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Since the introduction of vaccines for severe acute respiratory syndrome coronavirus 2 in the United States, there has been significant vaccine hesitancy, in part due to fear of adverse effects. We sought to investigate the rates of smell and taste changes after COVID-19 vaccination compared to other common vaccines. Our study cohort included individuals identified by Current Procedural Terminology code in the TriNetX database receiving the COVID-19 first series, COVID-19 booster, influenza, tetanus, diphtheria, pertussis (TDAP), or pneumococcal vaccines between December 15, 2020, and August 15, 2023. After 1:1 propensity score matching, postvaccination incidence of disturbance of smell and taste was significantly less likely after COVID-19 first series vaccine compared to influenza (odds ratios, OR: 0.27 [95% confidence interval, CI: 0.20-0.36]), TDAP (OR: 0.35 [95% CI: 0.26-0.47]), and pneumococcal vaccines (OR: 0.17 [95% CI: 0.09-0.32]). Similarly, incidence of disturbance of smell and taste was significantly less likely after COVID-19 booster vaccine compared to the influenza (OR: 0.60 [95% CI: 0.48-0.76]), TDAP (OR: 0.63 [95% CI: 0.47-0.85]), and pneumococcal vaccines (OR: 0.44 [95% CI: 0.28-0.68]). This study builds upon the literature demonstrating the safety of COVID-19 vaccination., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To examine prevalence of partial and complete HPV vaccination among middle-aged adults and factors associated with vaccination status., Study Design: Nationally representative cross-sectional survey., Setting: United States., Methods: Cohort includes adults aged 30 to 44 years from 2018 to 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey who completed questions about HPV vaccination status. Survey-weighted multivariable logistic regression was utilized to explore factors associated with partial and complete HPV vaccination status., Results: In this nationally representative cohort of 26,470 US middle-aged adults, 15.8% [95% confidence interval [CI]: 15.1%-16.6%] reported any HPV vaccination, and 6.5% [95% CI: 6.0%-7.0%] reported complete HPV vaccination. On multivariable regression, younger age, female sex, residence in the West or Northeast, higher educational attainment, unmarried status, having a personal healthcare provider, and gay or lesbian sexual orientation were associated with increased likelihood of vaccination. Race was variably associated with vaccination status. Annual income, insurance status, cancer history, head and neck cancer history, and time of last physician checkup were not associated with HPV vaccination status., Conclusion: HPV vaccination among middle-aged adults who were not previously vaccinated should be based on risk for new HPV infection and possible benefits of vaccination. While our analysis shows that consideration of personal factors likely plays a role in HPV vaccination in this cohort, we also find that gaps in vaccination may exist due to other socioeconomic disparities between sexes, educational attainment levels, racial/ethnic groups, geographic regions, and access to a personal healthcare provider. These factors' influence suggests potential room for improved public health measures., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Importance: Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear., Objective: To assess the clinical association between cannabis use and HNC., Design, Setting, and Participants: This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older., Exposure: Cannabis-related disorder., Main Outcomes and Measures: Diagnosis of HNC and any HNC subsite., Results: The cannabis-related disorder cohort included 116 076 individuals (51 646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non-cannabis-related disorder cohort included 3 985 286 individuals (2 173 684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n = 115 865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without HNC. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group., Conclusions and Relevance: This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.

Objective: Understand vaccination knowledge and barriers to vaccination among minority adults., Study Design: Cross-sectional survey., Setting: Otolaryngology clinics at a safety net hospital and a tertiary academic center and a head and neck cancer screening event., Methods: Survey was administered to consenting patients. Descriptive statistics and significance testing were used to characterize the data, with non-minority respondents as controls. Multivariate logistic regression was used to understand factors associated with vaccination., Results: HPV vaccination among our 241 respondents (n = 41, 17.67 %) and their qualifying children (n = 52, 33.55 %) was low. Non-vaccinated minorities were significantly more likely to express interest in HPV vaccination (28.66 % vs 8.66 %, p = 0.016). Minority patients were significantly less knowledgeable about HPV causing cervical (88.64 % vs 72.45 %, p = 0.024) and head and neck (68.18 % vs 44.90 %, p = 0.005) cancer and were also less aware of HPV infection (95.45 % vs 81.12 %, p = 0.020) among non-women. Lack of knowledge about the HPV vaccine was the most cited reason why minority patients did not or were uninterested in vaccination for themselves or their children. In a multivariable logistic regression of factors associated with HPV vaccination, only increased age demonstrated a significant association with vaccination likelihood (OR = 0.91, 95 % CI = [0.88-0.95], p < 0.001)., Conclusion: Reported HPV vaccination rates were low for both white and minority patients but did not significantly vary on univariate or multivariate analysis. However, minority respondents were significantly less knowledgeable about HPV and its manifestations; they most often cited inadequate knowledge as why did not receive or were uninterested in HPV vaccination. As such, HPV vaccination educational interventions may raise vaccination rates among minority populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Understand the differential association of onset and etiology of hearing loss with psychosocial outcomes among older adults., Methods: This is a cross-sectional cohort study based on 2017-2020 National Health and Nutrition Examination Survey. Adults aged ≥70 years who completed audiometric testing and questionnaires on onset and etiologies of hearing loss were included (n = 612). Outcomes included report of social avoidance and major depressive disorder (MDD, PHQ-9). Multivariable regression was utilized to examine differential associations of onset and etiology of hearing loss on psychosocial outcomes while adjusting for relevant factors., Results: In this nationally representative sample of US older adults with hearing loss, 20.8% [95%CI: 14.5-29.0%] reported social avoidance due to hearing loss and 7.2% [95%CI: 4.3-11.8] reported symptoms suggestive of MDD. Multivariable regression demonstrated self-reported onset of hearing loss between ages 6-19 years (OR:2.49 [95%CI: 1.52-4.10]) and 20-59 years (OR:1.95 [95%CI: 1.07-3.55]) was associated with higher avoidance of social interaction than reported onset at ≥70 years. Those with onset between 20-59 years (OR:4.28 [95%CI: 1.17-15.6]) and 60-69 years (OR:5.68 [95%CI: 1.85-17.5]) were more likely to report symptoms consistent with MDD than those with onset at ≥70. Multivariable regression did not demonstrate increased risk of avoiding social interactions or MDD due to hearing loss from noise exposure, ear infection, or ear disease versus aging alone., Conclusion: There was an association between earlier hearing loss onset with social avoidance and MDD. This suggests a need for research to investigate the impact of earlier diagnosis and intervention for hearing loss on psychosocial outcomes., Level of Evidence: 2b Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

This study investigated self-reported age of onset and etiology of hearing loss among older adults in the United States. Study cohort included older adult (≥70 years) survey respondents from the 2017 to 2020 National Health and Nutrition Examination Survey (n = 797). Overall, 51.1% [95% confidence interval [CI]: 46.1-56.1] of older adults self-reported hearing loss. Among older adults who reported hearing loss, the most reported age of onset was age 70 or older (41.7% [95% CI: 38.1%-45.3%]), followed by sequentially younger age brackets including ages 60 to 69 years (27.3% [95% CI: 23.6%-31.3%]) and ages 40 to 59 years (15.7% [95% CI: 12.9%-19.0%]). The most common etiology of hearing loss was aging (66.3% [95% CI: 60.8%-71.4%]) followed by loud long-term noise (30.3% [95% CI: 26.2%-34.9%]) and loud brief noise (13.8% [95% CI: 10.3%-18.4%]). Our study describes the most common age of onset and etiologies of hearing loss among a representative sample of United States older adults., Competing Interests: None., (© 2024 The Authors. OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

This study investigated management practices for Meniere's disease (MD) and their temporal trends from 2008 to 2022 within the TriNetX network database. Study cohort included adult patients (≥18 years) with the diagnosis of MD from TriNetX's multi-institutional medical records (n = 77,493). MD diagnosis and management were queried based on the international classification of diseases, tenth revision, current procedural terminology, and RXNorm codes. Temporal trends were analyzed using joinpoint regression. There was significant increase in rates of relevant medications prescribed within 12 months of MD diagnosis from 2008 to 2022 (annual percent change [APC]: 1.2 [95% confidence interval, CI: 0.4-1.9]). There were no significant changes in rate of intratympanic injection within 12 months of MD diagnosis (1.7 [95% CI: -1.1 to 4.5]). Rate of endolymphatic sac surgery and labyrinthectomy any time after MD diagnosis gradually decreased from 2008 to 2022 at APC of -8.1 (95% CI: -11.8 to -4.2) and -11.0 (95% CI: -14.0 to -7.7), respectively. Use of relevant medications has significantly increased during the early management of MD and the overall use of surgical treatments has decreased., Competing Interests: None., (© 2024 The Authors. OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology‐Head and Neck Surgery Foundation.)

Importance: Dizziness is a highly prevalent complaint with wide-ranging causes and resultant morbidity. Whether symptomatic dizziness and its various manifestations are associated with all-cause and cause-specific mortality is unknown., Objective: To examine the associations of symptomatic dizziness and its manifestations with all-cause and cause-specific mortality., Design, Setting, and Participants: This cohort study is a mortality follow-up study based on the 1999-2004 National Health and Nutrition Examination Survey. The study cohort included adults 40 years and older who completed questions about symptomatic dizziness, including problems with dizziness, balance, falling, and positional dizziness, within the past 12 months. Respondents were linked to mortality data through December 31, 2019. Data were analyzed from February to August 2023., Exposure: Self-reported symptomatic dizziness., Main Outcomes and Measures: All-cause and cause-specific (cardiovascular disease, diabetes, cancer, and unintentional injuries) mortality. Cox proportional hazard regression models were used to examine associations between symptomatic dizziness and all-cause and cause-specific mortality while adjusting for demographics and medical history., Results: In this nationally representative cohort of 9000 middle-aged and older US adults (mean [SD] age, 61.8 [13.8] years; 4570 [50.8%] female), prevalence of symptomatic dizziness was 23.8%. Specifically, 18.3% reported problems with dizziness, 14.5% reported problems with balance, 5.7% reported problems with falling, and 3.8% reported dizziness when turning in bed (positional dizziness). At a median (range) of 16.2 (0.1-20.6) years of follow-up, all-cause mortality for adults with symptomatic dizziness was higher than for those without (45.6% vs 27.1%). Symptomatic dizziness was associated with elevated risk for cause-specific mortality from diabetes (hazard ratio [HR], 1.66; 95% CI, 1.23-2.25), cardiovascular disease (HR, 1.33; 95% CI, 1.12-1.55), and cancer (HR, 1.21; 95% CI, 0.99-1.47) but not unintentional injuries (HR, 0.98; 95% CI, 0.51-1.88). Reporting problems with balance or falling was associated with increased all-cause mortality (balance: HR, 1.27; 95% CI, 1.17-1.39; and falling: HR, 1.52; 95% CI, 1.33-1.73), cardiovascular disease-specific mortality (balance: HR, 1.41; 95% CI, 1.20-1.66; and falling: HR, 1.49; 95% CI, 1.15-1.94), and diabetes-specific mortality risks (balance: HR, 1.74; 95% CI, 1.26-2.39; and falling: HR, 2.01; 95% CI, 1.26-3.18). There was no association between positional dizziness and mortality (HR, 0.98; 95% CI, 0.82-1.19)., Conclusions and Relevance: In this cohort study, symptomatic dizziness was associated with increased risk for all-cause and diabetes-, cardiovascular disease-, and cancer-specific mortality. The imprecision of the effect size estimate for cancer-specific mortality prevents making a definitive conclusion. Future studies are needed to determine whether symptomatic dizziness indicates underlying health conditions contributing to mortality or if early intervention for imbalance and falls can reduce mortality risk.

Meiotic drivers bias gametogenesis to ensure their transmission into more than half the offspring of a heterozygote. In Schizosaccharomyces pombe, wtf meiotic drivers destroy the meiotic products (spores) that do not inherit the driver from a heterozygote, thereby reducing fertility. wtf drivers encode both a Wtfpoison protein and a Wtfantidote protein using alternative transcriptional start sites. Here, we analyze how the expression and localization of the Wtf proteins are regulated to achieve drive. We show that transcriptional timing and selective protein exclusion from developing spores ensure that all spores are exposed to Wtf4poison, but only the spores that inherit wtf4 receive a dose of Wtf4antidote sufficient for survival. In addition, we show that the Mei4 transcription factor, a master regulator of meiosis, controls the expression of the wtf4poison transcript. This transcriptional regulation, which includes the use of a critical meiotic transcription factor, likely complicates the universal suppression of wtf genes without concomitantly disrupting spore viability. We propose that these features contribute to the evolutionary success of the wtf drivers., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: NLN, MABN, SEZ: Inventor on patent application based on wtf meiotic drivers. Patent application serial 62/491,107. The other authors declare that no competing interests exist., (Copyright: © 2022 Nuckolls et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

A modular total synthesis of kibdelomycin is disclosed that should enable structure-activity relationship (SAR) studies of this interesting class of antibiotics. The route uses simple building blocks and addresses lingering questions about its structural assignment and relationship to amycolamicin, a recently described natural product reported to have a similar structure. Initial antibacterial assays reveal that both C-22 epimers (the N-glycosidic linkage) of the natural product have similar activity while structurally truncated analogs lose activity., (© 2022 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

l-Lactate is an energetic and signaling molecule that may be produced through astrocyte-specific aerobic glycolysis and is elevated in striatal muscle during intensive exercise. l-Lactate has been shown to promote neurotrophic gene expression through astrocytes within the hippocampus, however, its role in neuroplasticity within the striatum remains unknown. This study sought to investigate the role of peripheral sources of l-lactate in promoting astrocyte-specific gene expression and morphology as well as its role in neuroplasticity within the striatum of healthy animals. Using in vitro primary astrocyte cell culture, administration of l-lactate increased the expression of the neurotrophic factors Bdnf, Gdnf, Cntf, and the immediate early gene cFos. l-Lactate's promotion of neurotrophic factor expression was mediated through the lactate receptor HCAR1 since application of the HCAR1 agonist 3,5-DHBA also increased expression of Bdnf in primary astrocytes. Similar to our previous report demonstrating exercise-induced changes in astrocytic structure within the striatum, l-lactate administration to healthy mice led to increased astrocyte morphological complexity as well as astrocyte-specific neurotrophic expression within the striatum. Our study failed to demonstrate an effect of peripheral l-lactate on synaptogenesis or motor behavior. Insufficient levels and/or inadequate delivery of l-lactate through regional cerebral blood flow within the striatum may account for the lack of these benefits. Taken together, these novel findings suggest a potential framework that links peripheral l-lactate production within muscle and intensive exercise with neuroplasticity of specific brain regions through astrocytic function., (© 2021 Wiley Periodicals LLC.)

Allylation and conjunctive cross-coupling represent two useful, yet largely distinct, reactivity paradigms in catalysis. The union of these two processes would offer exciting possibilities in organic synthesis but remains largely unknown. Herein, we report the use of allyl electrophiles in nickel-catalyzed conjunctive cross-coupling with a non-conjugated alkene and dimethylzinc. The transformation is enabled by weakly coordinating, monodentate aza-heterocycle directing groups that are useful building blocks in synthesis, including saccharin, pyridones, pyrazoles, and triazoles. The reaction occurs under mild conditions and is compatible with a wide range of allyl electrophiles. High chemoselectivity through substrate directivity is demonstrated by the facile reactivity of the β-γ alkene of the starting material, whereas the ϵ-ζ alkene of the product is preserved. The generality of this approach is further illustrated through the development of an analogous method with alkyne substrates. Mechanistic studies reveal the importance of the dissociation of the weakly coordinating directing group to allow the allyl moiety to bind and facilitate C(sp 3 )-C(sp 3 ) reductive elimination., (© 2020 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Currently, most critical care physicians maintain a patient's haemoglobin levels at 7 to 8 g dL-1. However, little data have been available on haemoglobin-related outcomes in burn patients. The purpose of this study was to evaluate inpatients with greater than 20% total body surface area burns and the effects of haemoglobin below 8 g dL-1 on clinical outcomes., Methods: This study included 70 patients with burns amounting to greater than 20% of total body surface area. Data were retrospectively evaluated and included age, gender, adult respiratory distress syndrome presence, length of intensive care unit stay, length of mechanical ventilation, days requiring vasopressors, renal insufficiency, positive cultures/infections, cardiovascular complications, number of operations, inhalation injury, and mortality. Logistic regression analyses that were adjusted for age, sex, and percent total body surface area were used to assess the relationships between haemoglobin and multiple clinical outcomes. Odds ratios (OR) were estimated with 99% confidence intervals (99% CI)., Results: Haemoglobin below 8 g dL-1 was associated with a need for vasopressors (OR = 2.17; 99% CI = 1.03-8.22). Furthermore, haemoglobin below 8 g dL-1 was associated with higher positive wound (OR = 2.86; 99% CI = 1.00-34.40), urine (OR = 4.63; 99% CI = 1.15-67.00), and lung cultures (OR = 2.24; 99% CI = 1.06-5.47). These associations largely remained after controlling for blood transfusions., Conclusions: Contrary to most other patient groups, burn patients with burns amounting to greater than 20% of total body surface area and low haemoglobin levels were more likely to develop positive cultures in urine, wounds, and the lung and require vasopressor treatment.

Background: Pre-emptive screening of urine for patients admitted to an intensive care unit can result in the misinterpretation of data and over- or under-treatment of urinary tract infection., Methods: Data were studied from 169 consecutive patients admitted to the neurologic or burn intensive care unit at Shands Hospital at the University of Florida. All patients had a urinary catheter in place at the time of admission. Urinalysis and urine culture were sent for analysis. Data included leukocyte esterase, urine nitrate, urine protein, pyuria or urine white blood cell count, and culture., Results: Leukocyte esterase and pyuria were the most sensitive indicators of a positive urine culture at 87.5% (95% CI: 71.3-100%) and 73.3% (95% CI: 51.0-95.7%), respectively; urine nitrate was specific at 100%. More than half of the patients (56.3%) with positive cultures did not initially receive antibiotics., Conclusion: The combination of leukocyte esterase and urine nitrate provides the best indicator for the initiation of antibiotic coverage for urinary tract infection prior to culture availability.

The collision-induced dissociation (CID) of cationic fatty acid-metal ion complexes has been extensively studied and, in general, provides rich structural information. In particular, charge-remote fragmentation processes are commonly observed allowing the assignment of double bond position. In a previous manuscript, we presented two methods to doubly deprotonate polyunsaturated fatty acids to form anionic fatty acid-sodium ion complexes, referred to as [M - 2H + Na] (-) ions. In the current manuscript, the CID behavior of these [M - 2H + Na] (-) ions is investigated for the first time. Significantly, we also present a deuterium-labeling experiment, which excludes the possibility that deprotonation occurs predominately at the α-carbon in the formation of fatty acid [M - H + NaF](-) ions. This supports our original proposal where deprotonation occurs at the bis-allylic positions of polyunsaturated fatty acids. CID spectra of polyunsaturated fatty acid [M - 2H + Na](-) ions display abundant product ions arising from acyl chain cleavages. Through the examination of fatty acid isomers, it is demonstrated that double bond position may be unequivocally determined for methylene-interrupted polyunsaturated fatty acids with three or more carbon-carbon double bonds. In addition, CID of [M - 2H + Na](-) ions was applied to 18:3 isomers of Nannochloropsis oculata and three isomers were tentatively identified: ∆(9,12,15)18:3, ∆(6,9,12)18:3, and ∆(5,8,11)18:3. We propose that structurally-informative product ions are formed via charge-driven fragmentation processes at the site of the resonance-stabilized carbanion as opposed to charge-remote fragmentation processes, which could be inferred if deprotonation occurred predominately at the α-carbon.

Purpose: PATIENTS AT HIGH RISK FOR DEVELOPING BREAST CANCER CAN BE IDENTIFIED USING A VALIDATED PREDICTIVE TOOL: the Gail model. Patients thus identified can undergo careful breast cancer screening and be considered for preventive measures, such as chemoprevention with tamoxifen or raloxifene. An organized health system can create a screening and high-risk intervention program for breast cancer and potentially save lives and resources. Multiple components of the health system must work together in a multidisciplinary manner to successfully implement such a program., Methods: Aurora Health Care is a large health system in Wisconsin. In 2007, a medical center within Aurora initiated a program to identify patients at high risk for developing breast cancer and intervene with screening and prevention. The program used the Gail model, which was administered to patients presenting for comprehensive physical examination at the women's center., Results: During the first year, 5,718 Gail model scores were calculated, and 15.2% of patients were deemed high risk. Most were counseled by their primary care providers, and few underwent screening with magnetic resonance imaging, genetics consultation, or chemoprevention. Primary care providers expressed concerns regarding the accuracy of the Gail model, the additional time necessary for patient counseling, how few patients underwent chemoprevention, and perceived medicolegal risk. The program was altered to address these concerns., Conclusion: Success of a breast cancer risk and intervention program in a large health system is more likely if concerns of participating disciplines are acknowledged and addressed.

This research analyzes the psychometric properties of a 34-item doctor-patient relational communication scale adapted from its survey research form [Commun Monogr 1987;54:307] for use as an observational instrument to rate doctor-patient interaction. Relational communication determines the affective "tone" of interpersonal communication, and is handled mostly through nonverbal channels. Relational communication provides the framework in which the content of a doctor-patient exchange, such as symptom reports by the patient, is interpreted and acted upon. The relational communication scale was adapted for use by three trained observers each of whom rated 20 videotaped interactions between medical students and standardized patients. Results indicate fair to excellent internal consistency, inter-rater reliability, inter-rater agreement, and construct validity for four of the six relational communication subscales. The scale is practical to administer and would lend itself for use in formative evaluation of medical student and physician communication skills.

Objectives: To determine whether an intravenous infusion of the calcium channel blocker diltiazem was effective and safe in treating sinus tachycardia in critically ill adult patients with contraindications to beta-blockers or in whom beta-blockers were ineffective., Design: Retrospective chart review., Setting: University medical center., Patients: The records of 171 surgical intensive care unit patients with sinus tachycardia treated with intravenous diltiazem were evaluated., Interventions: In all patients with sinus tachycardia (heart rate >100 beats/min), heart rate control with intravenous diltiazem was attempted after adequate intravascular volume expansion, pain, and anxiety control. In all patients, beta-blockade either was contraindicated or (in 7%) had failed. Intravenous diltiazem was administered as a slow 10-mg bolus dose (0.1-0.2 mg/kg ideal body weight), and then an infusion was started at 5 or 10 mg/hr and increased up to 30 mg/hr, as needed, to decrease heart rate to <100 beats/min. Variables retrospectively collected included demographic data, preinfusion blood pressure, mean arterial pressure, heart rate, and preinfusion pressure-rate quotients (pressure-rate quotient = mean arterial pressure / heart rate). Intravenous bolus dose, when given, and diltiazem infusion rate and time necessary to achieve the target heart rate also were recorded. The lowest heart rate recorded within 24 hrs from the initiation of the infusion and the time necessary to achieve the lowest heart rate after beginning the infusion were recorded., Measurements and Results: Of 171 patients studied, 97 (56%) were classified as responders. Multiple linear regression suggested that response could be predicted by age, pressure-rate quotients, baseline mean arterial pressure, and central nervous system failure. In the responders, a heart rate <100 beats/min was achieved in an average of 2 hrs, at a mean diltiazem infusion of 13.3 mg/hr. The lowest rate reached by the responders in a 24-hr period averaged 86 beats/min and was achieved in 4.8 hrs with a mean infusion rate of 14.8 mg/hr. Both target and lowest rate values were statistically different from baseline heart rate., Conclusion: Diltiazem was effective in achieving short-term control of heart rate in 56% of the patients, virtually without adverse effects, where beta-blockade was contraindicated or ineffective.

Purpose: To discuss the development, pilot testing, and analysis of a 34-item semantic differential instrument for measuring medical school applicants' emotional intelligence (the EI instrument)., Method: The authors analyzed data from the admission interviews of 147 1997 applicants to a six-year BS/MD program that is composed of three consortium universities. They compared the applicants' scores on traditional admission criteria (e.g., GPA and traditional interview assessments) with their scores on the EI instrument (which comprised five dimensions of emotional intelligence), breaking the data out by consortium university (each of which has its own educational ethos) and gender. They assessed the EI instrument's reliability and validity for assessing noncognitive personal and interpersonal qualities of medical school applicants., Results: The five dimensions of emotional intelligence (maturity, compassion, morality, sociability, and calm disposition) indicated fair to excellent internal consistency: reliability coefficients were .66 to .95. Emotional intelligence as measured by the instrument was related to both being female and matriculating at the consortium university that has an educational ethos that values the social sciences and humanities., Conclusion: Based on this pilot study, the 34-item EI instrument demonstrates the ability to measure attributes that indicate desirable personal and interpersonal skills in medical school applicants.