Environmental Pollution and Cardiovascular Disease: Part 2 of 2: Soil, Water, and Other Forms of Pollution.

With a growing body of evidence that now links environmental pollution to adverse cardiovascular disease (CVD) outcomes, pollution has emerged as an important risk factor for CVD. There is thus an urgent need to better understand the role of pollution in CVD, key pathophysiological mechanisms, and to raise awareness among health care providers, the scientific community, the general population, and regulatory authorities about the CV impact of pollution and strategies to reduce it. This article is part 2 of a 2-part state-of-the-art review on the topic of pollution and CVD-herein we discuss major environmental pollutants and their effects on CVD, highlighting pathophysiological mechanisms, and strategies to reduce CVD risk.

Environmental Pollution and Cardiovascular Disease: Part 1 of 2: Air Pollution.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Over the past 50 years, there has been a substantial decline in the incidence of CVD and related mortality in high-income countries, largely due to the mitigation of modifiable risk factors such as smoking, hypertension, and diabetes. However, a significant burden of CVD remains in low- to middle-income countries, despite their lower prevalence of traditional risk factors; other environmental factors, particularly pollution, play a significant role in this attributable risk. Mounting evidence underscores a strong association between pollution and adverse health effects, including CVD. This article is part 1 of a 2-part state-of-the-art review and discusses air pollution and its adverse effects on CVD, highlighting pathophysiological mechanisms and methods to reduce air pollution and exposure to these pollutants.

Auditory Word Comprehension Is Less Incremental in Isolated Words.

Partial speech input is often understood to trigger rapid and automatic activation of successively higher-level representations of words, from sound to meaning. Here we show evidence from magnetoencephalography that this type of incremental processing is limited when words are heard in isolation as compared to continuous speech. This suggests a less unified and automatic word recognition process than is often assumed. We present evidence from isolated words that neural effects of phoneme probability, quantified by phoneme surprisal, are significantly stronger than (statistically null) effects of phoneme-by-phoneme lexical uncertainty, quantified by cohort entropy. In contrast, we find robust effects of both cohort entropy and phoneme surprisal during perception of connected speech, with a significant interaction between the contexts. This dissociation rules out models of word recognition in which phoneme surprisal and cohort entropy are common indicators of a uniform process, even though these closely related information-theoretic measures both arise from the probability distribution of wordforms consistent with the input. We propose that phoneme surprisal effects reflect automatic access of a lower level of representation of the auditory input (e.g., wordforms) while the occurrence of cohort entropy effects is task sensitive, driven by a competition process or a higher-level representation that is engaged late (or not at all) during the processing of single words.

Myocarditis in the Setting of Recent COVID-19 Vaccination.

We report three patients who presented with chest pain after receiving either the BNT162b2 Pfizer/BioNTech or mRNA-1273 Moderna/NIH vaccine. Clinical presentation, biomarker, and cardiac MRI supported myocarditis. It is imperative that potential side effects of COVID-19 vaccine are reported to improve our knowledge about COVID-19 and mRNA vaccines.

Syntactic category constrains lexical competition in speaking.

We report two experiments that suggest that syntactic category plays a key role in limiting competition in lexical access in speaking. We introduce a novel sentence-picture interference (SPI) paradigm, and we show that nouns (e.g., running as a noun) do not compete with verbs (e.g., walking as a verb) and verbs do not compete with nouns in sentence production, regardless of their conceptual similarity. Based on this finding, we argue that lexical competition in production is limited by syntactic category. We also suggest that even complex words containing category-changing derivational morphology can be stored and accessed together with their final syntactic category information. We discuss the potential underlying mechanism and how it may enable us to speak relatively fluently.

Association of hypokalemia with an increased risk for medically treated arrhythmias.

BACKGROUND: Potassium replenishment protocols are often employed across broad patient populations to prevent cardiac arrhythmias. Tailoring potassium thresholds to specific patient populations would reduce unnecessary tasks and cost. The objective of this retrospective cohort study was to determine the threshold at which hypokalemia increases the risk for medically treated arrhythmias in cardiac versus medical and surgical intensive care units. METHODS: Patients captured in the publicly available Philips eICU database were assessed for initiation of either intravenous amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine as a surrogate for a clinically significant arrhythmia. A landmark time-to-event analysis was conducted to investigate the association of serum potassium values and time-marked administration of an antiarrhythmic drug. Analysis was adjusted for comorbidities, the use of vasopressor agents, diuretics, as well as age, gender and severity of illness. RESULTS: Among 20,665 admissions to cardiac intensive care units, 1,371 (6.6%) were treated with either amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine. For potassium values of ≥3.0<3.5mEq/L, antiarrhythmic treatment occurred at an increased rate compared to a baseline of ≥4.0≤5.0mEq/L (HR 1.23, 95% CI 1.01-1.51; P = 0.04). For admissions to medical and surgical intensive care units, 2,100 of 69,714 patients (3.0%) were treated with either amiodarone, adenosine, ibutilide, isoproterenol, or lidocaine. Potassium values of ≥3.0<3.5mEq/L were also associated with an increased hazard of treatment (HR 1.26, 95% CI 1.09-1.45; P = 0.002). In both cohorts, worsening hypokalemia was associated with an increased risk of antiarrhythmic drug treatment. In neither cohort were there statistically significant differences for serum potassium values of ≥3.5<4.0 and a baseline of ≥4.0≤5.0mEq/L. The proportion of patients initiated on vasopressors or inotropes was over four-fold higher in those treated with one of the antiarrhythmic drugs in both cohorts. CONCLUSIONS: Serum potassium levels <3.5mEq/L were associated with an increased hazard for treatment with specific antiarrhythmic drugs in a large cohort of patients admitted to both a cardiac as well as medical and surgical intensive care units. Potassium thresholds may be individualized further based on risk of relevant outcomes.

Chest Pain During Chemotherapy: A Case of Severe Myocardial Bridging.

A cancer patient presented with acute chest pain at rest 40 hours after IV fluorouracil infusion. Angiography showed evidence of myocardial bridging.

Developing incrementality in filler-gap dependency processing.

Much work has demonstrated that children are able to use bottom-up linguistic cues to incrementally interpret sentences, but there is little understanding of the extent to which children's comprehension mechanisms are guided by top-down linguistic information that can be learned from distributional regularities in the input. Using a visual world eye tracking experiment and a corpus analysis, the current study investigates whether 5- and 6-year-old children incrementally assign interpretations to temporarily ambiguous wh-questions like What was Emily eating the cake with __? In the visual world eye-tracking experiment, adults demonstrated evidence for active dependency formation at the earliest region (i.e., the verb region), while 6-year-old children demonstrated a spill-over effect of this bias in the subsequent NP region. No evidence for this bias was found in 5-year-olds, although the speed of arrival at the ultimately correct instrument interpretation appears to be modulated by the vocabulary size. These results suggest that adult-like active formation of filler-gap dependencies begins to emerge around age 6. The corpus analysis of filler-gap dependency structures in adult corpora and child corpora demonstrate that the distributional regularities in either corpora are equally in favor of early, incremental completion of filler-gap dependencies, suggesting that the distributional information in the input is either not relevant to this incremental bias, or that 5-year-old children are somehow unable to recruit this information in real-time comprehension. Taken together, these findings shed light on the origin of the incremental processing bias in filler-gap dependency processing, as well as on the role of language experience and cognitive constraints in the development of incremental sentence processing mechanisms.

Looking forwards and backwards: The real-time processing of Strong and Weak Crossover.

We investigated the processing of pronouns in Strong and Weak Crossover constructions as a means of probing the extent to which the incremental parser can use syntactic information to guide antecedent retrieval. In Experiment 1 we show that the parser accesses a displaced wh-phrase as an antecedent for a pronoun when no grammatical constraints prohibit binding, but the parser ignores the same wh-phrase when it stands in a Strong Crossover relation to the pronoun. These results are consistent with two possibilities. First, the parser could apply Principle C at antecedent retrieval to exclude the wh-phrase on the basis of the c-command relation between its gap and the pronoun. Alternatively, retrieval might ignore any phrases that do not occupy an Argument position. Experiment 2 distinguished between these two possibilities by testing antecedent retrieval under Weak Crossover. In Weak Crossover binding of the pronoun is ruled out by the argument condition, but not Principle C. The results of Experiment 2 indicate that antecedent retrieval accesses matching wh-phrases in Weak Crossover configurations. On the basis of these findings we conclude that the parser can make rapid use of Principle C and c-command information to constrain retrieval. We discuss how our results support a view of antecedent retrieval that integrates inferences made over unseen syntactic structure into constraints on backward-looking processes like memory retrieval.

Novel Method for Exchange of Impella Circulatory Assist Catheter: The "Trojan Horse" Technique.

Patients with an indwelling Impella may require escalation of hemodynamic support or exchange to another circulatory assistance platform. As such, preservation of vascular access is preferable in cases where anticoagulation cannot be discontinued or to facilitate exchange to an alternative catheter or closure device. Challenges exist in avoiding bleeding and loss of wire access in these situations. We describe a single-access "Trojan Horse" technique that minimizes bleeding while maintaining arterial access for rapid exchange of this percutaneous ventricular assist device.

Advantages and pitfalls of pocket ultrasound vs daily chest radiography in the coronary care unit: A single-user experience.

BACKGROUND: Pocket ultrasonography may enhance patient diagnosis and care. We sought to assess pocket ultrasound in detecting common conditions in the coronary care unit (CCU) compared to portable daily chest radiography (CXR) and conventional transthoracic echocardiography (TTE). METHODS: An experienced pocket ultrasound user performed a pocket ultrasound examination for interstitial edema, pneumonia, central line seen in the right ventricle, pleural and pericardial effusions, left atrial enlargement, and cardiomegaly. Data were blindly compared to the radiologist CXR interpretation and cardiologist TTE interpretation. RESULTS: A total of 102 CXR and pocket ultrasound examinations were performed in 66 patients. The most common CXR indication was "interval change" (37%) and finding central line (65%). Pocket ultrasound demonstrated overall good concordance with CXR ranging from 77% for pleural effusion to 92% for pneumonia. Additionally, the pocket ultrasound examination appeared to anticipate resolution of pulmonary edema prior to the CXR. Compared to TTE, pocket ultrasound had excellent sensitivity for cardiac findings with values ranging from 85% for left atrial enlargement to 100% for cardiomegaly, but limited specificity of cardiomegaly at just 51%. CONCLUSION: In the CCU, bedside pocket ultrasound reliably diagnoses common conditions identified by CXR with the advantage of lack of ionizing radiation and the suggestion of detecting the resolution of pulmonary edema prior to CXR. Pitfalls include only modest concordance for pleural effusions and limited specificity for cardiomegaly. Larger, multicenter studies are needed to determine whether pocket ultrasound can reduce routine daily CXR in the CCU and other intensive care settings.

Coreference and antecedent representation across languages.

Previous studies have shown that speakers of languages such as German, Spanish, and French reactivate the syntactic gender of the antecedent of a pronoun to license gender agreement. As syntactic gender is assumed to be stored in the lexicon, this has motivated the claim that pronouns in these languages reactivate the lexical entry of their antecedent noun. In contrast, in languages without syntactic gender such as English, lexical retrieval might be unnecessary. We used eye-tracking while reading to examine whether antecedent retrieval involves rapid semantic and phonological reactivation. We compared German and English. In German, we found early sensitivity to the semantic but not to the phonological features of the pronoun's antecedent. In English, readers did not immediately show either semantic or phonological effects specific to coreference. We propose that early semantic facilitation arises due to syntactic gender reactivation, and that antecedent retrieval varies cross-linguistically depending on the type of information relevant to the grammar of each language. (PsycINFO Database Record

The logic of syntactic priming and acceptability judgments.

A critical flaw in Branigan & Pickering's (B&P's) advocacy of structural priming is the absence of a theory of priming. This undermines their claims about the value of priming as a methodology. In contrast, acceptability judgments enable clearer inferences about structure. It is important to engage thoroughly with the logic behind different structural diagnostics.

Bridging the Health Data Divide.

Fundamental quality, safety, and cost problems have not been resolved by the increasing digitization of health care. This digitization has progressed alongside the presence of a persistent divide between clinicians, the domain experts, and the technical experts, such as data scientists. The disconnect between clinicians and data scientists translates into a waste of research and health care resources, slow uptake of innovations, and poorer outcomes than are desirable and achievable. The divide can be narrowed by creating a culture of collaboration between these two disciplines, exemplified by events such as datathons. However, in order to more fully and meaningfully bridge the divide, the infrastructure of medical education, publication, and funding processes must evolve to support and enhance a learning health care system.

Negative polarity illusions and the format of hierarchical encodings in memory.

Linguistic illusions have provided valuable insights into how we mentally navigate complex representations in memory during language comprehension. Two notable cases involve illusory licensing of agreement and negative polarity items (NPIs), where comprehenders fleetingly accept sentences with unlicensed agreement or an unlicensed NPI, but judge those same sentences as unacceptable after more reflection. Existing accounts have argued that illusions are a consequence of faulty memory access processes, and make the additional assumption that the encoding of the sentence remains fixed over time. This paper challenges the predictions made by these accounts, which assume that illusions should generalize to a broader set of structural environments and a wider range of syntactic and semantic phenomena. We show across seven reading-time and acceptability judgment experiments that NPI illusions can be reliably switched "on" and "off", depending on the amount of time from when the potential licensor is processed until the NPI is encountered. But we also find that the same profile does not extend to agreement illusions. This contrast suggests that the mechanisms responsible for switching the NPI illusion on and off are not shared across all illusions. We argue that the contrast reflects changes over time in the encoding of the semantic/pragmatic representations that can license NPIs. Just as optical illusions have been informative about the visual system, selective linguistic illusions are informative not only about the nature of the access mechanisms, but also about the nature of the encoding mechanisms.

Locality and Word Order in Active Dependency Formation in Bangla.

Research on filler-gap dependencies has revealed that there are constraints on possible gap sites, and that real-time sentence processing is sensitive to these constraints. This work has shown that comprehenders have preferences for potential gap sites, and immediately detect when these preferences are not met. However, neither the mechanisms that select preferred gap sites nor the mechanisms used to detect whether these preferences are met are well-understood. In this paper, we report on three experiments in Bangla, a language in which gaps may occur in either a pre-verbal embedded clause or a post-verbal embedded clause. This word order variation allows us to manipulate whether the first gap linearly available is contained in the same clause as the filler, which allows us to dissociate structural locality from linear locality. In Experiment 1, an untimed ambiguity resolution task, we found a global bias to resolve a filler-gap dependency with the first gap linearly available, regardless of structural hierarchy. In Experiments 2 and 3, which use the filled-gap paradigm, we found sensitivity to disruption only when the blocked gap site is both structurally and linearly local, i.e., the filler and the gap site are contained in the same clause. This suggests that comprehenders may not show sensitivity to the disruption of all preferred gap resolutions.

Linguistic representations and memory architectures: The devil is in the details.

Attempts to explain linguistic phenomena as consequences of memory constraints require detailed specification of linguistic representations and memory architectures alike. We discuss examples of supposed locality biases in language comprehension and production, and their link to memory constraints. Findings do not generally favor Christiansen & Chater's (C&C's) approach. We discuss connections to debates that stretch back to the nineteenth century.