-U test for comparing mean gain between experienced and inexperienced surgeons showed no significant difference (p = 0.281 at 4 kHz and p > 0.7 for the other frequencies). A Spearman rank correlation of the postoperative gain for air- and bone-conduction thresholds was obtained at each test frequency for the first 12 patients consecutively treated with a thermal memory-shape attachment prosthesis by two experienced and one inexperienced surgeon. This analysis does not support the hypothesis of a “learning effect” that should be associated with an improved outcome for successively treated patients.

Conclusion:

It is possible to avoid a learning curve in stapes surgery by applying a thermal memory-shape prosthesis in a standardized laser-assisted surgical procedure.
Diagnosing Large Vestibular Aqueduct: Radiological Review of High-Resolution CT Versus High-Resolution Volumetric MRI
Authors: Deep Nicholas L. , Carlson Matthew L. , Weindling Steven M. , Barrs David M. , Driscoll Colin L. W. , Lohse Christine M. , Lane John I. , Hoxworth Joseph M.
Published: June 2017

Objectives:

To compare the diagnostic yield of high-resolution volumetric T2-weighted MRI (HRT2-MRI) with high-resolution computed tomography (HRCT) for diagnosis of large vestibular aqueduct (LVA).

Study Design:

Three board-certified neuroradiologists performed an independent, blinded radiological review for diagnosing LVA with 2:1 age-matched controls on patients with both HRCT and HRT2-MRI imaging.

Setting:

Tertiary referral center.

Patients:

All patients between 2002 and 2016 with hearing loss who underwent both HRCT and HRT2-MRI and were diagnosed with LVA on either modality.

Main Outcome Measures:

Concordance rate for LVA between HRCT and HRT2-MRI.

Results:

Concordance rate for HRCT and HRT2-MRI for diagnosing LVA was 88% (124/141) when assessing both the midpoint and external aperture diameters. Fifteen ears had LVA on computed tomography (CT), but not on magnetic resonance imaging (MRI); in comparison, two ears had LVA on MRI, but not on CT (p = 0.002). Excellent inter-rater reliability among the three radiologists was demonstrated.

Conclusion:

Historically, HRCT has been the imaging modality of choice for diagnosing LVA. Although a higher concordance rate of HRT2-MRI was found compared with previous studies utilizing earlier MRI technology, HRCT still detected a larger number of patients with clinically significant hearing loss compared with MRI. Given the high concordance rate and efficacy of both modalities in diagnosing LVA, the ultimate decision of which modality to choose may depend on other patient-specific and clinical factors.
Single-chain factor XII: a new form of activated factor XII
Authors: Ivanov Ivan , Matafonov Anton , Gailani David
Published: June 2017

Purpose of review

Exposure of blood to foreign surfaces induces reciprocal conversion of the plasma proteins factor XII (fXII) and plasma prekallikrein (PPK) to the proteases α-fXIIa and α-kallikrein. This process, called contact activation, has a range of effects on host defence mechanisms, including promoting coagulation. The nature of the triggering mechanism for contact activation is debated. One hypothesis predicts that fXII has protease activity, either intrinsically or upon surface-binding, that initiates contact activation. We tested this by assessing the proteolytic activity of a recombinant fXII variant that cannot be converted to α-fXIIa.

Recent findings

The proteolytic activity of fXII-T (for ‘triple’ mutant), a variant with alanine substitutions for arginine at activation cleavage sites (Arg334, Arg344, and Arg353) was tested with known α-fXIIa substrates. FXII-T activates PPK in solution, and the reaction is enhanced by polyphosphate, an inducer of contact activation released from platelets. In the presence of polyphosphate, fXII-T converts fXII to α-fXIIa, and also converts the coagulation protein factor XI to its active form.

The findings support the hypothesis that contact activation is initiated through activity intrinsic to single-chain fXII, and indicate that preexisting α-fXIIa is not required for induction of contact activation.
Perioperative care of head and neck free flap patients
Authors: Kinzinger Michael R. , Bewley Arnaud F.
Published: June 2017

Purpose of review

This article reviews the recent literature on the perioperative care of head and neck surgical patients undergoing free tissue transfer.

Recent findings

As the overall success of head and neck free flaps has plateaued above 95%, recent literature on perioperative flap management has focused on minimizing complications, length of stay, and cost of treatment. Current areas of research include preoperative risk stratification, preoperative and postoperative nutrition, intraoperative fluid management, postoperative level of care, postoperative antibiotic prophylaxis, defining the impact of comorbidities, and developing comprehensive evidence-based perioperative care protocols.

Rates of complications for head and neck free flap surgery remain stubbornly high. Optimization of perioperative nutrition, antibiotics, fluid management, and the establishment of structured pathways has the potential to decrease these complication rates. However, more research is needed into defining and implementing optimal comprehensive care regimens for this complex patient population.
Granulocyte and Monocyte Apheresis for Induction of Remission in Children With New‐Onset Inflammatory Bowel Colitis
Authors: Rolandsdotter Helena , Eberhardson Michael , Fagerberg Ulrika L. , Finkel Yigael
Published: June 2017

Objective:

The aim of the study was to analyze the effect of granulocyte and monocyte apheresis (GMA) with mesalazine for induction of remission in pediatric patients with newly onset chronic inflammatory bowel disease (IBD) colitis.

Methods:

Thirteen pediatric patients with newly onset extensive IBD colitis were investigated per the ECCO/ESPGHAN IBD protocol. Of these 13, 12 received 10 treatments with Adacolumn (ADA) during a median of 6.25 weeks in combination with low‐to‐moderate doses of mesalazine, which was continued after apheresis. A control colonoscopy was performed 12 to 16 weeks after GMA treatment. Primary outcomes were mucosal healing (Mayo endoscopic score) and histopathologic grading of biopsies. A secondary outcome was disease activity as measured by the Pediatric Ulcerative Colitis Activity Index.

Results:

Twelve children (6 girls) with a median age of 14.6 years and a median duration of symptoms at diagnosis of 3.2 months received all planned 10 treatment sessions with ADA. Ten of 12 patients had pancolitis and 2 of 12 extensive colitis. A final diagnosis, however, indicated ulcerative colitis in 10 children and Crohn disease in 2 children. At control colonoscopy, 8 of 12 children were in clinical remission and the Mayo endoscopic score showed significant improvement in 9 of 12 patients (P = 0.006). Complete microscopic remission, according to the Geboes score, was observed in 2 patients.

Conclusions:

In this small study GMA for induction of remission of newly onset pediatric IBD colitis was effective in 8 of 12 patients. Further controlled studies are warranted to confirm the efficacy of this treatment model.
The Rate of Improvement in Long-Term Dynamic Psychotherapy For Borderline Personality Disorder
Authors: Perry J. Christopher , Bond Michael , Békés Vera
Published: June 2017

Controlled trials of psychotherapy and follow-up studies of borderline personality disorder (BPD) have shown significant, but usually limited, improvement. We examined the hypothesis that BPD changes more slowly than nonborderline disorders. In a study of long-term dynamic psychotherapy, 16 subjects with BPD and 35 with non-BPD disorders were treated for a median of 3 years with a follow-up of 5 years. From periodic assessments, we calculated the rate of change for each subject over the course of the study on each measure of symptoms and functioning. At intake, borderline psychopathology was associated with higher levels on 76% of 17 measures of comorbid axis I disorders, symptoms, and functioning. BPD psychopathology was associated with faster (not slower) rates of improvement on three measures, but after controlling for the initial level of each measure, there were no significant associations. These findings counsel both optimism and patience in the long-term treatment of patients with BPD.
Food-Induced Red Eye
Authors: Rodgin Susan G.
Published: June 2017

Purpose

This article addresses the etiology of red eyes and a novel case of food-induced red eye.

Case Report

An 82-year-old white male patient reported 50 years of episodes of severe unilateral bulbar injection in either eye following ingestion of certain foods. Thinned scleras in this particular patient made the injection in his eyes more observable. Photodocumentation of this reaction after he ingested these foods is shown.

Conclusions

It is hypothesized that this is a new explanation for an intermittent, unilateral, self-limited red eye—a food-induced red eye.
Incarceration, Sexual Risk-Related Behaviors, and HIV Infection Among Women at Increased Risk of HIV Infection, 20 United States Cities
Authors: Wise Akilah , Finlayson Teresa , Nerlander Lina , Sionean Catlainn , Paz-Bailey Gabriela ,   for the NHBS Study Group
Published: June 2017

Background:

Women involved in the criminal justice system experience multiple risk factors that increase the likelihood of acquiring HIV infection. We evaluated the prevalence of incarceration and compared behaviors among women with and without an incarceration history.

Methods:

We use the 2013 National HIV Behavioral Surveillance data, which uses respondent-driven sampling. We evaluate the association between incarceration and the following past 12 months outcomes: exchange sex, multiple casual sex partners (≥3), multiple condomless sex partners (≥3), HIV test, and sexually transmitted infection diagnoses. Log-linked Poisson regression models, adjusted for demographics and clustered on city, with generalized estimating equations were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals.

Results:

Of 5154 women, 11% were incarcerated within the previous year, 36% were ever incarcerated but not in the past 12 months, and 53% were never incarcerated. Prevalence of exchange sex (aPR 1.32, 1.20–1.46), multiple casual partners (aPR 1.59, 1.2–2.1), multiple casual condomless partners (aPR 1.47, 1.07–2.03), and sexually transmitted infection diagnosis (aPR 1.61, 1.34–1.93) were all higher among recently incarcerated women compared with those never incarcerated. We also found higher prevalence of recent HIV testing among women recently incarcerated (aPR 1.30, 1.18–1.43).

Discussion:

Nearly half of women in our study had been incarcerated. Recent incarceration was associated with several factors that increase the risk of HIV acquisition. HIV prevention, testing, and early treatment among women with a history of incarceration can maximize the effectiveness of the public health response to the HIV epidemic.
Health Care Use and HIV-Related Behaviors of Black and Latina Transgender Women in 3 US Metropolitan Areas: Results From the Transgender HIV Behavioral Survey
Authors: Denson Damian J. , Padgett Paige M. , Pitts Nicole , Paz-Bailey Gabriela , Bingham Trista , Carlos Juli-Ann , McCann Pamela , Prachand Nikhil , Risser Jan , Finlayson Teresa
Published: June 2017

Purpose:

HIV prevalence estimates among transgender women in the United States are high, particularly among racial/ethnic minorities. Despite increased HIV risk and evidence of racial disparities in HIV prevalence among transgender women, few data are available to inform HIV prevention efforts.

Methods:

A transgender HIV-related behavioral survey conducted in 2009 in 3 US metropolitan areas (Chicago, Houston, and Los Angeles County), used respondent-driven sampling to recruit 227 black (n = 139) and Latina (n = 88) transgender women. We present descriptive statistics on sociodemographic, health care, and HIV-risk behaviors.

Results:

Of 227 transgender women enrolled, most were economically and socially disadvantaged: 73% had an annual income of less than $15,000; 62% lacked health insurance; 61% were unemployed; and 46% reported being homeless in the past 12 months. Most (80%) had visited a health care provider and over half (58%) had tested for HIV in the past 12 months. Twenty-nine percent of those who reported having an HIV test in the past 24 months self-reported being HIV positive. Most of the sample reported hormone use (67%) in the past 12 months and most hormone use was under clinical supervision (70%). Forty-nine percent reported condomless anal sex in the past 12 months and 16% reported ever injecting drugs.

Conclusion:

These findings reveal the socioeconomic challenges and behavioral risks often associated with high HIV risk reported by black and Latina transgender women. Despite low health insurance coverage, the results suggest opportunities to engage transgender women in HIV prevention and care given their high reported frequency of accessing health care providers.