bluuebunny/crossref_metadata_2025 huggingface dataset:
A Characterization of Projective Special Unitary Group U3(7) by nse
Authors: Liu Shitian
Published: August 2013

Let G a group and ω(G) be the set of element orders of G. Let k∈ω(G) and let sk be the number of elements of order k in G. Let nse(G)={sk∣k∈ω(G)}. In Khatami et al. and Liu's works, L3(2) and L3(4) are uniquely determined by nse(G). In this paper, we prove that if G is a group such that nse(G) = nse(U3(7)), then G≅U3(7).
Design and Evaluation of a Direct Drive Valve Actuated by Piezostack Actuator
Authors: Jeon Juncheol , Nguyen Quoc-Hung , Han Young-Min , Choi Seung-Bok
Published: August 2013

This paper presents performance characteristics of a new type of direct drive valve (DDV) system driven by a piezostack actuator. The flexible beam mechanism is employed to amplify the output displacement from the piezostack actuator. After describing the operational principle of the proposed piezo DDV system, the governing equation of the whole piezo DDV system is then obtained by integrating the equations of the valve components. Based on the proposed model, significant structural components of the piezo DDV system are designed in order to achieve operational requirements (operating frequency: over 100 Hz; flow rate: 20 liter/Min.). An optimal design method is proposed for obtaining the geometry of the flexible beam mechanism by considering spool displacement, required operating frequency, and available space of the valve. After deciding the specific geometric dimensions of the piezo DDV system, a PID control algorithm is designed to enforce the spool position to the desired position trajectories by activating the piezostack actuator. Characteristics and control performances of the proposed piezo DDV system are evaluated using the MATLAB Simulink.
The p90 RSK Family Members: Common Functions and Isoform Specificity
Authors: Lara Romain , Seckl Michael J. , Pardo Olivier E.
Published: August 2013

The p90 ribosomal S6 kinases (RSK) are implicated in various cellular processes, including cell proliferation, survival, migration, and invasion. In cancer, RSKs modulate cell transformation, tumorigenesis, and metastasis. Indeed, changes in the expression of RSK isoforms have been reported in several malignancies, including breast, prostate, and lung cancers. Four RSK isoforms have been identified in humans on the basis of their high degree of sequence homology. Although this similarity suggests some functional redundancy between these proteins, an increasing body of evidence supports the existence of isoform-based specificity among RSKs in mediating particular cellular processes. This review briefly presents the similarities between RSK family members before focusing on the specific function of each of the isoforms and their involvement in cancer progression. Cancer Res; 73(17); 5301–8. ©2013 AACR.
Therapeutic PD-1 Pathway Blockade Augments with Other Modalities of Immunotherapy T-Cell Function to Prevent Immune Decline in Ovarian Cancer
Authors: Duraiswamy Jaikumar , Freeman Gordon J. , Coukos George
Published: August 2013

The tumor microenvironment mediates induction of the immunosuppressive programmed cell death-1 (PD-1) pathway, and targeted interventions against this pathway can help restore antitumor immunity. To gain insight into these responses, we studied the interaction between PD-1 expressed on T cells and its ligands (PD-1:PD-L1, PD-1:PD-L2, and PD-L1:B7.1), expressed on other cells in the tumor microenvironment, using a syngeneic orthotopic mouse model of epithelial ovarian cancer (ID8). Exhaustion of tumor-infiltrating lymphocytes (TIL) correlated with expression of PD-1 ligands by tumor cells and tumor-derived myeloid cells, including tumor-associated macrophages (TAM), dendritic cells, and myeloid-derived suppressor cells (MDSC). When combined with GVAX or FVAX vaccination (consisting of irradiated ID8 cells expressing granulocyte macrophage colony—stimulating factor or FLT3 ligand) and costimulation by agonistic α-4-1BB or TLR 9 ligand, antibody-mediated blockade of PD-1 or PD-L1 triggered rejection of ID8 tumors in 75% of tumor-bearing mice. This therapeutic effect was associated with increased proliferation and function of tumor antigen-specific effector CD8+ T cells, inhibition of suppressive regulatory T cells (Treg) and MDSC, upregulation of effector T-cell signaling molecules, and generation of T memory precursor cells. Overall, PD-1/PD-L1 blockade enhanced the amplitude of tumor immunity by reprogramming suppressive and stimulatory signals that yielded more powerful cancer control. Cancer Res; 73(23); 6900–12. ©2013 AACR.
The G-Protein–Coupled Receptor CLR Is Upregulated in an Autocrine Loop with Adrenomedullin in Clear Cell Renal Cell Carcinoma and Associated with Poor Prognosis
Authors: Nikitenko Leonid L. , Leek Russell , Henderson Stephen , Pillay Nischalan , Turley Helen , Generali Daniele , Gunningham Sarah , Morrin Helen R. , Pellagatti Andrea , Rees Margaret C.P. , Harris Adrian L. , Fox Stephen B.
Published: August 2013

Purpose: The G-protein–coupled receptor (GPCR) calcitonin receptor-like receptor (CLR) and its ligand peptide adrenomedullin (encoded by ADM gene) are implicated in tumor angiogenesis in mouse models but poorly defined in human cancers. We therefore investigated the diagnostic/prognostic use for CLR in human tumor types that may rely on adrenomedullin signaling and in clear cell renal cell carcinoma (RCC), a highly vascular tumor, in particular.

Experimental Design: In silico gene expression mRNA profiling microarray study (n = 168 tumors) and cancer profiling cDNA array hybridization (n = 241 pairs of patient-matched tumor/normal tissue samples) were carried out to analyze ADM mRNA expression in 13 tumor types. Immunohistochemistry on tissue microarrays containing patient-matched renal tumor/normal tissues (n = 87 pairs) was conducted to study CLR expression and its association with clinicopathologic parameters and disease outcome.

Results: ADM expression was significantly upregulated only in RCC and endometrial adenocarcinoma compared with normal tissue counterparts (P < 0.01). CLR was localized in tumor cells and vessels in RCC and upregulated as compared with patient-matched normal control kidney (P < 0.001). Higher CLR expression was found in advanced stages (P < 0.05), correlated with high tumor grade (P < 0.01) and conferred shorter overall survival (P < 0.01).

Conclusions: In human tissues ADM expression is upregulated in cancer type–specific manner, implicating potential role for adrenomedullin signaling in particular in RCC, where CLR localization suggests autocrine/paracrine mode for adrenomedullin action within the tumor microenvironment. Our findings reveal previously unrecognized CLR upregulation in an autocrine loop with adrenomedullin in RCC with potential application for this GPCR as a target for future functional studies and drug development. Clin Cancer Res; 19(20); 5740–8. ©2013 AACR.
Long-Term Speech and Language Outcomes in Prelingually Deaf Children, Adolescents and Young Adults Who Received Cochlear Implants in Childhood
Authors: Ruffin Chad V. , Kronenberger William G. , Colson Bethany G. , Henning Shirley C. , Pisoni David B.
Published: August 2013

This study investigated long-term speech and language outcomes in 51 prelingually deaf children, adolescents and young adults who received cochlear implants (CIs) prior to 7 years of age and had used their implants for at least 7 years. Average speech perception scores were similar to those found in prior research with other samples of experienced CI users. Mean language test scores were lower than norm-referenced scores from nationally representative normal-hearing, typically developing samples, although a majority of the CI users scored within 1 standard deviation of the normative mean or higher on the Peabody Picture Vocabulary Test, Fourth Edition (63%), and the Clinical Evaluation of Language Fundamentals, Fourth Edition (69%). Speech perception scores were negatively associated with a meningitic etiology of hearing loss, older age at implantation, poorer preimplant unaided pure-tone average thresholds, lower family income and the use of ‘total communication'. Subjects who had used CIs for 15 years or more were more likely to have these characteristics and were more likely to score lower on measures of speech perception compared to those who had used CIs for 14 years or less. The aggregation of these risk factors in the >15 years of CI use subgroup accounts for their lower speech perception scores and may stem from more conservative CI candidacy criteria in use at the beginning of pediatric cochlear implantation.
Antagonists to the Wnt Cascade Exhibit Sex-Specific Expression in Gonads of Sexually Mature Shovelnose Sturgeon
Authors: Amberg J.J. , Goforth R.R. , Sepúlveda M.S.
Published: August 2013

Little is known regarding molecular mechanisms involved in sex determination and differentiation in sturgeon species. We addressed this knowledge gap by using next generation pyrosequencing technology to provide transcript libraries and species-specific sequences for mature gonads of shovelnose sturgeon, Scaphirhynchus platorynchus. We then mined these libraries to identify gender-specific transcripts and quantified relative transcript abundance using quantitative real-time polymerase chain reaction (qPCR). We detected a limited number of genes known to play a role in sex differentiation in other species. The sequence for dmrt1 was found only in the testes library. The abundance of dmrt1 differed slightly between the sexes, but the melt curve suggests that there may be different isoforms of dmrt1 in ovaries and testes of shovelnose sturgeon. The transcription factor foxl2 was 5.3-fold greater in ovaries than in testes. Two antagonists to the Wnt cascade, dickkopf-1 (dkk1) and dapper-1 (dact1), were found only in the ovary library. Results from qPCR indicated that dkk1 and dact1 were upregulated 1,819.1- and 207.5-fold, respectively, in ovaries compared with testes. These results suggest that antagonists to the Wnt cascade may play significant roles in sex differentiation and gonadal development in sturgeon and could serve as sex markers in this group of ancient fish.
Capillary Endothelial Fatty Acid Binding Proteins 4 and 5 Play a Critical Role in Fatty Acid Uptake in Heart and Skeletal Muscle
Authors: Iso Tatsuya , Maeda Kazuhisa , Hanaoka Hirofumi , Suga Toshihiro , Goto Kosaku , Syamsunarno Mas Rizky A.A , Hishiki Takako , Nagahata Yoshiko , Matsui Hiroki , Arai Masashi , Yamaguchi Aiko , Abumrad Nada A. , Sano Motoaki , Suematsu Makoto , Endo Keigo , Hotamisligil Gökhan S. , Kurabayashi Masahiko
Published: August 2013

Objective—

Fatty acids (FAs) are the major substrate for energy production in the heart. Here, we hypothesize that capillary endothelial fatty acid binding protein 4 (FABP4) and FABP5 play an important role in providing sufficient FAs to the myocardium.

Approach and Results—

Both FABP4/5 were abundantly expressed in capillary endothelium in the heart and skeletal muscle. The uptake of a FA analogue, 125I-15-(
p
-iodophenyl)-3-(R,S)-methyl pentadecanoic acid, was significantly reduced in these tissues in double-knockout (DKO) mice for FABP4/5 compared with wild-type mice. In contrast, the uptake of a glucose analogue, 18F-fluorodeoxyglucose, was remarkably increased in DKO mice. The expression of transcripts for the oxidative catabolism of FAs was reduced during fasting, whereas transcripts for the glycolytic pathway were not altered in DKO hearts. Notably, metabolome analysis revealed that phosphocreatine and ADP levels were significantly lower in DKO hearts, whereas ATP content was kept at a normal level. The protein expression levels of the glucose transporter Glut4 and the phosphorylated form of phosphofructokinase-2 were increased in DKO hearts, whereas the phosphorylation of insulin receptor-β and Akt was comparable between wild-type and DKO hearts during fasting, suggesting that a dramatic increase in glucose usage during fasting is insulin independent and is at least partly attributed to the post-transcriptional and allosteric regulation of key proteins that regulate glucose uptake and glycolysis.

Conclusions—

Capillary endothelial FABP4/5 are required for FA transport into FA-consuming tissues that include the heart. These findings identify FABP4/5 as promising targets for controlling the metabolism of energy substrates in FA-consuming organs that have muscle-type continuous capillary.
Saturated Fatty Acid Palmitate Aggravates Neointima Formation by Promoting Smooth Muscle Phenotypic Modulation
Authors: Shen Hua , Eguchi Kosei , Kono Nozomu , Fujiu Katsuhito , Matsumoto Sahohime , Shibata Munehiko , Oishi-Tanaka Yumiko , Komuro Issei , Arai Hiroyuki , Nagai Ryozo , Manabe Ichiro
Published: August 2013

Objective—

Obesity is a major risk factor of atherosclerotic cardiovascular disease. Circulating free fatty acid levels are known to be elevated in obese individuals and, along with dietary saturated fatty acids, are known to associate with cardiovascular events. However, little is known about the molecular mechanisms by which free fatty acids are linked to cardiovascular disease.

Approach and Results—

We found that administration of palmitate, a major saturated free fatty acid, to mice markedly aggravated neointima formation induced by carotid artery ligation and that the neointima primarily consisted of phenotypically modulated smooth muscle cells (SMCs). In cultured SMCs, palmitate-induced phenotypic modulation was characterized by downregulation of SMC differentiation markers, such as SM α-actin and SM-myosin heavy chain, and upregulation of mediators involved in inflammation and remodeling of the vessel wall, such as platelet-derived growth factor B and matrix metalloproteinases. We also found that palmitate induced the expression of proinflammatory genes via a novel toll-like receptor 4/myeloid differentiation primary response 88/nuclear factor-κB/NADPH oxidase 1/reactive oxygen species signaling pathway: nuclear factor-κB was activated by palmitate via toll-like receptor 4 and its adapter, MyD88, and once active, it transactivated
Nox1
, encoding NADPH oxidase 1, a major reactive oxygen species generator in SMCs. Pharmacological inhibition and small interfering RNA–mediated knockdown of the components of this signaling pathway mitigated the palmitate-induced upregulation of proinflammatory genes. More importantly,
Myd88
knockout mice were resistant to palmitate-induced exacerbation of neointima formation.

Conclusions—

Palmitate seems to promote neointima formation by inducing inflammatory phenotypes in SMCs.
Expansion of the NKG2C+ Natural Killer–Cell Subset Is Associated With High-Risk Carotid Atherosclerotic Plaques in Seropositive Patients for Human Cytomegalovirus
Authors: Martínez-Rodríguez Jose Enrique , Munné-Collado Jessica , Rasal Raquel , Cuadrado Elisa , Roig Luis , Ois Angel , Muntasell Aura , Baro Teresa , Alameda Francesc , Roquer Jaume , López-Botet Miguel
Published: August 2013

Objective—

Human cytomegalovirus (HCMV), a pathogen involved in the development and progression of atherosclerosis, promotes in some individuals a marked reconfiguration of the natural killer (NK)–cell compartment whose hallmark is a persistent expansion of a peripheral blood NK-cell subset expressing the CD94/NKG2C NK receptor. We aimed to evaluate whether the HCMV-associated NK-cell compartment reconfiguration is related to carotid atherosclerotic plaque (CAP) instability.

Approach and Results—

NK receptor expression (ie, LILRB1, NKG2A, NKG2C, and killer immunoglobulin-like receptors [KIR]) by peripheral NK and T cells was evaluated in 40 patients with HCMV+ with CAP, including nonatherosclerotic strokes (n=15) and healthy subjects (n=11) as controls. High-risk CAP (n=16), defined as carotid stenosis >50% with ipsilateral neurological symptomatology in the previous 180 days, compared with non–high-risk CAP had higher %NKG2C+ NK cells (29.5±22.4% versus 16.3±13.2%;
P
=0.026; odds ratio, 1.053; 95% confidence interval, 1.002–1.106;
P
=0.042), with a corresponding reduction in the NKG2A+ NK subset (31.7±17.8% versus 41.8±15.8%;
P
=0.072). The proportions of NKG2C+ NK cells in high-risk CAP were inversely correlated with the CD4+/CD8+ ratio (
R
Spearman
=−0.629;
P
=0.009) and directly with high-sensitivity C-reactive protein levels (
R
Pearson
=0.591;
P
=0.012), consistent with higher subclinical systemic inflammation. The intraplaque inflammatory infiltrate, evaluated in 27 CAP obtained after endarterectomy, showed a higher presence of subintimal CD3+ lymphocytes in those patients with HCMV-induced changes in the peripheral NK- and T-cell compartments.

Conclusions—

The expansion of NKG2C+ NK cells in patients with CAP seems to be associated with an increased risk of plaque destabilization in some patients with chronic HCMV infection.
Smoking as a Risk Factor for Stroke in Women Compared With Men
Authors: Peters Sanne A.E. , Huxley Rachel R. , Woodward Mark
Published: August 2013

Background and Purpose—

It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men.

Methods—

PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled.

Results—

Data from 81 prospective cohort studies that included 3 980 359 individuals and 42 401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99–1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02–1.18)] but not in Asian (RRR, 0.97 [0.87–1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99–1.22]).

Conclusions—

Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.
The Impact of Recent Heat Waves on Human Health in California
Authors: Guirguis Kristen , Gershunov Alexander , Tardy Alexander , Basu Rupa
Published: August 2013

This study examines the health impacts of recent heat waves statewide and for six subregions of California: the north and south coasts, the Central Valley, the Mojave Desert, southern deserts, and northern forests. By using canonical correlation analysis applied to daily maximum temperatures and morbidity data in the form of unscheduled hospitalizations from 1999 to 2009, 19 heat waves spanning 3–15 days in duration that had a significant impact on health were identified. On average, hospital admissions were found to increase by 7% on the peak heat-wave day, with a significant impact seen for several disease categories, including cardiovascular disease, respiratory disease, dehydration, acute renal failure, heat illness, and mental health. Statewide, there were 11 000 excess hospitalizations that were due to extreme heat over the period, yet the majority of impactful events were not accompanied by a heat advisory or warning from the National Weather Service. On a regional basis, the strongest health impacts are seen in the Central Valley and the north and south coasts. The north coast contributes disproportionately to the statewide health impact during heat waves, with a 10.5% increase in daily morbidity at heat-wave peak as compared with 8.1% for the Central Valley and 5.6% for the south coast. The temperature threshold at which an impact is seen varies by subregion and timing within the season. These results suggest that heat-warning criteria should consider local percentile thresholds to account for acclimation to local climatological conditions as well as the seasonal timing of a forecast heat wave.
Fast and Slow Responses to Global Warming: Sea Surface Temperature and Precipitation Patterns
Authors: Long Shang-Min , Xie Shang-Ping , Zheng Xiao-Tong , Liu Qinyu
Published: August 2013

The time-dependent response of sea surface temperature (SST) to global warming and the associated atmospheric changes are investigated based on a 1% yr−1 CO2 increase to the quadrupling experiment of the Geophysical Fluid Dynamics Laboratory Climate Model, version 2.1. The SST response consists of a fast component, for which the ocean mixed layer is in quasi equilibrium with the radiative forcing, and a slow component owing to the gradual warming of the deeper ocean in and beneath the thermocline. A diagnostic method is proposed to isolate spatial patterns of the fast and slow responses. The deep ocean warming retards the surface warming in the fast response but turns into a forcing for the slow response. As a result, the fast and slow responses are nearly opposite to each other in spatial pattern, especially over the subpolar North Atlantic/Southern Ocean regions of the deep-water/bottom-water formation, and in the interhemispheric SST gradient between the southern and northern subtropics. Wind–evaporation–SST feedback is an additional mechanism for the SST pattern formation in the tropics. Analyses of phase 5 of the Coupled Model Intercomparison Project (CMIP5) multimodel ensemble of global warming simulations confirm the validity of the diagnostic method that separates the fast and slow responses. Tropical annual rainfall change follows the SST warming pattern in both the fast and slow responses in CMIP5, increasing where the SST increase exceeds the tropical mean warming.
Assessing the Hypothesis of Measurement Invariance in the Context of Large-Scale International Surveys
Authors: Rutkowski Leslie , Svetina Dubravka
Published: August 2013

In the field of international educational surveys, equivalence of achievement scale scores across countries has received substantial attention in the academic literature; however, only a relatively recent emphasis on scale score equivalence in nonachievement education surveys has emerged. Given the current state of research in multiple-group models, findings regarding these recent measurement invariance investigations were supported with research that was limited in scope to few groups and relatively small sample sizes. To that end, this study uses data from one large-scale survey as a basis for examining the extent to which typical fit measures used in multiple-group confirmatory factor analysis are suitable for detecting measurement invariance in a large-scale survey context. Using measures validated in a smaller scale context and an empirically grounded simulation study, our findings indicate that many typical measures and associated criteria are either unsuitable in a large group and varied sample-size context or should be adjusted, particularly when the number of groups is large. We provide specific recommendations and discuss further areas for research.
Students’ Impressions of Psychotherapists’ Offices
Authors: Devlin Ann S. , Nasar Jack L. , Cubukcu Ebru
Published: August 2013

Research suggests that the softness, personalization, and order of the interior design elements of an office might affect appraisals of its psychotherapist. This research examines whether these perceptions are stable across students’ judgments in three cultures: the United States, Turkey, and Vietnam. Participants in each country responded to 30 color photographs of psychotherapists’ offices viewed from the client’s perspective, rating the quality of care and comfort expected in each office. Analyses revealed strong correlations between responses by participants from each country. Perceived quality of care and comfort improved with increases in office softness/personalization and orderliness. Analysis of the reported reasons in making judgments confirmed the importance of these dimensions. Future research could test the consistency of these responses to broader and more diverse sets of respondents and offices. The findings suggest the potential value of psychotherapeutic environments that are soft/personalized and orderly.
The Effect of Sociopsychological Barriers on the Processing of New Information about Peace Opportunities
Authors: Porat Roni , Halperin Eran , Bar-Tal Daniel
Published: August 2013

During protracted intractable conflicts, society members develop a sociopsychological infrastructure that leads to selective and biased information processing, obstructing the penetration of new information that may facilitate peacemaking. To validate a process model that depicts the functioning of these barriers, we conducted a study among 207 Israeli Jews, focusing on the effects of long-term barriers on information processing. After measuring these barriers, we introduced an invented peace proposal and gave participants the option of processing additional information concerning its implications using the Decision Board Platform. Aided by this platform, we conducted an in-depth analysis of information acquisition strategies and found that four general worldviews (i.e., traditional and universal values, incremental theory, and authoritarianism) were associated with the ethos of conflict, which in turn was associated with the general amount and type of information processed. The theoretical and applied implications are discussed.
Copycat Firesetting
Authors: Doley Rebekah , Ferguson Claire , Surette Ray
Published: August 2013

Deliberate firesetting costs our community in destruction to property and lives. Public concern heightens when similar fires occur in a series, raising the specter of copycat firesetting. Difficulties associated with researching copycat crimes in general mean that not a lot is known about copycat firesetting. As an initial step toward filling this research gap, we explore connections between research on copycat crime and research into deliberate firesetting. The intention is to extract salient features from what is known about the phenomena of deliberate firesetting and copycat crime, map them together, and point out shared and unique characteristics. It is argued that a “copycat firesetter” is likely to exist as a distinct subgroup and potentially requiring targeted interventions.
The Return of Planning in China
Authors: Naughton Barry
Published: August 2013

Heilmann and Melton break important new ground in describing the revival of development planning in China and showing how planning is now interwoven with other aspects of the political system, particularly policy formulation and cadre evaluation. Clarification of the instruments planners use and their link to developmental outcomes would improve the argument. Although planners believe their plans are consistent with a market economy, it may turn out that the revival of planning after 2003 was purchased at the cost of significant distortions in the market economy and reduced efficiency.
The Distinctive Transition of China’s Five-Year Plans
Authors: Hu Angang
Published: August 2013

China has taken a distinctive path of economic transition, combining both the market and the plan. In introducing the market mechanism, the government has not abandoned the planning mechanism, as was done in other socialist countries, but instead has reformed it. The five-year plan has thus been transformed from economic planning to public affairs governance planning. Today the plan and the market are combined so that the two supplement and stimulate each other.
Frequency of Aspirating Gastric Tubes for Patients Receiving Enteral Nutrition in the ICU
Authors: Williams Teresa A. , Leslie Gavin , Mills Lauren , Leen Tim , Davies Hugh , Hendron David , Dobb Geoffrey J.
Published: August 2013

Background: Enteral nutrition (EN) tolerance is often monitored by aspirating stomach contents by syringe at prescribed intervals. No studies have been conducted to assess the most appropriate time interval for aspirating gastric tubes. We compared gastric tube aspirations every 4 hours (usual care) with a variable regimen (up to every 8 hours aspirations). Methods: This randomized controlled trial (RCT) enrolled patients who stayed in the intensive care unit (ICU) for >48 hours, had a gastric tube, and were likely to receive EN for 3 or more days. Patients were randomized (computer‐generated randomization) to either the control (every 4 hours) or intervention group (variable regimen). The primary outcome was number of gastric tube aspirations per day from randomization until EN was ceased or up to 2 weeks postrandomization. Results: Following Institutional Ethics Committee approval, 357 patients were recruited (control group, n = 179; intervention group, n = 178). No differences were found in age, sex, worst APACHE II score, or time to start of EN. In the intention‐to‐treat analysis, the intervention group had fewer tube aspirations per day (3.4 versus 5.4 in the control group, P < .001). Vomiting/regurgitation was increased in the intervention group (2.1% versus 3.6%, P = .02). There were no other differences in complications. Conclusion: This is the first RCT to examine the frequency of gastric tube aspirations. The frequency of gastric tube aspirations was reduced in the variable‐regimen group with no increase in risk to the patient. Reducing the frequency of aspirations saves nursing time, decreases risk of contamination of feeding circuit, and minimizes risk of body fluid exposure.
The Effect of a Low Fructose and Low Glycemic Index/Load (FRAGILE) Dietary Intervention on Indices of Liver Function, Cardiometabolic Risk Factors, and Body Composition in Children and Adolescents With Nonalcoholic Fatty Liver Disease (NAFLD)
Authors: Mager Diana R. , Iñiguez Ingrid Rivera , Gilmour Susan , Yap Jason
Published: August 2013

Background: Nonalcoholic fatty liver disease (NAFLD) is a common liver disease in obese children. Diets high in added fructose (high fructose corn syrup; HFCS) and glycemic index (GI)/glycemic load (GL) are associated with increased risk of NAFLD. Lifestyle modification is the main treatment, but no guidelines regarding specific dietary interventions for childhood NAFLD exist. We hypothesized that reductions in dietary fructose (total, free, and HFCS)/GI/GL over 6 months would result in improvements in body composition and markers of liver dysfunction and cardiometabolic risk in childhood NAFLD. Methods: Children and adolescents with NAFLD (n = 12) and healthy controls (n = 14) 7–18 years were studied at baseline and 3 and 6 months post–dietary intervention. Plasma markers of liver dysfunction (ALT, AST, γGT), cardiometabolic risk (TG, total cholesterol, LDL‐HDL cholesterol, Apo‐B100, Apo‐B48, Apo‐CIII, insulin, homeostasis model of assessment of insulin resistance [HOMA‐IR]), inflammation (TNF‐α, IL‐6, IL‐10), anthropometric, and blood pressure (BP) were studied using validated methodologies. Results: Significant reductions in systolic BP (SBP), percentage body fat (BF), and plasma concentrations of ALT (P = .04), Apo‐B100 (P < .001), and HOMA‐IR were observed in children with NAFLD at 3 and 6 months (P < .05). Dietary reductions in total/free fructose/HFCS and GL were related to reductions in SBP (P = .01), ALT (P = .004), HOMA‐IR (P = .03), and percentage BF in children with NAFLD. Reductions in dietary GI were associated with reduced plasma Apo‐B100 (P = .02) in both groups. With the exception of Apo‐B100, no changes in laboratory variables were observed in the control group. Conclusion: Modest reductions in fructose (total/free, HFCS) and GI/GL intake result in improvements of plasma markers of liver dysfunction and cardiometabolic risk in childhood NAFLD.
Nutrition Therapy for the Critically Ill Surgical Patient With Aortic Aneurysmal Rupture
Authors: Rahman Adam , Martin Claudio , Heyland Daren K.
Published: August 2013

Background: Our goal is to define nutrition therapy in critically ill patients after surgical repair of acute ruptured or dissecting aortic aneurysm to identify opportunities for quality improvement. Methods: International, prospective studies in 2007–2009 and 2011 were combined. Sites provided institutional and patient characteristics including from intensive care units (ICUs) admission to ICU discharge for a maximum of 12 days. We selected patients with aortic aneurysmal rupture or acute dissection staying in the ICU for ≥ 3 days. Results: There were 104 eligible patients from 72 distinct ICUs analyzed. Overall, 86.5% received artificial nutrition. There were 50.0% patients who received enteral nutrition (EN) only, 29.8% patients received a combination of EN and parenteral nutrition (PN), 6.7% patients received PN only, and 13.5% did not receive any nutrition. The mean time from admission to initiation of EN was 3.0 days (SD ± 2.4 days). The adequacy of calories from nutrition support was 46.8% (range 0%‐111%) with a mean of 10.0 kcal/kg/day. Of the total of 83 patients who received EN, 53 patients (63.8%) had interruption of EN. The reasons included fasting, intolerance, patients deemed too sick for enteral feeding, and loss of enteral feeding route. For patients with gastrointestinal intolerance, 3/30 patients (10%) received small bowel feeding and 23/30 patients (76.7%) of patients received motility agents. Conclusion: Postoperative critically ill patients with aortic aneurysmal rupture or acute dissection are at high risk for inadequate nutrition therapy, and there may be inadequate utilization of strategies to improve nutrition uptake.
The Role of Occupational Emotional Labor Requirements on the Surface Acting–Job Satisfaction Relationship
Authors: Bhave Devasheesh P. , Glomb Theresa M.
Published: August 2013

In this study we employ two distinct lenses of emotional labor—EL as occupational requirements and EL as intrapsychic processes of surface acting—and examine their relationship with job satisfaction. In a large, occupationally diverse sample, results indicate that occupational EL requirements are positively related to job satisfaction, whereas surface acting is negatively related to job satisfaction. Additionally, occupational EL requirements have a cross-level moderation effect on the relationship between surface acting and job satisfaction. Nonlinear effects are also observed for surface acting: the initial negative relationship of surface acting with job satisfaction is exacerbated at high levels of surface acting. Overall, this study enriches current research findings by incorporating the role of the occupational context, and provides insight into alternative evaluations of EL.
Enhancing Surveys of Health Care Professionals
Authors: Cho Young Ik , Johnson Timothy P. , VanGeest Jonathan B.
Published: August 2013

Surveys involving health care providers are characterized by low and declining response rates (RRs), and researchers have utilized various strategies to increase survey RRs among health professionals. Based on 48 studies with 156 subgroups of within-study conditions, a multilevel meta-regression analysis was conducted to summarize the effects of different strategies employed in surveys of health professionals. An estimated overall survey RR among health professionals was 0.53 with a significant downward trend during the last half century. Of the variables that were examined, mode of data collection, incentives, and number of follow-up attempts were all found to be significantly related to RR. The mail survey mode was more effective in improving RR, compared to the online or web survey mode. Relative to the non-incentive subgroups, subgroups receiving monetary incentives were more likely to respond, while nonmonetary incentive groups were not significantly different from non-incentive groups. When number of follow-ups was considered, the one or two attempts of follow-up were found to be effective in increasing survey RR among health professionals. Having noted challenges associated with surveying health professionals, researchers must make every effort to improve access to their target population by implementing appropriate incentive- and design-based strategies demonstrated to improve participation rates.
Improving Activity in Adults With Diabetes and Coexisting Obstructive Sleep Apnea
Authors: Chasens Eileen R. , Korytkowski Mary , Sereika Susan M. , Burke Lora E. , Drumheller Oliver J. , Strollo Patrick J.
Published: August 2013

This study in participants with type 2 diabetes and obstructive sleep apnea evaluated changes in activity, sleep quality, and daytime sleepiness after 4 weeks of continuous positive airway pressure (CPAP). This pilot study was a double-blind, randomized, placebo-controlled trial. Sleep apnea was quantified with an overnight sleep study. Sleep quality was measured by the Pittsburgh Sleep Quality Index, daytime sleepiness by the Epworth Sleepiness Scale, vigor and fatigue with the Profiles of Mood States, subjective activity with the Functional Outcomes of Sleep Questionnaire, and objective activity with the Bodymedia SenseWear Armband™. Subjects were randomized to either CPAP ( n = 12) or sham-devices ( n = 11). The intervention group had reduced apneas and hypopneas, daytime sleepiness, and fatigue; they also had improved sleep quality and increased objective activity and vigor. The study suggested that treatment of obstructive sleep apnea results in a modest improvement of activity in persons with type 2 diabetes.
Alternative Payment Models and Academy Advocacy
Authors: Setzen Michael , Denneny James C. , Waguespack Richard W. , Koopmann Charles F. , Lorenz Robert R. , Boss Emily F. , Lafreniere Denis C.
Published: August 2013

Program Description:

The physician payment landscape is changing as quality measures become more intertwined with payment. This miniseminar outlines the efforts of the Physician Payment Policy Work Group (3P) to prepare members for the implementation of the Affordable Care Act by giving them the tools to participate in diverse payment systems. Topics include public and private payment models including accountable care organizations (ACOs), bundling, and the importance of measures in the future of quality and payment initiatives. Presenters will discuss strategies including how resources such as Clinical Indicators and Policy Statements are used to advocate for appropriate policies by health insurance companies for coverage of services.

Educational Objectives:

1) Comprehend future healthcare reform initiatives, new payment models, and Academy efforts to prepare members for changes to how they will receive payment for services. 2) Recognize the measure sets we have formally developed in otolaryngology (sinusitis, otitis externa/otitis media) and how many providers can and will apply these measures to practice. 3) Be aware of Academy strategies for interaction with public and private payers and effective membership involvement.
Reconstruction of MOHS Defects
Authors: Jordan James R. , Wayne Ivan , Lazor John B.
Published: August 2013

Program Description:

Mohs defects are a common reconstructive challenge for head and neck surgeons. This panel will present a variety of options for reconstruction of defects based on the location and size of the defect. Extensive use of images will enhance the presentations.

Educational Objectives:

1) Compare the various options for reconstruction of Mohs defects based on location. 2) Compare the various options for reconstruction of Mohs defects based on size. 3) Avoid pitfalls in reconstruction of Mohs defects.
Challenging Cough Cases: A New Frontier in Otolaryngology
Authors: Altman Kenneth W. , Krouse John H. , Luong Amber U. , Carroll Thomas L. , Merati Albert L.
Published: August 2013

Program Description:

Otolaryngologists are playing an increasingly important role in the evaluation and treatment of patients with chronic cough. This miniseminar will involve the use of challenging case presentations, panel discussion, and audience participation to emphasize evidence‐based practice and the “state‐of‐the‐art” for patients with chronic cough. Controversial areas will include the concept of prioritization and use of evidence‐based protocols, the importance of early diagnosis in value‐based healthcare, and basic science mechanisms for inter‐relatedness of aerodigestive disease. Also, the costs of care, time to diagnosis and resolution, and underlying risks to the patient will be addressed.

Educational Objectives:

1) Use evidence‐based treatment guidelines in the evaluation and treatment of chronic cough. 2) Recite the spectrum of common and uncommon causes with an appreciation of the basic science mechanisms. 3) Evaluate these complex patients, perform a procedure‐oriented evaluation, and prescribe appropriate pharmacotherapy at their home institution.
Clinical Practice Guideline: Bell's Palsy
Authors: Baugh Reginald F. , Basura Gregory J. , Ishii Lisa , Schwartz Seth R.
Published: August 2013

Program Description:

This miniseminar will consist of a lively panel discussion on the evidence‐based recommendations for the treatment and management of Bell's palsy as outlined in the recently published AAO‐HNS Clinical Practice Guideline. The guideline seeks to improve the quality of and reduce variation in the care Bell's palsy patients receive. The panel will present the key action statements that address patient presentation, history, and physical examination; laboratory testing; electrodiagnostic testing; diagnostic imaging; surgical decompression; oral steroids and antiviral therapy; and patient follow‐up. Case studies will also be presented to illustrate the application of the evidence‐based recommendations in clinical practice.

Educational Objectives:

1) Decrease harmful variation in care for Bell's palsy patients. 2) Improve the quality of care and outcomes for Bell's palsy patients. 3) Practice accurate and efficient diagnosis of Bell's palsy, and when applicable, increase the use of appropriate counseling and rehabilitative options for patients.
Cutaneous Carcinoma: Beyond Mohs Surgery
Authors: Renner Gregory J. , Weber Randal S. , Yom Sue , Schmalbach Cecelia E. , Migden Michael , Golda Nicholas
Published: August 2013

Program Description:

This miniseminar is intended to be a discussion of how best to manage patients with cutaneous carcinomas with aggressive growth features, with local invasion and metastasis that may not be controlled with either traditional extirpative surgery or Mohs micrographic resection. This presentation will be primarily focused on issues related to aggressive growth situations with basal cell and squamous cell carcinomas, particularly those with perineural invasion. How far to go with extirpative surgery versus considerations for other treatments will be discussed.

Educational Objectives:

1) Recognize cutaneous carcinomas with aggressive growth features, including best tumor mapping and staging. 2) Interpret available treatment strategies when confronted with cutaneous carcinomas that are not likely to be controlled with surgical extirpation alone. 3) Define current concepts with use of targeted medical therapies in the treatment of advanced and metastatic cutaneous carcinomas.
Global Health 2013: Academy around the World
Authors: Randolph Gregory W. , Baek Chung‐Hwan , Benghalem Abdel‐Hamid , Chongkolwatana Cheerasook , Nassir Thana H. , Kameswaran Mohan
Published: August 2013

Program Description:

This international symposium will focus on the Academy's international relations and activities in a variety of key regions around the globe. President James L. Netterville, MD, will welcome the audience, and president‐elect Richard Waguespack, MD, and International Coordinator‐elect James E. Saunders, MD, will describe their vision for enhanced international collaboration. The AAO‐HNSF Regional Advisors for the Caribbean, Central America, Francophone Africa, the Middle East, and South Korea, as well as the Development Coordinator and Advisors for Young Professionals and Women Otolaryngologists, will introduce eminent speakers to describe the state of otolaryngology in these regions and subject areas, including socioeconomic and workforce issues.

Educational Objectives:

1) Recognize the myriad ways the Academy interacts with otolaryngology communities in different regions. 2) Consider the opportunities for collaboration in scientific exchange, research, fellowships, and observerships. 3) Articulate the Academy's resources available to members, subscribers, meeting attendees, and web visitors.
High‐Anxiety Head and Neck Trauma Cases: Lessons Learned
Authors: Brennan Joseph A. , Barrera Jose E. , Sniezek Joseph C. , Klem Christopher , Holt G. Richard , Donald Paul J.
Published: August 2013

Program Description:

The management of head and neck trauma patients is challenging, and critically important trauma lessons have been learned in Iraq, Afghanistan, and busy U.S. trauma centers. These lessons learned are relevant to all otolaryngologists who may be faced with such challenges resulting from trauma to the airway, the neck, and the craniofacial skeleton. High‐anxiety head and neck trauma cases will be presented, and the audience will use an interactive format to generate discussion on the best treatment options. The goal is to review the trauma pearls learned in the combat zone and in busy U.S. trauma centers.

Educational Objectives:

1) Apply the lessons learned with the head and neck trauma surgery performed in Iraq, Afghanistan, and busy U.S. trauma centers. 2) Implement trauma surgery pearls dealing with the traumatic airway, penetrating neck trauma, and fractures of the craniofacial skeleton. 3) Select the safest and most effective treatment option for challenging head and neck trauma cases presented to the audience.
Integrative Approach to Atypical Facial Pain and Headache
Authors: Wang Marilene B. , Senior Brent A. , Nguyen Chau T. , Taw Malcolm B.
Published: August 2013

Program Description:

The otolaryngologist may frequently deal with patients who present with atypical facial pain and headache, with no obvious anatomic, infectious, or inflammatory etiology. Such patients are challenging and require a multidisciplinary approach for diagnosis and treatment. In this miniseminar, we will review the definition, differential diagnosis, workup, and treatment recommendations for patients with atypical facial pain and headache. An integrative approach to the management of atypical facial pain will be outlined, including role for surgery, pharmacotherapy, complementary/alternative methods, mind‐body approaches, and lifestyle changes. Challenging cases will be presented to the panel of experts for discussion.

Educational Objectives:

1) Define atypical facial pain based on the International Headache Society's classification. Other diagnoses, including cranial neuralgias, optic neuritis, and temporomandibular joint must be ruled out. 2) Recognize the etiology of rhinogenic headache and discuss the workup, controversies, and recommended treatment options. 3) Apply integrative approaches to treatment of atypical facial pain, including pharmacotherapy, role for surgery, complementary/alternative methods, mind‐body approaches, and lifestyle changes.