bluuebunny/crossref_metadata_2025 huggingface dataset:
Greek Performance Culture
Authors: Yatromanolakis Dimitrios
Published: September 2017

Ancient Greece—despite differences in local societies and diverse discontinuities over a span of many centuries—laid distinctive emphasis on verbal art as performance and developed numerous forms of performance culture, from theatrical to political to musical. The present bibliographical article includes sections on major areas related to ancient Greek performance cultures (see below) and discusses scholarship written in different European languages (especially French, German, Greek, and Italian) instead of considering primarily English-language publications. The concept of performance in contemporary research in the social sciences and the humanities has acquired significantly broad connotations (it has become an all-encompassing concept, as in the case of social performance, and sometimes even a metaphor). It has thus been applied to many aspects of human activity and communicative interaction. In light of such usage of the concept, one may trace “performance” in a particularly large number of—or in all, as some theoretically informed scholarship would argue—areas related to ancient Greek material culture and texts. As these are areas surveyed and to be surveyed in the future in other Oxford Bibliographies articles, this bibliographical article does not address topics like ancient Greek sports (except briefly in General Overviews); performance of identity in the ancient Greek world (except, from a particular art-historical perspective, in Archaic and Early Classical Greek Art and Performance); politics and performance; performance and ethnicity; or the performance of hundreds of religious rituals in Greek antiquity (however, see Ritual and Performance and Burkert 1985, cited under General Overviews). In a bibliographical article focusing on performance culture, overlap among some sections is unavoidable. Given the prescribed structure and scope of Oxford Bibliographies articles, it has proved unfeasible to discuss all books, let alone articles, focusing on ancient Greek performance cultures from the archaic period to later eras. This article places emphasis not only on research on the archaeological material and written sources about sufficiently investigated performance contexts like theater and ancient Greek symposia, but also on archaeological and historical investigations of musical and poetic competitions; methodological perspectives on ritual, orality, and popular song; archaeological approaches to Music and Sound; and epigraphic and historical research on artists’ guilds.
Aristotle's Metaphysics
Authors: Galluzzo Gabriele
Published: September 2017

Aristotle’s Metaphysics, one of the most influential works in Western thought, is a collection of fourteen treatises or books. The title is not by Aristotle and is due to a Hellenistic editor, traditionally identified with Andronicus of Rhodes (first century bce). Metaphysics (ta meta ta phusika) means “the things after the physical things” and may point to the position of the metaphysical books in the Hellenistic edition of Aristotle’s works (after the physical books) or possibly to the order in which metaphysical issues should be learned in an ideal curriculum (after the study of physics). Aristotle, however, is not responsible for assembling the books of the Metaphysics into a single work. The collection is most likely to have been put together by Andronicus or someone else on the basis of the thematic similarities among the individual treatises. Although the Metaphysics is not a unified work in our sense, it seems undeniable that the different treatises of the collection pursue a general philosophical project or discipline, which Aristotle variously refers to as “wisdom,” “first philosophy,” or even “theology.” Such a discipline is described in the Metaphysics as a theoretical science, as opposed to practical and productive sciences, and it is sharply distinguished from the other two theoretical sciences, physics and mathematics. In many ways it would not be incorrect to describe Aristotle’s project in the Metaphysics as metaphysics. Many of the issues Aristotle deals with—such as existence, essence, individuation, identity, Universals, the nature of material objects, just to mention a few—are certainly issues that we would comfortably describe as metaphysical. But in other respects, Aristotle’s conception of metaphysics is broader than ours, as it includes philosophical areas—such as rational theology, cosmology, philosophy of mathematics and logic—that do not obviously fall within metaphysics in our sense, though they may be closely related to it. Aristotle’s Metaphysics has been enormously influential in shaping Arabic and Latin medieval thought and has remained central to early modern philosophy as well. Over the last sixty years or so, the Metaphysics has been rediscovered by metaphysicians in the analytic philosophy tradition as a source of philosophical insights. This renewal of philosophical interest has been matched by a proliferation of sophisticated scholarly works on Aristotle’s writing. This article has the twofold aim of mapping out resources on the text of the Metaphysics and offering bibliographical guidance on the philosophical issues dealt with in Aristotle’s writing.
Ovid’s Love Poetry
Authors: Thorsen Thea S.
Published: September 2017

Always brilliantly marshaling the rich resources of the art of literature, the love poetry of the great and prolific poet Ovid (43 bce–17/18 ce) displays a vigorous engagement with Rome and the human condition. Love permeates Ovid’s entire output. His epic masterpiece the Metamorphoses and his etiological Fasti are strongly marked by stories of love. And even in the exile to which Augustus condemned Ovid toward the end of his life, he insists, in his imaginary epitaph in Tristia 3.3.73 and his autobiography Tristia 4.10.1, that he is tenerorum lusor amorum, “the playful bard of tender loves.” Love is most conspicuously present in the earlier phase of Ovid’s career. Thus, in this poetry we find titles in which amor (love) features in various forms, such as the collection of elegies called Amores (Loves), which many think we now possess in the form of a second edition; the didactic manuals in elegiac couplets, the Ars amatoria (The art of love) 1–3; and the Remedia amoris (Cures for love). To these works belong also the fragments of the didactic Medicamina faciei femineae (Cosmetics for female beauty). Furthermore, the epistolary elegies known as the Heroides may be considered as a part of Ovid’s love poetry, since love is the common denominator of all the letters included. This work is commonly divided into two parts, the single Heroides 1–15 and the double Heroides 16–21, now frequently considered to have been composed at different times. In addition to the difficulties of establishing the chronological order of all the works of Ovid’s love poetry, the authenticity of a number of the Heroides has been questioned. Ovid’s love poetry, understood as these most conspicuously amorous works, displays a number of striking characteristics, such as sophisticated metapoetics and an innovative approach to established genres, especially that of Latin love elegy; a rich interplay with the preceding literature of both Greece and Rome and a striking interconnection of the various works by means of internal references (Ovidian loci similes, “similar passages”); a humorously playful and politically poignant engagement in the world of Augustus’s Rome and a particularly eager interest in human psychology. Finally, Ovid’s love poetry is strikingly crowded with female figures of great and varied significance.
Ovid’s Exile Poetry
Authors: Tissol Garth
Published: September 2017

Ovid’s poetry of exile, once considered of interest only as a source of historical and biographical details, now enjoys ever-increasing appreciation and esteem as poetry. Ovid was Rome’s best-known poet when in 8 ce he was abruptly exiled by Augustus for reasons that remain unclear. He regarded his place of exile at Tomis, on the shore of the Black Sea, as irredeemably desolate, and longed to return to Rome. Though wretched, he continued to write, producing two large collections of elegiac poetry, the Tristia, “sad poems,” and the Epistulae ex Ponto, epistolary elegies addressed to friends and supporters at Rome, in which he laments his lot and begs their help in lessening its misery. He also attacks an unnamed enemy in a poem of invective, the Ibis. To suit his new identity as a poet of lament, Ovid refashions himself and his elegiac style, remaining no less inventive and ingenious than in his earlier works.
Catherine of Siena
Authors: Luongo F. Thomas
Published: September 2017

Catherine of Siena (b. 1347–d. 1380) was an author, spiritual leader, religious reformer, and one of the more remarkable public figures of the Middle Ages. Born to a prosperous family of cloth dyers, in her youth she developed a reputation for unusual piety, and in her late teens or early twenties joined the local community of Dominican female penitents (precursors to what became in the 15th century the Dominican Third Order). She developed a following that included a number of young Sienese nobleman, as well as religious from various orders, and in 1374 was enlisted by the Dominican order and the papacy to help advance several causes, including a Crusade to the Holy Land and peace in Italy. Between 1374 and her death in 1380, through her letters and in person, Catherine advocated for ecclesiastical reform, the return of the papacy to Rome from Avignon, and the Roman observance after the schism of 1378. In addition to her letters—the largest epistolary collection by a woman in the Middle Ages—she is known for a masterpiece of mystical theology, her Libro di divvina dottrina (Book of Divine Teachings), better known today as the Dialogo, a synthesis of her spiritual insights, structured in the form of a dialogue between Catherine and God. It was largely through her Libro, in addition to the hagiographical tradition, that her reputation spread throughout Europe. Catherine became the object of an active cult before her canonization in 1461, and she was embraced in the early modern period as a mystic and model for female monasticism. In the period of Italian nationalism from the Risorgimento through World War II, she became an emblem of Catholic Italy, and more recently she has been valued more for her active engagement with the world as well as for her spiritual writings. Scholars of Catherine of Siena and her devotees—two not-mutually exclusive groups—have over time vacillated radically in their sense of Catherine’s association with Italian politics and society, and in their assessments of her writings and their place in literary culture. Until recently, she has not been taken seriously by Italian literary critical scholarship: the inspired, devotional character of her prose, and its mix of oral with literary characteristics, has seemed to place her outside of literature, properly speaking. But there is currently a renewed interest in Catherine as an author, as well as a return to questions regarding the complexities of her texts and their composition first raised in the initial flowering of Catherinian source criticism in the 1930s and 1940s. She emerged as an important figure in international medieval scholarship with the rise of interest in hagiography, lay spirituality, and women’s religion and gendered religiosity in the last quarter of the 20th century, and is now recognized by historians as a key representative of important trends in late-medieval religion.
American Indian Education
Authors: Faircloth Susan C.
Published: September 2017

This bibliography is structured to present seminal studies, reports, and other key resources that serve to introduce readers to the historical and contemporary issues impacting the education of Indigenous children, youth, and adults. This brief overview of resources is also intended to contextualize and promote increased understanding of the complex history of Indigenous education in the United States— a history complicated by the unique sociopolitical relationships between Indigenous peoples (for the purposes of this resource, American Indian and Alaska Natives) and the United States and its agents—both directly and indirectly. This relationship has implications for the way in which Indigenous students access or have access to educational programs, supports, and services and the values, beliefs, and philosophies that guide these programs, supports, and services. As Indigenous people and their communities continue to move forward in their efforts to engage in locally controlled, self-determined education, and to directly impact the overall design, quality, and ultimately the outcomes of Indigenous education, ongoing examination, reflection, and critique will be required.
LGBT Youth in Schools
Authors: Poirier Jeffrey M. , Mattheis Allison , Temkin Deborah
Published: September 2017

This review synthesizes recent literature and research on students in K–12 schools who are attracted to the same gender (lesbian, gay), attracted to people of the same or other genders (bisexual), or identify as a gender different than the one they were assigned at birth (transgender). Lesbian, gay, bisexual, and transgender (LGBT) young people have historically experienced vulnerability in schools because of challenges such as invisibility in school curricula; peer and staff rejection, harassment, and violence; and ill-equipped school professionals who lack the competence and will to effectively address bias and foster inclusive school environments. Foundational research in the field examines this vulnerability to document the experiences and needs of this population—and to draw attention to gaps in school policy, practice, and outcomes for LGBT students. Research examining vulnerabilities and challenges for this population is also prominent in the early 21st century because many of these concerns persist. At the same time, more recent research on LGBT youth in schools is attending to these young people’s positive assets and their resilience, including their abilities to effectively navigate conflict and stress and adapt to different situations. Throughout this article, “LGBT” is used as an umbrella acronym. Although the rich diversity of sexual orientation and gender identity and expression, such as students who are queer, genderqueer, or questioning their sexual orientation or gender identity is important, this article aims to provide a working vocabulary to address this population of youth discussed here. This article also aligns its terminology with the content of articles. In other words, if an article examines only transgender students, then the full LGBT acronym is not used when writing about that article. Research on LGBT youth in schools is substantial, given the growth of research studying related issues during the late 20th and early 21st centuries. This expanding research on LGBT youth in schools has spanned topics beyond their school experiences to include myriad issues such as their identity development within the school context; school-based policies, practices, and supports such as inclusive nondiscrimination policies; teacher practices that foster welcoming and inclusive school settings, and the benefits of safe spaces and targeted supports for LGBT students; and how school administrator and teacher preparation programs can lead to better school practice and outcomes for LGBT students. Other areas of research on LGBT youth in schools continue to emerge as the field’s understanding about diverse sexual orientation and gender identities expands, and as there is more attention given to the complexity of identity and expression including intersectionality (e.g., youth in schools who are LGBT and of color, or LGBT and immigrants).
Critical Periods
Authors: Birdsong David P.
Published: September 2017

A critical period is a bounded maturational span during which experiential factors interact with biological mechanisms to determine neurocognitive and behavioral outcomes. In humans, the construct of critical period (CP) is commonly applied to first-language (L1) and second-language (L2) development. Some language researchers hold that during a CP, various mechanisms are at work that result in successful language acquisition and language processing. Outside of the period, other factors and mechanisms are involved, resulting in deficits in acquisition and processing. Many researchers believe that L1 development is constrained by maturationally based CPs. However, this notion is more controversial in L2 acquisition research, where the Critical Period Hypothesis for L2 acquisition (CPH/L2A) is debated on empirical, theoretical, and methodological grounds. Bilingualism researchers study the possibility that CPs may govern the likelihood and degree of loss (attrition) of the L1 among bilinguals as they age. Studies of CPs in L1 acquisition and L2 acquisition have been conducted with learners of spoken languages, signed languages, and artificial languages. CP research is considered in educational policy, particularly in the context of foreign language instruction. On a terminological note, a distinction is sometimes drawn between “critical” and “sensitive” periods, the latter term denoting receptivity of the organism to shaping by experience (or, in certain studies, suggesting relatively mild effects). Some researchers use these terms interchangeably, while others use one but not the other. Here, “critical period” will be used as a cover term unless specific reference is being made to sensitive period.
Prolonged Detection of Japanese Encephalitis Virus in Urine and Whole Blood in a Returned Short-term Traveler
Authors: Huang G Khai Lin , Tio Shio Yen , Caly Leon , Nicholson Suellen , Thevarajan Irani , Papadakis Georgina , Catton Mike , Tong Steven Y C , Druce Julian
Published: September 2017

We describe a fatal case of Japanese encephalitis virus infection following short-term travel to Thailand. Viral RNA was detected in urine and whole blood out to 26 and 28 days, respectively, after the onset of symptoms. Live virus was isolated from a urine specimen from day 14.
The Global Trade Slowdown: Cyclical or Structural?
Authors: Constantinescu Cristina , Mattoo Aaditya , Ruta Michele
Published: September 2017

This paper focuses on the sluggish growth of world trade relative to income growth in recent years. We use a simple empirical strategy based on an error correction model to assess whether the global trade slowdown is structural or cyclical. An estimate of the relationship between trade and income in the past four decades reveals that the long-term trade elasticity rose sharply in the 1990s, but declined significantly in the 2000s, even before the global financial crisis. These results suggest that trade is growing slowly not only because of slow GDP growth, but also because of a structural change in the trade-GDP relationship in recent years. The available evidence suggests that a key driver of structural change over the 2000s is the slowing pace of international vertical specialization, which accounts for between one-quarter and one-half of the decline in import growth from the 1990s to the 2000s.
Critical Fungicide Spray Period for Citrus Black Spot Control in São Paulo State, Brazil
Authors: Lanza Fabrício Eustáquio , Metzker Tadeu Germano , Vinhas Thiago , Behlau Franklin , Silva Junior Geraldo José
Published: September 2017

The period of citrus black spot (CBS) control used in South Africa (SA) and Australia, from October to January or February, has not been as effective in São Paulo (SP), Brazil. This study aimed to evaluate different periods of protection and determine the critical period for CBS control in SP. A field trial was carried out for two seasons in a mature Valencia sweet orange orchard located in Mogi Guaçu, SP. Spray programs with a total of 60, 100, 140, 180, and 220 days of fruit protection (DFP) were evaluated. CBS symptoms and fruit drop decreased exponentially as the length of the period of protection increased. The reductions in CBS intensity and crop loss with these programs ranged from 34 to 96 and 50 to 77%, respectively. The programs with 180 and 220 DFP, which protected the fruit from September to March and May, showed the highest cost benefit. The critical period needed for CBS control in SP is longer than that in SA and Australia. The results obtained with the present study are helpful for scheduling a more efficient and rational program for CBS control not only in SP but also in other tropical and subtropical regions with similar weather conditions.
Understanding medulloblastoma
Authors: Quinlan Alyssa , Rizzolo Denise
Published: September 2017

Brain tumors are the most common solid tumor malignancies in childhood, and among them, medulloblastoma occurs with the greatest frequency. Because medulloblastomas occur in the posterior fossa, the presenting symptoms often are vague complaints and diagnosis may be delayed. Between 70% and 80% of patients who are diagnosed before metastatic dissemination survive, compared with 30% to 40% of those in higher risk groups. This article reviews the diagnosis, treatment, and prognosis for medulloblastoma.
In Search of Black Swans: Identifying Students at Risk of Failing Licensing Examinations
Authors: Barber Cassandra , Hammond Robert , Gula Lorne , Tithecott Gary , Chahine Saad
Published: September 2017

Purpose

To determine which admissions variables and curricular outcomes are predictive of being at risk of failing the Medical Council of Canada Qualifying Examination Part 1 (MCCQE1), how quickly student risk of failure can be predicted, and to what extent predictive modeling is possible and accurate in estimating future student risk.

Method

Data from five graduating cohorts (2011–2015), Schulich School of Medicine & Dentistry, Western University, were collected and analyzed using hierarchical generalized linear models (HGLMs). Area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy of predictive models and determine whether they could be used to predict future risk, using the 2016 graduating cohort. Four predictive models were developed to predict student risk of failure at admissions, year 1, year 2, and pre-MCCQE1.

Results

The HGLM analyses identified gender, MCAT verbal reasoning score, two preclerkship course mean grades, and the year 4 summative objective structured clinical examination score as significant predictors of student risk. The predictive accuracy of the models varied. The pre-MCCQE1 model was the most accurate at predicting a student’s risk of failing (AUC 0.66–0.93), while the admissions model was not predictive (AUC 0.25–0.47).

Conclusions

Key variables predictive of students at risk were found. The predictive models developed suggest, while it is not possible to identify student risk at admission, we can begin to identify and monitor students within the first year. Using such models, programs may be able to identify and monitor students at risk quantitatively and develop tailored intervention strategies.
Medical Students’ Empathy for Vulnerable Groups: Results From a Survey and Reflective Writing Assignment
Authors: Wellbery Caroline , Saunders Pamela A. , Kureshi Sarah , Visconti Adam
Published: September 2017

Purpose

As medical education curricula increasingly acknowledge the contributions of the social determinants of health to individual health, new methods of engaging students in the care of vulnerable groups are needed. Empathy is one way to connect students with patients, but little is known about how to nurture students’ empathy on behalf of populations. This study examined the relationship between individual and social empathy as groundwork for cultivating students’ empathy for vulnerable groups.

Method

In 2014–2015, first-year medical students completed the Social Empathy Index at the start and end of a two-semester population health course, and they completed a reflective writing assignment exploring the challenges of caring for vulnerable patients. Pre- and posttest mean survey scores were compared, and reflective writing assignments were analyzed for themes concerning social empathy.

Results

Data from 130 students were analyzed. Scores for the contextual understanding of systemic barriers domain increased significantly. There was a trend toward increased cumulative social empathy scores that did not reach statistical significance. Students’ essays revealed three themes relating to individual empathy as the foundation for social empathy; civic and moral obligations; and the role of institutional practices in caring for vulnerable groups.

Conclusions

This study extends understanding of empathy beyond care for the individual to include care for vulnerable groups. Thus, social empathy may function as a valuable concept in developing curricula to support students’ commitment to care for the underserved. Educators first need to address the many barriers students cited that impede both individual and social empathy.
Concurrent Use of Opioids and Benzodiazepines: Evaluation of Prescription Drug Monitoring by a United States Laboratory
Authors: McClure Fred Leland , Niles Justin K. , Kaufman Harvey W. , Gudin Jeffrey
Published: September 2017

Objectives:

Recently, more than 63% of the 52,404 drug overdose deaths in the United States involved heroin and opioid pain medications. More than 30% of opioid-related deaths also involved benzodiazepines. Previous studies examining the extent of concurrent opioid and benzodiazepine use have relied on prescription data. To gain fuller insight into the extent of the concurrent use problem, we analyzed opioid and benzodiazepine prescription patterns in the context of drug testing results.

Methods:

All specimens from patients that were prescribed at least 1 drug and were tested for both opioids and benzodiazepines by a national reference laboratory were included. This resulted in an analytical set of 231,228 sets of test results from 144,535 patients with diverse demographic factors being tested in a variety of health care settings.

Results:

Laboratory test results indicated concurrent use of opioids and benzodiazepines in over 25% of patients. In 52% of test results with evidence of concurrent use, 1 drug class was prescribed and the other was non-prescribed. Nearly 1 in 5 specimens (19%) testing positive for prescribed opioids also tested positive for non-prescribed benzodiazepines. Over 15% of specimens with prescribed benzodiazepines also demonstrated non-prescribed opioid use.

Conclusions:

The extent of concurrent use of benzodiazepines and opioids, particularly non-prescribed use, suggests the need for more effective clinician assessment and intervention. The results support the Centers for Disease Control and Prevention opioid prescribing guidelines that drug testing occur before and periodically throughout opioid use and suggest that this testing should be extended to patients prescribed benzodiazepines as well.
The Unexpected Urine Test: A Matter Far From Simple
Authors: Kertesz Stefan G.
Published: September 2017

For patients who receive opioids or benzodiazepines, urine drug tests shed some light on the question of whether patients take their medicines as directed. How often do patients prescribed these drugs fall short? A commercial laboratory's review of 144,535 urine samples found a high prevalence of disagreement between what clinic staff reported on laboratory requisitions and what was detected in the urine. Before concluding that most patients fail to take opioids and benzodiazepines correctly, we should take into account that urine tests sent to national laboratories reflect a skewed subset of patients who receive prescriptions. Additionally, laboratory requisitions prepared by office staff are not likely to perfectly reflect what is prescribed. Nevertheless, this report by McClure et al reminds us that urine drug test results will frequently diverge from what clinicians expect. Urine tests convey a signal requiring interpretation followed by careful, patient-centered decisions.
Cardiac complications of systemic sclerosis and management: recent progress
Authors: Rangarajan Vibhav , Matiasz Richard , Freed Benjamin H.
Published: September 2017

Purpose of review

Cardiac complications in systemic sclerosis (SSc) continue to be a leading cause of death in this patient population. Early recognition and treatment of the cardiac diseases commonly associated with SSc is essential.

Recent findings

Recent studies have confirmed the significant increase in mortality in SSc patients with cardiac involvement. Electrocardiography and echocardiography (2DE) continue to play a major role in screening and diagnosing cardiac manifestations such as arrhythmias or biventricular dysfunction, respectively. Novel techniques such as myocardial strain imaging on 2DE and T1 mapping on cardiovascular magnetic resonance are useful for detecting subclinical cardiac abnormalities, but the clinical relevance of these findings is still not known. An expert consensus was recently published to help establish best practice guidelines on management of cardiac complications in SSc, but data supporting these recommendations remain limited.

Recent studies continue to enhance our understanding of SSc cardiac disease. Although the results of these studies help lessen the ambiguity of managing and treating these patients, there is still much more research to be done.
Postoperative Resolution of Magnetic Resonance Imaging Signal Intensity Changes and the Associated Impact on Outcomes in Degenerative Cervical Myelopathy
Authors: Kato So , Nouri Aria , Reihani-Kermani Hamed , Oshima Yasushi , Cheng Joseph , Fehlings Michael G.
Published: September 2017

Study Design.

Subanalysis of the prospective AOSpine CSM North America and International studies.

Objective.

To describe the postoperative changes in magnetic resonance imaging (MRI) spinal cord signal intensity in degenerative cervical myelopathy (DCM) patients and to investigate the impact of its postoperative resolution on clinical outcomes.

Summary of Background Data.

When examining the spinal cord, hyperintensity found in MRI T2-weighted images and hypointensity in T1-weighted images are known to correlate with preoperative severity of DCM and to predict postoperative neurological recovery. However, the clinical importance of these signal intensity changes in postoperative images has not been established.

Methods.

Among 757 surgical DCM patients enrolled in two prospective multicenter studies, postoperative MRI images obtained between 6 and 24 months after the operation were examined with a focus on T2 hyper- and T1 hypointensity in the spinal cord. The 2-year postoperative Nurick grade, modified Japanese Orthopaedic Association score and modified Japanese Orthopaedic Association recovery rate (RR) were analyzed between patients with or without resolution of signal intensity changes.

Results.

A total of 167 patients with preoperative T2 hyperintensity were included with complete postoperative MRI images. Of these patients, 11% showed resolution of signal intensity changes, 70% retained T2 hyperintensity only, and 19% showed both T2 hyper- and T1 hypointensity postoperatively. There was a stepwise trend toward worse postoperative outcomes, with the no signal intensity change group showing the best outcome and the T1 hypointensity group showing the worst (mean RR: 72% vs. 51% vs. 36%, P = 0.02). Patients who exhibited resolution of T2 hyperintensity showed better outcomes than those who retained it (RR: 72% vs. 47%, P = 0.04), but the resolution of T1 hypointensity was not associated with improved outcomes (RR: 38% vs. 26%, P = 0.36).

Conclusion.

Postoperative resolution of T2 hyperintensity in patients with DCM was associated with the best clinical outcomes, whereas those with T1 hypointensity showed the worst.

Level of Evidence: 3
Diagnostic Accuracy of Point-of-Care Ultrasound Performed by Pulmonary Critical Care Physicians for Right Ventricle Assessment in Patients With Acute Pulmonary Embolism*
Authors: Filopei Jason , Acquah Samuel O. , Bondarsky Eric E. , Steiger David J. , Ramesh Navitha , Ehrlich Madeline , Patrawalla Paru
Published: September 2017

Objectives:

Risk stratification for acute pulmonary embolism using imaging presence of right ventricular dysfunction is essential for triage; however, comprehensive transthoracic echocardiography has limited availability. We assessed the accuracy and timeliness of Pulmonary Critical Care Medicine Fellow’s performance of goal-directed echocardiograms and intensivists’ interpretations for evaluating right ventricular dysfunction in acute pulmonary embolism.

Design:

Prospective observational study and retrospective chart review.

Setting:

Four hundred fifty bed urban teaching hospital.

Patients:

Adult in/outpatients diagnosed with acute pulmonary embolism.

Interventions:

Pulmonary critical care fellows performed and documented their goal-directed echocardiogram as normal or abnormal for right ventricular size and function in patients with acute pulmonary embolism. Gold standard transthoracic echocardiography was performed on schedule unless the goal-directed echocardiogram showed critical findings. Attending intensivists blinded to the clinical scenario reviewed these exams at a later date.

Measurements and Main Results:

Two hundred eighty-seven consecutive patients were evaluated for acute PE. Pulmonary Critical Care Medicine Fellows performed 154 goal-directed echocardiograms, 110 with complete cardiology-reviewed transthoracic echocardiography within 48 hours for comparison. Pulmonary Critical Care Medicine Fellow’s area under the curve for size and function was 0.83 (95% CI, 0.75–0.90) and 0.83 (95% CI, 0.75–0.90), respectively. Intensivists’ 1/2 area under the curve for size and function was (1) 0.87 (95% CI, 0.82–0.94), (1) 0.87 (95% CI, 0.80–0.93) and (2) 0.88 (95% CI, 0.82–0.95), (2) 0.88 (95% CI, 0.82–0.95). Median time difference between goal-directed echocardiogram and transthoracic echocardiography was 21 hours 18 minutes.

Conclusions:

This is the first study to evaluate pulmonary critical care fellows’ and intensivists’ use of goal-directed echocardiography in diagnosing right ventricular dysfunction in acute pulmonary embolism. Pulmonary Critical Care Medicine Fellows and intensivists made a timely and accurate assessment. Screening for right ventricular dysfunction using goal-directed echocardiography can and should be performed by pulmonary critical care physicians in patients with acute pulmonary embolism.
Calcium Hydroxylapatite Combined with Microneedling and Ascorbic Acid is Effective for Treating Stretch Marks
Authors: Casabona Gabriela , Marchese Paula
Published: September 2017

Background:

Stretch marks can have a negative psychological impact on some individuals. Methods are available for treating stretch marks, but high-quality evidence supporting their use is limited. We treat stretch marks using injections of diluted calcium hydroxylapatite (CaHA, Radiesse) filler combined with microneedling and topical ascorbic acid. This retrospective study evaluated the effectiveness of this combined therapy.

Methods:

Subjects presented with red (n = 25) or white (n = 10) striae on their buttocks, thighs, knees, abdomen, and breasts. CaHA filler was diluted 1:1 with lidocaine 2% without epinephrine. A maximum of 3.0 mL of filler was injected per patient at all skin depths using a 23G needle. This was immediately followed by microneedling and topical application of 20% ascorbic acid. Microneedling with ascorbic acid was repeated after 1 and 2 months. Skin biopsies were obtained from a patient who later underwent abdominoplasty.

Results:

The mean (±SD) pretreatment Manchester Scar Scale scores were 12.0 (±0.8), decreasing to 7.1 (±1.4) 1 month after the final treatment, indicating improvement in stretch mark appearance (P < 0.001). Subjects were very satisfied (n = 22; 62.9%), satisfied (n = 8; 22.9%), neither satisfied nor dissatisfied (n = 4; 11.4%), or unsatisfied (n = 1; 2.8%) with their treatment results. Analysis revealed a significant correlation between Scar Scale scores and Patient Satisfaction scores (r = 0.483; P = 0.003). Skin biopsies showed increased quantity and quality of collagen and elastin fibers in areas treated with combination therapy. Procedures were well tolerated.

Conclusion:

Combining 1:1 diluted CaHA with microneedling and topical ascorbic is safe and effective for treating stretch marks.
Cosmetic Surgery Training in Plastic Surgery Residency Programs
Authors: McNichols Colton H. L. , Diaconu Silviu , Alfadil Sara , Woodall Jhade , Grant Michael , Lifchez Scott , Nam Arthur , Rasko Yvonne
Published: September 2017

Background:

Over the past decade, plastic surgery programs have continued to evolve with the addition of 1 year of training, increase in the minimum number of required aesthetic cases, and the gradual replacement of independent positions with integrated ones. To evaluate the impact of these changes on aesthetic training, a survey was sent to residents and program directors.

Methods:

A 37 question survey was sent to plastic surgery residents at all Accreditation Council for Graduate Medical Education–approved plastic surgery training programs in the United States. A 13 question survey was sent to the program directors at the same institutions. Both surveys were analyzed to determine the duration of training and comfort level with cosmetic procedures.

Results:

Eighty-three residents (10%) and 11 program directors (11%) completed the survey. Ninety-four percentage of residents had a dedicated cosmetic surgery rotation (an increase from 68% in 2015) in addition to a resident cosmetic clinic. Twenty percentage of senior residents felt they would need an aesthetic surgery fellowship to practice cosmetic surgery compared with 31% in 2015. Integrated chief residents were more comfortable performing cosmetic surgery cases compared with independent chief residents. Senior residents continue to have poor confidence with facial aesthetic and body contouring procedures.

Conclusions:

There is an increase in dedicated cosmetic surgery rotations and fewer residents believe they need a fellowship to practice cosmetic surgery. However, the comfort level of performing facial aesthetic and body contouring procedures remains low particularly among independent residents.
New Internal Fixation Technique for Transconjunctival Fat Repositioning
Authors: Chang Cheol Ho , Cha Myung Kyu
Published: September 2017

To treat tear trough deformities in young patients, transconjunctival orbital fat repositioning has been widely used. Although internal fixation of transposed fat enables more secure and stable fixation than the externalized percutaneous suture method, the latter is used more commonly because of the narrow operation field and consequent technical difficulty of the internal fixation method. We describe a novel technique using a newly devised needle (Chang's needle) that facilitates internal fixation of transposed fat pedicles.
The Impact of Scleral Contact Lens Vault on Visual Acuity and Comfort
Authors: Otchere Heinz , Jones Lyndon , Sorbara Luigina
Published: September 2017

Purpose:

To assess how varying degrees of corneal clearance of scleral contact lenses (ScCL) impact visual acuity (VA) and comfort in patients with corneal ectasia.

Method:

Three ScCL were fitted to 20 subjects with previous diagnosis of either keratoconus (n=18) or pellucid marginal degeneration (n=2). Fitting of ScCL was based on corneal sagittal height (CSH) measured with Visante OCT at a 15-mm chord on the horizontal meridian. To select the ScCL from the diagnostic lens set, values of 325, 375, and 425 μm were randomly added in sequence to CSH. Subjects wore ScCL for 1 hr. Central corneal clearance (CCC) and topographic corneal clearance (TCC) along the vertical meridian were assessed using an ultralong optical coherence tomographer. High-contrast VA (HCVA) and low-contrast VA (LCVA) were measured using a logarithm of the minimum angle of resolution VA chart, and comfort ratings were obtained with a standard comfort scale (0–100).

Results:

Mean CSH in the horizontal meridian was 3.78±0.53 (range: 3.33–4.17) mm at a 15-mm chord. Mean CCC was 190±100 μm (TCC: 160±94 μm at +3 mm and 180±94 μm at −3 mm), 360±120 μm (TCC: 260±100 μm at +3 mm and 330±110 μm at −3 mm), and 450±170 μm (TCC: 320±120 μm at +3 mm and 400±120 μm at −3 mm) for each lens (P=0.001). Mean HCVA for lenses 1, 2, and 3 were 0.05±0.12, 0.07±0.11, and 0.11±0.08 respectively, which were significantly different (P=0.02). Tukey post hoc analysis showed that this difference was only significant between lenses 1 and 3 (P=0.01). Similar findings were found for LCVA. Comfort ratings for lenses 1, 2, and 3 were 74.9±9.2, 79.7±11.6, and 78.6±10.8, respectively (P=0.24).

Conclusion:

The CSH is an effective method of determining the appropriate lens/cornea relationship. Lens 2 (+375 μm) gave the best combination of acuity and comfort ratings. Evaluation of the fluorescein pattern must be balanced with VA and comfort ratings for successful fitting in a clinical setting.
Descemet Membrane Endothelial Keratoplasty in Eyes With Previous Laser Refractive Surgery: Outcomes and Complications
Authors: Zeidenweber Dorian A. , Mayko Zachary M. , Straiko Michael D. , Terry Mark A.
Published: September 2017

Purpose:

To evaluate the refractive predictability and efficacy of Descemet membrane endothelial keratoplasty (DMEK) for patients with previous laser refractive surgery.

Methods:

We retrospectively reviewed our cohort of endothelial keratoplasty surgical cases. We identified 21 eyes that underwent laser-assisted in situ keratomileusis (n = 17) or photorefractive keratectomy (n = 4) and were treated with DMEK for endothelial failure. Patients were analyzed preoperatively and at 6 months postoperatively for changes in visual acuity, refraction, and corneal topography.

Results:

Six months after surgery, eyes significantly improved to a mean best-corrected visual acuity of 20/23 (P < 0.001). Mean astigmatism amplitude changed from 1.13 ± 0.96 preoperatively to 0.92 ± 0.51 diopters postoperatively (P = 0.28). However, shifts in the axis of corneal astigmatism ranged from 1 to 70 degrees, with 6 eyes (30%) showing an axis shift of more than 30 degrees. Spherical equivalents in nontriple procedures remained unchanged (n = 16; P = 0.69) at 6 months.

Conclusions:

DMEK and DMEK triple procedures are predictable in patients with previous refractive surgery achieving good visual results. However, refraction after the use of toric intraocular lenses may be unpredictable because of the variability in changes of the magnitude and axis of corneal astigmatism; we recommend extreme caution in the use of the toric intraocular lens in this group of patients and proper counseling for possible individual postoperative residual astigmatism.
Prospective Randomized Trial Evaluating Ketamine for Adult Bronchoscopy
Authors: Fruchter Oren , Manevich Yair , Carmi Uri , Rozengarten Dror , Kramer Mordechai R.
Published: September 2017

Background and Objectives:

Ketamine has been used in pediatric flexible fiberoptic bronchoscopy (FFB). Its efficacy and safety for sedation of adults undergoing FFB has not been thoroughly investigated, and, consequently, it is not used by most interventional bronchoscopists. We aimed to evaluate the safety and efficacy of sedation for FFB under ketamine-propofol-midazolam (KPM) compared with the fentanyl-propofol-midazolam (FPM) regimen.

Materials and Methods:

This was a prospective randomized trial of adult patients (n=80) undergoing FFB, randomized to receive sedation with either KPM (n=39) or FPM (n=41). Vital signs including transcutaneous carbon dioxide tension (TcPCO2) were continuously monitored. Sedation-related complications and interventions to maintain respiratory and hemodynamic stability were compared. Both operator and patient were blinded to the sedation regimen used. The operator’s and patient’s satisfaction from sedation were assessed following recovery.

Results:

Maximal intraprocedural TcPCO2 values and minimal oxygen saturation did not differ significantly between the KPM and FPM groups (63.2±11.4 mm Hg vs. 61.1±7.2 mm Hg) and (77.1%±12.5% vs. 81.8%±12.0%), respectively. No significant differences were noted between the KPM and FPM groups with respect to sedation-related respiratory or hemodynamic complications. The operator’s and patient’s satisfaction from sedation was similar between the groups.

Conclusions:

Ketamine is as safe and effective as fentanyl for adult analgesia and sedation during FFB. In light of this observation and the fact that ketamine does not cause hemodynamic suppression, like most sedative agents, and is a potent bronchodilator, should encourage its more widespread use for adult sedation during FFB.
Conventional Transbronchial Needle Aspiration
Authors: Mehta Ravindra M. , Singla Abhinav , Balaji Arjun Lakshmana , Krishnamurthy Shantha , Bhat Rajani S. , Lokanath Chakravarthi
Published: September 2017

Introduction:

Conventional transbronchial needle aspiration (C-TBNA) is the originally described method for sampling mediastinal lymph nodes (MLN). After the advent of endobronchial ultrasound, the practice and reports of C-TBNA have dwindled. We report a large series of C-TBNA from the Indian subcontinent, highlighting aspects such as pathological spectrum, yield and complications, and reiterating its relevance in MLN sampling.

Methods:

The study population included 400 consecutive patients over 6.8 years who had C-TBNA done for MLN ≥1 cm in size. C-TBNA was done using a 19-G needle, with conscious sedation. A maximum of 7 passes per node were done. Rapid-on-site evaluation was done in >95% cases. Lymph nodes sampled were labeled “adequate” if lymphocytes were present, and “diagnostic” if a definitive diagnosis was made.

Results:

The study included 228 males and 172 females, mean age 49.4±14.7 years. The “adequacy” rate was 383/400 (95.75%), and “diagnostic” yield was 347/400 (86.75%). C-TBNA was the sole diagnostic modality in 215/400 (53.75%) patients. The diagnoses included tuberculosis (43%), sarcoidosis (25.5%) and malignancy (18.25%). Complications were rare.

Conclusions:

This is one of the largest studies of C-TBNA in literature, and one of the few studies to define accurate pathologic diagnosis of enlarged MLN in India. This is also the one of the largest series to define the yield of TBNA with rapid-on-site evaluation in MLN sampling. Currently, in many parts of the world, C-TBNA is still the most common MLN sampling procedure, from an availability, expertise, economic, and safety perspective.