Bypass language en route to meaning at your peril.

The learning account of the puzzle of ideography cannot be dismissed as readily as Morin maintains, and is compatible with the standardization account. The reading difficulties of deaf and dyslexic individuals, who cannot easily form connections between written letter strings and spoken words, suggest limits to our ability to bypass speech and reliably access meaning directly from graphic symbols.

Braille literacy as a human right: A challenge to the "inefficiency" argument against braille instruction.

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) affirms a right to education for disabled persons and aims to ensure braille instruction for blind individuals. However, there is evidence that braille instruction is often circumvented or abandoned early in CRPD nations because it is perceived as an inefficient learning medium for blind students. This perception persists despite insufficient empirical evidence and a lack of understanding of the efficiency of reading versus listening for learning in sighted individuals. We therefore investigated the efficiency of learning written versus spoken words in blind and sighted samples. Participants (23 blind, 20 sighted) studied the written definitions of 70 rare English words in successive rounds, presented in conjunction with written or spoken wordforms. Blind participants learned with equal efficiency across modalities, whereas sighted participants learned spoken words more efficiently. The findings indicate the inefficiency argument against teaching braille is groundless, both because braille word learning is not less efficient than auditory word learning for blind individuals, and because reading is valued in the education of sighted individuals despite its apparent inefficiency in that population.

Benchmarking challenging small variants with linked and long reads.

Genome in a Bottle benchmarks are widely used to help validate clinical sequencing pipelines and develop variant calling and sequencing methods. Here we use accurate linked and long reads to expand benchmarks in 7 samples to include difficult-to-map regions and segmental duplications that are challenging for short reads. These benchmarks add more than 300,000 SNVs and 50,000 insertions or deletions (indels) and include 16% more exonic variants, many in challenging, clinically relevant genes not covered previously, such as PMS2. For HG002, we include 92% of the autosomal GRCh38 assembly while excluding regions problematic for benchmarking small variants, such as copy number variants, that should not have been in the previous version, which included 85% of GRCh38. It identifies eight times more false negatives in a short read variant call set relative to our previous benchmark. We demonstrate that this benchmark reliably identifies false positives and false negatives across technologies, enabling ongoing methods development.

Culture is not destiny, for reading: highlighting variable routes to literacy within writing systems.

Cross-writing system research in psychology and cognitive neuroscience has yielded important findings regarding how a writing system's structure can influence the cognitive challenges of learning to read and the neural underpinnings of literacy. The current paper reviews these differences and extends the findings to demonstrate diversity in how skilled reading is accomplished within a single writing system, English. We argue that broad clusters of behavioral and neural patterns found across writing systems can also be found within subpopulations who display atypical routes to skilled English reading, subpopulations including Chinese-English bilinguals, deaf native signers, compensated readers, and distortion-sensitive readers. The patterns of interest include a tradeoff between the degree of reliance on phonological and morphological processing for skilled reading, a shift in attentional focus from smaller to larger orthographic units, and enhanced bilaterality of neural processing during word reading. Lastly, we consider how understanding atypical routes to reading may apply to other writing systems.

Curated variation benchmarks for challenging medically relevant autosomal genes.

The repetitive nature and complexity of some medically relevant genes poses a challenge for their accurate analysis in a clinical setting. The Genome in a Bottle Consortium has provided variant benchmark sets, but these exclude nearly 400 medically relevant genes due to their repetitiveness or polymorphic complexity. Here, we characterize 273 of these 395 challenging autosomal genes using a haplotype-resolved whole-genome assembly. This curated benchmark reports over 17,000 single-nucleotide variations, 3,600 insertions and deletions and 200 structural variations each for human genome reference GRCh37 and GRCh38 across HG002. We show that false duplications in either GRCh37 or GRCh38 result in reference-specific, missed variants for short- and long-read technologies in medically relevant genes, including CBS, CRYAA and KCNE1. When masking these false duplications, variant recall can improve from 8% to 100%. Forming benchmarks from a haplotype-resolved whole-genome assembly may become a prototype for future benchmarks covering the whole genome.

The role of word knowledge in error detection: a challenge to the broken error monitor account of dyslexia.

Dyslexic children often fail to correct errors while reading aloud, and dyslexic adolescents and adults exhibit lower amplitudes of the error-related negativity (ERN)-the neural response to errors-than typical readers during silent reading. Past researchers therefore suggested that dyslexia may arise from a faulty error detection mechanism that interferes with orthographic learning and text comprehension. An alternative possibility is that comprehension difficulty in dyslexics is primarily a downstream effect of low-quality lexical representations-that is, poor word knowledge. On this view, the attenuated ERN in dyslexics is a byproduct, rather than a source, of underdeveloped orthographic knowledge. Because the second view implies a direct association of the error response with comprehension skill in populations of all ability levels, the present study evaluates these alternatives through a reanalysis of behavioral and neural data from 31 typical adult readers. If it is true that faulty error processing can manifest as dyslexia, a model in which error monitoring contributes directly to comprehension should outperform a model in which it does not. ERNs recorded during spelling judgments were used as a measure of error detection aptitude in path analyses of reading comprehension. The data were better fit by a model in which error detection aptitude was a consequence of word knowledge than a model in which it contributed directly to comprehension. The findings challenge the notion that comprehension difficulty in dyslexics is attributable to error processing deficits and are consistent with the hypothesis that comprehension difficulty in dyslexics is partially attributable to low-quality word knowledge.

Corticosteroids in Community-Acquired Pneumonia: A Review of Current Literature.

Objective: To review the evidence and recommendations for the use of adjunctive corticosteroid therapy in community-acquired pneumonia (CAP). Data Sources: A literature search was conducted using PubMed (1993 to November 2020) using the search terms corticosteroids AND community-acquired pneumonia. Study Selection and Data Extraction: Pertinent randomized controlled trials, systematic reviews, and meta-analyses assessing the efficacy and safety of adjunctive corticosteroids in patients with pneumonia were evaluated for inclusion. Data Synthesis: Studies suggest that corticosteroids reduce time to clinical stability and length of hospital stay, but data regarding other important clinical outcomes, such as mortality, are limited. The greatest margin of benefit appears to be in patients with severe CAP. Evidence consistently demonstrates hyperglycemia as the most common adverse effect of corticosteroid therapy in CAP. Safety concerns regarding the potential impact of corticosteroids on the rate of CAP-related rehospitalizations require further investigation. Relevance to Patient Care and Clinical Practice: This review summarizes literature evaluating the efficacy and safety of adjunctive corticosteroids in patients with CAP. It also includes a discussion on current guideline recommendations, patient selection, corticosteroid regimens, adverse effect considerations, limitations, and future directions in this area of research. Conclusions: Studies reviewed suggest that corticosteroids are relatively beneficial and safe in patients with CAP, with the greatest benefit in severe CAP. Currently, the routine use of corticosteroids is not recommended by clinical practice guidelines with the exception of CAP and refractory septic shock. Further research is needed to better define the ideal role of corticosteroids in CAP.

Reference standards for accurate validation and optimization of assays that determine integrated lentiviral vector copy number in transduced cells.

Lentiviral vectors (LV) have emerged as a robust technology for therapeutic gene delivery into human cells as advanced medicinal products. As these products are increasingly commercialized, there are concomitant demands for their characterization to ensure safety, efficacy and consistency. Standards are essential for accurately measuring parameters for such product characterization. A critical parameter is the vector copy number (VCN) which measures the genetic dose of a transgene present in gene-modified cells. Here we describe a set of clonal Jurkat cell lines with defined copy numbers of a reference lentiviral vector integrated into their genomes. Genomic DNA was characterized for copy number, genomic integrity and integration coordinates and showed uniform performance across independent quantitative PCR assays. Stability studies during continuous long-term culture demonstrated sustained renewability of the reference standard source material. DNA from the Jurkat VCN standards would be useful for control of quantitative PCR assays for VCN determination in LV gene-modified cellular products and clinical samples.

Performance of non-laboratory staff for diagnostic testing and specimen collection in HIV programs: A systematic review and meta-analysis.

BACKGROUND: In most high HIV burden countries, many HIV patients do not have reliable access to required diagnostic laboratory tests. Task shifting of clinical tasks to lower cadres of health care workers and lay counselors has been successful in scaling up treatment for HIV and may also be an effective strategy in expanding access to essential diagnostic testing. METHODS: We screened major electronic databases between 1 January 2005 to 26 August 2018 to identify studies assessing ease of use and accuracy of task shifting of HIV-related diagnostic testing and/or specimen collection to non-laboratory health staff. Two independent reviewers screened all titles and abstracts for studies that analyzed diagnostic accuracy, patient impact, ease-of-use, or cost-effectiveness. Studies were assessed for quality, bias, and applicability following the QUADAS-2 framework. We generated summary estimates using random-effects meta-analyses. RESULTS: We identified 42 relevant studies. Overall, point-of-care CD4 testing performed by non-laboratory staff had a mean bias of -54.44 (95% CI: -72.40 --36.48) compared to conventional laboratory-based. Though studies were limited, the diagnostic accuracy of point-of-care alanine transaminase enzyme (ALT) and hemoglobin testing performed by non-laboratory staff was comparable to conventional laboratory-based testing by laboratory professionals. Point-of-care testing and/or specimen collection were generally found to be acceptable and easy to use for non-laboratory staff. CONCLUSIONS: Task shifting of testing using point-of-care technologies to non-laboratory staff was comparable to laboratory professionals operating the same technology in the laboratory. Some variability was observed comparing the performance of point-of-care CD4 testing by non-laboratory staff to conventional laboratory-based technologies by laboratory professionals indicating potential lower performance was likely technological rather than operator caused. The benefits of task shifting of testing may outweigh any possible harms as task shifting allows for increased decentralization, access of specific diagnostics, and faster result delivery.

Impact of SMS/GPRS Printers in Reducing Time to Early Infant Diagnosis Compared With Routine Result Reporting: A Systematic Review and Meta-Analysis.

BACKGROUND: Despite significant gains made toward improving access, early infant diagnosis (EID) testing programs suffer from long test turnaround times that result in substantial loss to follow-up and mortality associated with delays in antiretroviral therapy initiation. These delays in treatment initiation are particularly impactful because of significant HIV-related infant mortality observed by 2-3 months of age. Short message service (SMS) and general packet radio service (GPRS) printers allow test results to be transmitted immediately to health care facilities on completion of testing in the laboratory. METHODS: We conducted a systematic review and meta-analysis to assess the benefit of using SMS/GPRS printers to increase the efficiency of EID test result delivery compared with traditional courier paper-based results delivery methods. RESULTS: We identified 11 studies contributing data for over 16,000 patients from East and Southern Africa. The test turnaround time from specimen collection to result received at the health care facility with courier paper-based methods was 68.0 days (n = 6835), whereas the test turnaround time with SMS/GPRS printers was 51.1 days (n = 6711), resulting in a 2.5-week (25%) reduction in the turnaround time. CONCLUSIONS: Courier paper-based EID test result delivery methods are estimated to add 2.5 weeks to EID test turnaround times in low resource settings and increase the risk that infants receive test results during or after the early peak of infant mortality. SMS/GPRS result delivery to health care facility printers significantly reduced test turnaround time and may reduce this risk. SMS/GPRS printers should be considered for expedited delivery of EID and other centralized laboratory test results.

Individual Differences in Phonological Feedback Effects: Evidence for the Orthographic Recoding Hypothesis of Orthographic Learning.

Share (1995) has proposed phonological recoding (the translation of letters into sounds) as a self-teaching mechanism through which readers establish complete lexical representations. More recently, McKague et al. (2008) proposed a similar role for orthographic recoding, i.e., feedback from sounds to letters, in building and refining lexical representations. We reasoned that an interaction between feedback consistency measures and spelling ability in a spelling decision experiment would lend support to this hypothesis. In a linear mixed effects logistic regression of accuracy data this interaction was significant. Better spellers but not poorer spellers were immune to feedback effects in deciding if a word is spelled correctly, which is consistent with McKague et al.'s prediction that the impact of phonological feedback on word recognition will diminish when the orthographic representation for an item is fully specified. The study demonstrates the importance of considering individual differences when investigating the role of phonology in reading.

POC CD4 Testing Improves Linkage to HIV Care and Timeliness of ART Initiation in a Public Health Approach: A Systematic Review and Meta-Analysis.

BACKGROUND: CD4 cell count is an important test in HIV programs for baseline risk assessment, monitoring of ART where viral load is not available, and, in many settings, antiretroviral therapy (ART) initiation decisions. However, access to CD4 testing is limited, in part due to the centralized conventional laboratory network. Point of care (POC) CD4 testing has the potential to address some of the challenges of centralized CD4 testing and delays in delivery of timely testing and ART initiation. We conducted a systematic review and meta-analysis to identify the extent to which POC improves linkages to HIV care and timeliness of ART initiation. METHODS: We searched two databases and four conference sites between January 2005 and April 2015 for studies reporting test turnaround times, proportion of results returned, and retention associated with the use of point-of-care CD4. Random effects models were used to estimate pooled risk ratios, pooled proportions, and 95% confidence intervals. RESULTS: We identified 30 eligible studies, most of which were completed in Africa. Test turnaround times were reduced with the use of POC CD4. The time from HIV diagnosis to CD4 test was reduced from 10.5 days with conventional laboratory-based testing to 0.1 days with POC CD4 testing. Retention along several steps of the treatment initiation cascade was significantly higher with POC CD4 testing, notably from HIV testing to CD4 testing, receipt of results, and pre-CD4 test retention (all p<0.001). Furthermore, retention between CD4 testing and ART initiation increased with POC CD4 testing compared to conventional laboratory-based testing (p = 0.01). We also carried out a non-systematic review of the literature observing that POC CD4 increased the projected life expectancy, was cost-effective, and acceptable. CONCLUSIONS: POC CD4 technologies reduce the time and increase patient retention along the testing and treatment cascade compared to conventional laboratory-based testing. POC CD4 is, therefore, a useful tool to perform CD4 testing and expedite result delivery.

Lexical Stress and Linguistic Predictability Influence Proofreading Behavior.

There is extensive evidence that the segmental (i.e., phonemic) layer of phonology is routinely activated during reading, but little is known about whether phonological activation extends beyond phonemes to subsegmental layers (which include articulatory information, such as voicing) and suprasegmental layers (which include prosodic information, such as lexical stress). In three proofreading experiments, we show that spelling errors are detected more reliably in syllables that are stressed than in syllables that are unstressed if comprehension is a goal of the reader, indicating that suprasegmental phonology is both active during silent reading and can influence orthographic processes. In Experiment 1, participants received instructions to read for both errors and comprehension, and we found that the effect of lexical stress interacted with linguistic predictability, such that detection of errors in more predictable words was aided by stress but detection of errors in less predictable words was not. This finding suggests that lexical stress patterns can be accessed prelexically if an upcoming word is sufficiently predictable from context. Participants with stronger vocabularies showed decreased effects of stress on task performance, which is consistent with previous findings that more skilled readers are less swayed by phonological information in decisions about orthographic form. In two subsequent experiments, participants were instructed to read only for errors (Experiment 2) or only for comprehension (Experiment 3); the effect of stress disappeared when participants read for errors and reappeared when participants read for comprehension, reconfirming our hypothesis that predictability is a driver of lexical stress effects. In all experiments, errors were detected more reliably in words that were difficult to predict from context than in words that were highly predictable. Taken together, this series of experiments contributes two important findings to the field of reading and cognition: (1) The prosodic property of lexical stress can influence orthographic processing, and (2) Predictability inhibits the detection of errors in written language processing.

Transverse vs torsional ultrasound: prospective randomized contralaterally controlled study comparing two phacoemulsification-system handpieces.

PURPOSE: To compare surgical efficiency and multiple early clinical outcome variables in eyes undergoing phacoemulsification using either transversal or torsional ultrasound systems. SETTING: Assil Eye Institute, Beverly Hills, CA, USA. DESIGN: Prospective, randomized, clinician-masked, contralaterally controlled single-center evaluation. PATIENTS AND METHODS: Patients seeking cataract removal in both eyes with implantation of multifocal intraocular lenses were randomly assigned to one of two treatment rooms for phacoemulsification with either a transverse ultrasound system or torsional handpiece system. The contralateral eye was treated at a later date with the alternate device. A total of 54 eyes of 27 patients having similar degrees of cataract, astigmatism, and visual potential were included. All operative data were collected for analysis, and patients were followed for 3 months after surgery. RESULTS: Similar visual acuity was reported at all postoperative visits between the two groups. Mean phacoemulsification time and total power required were both significantly lower with the transverse system than with the torsional technique (P<0.05 for both). Similarly, mean total balanced salt solution used was significantly less with the transverse system vs torsional (P<0.05). Postoperative safety demonstrated significantly lower endothelial cell loss at 1 day and 1 month (P<0.05) with transverse vs torsional. Macular swelling was less at 1 week, 1 month, and 3 months with transverse vs torsional, although the difference did not achieve significance (P=0.1) at any single time point. Clinically detectable corneal edema was reported less frequently at all postoperative time points with the transverse system. CONCLUSION: The transverse ultrasound system was found to be possibly associated with less balanced salt-solution use, less phacoemulsification time, and less power required than the torsional phaco system. Postoperative data suggested that improved phaco efficiency may translate to a better overall safety profile for the patient.

Perioperative glucocorticoid prescribing habits in patients with inflammatory bowel disease: a call for standardization.

IMPORTANCE: High-dose glucocorticoids (GCs) are routinely given to surgical patients with a history of GC exposure to prevent perioperative acute adrenal insufficiency, but this practice is not well supported. OBJECTIVE: To evaluate the variability of perioperative GC dosing among patients with inflammatory bowel disease (IBD) undergoing major abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective study of 49 patients with IBD undergoing colorectal surgery at a single institution between July 2010 and August 2011. Data on patient comorbidities, intraoperative risk factors, surgical site infections, and 30-day readmission rates were prospectively collected from the National Surgical Quality Improvement Program. Preoperative GC exposure at the time of the index admission and perioperative GC therapy during admission were collected by review of the medical records. Patients were divided into 3 groups at the time of surgery: (1) 1 week or more of prior GC exposure, not receiving maintenance therapy (n = 15); (2) currently receiving budesonide (n = 10); and (3) currently receiving oral prednisone (n = 24). MAIN OUTCOMES AND MEASURES: Perioperative GC exposure was the main outcome. Qualitative comparisons of perioperative exposure stratified by preoperative GC exposure were done. A multivariate logistic regression analysis was performed to determine significant differences in surgical site infection and 30-day readmission rates among patients with and without perioperative GC exposure. RESULTS: Overall, 38 of 49 patients (78%) received perioperative GCs; intraoperative GCs were administered to 35 of 49 patients (71%), and 33 of 49 patients (67%) received postoperative GCs. Patients received intraoperative and postoperative GCs, respectively, as follows: 8 patients (53%) and 7 (47%) in group 1, 7 (70%) and 3 (30%) in group 2, and 20 (83%) and 23 (96%) in group 3. The median intraoperative GC dose was 100 mg (range, 50-267 mg of hydrocortisone or hydrocortisone equivalent for dexamethasone); the median total postoperative GC dose for the first 5 days after surgery was 485 mg (range, 50-890 mg of hydrocortisone or hydrocortisone equivalent for prednisone). The median duration of postoperative GC administration was 3 days for group 1, 6 days for group 2, and 7 days for group 3. No statistically significant difference in surgical site infection and 30-day readmission rates was detected in the GC exposure vs no-exposure groups. CONCLUSIONS AND RELEVANCE: Perioperative GC dosing among patients with IBD undergoing colorectal surgery is highly variable even within a single center. Additional studies are needed to define the risk of postoperative adrenal insufficiency and establish standardized practices for perioperative GC therapy, which may have the benefit of reducing GC overuse.

Error-related negativities during spelling judgments expose orthographic knowledge.

In two experiments, we demonstrate that error-related negativities (ERNs) recorded during spelling decisions can expose individual differences in lexical knowledge. The first experiment found that the ERN was elicited during spelling decisions and that its magnitude was correlated with independent measures of subjects' spelling knowledge. In the second experiment, we manipulated the phonology of misspelled stimuli and observed that ERN magnitudes were larger when misspelled words altered the phonology of their correctly spelled counterparts than when they preserved it. Thus, when an error is made in a decision about spelling, the brain processes indexed by the ERN reflect both phonological and orthographic input to the decision process. In both experiments, ERN effect sizes were correlated with assessments of lexical knowledge and reading, including offline spelling ability and spelling-mediated vocabulary knowledge. These results affirm the interdependent nature of orthographic, semantic, and phonological knowledge components while showing that spelling knowledge uniquely influences the ERN during spelling decisions. Finally, the study demonstrates the value of ERNs in exposing individual differences in lexical knowledge.

Comparison of intensive care unit medication errors reported to the United States' MedMarx and the United Kingdom's National Reporting and Learning System: a cross-sectional study.

The objective was to compare the characteristics of medication errors reported to 2 national error reporting systems by conducting a cross-sectional analysis of errors reported from adult intensive care units to the UK National Reporting and Learning System and the US MedMarx system. Outcome measures were error types, severity of patient harm, stage of medication process, and involved medications. The authors analyzed 2837 UK error reports and 56 368 US reports. Differences were observed between UK and US errors for wrong dose (44% vs 29%), omitted dose (8.6% vs 27%), and stage of medication process (prescribing: 14% vs 49%; administration: 71% vs 42%). Moderate/severe harm or death was reported in 4.9% of UK versus 3.4% of US errors. Gentamicin was cited in 7.4% of the UK versus 0.7% of the US reports (odds ratio = 9.25). There were differences in the types of errors reported and the medications most often involved. These differences warrant further examination.

Behavioral responses of batoid elasmobranchs to prey-simulating electric fields are correlated to peripheral sensory morphology and ecology.

Electrosensory pore number, distribution, and sensitivity to prey-simulating electric fields have been described for many shark species. Electrosensory systems in batoids have received much less attention. Pore number and distribution have yet to be correlated to differences in sensitivity. However, pore number, pore distribution and sensitivity have been linked to behavior, diet, and morphology and follow species-specific trends. We report here that cownose rays have a greater number of pores than the yellow stingray, most of which are concentrated on the anterior ventral surface for both species. However, yellow stingrays have a broader arrangement of pores on both their dorsal and ventral surfaces than the cownose rays. Yellow stingrays demonstrated a median behavioral sensitivity to weak electric fields of 22nVcm(-1) and are among the most highly sensitive batoids studied to date. Cownose rays are less sensitive than all other elasmobranch species with a median sensitivity of 107nVcm(-1). As reported in previous studies, a higher pore number did not result in greater sensitivity. Cownose rays are benthopelagic schooling rays and may benefit from reduced sensitivity to bioelectric fields when they are surrounded by the bioelectric fields of conspecifics. Yellow stingrays, on the other hand, are typically solitary and bury in the substrate. A greater number of pores on their dorsal surface might improve detection of predators above them. Also, increased sensitivity and a broader distribution of pores may be beneficial as small prey items move past a buried ray.

Early stage visual-orthographic processes predict long-term retention of word form and meaning: a visual encoding training study.

Adult learners of Chinese learned new characters through writing, visual chunking or reading-only. Following training, ERPs were recorded during character recognition tasks, first shortly after the training and then three months later. We hypothesized that the character training effects would be seen in ERP components associated with word recognition and episodic memory. Results confirmed a larger N170 for visual chunking training than other training and a larger P600 for learned characters than novel characters. Another result was a training effect on the amplitude of the P100, which was greater following writing training than other training, suggesting that writing training temporarily lead to increased visual attention to the orthographic forms. Furthermore, P100 amplitude at the first post-test was positively correlated with character recall 3 months later. Thus the marker of early visual attention (P100) was predictive of retention of orthographic knowledge acquired in training.

Changing trends in the use of seizure prophylaxis after traumatic brain injury: a shift from phenytoin to levetiracetam.

PURPOSE: Current guidelines for traumatic brain injury (TBI) recommend antiepileptic drugs (AEDs) for 7 days after injury to decrease posttraumatic seizure risk. Phenytoin decreases seizure risk 73% vs placebo during this time. Levetiracetam (LEV) is an alternative; however, no published data validate comparable efficacy. Our objective was to evaluate seizure incidence 7 days after TBI in patients treated with phenytoin (PHT) vs LEV and to characterize practice of AED selection. METHODS: A retrospective observational study was conducted using a Trauma Registry (Collector Trauma Registry; Digital Innovation, Inc, Forrest Hill, Md) to evaluate patients with TBI. Patients with an initial Head/Neck Abbreviated Injury Scale score of 3 or higher and a Glasgow Coma Scale of 8 or less were included. RESULTS: Of 109 patients, 89 received PHT, and 20, LEV. Two patients experienced posttraumatic seizure, 1 in each group. Sixty-eight patients survived to hospital discharge; 65% received prophylactic AED greater than 7 days. Ninety-eight percent of 81 patients admitted between 2000 and 2007 received PHT, whereas 64% of 28 patients admitted between 2008 and 2010 received LEV. CONCLUSION: Only 2 patients experienced posttraumatic seizure after receiving AED, indicating low incidence. Most surviving to hospital discharge received AED prophylaxis greater than 7 days despite guideline recommendations. After approval of intravenous LEV, a trend favoring LEV was observed.