Digestive Diseases and Sciences

Correction to: Fecal Microbiota Transplantation Capsules with Targeted Colonic Versus Gastric Delivery in Recurrent Clostridium difficile Infection: A Comparative Cohort Analysis of High and Low Dose The original version of the article unfortunately contained an error in article title. The corrected title is 'Fecal Microbiota Transplantation Capsules with Targeted Colonic Versus Gastric Delivery in Recurrent Clostridium difficileInfection: A Comparative Cohort Analysis of High and Low Dose'.

Third Time's a Charm: Immunization Strategies for Hepatitis B in Immunosuppressed Patients with Inflammatory Bowel Disease

Exocrine Pancreatic Insufficiency Following Acute Pancreatitis: True Association or EPIphenomenon?

Gut Microbiome in HIV Infection: Overcoming Barriers?

Open-and-Shut Case: An Uncommon Cause of GI Bleeding

Accuracy of EUS-FNA in Solid Pancreatic Lesions: Sometimes Size Does Matter

CT in Crohn's Disease Is Beneficial for Patient Care and Should Not Be Feared

Case Report of a Proposed, Novel, Endoscopic "Whitehead Pimple" Sign of Ectopic Esophageal Sebaceous Glands Based on Their Mimicking the Dermatologic and Histopathologic Characteristics of Cutaneous Whitehead Pimples/Closed Comedones

Letter to the Editor: "Gastric Per Oral Endoscopic Myotomy (G-POEM) for the Treatment of Refractory Gastroparesis: Early Experience"

Biliary Strictures After Liver Transplantation with Grafts from Donors After Cardiac Death: Narrowing Down the Etiologies

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Child's Nervous System

Pseudo-spontaneous third ventriculostomy

Twenty-three years follow-up after low-dose Gamma Knife surgery of a brainstem juvenile pilocytic astrocytoma: a case report and review of the literature Abstract Juvenile pilocytic astrocytoma (JPA) is a World Health Organization (WHO) grade I tumor that is the commonest to occur in the 0–19 age group, with an excellent prognosis of 96% 10-year survival in pediatric patients. Complete resection is the treatment of choice for JPAs. However, this is not always feasible due to the location of certain tumors, and the management following subtotal resection is controversial. Fractionated radiotherapy, chemotherapy, radiosurgery, and observation have all been used to treat tumor remnants. We report a young patient with good tumor control 23 years following low-dose Gamma Knife surgery (GKS) of a subtotally resected brainstem JPA and recommend that GKS may be a feasible treatment option to achieve long-term tumor control when subtotal resection cannot be achieved, even if the GKS prescription dose must be significantly reduced due to large tumor volume or proximity to critical structures sensitive to radiation.

Topical instillation of vancomycin lowers the rate of CSF shunt infections in children Abstract Introduction Shunt surgery in pediatric patients still bears a significant risk of infection, in addition to mechanical complications of the shunt system. Antibiotic-impregnated systems and perioperative antibiotics have been extensively studied for their potential to reduce shunt infections. We examined the effectiveness of intrawound application of vancomycin powder during shunt surgery. Patients and methods Patient records of 78 primary shunt implantations at a mean age of 40 months were reviewed. In total, 52 patients (mean age 50 months) had been treated according to standard surgical and perioperative procedures (Std), whereas 26 patients (mean age 20 months) additionally had received topical application of vancomycin powder before wound closure (Vmc). Overall infection rate was 3.8%, in Std patients 5.8%, and in Vmc patients 0%. The rates of CSF fistula and revision surgery were similar in both groups (5.8% vs 8% and 23.1% vs. 30%, respectively). Conclusion To the best of our knowledge, this is the first report on topical vancomycin instillation, indicating its efficacy for the prevention of shunt infection in pediatric patients. Further studies with a higher number of patients are needed to verify this finding.

Letter to the editor regarding the cover editorial: "Şânîzâde Mehmed Atâullah Efendi (1771?–1826), who is the author of the first modern anatomy book Mir'âtü'l-Ebdân fî Teşrîhi Âzâü'l-İnsân in the Ottoman Empire"

Drug refractory epilepsy in children: many concerns!

A reply to the letter to the editor by Ortug with regard to the paper "Şânîzâde Mehmed Atâullah Efendi (1771?–1826), who is the author of the first modern anatomy book Mir ' âtü ' l - Ebdân fî Teşrîhi Âzâü ' l - İnsân in the Ottoman Empire"

Microvascular decompression with partial occipital condylectomy in a case of pediatric spasmodic torticollis Abstract Spasmodic torticollis is a rare, neurologic disorder that is caused by abnormal nerve compression of the 11th cranial nerve by blood vessels or bony protrusions. It is typically treated pharmacologically and, if necessary, with surgical intervention. We report a unique case of spasmodic torticollis in a 15-year-old female that involved abnormal compression of the left 11th cranial nerve (CN) by the left vertebral artery, displaced by a hypertrophic left occipital condyle. After treatment with Botox was unsuccessful, the patient was treated with microvascular decompression and occipital condylectomy that adequately relieved the abnormal compression of CN XI. Mild symptoms persisted, and the patient underwent a partial section of the sternocleidomastoid muscle 1 year later, after which torticollis symptoms resolved.

A child with a stroke, drug-refractory epilepsy and congenital heart disease: can a hemispherectomy be safely performed between staged cardiac procedures? Abstract Background The safety of hemispherectomy between staged cardiac procedures is unknown and not previously reported. Method Retrospective review of a case with drug-resistant epilepsy due to stroke following bidirectional cavopulmonary connection (BDCPC). Results This report describes the first case of a successful pediatric peri-insular functional hemispherectomy in the setting of a BDCPC. A discussion of the complex preoperative planning from both a cardiac and neurological perspective is presented. Considerations regarding hemispherectomy and its effects on the cardiac physiology, and perioperative considerations are emphasized in clinical decision making. Conclusions A multidisciplinary approach was critical in this child which led to a successful outcome.

A case of central nervous system vasculitis presenting as a mass-like lesion Abstract Vasculitis of the central nervous system presenting as a mass lesion is a relatively uncommon occurrence. Even more uncommon is a vasculitis mimicking a demyelinating lesion. We present here an interesting case of a 15-year-old boy who was found to have a mass-like lesion on neuroimaging involving the left subcortical white matter and deep gray matter. The differential diagnosis for this lesion was primary demyelination versus a glial tumor, the former being more favored over the latter. Biopsy of this lesion however revealed findings compatible with a vasculitis, which was unexpected given the neuroimaging findings. To the authors' knowledge, case reports in the English literature of a vasculitic lesion mimicking demyelination are scarce. This case also serves as a reminder of the diagnostic difficulty that arises in a pediatric patient with an initial presentation of mass-like lesion.

Enhancing nodular lesions in Chiari II malformations in the setting of persistent hindbrain herniation: case report and literature review Abstract Background Chiari II malformation includes concomitant cerebellar tonsillar herniation, hydrocephalus, and myelomeningocele. Rarely, pediatric patients with persistent hindbrain herniation develop a new enhancing nodule at the cervicomedullary junction as adults. These new lesions may be suspicious for neoplastic growth, but it remains unclear if neurosurgical intervention is necessary. Case Report A 27-year-old female patient with history of Chiari II malformation and persistent hindbrain herniation presented with a 3-month history of headache and upper extremity weakness and numbness. Neuroimaging revealed a new enhancing nodule near the cervicomedullary junction suspicious for neoplasm. Following posterior fossa decompression and excision of the enhancing lesion, pathological analysis demonstrated only benign glioneural heterotopia. Results New enhancing nodules at the cervicomedullary junction in Chiari II malformation are exceedingly rare and are likely benign, reactive changes rather than a neoplastic process. Biopsy or surgical excision of these lesions is likely unnecessary for asymptomatic patients.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Needs and Solutions

I Paid More than You (Before)?! The Effects of Self-Construal and Comparison Target on Price Unfairness Perceptions Abstract Previous research suggests that when consumers encounter discrepant prices due to dynamic pricing, a social comparison evokes stronger unfairness perceptions than a temporal comparison does. In this paper, the authors show how this effect may vary depending on consumers' self-construal. Two experiments find that while independent consumers perceive stronger price unfairness when paying more than other consumers, interdependent consumers perceive stronger price unfairness when paying more than what they did in the past. These effects occur because consumers are differentially sensitive, as a function of their self-construal, to social versus temporal comparisons in their self-appraisal. Our results show that self-construal affects consumers' means for maintaining their self-appraisal and alters the relevance of different comparison targets in price unfairness perceptions.

Advertising Originality Decisions in Competition Abstract Originality is a critical determinant of advertising success. However, firms frequently opt to launch unoriginal advertising campaigns. Why would firms opt for unoriginal ads when originality is considered as the "pinnacle"? In this paper, the authors investigate advertising originality decisions for market leaders and followers. They first establish empirically that unoriginal advertising, and more specifically copycat advertising, is a common option across diverse markets even for leading brands. Then, they develop an analytical framework to investigate the optimality of originality decisions. They model creative advertising themes as a "best-shot" type of public good, where a firm's originality decision is influenced by market structure as well as market growth. The authors then examine whether a firm creates an original ad or opts for an unoriginal one, either by copycatting a competitor or by remaking an existing ad theme. The findings suggest that there is no oversupply of original ads. An original ad can be created by either the leading firm or its follower to boost the valuation of its loyal consumers and profit from higher prices or to attract switchers.

Using the Double Transparency of Autonomous Vehicles to Increase Fairness and Social Welfare Abstract Fully autonomous vehicles (AVs) create double transparency regarding human driving decisions. Opaque decision rules in the human mind have become transparent in AVs, and in turn, can be made transparent to third parties. This double transparency is creating an unprecedented opportunity to regulate driving decision rules to eliminate unreasonable selfishness and increase fairness and social welfare because AVs can be programmed to follow regulations 100% of the time. In this experimental ethics study, we performed an incentive aligned online experiment to examine humans' willingness to sacrifice other people's lives to protect their own in five different accident scenarios and to investigate the potential for AV regulation to curb unreasonable selfishness, thereby increasing fairness and social welfare. Our results reveal the need to regulate rules governing AV driving decisions; yet, a full transparency policy for decision algorithms may not necessarily lead to desired social effects. Thus, regulations should be tailored to different scenarios.

Coordinating Marketing and Production with Asymmetric Costs: Theory and Estimation Abstract This paper proposes a theoretical framework for decision making when the firm needs to make marketing and production/order decisions simultaneously before demand uncertainty is resolved. We discuss the theoretical properties of the framework for single and multi-product firms; in addition, we show that the framework can be extended to allow for competitive reaction in a duopoly setting. We propose an empirical method to operationalize the model and compare the results to those from extant methods. The empirical results for both single and multi-product firms show that the proposed method outperforms decision making using standard econometric methods. In particular, depending on customer lifetime value (CLV) and other error costs and price elasticities, the loss in potential profits by using the standard regression-based methodology or quantile regression can be considerable.

Examining Brand Strength of Political Candidates: a Performance Premium Approach Abstract Despite the growth of research on political marketing, fundamental questions concerning brand value of political candidates and its relationship with marketing mix activities remain unanswered. This research extends premium-based brand valuation methods to the political context by presenting a performance premium approach to assessing the strength of politicians' brands and exploring the relationship between politician brand strength and political advertising. We develop a joint hierarchical Bayesian model of brand performance and marketing activity and estimate our model using data on the election performance and advertising expenditures of political candidates from US House of Representatives elections. Our findings suggest that politicians who possess a strong brand—those that perform better than expected given the partisan leanings of their districts, advertising spending, and other model controls—face a consequence for their brand strength in which political advertising by their opponents has a stronger negative impact on their performance compared to the effect of political advertising against politicians with weaker brands. We discuss the implications of our findings for political marketing.

Marketing Scholars and Political Marketing: the Pragmatic and Principled Reasons for Why Marketing Academics Should Research the Use of Marketing in the Political Arena Abstract The marketing discipline needs to pay more attention to political marketing. Marketing has permeated deeply into the heart of elections and government. Numerous political players, including presidents and prime ministers, politicians, and parties, as well as government departments and councils turn to marketing in their pursuit of political goals. While media coverage of recent issues, such the Trump campaign's use of big data, has shone a spotlight on commercial marketing techniques in the political and governmental arena, scholars from multiple disciplines (marketing, political science, and communication) have been exploring cross-disciplinary research on political marketing for several decades. This article argues that it is time for the marketing discipline to embrace political marketing more openly than before. This article will make the case by outlining the broad scope of political marketing in practice and research, providing examples of political marketing, and then discussing the significant ethical implications of marketing politics. Finally, it will provide reasons for why marketing scholars should research this dynamic and profoundly impactful area.

A Factorial Hidden Markov Model for the Analysis of Temporal Change in Choice Models Abstract Consumers' preferences for various product attributes change over time. Modeling such temporal changes through a single process assumes that all the attributes' preferences change together with the same dynamics; however, this assumption is not appropriate when there are several processes with distinct characteristics. We propose a new non-homogeneous factorial hidden Markov model (FHMM) for choice models to dynamically segment consumers into distinct states while each preference parameter may follow a distinct Markov process. The transition probabilities are modeled as time-varying at the individual level, affected by covariates of a feedback term of the consumer's previous purchase decision, specific to each Markov process. We motivate the proposed approach by an application to a scanner panel choice dataset and find two processes with entirely different characteristics governing the shifts in two preference attributes. Model fit and prediction power based on Brier scores show the superiority of the proposed non-homogeneous FHMM in capturing temporal changes in preferences compared to a traditional hidden Markov model as well as a benchmark comparison model.

Social-Spatial Effects in Pricing: When and How Vertical Orientations Shape Processing of Price Comparisons Abstract Marketers frequently compare a product's sale price against its regular price to accentuate perceptions of value. The effectiveness of these price comparisons is predicated on consumers sufficiently processing the deal's depth (i.e., the regular price − sale price differential). Although research indicates consumers can generally make such assessments, we document an exception when price comparisons are presented in a format that aligns with the vertical orientation of consumers. The correspondence between vertical price comparisons and the mindsets of individuals who value social hierarchies (i.e., who are vertically oriented) induces a sense of "fit" that reduces processing and leads to similar responses to the offer regardless of deal depth. This effect manifests regardless of whether vertical orientations are measured as a chronic state or temporarily primed. Supporting our theorizing, vertically oriented participants report paying less attention and being less motivated to process price comparisons. Theoretical implications of these findings are discussed as are suggestions for future research examining how social views may shape consumer processing of product attribute and point-of-purchase information.

Understanding Influence of Marketing Thought on Practice: an Analysis of Business Journals Using Textual and Latent Dirichlet Allocation (LDA) Analysis Abstract Several calls have been made to understand the influence of marketing thought on practice (Rust et al. J Mark 68:76–89, 11). Practice includes practitioners who mostly use concepts and frameworks (general practice) and who mostly use quantitative models (quantitative practice). This paper compares the relative influence of marketing thought compared to other disciplines and uncovers seminal marketing thoughts that have influenced both general and quantitative practice. Using topic modeling procedures on 94 years of Harvard Business Review, 46 years of Sloan Management Review, and 47 years of Management Science, this paper illuminates the evolution of the influence of marketing thought over time. Despite marketing's slow start, it has an increasing influence on both general and quantitative practice. Foundational topics in marketing such as product, promotion, place, consumers, and marketing research methods have influenced both general and quantitative practice. Surprisingly, price has not influenced practice. Marketing Communications is increasingly influential while Channel Management, Product/Service Management, and surprisingly Customer Relationships have lost their early influence to practice. General practitioners find Marketing Environment and Business Models increasingly influential while quantitative practitioners find Social Influence and Metrics increasingly influential. Quantitative practice has kept up to speed with marketing thought that influence general practice.

Introduction to the Special Issue: 2016 Choice Symposium

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Ethics

Erratum to: Abusive Supervision and Subordinate Proactive Behavior: Joint Moderating Roles of Organizational Identification and Positive Affectivity The original version of this article was corrected: Figures 5 and 6 were updated.

Normative Underpinnings of Direct Employee Participation Studies and Implications for Developing Ethical Reflexivity: A Multidisciplinary Review Abstract This paper seeks to join studies which have drawn attention to the ethical reflexivity of research and the research enterprise in the organisational studies' field. Towards this end, we review OB, HRM, and IR studies on direct employee participation in organisations post-1990s to examine their normative underpinnings. Using Fox's (Industrial sociology and industrial relations. Research Paper 3, Royal Commission on Trade Unions and Employers' Associations, HMSO, London, 1966, Beyond contract: Work, power and trust relations. Faber and Faber, London, 1974) three frames—unitarist, pluralist, and radical—we compare the underpinnings within and across the chosen disciplines to bring ethical reflexivity to studies in this area of inquiry. Implications are drawn out to take forward the quest for more ethically reflexive employee participation research.

Abusive Supervision and Subordinate Proactive Behavior: Joint Moderating Roles of Organizational Identification and Positive Affectivity Abstract Drawing on the transactional model of stress, we propose that organizational identification and positive affectivity moderate the relationship between abusive supervision and proactive behavior. In Study 1, we collected data from a sample of 165 dentists and 41 supervisors in two Chinese hospitals. In Study 2, we used a sample of 226 employee-supervisor dyads from a large Chinese transportation company. The results of two studies showed that the interaction between abusive supervision and organizational identification on proactive behavior (personal initiative in Study 1 and organizational proactive behavior in Study 2) occurred only when positive affectivity was high. We discuss theoretical and managerial implications and indicate future research directions.

Dealing with the Full-of-Self-Boss: Interactive Effects of Supervisor Narcissism and Subordinate Resource Management Ability on Work Outcomes Abstract Extensive research has documented the harmful effects associated with working for a narcissistic supervisor. However, little effort has been made to investigate ways for victims to alleviate the burdens associated with exposure to such aversive persons. Building on the tenets of conservation of resources theory and the documented efficacy of functional assets to combat job-related stress, we hypothesized that subordinates' resource management ability would buffer the detrimental impact of narcissistic supervisors on affective, cognitive, and behavioral work outcomes for subordinates. We found support for our hypotheses across three independent samples of US workers (N = 187; 199; 136). Specifically, higher levels of subordinate resource management ability attenuated the harmful effects of supervisor narcissism on employee-reported emotional exhaustion, job tension, depressed mood, task performance, and citizenship behavior. Conversely, these relationships further deteriorated for subordinates with lower levels of resource management ability. Overall, our research contributes to the literature that, although extensively documenting the harmful ramifications of narcissism in organizations, has neglected to investigate potentially mitigating factors.

Legitimacy, Particularism and Employee Commitment and Justice Abstract Research on the effects of particularistic human resource practices (i.e., favoritism and nepotism) on organizational outcomes has concentrated on direct negative attitudinal and behavioral responses. By integrating legitimacy and social exchange theories, this paper proposes and tests the idea that legitimacy of particularistic practices might moderate their negative effects on employee attitudes at work. Through a survey of 415 employees across multiple organizational types, we show that the legitimacy of particularism mitigates its negative effects on affective commitment and perceived distributive and procedural justice in non-family-owned businesses only. We discuss implications for theory and practice.

Bystander Responses to Bullying at Work: The Role of Mode, Type and Relationship to Target Abstract Framed within theories of fairness and stress, the current paper examines bystanders' intervention intention to workplace bullying across two studies based on international employee samples (N = 578). Using a vignette-based design, we examined the role of bullying mode (offline vs. online), bullying type (personal vs. work-related) and target closeness (friend vs. work colleague) on bystanders' behavioural intentions to respond, to sympathise with the victim (defender role), to reinforce the perpetrator (prosecutor role) or to be ambivalent (commuter role). Results illustrated a pattern of the influence of mode and type on bystander intentions. Bystanders were least likely to support the victim and more likely to agree with perpetrator actions for cyberbullying and work-related acts. Tentatively, support emerged for the effect of target closeness on bystander intentions. Although effect sizes were small, when the target was a friend, bystanders tended to be more likely to act and defend the victim and less likely to reinforce the perpetrator. Implications for research and the potential for bystander education are discussed.

The Unwitting Accomplice: How Organizations Enable Motivated Reasoning and Self-Serving Behavior Abstract In this article, we demonstrate that individuals use motivated reasoning to convince themselves that their self-serving behavior is justified, which in turn affects the distribution of resources in business situations. Specifically, we explore how ambiguous contextual cues and individual beliefs can jointly form motivated reasoning. Across two experimental studies, we find that whereas individual ideologies that endorse status hierarchies (i.e., social dominance orientation) can strengthen the relationship between contextual ambiguity and motivated reasoning, individual beliefs rooted in fairness and equality (i.e., moral identity) can weaken it. Our findings contribute to person–situation theories of business ethics and provide evidence that two ubiquitous factors in business organizations—contextual ambiguity and social dominance orientation—give rise to motivated reasoning, enabling decision makers to engage in self-serving distributions of resources.

Do Victims of Supervisor Bullying Suffer from Poor Creativity? Social Cognitive and Social Comparison Perspectives Abstract This study explores the dark side of leadership, treats creative self-efficacy as a mediator, and frames supervisor bullying and employee creativity in the context of social cognition and social comparison. We theorize that with a high social comparison orientation, the combination of high supervisory abuse toward themselves (own abusive supervision) and low supervisory abuse toward other team members (peer abusive supervision) leads to a double whammy effect: When employees are "singled out" for abuse, these victims suffer from not only low creative self-efficacy due to supervisory abuse but also low supervisory creativity ratings. Results based on our two-wave data collected from multiple sources—253 employees and their 77 immediate supervisors—support our theory. The significant three-way interaction effect reveals that when social comparison orientation is high and peer abusive supervision is low (Time 1), own abusive supervision (Time 1) creates the strongest negative impact on creative self-efficacy (Time 2), which is significantly related to supervisory low creativity rating (Time 2). Our discoveries of egregious bullying offer provocative theoretical, empirical, and practical implications to the fields of leadership, abusive supervision, creativity, and business ethics.

The UN Framework on Business and Human Rights: A Workers' Rights Critique Abstract The "Protect, Respect, Remedy" Framework along with the UN Guiding Principles on Business and Human Rights is the current global standard regarding corporate conduct. This article analyses the UN Framework from the vantage point of labour rights in India by looking at the garment supply chain. It argues that it can do little to induce states and businesses to bring substantive improvements to working conditions in a largely informal economy like India. Without the state performing its duty to protect human rights, the secondary responsibility of corporations can do very little in realising the rights of workers. Nonetheless, its tallest contribution is that it has given a platform for civil society to push for better conduct from all businesses and marks the beginning of a unified international business and human rights agenda.

Will Creative Employees Always Make Trouble? Investigating the Roles of Moral Identity and Moral Disengagement Abstract Recent research has uncovered the dark side of creativity by finding that creative individuals are more likely to engage in unethical behavior. However, we argue that not all creative individuals make trouble. Using moral self-regulation theory as our overarching theoretical framework, we examine individuals' moral identity as a boundary condition and moral disengagement as a mediating mechanism to explain when and how individual creativity is associated with workplace deviant behavior. We conducted two field studies using multi-source data to test our hypotheses. In Study 1, the results indicated that creativity positively predicted moral disengagement for those low in moral identity. In Study 2 with multi-wave data, we replicated the finding that moral identity moderated the effect of creativity on moral disengagement in Study 1 and further revealed that moral disengagement mediated the interactive effects of creativity and moral identity on workplace deviant behavior. The theoretical and practical implications of these findings and directions for future research are discussed.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Synthese

Artifacts and affordances Abstract What are the affordances of artifacts? One view is that the affordances of artifacts, just as the affordances of natural objects, pertain to possible ways in which they can be manipulated (e.g., a computer keyboard affords grasping). Another view maintains that, given that artifacts are sociocultural objects, their affordances pertain primarily to their culturally-derived function (e.g., a computer keyboard affords typing). Whereas some have tried to provide a unifying notion of affordance to capture both aspects, here I argue that they should be kept separate. In this paper, I introduce a distinction between standard affordances, which concern the function of artifacts, and ad-hoc affordances, which refer to how artifacts are manipulated. I then argue for the neuropsychological plausibility of such a distinction, linking it to the dissociation between function knowledge and manipulation knowledge. Finally, I defend the equal status of these forms of knowledge and, hence, of standard and ad-hoc affordances, and I show that this has some implications for the debate on the role of motor processes in the conceptual knowledge of artifacts.

No work for a theory of epistemic dispositions Abstract Externalists about epistemic justification have long emphasized the connection between truth and justification, with this coupling finding explicit expression in process reliabilism. Process reliabilism, however, faces a number of severe difficulties, leading disenchanted process reliabilists to find a new theoretical home. The conceptual flag under which such epistemologists have preferred to gather is that of dispositions. Just as reliabilism is determined by the frequency of a particular outcome, making it possible to characterize justification in terms of a particular relationship to truth, dispositions are accompanied by concrete, worldly manifestations. By taking true beliefs as the result, not of certain processes but of particular dispositions, these epistemologists have attempted to respond to the numerous obstacles to reliabilism. Yet all this work has proceeded without regard to the wealth of contemporary work on the metaphysics of dispositions, making the new hope premature at best, ill-founded at worst. Combining contemporary dispositional accounts of justification with extant analyses of dispositions reveals that the latter is the case. The structural differences between epistemic justification and dispositions make it clear that not only should process reliabilism be abandoned, but the subsequent appeal to dispositions along with it.

Affective representation and affective attitudes Abstract Many philosophers have understood the representational dimension of affective states along the model of perceptual experiences. This paper argues affective experiences involve a kind of personal level affective representation disanalogous from the representational character of perceptual experiences. The positive thesis is that affective representation is a non-transparent, non-sensory form of evaluative representation, whereby a felt valenced attitude represents the object of the experience as minimally good or bad, and one experiences that evaluative standing as having the power to causally motivate the relevant attitude. I show how this view can make sense of distinctive features of affective experiences, such as their valence and connection to value in a way which moves beyond current evaluativist views of affect.

Correction to: Happily entangled: prediction, emotion, and the embodied mind In the original publication, funding information was missing: Andy Clark was supported by ERC Advanced Grant 692739 (XSPECT—Expecting Ourselves—Embodied Prediction and the Construction of Conscious Experience).

Linguistics and the explanatory economy Abstract I present a novel, collaborative, methodology for linguistics: what I call the 'explanatory economy'. According to this picture, multiple models/theories are evaluated based on the extent to which they complement one another with respect to data coverage. I show how this model can resolve a long-standing worry about the methodology of generative linguistics: that by creating too much distance between data and theory, the empirical credentials of this research program are tarnished. I provide justifications of such methodologically central distinctions as the competence/performance and core/periphery distinction, and then show how we can understand the push for simplicity in the history of generative grammar in this light.

In the quagmire of quibbles: a dialectical exploration Abstract Criticism may degenerate into quibbling or nitpicking. How can discussants keep quibblers under control? In the paper we investigate cases in which a battle about words replaces a discussion of the matters that are actually at issue as well as cases in which a battle about minor objections replaces a discussion of the major issues. We survey some lines of discussion dealing with these situations in profiles of dialogue.

Can Church's thesis be viewed as a Carnapian explication? Abstract Turing and Church formulated two different formal accounts of computability that turned out to be extensionally equivalent. Since the accounts refer to different properties they cannot both be adequate conceptual analysesof the concept of computability. This insight has led to a discussion concerning which account is adequate. Some authors have suggested that this philosophical debate—which shows few signs of converging on one view—can be circumvented by regarding Church's and Turing's theses as explications. This move opens up the possibility that both accounts could be adequate, albeit in their own different ways. In this paper, I focus on the question of whether Church's thesis can be seen as an explication in the precise Carnapian sense. Most importantly, I address an additional constraint that Carnap puts on the explicative power of axiomatic systems—an axiomatisation explicates when it is clear which mathematical entities form the theory's intended model—and that implicitly applies to axiomatisations of recursion theory used in Church's account of computability. To overcome this difficulty, I propose two possible clarifications of the pre-systematic concept of "computability" that can both be captured in recursion theory, and I show how both clarifications avoid an objection arising from Carnap's constraint.

Word choice in mathematical practice: a case study in polyhedra Abstract We examine the influence of word choices on mathematical practice, i.e. in developing definitions, theorems, and proofs. As a case study, we consider Euclid's and Euler's word choices in their influential developments of geometry and, in particular, their use of the term 'polyhedron'. Then, jumping to the twentieth century, we look at word choices surrounding the use of the term 'polyhedron' in the work of Coxeter and of Grünbaum. We also consider a recent and explicit conflict of approach between Grünbaum and Shephard on the one hand and that of Hilton and Pedersen on the other, elucidating that the conflict was engendered by disagreement over the proper conceptualization, and so also the appropriate word choices, in the study of polyhedra.

Ground-theoretic equivalence Abstract Say that two sentences are ground-theoretically equivalent iff they are interchangeable salva veritate in grounding contexts. Notoriously, ground-theoretic equivalence is a hyperintensional matter: even logically equivalent sentences may fail to be interchangeable in grounding contexts. Still, there seem to be some substantive, general principles of ground-theoretic equivalence. For example, it seems plausible that any sentences of the form \(A \wedge B\) and \(B \wedge A\) are ground-theoretically equivalent. What, then, are in general the conditions for two sentences to stand in the relation of ground-theoretic equivalence, and what are the logical features of that relation? This paper develops and defends an answer to these questions based on the mode-ified truthmaker theory of content presented in my recent paper 'Towards a theory of ground-theoretic content' (Krämer in Synthese 195(2):785–814, 2018).

On radical solutions in the philosophy of biology: What does "individuals thinking" actually solve? Abstract The philosophy of biology is witnessing an increasing enthusiasm for what can be called "individuals thinking". Individuals thinking is a perspective on the metaphysics of biological entities according to which conceiving of them as individuals rather than kinds enables us to expose ongoing metaphysical debates as focusing on the wrong question, and to achieve better accounts of the metaphysics of biological entities. In this paper, I examine two cases of individuals thinking, the claim that species are individuals and the claim that life on Earth is an individual. I argue that these claims fail to do the metaphysical work that one would want them to do. I highlight problems with the specific claims as well as with the general notion of 'individual', and argue that naturalistic metaphysicians of biology should think of the metaphysical status of theoretical entities, such as species and life, as fundamentally theory-dependent. This implies a metaphysical pluralism, that allows that in some theories species, life, and other such entities may feature as individuals, whereas in others they may feature as kinds.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Clinical Pharmacokinetics

Authors' Reply to Nicolas: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?"

Authors' Reply to Castello-Bridoux et al.: "Comment on Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?"

Comment on: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?"

Comment on: Levothyrox ® New and Old Formulations: Are They Switchable for Millions of Patients?

Comment on "Target-Controlled Continuous Infusion for Antibiotic Dosing: Proof-of-Principle in an In-silico Vancomycin Trial in Intensive Care Unit Patients"

Author's Reply to Trechot: "Comment on Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?"

Comment on: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?"

Authors' Reply to Coste et al.: "Levothyrox ® New and Old Formulations: Are they Switchable for Millions of Patients?"

Comment on "Levothyrox ® New and Old Formulations: Are They Switchable for Millions of Patients?"

Physiologically Based Pharmacokinetic Modeling for Trimethoprim and Sulfamethoxazole in Children Abstract Objective The aims of this study were to (1) determine whether opportunistically collected data can be used to develop physiologically based pharmacokinetic (PBPK) models in pediatric patients; and (2) characterize age-related maturational changes in drug disposition for the renally eliminated and hepatically metabolized antibiotic trimethoprim (TMP)–sulfamethoxazole (SMX). Methods We developed separate population PBPK models for TMP and SMX in children after oral administration of the combined TMP–SMX product and used sparse and opportunistically collected plasma concentration samples to validate our pediatric model. We evaluated predictability of the pediatric PBPK model based on the number of observed pediatric data out of the 90% prediction interval. We performed dosing simulations to target organ and tissue (skin) concentrations greater than the methicillin-resistant Staphylococcus aureus (MRSA) minimum inhibitory concentration (TMP 2 mg/L; SMX 9.5 mg/L) for at least 50% of the dosing interval. Results We found 67–87% and 71–91% of the observed data for TMP and SMX, respectively, were captured within the 90% prediction interval across five age groups, suggesting adequate fit of our model. Our model-rederived optimal dosing of TMP at the target tissue was in the range of recommended dosing for TMP–SMX in children in all age groups by current guidelines for the treatment of MRSA. Conclusion We successfully developed a pediatric PBPK model of the combination antibiotic TMP–SMX using sparse and opportunistic pediatric pharmacokinetic samples. This novel and efficient approach has the potential to expand the use of PBPK modeling in pediatric drug development.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Environmental

Review of The story of White Hall Centre: Outdoor education across the decades by Pete McDonald

Review of Ontology and closeness in human-nature relationships: Beyond dualisms, materialism and posthumanism by Neil H. Kessler

Teacher and student perceptions of an outdoor classroom Abstract A six-week study was conducted with two kindergarten teachers and 37 kindergarten students aged five and six to determine their perceptions of teaching and learning in a traditional indoor classroom compared to a newly constructed outdoor classroom. This mix-methods study took place in a charter school located in the southeast region of the United States. Observational data was collected in both the outdoor and indoor learning environments during the literacy block called "LMNOP time" as well as during recess or "free time." The teachers and children were also surveyed and interviewed. Of the 37 children who participated in the study, five of the children had special needs. Quantitative observations and qualitative interview records were analyzed to compare the impact of the learning environments on children with and without disabilities. The data revealed that both the teachers and the students reported an increased perception of wellbeing, pleasure, and interest when teaching and learning in the outdoor classroom. In addition, research assistants noted that the children with disabilities were less distracted and more on-task when working in the outdoor classroom.

Influence of adventure education instructor education on the perspectives and practices of preservice adventure educators Abstract The research described in this paper built on the embryonic work on the occupational socialization of adventure educators (AEs). Its purpose was to determine the influence of one adventure education instructor education (AEIE) program on the perspectives and practices of preservice AEs (PAEs). Fifteen PAEs and their instructor were participants. Data were collected with six qualitative techniques and analyzed by employing analytic induction and constant comparison. Results revealed that PAEs entered the AEIE program with one of three broad orientations to their subject matter: a leisure orientation, an outdoor pursuits orientation, and an unsophisticated adventure orientation. In addition, they revealed how these orientations were shaped by the differing acculturation the PAEs experienced. The study's findings also suggested that well-taught AEIE had helped those PAEs near to completing the program acquire a relatively sophisticated adventure orientation regardless of the orientations with which they commenced their training. Keys to the success of the AEIE program were the blend of personal and pedagogical skill displayed by the instructor and the nature and sequencing of the coursework in which the PAEs engaged.

Ecological education via "islands of discourse": teacher education at the intersection of culture and environment Abstract In this paper I share my understandings of an elective outdoor environmental education course, a significant component of which was a field school. I helped develop this course at the Canadian university where I work as an academic, with the field school conducted on the island of Kaua'i in Hawaii. The paper describes the university field school and aspects of the underpinning ideas which cohere the course, particularly the model of an ecology of home. The model highlights how technical, socio-cultural and ecological influences all shape interpretations relevant to environmental education. The course involved educational experiences across three botanical gardens in Kaua'i: each of these places contributed uniquely to the development of prospective teachers through the pedagogical idea of "islands of discourse."

Acknowledging the agency of a more-than-human world: material relations on a Snowy River journey Abstract In this article we describe our attempt to challenge our anthropocentric gaze during an outdoor environmental education (OEE) research project involving a 10-day journey with high school students on the Snowy River in south-eastern Australia. Although much contemporary OEE research explores place responsive methodologies that provide possibilities for expanding beyond human centered practices, such movements can be difficult to make. We attempt, through this project, to shift our gaze away from a human-centered viewpoint to understand ways in which new perspectives of journeys, place(s) and learning might be available. To do this we adopt a posthuman/relational materialist approach to explore how the material world is creative of places, people and learning opportunities beyond human centered ways of seeing. We argue for a focus on the more-than-human aspects of places and engage posthuman concepts that allow us to challenge traditional ways of researching. In doing so we seek to uncover and acknowledge the agency of the more-than-human world, and how material places and their elements are valuable in the creation of emergent learning possibilities on an OEE journey. Rather than exact findings, this article is an exploratory journey of thinking OEE in different ways, to explore new opportunities for place and context responsive learning and environmental understanding.

Review of preventing fatal incidents in school and youth group camps and excursions: understanding the unthinkable by Andrew Brookes

Mindful adventures: a pilot study of the outward bound mindfulness program Abstract Mindfulness can be successfully combined with adventure education but the area is understudied. This longitudinal quasi-experimental study investigated whether an 8-day Outward Bound Mindfulness Program in nature would increase levels of positive affect, savouring, and mindfulness. Results indicate the experimental group experienced a statistically significant increase in mindfulness, positive affect and savouring compared to the control group post-intervention, and that the increase was maintained at 3-months post-intervention. These results illuminate the lasting impact of an intervention which combines mindfulness with adventure education, and highlight the potential which natural environments may play in educational and therapeutic processes. Study limitations and need for further research are shared.

Flourishing in the forest: looking at Forest School through a self-determination theory lens Abstract Forest School offers opportunities for children and young adults to come into regular contact with nature. Although, in relevant literature, Forest School is seen as highly conducive to participants' motivation to learn, there is no theoretical framework that examines how this motivation can be optimized in relation to Forest School pedagogy. Self-Determination Theory offers a broad perspective for motivational processes and will be used as a guide in this article to advance such a framework. Self-Determination Theory proposes that well-being, which has been identified as an aim of Forest School, is promoted through the support of three basic psychological needs for autonomy, competence and relatedness. In this conceptual article, we make links between Forest School pedagogical practices and Self-Determination Theory, mainly focusing on the support of children's basic psychological needs. Furthermore, we make suggestions for ways in which to enhance practice through explicit links with need-supportive teaching practices, as these are identified in the Self-Determination Theory literature.

A qualitative exploration of the barriers and bridges to accessing community-based K-12 outdoor environmental education programming Abstract The purpose of this study was to explore factors impeding or enabling 4th grade access to a community-based outdoor environmental education (OEE) organization located in the pacific northwest United States called the Children's Forest, an initiative of the United States Forest Service. Qualitative findings indicated that teachers and administrators face significant dilemmas when having to make OEE curricular decisions in the context of broader educational mandates. Key findings suggest that OEE program staff can utilize policy-driven mandates to facilitate OEE participation and that savvy individual teachers can potentially help schools overcome policy-related, institutional, and interpersonal barriers to OEE participation. Further research is needed to corroborate and identify additional bridges and barriers that might impact diverse K-12 educator access to community-based OEE. Nonetheless, key learnings emerged from this study echoing past research and providing additional implications for future OEE practice and research.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Cardiology

Retrieval of an embolised occluder with an alligator forceps during staged paravalvular leakage closure

Percutaneous closure of a large atrial septal defect presenting with acute severe hemolysis

Association between atrial fibrillation and Helicobacter pylori Abstract The connection between atrial fibrillation (AF) and H. pylori (HP) infection is still matter of debate. We performed a systematic review and metanalysis of studies reporting the association between AF and HF. A systematic review of all available reports in literature of the incidence of HP infection in AF and comparing this incidence with subjects without AF were analysed. Risk ratio and 95% confidence interval (CI) and risk difference with standard error (SE) were the main statistics indexes. Six retrospective studies including a total of 2921 were included at the end of the selection process. Nine hundred-fifty-six patients (32.7%) were in AF, whereas 1965 (67.3%) were in normal sinus rhythm (NSR). Overall, 335 of 956 patients with AF were HP positive (35%), whereas 621 were HP negative (65%). In addition, 643 of 1965 NSR patients (32.7%) were HP positive while 1,322 were negative (67.3%; Chi-square 2.15, p = 0.21). The Cumulative Risk Ratio for AF patients for developing an HP infection was 1.19 (95% CI 1.08–1.41). In addition, a small difference risk towards AF was found (0.11 [SE = 0.04]). Moreover, neither RR nor risk difference were influenced by the geographic area at meta-regression analysis. Finally, there was a weak correlation between AF and HP (coefficient = 0.04 [95% CI −0.01–0.08]). We failed to find any significant correlation between H. pylori infection and AF and, based on our data, it seems unlikely than HP can be considered a risk factor for AF. Further larger research is warranted.

Variations on classification of main types of myocardial infarction: a systematic review and outcome meta-analysis Abstract Objective Classifying myocardial infarction into type 1 (T1MI) or type 2 (T2MI) remains a challenge in clinical practice. We aimed to identify factors contributing to variation in the classifications of MI into type 1 or type 2. In addition, pooled analyses of long-term mortality and reinfarction outcomes were performed. Methods We searched Medline, Embase and Web of Science through January 2018 for observational studies or clinical trials classifying patients as either T1MI or T2MI. Studies with baseline characteristics allowing a comparison between both groups were included. Inverse variance random-effects models were used to pool risk ratios (RR). Results Overall, 93,194 patients from 20 included observational studies were classified as T1MI and 9291 as T2MI; corresponding to 87.9% and 8.8% of all patients diagnosed with MI. Inclusion of ST-elevation MI patients was inconsistent among studies. Coronary angiography was performed in 77.7% and 31.5% of all patients with T1MI and T2MI, respectively. From a subgroup of 11 studies, percutaneous coronary intervention was performed in 79.2% of all patients classified as T1MI (range 44.2–93.0%) and 40.2% of all T2MI patients (range 0–87.5%). A meta-analysis of 6 studies (44,366 in total) on 2-year mortality showed worse outcome among T2MI patients (RR: 1.52, CI 1.07–2.17, P = 0.02; I2 = 92%). Risk of reinfarction at 1.6 years was higher among T2MI patients (RR: 1.68, CI 1.22–2.31, P = 0.001; I2 = 9%). Conclusions Classification of T1MI and T2MI varies widely among studies. A standardized approach with clear definitions is needed to avoid misclassification and ensure appropriate patient management.

Direct oral anticoagulants and vitamin K antagonists are linked to differential profiles of cardiac function and lipid metabolism Abstract Background Experimental data indicate that direct acting oral anticoagulants (DOAC) and vitamin K antagonists (VKA) may exert differential effects on cardiovascular disease. Methods Data from the prospective, observational, single-center MyoVasc Study were used to examine associations of DOAC as compared to VKA with subclinical markers of cardiovascular disease, cardiac function, and humoral biomarkers in heart failure (HF). Results Multivariable analysis adjusted for age, sex, traditional cardiovascular risk factors, comorbidities, and medications with correction for multiple testing demonstrated that DOAC therapy was among all investigated parameters an independent significant predictor of better diastolic function (E/E′: β − 0.24 [− 0.36/− 0.12]; P < 0.0001) and higher levels of ApoA1 (β + 0.11 g/L [0.036/0.18]; P = 0.0038) compared to VKA therapy. In propensity score-weighted analyses, the most pronounced differences between DOAC and VKA-based therapy were also observed for E/E′ (∆ − 2.36) and ApoA1 (∆ + 0.06 g/L). Sensitivity analyses in more homogeneous subsamples of (i) individuals with AF and (ii) individuals with asymptomatic HF confirmed the consistency and robustness of these findings. In the comparison of factor IIa and Xa-directed oral anticoagulation, no differences were observed regarding cardiac function (E/E′ ratio: βIIa inhibitor − 0.22 [− 0.36/− 0.08] vs. βXa inhibitor − 0.24 [− 0.37/− 0.11]) and lipid metabolism (ApoA1: βIIa inhibitor 0.10 [0.01/0.18] vs. βXa inhibitor 0.12 [0.04/0.20]) compared to VKA therapy. Conclusion This study provides the first evidence for differential, non-conventional associations of oral anticoagulants on cardiac function and lipid metabolism in humans. The potentially beneficial effect of DOACs in the highly vulnerable population of HF individuals needs to be further elucidated and may have implications for individually tailored anticoagulation therapy.

Impact of eplerenone on major cardiovascular outcomes in patients with systolic heart failure according to baseline heart rate Abstract Background Increased resting heart rate is a risk factor for cardiovascular mortality and morbidity. Mineralocorticoid receptor antagonists (MRAs) have been shown to improve cardiac sympathetic nerve activity, reduce heart rate and attenuate left ventricular remodelling. Whether or not the beneficial effects of MRA are affected by heart rate in heart failure patients with reduced ejection fraction (HFREF) is unclear. Methods We undertook a secondary analysis of data from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure study to assess if clinical outcomes, as well as the efficacy of eplerenone, varied according to heart rate at baseline. Results High resting heart rate of 80 bpm and above predisposed patients to greater risk of all outcomes in the trial, regardless of treatment allocation. The beneficial effects of eplerenone were observed across all categories of heart rate. Eplerenone reduced the risk of primary endpoint, the composite of cardiovascular death and hospitalisation for heart failure, by 30% (aHR 0.70; 95% CI 0.54–0.91) in subjects with heart rate ≥ 80 bpm, and by 48% (aHR 0.52; 95% CI 0.33–0.81) in subjects with heart rate ≤ 60 bpm. Eplerenone also reduced the risks of hospitalisation for heart failure, cardiovascular deaths and all-cause deaths independently of baseline heart rate. Conclusions Baseline heart rate appears to be an important predictor of major clinical outcome events in patients with HFREF, as has been previously reported. The benefits of eplerenone were preserved across all categories of baseline heart rate, without observed heterogeneity in the responses.

Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry Abstract Background Heart failure (HF) and atrial fibrillation (AF) often coexist, but data on the prognostic value of differing ablation strategies according to left ventricular ejection fraction (LVEF) are rare. Methods and results From January 2007 until January 2010, 728 patients with HF were enrolled in the multi-center German ablation registry prior to AF catheter ablation. Patients were divided into three groups according to LVEF: HF with preserved LVEF (≥ 50%, HFpEF, n = 333), mid-range LVEF (40–49%, HFmrEF, n = 207), and reduced LVEF (< 40%, HFrEF, n = 188). Ablation strategies differed significantly between the three groups with the majority of patients with HFpEF (83.4%) and HFmrEF (78.4%) undergoing circumferential pulmonary vein isolation vs. 48.9% of patients with HFrEF. The latter underwent ablation of the atrioventricular (AV) node in 47.3%. Major complications did not differ between the groups. Kaplan–Meier survival analysis demonstrated a significant mortality increase in patients with HFrEF (6.1% in HFrEF vs. 1.5% in HFmrEF vs. 1.9% in HFpEF, p = 0.009) that was limited to patients undergoing ablation of the AV node. Conclusions Catheter ablation strategies differ significantly in patients with HFpEF, HFmrEF, and HFrEF. In almost 50% of patients with HFrEF AV-node ablation was performed, going along with a significant increase in mortality rate. These results should raise efforts to further evaluate the prognostic effect of ablation strategies in HF patients.

Characteristics and outcomes of patients ≤ 75 years who underwent transcatheter aortic valve implantation: insights from the SOURCE 3 Registry Abstract Background Current trials and registries of transcatheter valve implantation (TAVI) mostly include patients older than 75 years. Little is known about younger patients who undergo this treatment. We investigated comorbidities among patients < 75 years old who underwent TAVI in the SAPIEN 3™ European post-approval SOURCE 3 Registry, and analysed outcomes at 30 days and 1 year. Methods and results Three age groups of patients were analysed for outcomes and characteristics: < 75 (n = 235), 75–80 (n = 391) and ≥ 80 years (n = 1320). Overall, the mean age was 81.6 ± 6.7 years; transfemoral access was used in 87.1% of patients treated with SAPIEN 3 transcatheter heart valves. The mean logistic EuroSCORE increased according to age group (12.6%, 17.3% and 19.7%, respectively, p < 0.001). Younger patients had a higher incidence of comorbidities, particularly those not included in surgical risk score assessment tools, e.g., severe liver disease, previous radiation therapy, and porcelain aorta. Mortality rates were similar between age groups at 30 days (1.7%, 2.0% and 2.3%, respectively, p = 0.79) and 1 year (14.2%, 9.3% and 13.3%, respectively, p = 0.08). However, sudden cardiac death rates were higher in the < 75 years age group compared with the ≥ 85 years age group (20.7% vs. 4.8%, p = 0.010). Conclusions In current TAVI practice, patients younger than 75 years are a minority (12%). Despite younger age and lower surgical risk scores, this cohort was characterized by comorbidities not accounted for by traditional surgical risk scores. More data are needed for this age group to guide the appropriate decision between surgery and TAVI. Clinicaltrial.gov number NCT02698956.

Prognostic significance of changes in heart rate following uptitration of beta-blockers in patients with sub-optimally treated heart failure with reduced ejection fraction in sinus rhythm versus atrial fibrillation Abstract Background In patients with heart failure with reduced ejection fraction (HFrEF) on sub-optimal doses of beta-blockers, it is conceivable that changes in heart rate following treatment intensification might be important regardless of underlying heart rhythm. We aimed to compare the prognostic significance of both achieved heart rate and change in heart rate following beta-blocker uptitration in patients with HFrEF either in sinus rhythm (SR) or atrial fibrillation (AF). Methods We performed a post hoc analysis of the BIOSTAT-CHF study. We evaluated 1548 patients with HFrEF (mean age 67 years, 35% AF). Median follow-up was 21 months. Patients were evaluated at baseline and at 9 months. The combined primary outcome was all-cause mortality and heart failure hospitalisation stratified by heart rhythm and heart rate at baseline. Results Despite similar changes in heart rate and beta-blocker dose, a decrease in heart rate at 9 months was associated with reduced incidence of the primary outcome in both SR and AF patients [HR per 10 bpm decrease—SR: 0.83 (0.75–0.91), p < 0.001; AF: 0.89 (0.81–0.98), p = 0.018], whereas the relationship was less strong for achieved heart rate in AF [HR per 10 bpm higher—SR: 1.26 (1.10–1.46), p = 0.001; AF: 1.08 (0.94–1.23), p = 0.18]. Achieved heart rate at 9 months was only prognostically significant in AF patients with high baseline heart rates (p for interaction 0.017 vs. low). Conclusions Following beta-blocker uptitration, both achieved and change in heart rate were prognostically significant regardless of starting heart rate in SR, however, they were only significant in AF patients with high baseline heart rate.

Transaxillary transcatheter aortic valve implantation utilizing a novel vascular closure device with resorbable collagen material: a feasibility study Abstract Objectives We herein aimed to evaluate technical feasibility of transaxillary (Tax) transcatheter aortic valve implantation (TAVI) utilizing a novel vascular closure device with a resorbable collagen plug and absence of suture material. Methods Between 05/2018 and 8/2018, eight patients (76.0 ± 5.9 years, 62.5% male, logEuroSCORE I 23.6 ± 4.7) received Tax-TAVI using the MANTA™ vascular closure device. Implanted transcatheter heart valves consisted of Edwards Sapien 3, NVT Allegra, Medtronic CoreValve EvolutR and SJM Portico. Results Puncture location depth was variable (3.5–7.5 cm). The left subclavian artery was used in five cases, the right subclavian artery in three cases. Low-pressure balloon-angioplasty for vessel closure was performed in 5/8 patients. VARC-2 defined device success was met in all patients. Major access site complication occurred in one patient with aneurysma spurium of the subclavian artery and consecutive stent implantation on postoperative day 5. Conclusion The MANTA™ device is applicable in Tax-TAVI, with potential particular advantages regarding easiness of use and marked access for subsequent interventions in case of vascular complications. Before conclusions regarding clinical efficacy and safety can be made, the device has to be evaluated in larger patient cohorts.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com