bluuebunny/crossref_metadata_2025 huggingface dataset:
Raetic and Runes
Authors: Salomon Corinna
Published: April 2020

The paper investigates the potential role of the Raetic inscription corpus for the derivation of the Germanic futhark. It gives an overview of the North Italic corpora and the current state of research, focussing on the Raetic epigraphical evidence. A detailed comparison of the grapheme inventories of Raetic and Runic as well as their respective epigraphical characteristics shows that the Raetic alphabets do not serve as convincing models for the Runic script.
Improving structure-based virtual screening performance via learning from scoring function components
Authors: Xiong Guo-Li , Ye Wen-Ling , Shen Chao , Lu Ai-Ping , Hou Ting-Jun , Cao Dong-Sheng
Published: April 2020

Scoring functions (SFs) based on complex machine learning (ML) algorithms have gradually emerged as a promising alternative to overcome the weaknesses of classical SFs. However, extensive efforts have been devoted to the development of SFs based on new protein–ligand interaction representations and advanced alternative ML algorithms instead of the energy components obtained by the decomposition of existing SFs. Here, we propose a new method named energy auxiliary terms learning (EATL), in which the scoring components are extracted and used as the input for the development of three levels of ML SFs including EATL SFs, docking-EATL SFs and comprehensive SFs with ascending VS performance. The EATL approach not only outperforms classical SFs for the absolute performance (ROC) and initial enrichment (BEDROC) but also yields comparable performance compared with other advanced ML-based methods on the diverse subset of Directory of Useful Decoys: Enhanced (DUD-E). The test on the relatively unbiased actives as decoys (AD) dataset also proved the effectiveness of EATL. Furthermore, the idea of learning from SF components to yield improved screening power can also be extended to other docking programs and SFs available.
Impact of the Allergy Clarification for Cefazolin Evidence-based Prescribing Tool on Receipt of Preferred Perioperative Prophylaxis: An Interrupted Time Series Study
Authors: Lam Philip W , Tarighi Payam , Elligsen Marion , Nathens Avery B , Riegert Daniel , Tarshis Jordan , Leis Jerome A
Published: April 2020

Implementation of a perioperative allergy and antibiotic assessment tool in patients with reported beta-lactam allergy resulted in a pronounced and sustained increase in perioperative cefazolin use. This intervention could result in improved efficiencies surrounding perioperative antibiotic administration and possible reductions in surgical site infection rates.
Epidemiology and Clinical Characteristics of Primary Amebic Meningoencephalitis Caused by Naegleria fowleri: A Global Review
Authors: Gharpure Radhika , Bliton John , Goodman Alexandra , Ali Ibne Karim M , Yoder Jonathan , Cope Jennifer R
Published: April 2020

Background

Primary amebic meningoencephalitis (PAM) is a rapidly progressive and often fatal condition caused by the free-living ameba Naegleria fowleri. To estimate the global occurrence, characterize the epidemiology, and describe the clinical features of PAM, we report a series of PAM cases published in the international literature and reported to the Centers for Disease Control and Prevention (CDC).

Methods

We performed a literature search of PAM case reports published through 2018. Additionally, we included cases reported through the CDC’s Free-Living Ameba surveillance or diagnosed via CDC’s Free-Living and Intestinal Amebas Laboratory. Cases were classified as confirmed, probable, or suspect on the basis of confirmatory testing, presentation, exposure, and disease course.

Results

A total of 381 PAM cases were identified. Seven reported survivors were classified as confirmed. The most commonly reported exposure associated with PAM was swimming/diving, and the most common class of water source was lakes/ponds/reservoirs. Patients were predominantly male (75%), with a median age of 14 years. Confirmed and probable cases were similar in their survival, course of illness, and cerebrospinal fluid (CSF) findings.

Conclusions

PAM is a rare but deadly disease with worldwide occurrence. Improved clinician awareness, resulting in earlier diagnosis and treatment, may contribute to increased survival among PAM patients. The case definition of probable used in this study appears to capture cases of PAM, as evidenced by similarities in outcomes, clinical course, and CSF profile to confirmed cases. In the absence of confirmatory testing, clinicians could use this case definition to identify cases of PAM.
School Social Work and the Educational Justice Movement: A Snapshot of Practice
Authors: Ball Annahita , Skrzypek Candra
Published: April 2020

Educational disparities and disproportionalities for oppressed children signal the need for an educational justice movement that focuses on macro-level changes within and outside of the educational system. School social workers are uniquely trained to engage in activities that promote educational justice, yet most school social workers focus on micro-level practice with individuals. Drawing on Teasley’s practice recommendations to improve educational outcomes for African American urban youths, this study examined the extent to which school social workers engage in macro-level practice strategies that promote educational justice. Cross-sectional survey data were collected from 112 school social workers. Results indicated that most participants reported little engagement in macro-level practice in support of educational justice, most notably in relation to leadership and public policy advocacy and school choice. Social workers reported the most engagement in areas associated with typical practice, such as family engagement and schoolwide needs assessment. Implications for school social work training, practice, and future research are discussed.
Investigation and modeling of energy consumption of tall office buildings in Iran's `hot-arid' and `cold' climate conditions
Authors: Ghiai Mohammad Mehdi , Arjmand Jamal Tabe , Mohammadi Omid , Ahmadi Mohammad Hossein , Assad Mamdouh El Haj
Published: April 2020

The construction of high-rise buildings has attracted human attention at the beginning of human civilizations’ formation. Presently, making tall buildings is considered as a necessary requirement due to the succeeding reasons: the population increase, the tendency to live in urban centers, the land utilization in the most populated centers of the cities, the need to decrease the cost of horizontal development of cities and technological advances. During the last century, issues related to environmental pollution and high energy use have affected these tall buildings. So, it is crucial to apply appropriate methods and patterns in order to adjust their environmental impacts as much as possible. In addition, the building industry accounts for a significant amount of energy consumption in the world. Therefore, energy-saving and efficiency can be mentioned as a significant issue due to the limitation of fossil resources. The importance of this issue has been increased by eliminating subsidies and realizing the price of fuels in Iran. Efforts in the field of high-rise buildings in Iran are chiefly based on general criteria regarding the location and characteristics of urban imagery and the field of urban design knowledge. The efforts contributed to the energy consumption have not been carried out. The present study provides patterns for the aim of designing high-rise buildings with official use in Tabriz and Yazd. The solutions for the opening design of tall buildings with regular forms to reduce energy consumption are proposed in this study.
Effects of Acaricides on the Functional and Numerical Responses of the Phytoseid Predator Neoseiulus idaeus (Acari: Phytoseiidae) to Spider Mite Eggs
Authors: de Sousa Neto E P , Mendes J de A , Filgueiras R M C , Lima D B , Guedes R N C , Melo J W S
Published: April 2020

Integrated control tactics are often necessary for pest management. This is especially true for organisms such as the two-spotted spider mite, Tetranychus urticae Koch. The management of this mite pest species relies on pesticide use, but its short life cycle associated with high selection pressure results in frequent problems of acaricide resistance and population outbreaks. Therefore, combining acaricides and natural enemies is an appealing strategy for managing this pest species. The predatory mite Neoseiulus idaeus Denmark & Muma (Phytoseiidae) is important in arid environments, where other natural enemies show low efficacy. Thus, we investigated the effects of representative acaricides used for managing spider mites around the world in several crops (i.e., abamectin, fenpyroximate, and azadirachtin), on the functional and numerical responses of the phytoseid predator N. idaeus to increasing egg densities of its prey. Acaricide exposure did not affect the type of N. idaeus functional response or attack rate (a). However, acaricide exposure decreased the amount of consumed prey and increased prey handling time (Th). All acaricides affected the numerical response of the predator, which reduced oviposition rates. Therefore, caution is required in attempts to integrate the control methods.
Effectiveness of Histocompatibility Matching in High-Risk Corneal Transplantation
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Collaborative Cornea Transplant Studies (CCTS) comprised two randomized, double-masked, clinical trials, the Antigen Matching Study (AMS) and the Crossmatch Study (CS), designed to determine whether matching HLA-A, -B, and/or HLA-DR antigens, donor-recipient crossmatching, or ABO compatibility reduced the risk of corneal allograft rejection and failure in high-risk patients. The studies showed that for patients needing a corneal graft with uncompromised immune systems and at high risk for corneal graft rejection: (1) neither HLA-A, -B, nor HLA-DR antigen matching substantially reduces the likelihood of corneal graft failure; (2) a positive donor-recipient crossmatch does not dramatically increase the risk of corneal graft failure; and (3) ABO blood group matching may be effective in reducing the risk of graft failure. Intensive steroid therapy after transplantation, frequent follow-up, medication and follow-up compliance, and patient education appear to play a significant role in corneal graft success.
Topical Corticosteroids for Bacterial Keratitis
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Steroids for Corneal Ulcers Trial (SCUT) was a randomized, placebo-controlled, double-masked clinical trial to determine whether topical corticosteroids were beneficial as an adjunctive therapy when treating bacterial corneal ulcers with topical antibiotics. The study found that, in the treatment of non-Nocardia bacterial corneal ulcers, topical corticosteroids initiated within 3 days of presentation as adjunctive therapy after at least 48 hours of antibiotic usage do not produce any short-term benefit but may be associated with improved long-term clinical outcomes. There was some evidence of short-term benefit in patients with baseline best-corrected visual acuity of counting fingers or worse, with ulcers completely covering the central 4-mm pupil, and in ulcers with infiltrates greater than 67% of the full corneal thickness at baseline.
Routine Preoperative Medical Testing Before Cataract Surgery
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Study of Medical Testing for Cataract Surgery was a randomized clinical trial in patients scheduled to undergo elective cataract surgery to determine whether routine medical testing before cataract surgery reduced the rate of complications during the perioperative period. The study showed that routine preoperative medical testing before cataract surgery does not reduce the risk of intraoperative or postoperative adverse medical events when compared to selective or no testing, nor does it reduce the rate of ocular surgical complications (such as posterior capsule rupture) or influence visual acuity outcome. The authors recommended that preoperative clinical assessment by a physician at least 7 days before surgery is a more logical and efficient approach. Tests should be ordered only when indicated by the history or findings on physical examination.
Prophylaxis of Postoperative Endophthalmitis Following Cataract Surgery
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The European Society of Cataract and Refractive Surgeons (ESCRS) multicenter endophthalmitis study, a randomized, partially masked, clinical trial using a 2 × 2 factorial design, examined the question of whether antibiotic prophylaxis (intracameral cefuroxime and topical perioperative levofloxacin) reduces the incidence of postoperative endophthalmitis after cataract surgery. The study showed that use of intracameral cefuroxime at the end of surgery reduced the occurrence of postoperative endophthalmitis to a level below 0.08%. The authors also recommended that to reduce the risk further, consideration should be given to avoiding the use of silicone intraocular lens optic material and using a scleral tunnel incision rather than a clear corneal incision.
The Relationship Between Optic Disc Area and Open-Angle Glaucoma
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Baltimore Eye Survey was a population-based survey of the prevalence of ocular disorders in East Baltimore, Maryland. To determine whether eyes with larger optic disc areas had a higher risk for developing open-angle glaucoma (OAG), one eye (the eye with the largest disc area) from each subject with glaucoma (diagnosed by visual field loss and a compatible optic disc appearance but not level of intraocular pressure [IOP]) was compared with those of subjects without glaucoma. There was no statistically significant difference in overall optic disc area between patients with OAG and control subjects, although patients with OAG tended to have slightly larger discs. Among the patients with OAG, disc area was not significantly related to IOP level after adjusting for age, race, and gender. The authors concluded that disc area was a weak risk factor for open-angle glaucoma.
Intraocular Pressure Reduction in the Treatment of Normal-Tension Glaucoma
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Collaborative Normal-Tension Glaucoma Study (CNTGS) was a randomized clinical trial to determine the effectiveness of a 30% reduction in intraocular pressure (IOP) (using either medical therapy or filtration surgery) on visual field (VF) progression in eyes with normal-tension glaucoma. The study found that reducing the IOP of patients with normal-tension glaucoma by 30% is beneficial to prevent progression of glaucomatous damage if the visual effects of cataracts are excluded from consideration. However, because not all untreated patients progressed, the natural history of normal-tension glaucoma must be considered before embarking on IOP reduction with therapy that may exacerbate cataract formation, unless normal-tension glaucoma threatens serious visual loss.
Intraocular Pressure Control and Long-Term Visual Field Loss in Open-Angle Glaucoma
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Collaborative Initial Glaucoma Treatment Study (CIGTS) was a randomized clinical trial to determine whether patients with newly diagnosed open-angle glaucoma (OAG) were managed better by initial treatment with medications (using a stepped regimen of medications starting initially with a topical beta-blocker) or by immediate filtration surgery (trabeculectomy with or without 5-fluorouracil). Although the surgery group achieved a lower mean intraocular pressure (IOP) than the medication group, both groups had similarly low rates of visual field progression. Three measures of IOP fluctuation over extended time, the range of IOP, the standard deviation of IOP, and the maximum IOP, seem to play an important role in visual field progression The results showed that more aggressive treatment was warranted when undue elevation or variation in IOP measures is observed.
Tube Shunt Surgery Versus Trabeculectomy in Eyes with Prior Ocular Surgery and Uncontrolled Glaucoma
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Tube Versus Trabeculectomy (TVT) Study was a randomized clinical trial comparing tube shunt surgery to trabeculectomy with mitomycin C in patients with uncontrolled glaucoma (intraocular pressure (IOP) ≥18 mm Hg and ≤40 mm Hg on maximum tolerated medical therapy) who had previously undergone cataract extraction with intraocular lens implantation and/or failed filtering surgery. The study did not demonstrate clear superiority of one glaucoma operation over the other, but indicated that both tube shunt surgery and trabeculectomy with mitomycin C were viable surgical options for treating medically uncontrolled glaucoma in this group of patients. Both procedures were associated with similar IOP reduction and use of supplemental medical therapy at 5 years. Additional glaucoma surgery was needed more frequently after trabeculectomy with MMC than tube shunt placement.
Argon Laser Photocoagulation for Macular Edema in Branch Vein Occlusion
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Branch Vein Occlusion Study (BVOS) was a randomized, incompletely masked, controlled clinical trial in patients with a branch retinal vein occlusion (BRVO) occurring 3 to 18 months earlier, with best corrected visual acuity of 20/40 or worse from macular edema. The study showed that argon laser grid photocoagulation could improve visual acuity in eyes with BRVO and macular edema reducing visual acuity to 20/40 or worse. After this study, grid photocoagulation of the macula became the standard of care for BRVO with macular edema with foveal involvement and capillary leakage with visual acuity of 20/40 or worse, and it remains the gold standard therapy for perfused macular edema in BRVO. Advantages are that it is proven, widely available, nonsurgical, and of relatively moderate cost.
Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) study was a randomized, controlled clinical trial to determine whether the use of supplemental therapeutic oxygen in premature infants reduced the probability of progression from prethreshold to threshold ROP and the need for peripheral retinal ablation. The study found that supplemental oxygen at pulse oximetry saturations of 96% to 99% did not cause additional progression of prethreshold ROP but also did not significantly reduce the number of infants requiring peripheral ablative surgery. However, the risk of adverse pulmonary events was increased.
Early Treatment of Prethreshold Retinopathy of Prematurity
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Early Treatment for Retinopathy of Prematurity (ETROP) study, a randomized, controlled clinical trial, compared peripheral retinal ablation with conventional management (observation and treatment if the eye developed threshold retinopathy of prematurity [ROP]) in infants with unilateral or bilateral high-risk ROP. Early treatment of high-risk prethreshold ROP significantly reduced unfavorable outcomes in both primary and secondary (structural) measures. The results of this study showed that it is possible to identify characteristics of ROP that predict which eyes are most likely to benefit from early peripheral retinal ablation.
Intravitreal Bevacizumab for Stage 3+ Retinopathy of Prematurity
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Bevacizumab Eliminates the Angiogenic Threat of Retinopathy of Prematurity (BEAT-ROP) study was a randomized, controlled clinical trial to determine whether intravitreal bevacizumab monotherapy was an effective therapy for treating zone I or zone II posterior stage 3+ (stage 3 with plus disease) retinopathy of prematurity (ROP). Intravitreal bevacizumab, as compared with conventional laser therapy, showed a significant benefit for zone I but not zone II disease. Development of peripheral retinal vessels (with possible recurrence of ROP) continued after treatment with intravitreal bevacizumab, but conventional laser therapy led to permanent destruction of the peripheral retina.
Early Photocoagulation for Diabetic Retinopathy
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Early Treatment Diabetic Retinopathy Study (ETDRS) was a randomized clinical trial involving nearly four thousand diabetic patients with early proliferative retinopathy, moderate to severe nonproliferative retinopathy, and/or diabetic macular edema in each eye. This paper (ETDRS report number 9) examined the question of when in the course of diabetic retinopathy it is most effective to initiate photocoagulation therapy. Based on the study findings, the authors recommended that panretinal scatter photocoagulation not be carried out in eyes with mild or moderate nonproliferative diabetic retinopathy; when retinopathy is more severe, however, panretinal scatter photocoagulation usually should not be delayed if the eye has reached the high-risk proliferative stage. Focal treatment should be considered for eyes with macular edema that involves or threatens the center of the macula, preferably before scatter photocoagulation for high-risk proliferative retinopathy becomes urgent.
Does Pars Plana Vitrectomy Improve Visual Outcomes in Patients with Complications of Proliferative Diabetic Retinopathy
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Early Treatment Diabetic Retinopathy Study (ETDRS) was a randomized clinical trial involving nearly four thousand diabetic patients with early proliferative retinopathy, moderate to severe nonproliferative retinopathy, and/or diabetic macular edema in each eye. This paper (ETDRS report number 17) describes the baseline previtrectomy characteristics, initial treatment assignments, indications for vitrectomy, and visual outcomes in the subgroup of patients in the ETDRS who had pars plana vitrectomy (PPV). The study showed that pars plana vitrectomy could improve visual outcomes in patients with complications from proliferative diabetic retinopathy such as vitreous hemorrhage and retinal detachment. PPV continues to play an important role in the management of complications from proliferative diabetic retinopathy.
Intensive Diabetes Management to Reduce the Risk of Retinopathy Developing or Progressing
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Diabetes Control and Complications Trial (DCCT) was a randomized clinical trial to determine whether intensive therapy in patients with insulin-dependent diabetes mellitus (IDDM) completely prevents the development of diabetic retinopathy. Two groups were studied: patients with IDDM of 1 to 5 years’ duration and no retinopathy or microalbuminuria at baseline (primary prevention cohort) and patients with IDDM of 1 to 15 years’ duration and minimal to moderate nonproliferative retinopathy and albuminuria (secondary intervention cohort). The study found that although intensive therapy in patients with IDDM did not prevent retinopathy completely, it reduced the risk of retinopathy developing or progressing, especially when started early in the course of IDDM. Even in patients with nonproliferative retinopathy of moderate severity, retinopathy was more likely to regress or remain unchanged over time with intensive therapy.
Immediate Vitrectomy and Intravenous Antibiotics for the Treatment of Postoperative Bacterial Endophthalmitis
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Endophthalmitis Vitrectomy Study (EVS) was a randomized, controlled clinical trial to determine the roles of immediate pars plana vitrectomy and systemic antibiotic treatment in the management of postoperative endophthalmitis in patients with clinical signs and symptoms of bacterial endophthalmitis within 6 weeks of cataract surgery or secondary intraocular lens (IOL) implantation and visual acuity between 20/50 and light perception. The study found that routine immediate pars plana vitrectomy is not necessary in patients with better than light perception vision at presentation but is of substantial benefit for those who have light perception-only vision (or worse). Most patients do not require treatment with intravenous antibiotics. Omission of systemic antibiotic treatment can reduce toxic effects, costs, and length of hospital stay.
Prevalence of Age-Related Maculopathy
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Beaver Dam Eye Study was a population-based cohort study designed to collect information on the prevalence and incidence of age-related cataract, macular degeneration, and diabetic retinopathy. The results of the baseline examination for macular degeneration are reported in this chapter. One or more drusen were present in the macular area of at least one eye in 95% of the population. Signs of age-related maculopathy were common in people seventy-five years of age or older. Women of this age group had an incidence of exudative macular degeneration two to three times higher than their male counterparts. This study was an early indication that age-related macular degeneration was becoming a public health problem in an aging American population.
Argon Laser Photocoagulation for Extrafoveal Neovascular Maculopathy
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Macular Photocoagulation Study (MPS) comprised three randomized clinical trials: the Senile Macular Degeneration Study (SMDS), the Ocular Histoplasmosis Study (OHS), and the Idiopathic Neovascularization Study (INVS). The goal was to determine whether, in patients with visual symptoms due to choroidal neovascularization outside the fovea (at least 200 microns from the center of the foveal avascular zone and a best corrected visual acuity of 20/100 or better caused by senile macular degeneration (now known as age-related macular degeneration), histoplasmosis, or idiopathic causes, argon blue-green laser photocoagulation prevents significant loss of visual acuity. Based on the study findings, the authors recommended that eyes with well-defined extrafoveal choroidal neovascular membranes should be treated with argon blue-green laser photocoagulation to prevent or delay significant loss of visual acuity.
Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) was a randomized, single-blind, noninferiority trial to evaluate the relative efficacy and safety of intravitreal injections of ranibizumab and bevacizumab (anti–vascular endothelial growth factor (VEGF) agents) for the treatment of neovascular age-related macular degeneration (AMD). At one year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule: bevacizumab administered monthly was equivalent to ranibizumab administered monthly, with 8.0 and 8.5 letters gained, respectively, and bevacizumab administered as needed was equivalent to ranibizumab as needed, with 5.9 and 6.8 letters gained, respectively. Ranibizumab given as needed with monthly evaluation had effects on vision that were equivalent to those of ranibizumab administered monthly. The comparison between bevacizumab as needed and monthly bevacizumab was inconclusive.
Effect of Pre-Enucleation Radiation on Mortality in Large Choroidal Melanomas
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Collaborative Ocular Melanoma Study (COMS) was a randomized clinical trial in patients with unilateral, large primary choroidal melanoma, defined as 2.0 mm or greater in apical height and greater than 16.0 mm in longest basal diameter, or greater than 10.0 mm in apical height regardless of the basal dimensions, to determine whether pre-enucleation external radiation to the globe and orbit significantly prolongs a patient’s lifespan compared to standard enucleation alone. The study showed that pre-enucleation external-beam radiation (20 Gy) did not improve survival compared with enucleation alone, although it did reduce the risk of orbital recurrence. This study established the appropriateness of primary enucleation alone in managing large choroidal melanomas not amenable to globe-conserving therapy.
Botulinum A Toxin Injection into Extraocular Muscles as an Alternative to Strabismus Surgery
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

In this chapter a case series is described of the use of botulinum A toxin for the treatment of strabismus in 19 patients with multiple types of strabismus with different etiologies. The maximum follow-up following botulinum injection was six months. Injection of botulinum A toxin into extraocular muscle to weaken the muscle was found to be a safe and effective alternative (or adjunct) to surgery for strabismus correction. The maximum time of paralysis occurred four to five days following the injection, and then gradually diminished, depending on the dose. The maximum correction of strabismus was 40 prism diopters. This was the first case series describing the use of botulinum A toxin for strabismus correction, and it led the way to further studies on the subject, which eventually led to FDA approval in 1990.
Botulinum A Toxin Injection as a Treatment for Blepharospasm
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

In this chapter a case series is described of the use of botulinum A toxin for the treatment of blepharospasm in thirty-nine patients with blepharospasm due to various causes—essential, Meige’s syndrome, hand apraxia, cerebrovascular disease, and parkinsonism. A reduction of abnormal movement occurred in all patients, lasting up to 170 days. Both the amount and the duration of effect were dose dependent. Tearing, dry-eye symptoms, or transient ptosis occurred in 20% of injections, especially in patients who had had previous eyelid surgery. Botulinum A toxin injection into the orbicularis oculi muscle was found to be a safe, simple, and symptomatically helpful treatment for blepharospasm that can be repeated at intervals as required.
Corticosteroids in the Treatment of Acute Optic Neuritis
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Optic Neuritis Treatment Trial (ONTT) was a randomized, placebo-controlled, clinical trial in patients with a history consistent with acute unilateral optic neuritis to determine whether treatment with either oral prednisone or intravenous methylprednisolone speeded the recovery of vision and improve visual outcome. The study found that intravenous methylprednisolone (started within eight days of symptom onset) followed by oral prednisone speeded the recovery of visual loss due to optic neuritis and resulted in slightly better vision at six months. Oral prednisone alone, however, was an ineffective treatment and may increase the risk of new episodes of optic neuritis.
Effect of Acetazolamide on Visual Function in Patients with Idiopathic Intracranial Hypertension and Mild Visual Loss
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Idiopathic Intracranial Hypertension Treatment Trial was a randomized, double-masked, placebo-controlled study in patients with idiopathic intracranial hypertension (IIH) and mild visual loss to determine whether acetazolamide was beneficial in improving vision when added to a low-sodium weight reduction diet. The study found that the use of acetazolamide with a low-sodium weight reduction diet resulted in modest improvement in visual field function. The mean improvement in perimetric mean deviation (PMD) was greater with acetazolamide (1.43 dB, from −3.53 dB at baseline to −2.10 dB at month 6) than with placebo (0.71 dB, from −3.53 dB to −2.82 dB); the difference was 0.71 dB. However, the clinical importance of this improvement remains to be determined.
Adrenal Glands
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The adrenal cortex is derived from mesoderm and the medulla, from neural crest ectoderm. An adrenal gland weighs approximately 5 g. The cortex secretes corticosteroids (cortisol), aldosterone, and sex hormones. Masses are most commonly asymptomatic. Adrenal incidentalomas are masses greater than 1 cm in diameter that are found in 2% to 4% of all CTs. Adrenalectomy is indicated for masses that are enlarging, larger than 4 to 6 cm, or functional (secreting hormone); the operation is fixated on safe transection of adrenal blood vessels. Complications are relatively uncommon with laparoscopic adrenalectomy.
Biliary Tree
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The biliary tree forms in the endodermal diverticulum of the caudal foregut. The left and right hepatic ducts drain the hepatic sinusoids and join to form the CHD, which joins the cystic duct to form the CBD. Hepatocytes produce bile, which passes through ducts and empties into the CHD and into the GB for storage. Small gallbladder stones occasionally descend into the CBD. Dilatation of the CHD (>4 mm) or CBD (>7 mm) is diagnosed with US. Patients with cholangitis should be resuscitated, given broad-spectrum antibiotics, and have the biliary tree drained with ERCP in preparation for cholecystectomy. ERCP can result in hemorrhage, injury to the duodenum, and pancreatitis.
Colon
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The colon is made up of the midgut which includes the proximal two-thirds of the transverse colon, and the hindgut, which includes the distal one-third of the transverse colon. The ileocecal junction to the anus is a distance of 1.5 m. Digested food (chyme) passes into the colon and is converted to feces by bacteria. The differential diagnosis of colonic masses includes cancer, carcinoid, lipoma, diverticular disease, ulcerative colitis, polyps, and Crohn disease. Treatment of colorectal cancer and symptomatic inflammatory colon disease usually involves wide surgical resection. Complications after surgery may include postoperative bleeding, leakage, and ileus.
Esophagus
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The esophagus is a hollow muscular tube approximately 25 cm in length, extending from the cricopharyngeus muscle to the gastroesophageal junction at the gastric cardia. It is the only organ that uses peristalsis. Achalasia is defined as failure of lower esophageal sphincter relaxation with concurrent esophageal aperistalsis. Esophageal manometry is the standard for diagnosing achalasia and DES. Achalasia is managed surgically with a Heller myotomy. Esophageal surgery may result in an iatrogenic perforation, thoracic duct injury, or anastomotic leak.
Jejunum and Ileum
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

During development, there is physiologic herniation of the midgut into the umbilical cord, and it then slips back in with a counterclockwise rotation. Jejunum and ileum occupy the mid abdomen and pelvis. The jejunum is involved in calcium and magnesium absorption. The ileum contains lymphoid tissue at the antimesenteric border. Small bowel infections present with a range of symptoms from diarrhea to severe dehydration to sepsis. Suspected SBO can be evaluated with plain radiography, upper GI studies, or CT. The treatment of SBO is initially nonoperative. Paralytic ileus occurs in many patients after abdominal surgery and is treated with IV fluids, nothing by mouth, and electrolyte replacement.
Pancreas
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The pancreas forms from the dorsal and ventral endodermal buds, which develop at the foregut-midgut junction. The head of the pancreas lies in the duodenal C-loop, anterior to the IVC and left renal vein. Islets of Langerhans carry out the endocrine function of the pancreas. Acute pancreatitis is caused by gallstones, alcohol, and trauma. CT with an IV contrast agent may be used to diagnose pancreatitis, pancreatic cancer, or complications after pancreatic surgery. Most patients with acute pancreatitis are managed conservatively. Pancreatic leaks occur in approximately 20% of operations on the pancreas.
Thyroid
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The thyroid gland forms from endoderm beginning at gestational week 5. The butterfly-shaped thyroid gland wraps around the trachea, cricoid, and thyroid cartilages. Excess thyroxine causes hyperthyroidism and suppression of the sensitive thyroid-stimulating hormone value. Hyperthyroidism may cause sweating, irritability, weight loss, and atrial fibrillation. US, nuclear imaging, and CT are useful. Collar incisions of the neck with transection of the platysma muscle, opening the median raphe, and exposing the thyroid isthmus are straightforward steps. Possible surgical complications are postoperative hematoma, RLN injury, and temporary hypoparathyroidism, and they should be avoided at all costs.
Trauma Assessment and Surgery
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

When the patient arrives in the emergency department, the primary survey should be for ABCDE: A, airway; B, breathing; C, circulation; D, disability; and E, exposure. Normothermia is ideal. Check vital signs often. CXR and pelvic radiographs may show evidence of fractures, bleeding, or perforation. If chin lift, jaw thrust, or endotracheal intubation are unsuccessful in establishing an airway, cricothyrotomy is indicated to provide an adequate airway.
Ministry of Advocacy
Authors: Coelho Tony
Published: April 2020

This section emphasizes the empowerment of others through the arts, employment, camping, and the Americans with Disabilities Act.
Livy’s Hope
Authors: Scheinman Allison , Scheinman Jon
Published: April 2020

This section demonstrates how fundraising can be the result of focusing on a goal as well as determination fueled by the love for a child, sibling, neighbor, or friend.
Sharon’s Ride.Run.Walk.
Authors: Rosenfeld William E. , Lippmann Susan M.
Published: April 2020

This section demonstrates how fundraising can be the result of focusing on a goal as well as determination fueled by the love for a child, sibling, neighbor, or friend.
Our Journey for Adelaide
Authors: Cervantes Kelly
Published: April 2020

The pursuit of medical careers, as well as advocating for epilepsy research, ketogenic therapies, and neuro-rehabilitation are among the efforts in this section on healthcare and research.
Navigating a New Path
Authors: Arthurs Susan
Published: April 2020

The pursuit of medical careers, as well as advocating for epilepsy research, ketogenic therapies, and neuro-rehabilitation are among the efforts in this section on healthcare and research.
My Road to Advocacy: A Personal Tale of Triumph with Epilepsy
Authors: Kaufman Kenneth R.
Published: April 2020

The pursuit of medical careers, as well as advocating for epilepsy research, ketogenic therapies, and neuro-rehabilitation are among the efforts in this section on healthcare and research.
My Advocacy Journey
Authors: Jacobson Catherine
Published: April 2020

The pursuit of medical careers, as well as advocating for epilepsy research, ketogenic therapies, and neuro-rehabilitation are among the efforts in this section on healthcare and research.
Epilepsy Education Everywhere
Authors: Kennedy Meghan
Published: April 2020

Furthering the missions of epilepsy organizations, by either volunteering for, starting, or running an organization that serves people with epilepsy have been the goals of the advocates who have dedicated their lives to organizational advocacy.
Diagnosis of Uncertainty to Positive Impact
Authors: Veach Jessica
Published: April 2020

Furthering the missions of epilepsy organizations, by either volunteering for, starting, or running an organization that serves people with epilepsy have been the goals of the advocates who have dedicated their lives to organizational advocacy.
Running Backwards to End Epilepsy
Authors: Zitomersky Loren
Published: April 2020

An elite athlete using her platform for epilepsy awareness, a person with epilepsy who climbed his way to a better life, and a man who ran a marathon backwards to raise funds and awareness of epilepsy are part of the journeys of the advocates in this section.
Go and Enjoy Your Life
Authors: Stanton Mike
Published: April 2020

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with uncontrolled seizures. This section details the lives of people who have lost a loved one to SUDEP and found meaning from their tragedies by helping others in similar situations.
Advocacy Through Informed Writing
Authors: Johnson Phylis Feiner
Published: April 2020

In this section, advocates use their skills in art, writing, and musical composition to positively impact the lives of many people with epilepsy.
When the Spirit Catches You
Authors: Folio Cynthia
Published: April 2020

In this section, advocates use their skills in art, writing, and musical composition to positively impact the lives of many people with epilepsy.
Why a New Approach to Medical Ethics Is Needed
Authors: Rhodes Rosamond
Published: April 2020

The Trusted Doctor: Medical Ethics and Professionalism rejects the well-entrenched views of medical ethics as everyday ethics or common morality applied to medicine. This chapter lays the foundation for the original account of medical ethics that follows in the book’s succeeding chapters. By presenting vivid examples and general arguments the author demonstrates ways in which the ethics of medicine is distinct and different from common morality. The chapter discusses the most popular common morality views, namely, the four principles approach expounded by Tom Beauchamp and James Childress in Principles of Biomedical Ethics and the ten rules approach presented by Bernard Gert, Charles Culver, and K. Danner Clouser in Bioethics: A Systematic Approach by presenting arguments that challenge their applicability to medical practice. A chart identifies some stark differences between the common morality approach and good medical practice and shows how everyday ethics is incompatible with medical professionalism.
The Distinctive Ethics of Medicine
Authors: Rhodes Rosamond
Published: April 2020

The derivation of medicine’s distinctive ethics begins in this chapter with a thought experiment demonstrating that trust is at the core of medical practice. Society allows doctors to develop special knowledge and skills and allows them to employ special powers, privileges, and immunities that could be particularly dangerous to members of society. The behavior of doctors therefore needs to be constrained by medicine’s distinctive ethics. The chapter argues that because individuals make themselves vulnerable by trusting medical institutions and clinicians based on their professional standing, the first duty of medical ethics must be to seek trust and be deserving of it. The second duty of medical ethics must be to use medical knowledge, skills, powers, privileges, and immunities for the benefit of patients and society, that is, to uphold medicine’s fiduciary responsibility. The chapter also provides case examples that illustrate how genuinely caring about patients’ well-being buttresses doctors’ ability to meet these responsibilities.
The Commitment to Science
Authors: Rhodes Rosamond
Published: April 2020

The association of medicine with science is at the core of the profession’s expertise. This chapter explains that doctors are duty-bound to base their diagnoses and treatment decisions on scientific evidence because patients rely on that commitment when seeking treatment and advice. Thus, the commitment to science is a core duty of medical ethics. The chapter argues that doctors should be committed to advancing biomedical knowledge and supporting medicine’s research agenda. In that light, the chapter opposes two widely accepted views. One is the World Medical Association’s position that physicians should focus exclusively on the good of their individual patient. The other is the US Common Rule’s distinction between clinical innovation and research, which has the effect of driving a wedge between medical ethics and research ethics. The chapter also addresses challenging issues of how human subject research should be conducted, research oversight, consent, vulnerable subjects, and placebo studies.
Duties of Behavior Toward Patients
Authors: Rhodes Rosamond
Published: April 2020

This chapter explains three central physician duties that clearly set medical ethics apart from common morality: nonjudgmental regard, nonsexual regard, and confidentiality. Because patients will not trust doctors when they are not confident in the doctor’s devotion and commitment to meeting their medical needs, doctors must avoid any intimation of judging a patient unworthy of care. Because doctors need their patients to trust that the intimacy of the doctor-patient relationship has no sexual overtones in spite of the revelation, nudity, and touching, doctors must maintain nonsexual regard in their patient interactions. Because doctors need patients to divulge intimate personal details about their behavior and history in order to make accurate diagnoses and develop treatment plans, patients must be able to trust their doctors to uphold confidentiality and only share medical information with other professionals on a need-to-know basis. These duties are explained and illustrated with numerous case examples.
Duties to Respect Patients’ Autonomy and Assess Capacity
Authors: Rhodes Rosamond
Published: April 2020

The two interrelated duties of respecting autonomy and assessing decisional capacity require considerable explanation. The first is acknowledged as a duty in most contemporary codes of medical ethics, while the second is not mentioned in any. This chapter provides a description of three distinct uses of the concept of autonomy and an overview and critique of different traditional and contemporary philosophers’ views on the concept of autonomy. To be trusted, doctors have to pay serious attention to patients’ opinions on what is good for them. They also have to recognize their fiduciary responsibility, step back from respectfully presuming that patients have autonomy, assess decisional capacity, and determine whether patients can be held responsible for their choices. Autonomous decisions should be respected, but when decisional capacity is impaired, paternalistic intervention may be required. Examples provide doctors with guidance for making the challenging decisions related to decisional capacity that have to be made in clinical practice.