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Background: The ligaments implicated in the earliest stages of developing a progressive collapsing foot deformity are poorly understood. Commonly employed cadaveric flatfoot models are created from simultaneous transection of multiple ligaments, making it difficult to assess early changes in pressure distribution from ligaments critical for maintaining load distribution. A serial transection of ligaments may provide insight into changes in pressure distribution under the foot to identify a potential combination of ligaments that may be involved in early deformities., Methods: Specimens were loaded using a custom designed axial and tendon loading system. Plantar pressure data for the forefoot and hindfoot were recorded before and after six sequential ligament complex transections., Findings: Sectioning the plantar fascia (first) and short/long plantar ligaments (second) failed to generate appreciable differences in load distribution. Dividing the spring ligament (third) led to changes in hindfoot load distribution with a shift towards the lateral column indicative of hindfoot valgus angulation. All subsequent conditions resulted in similar patterns in hindfoot plantar load distribution. An anterior shift in the center of pressure only occurred after transection of all six ligament complexes., Interpretation: Loss of the plantar fascia and short/long plantar ligaments are not critical in maintaining plantar load distribution or contact area. However, the additional loss of the spring ligament caused notable changes in hindfoot load distribution, indicating the combination of these three ligament complexes is particularly critical for preventing peritalar subluxation. Minimal changes in load distribution occurred when performing additional transections to reach a complete flatfoot deformity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

There are nearly 65 million people with chronic heart failure (CHF) globally, with no treatment directed at the pathologic cause of the disease, the loss of functioning cardiomyocytes. We have an allogeneic cardiac patch comprised of cardiomyocytes and human fibroblasts on a bioresorbable matrix. This patch increases blood flow to the damaged heart and improves left ventricular (LV) function in an immune competent rat model of ischemic CHF. After 6 months of treatment in an immune competent Yucatan mini swine ischemic CHF model, this patch restores LV contractility without constrictive physiology, partially reversing maladaptive LV and right ventricular remodeling, increases exercise tolerance, without inducing any cardiac arrhythmias or a change in myocardial oxygen consumption. Digital spatial profiling in mice with patch placement 3 weeks after a myocardial infarction shows that the patch induces a CD45 pos immune cell response that results in an infiltration of dendritic cells and macrophages with high expression of macrophages polarization to the anti-inflammatory reparative M2 phenotype. Leveraging the host native immune system allows for the potential use of immunomodulatory therapies for treatment of chronic inflammatory diseases not limited to ischemic CHF., (© 2023. The Author(s).)

Background: The Dichotic Digits Test (DDT) evaluates central auditory nervous system (CANS) dysfunction. The DDT is widely used in audiology clinics worldwide because it is clinically efficient and has good sensitivity and specificity for CANS lesions. However, the DDT shows a strong ceiling effect, which can mitigate its ability to detect subtle CANS dysfunction., Purpose: This study examines the effects of adding monaural and binaural speech-spectrum noise to the DDT in an effort to make the test more taxing to the CANS and thereby reduce the observed ceiling effect., Research Design: This was an experimental repeated measures study., Study Sample: The participants were 20 adults aged 18-50 years with normal, bilaterally symmetric peripheral hearing sensitivity., Data Collection and Analysis: Each participant was administered one standard DDT test list (no noise added) and DDT test lists with binaural, monaural right, and monaural left noise added. For each of the noise-added conditions, lists were administered at two different signal-to-noise ratios (SNRs), for a grand total of seven DDT test lists per participant, presented in randomized order. Monaural and binaural noise effects on DDT scoring indices (Right and Left Ear Percent Correct Scores, Combined Total Percent Correct Scores, and Dichotic Difference Scores), as well as noise effects on the Right Ear Advantage (REA) for speech, were examined. Mixed model analyses of variance (ANOVAs) were used to examine fixed effects and interactions of Noise Condition and Ear., Results: Adding noise to the standard DDT systematically reduced Right and Left Ear Percent Correct Scores and Combined Total Percent Correct Scores. Statistically significant differences on all indices were found between monaural and binaural noise-added conditions, suggesting a possible advantage for binaural listening in noise., Conclusions: These findings suggest that adding noise to tests of dichotic listening increases the difficulty of the task, and that further investigation of dichotic listening patterns in noise could potentially lead to more sensitive clinical evaluations of CANS integrity and function., Competing Interests: The authors declare that they have no conflict of interest., (American Academy of Audiology. This article is published by Thieme.)

Melanoma in Black patients carries a poor prognosis. Due to its rarity, melanoma in this population has not been well characterized. This study evaluates survival predictors in Black patients with melanoma. This was a retrospective cohort study of Black patients with cutaneous melanoma from the National Cancer Database 2004-2018. Of the 2464 cases, melanoma was more common among females than males (57.1% vs. 42.9%, p < .001). Median Breslow depth was 1.8 mm (interquartile range 0.4-4.4). Lower extremities were the most common location (52.8%), followed by upper extremities (13.1%) along with otherwise specified/overlapping/other (13.1%), then by trunk (11.8%), and lastly head and neck (9.2%). Stage at diagnosis was I (30.7%), II (27.5%), III (24.1%), and IV (17.7%). Ulceration was observed in 41.4% of lesions. Acral lentiginous melanoma (ALM) was the most common specific histologic subtype (20.3%), followed by superficial spreading melanoma (9.4%). After adjusting for confounders, higher stages and primary site on the head and neck were the strongest independent predictors of worse overall survival. Melanoma in Black patients is most likely to appear on the lower extremities. A large portion (41.8%) presented with stage III or IV disease. ALM was the most common specific histologic subtype., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Pain is one of the most common and debilitating symptoms of hidradenitis suppurativa (HS)., Objective: We sought to identify pain management therapies used in HS and assess patient-perceived effectiveness., Methods: An anonymous online survey was posted to Facebook HS support groups. Participants selected all that applied from a list of 20 therapies to indicate which ones they have tried for HS pain. For each therapy used, participants were asked to rate effectiveness on a 5-point scale: not successful (1), mildly successful (2), moderately successful (3), very successful (4), and extremely successful (5). Mean effectiveness ratings were calculated by averaging the corresponding numbers., Results: Of the 438 participants, 93.8% were female. Participants classified themselves as Hurley stage I (8.2%), II (53.4%), and III (38.4%). Warm compresses were the most commonly used therapy (82.4%), followed by ibuprofen/naproxen (74.7%), Epsom salt baths (57.8%), cold compresses (45.4%), and acetaminophen (44.7%). Marijuana smoking received the highest mean effectiveness rating (2.92 ± 1.10), followed by marijuana edibles (2.87 ± 1.10), and opioids (2.83 ± 0.98). Mean effectiveness ratings were lowest for bleach baths (1.52 ± 0.80), sitz baths (1.53 ± 0.56), massage (1.61 ± 0.92), gabapentin (1.64 ± 0.73), and acetaminophen (1.71 ± 0.75)., Conclusions and Relevance: Even the highest-rated pain management modalities are considered only moderately effective by HS patients.

Objectives/hypothesis: The aim of the study is to investigate whether close surgical margins impact oncologic outcomes compared to clear or involved surgical margins. We hypothesize that close surgical margins portend worse outcomes compared with clear margins, but improved outcomes compared with involved margins., Study Design: Systematic review., Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement standards, a systematic search was conducted for studies that reported oncologic outcomes following excision of primary mucosal head and neck squamous cell carcinoma (HNSCC). A meta-analysis was then performed, comparing local recurrence (LR), locoregional recurrence (LRR), and overall survival (OS) in patients with clear, close, and involved margins., Results: Twenty-six studies met the inclusion criteria, totaling 8,435 patients. About 96% of our included cases involved the oral cavity, 2% involved the oropharynx, and 2% other. Also, 68% of cases were T1/T2 and 32% were T3/T4. On meta-analysis, clear margins were associated with lower incidence of 5-year LR relative risk (RR) 0.50, 95% confidence interval [CI] 0.38-0.65) and higher 5-year OS (RR 1.22, 1.11-1.35), when compared with close margins. Involved margins had higher incidence of 5-year LR (RR 1.75, 1.16-2.64), higher incidence of LRR at last follow-up (RR 1.66, 1.37-2.00), and no difference in 5-year OS (RR 0.82, 0.60-1.11), when compared with close margins., Conclusions: There is a stepwise improvement in oncologic outcomes as surgical margin categorically improves from involved to close to clear. Patients with close margins therefore may benefit from adjuvant therapy. Further research is required to investigate whether these findings are seen in non-oral cavity cases because they were underrepresented in this analysis. Laryngoscope, 132:307-321, 2022., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Abstract: The advent of refractive surgery and corneal cross-linking for ectatic disease has further highlighted the need to recognize early or subclinical ectatic disease. Historical systems depend on anterior corneal changes that occur late in the disease course and are commonly associated with visual loss. Tomographic imaging allows for the acquisition of posterior corneal surface data and corneal thickness distribution. This led to the development of modalities to diagnose early or subclinical keratoconus and to screen patients for refractive surgery.This article reviews the modern methods for assessing changes in posterior corneal surface and pachymetric distribution, now accepted by the major cornea societies to be the hallmarks of ectatic disease. Screening tools utilized by the commonly used tomographic imaging devices are discussed, and the difference between screening for ectasia and diagnosing keratoconus is highlighted. The Belin ABCD staging and classification system and the ABCD Progression Display are reviewed as a new grading and monitoring system that can be used for earlier intervention and prevention of visual loss in keratoconus., Competing Interests: M. W. Belin serves as a consultant to OCULUS GmbH. He receives no royalties for any of the software mentioned in this article. The remaining authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: PUFAs play vital roles in the development, maintenance, and functioning of circuitries that regulate reward and social behaviors. Therefore, modulations in PUFA concentrations of these brain regions may disrupt reward and social circuitries contributing to mood disorders, developmental disabilities, and addictions. Though much is known about regional and phospholipid-pool-specific PUFA concentrations, less is known about the effects of dietary interventions that concurrently lowers n-6 PUFA and supplements n-3 PUFA, on brain PUFA concentrations. There is even less knowledge on the effects of sex on brain PUFA concentrations., Objective: This study aimed to comprehensively examine the interaction effects of diet (D), sex (S), brain regions (BR), and phospholipid pools (PL) on brain PUFA concentrations., Methods: Male and female C57BL/6J mice were fed 1 of 4 custom-designed diets varying in linoleic acid (LNA) (8 en% or 1 en%) and eicosapentaenoic acid/docosahexaenoic acid (EPA/DHA) (0.4 en% or 0 en%) concentrations from in utero to 15 weeks old. At 15 weeks old, the prefrontal cortex, dorsal striatum, and cerebellum were collected. Fatty acids of 5 major PL were quantified by GC-flame ionization detection. Repeated measures ANOVA was used to test for differences among the groups for D, S, BR, and PL., Results: No significant 4-way interactions on PUFA concentrations. DHA, predominant n-3 PUFA, concentrations were dependent on significant D × BR × PL interactions. DHA concentration was not affected by sex. Arachidonic acid (ARA; predominant n-6 PUFA) concentrations were not dependent on 3-way interactions. However, significant 2-way D × PL, BR × PL, and D × Sinteractions affected ARA concentrations. Brain fatty acid concentrations were differentially affected by various combinations of D, S, BR, and PL interactions., Conclusion: Though DHA concentrations are not affected by sex, ARA concentrations are affected by interactions of the 4 variables examined. This study provides comprehensive references in the investigation of complex interactions between factors that affect brain PUFA concentrations in mice., (Published by Oxford University Press on behalf of the American Society for Nutrition 2020.)

Voice changes caused by natural aging and neurodegenerative diseases are prevalent in the aging population and diminish quality of life. Most treatments involve behavioral interventions that target the larynx because of a limited understanding of central brain mechanisms. The songbird offers a unique entry point into studying age-related changes in vocalizations because of a well-characterized neural circuitry for song that shares homology to human vocal control areas. Previously we established a translational dictionary for evaluating acoustic features of birdsong in the context of human voice measurements. In the present study, we conduct extensive analyses of birdsongs from young, middle-aged, and old male zebra finches. Our findings show that birdsongs become louder with age, and changes in periodic energy occur at middle age but are transient; songs appear to stabilize in old birds. Furthermore, faster songs are detected in finches at middle age compared with young and old finches. Vocal disorders in humans emerge at middle age, but the underlying brain pathologies are not well identified. The current findings will motivate future investigations using the songbird model to identify possible brain mechanisms involved in human vocal disorders of aging. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Purpose: The aim of this study was to determine whether there are significant clinical variations in the Belin/Ambrosio Enhanced Ectasia Display (BAD display) parameters between Chinese and North American eyes and whether any variations are related to differences in corneal diameter., Design: Retrospective observational study., Methods: Files were generated from patients seeking refractive surgical correction. Patients with previous surgery, evidence of corneal ectasia, or scans representing a non-normal cornea were excluded. Unpaired t tests were performed for all variables. Regression analyses were performed for all variables with respect to corneal diameter, and compared to evaluate the influence of corneal diameter between populations. Data were graphed as standard scores (z scores) to compare different parameters., Results: 127 North American and 49 Chinese patients met study criteria. Statistically significant differences existed for corneal diameter (P < 0.01), anterior elevation at the thinnest point (P < 0.01), and Df (P < 0.01). In both populations, statistically significant correlations existed between corneal diameter and most indices, and most profoundly on pachymetric progression and final D. Regression slopes revealed a statistically significant difference for the influence of corneal diameter on ARTmax (P = 0.04) and was nearly significant for final D (P = 0.06)., Conclusions: Corneal diameter had the greatest influence on pachymetric progression and final D, and more profoundly in the Chinese. This suggests that incorporating corneal diameter as an additional variable may make the BAD display more universally applicable. Also, the differences in anterior elevation parameters suggest that specific ethnic/geographic normative values may be beneficial for the BAD display.

This essay examines the intersection of queerness and social class as it impinges on the field of LGBTQ+ studies. Specifically, it considers some of the disciplinary aims of queer critique in relation to the challenges facing first-generation queer scholars; in so doing, it suggests how forms of difference operate in relation to the personal over time. As a discipline committed to intersectional frameworks, LGBTQ+ studies (and its ongoing evolution) might thus usefully foreground overlapping understandings of outsiderness: namely, how queerness might be experienced as a form of class, and how class might be experienced as a form of queerness.

One of the most common complications following external ventricular drain (EVD) placement is infection. Routine cultures of cerebrospinal fluid (CSF) are often used to screen for infection, however several days may pass before infection is discovered. In this study, we compared the predictive value of daily recorded vital sign parameters and peripheral white blood count (WBC) in identifying ventriculostomy-related infections. Patients with EVDs who had CSF cultures for microorganisms performed between January 2011 and July 2017 were assigned to either an infected and/or uninfected study group. Clinical parameters were then compared using t-test, chi squared and multiple logistic regression analyses. Patients of any age and gender were included. One hundred seventy uninfected and 10 infected subjects were included in the study. Nine of the 10 infected patients had an elevated WBC (>10.4 × 10 3 /μL), with a significantly greater WBC (15.9 × 10 3 /μL) than the uninfected group (10.4 × 10 3 /μL) (p-value ≤ 0.0001). Using logistic regression, we found no association between patient vital signs and CSF infection except for WBC (p = .003). As a diagnostic marker for CSF infection, the sensitivity and specificity of WBC elevation greater than 15 × 10 3 /μL was 70% (7/10) and 90.2% (147/163), respectively. This study serves as a 'proof of concept' that WBC could be useful as potential screening tool for early detection of CSF infection post-EVD placement. Future investigation using a large, multicenter prospective study is needed to further assess the applicability of this parameter., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background Findings of both case control and in vitro investigations suggest that non-steroidal anti-inflammatory drugs (NSAIDs) may play a beneficial role in the occurrence, growth, and subsistence of glioblastoma multiforme (GBM) brain tumor in humans. Objective In the present retrospective cohort study, we assessed the impact of NSAID use on survival in patients diagnosed with and treated for GBM brain tumors. Methods The impact of NSAID use and six other potential prognostic indicators of survival were assessed in 71 patients treated for GBM brain tumors from February 2011 to June 2016. Survival analysis and cross-tabulation analyses were performed to examine the potential relationship between NSAID use and occurrence of intracranial hemorrhage over the course of treatment for GBM. Results Kaplan-Meier analysis revealed no significant difference in survival between patients with and without NSAID use (p = 0.75; 95% CI: 10.12, 18.13). Multiple Cox regression analysis identified only treatment with chemotherapy as imposing any statistically significant effect on survival (Hazard Ratio (HR) = 3.31; p < 0.001; 95% CI: 1.80, 6.07). Cross-tabulation revealed no significant effect of NSAID use on occurrence of hemorrhage during treatment, X 2 (2, N = 71) = 0.65, p 2-Sided = 0.42, (Fisher's Exact Test: p2-sided = 0.56, p1-sided = 0.31). Conclusion These results suggest that history of NSAID use is not a determinant of survival in GBM patients. More rigorous, prospective investigations of the effect of NSAID use on tumor progression are necessary before the utility of this family of drugs in the treatment of GBM can be adequately appraised., Competing Interests: The authors have declared that no competing interests exist.

Background and Aims: Initial clinical management decision in patients with acute gastrointestinal bleeding (GIB) is often based on identifying high- and low-risk patients. Little is known about the role of lactate measurement in the triage of patients with acute GIB. We intended to assess if lactate on presentation is predictive of need for intervention in patients with acute GIB., Patients and Methods: We performed a single-center, retrospective, cross-sectional study including patients ≥18 years old presenting to emergency with acute GIB between January 2014 and December 2014. Intensive care unit (ICU) admission, inpatient endoscopy (upper endoscopy and/or colonoscopy), and packed red blood cell (PRBC) transfusion were assessed as outcomes. Analyses included univariate and multivariate logistic regression analyses., Results: Of 1,237 patients with acute GIB, 468 (37.8%) had venous lactate on presentation. Of these patients, 165 (35.2%) had an elevated lactate level (>2.0 mmol/L). Patients with an elevated lactate level were more likely to be admitted to ICU than patients with a normal lactate level (adjusted odds ratio [AOR] 2.96, 95% confidence interval [CI] 1.74-5.01; p <0.001). Patients with an elevated lactate level were more likely to receive PRBC transfusion (AOR 3.65, 95% CI 1.76-7.55; p <0.001) and endoscopy (AOR 1.64, 95% CI 1.02-2.65; p =0.04) than patients with a normal lactate level., Conclusion: Elevated lactate level predicts the need for ICU admissions, transfusions, and endoscopies in patients with acute GIB. Lactate measurement may be a useful adjunctive test in the triage of patients with acute GIB., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: The aim of this study was to evaluate the associations between type and route of hormone use and urinary incontinence (UI) and pelvic organ prolapse (POP) in premenopausal and postmenopausal women., Methods: The authors used the National Health and Nutritional Examination Survey database for data from 2005-2006, 2007-2008, 2009-2010, and 2011-2012. Seven thousand sixty-six of the women included were premenopausal, and 5387 were postmenopausal. Premenopausal women were younger than 51 years and reported menstrual periods in the last 12 months. Postmenopausal women reported being in natural or surgical menopause. Urinary incontinence was defined as experiencing urinary leakage "less than once a month" or more. Pelvic organ prolapse was defined as an affirmative response to "experience bulging in the vaginal area." Hormone route and use were stratified in years. Pearson χ and Pearson correlations were used, with P < 0.05 considered significant., Results: In premenopausal women, birth control pills, estrogen/progestin pills, and estrogen-only patch use are associated with UI (P < 0.05). Birth control pills are associated with both UI and POP in premenopausal women (P < 0.05 for UI and POP). In postmenopausal women, estrogen-only pills, and estrogen/progestin pill use are associated with UI (P < 0.05). Birth control pill use is associated with POP in postmenopausal women (P = 0.029). Neither estrogen patch nor estrogen/progestin patch is associated with UI or POP in postmenopausal women., Conclusions: Type and route of hormone use have varied associations with UI and POP in premenopausal and postmenopausal women. Prospective studies are needed to further evaluate the effect of hormone type and route on UI and POP in premenopausal and postmenopausal women.

Latino/a youth have reported the highest rates of suicide attempts compared to White and African American youth for over 40 years. The data from the Youth Risk Behavior Surveillance System (YRBSS) cross-sectional subsamples of Latino/a youth (N = 13,378) at every year of data collection between 2005 and 2015 were examined for bullying, gun carrying, and suicidality. Results indicate that Latina girls are significantly more likely than boys to make a suicide attempt and report more bullying and more cyberbullying, but are less likely to carry a gun. Being bullied or carrying a gun were significantly associated with greater likelihood of suicide attempt among both boys and girls. Youth who carried a gun overall had higher rates of suicide attempts whether they were bullied or not, whereas youth who did not carry a gun were significantly more likely to attempt suicide if they were bullied. Over the past 10 years, gun carrying has decreased significantly for Latino boys and suicide attempts have decreased significantly for Latina girls. Findings have important implications of considering intersections of race and gender when developing antibullying and suicide prevention strategies. There are important policy implications for considering the mental well-being of youth who are caught carrying guns at school and considering that victimization varies by ethnicity and gender. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objectives: To verify accurate placement of the precordial ECG leads by identifying the 4th and 5th intercostal spaces as a function of the length of the sternum. This should decrease the percentage of lead misplacement leading to misdiagnoses., Methods: The population consisted of patients and healthy volunteers. The proposed method compared palpation of the 4th and 5th intercostal spaces to a percentile of the sternal length. Location of the 4th and 5th intercostal space using a simple device was evaluated to assist in proper placement of the precordial leads to obtain accurate diagnosis., Results: The location of the 4th and 5th intercostal space is related to the length of the sternum. It is 77% of the sternal length that measures 15cm for the 4th intercostal space. The position of the V1 and V2 electrodes decreases to 57% when the sternal length is 26cm. Similar data was obtained to locate the 5th intercostal space with proper position of V4-V6 electrodes. Tables are provided to facilitate this process. An instrument was designed to measure the 4th and 5th intercostal space as a function of the sternal length., Conclusions: The location of the 4th and 5th intercostal space is identified based on the length of the sternum., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Although digital rectal examination is an established part of physical examinations in patients with acute gastrointestinal bleeding, clinicians are reluctant to perform a rectal examination. We intended to assess whether rectal examination affects the clinical management decision in these patients., Methods: We performed a single-center, retrospective, cross-sectional study using data from electronic health records of patients aged ≥18 years presenting to the emergency department with acute gastrointestinal bleeding. Hospital admissions, intensive care unit admissions, gastroenterology consultation, initiation of medical therapy (proton pump inhibitor or octreotide), and inpatient endoscopy (upper endoscopy or colonoscopy) were assessed as outcomes. Univariate and multivariate logistic regression analyses were performed., Results: Of 1237 patients with acute gastrointestinal bleeding, 549 (44.4%) did not have a rectal examination. Patients who had a rectal examination were less likely to be admitted than patients who did not have a rectal examination (adjusted odds ratio [AOR], 0.49; 95% confidence interval [CI], 0.30-0.79; P = .004). Patients who had a rectal examination were less likely to be started on medical therapy (AOR, 0.64; 95% CI, 0.41-0.98; P = .04) and to have endoscopy (AOR, 0.64; 95% CI, 0.44-0.94; P = .02) than patients who did not have a rectal examination., Conclusions: Rectal examination in patients with acute gastrointestinal bleeding can assist clinicians with clinical management decision and reduce admissions, endoscopies, and medical therapy in these patients., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Rationale: Racial disparities in health and healthcare in the United States are well documented and are increasingly recognized in acute critical illnesses such as sepsis and acute respiratory failure., Objectives: Using a large, representative, U.S. nationwide database, we examined the hypothesis that black and Hispanic patients with severe acute respiratory failure have higher mortality rates when compared with non-Hispanic whites., Methods: This retrospective analysis used discharge data from the Agency for Healthcare Research and Quality, Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, for the years 2008-2012. We identified hospitalizations with acute respiratory failure using a combination of International Classification of Diseases, Ninth Revision, Clinical Modification, codes. A logistic regression model was fitted to compare in-hospital mortality rates by race., Measurements and Main Results: After adjusting for sex, age, race, disease severity, type of hospital, and median household income for patient ZIP code, blacks had a greater odds ratio of in-hospital death when compared with non-Hispanic whites (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14; P < 0.001), and Hispanics also had a greater odds ratio of in-hospital death when compared with non-Hispanic whites (OR, 1.17; 95% CI, 1.15-1.19; P < 0.001), and so did Asian and Pacific Islanders (OR, 1.15; 95% CI, 1.12-1.18; P < 0.001) and Native Americans (OR, 1.08; 95% CI, 1.00-1.15; P < 0.001) when compared with non-Hispanic whites (OR, 1.0)., Conclusions: Blacks, Hispanics, and other racial minorities in the United States were observed to exhibit significantly higher in-hospital sepsis-related respiratory failure associated mortality when compared with non-Hispanic whites.

Objectives: The primary objective of this study is risk stratification of patients with arrhythmic right ventricular cardiomyopathy (ARVC)., Background: There is a need to identify those who need an automatic implantable defibrillator (ICD) to prevent sudden death., Methods: This is an analysis of 88 patients with ARVC from three centers who were not treated with an ICD., Results: Risk factors for subsequent arrhythmic deaths were pre-enrollment sustained or nonsustained ventricular tachycardia (VT) and decreased left ventricular function., Conclusion: These factors serve as proposed guidelines for implantation of an ICD in patients with ARVC to prevent sudden death.

Several methods have been described in the literature to both evaluate and document progression in keratoconus, but there is no consistent or clear definition of ectasia progression. The authors describe how modern corneal tomography, including both anterior and posterior elevation and pachymetric data can be used to screen for ectatic progression, and how software programs such as the Enhanced Reference Surface and the Belin-Ambrosio Enhanced Ectasia Display (BAD) can be employed to detect earlier changes. Additionally, in order to describe specific quantitative values that can be used as progression determinants, the normal noise measurement of the three parameters (corneal thickness at the thinnest point, anterior and posterior radius of curvature (ARC, PRC) taken from the 3.0 mm optical zone centered on the thinnest point), was assessed. These values were obtained by imaging five normal patients using three different technicians on three separate days. The 95 % and 80 % one-sided confidence intervals for all three parameters were surprisingly small (7.88/4.03 μm for corneal thickness, 0.024/0.012 mm for ARC, and 0.083/0.042 mm for PRC), suggesting that they may perform well as progression determinants.

Purpose: Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced., Methods: A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival., Results: Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00%; for patients expected to survive less than 6 months (group I), it was 64.10%; 6-12 months (group II), 55.32%; and more than 12 months (group III), 77.21%. A progressive decrease in accuracy over time was statistically significant in groups I and II., Conclusions: The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.

Background: Right heart evaluation on coronary computed tomography angiography (CCTA) is underutilized due to nonopacification of the right heart chambers and poor endocardial resolution. We analyzed feasibility and reproducibility of right heart functional analysis by measuring CCTA-based tricuspid annular plane systolic excursion (CT-TAPSE) on ECG-gated CCTA and correlated the results with 2D transthoracic echocardiography (TTE)-derived TAPSE (Echo-TAPSE)., Methods: CT-TAPSE was measured on a total population of 41 patients who had CCTA and TTE performed within 6 months of each other. Two independent CCTA readers performed analysis on reformatted four-chamber view. Intra- and inter-observer variability analysis was performed on 16 randomly selected patients. Correlative (Spearman's R) and Bland-Altman analysis was used to assess the level of agreement between the 2 methods and to compare CT-TAPSE with Echo-TAPSE., Results: CT-TAPSE measured by Readers 1 and 2 on 16 randomly selected patients, demonstrated excellent intra-observer and inter-observer agreement, with very close correlation (R > 0.80 and 2-tailed P-value of <0.001). When tested in the entire study population of 41 patients, CT-TAPSE correlated closely with Echo-TAPSE (R = 0.738, P < 0.001). Bland-Altman analysis indicated that the 2 methods provided similar measures as majority of values lay within the 95% confidence limits. Based on abnormal Echo-TAPSE cutoff value of <16 mm, CT-TAPSE identified impaired right ventricle (RV) function with sensitivity of 82% and specificity of 93%, respectively., Conclusion: We demonstrated feasibility and reproducibility of assessing TAPSE on coronary CTA. RV functional analysis utilizing CT-TAPSE is simple and reproducible methodology, and is in close agreement with Echo-TAPSE., (© 2014, Wiley Periodicals, Inc.)

This article examines how nontraditional representations of gender can complicate received social norms, and it examines, in particular, how pre-adolescent suburban youth reconfigure social codes within popular film in order to identify positive queer aesthetics. While several studies have documented the function of classic and mainstream film in the tradition of queer reading, there has been comparatively less analysis devoted to the ways that filmic representations themselves might contribute to theoretical debates regarding sexual identity. As a case in point, this essay analyzes the 1978 musical Grease in order to suggest ways that critics might navigate between strict social constructionist and essentialist theories of sexual identity in order to identify avenues for queer identification within non-queer contexts.

A study was conducted to determine the safety of the dermal application of 10% imidacloprid/2.5% moxidectin topical solution in ivermectin-sensitive collies. Each milliliter of this solution contains 100mg of imidacloprid and 25mg of moxidectin. A total of 21 collies were prescreened for ivermectin-sensitivity and heartworm negative status prior to selection for the study. Animals were assigned based on the maximum ivermectin-sensitivity score demonstrated during the prestudy screening. Treatment groups included a 3x and 5x test article group, and a 3x and 5x mineral oil control group. The 3x and 5x doses were administered at three and five times, respectively, the 1x dose based on the animal's body weight. On day 0, 3 of the 21 dogs were treated with dermal applications of a preliminary dose of 3x test article to screen for unexpected signs of toxicity with the remaining 18 dogs being treated with 3x mineral oil to blind for the volume of liquid applied. After no signs of toxicity were observed, these same three dogs were treated with 3x of test article and 2x mineral oil on days 28 and 56. The remaining 18 animals were equally allocated to either a 5x test article group or a 5x control group and were each treated on days 28, 56, and 84. Personnel performing observations were blinded to treatment. Observations were made for clinical signs of ivermectin sensitivity twice daily during non-dosing days. On treatment days, dogs were observed hourly for the first 4h post-treatment and at 6, 8, 12, 18 and 24h. Signs of toxicosis were not observed in any of the dogs throughout the observation period. This study demonstrated the safety of imidacloprid/moxidectin, when administered to collies testing positive for ivermectin sensitivity at dosages up to five times the maximum recommended dose.

The development of a computer-based radiologic total lung capacity (TLC) measurement system designed to be used by non-physician personnel is detailed. Four operators tested the reliability and validity of the system by measuring inspiratory PA and lateral pediatric chest radiographs with a Graf spark pen interfaced to a DEC VAX 11/780 computer. First results suggest that the ultimate goal of developing an accurate and easy to use TLC measurement system for non-physician personnel is attainable.

The minimum spatial resolution required for a total digital radiology department has yet to be defined. A pilot study designed to provide this information was performed. Abnormal and normal radiographic images of children were digitized and redisplayed on film at spatial resolutions of 5.0, 2.5, 1.25, and 0.625 lp/mm. These resolutions are comparable to a digital display of a 14 X 14 in. chest image having pixel elements of 4096 X 4096, 2048 X 2048, 1024 X 1024, and 512 X 512, respectively. Contrast resolution was maintained at 12 bits or 4096 gray levels. The three phases of data acquisition were (1) the standard analysis of receiver operating characteristics, (2) a checklist evaluation of the "seeability" of important structures, and (3) a comparison of all resolutions and a discernment of usability. Fifteen radiologists participated in the study. On the basis of the pediatric cases used, the results showed that the needed spatial resolution for a total digital radiology department may be around 2.5 lp/mm (2048 X 2048). Checklist data on seeability of structures and comparisons of all resolutions give information on specific changes that are occurring as the resolution is decreased, and, when included with the receiver-operating-characteristic data, they become a major component in developing a resolution standard. The finding that 2.5 lp/mm is the required spatial resolution makes construction of a total digital radiology department possible with present state-of-the-art technology.

We used an observer-performance study to compare four different modes of presenting count-rate data from a radiation detector. Observers searched for small, concealed radioactive sources using a hand-held radiation-detector probe. The modes of count-rate presentation were a ratemeter, howler, multichannel scaler, and HRM III. The HRM III calculates the statistical significance of the difference between current and previous count rates and presents the result as an audio signal. We tested six observers with each mode of count-rate presentation, calculated receiver operating characteristic (ROC) curves, and used the areas under the ROC curves to compare the different modes. Observer performance was better with the multichannel scaler and HRM III than with either the ratemeter or the howler. The results suggest that observer performance with devices that use ratemeters or howlers can be enhanced by improving the mode of count-rate presentation.

Pixel signal-to-noise ratio is one accepted measure of image quality for predicting observer performance in medical imaging. We have found, however, that images with equal pixel signal-to-noise ratio (SNRp) but different correlation properties give quite different observer-performance measures for a simple detection experiment. The SNR at the output of an ideal detector with the ability to prewhiten the noise is also a poor predictor of human performance for disk signals in high-pass noise. We have found constant observer efficiencies for humans relative to the performance of a nonprewhitening detector for this task.