bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation Activity in Otolaryngology Residencies
Authors: Deutsch Ellen S. , Wiet Gregory J. , Cornett Mary Pat , Malekzadeh Sonya , Fried Marvin P. , Seidman Michael D. , Hussey Heather
Published: September 2014

Objectives:

(1) Determine simulation resources available within United States otolaryngology training institutions. (2) Determine current involvement in simulation within otolaryngology training programs. (3) Gauge interest in advancing simulation for training and assessment.

Methods:

A voluntary survey was sent to 104 program directors. The introduction provided a broad definition of simulation. Responses were collected between March 21 and April 5, 2013. Descriptive results are presented.

Results:

Responses were received for 43 (41%) of the surveys. A total of 39 of 43 respondents (91%) have a simulation center or program at their institution. A total of 34 of 43 respondents (79%) have onsite simulation, 32 (74%) have models, manikins, or other devices, and 25 (58%) have staff resources within their institution. A total of 8 of 43 respondents (19%) have extensive, 26 (60%) have limited, and 8 (19%) have no otolaryngology simulation activity at their institution. The most common applications of simulation within otolaryngology are emergency management (23 of 43 respondents; 53%) and otology (21 of 43; 49%). All 31 respondents use simulation for clinical training (100%), 11 (33%) for proficiency, and 7 for mastery (21%). Three of 36 (22%) use extensive, 12 (33%) limited, and 21 (58%) no simulation in research. None of 34 use simulation for otolaryngology credentialing, although 2 (6%) use simulation for advanced cardiac life support credentialing. A total of 31 of 37 respondents (84%) are interested in participating in multicenter trials of simulation initiatives.

Conclusions:

Simulation resources are widely available in otolaryngology training institutions. Survey respondents report limited but widespread participation in simulation activity, and widespread interest in participating in simulation trials.
State of the Otolaryngology Match: Has Competition Increased since the Early Match?
Authors: Abaza Mona M. , Cabrera‐Muffly Cristina
Published: September 2014

Objectives:

Demonstrate increasing demand of medical students applying to otolaryngology and decreasing supply of available residency training positions after the shift from an early match to conventional matching process. Demonstrate increasing United States Medical Licensing Examination (USMLE) Step I scores among matched otolaryngology applicants over time.

Methods:

Matching statistics were obtained for first year residency positions through the National Residency Matching Program from 1998 to 2013. Matching statistics were obtained for otolaryngology residency positions through the San Francisco Match from 1998 to 2005. Univariate cross‐sectional analysis was performed with a P value of. 05 determined as significant.

Results:

Comparing the early match time period to the conventional match time period, there was an increase in otolaryngology resident applicants overall (P =. 002) and US senior otolaryngology applicants (.0006). There was also an increase in unmatched otolaryngology applicants (.0497). USMLE Step I scores increased between match time periods both among matched (P =. 025) and unmatched applicants (P =. 036). When comparing 5‐year core otolaryngology residency positions to 6‐year or 7‐year research positions, the probability of having an unfilled research position was 24.8 times higher than having an unfilled core position.

Conclusions:

Eight years ago, otolaryngology changed from an early to conventional time frame matching process. The match is now more competitive, as evidenced by an increase in the overall number of otolaryngology residency applications, an increased number of unmatched applicants, and an increase of 17 points on average among matched applicants on the USMLE Step I Score. Meanwhile, otolaryngology research positions remain more unlikely to fill compared with core positions.
Outcome of FDG‐Avid Areas on PET‐CT Scans Organized for Investigation of Head and Neck Malignancy
Authors: Oozeer Nashreen B. , Mackenzie Kenneth
Published: September 2014

Objectives:

Positron emission tomography (PET) scans may highlight areas of increased fludeoxyglucose (FDG) uptake outside the head and neck (HN) region. These may represent a synchronous malignancy or an area of inflammation or infection. Our study aims to investigate the rate of increased FDG uptake PET scans organized for the investigation of head and neck squamous cell carcinoma (HNSCC) and report on the outcome of these FDG‐avid areas.

Methods:

A prospective database of PET scans maintained by the West of Scotland PET Centre was reviewed to identify all scans organized by the head and neck teams between January 2008 and December 2011. Areas with high FDG uptake, above the normal limits for different body tissues at which the radiologists advised further investigation, were noted. Case notes were reviewed and relevant head and neck consultants were contacted to identify further investigations and outcome of these “hot spots.”

Results:

Of 299 PET scans during the study period, 40 FDG‐avid areas outside the HN and lung were identified, the majority originating in the colon (56%), followed by the prostate and pelvic region. There were 9 confirmed second primary tumors (22.5%), which is a significant proportion of the group, and half of the group had an incidental high standardized uptake value (SUV; negative investigation). Eleven patients were not investigated due to poor health and palliative management.

Conclusions:

All increased SUV areas outside the head and neck region should be investigated to identify a synchronous primary which may determine a patient's overall management and long‐term outcome.
Age‐Related Changes of Muscular Thickness of the Pharyngeal Constrictors in Healthy Adults
Authors: Umezaki Toshiro , Sato Nobuhiro , Adachi Kazuo , Sawatsubashi Motohiro , Komune Shizuo
Published: September 2014

Objectives:

Age‐related sarcopenia has been recognized in skeletal muscles in relation to the decreased body mass index (BMI). In the swallowing muscles, however, there have been few findings concerning sarcopenia. We studied whether muscle volume of the pharyngeal constrictors decreases with age in healthy adults.

Methods:

A retrospective review of head and neck magnetic resonance imaging (MRI) of 207 adults (138 males and 69 females, 21‐96 years old) examined at the Department of Otolaryngology–Head and Neck Surgery of Kyushu University Hospital between 2010 and 2013 was performed. We measured muscle thickness at 4 levels (mid‐mandibular level, hyoid level, vocal fold level, and cricopharyngeal level) with OsiriX software. In each level, measuring points were set at median and 3 points with equal intervals in both sides on axial view of T2‐weighted MRI images. Averaged values of constrictor thickness were statistically analyzed in correlation to their age and BMI.

Results:

The pharyngeal constrictor muscles appeared thickest at the hyoid level (male: 2.18 ± 0.77 mm, female: 1.79 ± 0.83 mm), which showed no significant correlation to age (r = 0.03 in male and 0.07 in female, P >. 1) and BMI (r = 0.27 and 0.33, respectively, P >. 1). Results at other levels were almost the same as those at the hyoid. Laterality of the muscle thickness was observed at the cricopharyngeal level (left > right).

Conclusions:

The pharyngeal constrictors appear not to become thin in proportion to age and BMI, unlike skeletal muscles. Branchiogenic swallowing muscles may be tolerable against aging, as compared to skeletal muscles.
Cochlear Implantation for Single‐Sided Deafness: Early Outcomes for 12 Patients
Authors: Frisch Christopher D. , Sladen Douglas P. , Driscoll Colin , Zeitler Daniel M.
Published: September 2014

Objectives:

(1) Summarize hearing status in the nonimplant ear. (2) Report audiometric and subjective outcomes.

Methods:

Multi‐institutional retrospective chart review. We report outcomes of cochlear implantation in 12 patients with single‐sided deafness. Hearing status in the nonimplant ear included: 6 patients with American Academy of Otolaryngology—Head and Neck Surgery Class A, 4 with Class B, and 2 with Class C (1 with WRS 90%). Five of 12 (42%) patients had normal hearing in the nonimplanted ear. There were 6 male and 6 female patients. Average age was 51.5 years (range, 9‐75 years). Average preoperative word recognition score in the nonimplanted ear was 82% (range, 52%‐100%). Average preoperative pure tone average was 30.4 dB (range, 2‐60 dB).

Results:

Average post‐implantation follow‐up was 8 months (range, 1‐36 months). Etiologies of deafness included 5 idiopathic sudden‐sensorineural, 3 Ménière's Disease, 2 idiopathic progressive, 1 labyrinthitis, and 1 iatrogenic. Audiometric results for the implant‐only condition demonstrated mean consonant‐nucleus‐consonant score of 67% (range, 10%‐88%) and mean AzBio score of 83% (range, 73%‐97%). Objective testing in noise also showed substantial improvement compared to the preoperative condition. All are daily users.

Conclusions:

Although cochlear implantation for asymmetric hearing loss and single‐sided deafness is not Food and Drug Administration approved in the United States, our patients report a high level of satisfaction. Early audiometric data indicate that these patients score similarly to standard implant users in the CI only condition. In addition, they show substantial improvement in noise since preoperative testing. More data are needed to determine future candidacy for this intervention.
Management of Pediatric Patients with X‐Linked Stapes Gusher Syndrome
Authors: Merwin William H. , Buchman Craig A. , Adunka Oliver F. , Iseli Claire E.
Published: September 2014

Objectives:

Present outcomes of children with X‐linked stapes gusher (XLSG) syndrome managed at a single institution.

Methods:

A retrospective evaluation of children with radiographically confirmed XLSG was undertaken. Additionally, an analysis of surgical complications and speech perception outcomes in the published literature was carried out.

Results:

Eight male children with XLSG identified in the first year of life were included in the single institutional review. All demonstrated varying levels of mixed hearing loss with present acoustic reflexes. There was no associated medical comorbidities or intellectual disability. The average pure tone average (PTA) at initiation of care was 90 ± 14 dB HL. All patients were initially managed with conventional amplification and 4 went on to receive cochlear implants (mean age 7 years). Speech perception abilities were variable amongst the implanted children (PBK range = 8‐84%) despite radiographically confirmed electrode placement. One patient was too young to test. Children using amplification alone (n = 4) also demonstrated variable results. Literature review identified 21 other XLSG patients with cochlear implants (1 bilateral). Surgical complications included 4 postoperative cerebrospinal fluid leaks, 4 electrodes placed into the internal auditory canal, 2 electrode extrusions, and one device failure. Speech perception testing revealed 12 patients with open set abilities, 3 with closed set abilities, and 5 with only sound detection.

Conclusions:

Some children with XLSG can be managed with amplification alone. Cochlear implantation, while possible, presents issues with electrode placement, cerebrospinal fluid management and variable outcomes. Careful planning is needed in children with XLSG to minimize risk and optimize outcomes.
Middle Ear Implant versus Hybrid Cochlear Implant for High‐Frequency Sensorineural Hearing Loss
Authors: Glasscock Michael E.
Published: September 2014

Objectives:

Profound SNHL responds well to a standard cochlear implant (CI) with rewarding results. However, if the individual has residual hearing in the low frequencies there is a reasonable chance that the pure tones will be lost. Hybrid cochlear implants have been suggested as a solution for this problem. Unfortunately, there continues to be a loss of the low frequency pure tones in a large number of these patients.

Methods:

One solution would be to use a middle ear implant instead of a hybrid CI. The Maxum middle ear implant has the advantage of being a minimally invasive surgical procedure that can be performed under local anesthesia. A small magnet is attached to the stapes through a transcanal approach.

Results:

After 3 weeks an integrated processor coil (IPC) is inserted into the external auditory canal. The IPC has an electromagnet driver. By driving the stapes directly it is possible to obtain as much as 60 dB of functional gain in the high frequencies without distortion, acoustic feedback, or the sensation of occlusion.

Conclusions:

For these reasons the author believes a Maxum should be considered in these patients before a Hybrid Cochlear Implant. If the SNHL progresses, then a CI can still be performed at a later date. This sequence of events delays the invasion of the cochlea and in some cases prevents the need for a CI altogether.
Rescuing Noise‐Induced Permanent Threshold Shift by D‐Methionine in Guinea Pigs
Authors: Cheng Po‐Wen , Lo Wu C. , Wang Chi‐Te
Published: September 2014

Objectives:

This study examined the effectiveness of D‐methionine (D‐met) in rescuing a noise‐induced permanent threshold shift (PTS) and cochlear biochemistry following noise exposure.

Methods:

One hour after being exposed to continuous white noise at 105 ± 2 dB SPL for 6 hours, guinea pigs were treated 5 times at 12‐hour intervals with 200, 400, or 600 mg/kg D‐met or sterile 0.9% saline by intraperitoneal injection. Auditory brainstem responses were examined before and 14 days after noise exposure. Six guinea pigs with normal hearing that were not exposed to noise served as control animals. The level of D‐met in rescuing noise‐induced hearing loss and the changes in cochlear biochemistry, including membranous Na+, K+‐ATPase, and Ca2+‐ATPase, lipid peroxidation, and nitric oxide, were evaluated.

Results:

Hearing acuity had no significant differences before and 14 days after noise exposure for the animals treated with 600 mg/kg D‐met, compared with the control animals, whereas significant differences occurred among the animals in the other treatment groups. The level of rescue from noise‐induced PTS following treatment with D‐met was dose‐dependent. No significant differences in the mean enzyme activities were observed between the controls and the D‐met 600 mg/kg treatment group. The attenuation of the noise‐induced decreases in the enzyme activities was dose‐dependent. Likewise, D‐met‐dose‐dependent decreases in oxidative stress were observed in the D‐met treated groups.

Conclusions:

Treatment with D‐met significantly rescued noise‐induced PTS in a dose‐dependent manner. Significant attenuation of increased oxidative stress and decreased ATPase activities were concurrent with the D‐met‐mediated improvements in noise‐induced auditory dysfunction.
Obstructive Sleep Apnea during Pregnancy and Morbidity Outcome
Authors: Pinyopornpanish Poj , Sonsuwan Nuntigar , Sirichotiyakul Supatra
Published: September 2014

Objectives:

Obstructive sleep apnea (OSA) is increasingly a concern for a risk factor of poor pregnancy outcomes. However, to date, most research studies have relied on subjective research such as Epworth Sleepiness Scale (ESS). Therefore, our research design used polysomnography, which is an objective measurement to define OSA in pregnancy. The study aimed to measure the incidence of OSA in pregnancy, to reveal clinical examination which will be objective screening tool for OSA in pregnancy, and prove that OSA is a risk factor of poor pregnancy outcomes.

Methods:

Fifty healthy pregnant women who received antenatal care at Chiangmai University Hospital during October 2012 through April 2013 were measured by physical examination and polysomnography at GA 28th to 32nd weeks, and followed until the end of pregnancy to see the difference of poor pregnancy outcomes in OSA and non‐OSA group.

Results:

The incidence of OSA in pregnancy was 12%. OSA related to more overall poor pregnancy outcomes (relative risk [RR] = 5.86 [2.16‐15.96], P =. 007), more preterm labor (RR = 19.33 [3.89‐220.79], P <. 001), and more preeclampsia (RR = n/a, P =. 012). Friedman tongue position (FTP) equal or more than gr III was considered the screening tool for OSA in pregnancy, which yielded 66.7% sensitivity and 84.1% specificity.

Conclusions:

OSA could lead to a high‐risk pregnancy, which should be screened by multidisciplinary teams, to establish diagnosis and treatment for maternal and child health.
Spectral material characterization with dual-energy CT: comparison of commercial and investigative technologies in phantoms
Authors: Gabbai Michal , Leichter Isaac , Mahgerefteh Samuel , Sosna Jacob
Published: September 2014

Background

Dual-energy computed tomography (DECT) enables tissue discrimination based on the X-ray attenuations at different photon energies emitted by the tube. The spectral dependencies of net X-ray attenuation can be analyzed and used to characterize specific materials.

Purpose

To evaluate the capability of DECT to characterize and differentiate high-density materials, using spectral analysis.

Material and Methods

Images of phantoms containing iodine, barium, gadolinium, and calcium solutions in five concentrations were obtained from three DECT scanners and with sequential scanning at different kV values from three conventional MDCT devices. DECT studies were performed with commercial dual-source and rapid kV-switching systems, and a spectral-detector CT (SDCT) prototype based on dual-layer detector technology. Spectral maps describing Hounsfield Units (HU) in low- versus high-energy images were calculated and characterizing curves for all materials were compared.

Results

Spectral low- to- high energy maps yielded linear curves (R2 = 0.98–0.999) with increasing slopes for calcium, gadolinium, barium, and iodine, respectively. Slope differences between all material pairs were highest (reaching 45%) for DECT with dual-source (140/80 kV) and rapid kV-switching (60/80 keV), reaching statistical significance ( P < 0.05) with most techniques. Slope differences between all material pairs for sequential scanning were lower (reaching 32%). Slope differences lacked statistical significance for iodine-barium with two sequential-acquisition techniques and the dual-source DECT scanner, and the calcium-gadolium pair with the dual-source scanner.

Conclusion

All designated techniques for dual-energy scanning provide robust and material-specific spectral characterization and differentiation of barium, iodine, calcium, and gadolinium, though to varying degrees.
Timing of recanalization and outcome in ischemic-stroke patients treated with recombinant tissue plasminogen activator
Authors: Wei Xiao-Er , Zhao Yu-Wu , Lu Jing , Li Ming-Hua , Li Wen-Bin , Zhou Ya-Jun , Li Yue-Hua
Published: September 2014

Background

Intravenous administration of recombinant tissue plasminogen activator (rtPA) is approved treatment for acute ischemic stroke <3 h of symptom onset.

Purpose

To determine the impact of the timing and degree of recanalization on clinical outcome after rtPA infusion in patients.

Material and Methods

Seventy-five patients with ischemic stroke in the middle cerebral artery territory treated with intravenous rtPA within 3 h were studied consecutively. Magnetic resonance imaging (MRI), including magnetic resonance angiography (MRA), before, 6 h, and 24 h after thrombolytic therapy was undertaken. Depending on the MRA results acquired 6 h after rtPA infusion, recanalization was graded as: early recanalization (ER), delayed recanalization (DR), and no recanalization (NR). Clinical outcome was assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).

Results

Of patients in the ER, DR and NR groups, 71.4% (15/21), 13.3% (2/15), and 30.7% (12/39), respectively, showed dramatic improvement in NIHSS score 7 days after rtPA administration compared with those scores upon hospital admission. The 6-h and 24-h NIHSS scores and 3-month mRS scores of ER patients were significantly lower than those of the other two groups ( P < 0.05). The 24-h, 7-d NHISS and mRS scores of DR patients were significantly higher than NR patients ( P = 0.001, 0.002, 0.049, respectively). Three patients in the DR group died during follow-up.

Conclusion

These data suggest that DR is associated with clinical deterioration. Patients treated with rtPA thrombolysis should be under close observation for 6–24 h. Corresponding treatment should be considered once DR appears.
Assessment of myocardial edema and area at risk in a rat model of myocardial infarction with a faster T2 mapping method
Authors: Xia Rui , Lu Xi , Zhang Bing , Wang Yuqing , Liao Jichun , Zheng Jie , Gao Fabao
Published: September 2014

Background

The common T2 mapping is not suitable for the use in rat heart with high heart rate, unless data are acquired in multiple cardiac cycles.

Purpose

To evaluate a simplified T2 mapping method for faster assessment of myocardial edema and area at risk in a rat model of myocardial infarction.

Material and Methods

The simplified T2 mapping method (TR/TE, 1500 ms/10, 20, 30 ms) was implemented at a 7.0T MRI system. The accuracy of T2 mapping was compared with a standard T2 mapping method (TR, 2500 ms, 16 TEs equally spaced from 11 ms to 176 ms) in thigh muscles in rats ( n = 6) and a phantom. This method was further evaluated in normal rats ( n = 8) and rats with myocardial infarction ( n = 8). Late gadolinium enhancement images were also acquired in the rats with myocardial infarction.

Results

T2 values of simplified T2 mapping in the muscles and phantom were 27.3 ± 2 ms and 26.5 ± 1.1 ms, which were similar to the T2 values obtained by the standard T2 mapping method (28.1 ± 1.4 ms, P > 0.05; 26.9 ± 1.7 ms). No significant difference in T2 distribution (different segments and slices from base to apex) in the whole heart was found in normal rats (25.6 ± 3.3 ms, P > 0.05). The mean T2 value in the myocardial edema regions of myocardial infarction rats (37 ± 4.9 ms) was significantly higher than that of the normal rats (25.6 ± 3.3 ms, P < 0.001). The T2 value in the myocardial infarction core of myocardial infarction rats (39.9 ± 3.6 ms) was significantly higher than that of area at risk (34.7 ± 2.9 ms, P < 0.001).

Conclusion

The simplified myocardial T2 mapping is technically feasible and accurate, and can readily detect myocardial edema and area at risk in rats with high heart rate.
Statins Enhance Rotator Cuff Healing by Stimulating the COX2/PGE2/EP4 Pathway
Authors: Dolkart Oleg , Liron Tamar , Chechik Ofir , Somjen Dalia , Brosh Tamar , Maman Eran , Gabet Yankel
Published: September 2014

Background:

Statins are lipid-lowering drugs with many beneficial pleiotropic effects. Cyclooxygenase (COX2) selective inhibitors that are commonly prescribed in orthopaedic patients may effect healing. Evidence indicates that statins stimulate COX2 activity.

Hypothesis:

Atorvastatin (ATV) administration will enhance tendon healing by stimulating the acute inflammatory phase via increasing the production of prostaglandin E2 (PGE2).

Study Design:

Controlled laboratory study.

Methods:

After experimental rotator cuff (RC) tearing and suturing, 48 Wistar rats were randomly allocated into 4 groups: (1) ATV (20 mg/kg), (2) celecoxib (CEL; COX2 inhibitor) (10 mg/kg), (3) ATV + CEL (20 mg/kg + 10 mg/kg), and (4) saline alone. Animals were sacrificed 3 weeks after RC tears and repair, and tendon integrity was tested biomechanically in tension. To further evaluate the underlying mechanism of action, human and rat primary tenocytes were obtained from the supraspinatus tendon. Cultures were treated with a therapeutic dosage of 5 commonly used statins: CEL, ATV + CEL, PGE2, and a selective antagonist of PGE2 receptor 4 (EP4). Cell proliferation (thymidine incorporation), migration (wound healing assay), and adhesion (iCELLigence) were evaluated. The expression of all PGE2 receptors (EPs) was determined by quantitative reverse transcription polymerase chain reaction.

Results:

Tension testing of healed tendons demonstrated significantly higher maximal loading and stiffness in the ATV group as compared with the saline (+30% and +20%, respectively; P < .001) and CEL groups (+33% and +50%, respectively; P < .005). Celecoxib alone did not affect tendon healing ( P = .88). In line with these in vivo results, tenocytes treated with statins demonstrated significantly higher proliferation rates; CEL abrogated this effect, and PGE2 treatment stimulated tenocyte proliferation even in the presence of CEL. Also, ATV stimulated the migration (wound healing) and adhesion of tenocytes. Among all PGE2 receptors, tenocytes mainly express EP4, and an EP4 selective antagonist blocked the effect of ATV.

Conclusion:

Results indicate that ATV enhances tendon healing by stimulating tenocyte proliferation, migration, and adhesion via increased COX2 activity and autocrine/paracrine PGE2 signaling. Findings also demonstrate that this effect is mediated by EP4 signaling.

Clinical Relevance:

Although chronic inflammation contributes to the development of tendinopathy, study results advocate for a positive role of PGE2 in tendon healing during the acute inflammatory phase that follows tendon surgical repair. It is therefore suggested that ATV should be further investigated as a possible modality to improve tendon healing.
Design and analysis of a large horizontal vessel supported on multiple saddles according to three-moment theorem and Zick’s method
Authors: Duan Cheng-Hong , Hu You-Liang
Published: September 2014

For the engineering design of large horizontal vessels with uneven multiple saddles, no clear specifications are given in design codes, especially with uneven settlements. In this paper, an analytical method based on three-moment theorem with settlements is introduced to evaluate the shear forces and bending moments at some critical cross-sections of a large horizontal pressure vessel supported on 10 saddles with uneven settlements. Zick’s stress analysis method for a horizontal vessel supported on two saddles is extended to the multiple saddle arrangements. It is found that as a result of varied cross-section and uneven saddle supports, the shear forces and bending moments are different at different saddle sections. Finite element calculations are also performed to prove the analytical solutions. Results show that for the vessel without settlements, the bending moments and reactions obtained by the three-moment equation method are slightly larger than those obtained by finite element method. Non-uniform deformation of the vessel at different saddles may be contributed to the differences of the two results. For the vessel with settlements, the bending moments and reactions at some saddles obtained by the three-moment equation method are quite larger than those obtained by finite element method. But if the actual axis settlement of the vessel is applied to the three-moment equation method, the two results are close to each other. Experiments are also carried out to verify the reliability of the proposed method.
Association of TLR4 (D299G, T399I), TLR9 −1486T>C, TIRAP S180L and TNF-α promoter (−1031, −863, −857) polymorphisms with risk for systemic lupus erythematosus among South Indians
Authors: Rupasree Y , Naushad S M , Rajasekhar L , Uma A , Kutala V K
Published: September 2014

The rationale of this case-control study was to explore the association of Toll-like receptor 4 (TLR4) D299G, TLR4 T399I, TLR9 −1486 T>C, TIR-domain-containing adaptor protein (TIRAP) S180 L and tumor necrosis-α (TNF-α) promoter polymorphisms with susceptibility and phenotypic heterogeneity of systemic lupus erythematosus (SLE). PCR-RFLP, real-time PCR was used for the genetic analysis and expression studies and ELISA was used for the determination of specific autoantibodies. TLR4 D299G was associated with the risk for SLE (OR: 1.57, 95% CI: 1.08–2.28), while the TNF-α (−1031, −863, −857) CCC haplotype conferred protection. TLR4 and TIRAP polymorphisms were associated with reduced expression of HLA-DR. The presence of TLR4 and TLR9 polymorphisms increases the MHC2TA expression, while TIRAP polymorphism was associated with reduced expression. TLR4 D299 G showed an inverse association with pulmonary hypertension. TLR 4 T399I and TLR9 −1486 T>C showed a positive association with seizures and photosensitivity, respectively. TIRAP S180 L showed a positive association with alopecia and malar rashes, while an inverse association with psychosis was observed. TLR4 T399I ( r = 0.14, p = 0.05) and TIRAP S180 L ( r = 0.15, p = 0.03) showed a positive association with anti-Ro antibodies. On the other hand, TLR9 −1486 T>C showed an inverse association with anti-La antibodies ( r = −0.20, p = 0.006). To conclude, TLR4 D299G increases the risk for SLE, while TNF-α CCC haplotype reduces the risk for SLE. All these polymorphisms contribute toward phenotypic heterogeneity. TLR4 T399I, TLR9 −1486 T>C and TIRAP S180 L influence specific autoantibody production in SLE.
Supportive psychotherapy
Authors: Harari Edwin
Published: September 2014

Aim:

The aim of this article is to describe the principles of supportive psychotherapy.

Conclusion:

The author illustrates the principles of supportive psychotherapy with a case vignette. Supportive psychotherapy is an important clinical skill for all psychiatrists.
Nurse Practitioners in Aged Care
Authors: Clark Shannon J. , Parker Rhian M. , Davey Rachel
Published: September 2014

Meeting the primary health care needs of an aging population is an increasing challenge for many Western nations. In Australia, the federal government introduced a program to develop, test, and evaluate nurse practitioner models in aged care settings. In this article, we present a documentary analysis of 32 project proposals awarded funding under the Nurse Practitioner–Aged Care Models of Practice Program. Successfully funded models were diverse and were operated by a range of organizations across Australia. We identified three key priorities as underlying the proposed models: “The right care,” “in the right place,” and “at the right time.” In this article, we explore how these priorities were presented by different applicants in different ways. Through the presentation of their models, the program’s applicants identified and proposed to address current gaps in health services. Applicants contrasted their proposed models with available services to create persuasive and competitive applications for funding.
Latino Caregiver Experiences With Asthma Health Communication
Authors: Riera Antonio , Ocasio Agueda , Tiyyagura Gunjan , Krumeich Lauren , Ragins Kyle , Thomas Anita , Trevino Sandra , Vaca Federico E.
Published: September 2014

In this article, we analyze qualitative data from a purposeful sample of limited English proficiency (LEP) asthma health caregivers. We used ethnically concordant, semistructured, in-depth Spanish-language interviews and a follow-up focus group to explore issues related to communication during pediatric asthma encounters in medical settings. Inductive coding of Spanish transcripts by a bilingual research team was performed until thematic saturation was reached. Several key findings emerged. LEP caregivers encountered significant asthma burdens related to emotional stress, observed physical changes, and communication barriers. Language-discordant communication and the use of ad hoc interpreters were common. This finding is complex, and was influenced by perceptions of interpreter availability, delays in care, feelings of mistrust toward others, and individual emotional responses. Language-concordant education and suitable action plans were valued and desired. We discuss a revealing depiction of the LEP caregiver experience with asthma health communication and recommend areas for further inquiry.
Embedding Self-Determination and Futures Planning Within a Schoolwide Framework
Authors: Bohanon Hank , Castillo Jose , Afton Morgan
Published: September 2014

This article illustrates the infusion of self-determination approaches (e.g., futures planning) within a schoolwide context. Unfortunately, some students are not explicitly instructed by school staff to address their plans for the future. This may be a result of school professionals’ feelings of inadequacy to address skill sets outside of their specialization (e.g., content area, special education). By connecting self-determination practices with schoolwide initiatives (e.g., schoolwide positive behavior support, Common Core State Standards), educators in particular may be more willing to address these skills in their settings. This article provides an example of these types of connections with an actual case study of one student within an urban high school.
Every Second Counts
Authors: Rosengren Kristina , Gustafsson Ida , Jarnevi Elin
Published: September 2014

Amyotrophic lateral sclerosis (ALS) is a progressive disease that affects patients with a loss of speech and mobility. The aim of this study was to describe patients’ experiences of living with ALS in the end-of-life situations. A manifest content analysis was chosen for analysis narratives from four biographies by women who had ALS. The categories Suffering, Meaningfulness, and Experiences of a Limited life were identified as describing patients’ understanding of living with ALS. Nurses need to be trained in communication skills to maintain human dignity for patients who lost their speech regarding an intellect in shape. There is a need for information among family members about severe diseases, such as ALS, to improve high quality of care and well-being for all involved. Home health care has to invite and facilitate patients’ and relatives’ participation regarding the end-of-care processes to improve a sense of coherence to handle everyday life situation in the future.
Body size and the risk of multiple sclerosis in Norway and Italy: The EnvIMS study
Authors: Wesnes Kristin , Riise Trond , Casetta Ilaria , Drulovic Jelena , Granieri Enrico , Holmøy Trygve , Kampman Margitta T , Landtblom Anne-Marie , Lauer Klaus , Lossius Andreas , Magalhaes Sandra , Pekmezovic Tatjana , Bjørnevik Kjetil , Wolfson Christina , Pugliatti Maura , Myhr Kjell-Morten
Published: September 2014

Background:

Obesity may be a risk factor for developing multiple sclerosis (MS).

Objective:

We examined if body size influences the risk of MS in a population-based, case control study.

Methods:

A total of 953 cases and 1717 controls from Norway and 707 cases and 1333 controls from Italy reported their body size by choosing a silhouette 1 to 9 (largest) every fifth year from age 5 to 30 and at time of study. The body size-related MS risk was defined by odds ratios (ORs) in logistic regression analyses adjusting for age, smoking and outdoor activity.

Results:

In Norway a large body size (silhouettes 6–9) compared to silhouette 3 increased the risk of MS, especially at age 25 (OR 2.21; 95% CI 1.09–4.46 for men and OR 1.43; 95% CI 0.90–2.27 for women). When comparing silhouette 9 to 1, we found a significant dose-response from age 10 until age 30 peaking at age 25 (sex-adjusted OR 2.83; 95% CI 1.68–4.78). The association was present for at least 15 years prior to disease onset. No significant associations were found in Italy.

Conclusions:

Obesity from childhood until young adulthood is a likely risk factor for MS with a seemingly stronger effect in Norway than in Italy.
Behavioural improvements and emotional gains for students attending an Australian School for Specific Purposes
Authors: Hulme Melissa J , Cornish Alison M
Published: September 2014

Outcomes of students with behavioural and emotional difficulties attending a specialised educational programme, delivered in a tertiary education and health facility, were evaluated and compared with Australian normative data. A total of 45 students (5–10 years old) attending the school in Sydney, New South Wales, were identified. At enrolment, parent ratings on the Strengths and Difficulties Questionnaire (SDQ) significantly deviated from Australian normative data on all scales for males and on the overall score, conduct and hyperactivity scales for females. Clinically significant levels of hyperactivity, peer problems and conduct symptoms were identified. After an average attendance at the school of 8.82 months, ratings on the Children’s Global Assessment Scale (CGAS) indicated improved overall functioning, alongside specific improvements on SDQ rated emotion, conduct and social symptoms, and in Health of the Nation Outcomes Scales Child and Adolescent (HoNOSCA) rated social impairment and parents’ reported need for information about their child’s condition. Male students’ emotional symptoms no longer differed from those of typical Australian students. The findings provide initial evidence for the effectiveness of a multimodal, flexible and targeted school programme in remediating key student mental health symptoms. It is suggested that major concepts from attachment theory and explicitly taught behavioural skills are key elements of this unique programme that contribute to its apparent effectiveness.
Closed fifth metacarpal neck fractures: Do they need to be seen in fracture clinic? An emergency department pathway for assessment, management and criteria for fracture clinic referral
Authors: Abdelmalek Amir , Harrison Emily , Scott Sharon
Published: September 2014

Background

In our institution patients with fifth metacarpal neck fractures used to be referred to fracture clinic. The first audit aimed to assess if the referral changes management. This resulted in implementation of new practice, followed by the re-audit and follow up.

Methods

We looked at 6 months data retrospectively, followed by prospective data collection for 6 months after initiation of new practice and electronic monitoring of re-referrals. Local systems were used for data extraction. Fracture assessment included angulation, rotational deformity and whether it was an open injury. The financial department assessed the cost of each fracture clinic.

Results

Thirty-six patients included in the first audit compared to 27 in the re-audit, referral rate is 97% and 78%, respectively. All injuries were closed and there was no rotational deformity. Two patients had volar angulation more than 50° in the second sample but none in the first one. All patients were treated with neighbour strapping for one to two weeks and subsequent mobilisation. There were no instances of change of management with attendance at fracture clinic. Sixty percent got discharged in first appointment, compared to 50% after re-auditing. Re-referral rate is 0%. Each fracture clinic costs just over £700.

Conclusions

Patients with fifth metacarpal neck fractures should be managed in the ED through an agreed pathway, unless they have rotational deformity, are open or angled beyond 50° in which case they should be referred to the fracture clinic or on call orthopaedic team as appropriate. This will not only avoid an unnecessary attendance at fracture clinic, but also provide cost saving.
Targeting emotional impact in storytelling: Working with client affect in emotion-focused psychotherapy
Authors: Muntigl Peter , Knight Naomi K , Angus Lynne
Published: September 2014

Within emotion-focused therapy (EFT), the client’s ability to express and reflect on core emotional experiences is seen as fundamental to constructing the self and to entering into a change process. For this study, we 1) examine storytelling contexts in which clients do not disclose the emotional impact of their narrative, and 2) identify the interactional practices through which EFT therapists subsequently call attention to what the client may have felt. In doing so, we examine client stories drawn from video-taped individual psychotherapy sessions involving clinically depressed clients. Client stories and therapists’ responses to these stories were analysed using conversation analytic methods. Three different therapist response types were identified: eliciting, naming and illustrating the emotional impact of the client’s prior narrative. These responses also were found to differ in terms of how effectively they could display empathy and secure affiliation with clients. The implications of this work for therapeutic practice are discussed.
Reactive and proactive aggression in mainland Chinese secondary school students
Authors: Li Xiang , Fung Annis Lai-chu
Published: September 2014

As there has been little research in mainland China on the distinction between reactive and proactive aggression, the country’s educators and social workers work with an oversimplified definition of aggression that fails to consider different subtypes, thereby preventing the development of effective interventions. There is a pressing need to learn more about the particular subtypes of reactive and proactive aggression that prevail among mainland Chinese students. Here we report the validation and generalization in China of a well-designed assessment tool, the Reactive-Proactive Aggression Questionnaire (RPQ), which is widely used in the West to measure students’ reactive and proactive aggression. Our twofold objective is to determine 1) whether reactive and proactive aggression can be distinguished; and 2) whether the two-factor structure of the reactive and proactive aggression model is appropriate in a non-Western setting. This is a pioneering study designed to develop a reliable reactive/proactive aggression assessment instrument for the mainland Chinese context.

Findings

Consistent with the findings of previous validation studies on the RPQ, our findings indicate that reactive and proactive aggression are distinguishable in mainland China, but the factor structure differs slightly from the prior findings.

Applications

With modification of its factor structure, the RPQ can be considered a valid scale to measure the two dimensions of aggression in mainland China. An understanding of the distinction between them will facilitate effective treatment for aggressive students in this region.
The study of girls in social work: Major discourses and feminist ideas
Authors: Krumer-Nevo Michal , Berkovitz-Romano Adva , Komem Michal
Published: September 2014

The purpose of this article is to identify the professional discourse on girls over time, and to examine the extent and the ways in which feminist ideas and theories are expressed in this discourse, and in particular, in the scholarly social work body of knowledge in Israel. Thus, the article presents a feminist-historical analysis of research on girls in conditions of distress published in Israel during the years 1970–2010.

Findings

Four main theoretical discourses were found through an analysis of 107 publications: the pathological discourse; the discourse of vulnerability; the discourse of agency; and the intersectional discourse. The findings show that the number of studies on girls and the use of feminist discourses in them are on the rise. The girls’ characteristics, their sexual behavior, and its connections to the characteristics of their families are three focuses of the research all through the years. However, major differences were discovered in the ways these issues were interpreted in accordance with the guiding discourse adopted by each individual study.

Applications

The choice of a specific discourse leads to different social work practice with girls. In order to develop feminist practices with girls and to apply the most appropriate one, one should recognize the different available discourses, and their potentialities to the field.
Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care
Authors: Hallberg Ingalill Rahm , Cabrera Ester , Jolley David , Raamat Katrin , Renom-Guiteras Anna , Verbeek Hilde , Soto Maria , Stolt Minna , Karlsson Staffan
Published: September 2014

Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor’s level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor’s degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.
The relevance and potential roles of microphysiological systems in biology and medicine
Authors: Wikswo John P
Published: September 2014

Microphysiological systems (MPS), consisting of interacting organs-on-chips or tissue-engineered, 3D organ constructs that use human cells, present an opportunity to bring new tools to biology, medicine, pharmacology, physiology, and toxicology. This issue of Experimental Biology and Medicine describes the ongoing development of MPS that can serve as in-vitro models for bone and cartilage, brain, gastrointestinal tract, lung, liver, microvasculature, reproductive tract, skeletal muscle, and skin. Related topics addressed here are the interconnection of organs-on-chips to support physiologically based pharmacokinetics and drug discovery and screening, and the microscale technologies that regulate stem cell differentiation. The initial motivation for creating MPS was to increase the speed, efficiency, and safety of pharmaceutical development and testing, paying particular regard to the fact that neither monolayer monocultures of immortal or primary cell lines nor animal studies can adequately recapitulate the dynamics of drug–organ, drug–drug, and drug–organ–organ interactions in humans. Other applications include studies of the effect of environmental toxins on humans, identification, characterization, and neutralization of chemical and biological weapons, controlled studies of the microbiome and infectious disease that cannot be conducted in humans, controlled differentiation of induced pluripotent stem cells into specific adult cellular phenotypes, and studies of the dynamics of metabolism and signaling within and between human organs. The technical challenges are being addressed by many investigators, and in the process, it seems highly likely that significant progress will be made toward providing more physiologically realistic alternatives to monolayer monocultures or whole animal studies. The effectiveness of this effort will be determined in part by how easy the constructs are to use, how well they function, how accurately they recapitulate and report human pharmacology and toxicology, whether they can be generated in large numbers to enable parallel studies, and if their use can be standardized consistent with the practices of regulatory science.