bluuebunny/crossref_metadata_2025 huggingface dataset:
Granulocytic Sarcoma by AML M4eo (inv16) after Allogeneic Stem Cell Transplantation without Bone Marrow Involvement
Authors: Zaenker Stephan , Schweyer Stefan , Hasenkamp Justin , Truemper Lorenz , Wulf Gerald
Published: September 2011

Granulocytic sarcoma (GS) represents a rare type of extramedullar manifestation from the acute myeloid leukaemia (AML). We report the case of a patient with recurrences of AML M4eo leukaemia in the uterus and the small intestine at 3 and 5 years, respectively, after matched related peripheral blood stem cell transplantation (PBSCT). The patient underwent the withdrawal of immunosuppression, hysterectomy, and local irradiation at first relapse, as well as systemic chemotherapy and donor lymphocyte infusions at second recurrence, inducing a second and third complete remission, respectively. At year six after transplantation, the patient experienced disease progression by meningeosis leukaemia to which she succumbed despite intrathecal chemotherapy. Following allogeneic stem cell transplantation, awareness for atypical manifestations of granulocytic sarcoma appears prudent, the cellular immunotherapy should aim at immunological disease control.
Partially Transparent Jaumann-Like Absorber Applied to a Curved Structure
Authors: Motevasselian Alireza , Jonsson B. L. G.
Published: September 2011

A Jaumann absorber with its metal backing replaced with a combined low-pass and polarizer FSS is investigated with respect to its absorption and its polarization-dependent low-frequency transparency properties. This structure is applied to an idealized curved wing-front end, and its monostatic radar cross-section is determined. The FSS-Jaumann structure preserves an absorption similar to the planar Jaumann absorber in the higher frequency interval and enables a partial transparency in the TEzpolarization at 1 GHz. In addition, once the structure is applied to the wing-front end, a significant reduction in two-dimensional radar cross-section for both the TMzand TEzpolarization over 2–16 GHz is observed. A sensitivity analysis shows that the resistivity of the inner resistive layer has a large impact on the 1 GHz transmission.
GABA Neuron Alterations, Cortical Circuit Dysfunction and Cognitive Deficits in Schizophrenia
Authors: Gonzalez-Burgos Guillermo , Fish Kenneth N. , Lewis David A.
Published: September 2011

Schizophrenia is a brain disorder associated with cognitive deficits that severely affect the patients' capacity for daily functioning. Whereas our understanding of its pathophysiology is limited, postmortem studies suggest that schizophrenia is associated with deficits of GABA-mediated synaptic transmission. A major role of GABA-mediated transmission may be producing synchronized network oscillations which are currently hypothesized to be essential for normal cognitive function. Therefore, cognitive deficits in schizophrenia may result from a GABA synapse dysfunction that disturbs neural synchrony. Here, we highlight recent studies further suggesting alterations of GABA transmission and network oscillations in schizophrenia. We also review current models for the mechanisms of GABA-mediated synchronization of neural activity, focusing on parvalbumin-positive GABA neurons, which are altered in schizophrenia and whose function has been strongly linked to the production of neural synchrony. Alterations of GABA signaling that impair gamma oscillations and, as a result, cognitive function suggest paths for novel therapeutic interventions.
Analysis of the Emergence in Swarm Model Based on Largest Lyapunov Exponent
Authors: Wu Yu , Su Jie , Tang Hong , Tianfield Huaglory
Published: September 2011

Emergent behaviors of collective intelligence systems, exemplified by swarm model, have attracted broad interests in recent years. However, current research mostly stops at observational interpretations and qualitative descriptions of emergent phenomena and is essentially short of quantitative analysis and evaluation. In this paper, we conduct a quantitative study on the emergence of swarm model by using chaos analysis of complex dynamic systems. This helps to achieve a more exact understanding of emergent phenomena. In particular, we evaluate the emergent behaviors of swarm model quantitatively by using the chaos and stability analysis of swarm model based on largest Lyapunov exponent. It is concluded that swarm model is at the edge of chaos when emergence occurs, and whether chaotic or stable at the beginning, swarm model will converge to stability with the elapse of time along with interactions among agents.
Augmentation of Tonic GABAAInhibition in Absence Epilepsy: Therapeutic Value of Inverse Agonists at Extrasynaptic GABAAReceptors
Authors: Errington Adam C. , Cope David W. , Crunelli Vincenzo
Published: September 2011

It is well established that impaired GABAergic inhibition within neuronal networks can lead to hypersynchronous firing patterns that are the typical cellular hallmark of convulsive epileptic seizures. However, recent findings have highlighted that a pathological enhancement of GABAergic signalling within thalamocortical circuits is a necessary and sufficient condition for nonconvulsive typical absence seizure genesis. In particular, increased activation of extrasynaptic GABAAreceptors (eGABAAR) and augmented “tonic” GABAAinhibition in thalamocortical neurons have been demonstrated across a range of genetic and pharmacological models of absence epilepsy. Moreover, evidence from monogenic mouse models (stargazer/lethargic) and the polygenic Genetic Absence Epilepsy Rats from Strasbourg (GAERS) indicate that the mechanism underlying eGABAAR gain of function is nonneuronal in nature and results from a deficiency in astrocytic GABA uptake through the GAT-1 transporter. These results challenge the existing theory that typical absence seizures are underpinned by a widespread loss of GABAergic function in thalamocortical circuits and illustrate a vital role for astrocytes in the pathology of typical absence epilepsy. Moreover, they explain why pharmacological agents that enhance GABA receptor function can initiate or exacerbate absence seizures and suggest a potential therapeutic role for inverse agonists at eGABAARs in absence epilepsy.
A Case Report on the Surgical Treatment of the Huge Inflammatory Pseudotumor in the AIDS Patient with Hemophilic
Authors: Liu Baochi , Liu Li , Feng Yanling , Li Lei
Published: September 2011

An HIV infected hemophilia patient with huge inflammatory pseudotumor was in severe ill condition. The operation of right hip joint amputation was performed on the patient with perioperative infusion of coagulation factor VIII and highly active antiretroviral therapy (HAART). The pathological found that Inflammatory cell infiltration, formation of folliculus lymphaticus, muscular fiber breakage, and fibrous tissue hyperplasy, necrosis in both soft tissue and bone were seen in inflammatory pseudotumour. The vital signs remained stable during the operation and patient's overall health condition improved significantly ten months after operation. With the infusion of coagulation factor VIII and HAART, HIV infected hemophilia patient can be safety operation and may get effective result.
Identification and Characterization of Cell Wall Proteins of a Toxic Dinoflagellate Alexandrium catenella Using 2‐D DIGE and MALDI TOF‐TOF Mass Spectrometry
Authors: Wang Da-Zhi , Dong Hong-Po , Li Cheng , Xie Zhang-Xian , Lin Lin , Hong Hua-Sheng
Published: September 2011

The cell wall is an important subcellular component of dinoflagellate cells with regard to various aspects of cell surface‐associated ecophysiology, but the full range of cell wall proteins (CWPs) and their functions remain to be elucidated. This study identified and characterized CWPs of a toxic dinoflagellate, Alexandrium catenella, using a combination of 2D fluorescence difference gel electrophoresis (DIGE) and MALDI TOF‐TOF mass spectrometry approaches. Using sequential extraction and temperature shock methods, sequentially extracted CWPs and protoplast proteins, respectively, were separated from A. catenella. From the comparison between sequentially extracted CWPs labeled with Cy3 and protoplast proteins labeled with Cy5, 120 CWPs were confidently identified in the 2D DIGE gel. These proteins gave positive identification of protein orthologues in the protein database using de novo sequence analysis and homology‐based search. The majority of the prominent CWPs identified were hypothetical or putative proteins with unknown function or no annotation, while cell wall modification enzymes, cell wall structural proteins, transporter/binding proteins, and signaling and defense proteins were tentatively identified in agreement with the expected role of the extracellular matrix in cell physiology. This work represents the first attempt to investigate dinoflagellate CWPs and provides a potential tool for future comprehensive characterization of dinoflagellate CWPs and elucidation of their physiological functions.
The Role of PTEN in Tumor Angiogenesis
Authors: Rodriguez Stéphane , Huynh-Do Uyen
Published: September 2011

During the past 20 years, the phosphatase and tensin homolog PTEN has been shown to be involved in major physiological processes, and its mutation or loss is often associated with tumor formation. In addition PTEN regulates angiogenesis not only through its antagonizing effect on the PI3 kinase pathway mainly, but also through some phosphatase-independent functions. In this paper we delineate the role of this powerful tumor suppressor in tumor angiogenesis and dissect the underlying molecular mechanisms. Furthermore, it appears that, in a number of cancers, the PTEN status determines the response to chemotherapy, highlighting the need to monitor PTEN expression and to develop PTEN-targeted therapies.
One-Dimensional SnO2Nanostructures: Synthesis and Applications
Authors: Pan Jun , Shen Hao , Mathur Sanjay
Published: September 2011

Nanoscale semiconducting materials such as quantum dots (0-dimensional) and one-dimensional (1D) structures, like nanowires, nanobelts, and nanotubes, have gained tremendous attention within the past decade. Among the variety of 1D nanostructures, tin oxide (SnO2) semiconducting nanostructures are particularly interesting because of their promising applications in optoelectronic and electronic devices due to both good conductivity and transparence in the visible region. This article provides a comprehensive review of the recent research activities that focus on the rational synthesis and unique applications of 1D SnO2nanostructures and their optical and electrical properties. We begin with the rational design and synthesis of 1D SnO2nanostructures, such as nanotubes, nanowires, nanobelts, and some heterogeneous nanostructures, and then highlight a range of applications (e.g., gas sensor, lithium-ion batteries, and nanophotonics) associated with them. Finally, the review is concluded with some perspectives with respect to future research on 1D SnO2nanostructures.
Large Prospective Study of Ovarian Cancer Screening in High-Risk Women: CA125 Cut-Point Defined by Menopausal Status
Authors: Skates Steven J. , Mai Phuong , Horick Nora K. , Piedmonte Marion , Drescher Charles W. , Isaacs Claudine , Armstrong Deborah K. , Buys Saundra S. , Rodriguez Gustavo C. , Horowitz Ira R. , Berchuck Andrew , Daly Mary B. , Domchek Susan , Cohn David E. , Van Le Linda , Schorge John O. , Newland William , Davidson Susan A. , Barnes Mack , Brewster Wendy , Azodi Masoud , Nerenstone Stacy , Kauff Noah D. , Fabian Carol J. , Sluss Patrick M. , Nayfield Susan G. , Kasten Carol H. , Finkelstein Dianne M. , Greene Mark H. , Lu Karen
Published: September 2011

Previous screening trials for early detection of ovarian cancer in postmenopausal women have used the standard CA125 cut-point of 35 U/mL, the 98th percentile in this population yielding a 2% false positive rate, whereas the same cut-point in trials of premenopausal women results in substantially higher false positive rates. We investigated demographic and clinical factors predicting CA125 distributions, including 98th percentiles, in a large population of high-risk women participating in two ovarian cancer screening studies with common eligibility criteria and screening protocols. Baseline CA125 values and clinical and demographic data from 3,692 women participating in screening studies conducted by the National Cancer Institute–sponsored Cancer Genetics Network and Gynecologic Oncology Group were combined for this preplanned analysis. Because of the large effect of menopausal status on CA125 levels, statistical analyses were conducted separately in pre- and postmenopausal subjects to determine the impact of other baseline factors on predicted CA125 cut-points on the basis of 98th percentile. The primary clinical factor affecting CA125 cut-points was menopausal status, with premenopausal women having a significantly higher cut-point of 50 U/mL, while in postmenopausal subjects the standard cut-point of 35 U/mL was recapitulated. In premenopausal women, current oral contraceptive (OC) users had a cut-point of 40 U/mL. To achieve a 2% false positive rate in ovarian cancer screening trials and in high-risk women choosing to be screened, the cut-point for initial CA125 testing should be personalized primarily for menopausal status (50 for premenopausal women, 40 for premenopausal on OC, and 35 for postmenopausal women). Cancer Prev Res; 4(9); 1401–8. ©2011 AACR.
Green Tea Gets Molecular
Authors: Rouzer Carol A. , Marnett Lawrence J.
Published: September 2011

Green tea and its major polyphenolic flavonoid, epigallocatechin gallate (EGCG), have been credited with cancer chemopreventive activity for many years; the mechanism for this activity, however, has remained obscure. Now, as reported in this issue of the journal (beginning on page 1366), Urusova and colleagues showed direct binding of EGCG to the peptidyl prolyl cis/trans isomerase Pin1, which inhibited Pin1 enzymatic activity. They showed that Pin1 expression is required for EGCG effects on cell growth, c-Jun activation, and transcription regulation mediated by NF-κB and activator protein-1. The data provide a glimpse of the mechanism of action of EGCG and set a new bar for the future study of natural products with chemopreventive activity. Cancer Prev Res; 4(9); 1343–5. ©2011 AACR.
Rorγt+ Innate Lymphoid Cells in Intestinal Homeostasis and Immunity
Authors: Aparicio-Domingo Patricia , Cupedo Tom
Published: September 2011

Innate lymphoid cells (ILC) combine innate and adaptive immune functions and are part of the first line of defense against mucosal infections. ILC are set apart from adaptive lymphocytes by their independence on RAG genes and the resulting absence of specific antigen receptors. In this review, we will discuss the biology and function of intestinal ILC that express the nuclear hormone receptor Rorγt (encoded by the Rorc gene) and highlight their role in intestinal homeostasis and immunity.
The Impact of CHIP Coverage on Children With Asthma in Alabama
Authors: Menachemi Nir , Blackburn Justin , Sen Bisakha , Morrisey Michael A. , Becker David J. , Caldwell Cathy , Kilgore Meredith L.
Published: September 2011

This study evaluates the impact of coverage in ALL Kids, the Alabama Child Health Insurance Program (CHIP), by examining asthma-related utilization and outcomes among children continuously enrolled for 3 years (N = 1954)with persistent asthma at enrollment. Outcomes and costs were compared for the first, second, and third years of enrollment using repeated measures analysis of variance and controlling for age, gender, and year fixed-effects. Compared with subsequent years, first year enrollment utilization was higher for asthma-related hospitalizations (6% vs 2% vs 2%; P < .0001) and emergency visits (10% vs 3% vs 2%; P < .0001). Also decreasing were asthma-related outpatient visits (1.46 vs 1.12 vs 0.94; P < .0001), quick-relief prescriptions (2.6 vs 2.2 vs 2.1; P < .0001), and long-term control prescriptions (5.8 vs 5.2 vs 4.4; P < .0001). As a result, significant declines in the mean costs per child were observed. Ongoing ALL Kids coverage is associated with improved disease-management and lower costs for persistent asthma.
Complementary Tools for Studying the Cold War in Africa
Authors: Stephens Carla R.
Published: September 2011

This review of Piero Gleijeses’ monumental historical text, Conflicting Missions: Havana, Washington and Africa, 1959-1976, and Jihan El-Tahri’s award-winning documentary, Cuba: An African Odyssey, not only examines the strengths and weaknesses of these powerful complementary texts regarding Cuban internationalism in Africa but also provides pedagogical guidance for their use in teaching about the Cold War in Africa. These texts demonstrate how central Africa was to the history of the period and provide a means for educators to undermine students’ preconceived notions of the power of the West, African insignificance, and the major actors in the Cold War. This review offers suggestions for how instructors might use the two media to stimulate students’ critical thinking about such broad historical and political themes as race and culture, imperialism and anticolonialism, nationalism, revolution, and nation building foundational to the discourse. Additionally, it suggests other resources—books, newspaper articles, and primary documents—that might also be used when examining this tumultuous historical moment.
Lincoln and May
Authors: Merwin Michelle M.
Published: September 2011

The author presents the life of Abraham Lincoln as an example of Rollo May’s philosophical conceptualization of destiny. May used the term destiny to refer to the talents and limitations fated to us. Moreover, he emphasized the responsibility to act with freedom to shape destiny. In overcoming hardship and achieving greatness, Lincoln challenged his destiny. Additionally, the author proposes that Lincoln’s depression was precipitated by a moral crisis, relating to his personal responsibility in developing “self.” Lincoln’s observations about the causes of his depression are understood in terms of encounters with destiny. Not in spite of but because of his misery, he defined and fulfilled his destiny, thereby creating a life of meaning and significance. Thus, Lincoln is presented as a model for May’s ideas about challenging life’s limitations, developing talents, grappling with life’s pain, and creating meaning.
Math Fluency Is Etiologically Distinct From Untimed Math Performance, Decoding Fluency, and Untimed Reading Performance
Authors: Petrill Stephen , Logan Jessica , Hart Sara , Vincent Pamela , Thompson Lee , Kovas Yulia , Plomin Robert
Published: September 2011

The authors examined whether math fluency was independent from untimed math and from reading using 314 pairs of school-aged twins drawn from the Western Reserve Reading and Math Projects. Twins were assessed through a 90-min home visit at approximately age 10 and were reassessed in their homes approximately 1 year later. Results suggested that the shared environment and genetics influenced the covariance among math fluency, untimed math measures, and reading measures. However, roughly two thirds of the variance in math fluency was independent from untimed math measures and reading, including reading fluency. The majority of this independent variance was the result of genetic factors that were longitudinally stable across two measurement occasions. These results suggest that math fluency, although related to other math measures, may also be a genetically distinct dimension of mathematics performance.
A new converter fault discrimination method for a 12-pulse high-voltage direct current system based on wavelet transform and Hidden Markov Models
Authors: Tahan Mohamad , Monsef Hassan , Farhangi Shahrokh
Published: September 2011

The progressive development in high-voltage direct current (HVDC) transmission enhances the need to implement an efficient protection scheme to distinguish the minimum faulty part of the system and to relieve the stressed equipment. This paper proposes a new classification method based on Hidden Markov Models and wavelet transform to discriminate HVDC converter faults. In the proposed technique, probabilistic characteristics of signals discriminate fault signals without any deterministic index, so more flexible classification in different system conditions is achieved. Based on this method, high-speed protection decisions with small computational time could be performed in approximately 5 ms for severe system faults, and in 12.5 ms for faults that are restricted by protective control decision. PSCAD/EMTDC software simulations demonstrate suitable performance of this scheme for different fault types and system conditions in the International Council for Large Electric Systems (CIGRE) HVDC benchmark. All simulation results validate the stability and robustness of proposed scheme in different conditions, such as noisy systems.
Adolescents’ Susceptibility to Peer Pressure
Authors: Chan Siu Mui , Chan Kwok-Wai
Published: September 2011

Studies on factors affecting susceptibility to peer pressure are not plentiful although this susceptibility has been found to be associated with youth problems such as substance use and risky sexual behavior. The present study examined how adolescents’ susceptibility to peer pressure is related to their relationships with mothers and emotional autonomy from parents. Data were collected from 550 Hong Kong secondary school students using questionnaires. Structural equation modeling results showed that mothers’ behavioral control and psychological control predicted adolescents’ susceptibility to peer pressure in negative and positive directions respectively. A mediation model is established in which maternal warmth was a negative predictor of adolescents’ susceptibility to peer pressure in the areas of peer activities, family activities, school activities, and misconduct behaviors and its effects were mediated by adolescents’ emotional autonomy from parents. Implications for parenting programs are discussed.
Influence of Glycols on the Glycolysis Process and the Structure and Properties of Polyurethane Elastomers
Authors: Datta J. , Haponiuk J. T.
Published: September 2011

In this work, the influence of glycols on the glycolysis process and the properties of obtained polyurethanes were investigated. The glycolysates were produced via glycolysis of waste polyurethane foam in the reaction with one of the following glycols: 1,3-propanediol, 1,5-pentanediol, and 1,6-hexanediol.The reactions were carried out for different mass ratios of polyurethane wastes to glycolysis agent, i.e. 6:1, 8:1, and 10:1. Polyurethanes were synthesized from the obtained intermediates by a one-step method of mixing polymeric di-isocyanate and the glycolysis products with molecular masses ranging from 700 to 1000, while a polyol (Poles 55/20) was used as a chain elongation agent. The influence of glycolysates on tensile strength and elongation at break of polyurethanes was investigated using a Zwick universal tensile tester. Thermal decomposition of the obtained glycolysates and polyurethanes was investigated by thermogravimetry coupled with Fourier transform infrared spectroscopy. It has been found that of all used glycols, 1,6-hexanediol gives the best improvement in the thermal stability of polyurethanes during the glycolysis process. The mean hardness of polyurethanes decreases but rebound resilience increases with chain length of the glycol used for obtaining glycolysates.
Further Understanding Accountability in Public Organizations
Authors: Yang Kaifeng
Published: September 2011

Accountability research in public organizations has made significant progress, but it remains unclear exactly how public managers deal with conflicting accountability pressures and how accountability systems can make a positive difference. This article reviews the accountability literature and submits that developing more actionable knowledge requires more attention to the interactive relationship between human agency and accountability structure and to the causal mechanisms linking accountability, behavior, and outcome in a long period of time. Giddens’ structuration theory is used to illustrate a more interactive and dynamic understanding of accountability. Theoretical and methodological implications for future research are discussed accordingly.
Conceptual and Functional Diversity of the Ombudsman Institution
Authors: Abedin Najmul
Published: September 2011

This article identifies and examines various types of the ombudsman institution that have evolved over the years, provides a clear and systematic classification of these models, and compares and contrasts them. Relatively recent developments can be better understood if they are also discussed in the light of the past. For this reason at the beginning of this article, the origin, development, and salient features of the original/classical model of the ombudsman institution are briefly discussed. Against this backdrop, the emerging pattern and the salient features of other types or deviant/distorted models of ombudsman offices are examined.
Prosocial Involvement Among African American Young Adults
Authors: White-Johnson Rhonda L.
Published: September 2011

Prosocial involvement is conceptualized as support for or engaging in behaviors that contribute to or benefit African American communities. The current study examines the relationship between prosocial involvement and race-related factors among 303 African American college students. Using two underlying dimensions of prosocial involvement, prosocial attitudes and prosocial behaviors, models were tested to examine racial discrimination and racial identity as predictors of prosocial involvement. Overall, participants showed strong support for prosocial involvement. Racial discrimination, racial centrality, and private regard were positively related to both dimensions of prosocial involvement. There was also a positive association between nationalist and assimilation ideology with prosocial attitudes. Findings from this study highlight the complexity of prosocial involvement and the relevance of race-related factors among African American college students.
Business of Medicine
Authors: Waguespack Richard W. , Koch Wayne M. , Marple Bradley F. , Dillon Jane T. , Moran Willard B. , Koopmann Charles F. , Setzen Michael , Eisenberg Lee D.
Published: September 2011

Program Description

Declining reimbursement over many years now threatens the viability of physician practices across specialties and practice settings. This miniseminar will outline the efforts of our Academy, specifically the Physician Payment Policy Work Group (3P), to advocate for fair reimbursement for our members in increasingly challenging public and private payer environments. Topics include updates on government health care reform, the Current Procedural Terminology (CPT) and Relative Value Update Committee (RUC) processes, coding and reimbursement for new technology, and new public and private payment models including the Accountable Care Organization concept. Strategies will be described as to how members can become actively involved to make a difference for our specialty.

Educational Objectives

1) Learn current healthcare reform initiatives, new payment models, and Academy efforts on Capitol Hill. 2) Understand Academy interaction with the AMA’s CPT Editorial Panel and Relative Value Update Committee. 3) Know Academy strategies for interaction with public and private payers, and effective membership involvement.
Apology and Disclosure
Authors: Roberson David W. , Hanscom Robert , Kenney Linda K. , Wojcieszak Douglas B. , Troxel David
Published: September 2011

Program Description

Following errors and adverse events, the traditional legal and risk management advice to physicians has been to refrain from any disclosure or apology which might be used against the physician legally. Other factors which may inhibit disclosure and apology include a medical culture of perfection and a lack of experience with effective communication techniques. An increasing body of work has shown that the traditional technique of stonewalling is naturally infuriating to patients and is much more likely to lead to lawsuits. In addition, it places physicians in an intolerable position, since the natural human impulse of the caregiver is to apologize for mistakes and then to do everything possible to make things right. A number of non‐profit organizations and a few forward‐thinking malpractice carriers and institutions are now encouraging prompt, honest disclosure of adverse events, and apology when a genuine error has occurred. Experience to date has been that this more honest process is tremendously relieving to patients and physicians, and that malpractice suits and losses are substantially less when patients are treated honestly. In this miniseminar, three national experts on errors, disclosure, and apology, will discuss the ethical imperative for disclosure and the data that support this approach, both from a patient/provider satisfaction standpoint and a risk reduction standpoint. Doug Wojcieszak, the founder of Sorry Works! will speak about the advantages of disclosure and (when appropriate) apology from a patient perspective. Linda Kenney of Medically Induced Trauma Support Services will speak to how a culture of secrecy around errors harms both patients who are kept in the dark and physicians who aren’t able to be honest with their patients. Rob Hanscom, Vice President of Loss Prevention of Risk Management Foundation (a branch of Harvard’s medical malpractice carrier), will explain why insurance carriers may support thoughtful disclosure and apology policies. A discussion period will cover the issues of what and when to disclose to patients about adverse events, and the difficult question of when an apology is and is not appropriate. We will also present effective techniques for both disclosure and (when appropriate) apology.

Educational Objectives

1) Understand the literature supporting disclosure and apology as the ethically appropriate response to adverse events. 2) Understand the evidence that disclosure and apology reduce the likelihood of litigation. 3) Know strategies to facilitate disclosure and apology after errors and adverse events.
Practice Considerations and Contracts for New Employment
Authors: Sturm‐O’Brien Angela K. , Glazer Robert A. , Fried Marvin P. , Zacharia Daniel , Ghossaini Soha N.
Published: September 2011

Program Description

The AAO‐HNS Section for Residents and Fellows and Women in Otolaryngology are sponsoring a miniseminar to assist physicians in embarking on or changing a career in otolaryngology. Important decisions regarding the right type of practice, finding practice opportunities, and interviewing insights will be explored. Discussion will include appropriate questions that physicians should ask themselves and their potential employers. Tips for successful interviewing and placement will be provided by an experienced and highly successful private practice employer. Considerations for those seeking an academic position will also be explored. An attorney will provide insight into negotiation of a fair contract and benefits package from both the employer and employee standpoint. Avoidance of common pitfalls will also be discussed. Issues specific to women in otolaryngology contract negotiation will be addressed, as well. This miniseminar will conclude with an interactive question and answer session.

Educational Objectives

1) Appreciate factors crucial in evaluating a practice opportunity specific to women and young physicians. 2) Be prepared for a successful interview. 3) Understand the basics of and avoid common pitfalls in negotiating medical employment contracts.
Surgical CAHPS for Measuring Patient Experience: A Pilot for Future MOC Requirements
Authors: Rhee John S. , Witsell David L.
Published: September 2011

Program Description

The Surgical Consumer Assessment of Healthcare Providers and Systems (SCAHPS®) is a standardized tool sponsored by the American College of Surgeons and the Surgical Quality Alliance that asks consumers and patients to report on and evaluate their experiences and satisfaction with their surgical care. The survey covers topics such as communication skills of providers (surgeon, anesthesiologist) and front office staff, and assesses all phases of the surgery (pre‐, intra‐, postoperative) for inpatient and outpatient settings.

Through presentation of both aggregate data and outlier case analysis from the AAO‐HNS pilot, this interactive miniseminar aims to give attendees a practical understanding of the utility of a survey like SCAHPS for assessing patient experience given the upcoming requirements under Part IV of MOC.

Health plans, insurers, and specialty boards may use the data from the SCAHPS for quality improvement activities and other financial incentive programs. Specifically, beginning in 2011, the American Board of Otolaryngology Part IV (Evaluation of Performance in Practice) Maintenance of Certification will require assessment of the interpersonal and communication skills of the surgeon using the SCAHPS or an equivalent survey.

Given this MOC requirement, the AAO‐HNSF BOD mandated the undertaking of this pilot in December 2009 to better understand the challenges and utility of assessing physician communication and the patient experience.

Educational Objectives

1) Describe the tool itself and the utility of the scores that assess surgeon‐physician communication. 2) Describe the feasibility and challenges of implementing a patient experience survey in busy academic and private otolaryngology–head and neck surgery practices. 3) Share lessons learned from outlier case analysis.
The Future of Our Specialty: Selecting and Training Residents in 2011
Authors: Tsue Terance , Stewart Michael G. , Goebel Joel A. , Levenberg Patricia , Franzese Christine B.
Published: September 2011

Program Description

Otolaryngology programs continue to attract some of the best medical student applicants, but there have been increasing challenges placed on residency training. ACGME, medico‐legal, public expectations, and financial pressures have changed the methods in which we train residents. This miniseminar will involve an expert panel discussion of the evolving aspects of otolaryngology residency training, which will expand into a town hall–type format using the audience response system and a roaming microphone for active audience contribution. The panel will include initiating perspectives from the ACGME RRC Executive Director, President of the Otolaryngology Program Directors Organization, members of the ABOto Education Council, an Associate Dean for GME and seasoned Program Directors. The discussion will focus on the important decision steps of both the residency applicant and program in the course of training: 1) How to select the right residency program applicant, including what is known and being studied with regard to resident performance and outcomes. 2) A review of match statistics including how we compare with other competing specialties that our applicants consider. 3) The here and now in terms of the new accreditation and duty hour rules, and what remains in the near future for program accreditation (milestones, etc). What does the average otolaryngology program look like (current program accreditation statistics), and what are some best practice solutions to adapt to the changing environment. 4) The use of the In‐training examination by programs and residents in preparation for the board certification and re‐certification.

Educational Objectives

1) Learn to improve a program’s resident applicant selection process to maximize resident performance and outcomes. 2) Understand how a program’s match and accreditation outcomes compare nationally. 3) Understand the current and future expectations for program accreditation and training.
What’s New in Quality Improvement: What to Prepare For
Authors: Nussenbaum Brian , Kienstra Matthew A.
Published: September 2011

Program Description

Our duty as otolaryngologists to provide the best care possible depends on our ability to stay current with the literature. This important task is becoming more difficult in this era of long hours, more clinical demands, and an ever‐growing body of medical literature. Additionally, key research findings that influence policies at hospitals and surgical centers are frequently not published in the usual journals read by otolaryngologists. The educational objectives of this miniseminar are to discuss current original research findings, provide a forum for the exchange of scholarly ideas, and highlight examples of best practice as related to new findings in the literature of patient safety and quality improvement. The format will be through the use of PowerPoint presentations with critical appraisal of the articles using the criteria described by SQUIRE (Standards for Quality Improvement Reporting Excellence), and then considering the validity and usefulness of the results in a practical manner toward our clinical practices. Articles will be chosen that have direct relevance and impact on the practice of otolaryngology‐head and neck surgery. The articles will be chosen by the members of the Patient Safety and Quality Care Committee.

Educational Objectives

1) Describe important recent research findings in the fields of patient safety and quality improvement. 2) Understand the relevance of these new findings to the everyday clinical practice of otolaryngology‐head and neck surgery. 3) Learn about the SQUIRE guidelines for reporting quality improvement studies.
Facial Plastic and Reconstructive Surgery
Authors: Wax Mark K. , Rosenthal Eben L. , Fedok Fred G. , Wang Tom D.
Published: September 2011

Program Description

Patients with facial nerve paralysis suffer significant cosmetic and functional morbidity due to lack of eye protection, ectropion, and lack of muscular control of the lower face. These effects can not only socially isolate the patient but may cause devastating complications to the affected organ including corneal ulceration and poor oral intake requiring nutritional supplementation. While the etiology of facial paralysis can be multifactorial, most of these patients eventually require the attention of the facial plastic reconstructive surgeon. Management of the eye involves not only loading the upper eyelid but tightening the lower eyelid. Many procedures are available for this rehabilitation, and these will be discussed. Gold weight versus platinum weight for the upper lid, shortening, tarsal strip, or wedge excision of the lower lid will be compared and contrasted. Mid‐face reconstruction can be addressed by mid‐face lifting or by nasal valve repair. The high incidence of nasal obstruction following facial nerve paralysis often is not recognized and should not be neglected. Rehabilitation of the nasal valve is straight forward and well received by patients. The lower face functions to allow for proper articulation and deglutition. Without oral competence, drooling and social isolation will occur. The reconstructive options for the lower face can be considered as either dynamic using a temporalis muscle sling or as dynamic with just some form of acellular suspension. The advantages and risks associated with the procedures and the operative results of these techniques will be discussed by the panel. Each panelist in this multidisciplinary presentation will present their preferred method of rehabilitation and then case scenarios will be used to explore subtleties of each surgical approach. This miniseminar will consist of a short presentation by each panelist with a focus on individual case management presentations. Audience participation will be encouraged.

Educational Objectives

1) Be able to manage the acute and chronic effects of paralysis of the upper eye. 2) Add tarsal strip to their management paradigm of the lower lid. 3) Discuss the benefits and disadvantages of lower face reanimation with dynamic vs adynamic reconstruction.
Innovations in Managing Cleft Lip/Palate: A Multicenter Perspective
Authors: Tollefson Travis T. , Buckmiller Lisa M. , Tatum Sherard A. , Senders Craig W. , Sykes Jonathan M. , Sidman James D. , Wang Tom D.
Published: September 2011

Program Description

Cleft and craniofacial teams with both pediatric otolaryngology and facial plastic surgery backgrounds continue to develop. Novel approaches in the management of children with cleft lip and palate have contributed to a variety of treatment paradigms. Each institution and individual surgeon brings a unique perspective of treatment preferences that are worthy of discussion. Beginning in the prenatal period, advances in ultrasound technology now allow parents and surgeons to begin early preparation and education. Presurgical orthopedic devices introduced in the 1960s by the late 1990s have developed into nasoalveolar molding. The appliance is created in conjunction with an orthodontist with adjustments leading to approximation of the alveolar segments, as well as to mold the nasal deformity (columellar lengthening). Recently published modifications of the microform, unilateral, and bilateral cleft lip repair will be presented. Other innovations seeking to improve the aesthetic outcomes such as the subunit approach, suture choice, tissue glue, and scar prevention with silicone gel will be justified. Cleft surgeons from five institutions will present their approach to the cleft lip nasal deformity at the time of cleft lip repair. This can range from delaying repair (no rhinoplasty) to bolstering placement, or even direct lower lateral cartilage repositioning with rhinoplasty. This miniseminar will provide the participant a perspective on how different institutions approach common problems in management of the cleft lip, palate, and nasal deformity. This forum supports the goals of the Specialty Surgery Committee of the AAFPRS in fostering collaboration between those cleft surgeons within pediatric otolaryngology and the facial plastic surgery subspecialties. Secondary speech surgery evaluation and treatment will be presented with fluoroscopic and endoscopic examples and panelist discussion. Lastly, difficult cases will also be presented. Audience touchpad interaction will facilitate discussion. The format will include presentations including intraoperative video and subsequent discussion of the following topics: Presurgical nasoalveolar molding, unilateral cleft lip and nasal deformity repair, bilateral cleft lip and nasal deformity repair, primary cleft rhinoplasty options, and management of the extremely wide cleft lip and nasal deformity.

Educational Objectives

1) Understand the timing and techniques for cleft lip/palate repair based on evidence‐based guidelines. 2) Learn the panelists’ preferred basic and advanced cleft lip repair designs. 3) Be able to interpret and choose treatment for velopharyngeal dysfunction audibly, on fluoroscopy, and nasopharyngoscopy.
Office‐Based Facial Plastic Procedures for Otolaryngologists
Authors: Carniol Paul J. , Fedok Fred G. , Sykes Jonathan M. , Langsdon Phillip R.
Published: September 2011

Program Description

The modern otolaryngologist has had residency‐based, and in many cases, advanced fellowship training in a wide spectrum of facial plastic and reconstructive procedures to correct congenital‐, acquired‐, and aging‐related deformities. Due to advances in technologies, there has been an increase in the ability to offer patients a variety of effective and minimally invasive interventions in the office setting. Among these interventions, the use of injected botulinum toxin has become common in the treatment of rhytids, hyperfunctional lines, and facial dystonias. The treatment of skin and subcutaneous contour deformities is also a common challenge for which patients seek consultation. Although previously the materials used for correction were limited in number, there has now been an increasing number of widely used and newly introduced materials made available to the practitioner. The introduction of hyaluronic acid–based agents created a significant increase in acceptance and demand for filler substances by patients. More recently approved and soon to be approved fillers promise to increase the application. Laser and light technologies, including laser hair removal, offer intervention for an increasingly large number of clinical issues including the treatment of wrinkles, hyperpigmentation, cutaneous vascular lesions, rosacea, unwanted hair, and other aging‐related skin conditions. Finally, although not representing new technology, but instead low‐cost effective treatments, the practitioner will find the availability of skin care services, particularly the use of various chemical peeling agents, to be a useful adjunct in the office setting. The purpose of the miniseminar is to present an up‐to‐date review of safe, effective office‐based procedures that the otolaryngologist may have available to patients in their office. The presentations will review the pertinent pharmacology, physics where applicable, and anatomy. Technique, preoperative and post procedure issues will be discussed. The clinical photo‐rich presentations will demonstrate technique and patient selection. The prevention and management of complications will be reviewed. This miniseminar will update the attendees that have previous training in these procedures and serve as an introduction to those that are exploring these procedures.

Educational Objectives

1) Learn the indications and techniques for cosmetic botulinum toxin injections. 2) Learn the indications and techniques for facial filler injections. 3) Learn the indications and techniques for chemical peels, lasers, and light‐based devices.
Applying PSQI: Metrics and More
Authors: Shah Rahul K. , Eisenberg Lee D. , Nussenbaum Brian , Jalisi Scharukh
Published: September 2011

Program Description

There is significant external pressure on physicians and healthcare organizations to measure physician outcomes (metrics). However, metrics are quite complicated to develop, validate, and implement. Unfortunately, agencies such as The Joint Commission via hospital medical staffs are requiring evaluations of ongoing professional practice (OPPE) and focused professional practice evaluations (FPPE). As a group, surgeons are not very well versed on this topic. It has come to the attention of the Patient Safety and Quality Improvement Committee of the Academy that many members seek education on creation of metrics and to ensure their non‐punitive applications. This miniseminar will begin with an overview of the pertinent definitions and organizations involved in the quality landscape. This brief overview will attempt to be a primer for otolaryngologists such that they can understand the priorities of the quality movement and how to prepare for such in their practices. The primer will also help lay the foundation for the discussion on metrics and how they relate back to the mandates of OPPE. The miniseminar will then discuss how to create and implement metrics from three varying perspectives. We will demonstrate this for a large, multi‐specialty practice group, an academic department, and an academic hospital. Participants will learn what constitutes an appropriate metric and how these should ideally be designed for implementation in their practices.

Educational Objectives

1) Understand the priorities of the quality movement and how to meet the requirements of various constituencies. 2) Learn how to create and implement quality improvement metrics within the practice setting (multi‐specialty group practice, academic department, and academic hospital).