Hearing and Vestibular Loss with Misuse of Opioids and Illicit Drugs: A Review of the Literature

Background: The purpose of this review was to summarize the literature regarding the effects of opioids and illicit drugs on the auditory and vestibular systems. Methods: Data were sourced from published papers reporting hearing loss (HL) and/or vestibular loss (VL) following misuse or overdose of opioids or illicit drugs. Most papers consisted of retrospective single-case reports, with few retrospective reviews or prospective cohort studies. Search terms included variations of HL, VL, opioids, and illicit drugs. Search results yielded 51 articles published between 1976 and 2021. A total of 44 articles were reviewed after excluding studies that were not available in English (n = 3), only described acute effects in healthy cohorts (n = 3) or only described general health aspects in a group on methadone maintenance (n = 1). Results: Sixteen studies reported ototoxicity from illicit drugs, 27 from prescription opioids, and 1 was unspecified. This review shows that HL associated with amphetamines and cocaine was typically sudden, bilateral, and temporary. HL from cocaine/ crack and heroin often presented with greatest losses in the mid-frequency range. HL associated with opioids was typically sudden, bilateral, moderately severe to profound, and in most cases permanent. The literature is sparse regarding VL from illicit drugs and opioids. Conclusion: Practitioners who see patients for sudden or rapidly progressive HL or VL with no apparent cause should inquire about misuse of illicit drugs and opioids, particularly when the HL does not respond to steroid treatment

Differentiation of Patients with Balance Insufficiency (Vestibular Hypofunction) versus Normal Subjects Using a Low-Cost Small Wireless Wearable Gait Sensor

Balance disorders present a significant healthcare burden due to the potential for hospitalization or complications for the patient, especially among the elderly population when considering intangible losses such as quality of life, morbidities, and mortalities. This work is a continuation of our earlier works where we now examine feature extraction methodology on Dynamic Gait Index (DGI) tests and machine learning classifiers to differentiate patients with balance problems versus normal subjects on an expanded cohort of 60 patients. All data was obtained using our custom designed low-cost wireless gait analysis sensor (WGAS) containing a basic inertial measurement unit (IMU) worn by each subject during the DGI tests. The raw gait data is wirelessly transmitted from the WGAS for real-time gait data collection and analysis. Here we demonstrate predictive classifiers that achieve high accuracy, sensitivity, and specificity in distinguishing abnormal from normal gaits. These results show that gait data collected from our very low-cost wearable wireless gait sensor can effectively differentiate patients with balance disorders from normal subjects in real-time using various classifiers. Our ultimate goal is to be able to use a remote sensor such as the WGAS to accurately stratify an individual’s risk for falls

Hypervelocity Impact of Unstressed and Stressed Titanium in a Whipple Configuration in Support of the Orion Crew Exploration Vehicle Service Module Propellant Tanks

Hypervelocity impacts were performed on six unstressed and six stressed titanium coupons with aluminium shielding in order to assess the effects of the partial penetration damage on the post impact micromechanical properties of titanium and on the residual strength after impact. This work is performed in support of the definition of the penetration criteria of the propellant tanks surfaces for the service module of the crew exploration vehicle where such a criterion is based on testing and analyses rather than on historical precedence. The objective of this work is to assess the effects of applied biaxial stress on the damage dynamics and morphology. The crater statistics revealed minute differences between stressed and unstressed coupon damage. The post impact residual stress analyses showed that the titanium strength properties were generally unchanged for the unstressed coupons when compared with undamaged titanium. However, high localized strains were shown near the craters during the tensile tests

How European Union Membership Can Undermine the Rule of Law in Emerging Democracies

The European Union views the spread of economic prosperity and rule of law to countries emerging from dictatorship as among its primary goals when considering countries as candidates for membership. Existing literature often suggests that EU membership confers significant benefits on the accession countries, and these countries are willing to undergo costly and difficult reforms to reap these benefits. Through strict membership conditions, member states force accession countries to commit to democracy. Drawing on theoretical work in the fields of law, politics, and economics, this article reassesses the conventional wisdom. It argues that, under certain conditions, the reforms required of would-be members could have the perverse effect of undermining the establishment of legitimate law in transitional democracies. Using an agent-based model, the article elucidates a theory in which placing laws on the books around which no societal consensus exists can create perverse incentives for citizens and government officials and may lead to an erosion of the rule of law

High Energy Replicated Optics to Explore the Sun: Hard X-Ray Balloon-Borne Telescope

Set to fly in the Fall of 2013 from Ft. Sumner, NM, the High Energy Replicated Optics to Explore the Sun (HEROES) mission is a collaborative effort between the NASA Marshall Space Flight Center and the Goddard Space Flight Center to upgrade an existing payload, the High Energy Replicated Optics (HERO) balloon-borne telescope, to make unique scientific measurements of the Sun and astrophysical targets during the same flight. The HEROES science payload consists of 8 mirror modules, housing a total of 109 grazing-incidence optics. These modules are mounted on a carbon-fiber - and Aluminum optical bench 6 m from a matching array of high pressure xenon gas scintillation proportional counters, which serve as the focal-plane detectors. The HERO gondola utilizes a differential GPS system (backed by a magnetometer) for coarse pointing in the azimuth and a shaft angle encoder plus inclinometer provides the coarse elevation. The HEROES payload will incorporate a new solar aspect system to supplement the existing star camera, for fine pointing during both the day and night. A mechanical shutter will be added to the star camera to protect it during solar observations. HEROES will also implement two novel alignment monitoring system that will measure the alignment between the optical bench and the star camera and between the optics and detectors for improved pointing and post-flight data reconstruction. The overall payload will also be discussed. This mission is funded by the NASA HOPE (Hands On Project Experience) Training Opportunity awarded by the NASA Academy of Program/Project and Engineering Leadership, in partnership with NASA's Science Mission Directorate, Office of the Chief Engineer and Office of the Chief Technologis

Venue-Based Recruitment of Women at Elevated Risk for HIV: An HIV Prevention Trials Network Study

Background: The challenge of identifying and recruiting U.S. women at elevated risk for HIV acquisition impedes prevention studies and services. HIV Prevention Trials Network (HPTN) 064 was a U.S. multisite, longitudinal cohort study designed to estimate HIV incidence among women living in communities with prevalent HIV and poverty. Venue-based sampling (VBS) methodologies and participant and venue characteristics are described. Methods: Eligible women were recruited from 10 U.S. communities with prevalent HIV and poverty using VBS. Participant eligibility criteria included age 18–44 years, residing in a designated census tract/zip code, and self-report of at least one high-risk personal and/or male sexual partner characteristic associated with HIV acquisition (e.g., incarceration history). Ethnography was conducted to finalize recruitment areas and venues. Results: Eight thousand twenty-nine women were screened and 2,099 women were enrolled (88% black, median age 29 years) over 14 months. The majority of participants were recruited from outdoor venues (58%), retail spaces (18%), and social service organizations (13%). The proportion of women recruited per venue category varied by site. Most participants (73%) had both individual and partner characteristics that qualified them for the study; 14% were eligible based on partner risk only. Conclusion: VBS is a feasible and effective approach to rapidly recruit a population of women at enhanced risk for HIV in the United States. Such a recruitment approach is needed in order to engage women most at risk and requires strong community engagement

Neuroendocrine carcinoma arising in soft tissue: three case reports and literature review

<p>Abstract</p> <p>Background</p> <p>Neuroendocrine tumours (NET) are tumours arising from neuroendocrine cells of neural crest origin. They are characterised by the presence of neurosecretory granules which react positively to silver stains and to specific markers including neuron specific enolase, synaptophysin and chromogranin. Metastasis to the skin occurs infrequently but primary soft tissue NET is excessively rare.</p> <p>Case presentation</p> <p>We report our experience with 3 such cases. In the first case, the NET originated in muscle and was treated with wide surgical excision and adjuvant radiotherapy. The second case presented as a subcutaneous mass in the foot and the tumour was positive on ¹²³I mIBG scan. She has had prolonged recurrence-free survival following primary hypo-fractionated radiotherapy. In the third case, a cutaneous nodule proved to be a NET and at surgery, lymph node disease was present. He has remained disease-free after surgical excision without the need for external beam radiotherapy.</p> <p>Conclusion</p> <p>These tumours appear to have a good prognosis. Complete excision offers potentially curative treatment. Adjuvant radiotherapy may be helpful when the tumour margin is narrow. For patients with unresectable disease or where surgery would not be appropriate, radiotherapy appears to be an effective therapeutic option.</p

The astrobiology primer: An outline of general knowledge - Version 1, 2006

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