bluuebunny/crossref_metadata_2025 huggingface dataset:
The CLASP Intervention: Questions, Issues, and Concluding Comments
Authors: Miller Ivan W. , Gaudiano Brandon A. , Weinstock Lauren M.
Published: June 2022

This chapter tackles the issues and concluding comments of the CLASP intervention. CLASP is a distinctive combination of individual psychotherapy, family intervention, and case management, which is conducted primarily via telehealth. This chapter clarifies the difference in roles between a typical outpatient therapist and a CLASP treatment advisor. Prioritization of risk factors is a collaborative process between CLASP advisors, the patient, and the patient’s significant other amid the development of the Life Plan. The chapter also discusses advisors’ giving patients access to communication via free or low-cost phones, free online numbers, or video conferencing services. It discusses some procedures in facilitating the use of community crisis resources to access CLASP.
Assessment of Dissociation, Trauma-Related Disorders, and Dissociative Disorders
Authors: Brand Bethany L. , Schielke Hugo J. , Schiavone Francesca , Lanius Ruth A.
Published: June 2022

The assessment of trauma-related disorders (TRD) and dissociative disorders (DD) is not widely taught. Accurate assessment of dissociative symptoms can be challenging without adequate training. Clinicians who have not been trained in assessing TRD may mistakenly attribute TRD and DD symptoms to psychosis, bipolar disorder, borderline personality disorder, or malingering. As a result, TRD and DD are frequently underdiagnosed and misdiagnosed, preventing these highly symptomatic individuals from receiving appropriate treatment. This chapter provides a practical overview of the assessment of trauma-related and dissociative symptoms, including self-report measures and structured assessment tools that can complement the clinical interview; the assessment of common comorbidities; methods of distinguishing TRD and DD from diagnoses with similar presentations; and potential alternative explanations for apparently dissociative experiences. The chapter also discusses the possible challenges and pitfalls of using “general” psychological assessment instruments that have not been validated with individuals with complex trauma histories.
An Overview of Complex Trauma-Related Disorder Treatment and the Treatment of Patients with Dissociative Disorders (TOP DD) Studies’ Research Findings
Authors: Brand Bethany L. , Schielke Hugo J. , Schiavone Francesca , Lanius Ruth A.
Published: June 2022

This chapter reviews research about treatment for trauma-related disorders (TRDs) and discusses the functions of risky, unhealthy behaviors in TRDs. Teaching patients four core skills that provide safer ways to meet these functions promotes stabilization: grounding, separating past from present, self-compassionate emotion regulation, and getting healthy needs met safely. The Finding Solid Ground educational program teaches these skills and was the foundation of the Treatment of Patients with Dissociative Disorders (TOP DD) Network study. Together, the TOP DD studies show that when individuals with TRDs are treated by clinicians who focus on dissociative and other trauma-based symptoms, patients’ safety improves, hospitalizations become less frequent, and treatment costs decrease. The TOP DD studies indicate that education about safety, emotion regulation, and symptom management, combined with individual therapy that addresses TRDs, is associated with a wide range of improvements for TRD individuals. Treatment focused on TRDs help highly dissociative individuals find solid ground in healing from trauma.
Understanding and Addressing the Impact of Trauma on Relational Functioning
Authors: Brand Bethany L. , Schielke Hugo J. , Schiavone Francesca , Lanius Ruth A.
Published: June 2022

Challenges involving boundary management, the therapeutic frame, and interpersonal patterns repeatedly emerge in trauma treatment. These issues emerge out of the lessons that patients learned via abusive relationships about control and others’ unreliability and abusiveness. This chapter discusses methods for recognizing and resolving trauma-based interpersonal patterns such as boundary management, traumatic reenactments, mistrust of the therapist, and ruptures in the therapeutic relationships. The impact of insecure attachment on the therapeutic relationship is addressed, including patients’ difficulties tolerating therapists’ absences, overly frequent calls between sessions, and help rejection. Roleplays are presented with specific language and approaches that can guide clinicians in recognizing and discussing trauma-based relational difficulties. Although challenging, these “echoes of trauma” in the therapeutic relationship serve as powerful opportunities to resolve the interpersonal impact of victimization.
Understanding and Working with Dissociative Self-States
Authors: Brand Bethany L. , Schielke Hugo J. , Schiavone Francesca , Lanius Ruth A.
Published: June 2022

This chapter offers an introduction to understanding and working with people who have dissociative self-states (DSS). Toward this end, the chapter discusses similarities and differences between DSS and normative self-state functioning, the link between DSS and disorganized attachment, descriptions of DSS systems, relationships between DSS, and functions of DSS. The chapter then offers principles for working with persons with DSS and describes commonly encountered DSS types and strategies for working with them. In addition, this chapter includes examples of ways to respond to and work with patients presenting with specific, common challenges, such as working with self-states in relation to unsafe or risky behaviors; investigating the underlying concerns of patients who have self-states reluctant to make changes in their thinking and/or behavior; working with patients who cannot remember their behavior, experiences, or a previous session; and working with childlike self-states.
The Finding Solid Ground Program and How to Use It in Individual and Group Settings
Authors: Brand Bethany L. , Schielke Hugo J. , Schiavone Francesca , Lanius Ruth A.
Published: June 2022

This chapter offers guidance on how to use the Finding Solid Ground Program Workbook’s information sheets and exercises in individual and group contexts. The Finding Solid Ground program provides complex trauma patients with a coherent, comprehensive approach to trauma treatment rooted in an understanding of the neurobiological impacts of trauma. The program’s structure and materials provide information in a sequence that introduces the most important foundational information and skills first and builds on these, session by session, in a manner (and at a pace) designed to be manageable. This approach reduces the likelihood of unintentionally overwhelming and dysregulating patients while trying to help them learn how to reduce dysregulation and increase adaptive strengths. This kind of approach is crucial in treating individuals with trauma-related disorders, addresses issues that are often misunderstood by clinicians, and can make a meaningful difference in patients’ initial and continued engagement in treatment.
Grounding
Authors: Schielke Hugo J. , Brand Bethany L. , Lanius Ruth A.
Published: June 2022

Grounding offers powerful help toward managing and reducing symptoms related to trauma, including feeling “too much” (feeling strong or overwhelming feelings or urges); feeling “too little” (feeling disconnected or numb); feeling confused or having a hard time thinking clearly; losing track of time or where you are; having a hard time noticing when things are safer; or feeling like the past is happening again. This module will help you learn and practice the two core grounding skills (orienting to and anchoring in the present). In addition, the module describes how to notice you are getting ungrounded and offers 101 ways to get and stay grounded so you can find the ways of grounding that work best for you. By doing this work, you can learn to prevent yourself from getting overwhelmed by developing healthy, healing-focused ways to manage when you start to feel too much or too little.
Separating Past from Present
Authors: Schielke Hugo J. , Brand Bethany L. , Lanius Ruth A.
Published: June 2022

Trying to keep us safer, our minds are often on alert for signs of danger. Unfortunately, because we notice similarities with past experiences far easier than differences, this means we can have significant difficulty noticing when situations are safer. In other words, we can have difficulty separating the past from the present. This module offers ways to help yourself notice when the present is safer than the past and be more aware of your current resources and options. It will also help you learn how to catch thinking mistakes that can make it difficult to separate past from present, imagery techniques that can help you separate the present from the past, and how to contain traumatic intrusions, all of which will help you see the “here and now” more clearly, making it easier to stay grounded, heal, and grow.
Additional Foundations
Authors: Schielke Hugo J. , Brand Bethany L. , Lanius Ruth A.
Published: June 2022

This module offers ways to help yourself make progress toward getting and feeling safer. This module focuses on teaching you things you can do toward healing the impact of trauma, and steps you can expect along the way. As part of this, you will learn how to notice signs you might be having trauma-related thoughts, and how to manage them so that past experiences do not automatically make you feel bad. This module will also help you develop and use plans for managing intense emotions, noticing and managing trauma-based thoughts, and developing and using imagery techniques for when you’re feeling too much.
Addressing Trauma-Based Thinking
Authors: Schielke Hugo J. , Brand Bethany L. , Lanius Ruth A.
Published: June 2022

This module focuses on learning how to identify and reduce trauma-based thinking, which is often unfair or distorted but feels true due to trauma. This module will discuss trauma-based thoughts as a common symptom of having experienced trauma and will help you learn how to reduce trauma-based thoughts. It will help you practice identifying trauma-based thoughts, noticing evidence that challenges trauma-based thoughts. It will also help you identify and generate healing-focused thoughts and work toward shifting from trauma-based thoughts to healing-focused thinking. This difficult, important work builds on all you’ve already done as part of this program. Taking the time to do the work involved in reducing trauma-based thoughts can go a long way toward getting and feeling safer.
Improving Your Relationship with Emotions, Body Sensations, and Aspects of Self
Authors: Schielke Hugo J. , Brand Bethany L. , Lanius Ruth A.
Published: June 2022

Trauma can dramatically change the range of emotions and physical sensations that feel comfortable or manageable. People who have experienced trauma often feel too much or too little emotion and body sensations. Traumatic experiences can lead people to believe that certain feelings are not OK—or that no emotions are OK. This can lead people to not want their emotions and body sensations and to be afraid of emotions and sensations. In addition, they may never have learned how to have a healthy relationship with their emotions, body sensations, or themselves as a person. At the same time, it is difficult to get and feel safer without a healthy relationship with your emotions, body, and all of who you are. This module will help you work toward manageably developing healthy relationships with these aspects of your experience. This will gradually help you get and feel safer.
Pulling Policy Levers to Curtail Expulsion
Authors: Zinsser Katherine M.
Published: June 2022

Technically, Aiden never should have been expelled. It was illegal for the program to push him out just because of his behavior. Unfortunately, at the time, his mother and the preschool’s director did not know that Illinois had banned the practice. Legislation is often used to promote social change, and across the country, policymakers are attempting to prohibit young children’s exclusion through a variety of mechanisms. This chapter reviews the history of state and federal school discipline policy and describes several different approaches being used today. Illinois’s progressive approach to banning early childhood expulsion is highlighted, and the chapter concludes with a review of findings from an ongoing evaluation of the law’s implementation, impact, and unintended consequences. Findings from the research-practice-policy coalition guiding the evaluation can serve as a model for other jurisdictions working to prevent children’s exclusion for early childhood education settings.
What Is Consciousness?
Authors: McVeigh Brian J.
Published: June 2022

This chapter contends that for clinical purposes, tidying up the idiom of mentation will go a long way in helping discern how various interventions relate, cohere, and operate. This chapter, in order to contribute to clearing the theoretical thicket, proposes that what is vaguely called consciousness can be broken down into FOCI. Since much of one’s mental healing transpires on the back of consciousness, it behooves one to comprehend what consciousness signifies. This chapter, then, clarifies the meaning of conscious interiority. This chapter also treats “underground” and “background” psychological processes and four types of nonconsciousness; consciousness as a type of meta-framing; the creative potential of language to construct cognition; metaphors as meta-framing; and the therapeutic use of metaphors.
Runaway Consciousness
Authors: McVeigh Brian J.
Published: June 2022

This chapter explores how conscious interiority, which ordinarily is a benefit, can go awry. Under certain circumstances, e.g., if life experiences or innate vulnerabilities overwhelm a person, FOCI can lead to runaway consciousness. Consequently, FOCI end up hindering mental health and mutate into psychological processes in need of modification themselves. And yet FOCI themselves can be deployed as therapeutic techniques to correct distorted cognition and hyper-interiorization (i.e., the therapeutically directed uses of FOCI). This chapter also explores the role of resistance and how individual self-deception and institutional mendacity interlock. Three types of consciousness are distinguished: everyday, therapeutic, and excessive or hyper-interiorized.
Using Conscious Interiority as a Therapeutic Tool
Authors: McVeigh Brian J.
Published: June 2022

This chapter returns to the particular systems of psychotherapy (introduced in Chapter 5). However, in this chapter the interventions and techniques of the various systems are examined to illustrate how they incorporate FOCI for healing purposes. In other words, conscious interiority is shown to operate as a therapeutic tool in the different psychotherapeutic systems, thereby bolstering the common factors and integrative psychological approach of this book. This is accomplished by examining how hyper-interiority is corrected by utilizing FOCI; in rational emotive behavior therapy (disputing irrational notions via active-directive approach); cognitive behavior therapy (identifying and learning maladaptive behaviors); client-centered therapy (highlighting the interiorized, subjective contents of mind); existential therapy (confronting our self-individuation); Gestalt therapy (focusing on the experiential self); dialectical behavior therapy (balancing the need for change with the way things are); acceptance and commitment therapy (coming to terms with one’s circumstances and enacting one’s values). Also examined are the A-B-C-D chain of cognition, FOCI and self-improvement, and self-change through self-reflexivity.
Groups and Families as Therapeutic Systems
Authors: McVeigh Brian J.
Published: June 2022

This chapter examines the processual, transitional, and systems-theoretical facets of group and family therapies while highlighting how they relate to various FOCI. Groups and families are not just aggregates of individuals who happen to end up together; they need to be conceived as emotionally-charged systems whose interactive dynamics can be perceived as transitioning through distinct and discernible stages. Also explored are the dynamics of positive change and transformation via communitas and cohesiveness; transference and countertransference as elements of transformation; group facilitators as stage directors; different approaches to family therapy; communication and information flow within the family; and parenting styles and conscious interiority.
Anatomy of four human Argonaute proteins
Authors: Nakanishi Kotaro
Published: June 2022

MicroRNAs (miRNAs) bind to complementary target RNAs and regulate their gene expression post-transcriptionally. These non-coding regulatory RNAs become functional after loading into Argonaute (AGO) proteins to form the effector complexes. Humans have four AGO proteins, AGO1, AGO2, AGO3 and AGO4, which share a high sequence identity. Since most miRNAs are found across the four AGOs, it has been thought that they work redundantly, and AGO2 has been heavily studied as the exemplified human paralog. Nevertheless, an increasing number of studies have found that the other paralogs play unique roles in various biological processes and diseases. In the last decade, the structural study of the four AGOs has provided the field with solid structural bases. This review exploits the completed structural catalog to describe common features and differences in target specificity across the four AGOs.
Subtypes of Dual Users of Combustible and Electronic Cigarettes: Longitudinal Changes in Product Use and Dependence Symptomatology
Authors: Buu Anne , Tong Zhaoxue , Cai Zhanrui , Li Runze , Yang James J , Jorenby Douglas E , Piper Megan E
Published: June 2022

Introduction

Cross-sectional surveys found behavioral heterogeneity among dual users of combustible and electronic cigarettes. Yet, prior classification did not reflect dynamic interactions between cigarette and e-cigarette consumption, which may reveal changes in product-specific dependence. The contexts of dual use that could inform intervention were also understudied.

Methods

This study conducted secondary analysis on 13 waves of data from 227 dual users who participated in a 2-year observational study. The k-means method for joint trajectories of cigarette and e-cigarette consumption was adopted to identify the subtypes of dual users. The time-varying effect model was used to characterize the subtype-specific trajectories of cigarette and e-cigarette dependence. The subtypes were also compared in terms of use contexts.

Results

The four clusters were identified: light dual users, predominant vapers, heavy dual users, and predominant smokers. Although heavy dual users and predominant smokers both smoked heavily at baseline, by maintaining vaping at the weekly to daily level the heavy dual users were able to considerably reduce cigarette use. Yet, the heavy dual users’ drop in cigarette dependence was not as dramatic as their drop in cigarette consumption. Predominant vapers appeared to engage in substitution, as they decreased their smoking and increased their e-cigarette dependence. They were also more likely to live in environments with smoking restrictions and report that their use of e-cigarettes reduced cigarette craving and smoking frequency.

Conclusions

Environmental constraints can drive substitution behavior and the substitution behavior is able to be sustained if people find the substitute to be effective.

Implications

This study characterizes subtypes of dual users based on the dynamic interactions between cigarette use and e-cigarette use as well as product-specific trajectories of dependence. The subtypes differ in not only sociodemographic characteristics but also contexts of cigarette and e-cigarette use. Higher motivation to use e-cigarettes to quit smoking and less permissive environment for smoking may promote substitution of cigarettes by e-cigarettes.
Updated evidence-based developmental attainments for children: First 6 years
Authors: Dosman Cara , Gallagher Sheila , LaBerge Patricia , Sahagian Whalen Sandra , Koscielnuk Dorrie , Plaisance Madeleine , Dufour Laurie-Anne , Andrews Debbi
Published: June 2022

An accurate and well-rounded understanding of child development is essential to optimize child functioning and health. The First Six Years Developmental Attainments chart empowers clinicians to give parenting guidance and to evaluate age-specific developmental attainment of their pediatric patients. A practical knowledge translation tool, the chart integrates a comprehensive array of developmental skill attainments, citing the range of sources from classic to current literature. It includes definitions, explanations, and examples for skills, attainment age range, percentile, and oldest age of attainment where available so that the reader can ‘estimate the age’ for a child’s skills in each developmental sector. Sub-headings focus the clinician’s search for skills. This updated office reference is of critical use when clinicians guide parents with strategies suited to the child’s level of developmental skills. With levels of evidence described, this clinical tool could be used for future national or international studies to develop strategies most useful for clinicians, trainees of different levels, and parents supporting child development.
A randomized controlled pilot study of intranasal lidocaine in acute management of paediatric migraine and migraine-like headache
Authors: Maki Kate , Doan Quynh , Sih Kendra , Stillwell Karly , Chun Alaina , Meckler Garth
Published: June 2022

Objectives

This study was aimed to determine the sample size required to conduct an efficacy randomized controlled trial (RCT) to evaluate superiority of intranasal (IN) lidocaine to placebo as an analgesic option for children presenting to the paediatric emergency department (PED) with migraine or posttraumatic headache with migraine features and to evaluate study protocol feasibility.

Study Design

This study is a double-blind RCT of children aged 7 to 16 years at a single-centre PED. Thirty-two participants were randomized to receive either IN 2% lidocaine or 0.9% sodium chloride. The primary outcome measure was the proportion of subjects with a Verbal Numeric Rating Scale pain score of <4 at 30 and 60 minutes post-IN therapy. Primary outcome data were analyzed using a test of differences between proportions. Secondary objectives included assessing the feasibility of our study protocol by evaluating recruitment rates, adverse drug events, and PED length of stay (LOS).

Results

Six of 17 participants in the lidocaine group and 2 of 15 in the placebo group were treated successfully. Using these proportions with 95% confidence intervals and 80% power, the sample size required to find a significant difference between proportions would be 67 participants per arm. Our enrolment rate was 55% and there were no serious adverse drug events. The median PED LOS was similar between groups.

Conclusion

We determined the sample size required to conduct a definitive RCT to evaluate the superiority of IN lidocaine to placebo and found the study protocol is feasible but identified important considerations in PED migraine trial design.
Iron oxide nanoparticles with photothermal performance and enhanced nanozyme activity for bacteria-infected wound therapy
Authors: Guo Jiaxin , Wei Wenying , Zhao Yanan , Dai Honglian
Published: June 2022

Metal-based nanomaterials usually have broad-spectrum antibacterial properties, low biological toxicity and no drug resistance due to their intrinsic enzyme-like catalytic properties and external field (magnetic, thermal, acoustic, optical and electrical) responsiveness. Herein, iron oxide (Fe3O4) nanoparticles (IONPs) synthesized by us have good biosafety, excellent photothermal conversion ability and peroxidase-like catalytic activity, which can be used to construct a photothermal-enzymes combined antibacterial treatment platform. IONPs with peroxide-like catalytic activity can induce H2O2 to catalyze the production of •OH in a slightly acidic environment, thus achieving certain bactericidal effects and increasing the sensitivity of bacteria to heat. When stimulated by near-infrared light, the photothermal effect could destroy bacterial cell membranes, resulting in cleavage and inactivation of bacterial protein, DNA or RNA. Meanwhile, it can also improve the catalytic activity of peroxidase-like and promote IONPs to catalyze the production of more •OH for killing bacteria. After IONPs synergistic treatment, the antibacterial rate of Escherichia coli and Staphylococcus aureus reached nearly 100%. It also has an obvious killing effect on bacteria in infected wounds of mice and can effectively promote the healing of S. aureus-infected wounds, which has great application potential in clinical anti-infection treatment.
Immunosuppressive treatments selectively affect the humoral and cellular response to SARS-CoV-2 in vaccinated patients with vasculitis
Authors: Monti Sara , Fornara Chiara , Delvino Paolo , Bartoletti Alice , Bergami Federica , Comolli Giuditta , Sammartino Josè Camilla , Biglia Alessandro , Bozzalla Cassione Emanuele , Cassaniti Irene , Baldanti Fausto , Lilleri Daniele , Montecucco Carlomaurizio
Published: June 2022

Objectives

To analyse humoral and cellular immune response to mRNA COVID-19 vaccines in patients with GCA.

Methods

Consecutive patients with a diagnosis of GCA receiving two doses of BNT162b2 vaccine were assessed at baseline and 3 weeks from the second vaccine dose. Healthy subjects (n = 51) were included as controls (HC). Humoral response was assessed with Spike-specific IgG antibody response (S-IgG) and neutralizing antibodies (NtAb). Specific T cell response was assessed by enzyme linked immunosorbent spot (ELISpot).

Results

Of 56 included patients with GCA, 44 were eligible after exclusion of previous evidence of COVID-19 and incomplete follow-up. A significant proportion of patients with GCA (91%) demonstrated antibody (S-IgG) response, but this was significantly lower than HCs (100%); P < 0.0001. Neutralizing activity was not detected in 16% of patients with GCA. Antibody titres (S-IgG and NtAb) were significantly lower compared with HCs. Humoral response (S-IgG and NtAb) was significantly hampered by treatment with MTX. Cellular response was lacking in 30% of patients with GCA (vs 0% in HCs; P < 0.0001). Cellular response was significantly influenced by the levels of baseline peripheral T-lymphocytes and by glucocorticoid treatment. Treatment with tocilizumab did not affect any level of the immune response elicited by vaccination.

Conclusions

Although patients with GCA apparently achieve a robust antibody seroconversion, there is a significant impairment of the neutralizing activity. MTX significantly reduced all levels of the humoral response. Up to one-third of patients do not develop a cellular immune protection in response to COVID-19 vaccination.
Modifying Outdated Blood Donation Restrictions on Men Who Have Sex with Men
Authors: Velasco Roque Anthony F. , Golino Amanda J. , Fontenot Justin
Published: June 2022

Current practices are discriminatory and no longer supported by science.
Telehealth Expansion During the COVID-19 Pandemic and Beyond
Authors: Demeke Hanna B. , Umeakunne Erica
Published: June 2022

Information and resources for health care providers.
New Drug for Metastatic Castration-Resistant Prostate Cancer
Authors: Aschenbrenner Diane S.
Published: June 2022

Pluvicto (lutetium Lu 177 vipivotide tetraxetan) has been approved for the treatment of adult patients with prostate-specific membrane antigen–positive metastatic castration-resistant prostate cancer who have received androgen receptor pathway inhibition and taxane-based chemotherapy.
Night Shift
Authors: Vizoso Hector
Published: June 2022

Sometimes nothing a nurse does for a patient feels like enough.
Myxedema coma
Authors: Mitchell-Brown Fay , Gates Claire
Published: June 2022

Myxedema coma (MC) develops from a long-standing, unrecognized, or untreated hypothyroidism. This article discusses the pathophysiology, clinical manifestations, treatment, and nursing considerations for patients with MC.
The Acoustics of Instant Ear Tips and Their Implications for Hearing-Aid Fitting
Authors: Cubick Jens , Caporali Sueli , Lelic Dina , Catic Jasmina , Vikær Damsgaard Anne , Rose Steen , Ives Terri , Schmidt Erik
Published: June 2022

Objectives:

Today, approximately 70 to 80% of hearing aid fittings are made with silicone instant ear tips rather than custom earmolds. Nevertheless, little is known about the impact of instant ear tips on the acoustic coupling between the hearing aid receiver and the individual ear canal, even though it can have a major impact on the overall sound of the hearing aids. This study aimed to investigate the acoustic properties of different instant ear tip types and their across-subject variability, the within-subject reliability of those properties, and the influence of the users’ level of experience with ear-tip insertion on the acoustics. Furthermore, subjective ratings of occlusion produced by the ear tips were considered.

Design:

Five types of instant ear tips (Open, Tulip, Round [2-vent], Round [1-vent], Double Domes) provided by the hearing aid manufacturer Widex were considered in this study. Probe-microphone measurements were performed at the eardrums of 30 participants (60 ears). In the first experiment, the real ear occluded insertion gain and the vent effect (VE) were measured, and the listeners rated the subjective occlusion experienced with each ear tip. In the second experiment, the same measurements were repeated six times per participant. The within-subject variability of the acoustic ear tip properties was investigated as well as the impact of the degree of users’ experience with ear tip insertion on the resulting real ear measurements.

Results:

All tested ear tips were, on average, acoustically transparent up to 1 kHz except Double Domes, which were only transparent up to 600 Hz. Distinct VE profiles were found for each ear tip type, but a large across-subject variability was observed for both real ear occluded insertion gain and VE. However, the within-subject reliability was high. The measured VE was highly correlated with the perceived occlusion. Finally, no significant effect of the level of experience in ear tip insertion on the acoustic properties of the ear tips was found, but the within-subject variability was larger in the less experienced group.

Conclusions:

These results suggest that the acoustic properties of instant ear tips and their coupling to the individual ear canal impact the resulting hearing aid fitting and should be considered by the hearing care professionals and reflected in the fitting software. The high within-subject reliability indicates that the ear tip acoustics remain stable for the individual in daily use. Finally, real ear measurements should be considered an essential part of the hearing aid fitting process in clinical practice to ensure an optimal fit for the individual hearing aid user.
Relationship Between Automated Pupillometry Measurements and Ventricular Volume in Patients With Aneurysmal Subarachnoid Hemorrhage
Authors: Campos Yesica Andrea , Rana Priyanka , Reyes Ranier G. , Mazhar Khadijah , Stutzman Sonja E. , Atem Folefac , Olson DaiWai M. , Aiyagari Venkatesh
Published: June 2022

INTRODUCTION: Pupillometry allows for a standardized assessment of the pupillary light reflex. Acute hydrocephalus (HCP) is a common complication in patients with aneurysmal subarachnoid hemorrhage (aSAH). HCP may affect the pupillary light reflex because of increased intracranial pressure or dilation of the rostral aqueduct. The association between the pupillary light reflex and HCP in aSAH patients has not been clearly established. The objective of this study is to analyze the correlation between the Neurological Pupil index (NPi) and the degree of HCP in aSAH patients. METHODS: The Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care Registry is a prospectively collected database of pupillometry readings in patients admitted to 4 different neurological intensive care units. Patients in the registry with aSAH who had pupillometry assessments within 6 hours of a brain computed tomography were studied. The degree of HCP was quantified using the HCP score, and the relationship between the NPi and HCP was analyzed after controlling for confounders. RESULTS: A total of 43 patients were analyzed (mean age, 54 ± 15 years; 53.2% male; mean HCP score, 5.3 ± 3.8). Thirty-eight patients had HCP. Mean NPi for the right eye was 4.02 (±1.2), and that for the left eye was 3.7 (±1.5). After adjusting for age, sex, race, and sedation, there was no significant correlation between HCP and NPi (right eye: r = 0.12, P = .44; left eye: r = 0.04, P = .8). CONCLUSION: In patients with aSAH, NPi was not correlated with HCP score. A small sample size could be a limitation of this study. Additional studies are needed to characterize the clinical significance of pupillometry in the evaluation of patients with aSAH and HCP.
Telemedicine practices in adult patients with atrial fibrillation
Authors: Watkins April Kathleen , Clark Angela P. , Champion Jane Dimmitt
Published: June 2022

Background:

Atrial fibrillation is a cardiac rhythm disorder associated with embolic stroke risk, decreased functional capacity, and worsening quality of life. Increasing patient access to atrial fibrillation specialists via telemedicine has the potential to improve patient outcomes.

Objectives:

The purpose of this systematic review was to describe atrial fibrillation telehealth education treatment programs unrelated to postablation or early detection of atrial fibrillation.

Data Sources:

PubMed and CINAHL databases were searched using key terms identified by the authors and informed by a panel of clinicians with expertise in cardiac electrophysiology.

Conclusions:

Little literature exists on educational telehealth programs for atrial fibrillation treatment unrelated to postablation or early detection of atrial fibrillation. Only three studies met our inclusion criteria. Three themes emerged from review of these studies: (a) atrial fibrillation requires specialty care that is difficult to obtain; (b) comprehensive atrial fibrillation education should include a broad overview of the condition, management options, stroke prevention, and symptom management; and (c) telemedicine is effective for diagnosing and managing atrial fibrillation.

Implications for Practice:

Telemedicine clinics for atrial fibrillation represent an emerging form of clinically important health care delivery. These clinics can potentially decrease wait time for specialty care access, reduce unnecessary emergency department visits, reduce stroke risk, and increase guideline adherence. Nurse practitioners are well suited to create and lead telemedicine atrial fibrillation clinics with relevant clinical expertise and collaborative skills.
Prognostic value of serial score measurements of the national early warning score, the quick sequential organ failure assessment and the systemic inflammatory response syndrome to predict clinical outcome in early sepsis
Authors: Zonneveld Lara E.E.C. , van Wijk Raymond J. , Olgers Tycho J. , Bouma Hjalmar R. , ter Maaten Jan C.
Published: June 2022

Background and importance

Sepsis is a common and potentially lethal syndrome, and early recognition is critical to prevent deterioration. Yet, currently available scores to facilitate recognition of sepsis lack prognostic accuracy.

Objective

To identify the optimal time-point to determine NEWS, qSOFA and SIRS for the prediction of clinical deterioration in early sepsis and to determine whether the change in these scores over time improves their prognostic accuracy.

Design

Post hoc analysis of prospectively collected data.

Settings and participants

This study was performed in the emergency department (ED) of a tertiary-care teaching hospital. Adult medical patients with (potential) sepsis were included.

Outcome measures and analysis

The primary outcome was clinical deterioration within 72 h after admission, defined as organ failure development, the composite outcome of ICU-admission and death. Secondary outcomes were the composite of ICU-admission/death and a rise in SOFA at least 2. Scores were calculated at the ED with 30-min intervals. ROC analyses were constructed to compare the prognostic accuracy of the scores.

Results

In total, 1750 patients were included, of which 360 (20.6%) deteriorated and 79 (4.5%) went to the ICU or died within 72 h. The NEWS at triage (AUC, 0.62; 95% CI, 0.59–0.65) had a higher accuracy than qSOFA (AUC, 0.60; 95% CI, 0.56–0.63) and SIRS (AUC, 0.59; 95% CI, 0.56–0.63) for predicting deterioration. The AUC of the NEWS at 1 h (0.65; 95% CI, 0.63–0.69) and 150 min after triage (0.64; 95% CI, 0.61–0.68) was higher than the AUC of the NEWS at triage. The qSOFA had the highest AUC at 90 min after triage (0.62; 95% CI, 0.58–0.65), whereas the SIRS had the highest AUC at 60 min after triage (0.60; 95% CI, 0.56–0.63); both are not significantly different from triage. The NEWS had a better accuracy to predict ICU-admission/death <72 h compared with qSOFA (AUC difference, 0.092) and SIRS (AUC difference, 0.137). No differences were found for the prediction of a rise in SOFA at least 2 within 72 h between the scores. Patients with the largest improvement in any of the scores were more prone to deteriorate.

Conclusion

NEWS had a higher prognostic accuracy to predict deterioration compared with SIRS and qSOFA; the highest accuracy was reached at 1 h after triage.
Medulloblastoma and Down Syndrome: An Extremely Rare Association
Authors: Baroni Lorena V. , Muñoz Cassina Tamara , Fernández Ponce Nicolás , Pinto Natalia , Vázquez Valeria , Lubieniecki Fabiana , Alderete Daniel
Published: June 2022

Medulloblastoma has a reduced incidence in Down syndrome (DS). This protective characteristic has not been clarified yet. Here, we report the second case of SHH medulloblastoma and DS documented in the literature. A complete surgery was performed followed by reduced craniospinal irradiation dose and adjuvant chemotherapy. No evidence of tumor recurrence was observed. The overall survival was 9.1 years. No family history or physical stigma of other hereditary predisposition syndrome was found. In the elucidation of this extremely rare association, future case reports play an important role in defining the spectrum of brain tumors and their peculiar features in DS.
The Value of Static Perimetry in the Diagnosis and Follow-up of Negative Dysphotopsia
Authors: Rozendal Lisa R. W. , van Vught Luc , Luyten Gregorius P. M. , Beenakker Jan-Willem M.
Published: June 2022

SIGNIFICANCE

There is a clinical need for a quantitative test to objectively diagnose negative dysphotopsia, especially because the diagnosis is generally assessed using patients' subjective descriptions. In the search of a clinical test to objectify the shadow experienced in negative dysphotopsia, this study excludes static perimetry as suitable evaluation method.

PURPOSE

This study aimed to evaluate the value of static perimetry in the objective assessment and follow-up of negative dysphotopsia.

METHODS

Peripheral 60-4 full-threshold visual field tests were performed in 27 patients with negative dysphotopsia and 33 pseudophakic controls. In addition, 11 patients with negative dysphotopsia repeated the test after an intraocular lens exchange. Both the total peripheral visual field and the averaged peripheral visual field from 50 to 60° eccentricity were compared between patients and controls, and pre-operatively and post-operatively in patients who had an intraocular lens exchange.

RESULTS

The peripheral visual fields from 30 to 60° did not show significant differences between patients with negative dysphotopsia and pseudophakic controls. Analysis of the peripheral visual field from 50 to 60° showed a median [Q1, Q3] of 20.0 [17.1, 22.5] dB in the negative dysphotopsia group compared with 20.1 [15.5, 21.3] dB in the control group (P = .43). Although 82% of patients treated with an intraocular lens exchange subjectively reported improvement of their negative dysphotopsia complaints post-operatively, there were no significant differences in their total peripheral visual field or averaged peripheral visual field from 50 to 60° (P = .92).

CONCLUSIONS

Full-threshold static perimetry with a Goldmann size III stimulus up to 60° eccentricity does not show significant differences between patients with negative dysphotopsia and pseudophakic controls or between measurements before and after intraocular lens exchange. Therefore, this type of static perimetry cannot be used as a quantitative objective test for diagnosis or follow-up of patients with negative dysphotopsia.
Short Falls in Childhood Occasionally Cause Major Brain Injuries Because of Unusual Circumstances
Authors: Feldman Kenneth W. , Sokoloff Michael , Otjen Jeffrey P. , Wright Jason N. , Lee Amy , Ebel Beth , Blair Amanda B.
Published: June 2022

Objective

Short, early childhood falls rarely cause severe brain injuries or death. However, it is important to recognize that they occasionally occur because of unusual circumstances. We sought to document several such injuries.

Methods

Records and imaging were reviewed for children younger than 6 years, hospitalized between 2015 and 2020 for major closed head injuries following less than 4-ft falls. Major injury was defined as intensive care admission more than 2 days, neurosurgical intervention, death, or disability at hospital discharge. Subjects were identified through Seattle and Spokane, Washington abuse consultations. Harborview Medical Center's trauma registry and Seattle Children's Hospital's Hemophilia Treatment Program and Radiology were searched for subjects.

Results

We identified 12 young children who sustained major closed head injury due to short falls. Seven developed major space-occupying epidural hemorrhages. One child developed internal hydrocephalus after intraventricular hemorrhage. One child with prior meningomyelocele, Chiari 2 malformation, and ventriculoperitoneal shunt developed shunt decompensation after an acute-on-chronic subdural hemorrhage. One child developed an internal capsule stroke because of a previously undiagnosed calcifying angiopathy. Another child developed space-occupying subdural hemorrhage associated with previously unrecognized platelet pool disorder. Only this child had abuse concerns, which were resolved with his coagulopathy diagnosis. One child had a diastatic skull fracture leading to pseudomeningocele.

At Harborview Medical Center, 140 children were seen for short falls in the emergency department or inpatient service. Among the 40 needing intensive care, 4 (12.5%) had major injuries after short falls. Our hemophilia treatment program did not see any children who had sustained major injury following a short fall in a 5½ year period.

Conclusions

Although young children rarely sustain major head injury following short falls, serious head injuries do occasionally occur because of unusual injury mechanisms or preexisting conditions. It is important to fully evaluate these patients to differentiate these unintentional falls from abusive head injury.
Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Periorbital Aging
Authors: Boonipat Thanapoom , Abu-Ghname Amjed , Lin Jason , Garcia-Gonzalo Esperanza , Bite Uldis , Stotland Mitchell A.
Published: June 2022

Background:

The perceptual response to aging changes in the periorbital region and the effects of surgical rejuvenation on that response have not been elucidated. The authors examined the reflexive visual response to periorbital aging before and after brow lift and upper blepharoplasty surgery and investigated how observers’ character attributions of the images were affected by the rejuvenative intervention.

Methods:

Preoperative and postoperative photographs were obtained of patients with brow ptosis and dermatochalasis who underwent brow lift and blepharoplasty. Forty observers examined each image while an infrared eye-tracking camera continuously recorded their eye movements. The observers rated the images with respect to character attributes (attractiveness, trustworthiness, sociability, healthiness, and capability) on a scale of one to seven.

Results:

Fourteen patients who underwent brow lift and blepharoplasty were identified and studied. The surgical intervention was found to increase observers’ attention to the eye and brow region, while decreasing relative attention to the forehead and lower eyelid areas; increase the two-dimensional surface area of the forehead and eye and brow zones in a manner directly associated with the measured changes in visual attention; and significantly increase the ratings for all five positively valanced character attributes compared with preoperative controls.

Conclusions:

The authors provide an important combination of explicit and implicit data illustrating how surgical rejuvenation unveils the periorbital region to the observer. This change in pattern of inspection was associated with an improvement in the perception of character.
Defining the Relationship Between Pocket and Breast Implant Surface Area as the Basis for a New Classification System for Capsular Contracture
Authors: Hammond Dennis C. , Michigan Rapids , Chaudhry Arif
Published: June 2022

Background:

The precise etiology and treatment for capsular contracture remains uncertain at least partially due to the fact that there is no reliable quantitative measurement tool. To address this, it is postulated that the surface area of an implant as defined by the surrounding pocket may provide a quantifiable variable that can be measured to evaluate the degree of capsular contracture.

Methods:

A bench model for capsular contracture was developed. The surface area of a series of spherical test objects and non-contracted and contracted breast implants was measured using a wax coating technique as well as three-dimensional reconstructions created from CT scan images.

Results:

Comparison of the mathematically calculated surface areas to the wax and CT results for spheres of known dimension provided nearly identical values documenting the accuracy of the two experimental methods. Comparison of the surface area measurements between the test groups showed that the average decrease in surface area for all implants was 20%, ranging from a high of 30.9% for a low profile implant to a low of 14.1 % for a high profile implant. The anatomically shaped devices demonstrated nearly uniform degrees of surface area change over three different heights with volume and projection held relatively constant.

Conclusions:

The described bench model provides a useful tool for the study of capsular contracture. Surface area is a descriptive variable that can assess the degree of capsular contracture that is present. A classification system based on surface area is presented.