bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological Features of Cell Blocks Prepared from Residual Liqui-PREP Samples Can Distinguish between High-Grade Squamous Intraepithelial Lesions and Squamous Cell Carcinomas
Authors: Wei Qingzhu , Liu Jianghuan , Zhang Zhixiong , Yang Qiao , Zhao Tong
Published: April 2011

Objective: To evaluate the diagnostic value and compare morphological features of cell block sections of high-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinomas (SCC). Study Design: A total of 135 cell blocks were prepared from residual Liqui-PREP samples. Of these, 43 biopsy-confirmed cases (24 HSIL and 19 SCC) were reviewed. Morphological features determined included cell clusters, epithelial-stromal interface, stromal invasion and tumor necrosis. Results: Ninety-three percent (40/43) of cell block diagnoses were consistent with histological diagnoses, which was better than the cytological diagnoses (81.4%; 35/43). The mean cell block size was 0.54 cm (range, 0.3–1.0 cm) for HSIL and 0.84 cm (range, 0.4–1.4 cm) for SCC (p < 0.0001). Cell clusters were present in 70.8% (17/24) of HSIL and 100% (19/19) of SCC (p < 0.0001). No epithelial-stromal interface, stromal invasion or tumor necrosis was observed on HSIL cell block sections, which is in contrast to the 84.2% (16/19), 68.4% (13/19) and 42.1% (8/19) on SCC cell blocks, respectively (p < 0.05). Conclusion: Cell blocks may increase the diagnostic accuracy of liquid-based cytology. The presence of stromal invasion, epithelial-stromal interface and tumor necrosis on cell block sections may be useful for accurate SCC diagnosis.
Infectious Organisms on Papanicolaou Smears Should Not Influence the Diagnosis of Atypical Squamous Cells of Undetermined Significance
Authors: Nasser Haitham , Hayek Sylvia , Balasubramaniam Mamtha , Kuntzman Tomi J.
Published: April 2011

Background: Atypical squamous cells of undetermined significance (ASCUS) remain the center of diagnostic controversy and patients’ stress despite recent advances in cervical cancer screening and the introduction of human papilloma virus (HPV) testing. The role of infectious agents in the induction of such changes is not well understood. Aim: We aim at reviewing the effect of the different infectious organisms in Papanicolaou (PAP) smears on the ASCUS diagnosis. Material: 133 ASCUS cases associated with variable infectious organisms (ASCUS-infection group) with secondary HPV testing and appropriate follow-up studies were reviewed. A control group of 310 ASCUS cases without any organisms (ASCUS-only group) was selected for comparison. Results: The ASCUS-infection group had a significantly higher proportion of HPV-positive tests than the ASCUS-only group (p = 0.0027). There was no significant difference on follow-up PAPs and biopsies between the two groups (p = 0.4272). They showed an overall mean of 75% negative, 20% low-grade lesions, and 5% high-grade lesions/carcinoma in situ on follow-up. Conclusion: Our study demonstrates no significant effect of infections on the cytological changes diagnostic of ASCUS. The cytologist should make this diagnosis neglecting any background infections even when predominant.
Evaluation of the Effect of Acetyl L-Carnitine on Experimental Cisplatin Ototoxicity and Neurotoxicity
Authors: Gunes Dilek , Kirkim Günay , Kolatan Efsun , Guneri Enis Alpin , Ozogul Candan , Altun Zekiye , Serbetcioglu Bülent , Yilmaz Osman , Aktas Safiye , Mutafoglu Kamer , Tufekci Ozlem , Erbayraktar Zübeyde , Olgun Nur
Published: April 2011

Introduction: Cisplatin (CDDP) is an effective and widely used chemotherapeutic agent for pediatric tumors, and ototoxicity is one of the dose-limiting side effects. Objective: It was the aim of our study to investigate the effect of acetyl L-carnitine (ALCAR) on experimental CDDP ototoxicity by audiologic tests, histomorphologic, immunohistochemical and ultrastructural examinations and to investigate the apoptotic pathways. Materials and Methods: Wistar albino rats (n = 28) were studied. Baseline audiological tests were performed in 4 groups: group 1, control; group 2, ALCAR; group 3, CDDP; group 4, CDDP + ALCAR-administered rats. Control audiological tests were performed on the 3rd day, and then the rats were sacrificed. Ear and brain specimens were examined by transmission electron microscopy, and caspase 3, 8 and 9 activities were investigated. Results: The CDDP-administered rats showed significant auditory brainstem response threshold shifts using all stimuli (clicks, 6-kHz and 8-kHz tone burst) compared with the control groups. The CDDP + ALCAR-administered rats showed significant auditory brainstem response threshold shifts by only click stimuli compared with the control groups. In the brain, spiral ganglion and organ of Corti, ultrastructural damage was prominent in group 3; the number of TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling)-positive cells and caspase 3, 8 and 9 immunostaining cells was significantly high in group 3. Conclusion: ALCAR improves CDDP-induced auditory impairment, and also antioxidative and antiapoptotic properties of ALCAR on CDDP ototoxicity were supported by the findings.
Quantitative Automated Image Analysis System with Automated Debris Filtering for the Detection of Breast Carcinoma Cells
Authors: Martin David T. , Sandoval Sergio , Ta Casey N. , Ruidiaz Manuel E. , Cortes-Mateos Maria Jose , Messmer Davorka , Kummel Andrew C. , Blair Sarah L. , Wang-Rodriguez Jessica
Published: April 2011

Objective: To develop an intraoperative method for margin status evaluation during breast conservation therapy (BCT) using an automated analysis of imprint cytology specimens. Study Design: Imprint cytology samples were prospectively taken from 47 patients undergoing either BCT or breast reduction surgery. Touch preparations from BCT patients were taken on cut sections through the tumor to generate positive margin controls. For breast reduction patients, slide imprints were taken at cuts through the center of excised tissue. Analysis results from the presented technique were compared against standard pathologic diagnosis. Slides were stained with cytokeratin and Hoechst, imaged with an automated fluorescent microscope, and analyzed with a fast algorithm to automate discrimination between epithelial cells and noncellular debris. Results: The accuracy of the automated analysis was 95% for identifying invasive cancers compared against final pathologic diagnosis. The overall sensitivity was 87% while specificity was 100% (no false positives). This is comparable to the best reported results from manual examination of intraoperative imprint cytology slides while reducing the need for direct input from a cytopathologist. Conclusion: This work demonstrates a proof of concept for developing a highly accurate and automated system for the intraoperative evaluation of margin status to guide surgical decisions and lower positive margin rates.
Abnormal Cervical Cytology in the Diagnosis of Uterine Papillary Serous Carcinoma: Earlier Detection of a Poor Prognostic Cancer Subtype
Authors: Skaznik-Wikiel Malgorzata E. , Ueda Stefanie M. , Frasure Heidi E. , Rose Peter G. , Fleury Aimee , Grumbine Francis C. , Fader Amanda Nickles
Published: April 2011

Objective: Early detection of uterine papillary serous (UPSC), clear cell (CCC), and grade 3 endometrioid carcinomas (G3EC) – all poor prognostic variants of endometrial carcinoma (EC) – is of particular clinical relevance. The study objective was to assess the utility of liquid-based cytology (Pap) in the detection of high-grade EC. Study Design: A retrospective, two-institution analysis of patients diagnosed with UPSC, CCC, or G3EC with a preoperative Pap from 1999 to 2010 was conducted. Results: One hundred and one patients were evaluated; 51.5% had UPSC, 27.7% had CCC, and 20.8% had G3EC. Stage I/II disease was found in 69.3% of patients, and 46/101 patients (45.5%) had abnormal Paps. Significantly more patients with UPSC had abnormal Paps (65.7%) than those with CCC (25%) or G3EC (23.8%; p < 0.001). An abnormal Pap was the only presenting clinical finding in a significant number of asymptomatic UPSC patients (26.9%) compared with 4% of patients with CCC and G3EC (p = 0.005). On multivariate analysis, UPSC histology was the only variable associated with an abnormal Pap. Conclusions: A high incidence of abnormal cervical cytology was observed in women with high-grade EC, particularly in UPSC patients. Although hypothesis generating, a proportion of asymptomatic UPSC patients had abnormal cytology, signifying that Pap smear screening may help detect the disease before the patient develops symptoms.
Small Cell Carcinoma of the Ovary Presenting in a Urine Cytology Specimen: A Case Report
Authors: Jazaerly Tarek , Jaratli Hayan , Jacques Suzanne M. , Giorgadze Tamar
Published: April 2011

Background: Small cell carcinoma (SMCC) is rarely diagnosed in urine specimens. Cytologically, this tumor is similar to pulmonary SMCC. However, clinicopathologic correlation may be required to differentiate between primary urinary bladder SMCC and metastatic SMCC from a remote primary or secondary bladder involvement by direct extension of the tumor from nearby organs (prostate, uterus, or ovary). A unique case of a rare pulmonary-type ovarian SMCC, the tumor cells of which were detected in a voided urine specimen, is described herein. Case: A 79-year-old female presented to the urologic clinic with a history of metastatic SMCC of unknown primary with hematuria. The voided urine specimen examination revealed tumor cells cytomorphologically consistent with small cell neuroendocrine carcinoma. Following cytologic diagnosis, cystoscopic examination and bladder biopsy were performed. The histopathology revealed a widely invasive tumor with a morphology typical of SMCC. The overlying urothelium was unremarkable. By immunohistochemistry, tumor cells were found positive for neuroendocrine markers, EMA and WT-1. The morphologic and immunohistochemical features of the tumor were most consistent with urinary bladder involvement by pulmonary-type primary ovarian SMCC. Conclusion: It is justified to think that SMCC cell detection in urine specimens does not necessarily imply their origin from primary bladder malignancy. Performing additional studies may be prudent in order to exclude secondary involvement of the bladder in this tumor as the correct diagnosis has significant clinical implications.
Utility of Napsin A and Thyroid Transcription Factor 1 in Differentiating Metastatic Pulmonary from Non-Pulmonary Adenocarcinoma in Pleural Effusion
Authors: Kim Jo-Heon , Kim Young-Sill , Choi Yoo-Duk , Lee Ji-Shin , Park Chang-Soo
Published: April 2011

Objective: It was our aim to evaluate the usefulness of napsin A and thyroid transcription factor 1 (TTF-1) in the differential diagnosis of metastatic pulmonary and non-pulmonary adenocarcinomas (ACs) in pleural effusion. Study Design: A total of 84 pleural effusion fluid cell blocks were collected from metastatic ACs. There were 53 pulmonary ACs and 31 non-pulmonary ACs. Immunohistochemical staining was performed with antibodies against napsin A and TTF-1. Results: Napsin A was positive in 44/53 (83%) cases of pulmonary ACs, and TTF-1 was positive in 30/53 (57%) cases of pulmonary ACs. All non-pulmonary ACs were negative for napsin A and TTF-1. Napsin A showed a reactivity in >75% of the tumor cells in 36 of the 44 positive cases (82%), whereas TTF-1 showed a reactivity in >75% of the tumor cells only in 6 of the 30 positive cases (20%; p < 0.01). Poorly differentiated pulmonary ACs expressed napsin A (73%) more frequently than TTF-1 (53%), but this was not statistically significant (p = 0.45). Conclusion: We conclude that napsin A is superior to TTF-1 with regard to distinguishing between metastatic pulmonary and non-pulmonary ACs in cell blocks prepared from malignant pleural effusions.
Validity of Estimated Glomerular Filtration Rates for Assessment of Baseline and Serial Renal Function in Patients With Atherosclerotic Renal Artery Stenosis
Authors: Madder Ryan D. , Hickman Leaden , Crimmins Geoffrey M. , Puri Mohammad , Marinescu Victor , McCullough Peter A. , Safian Robert D.
Published: April 2011

Background—

Despite routine use of estimated glomerular filtration rates (GFRs) as major renal end points in clinical trials of renal revascularization, serial GFR estimates have never been validated in patients with renal artery stenosis (RAS). The purpose of this study was to evaluate the validity of GFR estimates in patients with atherosclerotic RAS.

Methods and Results—

Serum creatinine (SCr) and
125
I-iothalamate GFR (I-GFR) were measured in patients with RAS. GFR estimates were calculated from Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockroft-Gault (CG) formulas. Using I-GFR as the reference standard, the sensitivity, specificity, and receiver operating characteristic area under the curve (AUC) were determined for MDRD, CKD-EPI, CG, and reciprocal SCr for identifying I-GFR <60 mL/min per 1.73 m
2
and a 20% change in I-GFR over time. Between 1998 and 2007, 541 I-GFR measurements were performed in 254 consecutive patients with RAS. MDRD, CKD-EPI, and CG GFR estimates demonstrated good sensitivity (86% to 95%), modest specificity (67% to 71%), and good reliability (AUC, 0.86 to 0.94) for identifying I-GFR <60 mL/min per 1.73 m
2
. GFR estimates had good specificity (87% to 95%), poor sensitivity (0% to 45%), and poor reliability (AUC, 0.61 to 0.65) for detecting 20% changes in I-GFR over follow-up.

Conclusions—

In patients with RAS, GFR estimates demonstrate good sensitivity and modest specificity for identifying I-GFR <60 mL/min per 1.73 m
2
but poor sensitivity and reliability for detecting 20% changes in I-GFR. GFR estimates should not be used in clinical trials as major end points to assess serial GFR after renal revascularization.
Relationships between Snow and the Wintertime Minneapolis Urban Heat Island
Authors: Malevich Steven B. , Klink Katherine
Published: April 2011

Urban heat islands (UHIs) are one of the best-recorded incidences of anthropogenic climate change. Studies from across the globe have examined this phenomenon, but relatively few have focused on cold-winter cities and the effects of snow cover and snowfall. This study uses hourly temperature measurements from 1 December 2008 through 28 February 2009 at 22 urban sites in Minneapolis, Minnesota, to investigate the effect of snow cover and snowfall on the UHI. Snow effects on temperature are estimated for calm conditions using a linear mixed-effect (LME) model. For the winter of 2008/09, the average wintertime UHI was approximately 1.0°C, with a peak near midday rather than at night. The LME model results suggest that a snow cover of 5 cm or more increased the magnitude of the UHI by about 1.0°C during the day and by about 0.5°C at night. The model also indicates that the presence of moderate snowfall decreased the magnitude of the UHI by up to 2.0°C, although this result is based on a comparatively small number of events. The high albedo of snow is posited to contribute to the enhanced UHI during the day, and snow’s insulating properties are likely contributors to the characteristics of the nighttime UHI.
Trajectory-Tracking Scheme in Lagrangian Form for Solving Linear Advection Problems: Preliminary Tests
Authors: Dong Li , Wang Bin
Published: April 2011

A Lagrangian linear advection scheme, which is called the trajectory-tracking scheme, is proposed in this paper. The continuous tracer field has been discretized as finite tracer parcels that are points moving with the velocity field. By using the inverse distance weighted interpolation, the density carried by parcels is mapped onto the fixed Eulerian mesh (e.g., regular latitude–longitude mesh on the sphere) where the result is rendered. A renormalization technique has been adopted to accomplish mass conservation on the grids. The major advantage of this scheme is the ability to preserve discontinuity very well. Several standard tests have been carried out, including 1D and 2D Cartesian cases, and 2D spherical cases. The results show that the spurious numerical diffusion has been eliminated, which is a potential merit for the atmospheric modeling.
The Generalized Discrimination Score for Ensemble Forecasts
Authors: Weigel Andreas P. , Mason Simon J.
Published: April 2011

This article refers to the study of Mason and Weigel, where the generalized discrimination score D has been introduced. This score quantifies whether a set of observed outcomes can be correctly discriminated by the corresponding forecasts (i.e., it is a measure of the skill attribute of discrimination). Because of its generic definition, D can be adapted to essentially all relevant verification contexts, ranging from simple yes–no forecasts of binary outcomes to probabilistic forecasts of continuous variables. For most of these cases, Mason and Weigel have derived expressions for D, many of which have turned out to be equivalent to scores that are already known under different names. However, no guidance was provided on how to calculate D for ensemble forecasts. This gap is aggravated by the fact that there are currently very few measures of forecast quality that could be directly applied to ensemble forecasts without requiring that probabilities be derived from the ensemble members prior to verification. This study seeks to close this gap. A definition is proposed of how ensemble forecasts can be ranked; the ranks of the ensemble forecasts can then be used as a basis for attempting to discriminate between corresponding observations. Given this definition, formulations of D are derived that are directly applicable to ensemble forecasts.
Obesity Prevention, Screening, and Treatment: Practices of Pediatric Providers Since the 2007 Expert Committee Recommendations
Authors: Rausch John Conrad , Rothbaum Perito Emily , Hametz Patricia
Published: April 2011

This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers’ reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents ( P < .05). Although most providers felt comfortable counseling patients and families about the prevention of overweight and obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers’ approach to overweight and obese children.
Reconsidering Insider Status for Families During the Transition From Early Intervention to Preschool Special Education
Authors: Podvey Mara C. , Hinojosa Jim , Koenig Kristie P.
Published: April 2011

Scholars know little about families’ experiences when receiving related services and how these services affect the shift from a family-centered to an educational program. In this qualitative interview study, the authors explored the transition experiences of six families over a 3-month period, focusing on the role of related therapy services and therapists. In the metatheme titled The Outsiders, the authors discuss these families’ views of their changing roles as their children enter preschool programs. Families in this study felt removed from their former role as an integral member of their children’s intervention team once their children entered school. Based on these families’ reported experiences, the authors propose strategies for professionals to improve their communication with parents to help them during this transition.
Highlighting Relatedness Promotes Prosocial Motives and Behavior
Authors: Pavey Louisa , Greitemeyer Tobias , Sparks Paul
Published: April 2011

According to self-determination theory, people have three basic psychological needs: relatedness, competence, and autonomy. Of these, the authors reasoned that relatedness need satisfaction is particularly important for promoting prosocial behavior because of the increased sense of connectedness to others that this engenders. In Experiment 1, the authors manipulated relatedness, autonomy, competence, or gave participants a neutral task, and found that highlighting relatedness led to higher interest in volunteering and intentions to volunteer relative to the other conditions. Experiment 2 found that writing about relatedness experiences promoted feelings of connectedness to others, which in turn predicted greater prosocial intentions. Experiment 3 found that relatedness manipulation participants donated significantly more money to charity than did participants given a neutral task. The results suggest that highlighting relatedness increases engagement in prosocial activities and are discussed in relation to the conflict and compatibility between individual and social outcomes.
Cultural Coproduction of Four States of Knowledge
Authors: Swedlow Brendon
Published: April 2011

In States of Knowledge (2004), Sheila Jasanoff argues that we gain explanatory power by thinking of natural and social orders as being produced together, but she and her volume contributors do not yet offer a theory of the coproduction of scientific knowledge and social order. This article uses Mary Douglas’s cultural theory to identify four recurring states of knowledge and to specify political–cultural conditions for the coproduction of scientific knowledge, social order, and scientific, cultural, and policy change. The plausibility of this theory is illustrated by using it to explain the coproduction and transformation of forest and wildlife science and management in the Pacific Northwest.
The acts of faith: On witnessing in Derrida and Arendt
Authors: Barbour Charles
Published: April 2011

In a brief comment in ‘History of the Lie’, his one sustained engagement with Arendt, Derrida criticizes the ‘absence’ of any reference to the ‘problematic of testimony, witnessing, or bearing witness’ in her work, and asserts that she was ‘not interested’ in what ‘distinguishes’ testimony from ‘proof’. This passage links Derrida’s reading of Arendt to a theme that concerns him throughout his later work, specifically the ‘affirmation’ or ‘act of faith’ that ostensibly conditions all human relations, and the possibility of sociality in general. In this article, I claim not only that Arendt did address the problem of testimony or witnessing, and the difference between bearing witness and establishing proof, but also that her consideration of these issues represents an alternative to many of the arguments Derrida develops in his later work, especially his approach to responsibility and judgment, secrecy and memory, and the relation between the self and others.
Keeping it open: Ontology, ethics, knowledge and radical democracy
Authors: Kioupkiolis Alexandros
Published: April 2011

Its preoccupation with ontology presents radical democracy with a thorny dilemma: how to combine commitment and affirmation with a distinctive emphasis on contingency and contestability. The article addresses this dilemma by engaging with three different perspectives. Ernesto Laclau’s work shows the intrinsic constraints of ontology and the inadequacy of a simple distinction between ontology and ethico-political decision. Simon Critchley opposes tying radical politics to ontological prefiguration and argues for a particular ethico-political orientation. But ethics and politics come entwined with ontological assumptions, and the ethical direction of politics can be as restrictive as its ontological framing. William Connolly weds ontology and ethics to a sharp awareness of their contestability. But his approach does not reach deep enough. It is not alive to the contestability of the very recognition of contestability. To enhance openness and reflexivity, projects of radical democracy should combine a dimension of substantive, detailed accounts with a reflexive commitment to contestability, which disrupts, questions and renews the thicker descriptions in the name of democracy and truth.
Tobacco Use among Rural African American Young Adult Males
Authors: Carroll William R. , Foushee Herman R. , Hardy Claudia M. , Floyd Tammi , Sinclair Catherine F. , Scarinci Isabel
Published: April 2011

Objective

Tobacco‐related disease is a primary source of mortality for African American men. Recent studies suggest that alternative tobacco products may have supplanted cigarettes as the most common products used by young African Americans. Effective cessation strategies require community‐specific prevalence data. This project measures the prevalence of 9 tobacco products among young African American men in rural Alabama.

Study Design

Principles of community‐based participatory research were used to design a verbally administered tobacco product survey to measure the prevalence and behavioral factors influencing use.

Setting

Black Belt counties of rural Alabama.

Subjects and Methods

African American men aged 19 to 30 years were recruited from the target counties. Participants were stratified by income and education level. Prevalence rates for 9 products were determined, and logistic regression analysis was performed.

Results

A total of 415 participants completed surveys. Cigarettes were the most common product ever (54%) and currently (39.9%) used. Participants who attended school for more than 12 years or attended religious services were less likely to use cigarettes. Marijuana and blunts were used next most commonly. Only 35 respondents (8.9%) currently used mini‐cigars. Other products, bidis/kreteks, smokeless tobacco, and pipes were used uncommonly in this sample.

Conclusions

Cigarettes remain the dominant tobacco product used by young African American men in rural Alabama. Cigarette prevalence far exceeds that measured statewide for African American men of the same age. Alternative products were not commonly used in this study population. Effective community‐based intervention must target cigarette initiation and cessation in this vulnerable population.
Improved Airway Visualization during Direct Laryngoscopy Using Self‐retaining Laryngeal Retractors
Authors: Longstreet Beck , Bhama Prabhat K. , Inglis Andrew F. , Saltzman Babette , Perkins Jonathan A.
Published: April 2011

Objective

To measure the degree to which the Lindholm laryngeal distending forceps improve visualization during direct laryngoscopy in selected pediatric patients.

Study Design

Case series with chart review.

Setting

Pediatric hospital.

Subjects and Methods

Subjects included children undergoing direct laryngoscopy using the Lindholm laryngeal distending forceps. Intraoperative endoscopic photos with and without false cord retraction via the Lindholm laryngeal distending forceps were obtained from the Seattle Children’s Hospital airway endoscopy photo library. Analysis was performed using imaging software. Comparisons of visible vocal cord and glottic opening areas as well as anterior commissure angles with and without the Lindholm laryngeal distending forceps were performed with a paired and unpaired Student t test.

Results

The use of the Lindholm laryngeal distending forceps increased the glottic opening by a mean of 359% (95% confidence interval [CI], 255%‐463%) and increased visualized true vocal cord area by 337% (197%‐477%). Angle at the anterior commissure increased from a mean of 24.9° to a mean of 71.5°, resulting in a net mean angle increase of 46.6° (95% CI, 40.2°‐52.9°). All measured changes were statistically significant with P values <.01.

Conclusions

When placed at the level of the false vocal folds, Lindholm laryngeal distending forceps will, at least in certain cases, greatly increase the visible area of the superior surface of the vocal folds, the anterior commissure, and, by increasing the glottic opening, the subglottic region. This improved visualization may enhance the surgeon’s ability to diagnose and treat pathologies in these anatomic regions during direct laryngoscopy.
Clinical Equipoise in Sleep Surgery
Authors: Field Clarice J. , Robinson Sam , Mackay Stuart , Harrison James D. , Marshall Nathaniel S.
Published: April 2011

Objective

Surgical approaches for alleviating snoring and/or obstructive sleep apnea (OSA) have been questioned because of a lack of evidence from high‐quality randomized controlled trials (RCTs). An ethical requirement for RCTs is that they must test questions where community equipoise (ie, uncertainty) exists as to the correct treatment. We aimed to measure perceived importance, community equipoise, and willingness to enroll patients in 5 potential trial targets among members of the Australian Society for Otolaryngology Head and Neck Surgery (ASOHNS).

Study Design, Setting, and Subjects

All ASOHNS members were surveyed using a multistage mail, email, Internet, and phone‐based questionnaire.

Methods

Equipoise was measured for each of the scenarios using a bidirectional linear scale comparing 2 treatments. Responses were categorized into 1 of 3 groups: (A) preferred treatment 1, (B) completely undecided, and (C) preferred treatment 2. The resulting proportions are called equipoise ratios: A:B:C. Using tick boxes, the authors queried the general clinical importance and willingness to enroll patients for all scenarios.

Results

A total of 167 of 313 surgeons responded (53.4%). Three of the 5 trial scenarios exhibited evidence of community equipoise, but 2 scenarios, radiofrequency ablation plus uvulopalatopharyngoplasty (UPPP) versus UPPP alone and upper‐airway reconstruction versus mandibular advancement splint (MAS), did not have strong support for enrolling patients. Informal feedback indicates one of these may be feasible in a smaller number of specifically trained surgeons.

Conclusion

We suggest 2 potential RCT targets: septoplasty and turbinate reduction versus conservative measures for snoring and airway reconstruction versus MAS for OSA, where importance, clinical equipoise, and willingness all exist.
Intratympanic Dexamethasone to Prevent Cisplatin Ototoxicity
Authors: Murphy Denise , Daniel Sam J.
Published: April 2011

Objective

To determine whether intratympanic administration of dexamethasone reduces ototoxicity from systemic cisplatin.

Study Design

Prospective animal study.

Setting

Cisplatin chemotherapy induces ototoxicity manifesting as irreversible, sensorineural hearing loss. This is due to damage to the inner ear structures by free radicals. Steroidal anti‐inflammatories have been shown to reduce the formation of free radicals and protect hearing in animal models.

Subjects and Methods

Pure tone auditory brainstem responses were obtained in 58 female albino guinea pigs before and 3 days after intraperitoneal (IP) cisplatin chemotherapy. Auditory brainstem responses were also taken up to 1 month after a low dose of cisplatin. Part I consisted of a dosing study to determine the optimal ototoxic dose of cisplatin. In part II, auditory brainstem response thresholds were compared after bilateral intratympanic dexamethasone doses to act as controls. For part III, the otoprotection of dexamethasone against cisplatin was tested in separate bilateral and unilateral studies.

Results

IP injection of 12 mg/kg of cisplatin induced significant hearing loss (57.2 ± 4.4 dB, P <. 01) with 0% mortality. Ears treated with intratympanic dexamethasone alone showed no significant threshold changes. Ears that received IP cisplatin and intratympanic dexamethasone showed reduced threshold shifts at 8 kHz when the greatest concentration of dexamethasone was administered.

Conclusion

Modest intratympanic dexamethasone otoprotection of the guinea pig ear was greatest at the highest concentration tested and occurred in a frequency‐dependent manner. Intratympanic dexamethasone presents as a safe, simple, and effective treatment modality to minimize cisplatin ototoxicity without interfering with the chemotherapeutic effects of cisplatin.
Topical Mithramycin‐A Modulates Submucosal Collagen Deposition after Esophageal Burn Injury in Rats
Authors: Davis Paul Lawson , Hardison Scott , Sullivan Christopher A.
Published: April 2011

Objective

To evaluate efficacy of a drug‐eluting, dissolvable esophageal (DEDE) stent for the prevention of submucosal collagen deposition in a rat model of acute esophageal injury.

Setting

University laboratory.

Study Design

Interventional randomized controlled trial.

Subjects and Methods

Forty two adult, male, age‐matched Sprague Dawley rats were randomized to undergo either sham esophageal surgery, esophageal burn injury, or esophageal burn injury and placement of a DEDE stent. All animals underwent open gastrotomy under anesthesia. In group 1, a cautery device was inserted through the gastrotomy into the distal esophagus and removed without creating an injury. In group 2, the cautery was placed in the distal esophagus and a circumferential thermal burn injury was created. In group 3, an identical burn injury was created and a DEDE stent was placed at the site of injury and secured. On postoperative day 28, animals were sacrificed, and the distal esophagi were harvested and processed for histology. Submucosal collagen area was quantified histologically and compared across the 3 experimental groups.

Results

After the investigators controlled for luminal circumference and multiple measurements, submucosal collagen area was increased in group 2 (burn) compared with group 1 (sham) (P =. 012). Submucosal collagen area was decreased in group 3 (DEDE stent) compared with group 2 (P =. 042). No statistically significant difference in submucosal collagen area was observed between animals in group 1 and group 3 (P =. 800).

Conclusions

Topical application of mithramycin‐A via a DEDE stent modulates collagen deposition after acute thermal injury in the rat esophagus.
Attachment insecurities and identification of at-risk individuals following the death of a loved one
Authors: Jerga Angelique M. , Shaver Phillip R. , Wilkinson Ross B.
Published: April 2011

We examined variables that might identify at-risk individuals following the death of a significant other. Previous research indicates attachment anxiety is associated with more intense grief, while avoidant individuals seem to cope with loss as well as secure individuals. Participants in this study (368 adults aged 17–49) completed an online survey measuring general and relationship-specific attachment insecurities, relationship characteristics, loss circumstances, and typical and prolonged grief symptoms. General attachment anxiety and avoidance were related to prolonged grief symptoms but not to typical symptoms. Relationship-specific anxiety was positively related to grief symptoms, while specific avoidance was negatively related. The results support the distinction between general and specific attachment insecurities and between normative and prolonged grief reactions.
A structural model of the antecedents to entrepreneurial capacity
Authors: Díaz-Casero J. Carlos , Hernández-Mogollón Ricardo , Roldán José L.
Published: April 2011

Much research has highlighted the influence of certain factors of the environment on entrepreneurship.  This article proposes a structural model that relates three of these environmental variables to entrepreneurial capacity.  These are entrepreneurial education and training, research and development transfer and cultural and social norms. These relationships were tested via empirical analysis of a sample of 380 Spanish experts, applying the Partial Least Squares (PLS) technique. The findings allow confirmation of the outstanding role of cultural and social norms in entrepreneurial capacity. Entrepreneurial education and training is not a significant antecedent variable of entrepreneurial capacity:  rather it is an indirect enabler via cultural and social norms. Finally, research and development transfer exerts a significant positive influence on entrepreneurial capacity.  This article also represents a pioneering methodological contribution to the study of the Global Entrepreneurship Monitor data. These data were analysed by applying structural equation modelling according to the PLS technique.
Optimism and chance: The elephants in the entrepreneurship room
Authors: Storey David J.
Published: April 2011

This article argues that existing theories of new and small firms fail to capture the temporal diversity of such enterprises. Most are ‘one-way bets’ because they provide an explanation only for growing firms. To address this, this article combines the role of chance with the optimism of the business owner into optimism and chance (OC) theory. This provides an insight into why, for example, very few new or small firms grow continuously and why, when compared to Europe, individuals in the USA who initially failed in business, ultimately became successful.
Conflicting Stakeholder Interests and Natural Gas
Authors: Lewin Jeffrey E. , Strutton David , Paswan Audhesh K.
Published: April 2011

Creation of a less expensive, domestically sourced, and more environmentally neutral energy grid is becoming a global imperative and natural gas (NG) is seen as a crucial component of this impetus. But expansion of NG production is fraught with significant macromarketing challenges; especially in light of recent discoveries of substantial NG reserves beneath heavily populated metropolitan areas. To understand certain decision-making dilemmas involving the benefits and burdens encountered in this macromarketing context, the effect of individualistic and altruistic values (manifesting as personal and societal costs and benefits) on safety and regulatory concerns associated with NG exploration and production are examined. Results suggest cost-oriented values, both individualistic and altruistic, are positively associated with safety and regulatory concerns; whereas benefit-oriented values have a negative association with concerns. These findings yield insights into how various challenges that arise within an extremely complex alternative energy agora might be addressed at local and global levels.
Pleural Endometriosis in an Aged Rhesus Macaque (Macaca mulatta)
Authors: Assaf B. T. , Miller A. D.
Published: April 2011

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity and is one of the most common reproductive abnormalities encountered in women as well as Old World primates. The majority of endometriosis cases in Old World primates occur within the abdominal cavity, with spread to extraabdominal sites considered to be a rare event. A 19-year-old multiparous female rhesus macaque ( Macaca mulatta) presented to necropsy for difficulty breathing and weight loss. Grossly, the animal had marked abdominal endometriosis and severe hemoabdomen and hemothorax, the latter of which was accompanied by marked pleural fibrosis. Histologic examination confirmed the abdominal endometriosis and also revealed numerous uterine glands and stroma embedded within the pleural fibrosis. Rafts of endometrial tissue were present within pulmonary lymphatics and the tracheobronchial lymph nodes. Immunohistochemically, all ectopic endometrial tissue had varying degrees of positive immunoreactivity to cytokeratin, vimentin, progesterone and estrogen receptors, and calretinin but was negative for desmin and carcinoembryonic antigen. Pleural endometriosis is an extremely rare manifestation of endometriosis in nonhuman primates. This case report emphasizes lymphatic spread as a likely mechanism for extrauterine endometriosis.
Providing End-of-Life Care in Care Homes for Older People
Authors: Goddard Cassie , Stewart Frances , Thompson Genevieve , Hall Sue
Published: April 2011

The study aimed to explore the views of care home staff (CHS) and community nurses (CNs) on providing end-of-life care (EOLC) in care homes. Participants were randomly selected and qualitative interviews conducted with 80 CHS and 10 CNs. Themes emerging from the data included the following: The meaning of EOLC; starting EOLC; dying in the care home; stress of providing EOLC; improving EOLC; and the role of the CN. CHS felt that planning for the end of life was important before residents reached the dying phase, which some found difficult to determine. Although CHS wished to avoid residents being transferred to hospital to die, they acknowledged that improvements in their skills and the resources available to them were needed to manage EOLC effectively. CNs were critical of the EOLC provided in some care homes, reporting tensions over their relationship with CHS. As the number of older people who die in care homes increases, there is a need to overcome these barriers to provide good EOLC.
The Impact of a Gerontology Course and a Service-Learning Program on College Students’ Attitudes Toward People With Dementia
Authors: Yamashita Takashi , Kinney Jennifer M. , Lokon Elizabeth J.
Published: April 2011

We examined the effects of a gerontology course and an intergenerational service-learning project for people with dementia (PWD) on three dimensions of students’ attitudes including attitudes toward older people, community service for older people, and working with PWD. Data consisted of a combination of pretest/posttest survey and review of journals that students maintained during the service-learning project. Results indicated that students who completed the gerontology course, and those who completed both the course and the service-learning project, reported significantly more positive attitudes toward older adults, whereas students in the course only had significantly less positive attitudes about working with PWD, and those in the other courses (sociology) showed no change in their attitudes. Students’ journals are replete with reports of the satisfaction they derived from their experiences. The findings highlight opportunities and challenges that should be considered in future intergenerational service-learning programs and gerontological education.
Uncertainty and Decision Making for Residents with Dementia
Authors: Lopez Ruth Palan , Guarino A.J.
Published: April 2011

Uncertainty is a significant barrier confronting surrogate decision makers (SDMs) who make treatment decisions for nursing home (NH) residents with dementia. The study purpose is to describe uncertainty among SDMs of NH residents with dementia and to identify factors associated with greater Uncertainty. We employed a nonexperimental, cross-sectional design using mailed survey and recruited 155 SDM participants from eight NHs in New England. The survey contained the Mishel Uncertainty in Illness Scale For Family Members. Independent variables included resident and SDM sociodemographic characteristics, Advance Directives, Credible Authority, Social Support, and Perceived Self-Efficacy for Surrogate Decision Making. Results of a simultaneous multiple regression analysis identified Perceived Self-Efficacy, Social Support, and Close Relative explained 22% of the Uncertainty variance. These findings suggest that close family relatives who serve as SDMs for NH residents with dementia may benefit from increasing social support and enhancing SDMs’ self-efficacy for decision making.
Evaluation of Night-Time Pain Characteristics and Quality of Sleep in Postoperative Turkish Orthopedic Patients
Authors: Büyükyılmaz Funda Esen , Şendir Merdiye , Acaroğlu Rengin
Published: April 2011

This descriptive, correlational study was conducted to determine orthopedic patients’ night-time pain characteristics, their quality of sleep and the contributing factors to poor sleep experiences, and the relationship between pain and sleep. Data were collected by using the McGill Pain Questionnaire-SF (MPQ-SF) and Pittsburgh Sleep Quality Index (PSQI) on the second postoperative day. Data were analyzed using the SPSS version 10.0 for Windows. Mean age of the 75 patients was 49.55 ± 21.10 years and were hospitalized in the orthopedic wards for 10.56 ± 14.74 days. Of the sample, 65.3% were female and 36% had hip/knee arthroplasty surgery. Pain (45%) and noise (23%) were found to be the most cited factors affecting the sleep of patients in postoperative periods. They experienced “external” pain at the surgical site and verbalized their pain as “stabbing” and “tiring-exhausting.” Patients’ night-time pain was determined to be severe (6.59 ± 1.62); their quality of sleep was also poor (9.24 ± 3.53). A statistically significant correlation was found between patients’ pain intensity and quality of sleep ( p≤.05).
Overweight, Obesity, and Metabolic Syndrome in Adults and Children in South Korea: A Review of the Literature
Authors: Jang Myoungock , Berry Diane
Published: April 2011

Overweight, obesity, and metabolic syndrome are increasing in South Korea dramatically. This review of the literature summarizes published studies on the prevalence of overweight, obesity, and metabolic syndrome in South Korean adults and children; summarizes studies related to obesity management and prevention in South Korean adults and children; and identifies gaps in the literature for further research. A PubMed, CINAHL, and Google Scholar search identified articles published between January 1, 2000, and June 30, 2010, using the following key search terms: overweight, obesity, adult, children, adolescent, metabolic syndrome, prevention, and South Korea. Inclusion criteria included articles published in English or Korean, and primary or secondary research that measured the prevalence and characteristics of overweight and obesity or described a management or prevention program. Twelve articles met the inclusion criteria and were categorized into either adult or child studies. In adults, the prevalence of overweight and obesity has increased as South Korea has moved from an agricultural to a modern society. In children, there were associations between infant feeding patterns, familial relationships, and dietary and physical activity patterns. There were few programs to manage or prevent overweight. Further research is needed to develop effective strategies to prevent and manage overweight and obesity in adults and children, using family-based interventions that include multigenerational family members.
Systemic Lupus Erythematosus: The Impact of Individual, Couple, and Family Dynamics
Authors: Sperry Len
Published: April 2011

Systemic lupus erythematosus (SLE) is an increasingly common chronic medical condition that affects not only patients but also their families. Because this condition has significant psychosocial impact, effective treatment requires an integration of psychosocial treatment—including individual, couples, and family counseling—with conventional medical treatment. Individual psychological dynamics as well as couple and family dynamics that can influence the treatment process are described along with implications for couples counseling. An illustrative case example is included.