Article
Clinical Neurology
Adam Omelianchuk, James Bernat, Art Caplan, David Greer, Christos Lazaridis, Ariane Lewis, Thaddeus Pope, Lainie Friedman Ross, David Magnus
Summary: The Uniform Determination of Death Act (UDDA) has been a model statute for 40 years, but there is a growing recognition that it needs to be updated, especially in terms of aligning the legal criteria for determining death with the medical standards. This article argues for revising the UDDA to specify neurorespiratory criteria, which include permanent loss of consciousness, ability to breathe spontaneously, and brainstem reflexes, as the criteria for determining death.
Article
Clinical Neurology
James L. Bernat
Summary: Brain death, also known as death determination by neurologic criteria, is currently a subject of controversy as the U.S. Uniform Law Commission seeks to revise the Uniform Determination of Death Act. The Act was developed in 1980 to establish a uniform standard for determining death based on the irreversible cessation of all brain functions.
Article
Critical Care Medicine
Ariane Lewis
Summary: The Uniform Determination of Death Act (UDDA), the recommended legal statute for determination of death in the United States, is being updated by the Uniform Law Commission (ULC) due to concerns raised by experts in various fields. The drafting committee is tasked with addressing key questions and proposing revisions to provide clarity and consistency in the distinction between life and death. Once finalized, individual states can choose to adopt the revisions.
NEUROCRITICAL CARE
(2022)
Article
Critical Care Medicine
Ariane Lewis
Summary: This article provides a historical background and survey results related to the revision of the Uniform Determination of Death Act (UDDA) and explores the ethical principles and existing guidance regarding objections to the use of neurologic criteria to declare death. It also examines the perspectives of stakeholders and identifies questions for the drafting committee to consider, as well as the potential downstream effects of their decision.
NEUROCRITICAL CARE
(2022)
Article
Green & Sustainable Science & Technology
Philipp K. Wegerer, Monica Nadegger
Summary: Resistance against tourism development has become a significant aspect of tourism research. However, little attention has been given to online resistance against tourism development. This study examines an online petition against a large-scale infrastructure project in the Austrian Alps and analyzes the justification strategies employed by activists. The findings reveal that activists' rationales are embedded in a broader degrowth discourse, highlighting the conflict between the opposing perspectives of activists and project initiators regarding nature as a primary discourse object.
JOURNAL OF SUSTAINABLE TOURISM
(2023)
Article
Medicine, General & Internal
Federico Baronio, Alice Marzatico, Rosaria De Iasio, Rita Ortolano, Antonio Fanolla, Giorgio Radetti, Antonio Balsamo, Andrea Pession, Alessandra Cassio
Summary: Premature pubarche (PP) can be an early manifestation of non-classic congenital adrenal hyperplasia caused by 21 hydroxylase deficiency (NC21OHD). This study evaluated the predictive value of baseline androgens, 17-OHP levels, and auxological features in suggesting the presence of NC21OHD and the need for an ACTH test to confirm the diagnosis. Key predictive features for NC21OHD were identified, including baseline 17 OHP >200 ng/mL, bone age advance >2 years, and DHEA-S levels >228 ng/mL. These findings can help guide diagnostic decisions for patients with PP.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Orthopedics
Jean Fitzpatrick Timmerberg, Steven B. Chesbro, Gail M. Jensen, Robin L. Dole, Diane U. Jette
Summary: Competency-based education is an approach that emphasizes learner progression through the demonstration of competencies. The lack of such a framework in physical therapy may lead to variations in skills and practice, hindering the delivery of high-quality patient care. Therefore, adopting competency-based education in the physical therapy profession is crucial for ensuring safe and efficient practice.
Article
Critical Care Medicine
Ariane Lewis
Summary: This article discusses the pause in the revision of the Uniform Determination of Death Act (UDDA) by the Uniform Law Commission, and the thematic review of comments submitted by medical organizations, organ procurement organizations, and advocacy organizations. While most organizations support revision, there are differing viewpoints on the approach, making it difficult to reach a consensus.
NEUROCRITICAL CARE
(2023)
Review
Immunology
Shiya Yao, Yuejun Han, Mengxiang Yang, Ketao Jin, Huanrong Lan
Summary: Immunotherapy has played a significant role in the treatment of colorectal cancer, but some cases show poor response. Certain chemotherapeutic agents have immune-stimulatory properties, and the concept of inducing chemotherapy has been introduced to improve the efficacy of immunotherapy. However, there are still challenges and further research is required.
FRONTIERS IN IMMUNOLOGY
(2023)
Article
Ethics
Alberto Molina-Perez, James L. Bernat, Anne Dalle Ave
Summary: The Uniform Determination of Death Act (UDDA) provides two conflicting interpretations of determining death based on cessation of functions. One interpretation considers only the cessation of spontaneous functions, regardless of artificial means, while the other interpretation includes both spontaneous and artificially supported functions. This conceptual inconsistency leads to the conclusion that conscious individuals with artificially supported respiratory and circulatory functions are considered dead or that individuals with entirely destroyed and irreversible brains can still be alive. Solutions to mitigate this inconsistency are explored.
JOURNAL OF MEDICINE AND PHILOSOPHY
(2023)
Article
Ethics
D. Alan Shewmon
Summary: Discrepancies between the Uniform Determination of Death Act (UDDA) and the adult and pediatric diagnostic guidelines for brain death (BD) have led to proposals for revising the UDDA. The proposed revision called RUDDA has attracted attention, but 107 experts agree that it is not the right approach. They highlight the risks of false-positive errors in the guidelines, the importance of hypothalamic function, and the unnecessary and potentially harmful nature of the apnea test. They also stress the need to respect individuals' judgments and beliefs regarding the concept of death.
JOURNAL OF MEDICINE AND PHILOSOPHY
(2023)
Editorial Material
Psychiatry
Edward Silberman, Richard Balon, Vladan Starcevic, Richard Shader, Fiammetta Cosci, Giovanni A. Fava, Antonio E. Nardi, Carl Salzman, Nicoletta Sonino
Summary: The current discussions on benzodiazepines in psychiatric literature have shown a negative bias and deviated from the scientific evidence base. It is recommended to return to the evidence and adhere to clear definitions and conceptual rigor when discussing benzodiazepines.
BRITISH JOURNAL OF PSYCHIATRY
(2021)
Review
Virology
Stephen J. Scholand, Beatriz P. Quiambao, Charles E. Rupprecht
Summary: Rabies is a devastating disease that needs appropriate and timely prevention and treatment. The current categorization for rabies exposure needs revision to include a special Category IV for severe bites. Multiple factors that contribute to the severity of the disease have not been considered in current recommendations. The introduction of Category IV will optimize patient management and improve care for high-risk patients, highlighting the urgency of this neglected disease at a global level.
Review
Behavioral Sciences
John Molot, Margaret Sears, Hymie Anisman
Summary: Multiple chemical sensitivity (MCS) is a complex medical condition characterized by diverse features and common comorbidities associated with low dose chemical exposures. The development of MCS is linked to genetic influences, gene-environment interactions, oxidative stress, inflammation, cell dysfunction, and psychosocial influences. Sensitization of TRP receptors, particularly TRPV1 and TRPA1, is implicated in the pathogenesis of MCS. Misunderstanding of MCS as solely psychological in nature has resulted in stigmatization of patients and denial of their disability accommodation. Evidence-based education, as well as recognition of receptor-mediated biological mechanisms, is crucial for appropriate support and advocacy for MCS patients.
NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS
(2023)
Review
Neurosciences
Jennifer Barredo, Melanie L. Bozzay, Jennifer M. Primack, Heather T. Schatten, Michael F. Armey, Linda L. Carpenter, Noah S. Philip
Summary: Despite advancements in psychiatric and psychological treatments, suicide rates continue to rise. One reason for this could be the lack of integration between neurocircuitry models and contemporary suicide theories. Another challenge is the variable nature of suicide risk over time, which requires closer attention in intervention studies. Future research should focus on real-time tracking and biologically based interventions to develop more effective strategies for suicide reduction.
BIOLOGICAL PSYCHIATRY
(2021)
Letter
Geriatrics & Gerontology
Ladislav Volicer, Thaddeus Mason Pope, Karl E. Steinberg, Stanley A. Terman
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
(2023)
Article
Ethics
Ariane Lewis
Summary: This article examines the management of court cases in the United Kingdom regarding objections to the use of neurologic criteria to determine death. It summarizes important legal cases and discusses ethical issues raised by these challenges, comparing them to the situation in the USA.
AMERICAN JOURNAL OF BIOETHICS
(2023)
Article
Clinical Neurology
Ariane Lewis, Steven Galetta
Summary: In their research article, Chassoux et al. conducted a retrospective review on 60 patients with focal cortical dysplasia type 2 (FCD2) in the central region who underwent surgical resection. They found that 88% of patients achieved seizure freedom after surgery, and although 87% experienced early transitory postoperative deficits, 40% of them fully recovered. It was also observed that patients with FCD2 can have preoperative and postoperative neurologic deficits, and some patients showed improvement after surgery.
Review
Medicine, General & Internal
Ariane Lewis
Summary: This manuscript explores the international variability in the diagnosis and management of disorders of consciousness (DoC). The impact of financial, legal, cultural, religious, and psychosocial considerations on DoC diagnosis and management is discussed. Improvements in clinical care, education, advocacy, and research are needed globally. Standardized methodology for evaluating consciousness and prognosticating outcome is imperative, as well as education to raise awareness and develop communication techniques about DoC. Equity in access to expertise and resources is necessary, along with harmonization of existing datasets and establishment of international clinical trial networks.
Article
Clinical Neurology
Cen Zhang, Arielle Kurzweil, Perrin Pleninger, Aaron Nelson, Lindsey Gurin, Sondra Zabar, Steven L. Galetta, Laura J. Balcer, Ariane Lewis
Summary: A survey of NYU neurology teaching faculty found a high proportion of discomfort and lack of experience in providing negative feedback, debriefing after an adverse outcome, and assisting struggling colleagues. Female faculty and those early in their careers were more likely to feel uncomfortable. Faculty development is needed to improve communication skills.
JOURNAL OF CLINICAL NEUROSCIENCE
(2023)
Article
Cardiac & Cardiovascular Systems
Jennifer A. Frontera, Ariane Lewis, Les James, Kara Melmed, Brendan Parent, Eytan Raz, Syed T. Hussain, Deane E. Smith, Nader Moazami
Summary: The use of thoracoabdominal normothermic regional perfusion (TA-NRP) in donation after circulatory death (DCD) is an important development in organ donation. However, there have been concerns about the restoration of brain blood flow. In this study, the authors used intraoperative transcranial Doppler (TCD) to assess brain blood flow in two DCD TA-NRP cases and found no evidence of restored blood flow.
JOURNAL OF HEART AND LUNG TRANSPLANTATION
(2023)
Article
Critical Care Medicine
Ariane J. Lewis, Michael Young, Benjamin J. Rohaut, Ralf Jox, Jan J. Claassen, Claire Creutzfeldt, Judy Illes, Matthew Kirschen, Stephen J. Trevick, Joseph Fins
Summary: Interest in disorders of consciousness (DoC) has increased, highlighting the importance of understanding DoC biology, care needs, treatment options, and outcome prediction. Ethical considerations related to rights and resources should be taken into account when conducting research on DoC.
NEUROCRITICAL CARE
(2023)
Article
Clinical Neurology
Danielle Feng, Ariane Lewis
NEUROLOGIC CLINICS
(2023)
Article
Clinical Neurology
Megan Finneran, Ariane Lewis
Summary: There is a call for the neuroscience community to promote uniformity in the determination of brain death/death by neurologic criteria (BD/DNC). Engaging with state medical societies is one way to achieve this advocacy. The principal author recognized the ambiguity and inconsistency in her hospital's policy on BD/DNC determination, leading her to propose a resolution to the Illinois State Medical Society (ISMS) in order to encourage uniformity across the state. Although ISMS approved the resolution, its effectiveness remains uncertain due to certain shortcomings. Nevertheless, other neuroscience clinicians are encouraged to collaborate with their respective state medical societies to advocate for uniformity in BD/DNC determination.
Article
Critical Care Medicine
Sung-Min Cho, Chiara Robba, Michael N. Diringer, Daniel F. Hanley, J. Claude Hemphill, Janneke Horn, Ariane Lewis, Sarah L. Livesay, David Menon, Tarek Sharshar, Robert D. Stevens, James Torner, Paul M. Vespa, Wendy C. Ziai, Marcus Spann, Raimund Helbok, Jose Suarez
Summary: To address the lack of knowledge regarding clinical trial design for patients with disorders of consciousness (DoC), a research group conducted a gap analysis and proposed optimal clinical trial designs for DoC studies.
NEUROCRITICAL CARE
(2023)
Article
Critical Care Medicine
Ariane Lewis
Summary: This article discusses the pause in the revision of the Uniform Determination of Death Act (UDDA) by the Uniform Law Commission, and the thematic review of comments submitted by medical organizations, organ procurement organizations, and advocacy organizations. While most organizations support revision, there are differing viewpoints on the approach, making it difficult to reach a consensus.
NEUROCRITICAL CARE
(2023)
Letter
Clinical Neurology
Ariane Lewis, Steven Galetta
Letter
Clinical Neurology
Steven E. Galetta, Aravind Ganesh, Ariane Lewis, James E. Siegler III
Summary: International guidelines recommend intravenous anesthesia for 24-48 hours to treat refractory status epilepticus, but the cessation of seizures in patients with this condition is poorly defined. In a retrospective analysis of 147 patients, the achievement of burst suppression on EEG was not associated with termination of seizures, survival, or return to pre-illness level of function. However, in patients with anoxic brain injury, a higher degree of burst suppression was linked to increased odds of seizure termination and in-hospital survival.
Letter
Clinical Neurology
Ariane Lewis, Steven Galetta
Correction
Clinical Neurology
Steven Galetta, Aravind Ganesh, Ariane Lewis, James E. Siegler III