bluuebunny/crossref_metadata_2025 huggingface dataset:
Poetics
Authors: McOsker Michael
Published: August 2020

This chapter considers Epicurean engagement with poetry and poetics from Epicurus until Philodemus and Lucretius in the first century bce. In general, Epicureans have two concerns; the first is to clarify that poetry is not an authoritative source of truth, and the second is to understand poetry on its own terms. So far as sources allow, earlier Epicureans emphasize the first goal, probably because it was important to draw a clear line between Epicurus’ teaching and the claims made by (or attributed to) poets. The second concern is emphasized in the later school, in the treatises of Demetrius Laco and Philodemus of Gadara, though, I suggest, they rely on philosophical positions developed in the first generations of the school to support their arguments. The chapter examines Epicurus’s views in some detail, because of their importance, though it seems that Metrodorus’ treatise On Poems was in fact the major work on poetry in the early Garden. The chapter also discusses Philodemus’s account of poetry at length, given that a relatively high proportion of his treatise survives. Several important views emerge, e.g. poetry per se is useless, but in the right hands, its contents can be used as raw material for ethical discussions, and good poetry consists of an interrelationship between good form and good content that provokes a certain reaction in the audience.
Epicurus in Nineteenth-Century Germany
Authors: Porter James I.
Published: August 2020

Epicurus marks a unique point of convergence for three unlikely bedfellows in the nineteenth century: Hegel, Marx, and Nietzsche. Each sees a different “Epicurus” in this fourth-century successor to Democritus, the fifth-century co-founder of atomism. Each renders Epicurus and his materialism into a symptom of modernity’s engagement with antiquity, a role that atomism increasingly played from the Enlightenment onwards. Fresh readings of each of these philosophers contribute to a better understanding of their ways of construing the history of ideas, and in particular their bold reinterpretations of Epicurus himself, in addition to correcting a number of misconceptions surrounding their individual readings of Epicurus, be this in Hegel’s Lectures on the History of Philosophy and his Science of Logic, Marx’s dissertation, or Nietzsche’s sprawling corpus of published and unpublished writings.
Epistemology
Authors: Striker Gisela
Published: August 2020

This chapter presents Epicurus’s theory of knowledge as a response to the epistemological pessimism of Democritus. The first section discusses the three “criteria of truth”—sense impressions, preconceptions, and the feelings of pleasure and pain; and also Epicurus’s account of perceptual error, by which he tried to show that the senses do after all offer true and consistent, if sometimes fragmentary, information. The second section deals with Epicurus’s scientific method, i.e. the confirmation and refutation of beliefs or theoretical hypotheses. In a final section, I briefly discuss the role of the feelings as criteria in ethics, and the kind of reasoning Epicurus used to call ἐπιλογισμός.
Psychology
Authors: Asmis Elizabeth
Published: August 2020

This chapter focuses on three main questions. In the first place, how are soul, mind, and body related to each other? Second, how does the union of body and soul produce cognition? Third, how does the union of body and soul produce a person? The chapter shows first that the soul is a corporeal entity, whose functions, including the mind, depend on the type of body in which it is enclosed. What differentiates humans from other animals is that a part of the chest unites with a part of the soul in such a way as to produce the power of reason. The next section considers what is unique about Epicurean cognition. Here the chapter highlights the importance of epibolê (“attention”), the act of selecting objects of perception or thought from the huge number of atomic configurations that are continually bombarding the senses or mind. Epicurean “attention” offers an explanation of intentionality. The last part of the chapter brings in the feelings, pathê, in order to round out the notion of a person. The chapter argues that the so-called “emotions,” such as anger or fear, are feelings that have been joined by cognition. Last, I suggest that our materialist constitution gives us the power to change ourselves without there being any need to assume the emergence of new properties.
Cosmology and Meteorology
Authors: Lehoux Daryn
Published: August 2020

This chapter explores Epicurean explanations of a set of phenomena that are not directly reachable by empirical study because they happen at a remote distance from humans on earth. These include cosmological phenomena such as the shape and size of the universe, astronomical phenomena such as the rising and setting of the sun, as well as meteorological phenomena such as thunder, lightning, and earthquakes. I argue that these phenomena are particularly important to Epicurean ethics insofar as they are presented as causing great fear in non-Epicureans, who fail to understand that they are explainable without recourse to divine beings. In the end, Epicureans do not typically offer single authoritative explanations for these individual phenomena, but instead have recourse to the idiosyncratic Epicurean doctrine of multiple explanation, where inaccessible phenomena are often given multiple possible explanations, only one of which need be correct to allay fear, even if we cannot know which particular explanation is the right one.
Ankle arthritis – an important signpost in rheumatologic practice
Authors: Kiely Patrick D W , Lloyd Mark E
Published: August 2020

Ankle arthritis is a useful clinical signpost to differential diagnosis in rheumatic disease. Biomechanical features and differences in cartilage physiology compared with the knee may confer protection of the ankle joint from factors predisposing to certain arthritides. The prevalence of ankle OA is low, and usually secondary to trauma. Primary OA of the ankle should be investigated for underlying causes, especially haemochromatosis. New presentations of inflammatory mono/oligo arthritis involving the ankle are more likely due to undifferentiated arthritis or spondyloarthritis than RA, and gout over CPPD. The ankle is often involved in bacterial and viral causes of septic arthritis, especially bacterial, chikungunya and HIV infection, but rarely tuberculosis. Periarticular hind foot swelling can be confused with ankle arthritis, exemplified by Lofgren’s syndrome and hypertrophic osteoarthropathy where swelling is due to subcutaneous oedema and osteitis respectively, and the ankle joint is rarely involved.
Assessing Late Vegetative and Tasseling Fungicide Application Timings on Foliar Disease and Yield in Indiana Corn
Authors: Telenko Darcy E. P. , Ravellette Jeffrey D. , Wise Kiersten A.
Published: August 2020

Gray leaf spot (Cercospora zeae-maydis) is a foliar disease of corn (Zea mays) that consistently reduces yields across the United States and is an annual concern in Indiana corn production. Field trials were conducted in West Lafayette, IN, over 3 years (2016 to 2018) to evaluate the effectiveness of 12-leaf collar stage (V12) foliar fungicide applications compared with tasseling (VT) applications for gray leaf spot management and yield. Results indicated that during years in which foliar disease severity was less than 4%, there was no effect of application timing on gray leaf spot severity. In 2018, when gray leaf spot levels exceeded 5%, significantly less disease was observed in treatments receiving VT applications compared with V12 applications. Application timing did not affect yield in any year of the experiment. In 2016, benzovindiflupyr + azoxystrobin + propiconazole resulted in greater yields compared with the nontreated control, and in 2018, pyraclostrobin + metconazole and benzovindiflupyr + azoxystrobin + propiconazole resulted in greater yields compared with the nontreated control. This research indicates that in high disease pressure environments and years, Indiana farmers may want to continue to apply fungicides at VT rather than apply prior to tassel.
Ocular allergic contact dermatitis from topical drugs
Authors: Erdinest Nir , Nche Eleanor , London Naomi , Solomon Abraham
Published: August 2020

Purpose of review

Ocular allergic contact dermatitis is a common yet challenging and frequently misdiagnosed condition. Inappropriate or delayed treatment can contribute to a variety of clinical symptoms such as tearing and itching with signs such as ptosis and cicatricial ectropion, resulting in deterioration of disease, for which the topical medication was originally prescribed to resolve.

Recent findings

Understanding previously unrecognized pathogenic mechanisms involving ocular contact dermatitis has driven new approaches to control the inflammatory process by neutralizing inflammatory mediators and their receptors.

Early diagnosis and removing the antagonizing substance is crucial to manage ocular contact dermatitis. Steroid therapy is usually required to reduce symptoms. As ocular allergic dermatitis often develops in patients using drugs for chronic conditions that necessitate chronic application, it may be difficult at times to discontinue or replace the offending agent.
Epinephrine in anaphylaxis: too little, too late
Authors: Lieberman Jay Adam , Wang Julie
Published: August 2020

Purpose of review

Epinephrine is the agreed-upon first line treatment for anaphylaxis, yet it continues to be underused by patients/caregivers and providers alike.

Recent findings

There are unfortunately limited data on how epinephrine can best be utilized in anaphylaxis, which hinders how best to inform patients and providers. Studies reporting underuse suggest various barriers and themes on why this may happen.

Continued education of patients, caregivers, and providers is needed; however, is not likely to be enough to close the gap. Thus, novel studies on how to increase use; increase availability in a cost-effective manner; and newer, effective delivery routes are still needed.
Evaluation of Methadone Maintenance Treatment in Armenia, Colombia: A Cross-sectional Study Responding to a National Priority
Authors: Borda Juan P. , Gutiérrez Luz G. , López Luhana , Orrego Deivi A.
Published: August 2020

Colombia has experienced a dramatic increase of heroin use in the last 3 decades, stablishing the first methadone maintenance treatment (MMT) program in 2004. Although international evidence indicates that MMT has important benefits for people with opioid use disorder, technical and logistical difficulties have been identified in Colombia that can compromise the effectiveness of this treatment modality. In this cross-sectional study, a total of 148 subjects with opioid use disorder were interviewed in the city of Armenia (Colombia) using the Opiate Treatment Index, comparing the drug use, social functioning, human immunodeficiency virus risk behaviors, criminal activity, and the physical/mental health among subjects involved in MMT and those not receiving treatment. Despite the above-mentioned difficulties, subjects participating in MMT reported less illegal substance use (specifically heroin and basuco), less human immunodeficiency virus risk behaviors, better social functioning, less criminal activity, and less physical and mental health problems than those not receiving treatment. In addition, subjects involved in MMT reported a daily use of heroin and lower than recommended dosages of methadone. Therefore, Colombia should continue expanding MMT programs across the country, integrating the available harm reduction strategies and providing continuous training for health professionals in charge of these programs.
ASCCP Risk-Based Colposcopy Recommendations Applied in Thai Women With Atypical Squamous Cells of Undetermined Significance or Low-Grade Squamous Intraepithelial Lesion Cytology
Authors: Phianpiset Rattiya , Ruengkhachorn Irene , Jareemit Nida , Ittiamornlert Pornprom , Chaopotong Pattama , Hanamornroongruang Suchanan , Horthongkham Navin
Published: August 2020

OBJECTIVE:

To compare the proportion of cervical intraepithelial neoplasia (CIN) 2 or worse pathology among different risk strata according to the ASCCP when applied in women who had atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL) cervical cytology; to assess performance of colposcopy; and to assess the independent predictors for detected CIN 2 or worse pathology.

METHODS:

This is a secondary analysis of a previous prospective study, which included Thai women with ASC-US or LSIL cytology who underwent high-risk human papillomavirus (HPV) testing and subsequent colposcopy with directed biopsy. Patients were classified as lowest-risk, intermediate-risk, or highest-risk based on cervical cytology, high-risk HPV testing, and colposcopic impression. The proportion of CIN 2 or worse pathology and associated prognostic factors were analyzed.

RESULTS:

Of 697 women, 103 (14.8%), 573 (82.2%) and 21 (3%) were classified into lowest-risk, intermediate-risk, and highest-risk groups, respectively. The proportion of CIN 2 or worse pathology was 1%, 11.2%, and 61.9% in those same groups, respectively (P<.001). Colposcopy to detect CIN 2 or worse pathology had a sensitivity, specificity, positive predictive value, and negative predictive value of 98.7%, 18%, 13.2%, and 99.1%, respectively. Independent predictors for detecting CIN 2 or worse pathology were positive high-risk HPV, HPV 16/18 positivity, and high-grade colposcopic impression.

CONCLUSION:

This study supports a no biopsy with follow-up strategy in the lowest-risk group, inconsistent with ASCCP recommendations, but is in alignment with a strategy of multiple targeted biopsies in the intermediate-risk and highest-risk groups.
Pediatric Floating Elbow Injuries Are Not as Problematic as They Were Once Thought to Be: A Systematic Review
Authors: Baghdadi Soroush
Published: August 2020

Background:

Pediatric ipsilateral supracondylar humerus and forearm fractures (floating elbow), are historically reported to have a high rate of complications, including pediatric acute compartment syndrome (PACS). As a result, treatment paradigms for these types of injuries differ in the urgency, extent of fixation, and type of immobilization than if each fracture were treated in isolation. We aimed to systematically review the literature on pediatric floating elbow injuries and assess the reported risk of PACS along with risk factors for poor outcomes.

Methods:

A systematic review was performed in November 2019 in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An exhaustive search of the PubMed and Embase databases was conducted for peer-reviewed literature between 1999 and 2019. Two reviewers filtered the results, looking for articles in English that reported >10 pediatric floating elbow cases. Primary outcomes were the rate and risk factors for developing PACS. Secondary outcomes included patient and injury characteristics, treatment strategies, other complications (eg, neurovascular injuries), and final outcomes.

Results:

The initial search yielded a total of 150 studies. Following review, 11 studies were included, with 433 patients available for review. The mechanism of injury was a fall in 96% of cases. Closed reduction and percutaneous pinning was the most common treatment performed for both fractures. Only 8/433 patients (2%) developed PACS. The incidence of a pulseless limb at presentation was 4%, and all patients regained a pulse following reduction. Three cases of iatrogenic ulnar nerve injury were reported in the setting of medial pin placement. Good to excellent results were reported in 83% to 100% of patients, based on the modified Flynn criteria.

Conclusions:

Despite being limited to heterogenous and retrospective case series, the evidence reviewed in this study contradicts the current belief of a high risk of PACS or other complications in pediatric floating elbows. PACS is much more common with displaced fractures in the setting of delayed treatment. The rate of other complications is comparable to isolated supracondylar humerus fractures. Evidence supports treating these injuries in an urgent fashion in the setting of a displaced fracture, although fixation of both distal and proximal fractures is not supported by evidence. The outcomes of pediatric floating elbows are generally good and do not reflect the poor prognosis that adult floating elbows represent.

Level of Evidence:

Level IV—systematic review of level IV studies.
Arthroscopic Labral Reconstruction of the Hip: A Decade of Growing Evidence and Technical Evolution
Authors: White Brian J. , Herzog Mackenzie M.
Published: August 2020

The field of hip arthroscopy has rapidly evolved over the past 2 decades. Originally, surgical treatment of the hip primarily involved resection of damaged tissue. More recently, arthroscopic surgical procedures that aim to preserve and restore the function of the labrum have been advocated and have shown superior results when compared with debridement or excision. Although labral repair has been largely adopted as a standard labral preservation procedure to treat labral tears, continued innovation in hip arthroscopy techniques and tools has paved the way for labral reconstruction as an alternative and even preferable treatment option. As the clinical field has developed and expanded, so too has the availability and quality of evidence on indications, treatments, and outcomes of hip arthroscopy procedures. The purpose of this manuscript is to review the current literature on indications, arthroscopic technique, and outcomes of arthroscopic acetabular labral reconstruction and provide the lead author’s experience with arthroscopic labral reconstruction over the past decade. A growing body of evidence supports the potential to achieve positive patient-reported outcomes and low revision rates with labral reconstruction across different indications. These promising outcomes across a wide variety of settings and pathologies suggest that labral reconstruction can effectively increase function and decrease pain, making it an important hip preservation tool for the hip arthroscopist.
Inflammation-mediated age-dependent effects of casein kinase 2-interacting protein-1 on osteogenesis in mesenchymal stem cells
Authors: Tian Xiao-Guang , Gong Fei-Fei , Li Xi , Meng Fan-Hao , Zhou Zheng , Zhang Hai-Zhong
Published: August 2020

Background

The casein kinase 2-interacting protein-1 (CKIP-1) is important in the development of osteoblasts and cardiomyocytes. However, the effects of CKIP-1 on osteoblast precursor mesenchymal stem cells (MSCs) remain unclear. This study aimed to determine whether CKIP-1 affects osteogenic differentiation in MSCs and explore the relationship of CKIP-1 and inflammation.

Methods

Bone marrow MSCs of CKIP-1 wild type (WT) and knockout (KO) mice were cultivated in vitro. Cell phenotype was analyzed by flow cytometry, colony formation was detected to study the proliferative ability. Osteogenic and adipogenic induction were performed. The osteogenic ability was explored by alizarin red staining, alkaline phosphatase (ALP) staining and ALP activity detection. Quantitative real-time polymerase chain reaction (qRT-PCR) was carried out to determine the mRNA expression levels of osteoblast marker genes. The adipogenic ability was detected by oil red O staining. Content of the bone was analyzed to observe the differences of bone imaging parameters including trabecular bone volume/tissue volume (BV/TV), bone surface area fraction/trabecular BV, trabecular number (Tb.N), and trabecular spacing (Tb.sp). Interleukin (IL)-1β was injected on WT mice of 2 months old and 18 months old, respectively. Difference in CKIP-1 expression was detected by RT-PCR and western blot. The relationship between CKIP-1 and inflammation was explored by RT-PCR and western blot.

Results

ALP assays, alizarin red staining, and qRT-PCR showed that MSCs derived from CKIP-1 KO mice exhibited a stronger capability for osteogenesis. Micro-computed tomography detection showed that among 18-month-old mice, CKIP-1 KO mice presented significantly higher bone mass compared with WT mice (P = 0.02). No significant difference was observed in 2-month-old mice. In vivo data showed that expression of CKIP-1 was higher in the bone marrow of aging mice than in young mice (4.3-fold increase at the mRNA level, P = 0.04). Finally, the expression levels of CKIP-1 in bone marrow (3.2-fold increase at the mRNA level, P = 0.03) and cultured MSCs were up-regulated on chronic inflammatory stimulation by IL-1β.

Conclusions

CKIP-1 is responsible for negative regulation of MSC osteogenesis with age-dependent effects. Increasing levels of inflammation with aging may be the primary factor responsible for higher expression levels of CKIP-1 but may not necessarily affect MSC aging.
New evidence on prognostic features, prevention and treatment of congenital Cytomegalovirus infection
Authors: Sebghati Mercede , Khalil Asma
Published: August 2020

Purpose of review

Congenital Cytomegalovirus (CMV) infection remains a major cause of lifelong disability, with no systematic screening implemented in pregnancy or the postnatal period. In this review article, we outline the preventive strategies, antenatal prognostic features and experimental therapies as well as evidence of efficacy from recent trials.

Recent findings

A recent randomized, double blinded, placebo-controlled study investigated the efficacy of Valaciclovir in women contracting primary CMV in the periconception period or first trimester. They concluded that Valaciclovir at a dose of 8 g/day is effective in reducing the rate of foetal CMV infection following early maternal primary infection. Administration of CMV hyperimmune globulin (HIG) was investigated in a recent randomized double-masked controlled trial. This study concluded that CMV HIG was ineffective at reducing the risk of congenital CMV among women with primary CMV in early pregnancy.

Congenital CMV infection remains a significant cause of disability. There is currently no vaccine available, with the best preventive strategy being patient education on transmission as well as hygiene measures to reduce risk of exposure. Experimental therapies have been investigated in recent years and there is evidence supporting the use of Valaciclovir. Data for the efficacy of CMV HIG remains inconsistent and administration is currently limited to clinical trial settings.
Consenting and ethical considerations in embryo cryopreservation
Authors: Khorshid Arian , Alvero Ruben
Published: August 2020

Purpose of review

An emerging body of literature has elucidated the growing burden of surplus embryos left in storage without any clear disposition. An out dated consent process is a significant but easily remedied contributor to this problem. We propose a novel approach to consenting for disposition of surplus embryos.

Recent findings

Decisional conflicts that stem from the moral status of embryos and from evolving personal values contribute to surplus embryos being left in storage. Barriers to donation of embryos to research or to other patients also discourage embryo disposition decisions. A flawed informed consent process compromises the physician--provider relationship and complicates decision-making.

Centralizing the process of donating embryos to research and to patients would lower barriers to these disposition options. The informed consent protocol must be redesigned as a longitudinal, narrative process compatible with the evolving values and fertility outcomes of patients. Counselors should be integrated into all discussions regarding embryo disposition from the onset of fertility treatment through its conclusion to facilitate the decision-making process.
The Effects of a Senofilcon A Contact Lens With and Without a Photochromic Additive on Positive Dysphotopsia Across Age
Authors: Hammond Billy R. , Buch John , Sonoda Leilani , Renzi-Hammond Lisa
Published: August 2020

Objective:

The visual effects of wearing a photochromic contact lens (test) were directly compared with a nonphotochromic contact lens (control). Positive dysphotopsia (halos, starbursts) and intraocular scatter (behaviorally determined) were assessed. Both younger and middle-aged subjects were evaluated to examine the influence of age.

Methods:

Fifty-four subjects (18–62 years) were tested using a contralateral design. Subjects were fit with a photochromic contact lens on one eye and a nonphotochromic contact lens on the other eye, randomly assigned. Testing occurred with and without photochromic activation (darkened) by use of a violet activator (365 nm, half-bandwidth 20 nm). The extent of dysphotopsia (halos and spokes) was measured using an aperture (∼4 mm) that created a bright point source of light 45 inches from the plane of the eye. Between the point source and subject, a centering precision caliper was used to measure lateral spread. Two-point thresholds were determined by measuring the minimum distance between two points of broadband xenon light.

Results:

The photochromic contact lens produced smaller halo diameters than the control contact lens, both activated (41% on average) and inactivated (21% on average), and age strata was a significant factor (P<0.001) with the older group showing a greater reduction. The photochromic contact lens produced smaller starburst diameters than the control contact lens, both activated (37% on average) and inactivated (23% on average), and age strata was a significant factor (P=0.001) with the older group showing a greater reduction. The two-point thresholds were reduced (25% activated, 9% inactivated) on average but the age effect was not significant (P<0.10).

Conclusions:

The senofilcon A lens with photochromic additive reduced the extent of positive dysphotopsia compared with the same lens without the additive, regardless whether the lens was activated or not. The visual benefit was greatest with the older subjects.
Clinical Profile and Demographic Distribution of Corneal Dystrophies in India: A Study of 4198 Patients
Authors: Das Anthony Vipin , Chaurasia Sunita
Published: August 2020

Purpose:

To describe the clinical profile and demographic distribution of corneal dystrophy in patients presenting to a multitier ophthalmology hospital network in India.

Methods:

This cross-sectional hospital-based study included 2,151,584 new patients presenting between March 2012 and December 2019 (∼8 year period). Patients with a clinical diagnosis of corneal dystrophy in at least 1 eye were included as cases. The data were collected by using an electronic medical record system.

Results:

Overall, 4198 new patients (0.20%) were diagnosed with corneal dystrophy. The prevalence rates were 0.19% in children (age < 16 years) and 0.20% in adults. Most patients were women (51.86%). The mean age of the patients was 43.61 ± 21.39 years. Most patients (18.79%) were between 61 and 70 years of age. The most common anatomical location of the dystrophy was endothelium (51.71%), followed by stroma (43.55%) and Bowman membrane/epithelium (4.73%). The most common corneal dystrophy was Fuch endothelial corneal dystrophy (41.89%). Most eyes had mild or no visual impairment (43.43%). Of the 8193 eyes, 998 eyes (12.18%) underwent a corneal surgery. Among those who underwent surgical intervention, endothelial keratoplasty was the most commonly performed surgical procedure (52%), followed by penetrating keratoplasty (22%).

Conclusions:

Corneal dystrophy is a rare disease, affecting patients seeking eye care in India. Endothelial dystrophies were the most common, followed by stromal dystrophies. Among the stromal dystrophies, macular dystrophy was the most common. At initial presentation, visual impairment was mild to moderate in most patients, and surgical intervention was needed in 12.18% of the eyes during the study period.
Continuous Electroencephalographic Training for Neuroscience Intensive Care Unit Nurses: A Feasibility Study
Authors: Picinich Christine , Kennedy Jeffrey , Thind Harjot , Foreman Christine , Martin Ryan M. , Zimmermann Lara L.
Published: August 2020

BACKGROUND: Use of continuous electroencephalographic (cEEG) monitoring has more than doubled at our institution for the last 4 years. Although intensive care unit cEEG is reviewed remotely by board-certified epileptologists every 4 to 6 hours, there are inherent delays between occurrence, recognition, and treatment of epileptiform activity. Neuroscience intensive care unit (NSICU) nurses are uniquely positioned to monitor cEEG in real time yet do not receive formal training. The purpose of this study was to evaluate the effectiveness of an education program to teach nurses to monitor cEEG, identify a burst suppression pattern, and measure the duration of suppression. METHODS: We performed a retrospective analysis of pretest and posttest data. All NSICU nurses (40) were invited to complete the pretest (PT-0), with 25 participating. Learning style/preference, demographics, comfort with cEEG, and knowledge of EEG fundamentals were assessed. A convenience cohort of NSICU nurses (13) were selected to undergo EEG training. Posttests evaluating EEG fundamental knowledge were completed immediately after training (PT-1), at 3 months (PT-3), and at 6 months (PT-6). The cohort also completed a burst suppression module after the training, which assessed ability to quantify the duration of suppression. RESULTS: Mean cohort test scores significantly improved after the training (P < .001). All nurses showed improvement in test scores, and 76.9% passed PT-1 (a score of 80% or higher). Reported mean comfort level with EEG also significantly improved after the training (P = .001). There was no significant difference between mean cohort scores between PT-1, PT-3, and PT-6 (all 88.6%; P = 1.000). Mean cohort score from the bust suppression module was 73%, with test scores ranging from 31% to 93%. CONCLUSIONS: NSICU nurses can be taught fundamentals of cEEG, to identify a burst suppression pattern, and to quantify the duration of suppression. Further research is needed to determine whether this knowledge can be translated into clinical competency and affect patient care.
Changes in Bone Conduction Implant Geometry Improve the Bone Fit in Mastoids of Children and Young Adults
Authors: Wenzel Claudia , Schilde Sebastian , Plontke Stefan K. , Rahne Torsten
Published: August 2020

Objectives:

In 2012 the first active bone conduction implant was introduced, but did not fit into the mastoids of some adults and many children. Thus, a geometry change of the transducer was proposed (BCI 602). In this study, we aimed to determine whether these changes improved the mastoid cavity fit of the implant in children and young adults.

Design:

We retrospectively analyzed computed tomography scans of 151 mastoids from 81 children and adolescents (age range, 5 mo to 20 yr) and 52 control mastoids from 33 adults. After three-dimensional reconstruction of the temporal bone from computed tomography, we virtually implanted the BCI 602 into the mastoids, and compared the bone fit with that of the BCI 601.

Results:

The BCI 602 could be virtually implanted in 100% of patients ≥12 years old, while the BCI 601 transducer could be completely embedded in the bone of only 70% of these mastoids. Moreover, virtual implantation of the BCI 602 was possible in 75% of children 3 to 5 years of age, while the BCI 601 did not fit in the mastoids of any patients under 5 years old without the use of lifts.

Conclusions:

Compared to the BCI 601, placement of the BCI 602 allegedly requires less bone removal. The newer BCI 602 transducer is more likely than its predecessor to be completely accommodated in the mastoid bone among all age groups and indications. Preoperative planning is still recommended to avoid exposure of delicate structures.
MITF Is Mutated in Type 1 Waardenburg Syndrome With Unusual Phenotype
Authors: Li Wu , Feng Yong , Chen Hongsheng , He Chufeng , Mei Lingyun , Liu Xue Zhong , Men Meichao
Published: August 2020

Background:

Waardenburg syndrome (WS) is a rare disorder characterized by varying combinations of sensorineural hearing loss and abnormal pigmentation of the hair and skin. WS is classified into four subtypes (WS1–WS4) based on additional symptoms. Dystopia canthorum is a hallmark of WS type 1. There are two genes linked to WS type 1, including PAX3 and EDNRB.

Objective:

This study aimed to investigate the genetic etiology of WS type 1 in a pair of twins from China with profound hearing loss, blond hair and eyebrows, dystopia canthorum, and brown irides.

Methods:

The target capture sequencing and Whole-exome sequencing were performed to detect mutations in WS-related genes.

Results:

A novel de novo frameshift mutation, p.L341Rfs∗18 in MITF was identified in the twins. Hearing thresholds showed substantial improvements following cochlear implantation with a pure-tone average of 30 dB in free-field conditions.

Conclusions:

The study showed the new genotype–phenotype correlations of MITF to WS type 1. Further molecular analysis is necessary to reappraise the current classification on WS.
Left Ventricular Assist Device Implantation in Hypertrophic and Restrictive Cardiomyopathy: A Systematic Review
Authors: Sreenivasan Jayakumar , Kaul Risheek , Khan Muhammad Shahzeb , Ranka Sagar , Demmer Ryan T. , Yuzefpolskaya Melana , Aronow Wilbert S. , Warraich Haider J. , Pan Stephen , Panza Julio A. , Cooper Howard A. , Naidu Srihari S. , Colombo Paolo C.
Published: August 2020

Left ventricular assist device (LVAD) implantation in patients with advanced heart failure due to hypertrophic or restrictive cardiomyopathy (HCM/RCM) presents technical and physiologic challenges. We conducted a systematic review of observational studies to evaluate the utilization and clinical outcomes associated with LVAD implantation in patients with HCM/RCM and compared these to patients with dilated or ischemic cardiomyopathy (DCM/ICM). We searched MEDLINE, EMBASE, and Scopus from inception through May 2019 and included appropriate studies describing the use of an LVAD in patients with HCM/RCM. We identified six studies with a total of 2,766 patients with HCM/RCM and advanced heart failure, among whom 338 patients (12.2%) underwent LVAD implantation. In patients listed for transplant, the rate of LVAD implantation was significantly lower in patients with HCM/RCM compared to that in patients with DCM/ICM (4.4% vs. 18.2%, p < 0.001). Adverse clinical outcomes were significantly higher in HCM/RCM than in DCM/ICM, including operative/short-term mortality (14.0% vs. 9.0%), right ventricular failure (50.0% vs. 21.0%), infection (15.5% vs. 11.2%), bleeding (40.2% vs. 12.5%), renal failure (15.0% vs. 5.1%), stroke (5.0% vs. 2.4%), and arrhythmias (18.0% vs. 7.7%) (all p values <0.001).
OptiVol for Volume Assessment in Patients With Continuous Flow Left Ventricular Assist Device
Authors: Zeitler Emily p. , Cooper Lauren b. , Clare Robert M. , Chiswell Karen , Lowenstern Angela , Rogers Joseph G. , Milano Carmelo A. , Schroder Jacob N. , Al-Khatib Sana m , Mentz Robert J.
Published: August 2020

OptiVol (Medtronic PLC, Minneapolis, MN) is a diagnostic feature of some cardiac implantable electronic devices (CIEDs) based on changes in thoracic impedance (TI) over time. Changes in TI can predict heart failure (HF) hospitalizations and mortality in HF populations. However, the utility of this feature is unknown in patients with a left ventricular assist device (LVAD). To determine if OptiVol and TI correlate with clinical HF events in a population of LVAD patients, hospitalization outcomes were collected retrospectively from the electronic health records at a single academic medical center in 80 LVAD patients with an OptiVol-capable CIED. Demographics, medical history, and available clinical data were reviewed and reported. The primary outcomes of interest were TI and OptiVol trends before and after hospitalization, and association of trends before and after these events was evaluated. Most patients had a HeartMate II LVAD and most CIEDs were defibrillators, and 23 (29%) had at least one HF hospitalization during the study period. HF hospitalizations were preceded by signs of volume overload in Optivol (60%) and TI (78%) with recovery of these measures post hospitalization in 33% and 25% of patients, respectively. Monitoring of TI and OptiVol may be one effective component of HF management in LVAD patients as part of a comprehensive program.
Inflow Cannula Position Influences Improvement in Mitral Regurgitation After Ventricular Assist Device Implantation
Authors: Pasrija Chetan , Sawan Mariem A. , Sorensen Erik , Gammie James S. , Madathil Ronson , Tran Douglas , Wang Libin , Ton Van-Khue , Feller Erika , Griffith Bartley P. , Kon Zachary N. , Kaczorowski David J.
Published: August 2020

Significant residual mitral regurgitation (MR) after left ventricular assist device (LVAD) implantation has been associated with increased morbidity and mortality. The effect of cannula position on improvement of preexisting MR has yet to be evaluated. Consecutive patients who underwent centrifugal LVAD implantation with >mild preoperative MR and without concomitant mitral repair were reviewed. Left ventricular assist device position was determined by the angle between actual and ideal inflow cannula on computed tomography. The magnitudes of angles (anterior and lateral angle) were added to form an LVAD position assessment (LVADpa). Mitral regurgitation was numerically classified, and improvement in MR was determined by difference in MR preoperatively to MR >1 month postoperatively with a median of 162 (interquartile range: 78–218) days. The primary analysis examined the relationship between LVADpa and postoperative MR. Forty-one patients were identified with >mild preoperative functional MR. Mean age was 51 ± 13 years with an ejection fraction of 16 ± 4%. Overall, MR improved from moderate-severe preoperatively to mild postoperatively (p < 0.001). On multivariable analysis, higher LVADpa deviation was associated with greater postoperative MR (odds ratio [OR] = 2.29, p = 0.005) and higher 1-month pulsatility index was associated with lower postoperative MR (OR = 0.47, p = 0.011). Inflow cannula position during centrifugal LVAD implantation is an important determinant of postoperative MR.
Blood pressure management in emergency department patients with spontaneous intracerebral hemorrhage
Authors: Kuhn Diane , Tiffany Laura , Beher Richa , Boswell Sharon , Giraldo Diego , Hassan Mubariz , Haase Daniel J. , Khan Areesha , Hassan Soha , Matta Ann , Sapru Mayga , Tran Quincy K.
Published: August 2020

Introduction

Despite the well documented importance of blood pressure management in patients with spontaneous intracerebral hemorrhage (sICH), little is known about whether emergency departments (EDs) are able to achieve close monitoring and precise management. Our study characterizes ED monitoring and management of blood pressure in sICH patients.

Methods

This is a retrospective study of adults with sICH and elevated intracranial pressure. Patients who were admitted from any referring ED to our CCRU from 1 August 2013 to 30 September 2015 were included. We graphically assessed the association between average minutes between blood pressure measurements and average minutes between administration of antihypertensives. We also performed logistic regression to evaluate factors associated with close blood pressure monitoring and the achievement of goal blood pressure in patients with sICH who presented with hypertension.

Results

Of 115 patients, 73 presented to the ED with SBP above 160 mmHg. Length of stay in the ED was significantly associated with a longer period between blood pressure measurements. Longer periods between blood pressure measurements were a significant determinant of failure to achieve blood pressure goal in sICH patients. Longer periods between blood pressure measurements were significantly associated with longer periods between administration of antihypertensives.

Conclusion

Our study suggests that blood pressure monitoring is related to the frequency of blood pressure interventions and achievement of adequate blood pressure control in patients with sICH. There is significant variability in EDs’ achievement of the recommended close blood pressure monitoring and management in patients with sICH.
Hemodynamic responses of resistance exercise performed with repetitions to failure and not to failure in adults with hypertension
Authors: Domingues Lucas B. , Cadore Eduardo L. , Ferrari Rodrigo
Published: August 2020

Objective

To evaluate and compare the hemodynamic responses of resistance exercise (RE) performed with repetitions to failure vs. not to failure in individuals with hypertension.

Methods

Twenty participants were randomly allocated to perform three experimental sessions: a RE session performed with repetitions to failure (RF); a RE session performed with repetitions not to failure (NRF); and a non-exercise control session (Con). RE sessions were composed of four sets of 10 repetitions in four exercises involving large muscle groups. To ensure that the sets could be performed with RF or NRF, intensities corresponding to 75% and 50% of one-repetition maximum test were adopted in RF and NRF sessions, respectively. The Con was performed in seated rest. Blood pressure and rate-pressure product were measured before, during and after the experimental sessions for 1 h.

Results

SBP and DBP decreased after NRF compared with Con (systolic post 1 h: –7.7 ± 1.1 mmHg, P < 0.001; diastolic post 1 h: –4.2 ± 0.7 mmHg, P = 0.001), and after RF compared with Con (systolic post 1 h: –8.2 ± 1.3 mmHg, P < 0.001; diastolic post 1 h: –7.4 ± 1.4 mmHg, P < 0.001). No significant difference was found in blood pressure between RF and NRF sessions after 1 h. Rate-pressure product was lower during NRF compared with RF (P = 0.001), suggesting a higher cardiovascular demand during the RF session.

Conclusion

The RF and NRF sessions are equally effective to promote post-exercise hypotension. In addition, NRF session can reduce cardiac demand during the exercise and should be recommended in adults with hypertension.
Renal Failure is Associated With Increased Mortality and Hospital Utilization in Patients Admitted With Nonalcoholic Steatohepatitis
Authors: Reja Mishal , Patel Roohi , Pioppo Lauren , Tawadros Augustine , Bhurwal Abhishek , Marino Daniel , Rustgi Vinod
Published: August 2020

Goals:

We aimed to investigate the mortality and hospital utilization outcomes of hospitalized nonalcoholic steatohepatitis (NASH) patients with and without kidney failure in a nationwide cohort.

Background:

NASH is a common medical condition associated with significant morbidity and mortality. A paucity of data exists regarding the impact of kidney failure (defined as acute and chronic kidney failure) on outcomes of NASH hospitalizations.

Materials and Methods:

We conducted a retrospective cohort study using the 2016 Nationwide Inpatient Sample dataset of adult patients hospitalized for NASH, stratified for the presence of renal failure. The primary outcome was inpatient mortality, predictors were analyzed using multivariate logistic regression. Secondary outcomes were the length of stay and mean total hospitalization charges.

Results:

The overall sample included 7,135,090 patients. Among 6855 patients admitted for NASH, 598 or 8.7% had comorbid kidney failure. After multivariate regression analysis, NASH patients with renal failure had increased in-hospital mortality [odds ratio=28.72, 95% confidence interval (CI): 8.99-91.73], length of stay (β=3.02, 95% CI: 2.54-3.5), total hospital charges (β=$37,045, 95% CI: $31,756.18-$42,335.62). Positive predictors of mortality in the renal failure group were Charlson Comorbidity Index ≥3 [adjusted odds ratio (aOR)=3.46, 95% CI: 1.04-11.51], variceal bleeding (aOR=3.02, 95% CI: 1.06-8.61), and hepatic encephalopathy (aOR=26.38, 95% CI: 1.29-540.56). Predictors of decreased mortality were Medicaid (aOR=0.047, 95% CI: 0.28-0.79) and private insurance (aOR=0.56, 95% CI: 0.38-0.83).

Conclusions:

The prevalence of renal failure in NASH hospitalizations is associated with markedly increased mortality, hospital costs, and length of stay. As a result, clinicians should be vigilant in treating kidney failure in this population.
Impact of Knowledge and Risk Perceptions on Older Adults’ Intention for Surveillance Colonoscopy
Authors: Calderwood Audrey H. , Carter Courtney , Durand Marie-Anne , O’Connor Sharon , Boardman Maureen
Published: August 2020

Goals:

The authors aimed to characterize older adults’ intentions for future surveillance colonoscopy, knowledge of polyps, and predictors of colonoscopy plans.

Background:

Guidelines recommend that the decision to continue or stop surveillance colonoscopy in older adults with colon polyps be “individualized.” Although older adults want to be included in decision making, how knowledge regarding polyps influences decisions is unknown.

Study:

In collaboration with a rural family medicine practice, the authors invited adults aged 65 years and older with a history of colon adenomas to complete a 14-item survey regarding intention for colonoscopy and knowledge of colon polyps.

Results:

Sixty-seven of 105 (63%) patients completed the survey. The mean age was 72 years. Regarding future surveillance, 53% planned to return, 25% were unsure, and 22% did not plan to return. There were no significant differences in baseline characteristics on the basis of the intention for future colonoscopy. Regarding polyp knowledge, 73% had correct knowledge around how common polyps are; 50% thought that more than half of untreated polyps would become cancerous—an inaccurately elevated perception by 10 folds. Respondents who perceived polyps to have a high malignant potential were more likely to report plans for surveillance colonoscopy (68% vs. 39%; P=0.03).

Conclusions:

In this survey of older adults with a history of polyps, many had a falsely elevated perception of polyps’ potential for cancer that was associated with a higher intention for future colonoscopy. Ensuring older adults have an understanding of the risks of polyps is an essential step toward improving decision making around surveillance colonoscopy.