bluuebunny/crossref_metadata_2025 huggingface dataset:
Voice-Sensitive Regions, Neurons, and Multisensory Pathways in the Primate Brain
Authors: Perrodin Catherine , Petkov Christopher I.
Published: October 2019

The social interactions of many animals critically depend on identifying other individuals to interact with or avoid. Recognizing specific individuals by voice requires extracting auditory indexical cues in communication signals, such as the voice-identity related content in vocalizations. Moreover, recognizing individuals can be facilitated by combining different forms of sensory inputs, such as when a vocalization is heard while the corresponding facial expression is seen. Our understanding of the neuronal substrates involved in processing voice content in communication sounds has been steadily increasing: neurobiological insights are now available not only from human neuroimaging studies but also from comparative neuroimaging data in non-human animals, which together identify the cross-species correspondences that can be made between voice-sensitive brain regions. The insights obtained using brain functional imaging have also had the added benefit of establishing certain animals as model systems in which neuronal processes and pathways can be interrogated at finer neurobiological scales than is possible in humans. The use of bridging neuroimaging techniques in humans and other animals allows the neuronal-level insights obtained in animal models to better translate to and inform the understanding of homologous processes in the human brain. This chapter provides an overview of these developments, summarizing knowledge on the functional characteristics of voice-sensitive neurons and on cortical pathways that integrate auditory voice with visual face input. It highlights how some of the gaps in our understanding have begun to close and identifies empirical challenges that remain on the horizon.
Emotional and Social Communication in Non-Human Animals
Authors: Snowdon Charles T.
Published: October 2019

Non-human animals use vocalizations for a variety of emotional and social functions. The chapter begins with a brief discussion of theoretical issues concerning vocal communication in non-human species. It applies Darwin’s comparative approach to visual signals of emotional expression to vocal signals, using music as an example of human emotional communication from which parallels to animal signals can be seen. The relationship between affective state and vocal signals across species is reviewed to identify whether there are some cross-species universals in acoustic structure that communicate affective state. The chapter then examines the induction of emotional states in listeners through different call structures. One of the main social aspects of vocal communication is signalling identity—species, population, group, sex, mate, and individual. Two additional areas of interest are calls used to signal status and those used to mark close social relationships between individuals within a group. Social interactions can shape vocal structure to create convergence in calls or to help young animals acquire adult skills. Vocalizations of many species are also used in flexible, rather than stereotyped, ways in response to social and environmental cues.
The Electrophysiology and Time Course of Processing Vocal Emotion Expressions
Authors: Paulmann Silke , Kotz Sonja A.
Published: October 2019

Emotional communication is a key component of human social interactions. Listeners need to rapidly decode emotionally relevant signals and adapt their behaviour accordingly. This chapter summarizes recent findings on the time course underlying vocal emotion processing, with a particular focus on suprasegmental information as expressed by the voice and intonation in speech. Evidence from both behavioural investigations and electrophysiological (EEG) recordings confirms that vocal emotion processing includes early rapid—most likely involuntary—appraisal, as well as enhanced cognitive emotional meaning evaluation. Reviewed findings also suggest that influences such as task demands, individual differences, as well as social-psychological factors can alter the identified processing steps. In short, findings suggest that emotional vocal expression processing is a multi-layered process which follows a distinct time course.
Recognizing Speakers Across Languages
Authors: Perrachione Tyler K.
Published: October 2019

Listeners identify voices more accurately in their native language than an unknown, foreign language, in a phenomenon known as the language-familiarity effect in talker identification. This effect has been reliably observed for a wide range of different language pairings and using a variety of different methodologies, including voice line-ups, talker-identification training, and talker discrimination. What do listeners know about their native language that helps them recognize voices more accurately? Do listeners gain access to this knowledge when they learn a second language? Is linguistic competence necessary, or can mere exposure to a foreign language help listeners identify voices more accurately? This chapter reviews the more than three decades of research on the language-familiarity effect in talker identification, with an emphasis on how attention to this phenomenon can inform not only better psychological and neural models of memory for voices, but also better models of speech processing.
Vocal Attractiveness
Authors: Pisanski Katarzyna , Feinberg David R.
Published: October 2019

This chapter reviews studies on voice attractiveness from evolutionary, social, and cognitive neuroscience perspectives. Taking this interdisciplinary approach, it explores what makes a voice attractive, and why it matters. Focusing largely on men and women’s preferences for sex-typical sexually dimorphic features in the voice (vocal masculinity and femininity), the chapter discusses the evolutionary underpinnings of fundamental and formant frequencies as vocal indicators of quality. It reviews the many ways in which social, physiological, and neurocognitive mechanisms can combine to influence what we perceive as attractive, from selection on perceivers to choose high-quality mates and cooperative affiliates, to the influence of social context and perceptual biases. For example, fluency of processing and mere exposure effects may drive preferences for average voices. Other topics of discussion include voice modulation, cross-modality in voice and face attractiveness, cross-cultural and individual variation in voice preferences, and the implications of voice attractiveness on reproductive and socioeconomic success.
Voice ProcessingImplications for Earwitness Testimony
Authors: Stevenage Sarah
Published: October 2019

Are we reliable earwitnesses? Imagine a telephone call in which all you hear is the single word ‘Hello … ?’. From that single word you can tell a considerable amount about the caller. You can tell their gender and their likely age range. You can detect a rising intonation that indicates uncertainty or a question. You can discern their accent and thus perhaps their nationality. Last, but most important, you perhaps can tell their identity. Voice perception is a highly sophisticated ability, drawing on numerous characteristics of the voice signal and yielding numerous judgements or estimations about the speaker. This chapter focuses on the reliability of those voice-perception abilities, with the express purpose of being able to establish our capacity as earwitnesses. Across this chapter, the latest scientific findings will be reviewed, allowing identification of the decisions that earwitnesses will be good at, and the decisions that may be less reliable.
Neurocomputational Models of Voice and Speech Perception
Authors: Kröger Bernd J.
Published: October 2019

This chapter outlines a comprehensive neurocomputational model of voice and speech perception based on (i) already established computational models, as well as on (ii) neurophysiological data of the underlying neural processes. Neurocomputational models of speech perception comprise auditory as well as cognitive modules, in order to extract sound features as well as linguistic information (linguistic content). A model of voice and speech perception in addition needs to process paralinguistic information like gender, age, emotional or affective state of speaker, etc. It is argued here that modules of a neurocomputational model of voice and speech perception need to interact with modules which go beyond unimodal auditory processing because, for example, processing of paralinguistic information is closely related to such as visual facial perception. Thus, this chapter describes neural modelling of voice and speech perception in relation to general communication and social-interaction processes, which makes it necessary to develop a hypermodal processing approach.
Voice and Speech Synthesis—Highlighting the Control of Prosody
Authors: Hirose Keikichi
Published: October 2019

After starting as an effort to mimic the human process of speech sound generation, the quality of synthetic speech has reached a level that makes it difficult to notice that it is synthetic. This owes to the development of waveform concatenation methods which select the most appropriate speech segments from a huge speech corpus. Although the lack of flexibility in producing various speech qualities/styles has been pointed out, this problem is about to be solved by introducing statistical frameworks into parametric speech synthesis. Now, a speaker can even speak a foreign language in his/her voice using advanced voice-conversion techniques. However, if we consider prosodic features of speech, current technologies are not appropriate to handle their hierarchical structure over a long time span. Introduction of prosody modelling into the speech-synthesis process is necessary. In this chapter, after viewing the history of voice/speech synthesis, technologies are explained, starting from text-to-speech and concept-to-speech conversion. Then, methods of sound generation are introduced. Statistical parametric speech synthesis, especially HMM-based speech synthesis, is introduced as a technology that enables flexible speech synthesis—that is, synthetic speech with various qualities/styles requiring a smaller amount of speech corpus. After that, the problem of frame-by-frame processing for prosodic features is addressed and the importance of prosody modelling is pointed out. Prosodic (fundamental frequency) modelling is surveyed and, finally, the generation process model is introduced with some experimental results when applied to HMM-based speech synthesis.
Deficits in Voice-Identity ProcessingAcquired and Developmental Phonagnosia
Authors: Roswandowitz Claudia , Maguinness Corrina , von Kriegstein Katharina
Published: October 2019

The voice contains elementary social communication cues, conveying speech, as well as paralinguistic information pertaining to the emotional state and the identity of the speaker. In contrast to vocal-speech and vocal-emotion processing, voice-identity processing has been less explored. This seems surprising, given the day-to-day significance of person recognition by voice. A valuable approach to unravel how voice-identity processing is accomplished is to investigate people who have a selective deficit in recognizing voices. Such a deficit has been termed phonagnosia. This chapter provides a systematic overview of studies on phonagnosia and how they relate to current neurocognitive models of person recognition. It reviews studies that have characterized people who suffer from phonagnosia following brain damage (i.e. acquired phonagnosia) and also studies which have examined phonagnosia cases without apparent brain lesion (i.e. developmental phonagnosia). Based on the reviewed literature, the chapter emphasizes the need for a careful behavioural characterization of phonagnosia cases by taking into consideration the multistage nature of voice-identity processing and the resulting behavioural phonagnosia subtypes.
The Singing Voice
Authors: Sundberg Johan
Published: October 2019

The sound quality of singing is determined by three basic factors—the air pressure under the vocal folds (or the subglottal pressure), the mechanical properties of the vocal folds, and the resonance properties of the vocal tract. Subglottal pressure is controlled by the respiratory apparatus. It regulates vocal loudness and is varied with pitch in singing. Together with the mechanical properties of the folds, which are controlled by laryngeal muscles, it has a decisive influence on vocal fold vibrationswhich convert the tracheal airstream to a pulsating airflow, the voice source. The voice source determines pitch, vibrato, and register, and also the overall slope of the spectrum. The sound of the voice source is filtered by the resonances of the vocal tract, or the formants, of which the two lowest determine the vowel quality and the higher ones the personal voice quality. Timing is crucial for creating emotional expressivity; it uses an acoustic code that shows striking similarities to that used in speech. The perceived loudness of a vowel sound seems more closely related to the subglottal pressure with which it was produced than with the acoustical sound level. Some investigations of acoustical correlates of tone placement and variation of larynx height are described, as are properties that affect the perceived naturalness of synthesized singing. Finally, subglottal pressure, voice source, and formant-frequency characteristics of some non-classical styles of singing are discussed.
Meditation and the Modern Encounter between Asia and the West
Authors: King Richard E.
Published: October 2019

In the West, meditation has been particularly associated with Asian religions and seen as illustrative of the mystical nature of eastern culture. This chapter explores the impact of the colonial encounter between Europe and Asia. In this context, Asian meditative practices became abstracted from their traditional cosmological, ritualistic, and cultural contexts and reframed in terms of key conceptual binaries and assumptions deriving from modern Western culture. These include a Cartesian distinction between mind and body (with mind being associated with meditation and Buddhist mindfulness, and the body linked to “Hindu” yoga and its modern postural forms). Asian forms of meditation were translated according to a modern psychological framework and encountered in relation to the dichotomies between science and religion on the one hand and religious tradition and a de-traditionalized notion of spirituality on the other. The approaches taken in the Western encounter with Asian meditation tell us as much about the intellectual grooves of the modern Western episteme as they do about the Asian meditative traditions to which they relate.
Meditation and Emotion
Authors: Lomas Tim
Published: October 2019

This chapter offers an overview of the intricate connections between meditation and emotion. It begins by outlining a framework for understanding meditation, whereby practices can be classified according to four key parameters: behaviors of mind; object; attitude; and form. It also introduces some basic ideas around the nature of emotions, and affective experience more broadly. After that, the chapter has two main sections. The first explores direct interactions between meditation and emotion, where practices specifically target or elicit certain emotions. We shall look at four clusters of emotions: dysphoric; compassionate; reverential; and ambivalent. The second part then examines indirect interactions, in which the emotional effects of meditation are mediated by other processes. There we consider three such processes: physiology; cognition; and self-transcendence. Although the presentation is necessarily brief, the chapter gives an indication of the ways in which meditation may impact upon emotional experience. The chapter concludes by outlining directions for future research.
Buddhist Meditation in Tibet
Authors: Halkias Georgios T.
Published: October 2019

Tibetan Buddhism is characterized by an extensively diverse corpus of contemplative practices that draws from over one thousand years of Indian historical developments in Buddhist philosophical discourse and experimentation with contemplative techniques. Traditions of Chinese and Central Asian Buddhism also played a role in influencing some of the contents and structure of the Tibetan Buddhist canon that contains a voluminous collection of exoteric and esoteric meditations. The purpose of Tibetan Buddhist meditations (sgom pa) is to progress toward the cherished goal of Mahāyāna: to lead oneself and all others to liberation. In order to offer a general and useful overview of meditations across Indo-Tibetan lineages and schools, this chapter will resort to emic categories of classification, such as the distinction between exoteric (sutra) and esoteric (tantra), and between meditations with and without a “reference object” (sgom bya). By invoking traditional categories of distribution we will come to appreciate how Tibetan scholars and practitioners have organized and understood the rich Buddhist heritage they have inherited. At the end, we will consider rituals (cho ga), even if they are not strictly classified as meditation techniques, as an in-between category where contemplation is an integral part of the performance.
History of Neuropsychology in Latin America
Authors: Arango Lasprilla Juan Carlos , Olabarrieta-Landa Laiene , Gonzalez Isabel , Leal Giselle , Álvarez Alcántara José Enrique , Rivera Diego
Published: October 2019

This chapter presents the history of neuropsychology in Latin America during five main periods. Prior to 1950, the term “neuropsychology” was rarely used. The development of this specialty in Latin America did not take place until the second half of the 20th century, centered primarily in Argentina and Uruguay. Historically, the development of neuropsychology has been slowed down by local wars, armed conflicts, and dictatorships. During the Second World War, intellectuals and scientists in neuroscience emigrated to Latin America and helped to advance the field. The period between 1970 and 1999 was mainly characterized by the evolution of neuropsychology in Colombia and Mexico and by the influence of the United States in Latin American neuropsychology. From 2000 until 2017, neuropsychology experienced a rapid growth, including establishment of graduate programs, societies, clinics/centers, Latin American scientific journals, and research publications, as well as the creation of Spanish language neuropsychological tests. As of 2018, most professionals in neuropsychology in Latin America work in private practices or universities, and their main activity is assessment and diagnosis of neurodevelopmental and neurodegenerative disorders, although they also engage in rehabilitation and teaching activities. Due to the lack of written records, there is scarce information regarding the history and current state of neuropsychology in some Latin American countries, including Belize, Haiti, and the Dominican Republic. Current barriers to the advancement of the field and future directions to improve the current situation are described.
Metabolomics analysis revealed significantly higher synovial Phe/Tyr ratio in reactive arthritis and undifferentiated spondyloarthropathy
Authors: Muhammed Hafis , Kumar Dinesh , Dubey Durgesh , Kumar Sandeep , Chaurasia Smriti , Guleria Anupam , Majumder Sanjukta , Singh Rajeev , Agarwal Vikas , Misra Ramnath
Published: October 2019

Objective

To compare the synovial phenylalanine/tyrosine (Phe/Tyr) ratio between ReA/uSpA and RA and OA by NMR spectroscopy.

Methods

Paired SF and serum of 30 patients with ReA/uSpA were collected and analysed using a 1D 1H Carr Purcell Meiboom Gill NMR spectra recorded on 800 MHz NMR spectrometer equipped with a TCI Cryoprobe (at 300 K). Phe and Tyr were quantified. SF from 25 patients with RA fulfilling ACR classification criteria and 21 patients with OA were taken as inflammatory and non-inflammatory controls.

Results

The synovial Phe/Tyr ratio was significantly higher in ReA/uSpA compared with RA and OA. Synovial Phe/Tyr ratios were comparable in RA and OA patients. Compared with serum, the Phe/Tyr was significantly higher in the SF in ReA/uSpA. The Phe/Tyr ratio was also found to be positively correlated between serum and SF samples, with a regression coefficient (r2) of 0.287.

Conclusions

This NMR-based metabolomics study demonstrates that the synovial Phe/Tyr ratio is specifically elevated in ReA/uSpA.
How (when) does technological innovation improve government effectiveness? An empirical investigation with cross-national evidence
Authors: Zang Leizhen , Xiong Feng
Published: October 2019

How to understand the impacts of government effectiveness (GE) on technological innovation has received full attention. But in turn, it is still a puzzle how technological innovation promotes GE. With the intention of providing rigorous empirical evidence to fill the gap, authors efficiently selected variables based on novel machine learning and analyzed the influence mechanism of technological innovation on GE through different models, using panel data from global countries over 20 years. The investigation has revealed that the relationship between technological innovation and GE is not a simple linear relation but a more complicated inverted U-shaped relation. We also distinguished the impacts of technological innovation on GE in countries with diverse democratic and developing levels. This pioneering work has provided new insights to our understanding of innovation diffusion and determinants of GE.
Ischemia-modified Albumin as a Biomarker for Prediction of Poor Outcome in Patients With Traumatic Brain Injury: An Observational Cohort Study
Authors: Radwan Tarek A.M. , Fahmy Rania S. , El Emady Mohamed F.M. , Khedr Ahmed S.E.D.M. , Osman Safinaz H. , ElSonbaty Mohamed I. , El-Kholy Badawy M. Badawy , Thabit Mohamed A. , Elkatatny Amr M.
Published: October 2019

Background:

Biomarkers can assist in outcome prediction and therapeutic decision making after traumatic brain injury (TBI). The aim of this study was to evaluate the role of ischemia-modified albumin (IMA) in the prediction of mortality in patients with TBI.

Methods:

In this observational study IMA was measured on admission to intensive care unit (D0) and 24 hours later (D1) in a cohort of patients with mixed TBI severity. The primary outcome was the correlation between IMA and 28-day mortality. Secondary outcomes included the incidence of elevated IMA, and the correlation between the severity of TBI and IMA, and between IMA and change in Glasgow coma score (GCS). The area under receiver operating characteristic curve analysis was performed to detect optimal IMA cut-off value for the detection of mortality.

Results:

Fifty-four patients were included in the study; IMA was elevated in 49 (90.7%) on admission to the intensive care unit. Of the 49 patients with elevated IMA, 22 had a decrease in IMA while 27 had an increase by 24 hours. IMA levels were higher at D0 and D1 (P<0.001 for both) in patients who died compared with those who survived. Twenty-one patients died (mortality rate 38.9%); all had elevated IMA on D0 and D1 and higher IMA levels at D1 compared with D0. Optimal cut-off values for IMA predicted mortality with 76.2% sensitivity and 81.8% specificity at D0 and with 100% sensitivity and specificity at D1. IMA values at D0 and D1 were correlated with D0 and D1 GCS, respectively (both P<0.001).

Conclusion:

IMA levels were elevated in patients following TBI, and can predict mortality with high sensitivity and specificity.
The Incisura
Authors: Klein Lloyd W. , Shahrrava Anahita
Published: October 2019

Analysis of the arterial pressure waveform remains useful in modern practice to assess alterations that may indicate significant abnormalities of cardiovascular parameters. The recognition of abnormalities of the incisura and dicrotic wave should alert the clinician to seek specific etiologic factors. Understanding the physiological origins of the incisura and dicrotic notch enhance its clinical utility in accurately diagnosing abnormal hemodynamic states. This review summarizes the hemodynamic events causing and affecting the inscription of the incisura in the arterial waveform.
Premature Ventricular Contractions and Cardiomyopathy
Authors: You Cindy X. , Liu Christopher F.
Published: October 2019

Premature ventricular contractions (PVCs) are a common arrhythmia that may cause symptoms of variable severity. PVCs have recently garnered interest in their ability to induce adverse structural heart remodeling in an entity known as PVC-induced cardiomyopathy. This entity is a retrospective diagnosis that likely remains under-recognized and may occur concurrently with other forms of cardiomyopathy. The appropriate identification and management of PVCs in the setting of associated cardiomyopathy may have a significant impact on cardiac function and the clinical course, including recovery of left ventricular ejection fraction and improvement in patient functional status. Treatment consists of catheter ablation and/or antiarrhythmic drug therapy, but continued monitoring and follow-up are required, as the recurrence of high PVC burden may lead to redevelopment of cardiomyopathy.
Functional Mitral Regurgitation in Heart Failure
Authors: Shah Tara , Zhong Ming , Minutello Robert M.
Published: October 2019

Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition. However, new, minimally invasive transcatheter therapies, in particular the MitraClip system, have shown promise in the treatment of FMR in selected patients. This review will summarize the pathophysiology underlying FMR, the prognosis of patients with heart failure and FMR, and the various medical and procedural treatment options currently available and under investigation.
Using High Sensitivity Troponins to Rule Out Acute Coronary Syndrome and Lower Admission Rates
Authors: Potomac Whitney , Diercks Deborah B.
Published: October 2019

Chest pain is a common complaint encountered by Emergency Medicine physicians in the emergency department (ED). History taking, electrocardiograms, and cardiac biomarkers are the mainstays of the evaluation process of patients who present to the ED with symptoms of an acute coronary syndrome. Cardiac troponin is the primary biomarker used for the diagnosis of acute myocardial infarction. In January 2017, high sensitivity cardiac troponins (hs-cTns) were approved for use in the United States. These markers have increased sensitivity and can more rapidly detect myocardial injury, making them very useful in the ED. However, despite improved sensitivity, elevations in hs-cTn can occur in a large number of patients who are not currently experiencing an acute myocardial infarction. As a result, it is important that clinicians understand the value of serial cardiac biomarker measurements and how to incorporate hs-cTn levels below the limit of detection into clinical decision-making. A large percentage of these low-risk patients end up having negative cardiac work-ups. This article will include a discussion on how to utilize common risk stratification tools in the ED to identify cohorts of patients suitable for discharge without additional testing. ED physicians must understand the limitations and benefits of hs-cTn levels and how to incorporate the information obtained from these biomarkers into risk scores in order to strengthen disposition decisions and safely discharge patients from the ED.
Very Late Stent Thrombosis in Drug-Eluting Stents New Observations and Clinical Implications
Authors: Wang Xiang , Chen Xinxin , Sun Wanqing , Tian Tao , Zhou Shanshan , Zhang Zhiguo , Gao Ming , Qiao Bokang , Zheng Yang
Published: October 2019

Despite the reduction in stent failure with newer-generation drug-eluting stents, very late stent thrombosis (VLST) remains an unpredictable and potentially catastrophic complication of coronary revascularization procedures and is associated with high morbidity and mortality. Here, we present an updated overview of the latest advances in understanding the causes of VLST. Clinical studies that revealed potential risk factors and pathophysiologic studies on the mechanisms of VLST are discussed. Importantly, novel insights from recent advances in intravascular imaging are included. To date, there is no clinical guideline for VLST treatment. We propose an evidence-based recommendation that an intravascular-imaging-informed percutaneous coronary intervention strategy combined with optimized antiplatelet therapy is the foundation for successful VLST clinical management. Moreover, the future of VLST prevention, such as improved patient risk stratification and advances in addressing late stent failure, are also discussed.
Drug causes of intracerebral haemorrhage
Authors: Burrage Daniel Richard
Published: October 2019

Many drugs have the potential to cause intracerebral haemorrhage. The mechanisms that underlie this association include elevation of blood pressure and increasing bleeding tendency. The consequences of intracerebral haemorrhage can be devastating for the individual, so careful risk assessment prior to drug initiation and close monitoring during treatment should be enacted when using medicines with an established association with haemorrhagic stroke.
Central arterial stiffness and retinal vessel calibers: the Atherosclerosis Risk in Communities Study–Neurocognitive Study
Authors: Meyer Michelle L. , Klein Barbara E. , Klein Ronald , Palta Priya , Sharrett A. Richey , Heiss Gerardo , Nambi Vijay , Wong Tien Y. , Tanaka Hirofumi
Published: October 2019

Background:

The retinal microvasculature provides a window to the cerebral vasculature and enables examination of changes in retinal caliber that may mimic those occurring in cerebrovascular disease. The association of central arterial stiffness and retinal vessel caliber in a population sample is not fully understood.

Methods:

In 1706 older adults (mean age 76.3, 58.1% women) from the population-based Atherosclerosis Risk in Communities Study, we examined the cross-sectional association of central arterial stiffness [carotid–femoral pulse wave velocity (cfPWV)] with retinal vessel calibers [central retinal arteriolar equivalent (CRAE) and central retinal vein equivalent (CRVE)]. We estimated the association of cfPWV with CRAE narrowing (<25th percentile) and CRVE widening (>75th percentile) after adjustment for age, sex, race-field center, BMI, smoking, and type 2 diabetes. We tested for effect modification by sex, hypertension, and type 2 diabetes.

Results:

Carotid–femoral PWV (m/s) was not associated with the odds of CRAE narrowing [odds ratio (OR): 0.99; 95% CI: 0.95–1.03]. The association of cfPWV with CRVE widening was stronger in those without hypertension (OR: 1.10; 95% CI: 1.01–1.20) versus those with hypertension (OR: 1.01 95% CI: 0.96–1.05) and slightly stronger in those with type 2 diabetes (OR: 1.07; 95% CI: 1.00–1.14) versus without type 2 diabetes (OR: 1.01; 95% CI: 0.96–1.06).

Conclusions:

In older adults, cfPWV was associated with wider retinal venular caliber, particularly in individuals without hypertension. Central arterial stiffening may be associated with cerebral microvascular changes, as exhibited in its retinal vasculature component.
Use of simulated patients to assess hypertension case management at public healthcare facilities in South Africa
Authors: Burger Ronelle , Christian Carmen S. , Gerdtham Ulf-G. , Haal Karel , Hompashe Dumisani M. , Smith Anja , Schutte Aletta E.
Published: October 2019

Objective:

Our study aims to evaluate hypertensive case management in South Africa's public health sector using simulated patients.

Method:

Our study describes interactions between hypertensive simulated patients and primary healthcare workers at 39 public sector healthcare facilities in two metropolitan centres in the Eastern and Western Cape Provinces of South Africa. Our analysis focus on 97 interactions where our eight simulated patients tested within range for stage 1 hypertension, that is with SBP 140–159 mmHg and/or DBP 90–99 mmHg. For this subset, we describe how healthcare workers communicated the outcome of the blood pressure test, and whether they follow government guidelines on risk assessment and lifestyle advice.

Results:

Healthcare workers highlighted the risks associated with hypertension in one out of three cases and stressed the importance of regular monitoring of blood pressure in less than half of cases. Hypertensive patients received advice on all six lifestyle risk factors in 8% of cases. 39% of patients received no lifestyle advice at all. In one out of four cases, hypertensive patients left the facility without a hypertension diagnosis and with no prospect of a follow-up visit.

Conclusion:

Simulated patients can assess the quality of hypertension case management, yielding granular and comprehensive information that can help mobilize resources to improve care. The management of hypertension patients in South African public healthcare facilities is critically insufficient. Given that hypertension is responsible for a rising share of deaths in South Africa and many of these deaths are preventable, urgent intervention is needed.
VASOPROLIFERATIVE TUMORS IN INTERMEDIATE UVEITIS
Authors: Pichi Francesco , Neri Piergorgio , Agarwal Aniruddha , Invernizzi Alessandro , Choudhry Netan , Amer Radgonde , Lembo Andrea , Nucci Paolo , Thompson Ian , Sen H. Nida , Shields Carol L.
Published: October 2019

Purpose:

To describe patients with intermediate uveitis complicated by vasoproliferative tumors (VPTs).

Methods:

Data were collected at seven Uveitis/Ocular Oncology centers on demographic, ophthalmic findings at baseline and at follow-up, and on imaging. The therapeutic intervention, final visual acuity, and duration of follow-up were recorded.

Results:

A total of 36 eyes from 34 patients (12 men, 22 women; mean age 35.3 ± 14.2 years) were included in this study. Visual acuity at presentation ranged from 20/40 to counting fingers. At the time of VPT diagnosis, intermediate uveitis was active in all eyes. The mean VPT thickness was 3.06 ± 0.86 mm. Local treatment to the VPT was provide in 22 eyes (61.1%) and no local treatment to the VPT in 14 eyes (38.9%). After the VPT was detected, systemic or local treatment for the inflammation was initiated and on follow-up FAs 94.4% of the eyes showed resolution of the vascular leakage. During follow-up of 35.8 months, the 22 VPTs treated locally had a reduction in the tumor thickness to 1.25 mm, whereas the 14 VPTs untreated remained stable (final mean tumor thickness 2.65 mm).

Conclusion:

The presence of active intermediate uveitis accompanied by VPTs suggests the need for an aggressive uveitis treatment.
Peripheral Hypertrophic Subepithelial Opacities of Corneal Grafts After Deep Anterior Lamellar Keratoplasty
Authors: Feizi Sepehr , Karjou Zahra , Masoudi Ali , Moshtaghion Seyed-Mohamadmehdi , Azari Amir A.
Published: October 2019

Purpose:

To investigate possible underlying etiologies of the development of peripheral graft hypertrophic subepithelial opacities (PGHSO) and to evaluate the effects of these opacities on visual outcomes after deep anterior lamellar keratoplasty (DALK).

Methods:

This prospective, interventional case series enrolled 29 eyes with keratoconus that underwent DALK and developed PGHSO (group 1). The control group consisted of 32 eyes with keratoconus that underwent DALK during the same period and had a clear graft at the final examination (group 2). Possible underlying risk factors for the development of PGHSO were investigated, and postoperative refractive and topographic outcomes were compared between the 2 study groups.

Results:

Eyes of group 1 had well-defined elevated peripheral subepithelial opacities of the corneal graft, originating from the donor–recipient junction. The central 4-mm area of the graft was clear in all eyes of this group. Compared with the controls, group 1 had flatter grafts at postoperative month 1 and a longer time interval from surgery to initial suture removal. The 2 study groups were comparable in other investigated factors, including the severity of keratoconus, surgical technique, duration of topical steroid use, and donor quality. No significant differences were observed between the case and control groups in postoperative visual acuity and graft surface regularity.

Conclusions:

Graft flattening during the early postoperative period and prolonged time interval from surgery to initial suture removal might be factors predisposing to the development of PGHSO. This complication did not affect postoperative visual outcomes when the central 4-mm area of the graft remained clear.
Outcomes of Repeat Anterior Lamellar Keratoplasty
Authors: Woo Jyh Haur , Tan Yar Li , Htoon Hla Myint , Tan Donald Tiang Hwee , Mehta Jodhbir S.
Published: October 2019

Purpose:

To describe the outcomes and complications of repeat anterior lamellar keratoplasty (ALK) after a failed primary ALK.

Methods:

This was a retrospective case series. Twenty-three eyes of 22 patients who underwent repeat ALK for optical indications from January 1, 1991, to December 31, 2017, were included. Clinical data were recorded from the Singapore Corneal Transplant Study database. Outcome measures were graft survival, best-corrected visual acuity (BCVA), and complications.

Results:

Of the 780 cases of ALK performed for optical indications during the study period, 23 cases (2.9%) underwent repeat ALK. Primary ALK comprised of 16 deep ALK and 7 automated lamellar therapeutic keratoplasty cases. After repeat ALK, 21 eyes had further dissection down to the descemetic or predescemetic plane, whereas 2 eyes had graft exchange for failed automated lamellar therapeutic keratoplasty. The graft survival of repeat ALK was 93.2%, 86.1%, and 78.3% at 1, 3, and 5 years, respectively. There were 4 cases of graft failure with a mean time to failure of 2.0 ± 1.7 years. After the repeat ALK procedure, 63.6% and 66.7% of eyes achieved a BCVA of LogMAR +0.3 (20/40) or better at 1 and 2 years, respectively. Five eyes (17.4%) had an intraoperative microperforation.

Conclusions:

In the case of a failed ALK graft for a range of optical indications, a repeat ALK procedure offers a viable and safe surgical option with good long-term graft survival and visual outcomes, while avoiding the various disadvantages of performing penetrating keratoplasty, especially the risk of allograft endothelial rejection.
Nurse practitioners leading the way: An exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands
Authors: Boeijen Enzio R. K. , Peters Jeroen W. B. , van Vught Anneke J. A. H.
Published: October 2019

Background:

Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse.

Purpose:

To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic.

Methodological orientation:

Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice.

Sample:

Twelve semi-structured interviews were conducted with NPs from two hospital settings.

Conclusions:

The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification.

Implications for practice:

This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams.
Competency-based education in transitioning nurse practitioner students from education into practice
Authors: Hodges Ashley L. , Konicki Annette Jakubisin , Talley Michele H. , Bordelon Curry J. , Holland Aimee C. , Galin F. Shawn
Published: October 2019

Competency-based education (CBE) provides a framework for nursing programs including those educating nurse practitioners (NPs). The basic assumption of CBE is that the student will demonstrate acquisition of the identified essential knowledge, skills, and attitudes expected for the designated educational process before leaving the learning environment. The work done to date in developing competencies and progression indicators provides the critical basis to move toward a common language and clear expectations for the continuum of linear progression of proficiency. Entrustable professional activities (EPAs) are built on competencies and stated as measurable activities that providers can be expected to do, at varying levels of competence or trust or supervision, and allow the faculty member, preceptor, or supervisor to make decisions as to what teaching methods and level of supervision are needed. Numerous methods are used to measure competency in clinical skill knowledge, performance, and practice readiness including clinical preceptor feedback, objective structured clinical examination, and simulation, just to name a few. NP programs continue to struggle with the education practice gap between theory and the actual provision of care. The discussion about novel and reliable methods for measurement of competencies must address the strategic importance of a consensus about when, where, and how students can obtain the appropriate amount and type of experience and supervision required in the transition to independent practice. There is also a significant need for processes and standardized guidelines that can contribute to EPA development.
Establishing nurse practitioner clinical practicums: Addressing fiscal realities
Authors: Delaney Kathleen R. , Swartwout Kathryn , Livesay Sarah L. , Bavis Margaret Perlia
Published: October 2019

As demand expands for nurse practitioner clinical practicum sites, the supply of preceptors is decreasing. The traditional model of in-kind clinical training is losing its foothold for a variety of reasons. A looming question is how quickly a “pay to precept” norm will grow and what will be the costs. The pay for precepting movement is discussed including current trends, costs, and emerging compensation models. To adapt to this trend, alternative ways of drawing the precepting value proposition are suggested, particularly decreasing preceptor and site demands while increasing students' readiness to enter clinical practicum and tapping into faculty expertise to add value to the partnership. The authors provide suggestions on building a strategy for rethinking the structure of student precepting arrangements and compensation models.
Escalating interventional recanalization therapy in non-cirrhotic, non-malignant acute portal vein thrombosis
Authors: Gerwing Mirjam , Wilms Christian , Heinzow Hauke , Sporns Peter B. , Heindel Walter , Schmidt Hartmut , Wildgruber Moritz , Köhler Michael
Published: October 2019

Objective:

To evaluate the effectiveness of interventional therapy in acute, non-malignant, non-cirrhotic portal vein thrombosis.

Methods:

We present a retrospective study of eight consecutive patients who presented with an acute non-malignant, non-cirrhotic portal vein thrombosis and were treated by mechanical recanalization using an escalating scheme including local aspiration, thrombolysis, rheolysis and the implantation of transjugular intrahepatic portosystemic shunt or other visceral stents.

Results:

Recanalization rates applying the escalating scheme were good, with a success rate of 75%. However, major complications occurred in 50% of patients, mostly due to bleeding at the percutaneous access site, and minor complications in 12.5% of patients.

Conclusion:

Interventional therapy is effective in acute portal vein thrombosis, but should only be performed at specialized centers and based on an individual treatment decision.
Polymorphisms in Genes Coding for Folate-Related Enzymes and Colorectal Cancer
Authors: Gholamalizadeh Maryam , Doaei Saeid , Shahvegharasl Zahra , Hajiesmaeil Mogge , Aminifard Atefeh , Mosavi-Jarrahi Alireza , Mohammad Esmail Akbari , Mirzaei Dahka Samaneh
Published: October 2019

This review examined the association between folate and risk of colorectal cancer and single-nucleotide polymorphisms in 4 genes coding for folate metabolism–related enzymes may be involved. Individuals with single-nucleotide polymorphisms in these key enzymes in the folate pathways may need different amounts of dietary folate to prevent colorectal cancer.
Flexor Tendon: Development, Healing, Adhesion Formation, and Contributing Growth Factors
Authors: Titan Ashley L. , Foster Deshka S. , Chang James , Longaker Michael T.
Published: October 2019

Management of flexor tendon injuries of the hand remains a major clinical problem. Even with intricate repair, adhesion formation remains a common complication. Significant progress has been made to better understand the mechanisms of healing and adhesion formation. However, there has been slow progress in the clinical prevention and reversal of flexor tendon adhesions. The goal of this article is to discuss recent literature relating to tendon development, tendon healing, and adhesion formation to identify areas in need of further research. Additional research is needed to understand and compare the molecular, cellular, and genetic mechanisms involved in flexor tendon morphogenesis, postoperative healing, and mechanical loading. Such knowledge is critical to determine how to improve repair outcomes and identify new therapeutic strategies to promote tissue regeneration and prevent adhesion formation.