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Dysphagia is a common problem affecting all ages. It is increasing in frequency particularly among the younger population due to the rising incidence of eosinophilic oesophagitis, a condition which often leads to acute presentation to hospital for the first time with food bolus obstruction requiring endoscopic removal. Careful history taking remains the first and most important step in evaluating dysphagia, and it is especially important to distinguish an oropharyngeal versus oesophageal origin, which helps to guide further investigation and therapy. The three main investigations for dysphagia remain endoscopy, barium study and manometry, with endoscopy also offering therapeutic potential. Management is largely determined by the eventual diagnosis, often in a multi-disciplinary setting.

Our knowledge of the pathophysiology of eosinophilic esophagitis is constantly evolving. There is significant association between eosinophilic esophagitis and atopy; however, multiple studies have refuted the role of IgE in its pathogenesis. Instead, new data have demonstrated an elevated IgG4 level in patients with eosinophilic esophagitis. We review the current understanding of eosinophilic esophagitis pathogenesis and highlight the increasing evidence for the role of IgG4.

Background and Aim Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) can be difficult to distinguish as many of their clinical and histological features overlap. Preliminary data suggest a potential association between EoE and immunoglobulin G4 (IgG4) but not GERD. This study aimed to examine the role of esophageal mucosal IgG4 staining when differentiating EoE from GERD. Methods Esophageal biopsy specimens from patients with proven EoE and GERD were evaluated, and immunohistochemical staining for IgG4 was performed by an experienced gastrointestinal pathologist blinded to the clinical and endoscopic data. The results on IgG4 staining were then correlated with clinical, endoscopic, and histological features. Results Sixty patients were included in the study, with 30 EoE (38.8 ± 12.8 years, 23 M:7 F) and 30 GERD (50.7 ± 14.3 years, 14 M:16 F) patients. The prevalence of a positive intercellular IgG4 stain was significantly higher in the EoE patients than those with GERD (23/29 vs 2/30; P, Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) can be difficult to distinguish as many of their clinical and histological features overlap. Preliminary data suggest a potential association between EoE and immunoglobulin G4 (IgG), but not GERD. Our study has shown that positive IgG4 staining in esophageal biopsies has a high specificity and PPV for EoE, and this can be a useful marker to distinguish the disease from GERD.

Background Neonatal systemic vasculitis syndromes have been reported in infants born to mothers with systemic lupus erythematosus, Sjögren’s syndrome, Behҫet’s disease, cutaneous polyarteritis nodosa and anti-neutrophil cytoplasmic antibody-associated vasculitides. Here we report a novel association of a case of new-onset maternal seronegative inflammatory arthritis associated with a transient systemic vasculitis in a neonate. Case presentation In the first 24 h of life, a preterm Caucasian baby boy was noted to have blue discoloration to all four extremities. Despite antibiotics, fresh frozen plasma and anticoagulation, the discoloration remained, particularly in the left index finger. This was associated with fever and a maximum C-reactive protein (CRP) of 148 mg/L. Intravenous immunoglobulin (IVIG) was given with short-term improvement. Initial echocardiogram showed enlarged coronary arteries with normalization on repeat 1 week later. Clinical signs and symptoms responded to high dose oral steroid administration. MRI angiography (MRA) of the body and heart showed tortuosity of arteries in the upper and lower extremities with gadolinium uptake, suggestive of vasculitis. Autoantibody profile negative. Genetic panel for hereditary autoinflammatory diseases was negative as was whole exome sequencing performed on the trio. The baby was weaned off steroids by 5 months of age. A small distal autoamputation of the left index finger occurred. He was born to a 28-year-old woman who developed new onset severe symmetrical polyarthritis at 8 weeks gestation. This was presumed a reactive arthritis secondary to a dental infection. Infectious work up and autoantibodies were negative. She was treated with high dose prednisone for the remainder of her pregnancy. The mother was weaned off prednisone, treated with hydroxychloroquine for 8 months post-partum and remains in remission. A repeat MRA done at 1 year old showed mild residual tortuosities of the arteries in the forearms. The remainder of the medium and large vessels were within normal limits with no gadolinium enhancement to suggest active disease. The child is now 4 years old with normal growth and development. Conclusion This is a unique case of new-onset seronegative presumed reactive arthritis in a mother with the rare development of a successfully treated medium vessel vasculitis in an infant.

The prevalence and incidence of eosinophilic esophagitis (EoE) has been increasing over recent years. However, the natural history remains incompletely understood particularly the differences in disease characteristics and progression of childhood-onset and adult-onset EoE. The aim of this study was to evaluate the disease characteristics and progression of childhood-onset and adult-onset EoE.A cross-sectional, questionnaire-based study, on 87 adults and 67 children from 2 major tertiary hospitals in South Australia was conducted. Data of those who were diagnosed with EoE between 1999 and 2018 were collected and correlated with medical records.Of the 87 adults with EoE, 34 (39%) were diagnosed at the age of 18 years (childhood-onset EoE). Reflux symptoms were more common in childhood-onset EoE, whereas asthma was more common in adult-onset EoE. The median duration of symptoms prior to diagnosis of EoE was 1-4 years in childhood-onset disease (44%) and ≥ 10 years in adult-onset disease (34%). Food impaction was significantly more common on initial presentation in those with adult-onset EoE, whereas weight loss was more common in childhood-onset EoE. At the time of questionnaire, regurgitation, abdominal pain, and bloating were more common in childhood-onset EoE. Those with childhood-onset EoE were more likely to have multiple symptoms at questionnaire when compared with their adult-onset counterparts. In both groups, 15% (5/34 childhood-onset EoE and 8/53 adult-onset EoE) were asymptomatic at the time of questionnaire.Childhood-onset EoE appears to be a progressive disease from childhood to adulthood, however with more inflammatory-type symptoms post transition compared to those with adult-onset EoE.

Chronic Hepatitis B virus infection, the leading cause of hepatocellular carcinoma worldwide, disproportionately affects Asian Pacific Islanders (APIs) within the USA. Among APIs, the Hmong have one of the highest rates of chronic HBV infection—up to 18% compared to 0.1% for non-Hispanic Caucasians. This study sought to estimate the prevalence of HBV infection and assess the need for community HBV education within Milwaukee County’s Hmong. Between 3/2013 and 12/2019, 287 Hmong participants were screened for HBV and 271 were provided targeted HBV education to evaluate its impact on HBV knowledge. Among participants screened, 178 (62%) were immune; 77 (27%) susceptible; 27 (9%) positive; and 5 (2%) in a “gray zone.” Targeted health education showed statistically significant improvement in HBV knowledge. With 38% lacking immunity to HBV and 9% with active infection, there remains a significant need for HBV screening, vaccination, and education in Milwaukee’s Hmong community.

Vascular complications (VCs) are difficult to predict and remain an important issue after transfemoral (TF) transcatheter aortic valve implantation (TAVI) although their incidence has decreased with size reduction of introducers. We aimed to evaluate a standardized measurement of femoral artery depth (FAD) using computed tomography (CT) to predict VCs after TAVI. We performed a retrospective study of 679 TF TAVI patients. We evaluated a standardized CT method to measure FAD immediately above the bifurcation. Sheath-to-femoral-artery ratio (SFAR), calcification, and tortuosity were also evaluated. VCs were defined by the Valve Academic Research Consortium (VARC)-2. Receiver operating characteristic (ROC) curves were used to predict major VCs and the need for a stent-graft. The median values of FAD and SFAR were 49.0 (36.2 to 66.7) mm and 0.95 (0.81 to 1.18), respectively. Major VCs occurred in 37 (5.4%) patients and a stent-graft was required in 49 (7.1%) patients. FAD predicted the need for a stent-graft [0.61 (0.51 to 0.70), p = 0.04] but not major VCs [0.52 (0.40 to 0.63), p = 0.76]. In contrast, SFAR did not predict the need for a stent-graft [0.53 (0.43 to 0.62), p = 0.61] but predicted major VCs [0.70 (0.58 to 0.81), p = 0.001]. Calcification and tortuosity predicted neither major VCs nor the need for a stent-graft. In conclusion, the results of our study suggest that CT measurements of FAD and SFAR provide additional information to predict major VCs and the need for a femoral stent-graft after TF TAVI.

Urban residents often use public transit to travel throughout the city yet find it difficult to learn about events in one's neighborhood. Transit rides can also be isolating and routine, despite seeing the same people regularly. As a result, there are opportunities to connect with others on the same route. While digital technologies such as community systems, social media, and public displays have been studied to understand how people engage with each other in their community, little is known about the challenges people face when searching for local information while commuting. Our research explores how one form of technology, location-based games (LBGs), supports urban commuters in digital placemaking. We present a prototype of an LBG, City Explorer, that allows riders to maintain an awareness of location-specific events and to support the sharing of community information. City Explorer is designed for public transit riders in a metropolitan city to collaborate with other riders, supporting community awareness, and facilitating discussions related to places on their transit route.

Background: Colorectal cancer (CRC) is rising in incidence in young adults, and this observation is currently unexplained. We investigated whether having a personal history of type 2 diabetes mellitus (T2D) was a potential risk factor for young-onset colorectal cancer (YOCRC). Methods: The South Australian Young Onset (SAYO) CRC study is a series of young adults with CRC below age 55. Ninety unrelated YOCRC cases were recruited to the study. Personal history and detailed family history of T2D were obtained at face-to-face interview and confirmed from medical records. Whole exome sequencing was conducted on germline DNA from each CRC case. Controls for personal history studies of T2D were 240 patients with proven clear colonoscopies and no known CRC predispositions. Results: The median age of YOCRC cases was 44 years (18–54) and of controls was 45 years (18–54), and 53% of both cases and controls were females (P = 0.99). Left-sided (distal) CRC was seen in 67/89 (75%) of cases. A personal history of T2D was confirmed in 17/90 (19%) YOCRC patients compared with controls (12/240, 5%; P < 0.001; odds ratio = 4.4; 95% confidence interval, 2.0–9.7). YOCRC patients frequently reported at least one first-degree relative with T2D (32/85, 38%). Ten of 87 (12%) of YOCRC cases had CRC-related pathogenic germline variants, however, no pathogenic variants in familial diabetes-associated genes were seen. Conclusions: Though the mechanism remains unclear, our observations suggest that there is enrichment for personal history of T2D in YOCRC patients. Impact: A diagnosis of T2D could therefore potentially identify a subset of young adults at increased risk for CRC and in whom early screening might be appropriate. Refereed/Peer-reviewed

Eosinophilic oesophagitis (EoE) and gastro-oesophageal reflux disease (GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult. Although the term proton-pump inhibitor responsive oesophageal eosinophilia has recently been retracted from the guidelines, a relationship between EoE and GORD still exists. This relationship is complex as they may coexist, either interacting bidirectionally or are unrelated. This review aims to outline the differences and potential relationship between the two conditions, with specific focus on histology, immunology, pathogenesis and treatment.

Purpose To compare the effects of a hydrogen peroxide (H2O2)-based lens care solution and a polyhexamethylene biguanide (PHMB) multi-purpose solution on the eyelids when used with silicone hydrogel (SiHy) contact lenses. Methods A total of 74 symptomatic wearers of ACUVUE® OASYS® (senofilcon A; n = 39) or PureVision® (balafilcon A; n = 35) contact lenses were randomised 1:1 to either CLEAR CARE® Cleaning & Disinfecting Solution or renu® fresh™ multi-purpose solution (n = 37 each). Assessments of hyperaemia, papillae and lid margin staining of eyelid tissue were evaluated subjectively by a masked investigator at enrolment (with the subjects’ habitual SiHy contact lenses and PHMB-preserved care systems), at dispensing visit (when no lenses were worn) and at 3-months’ follow-up. Results There were no differences in eyelid assessments between the two lens care groups at dispensing visit (p = 0.086 to 0.947). After 3 months, the papillae response was significantly less marked with H2O2-based solution than with PHMB-based solution (p = 0.017). Lid hyperaemia (p Conclusion In symptomatic contact lens wearers, a H2O2-based lens care solution used with senofilcon A and balafilcon A lenses was better tolerated by eyelid tissues than was a PHMB-based solution and led to a decrease in clinical markers of eyelid inflammation.

Collaboration is a core component of work activities amongst flight attendants. This is as they work to promote onboard safety and deliver a high level of customer service. Yet we know little of how flight attendants collaborate and how we can best design technology to support this collaboration. Through an interview study with flight attendants, the authors explored their collaborative practices and processes and how technology aided such practices. While technologies like interphones and flight attendant call buttons act as collaboration tools, they identified instances where the usability and functionality of these devices were barriers for maintaining efficient communication, situation awareness, and information exchange. The authors used these results to identify design suggestions for technology that can enhance communication and collaboration in aircraft settings amongst flight attendants. To illustrate these design suggestions, they designed and developed Smart Crew, a smartwatch application that allows flight attendants to maintain an awareness of each other and communicate through messaging with haptic feedback. Smart Crew is designed with an emphasis on real time information access, location updates and direct communication between flight attendants regardless of their location on the airplane.

In healthy adults, the ability to prioritize learning of highly valued information is supported by executive functions and enhances subsequent memory retrieval for this information. In Alzheimer's disease (AD) and behavioural-variant frontotemporal dementia (bvFTD), marked deficits are evident in learning and memory, presenting in the context of executive dysfunction. It is unclear whether these patients show a typical memory bias for higher valued stimuli. We administered a value-directed word-list learning task to AD (n = 10) and bvFTD (n = 21) patients and age-matched healthy controls (n = 22). Each word was assigned a low, medium or high point value, and participants were instructed to maximize the number of points earned across three learning trials. Participants’ memory for the words was assessed on a delayed recall trial, followed by a recognition test for the words and corresponding point values. Relative to controls, both patient groups showed poorer overall learning, delayed recall and recognition. Despite these impairments, patients with AD preferentially recalled high-value words on learning trials and showed significant value-directed enhancement of recognition memory for the words and points. Conversely, bvFTD patients did not prioritize recall of high-value words during learning trials, and this reduced selectivity was related to inhibitory dysfunction. Nonetheless, bvFTD patients showed value-directed enhancement of recognition memory for the point values, suggesting a mismatch between memory of high-value information and the ability to apply this in a motivationally salient context. Our findings demonstrate that value-directed enhancement of memory may persist to some degree in patients with dementia, despite pronounced deficits in learning and memory.

A rear mounted, powered, drive wheel has been developed to assist with mobility for manual wheelchairs. The version tested operates in two modes (indoor and outdoor). To start in the indoor mode users must initiate propulsion with sufficient force to trigger the motor. To stop users must apply a braking force through the handrims. . The objectives of this study were to compare (1) the minimum force required to start a wheelchair with and without the drive, and (2) the distances and forces needed to stop a wheelchair at different treadmill speeds with and without the device. We used a crossover study design with 24 able-bodied persons. The main outcome measures were starting force single push speed, stopping distance, and stopping force. Participants did not have significantly increased starting force or single push speed using the drive. Participants had significantly shorter absolute stopping distance (p = 0.045 and reduced stopping force (p = 0.02) using the add-on at both treadmill speeds. Given the decreased stopping distances, the add-on may be a viable option for wheelchair users with limited upper limb strength.

BACKGROUND Organ donation after circulatory death (DCD) is increasingly being used as a means of addressing the organ supply/demand mismatch in solid organ transplantation. There is reluctance to use DCD hearts, due to an inability to precisely identify hearts that have suffered irreversible injury. We investigated novel biomarkers and clinically relevant endpoints across a spectrum of warm ischemic times, before and during ex vivo heart perfusion (EVHP), to identify features associated with a nonviable cardiac phenotype. METHODS Donor rats sustained a hypoxic cardiac arrest, followed by variable acirculatory standoff periods (DCD groups). Left ventricular function, histochemical injury, and differences in left ventricular gene expression were studied before, and during, EVHP. RESULTS As warm ischemic time exposure increased in DCD groups, fewer hearts were functional during EVHP, and ventricular function was increasingly impaired. Histochemical assessment identified severely injured hearts during EVHP. A novel gene expression signature identified severely injured hearts during EVHP (upregulation of c-Jun, 3.19 (2.84-3.60); P = 0.0014; HMOX-1, 3.87 (2.72-5.50); P = 0.0037; and Hsp90, 7.66 (6.32-9.27); P < 0.0001 in DCD20), and may be useful in identifying high-risk hearts at the point of harvest (Hsp90). CONCLUSIONS We demonstrate that our preclinical model recapitulates the cardio-respiratory decompensation observed in humans, and that EVHP appears necessary to unmask distinguishing features of severely injured DCD hearts. Furthermore, we outline a clinically relevant multimodal approach to assessing candidate DCD hearts. Novel mRNA signatures correlated with elevations in cardiac Troponin-I in severely injured hearts during EVHP, and may also detect injury at the point of harvest.

Background: Colorectal cancer (CRC) diagnosed at

Objective The purpose of this study was to evaluate the effectiveness of a pharmacist-led initiative to reduce outpatient fluoroquinolone prescribing in the emergency department (ED). Design Eight common indications for fluoroquinolone prescribing were selected for intervention. The intervention consisted of a multimodal prescriber education program providing empirical recommendations for antibacterial agents on the basis of guidelines, the local ED antibiogram, and clinical trials. The electronic medical record was reviewed to identify all prescriptions for moxifloxacin, ciprofloxacin, and levofloxacin oral tablets written at the time of discharge by ED providers. Setting and participants This study was conducted in a 62-bed emergency department at an academic community medical center with approximately 90,000 ED visits per year. Adult patients who were prescribed an oral fluoroquinolone at discharge from the ED were included. Outcome measures The primary outcome of the study was fluoroquinolone days of therapy (DOT) prescribed per 100 ED visits. Results In the preintervention group, the primary outcome of fluoroquinolone DOT per 100 ED visits was 18.4, 17.8, 16.5, 19.8, and 16.8 for the months of December 2017 through April 2018, respectively. The fluoroquinolone DOT per 100 ED visits in the postintervention group was 8.7, 7.9, 8.0, 6.3, and 6.0 for the months of December 2018 through April 2019, respectively. The fluoroquinolone DOT per 100 ED visits was found to be significantly shorter in the postintervention group with P = 0.009. Conclusion The results of this study reveal that pharmacist-led interventions, focused on multimodal provider education, were effective at reducing ED discharge prescriptions for fluoroquinolones.

Preterm sepsis is characterized by systemic bacterial invasion and inflammatory response. Its pathogenesis is unclear due to lack of proper animal models. Heme oxygenase-1 (HO-1) can affect physiologic and pathologic conditions through its anti-inflammatory, antioxidative, and anti-apoptotic properties. Since HO-1 is developmentally regulated, it may play a role in the pathogenesis of preterm sepsis. For this study, sepsis was induced using the non-surgical "cecal slurry" (CS) model. CS was given intraperitoneally at various doses to 4-day-old newborn mice to determine dose-dependent effects. The LD40 was then given and changes in bodyweight, bacterial colonization of organs, hematology, serum biochemistry, and immunomodulatory gene expression were determined. We found a dose-dependent mortality with an LD40 of 2.0 mg/g. Significant bacterial colonization and hematological changes (leukocytopenia, thrombocytopenia, and lymphocytopenia) and increased gene expression of pro-inflammatory cytokines, pattern-recognition receptors, and other genes related to immune responses were also observed. Twenty-four hours post-sepsis induction, bodyweight loss was associated with mortality and organ damage. Finally, to elucidate a protective role of HO-1, 30-μmol heme/kg was given subcutaneously 24 h pre-sepsis induction. HO activity in livers and spleens significantly increased 64% and 50% over age-matched controls 24 h post-heme administration. Importantly, heme significantly reduced mortality from 40.9% to 6.3% (P

PURPOSE The relationship between contact lens wettability and comfort has been extensively evaluated; however, a direct correlation between the characteristics of the pre-lens tear film and the symptoms associated with contact lens discomfort has yet to be established. In addition, there is relatively limited knowledge relating to the entire tear film kinetics during the inter-blink period in contact lens wearers. The purpose of this analysis was to identify the characteristics of the pre-lens tear film kinetics that may be associated with the symptoms of contact lens discomfort. METHODS The study population comprised 202 soft (hydrogel and silicone hydrogel) contact lens wearers attending pre-screening visits at the OTG-i research clinic. All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and the tear film was quantified via post hoc, masked analysis of high definition digital Tearscope videos recorded at the visit. The tear film kinetics of the least symptomatic wearers (OSDI lowest quintile scores, n = 45) were compared to the tear film kinetics of the most symptomatic wearers (OSDI highest quintile scores, n = 43). The hypothesis tested was that the tear film kinetics of asymptomatic wearers were better than tear film kinetics of symptomatic wearers. RESULTS The distribution of lens types worn was as follows: Daily Disposable 46.5%, 1-Month Replacement 39.6%, and 2-Week Replacement 13.6%. 48.2% of lenses were silicone hydrogel and 51.8% hydrogel. Symptomatic wearers had a shorter break-up time (4.7 s vs. 6.0 s; p = 0.003), lesser surface coverage by the tear film during the interblink period (95.1% vs. 98.5%; p < 0.001) and greater surface exposure at the time of the blink (9.4% vs. 3.9%; p = 0.001). CONCLUSIONS The current study demonstrated that the tear film kinetics of asymptomatic and symptomatic contact lens wearers were different, the findings supporting the hypothesis of poorer tear film kinetics for symptomatic than asymptomatic wearers in a general contact lens wearing population.

Purpose To determine whether anxiety or depression is associated with takotsubo stress cardiomyopathy (TSCM). Methods A retrospective case-control study was conducted among 73 TSCM cases and 111 acute coronary syndrome (ACS) controls matched for age, sex, and cardiac catheterization date. The study was conducted between May 1, 2009, and February 28, 2010. The Hospital Anxiety and Depression Scale was completed by all participants after hospital discharge. The Hospital Anxiety and Depression Scale was used to assess psychological distress with measurement of anxiety and depression scores. The presence of a stressful emotional or physical trigger before the TSCM presentation was determined. Univariate testing was performed to quantify the associations between anxiety and depression and TSCM trigger status. Multivariable logistic regression was used to quantify the independent associations between anxiety and depression and TSCM status after controlling for relevant covariates. Results The mean anxiety score was 6.7 ± 4.7 for TSCM cases versus 5.4 ± 3.4 for ACS controls (P = .06). The mean depression score was 4.3 ± 3.7 for TSCM cases versus 4.0 ± 3.1 for controls (P = .61). Anxiety was particularly associated with TSCM status with an emotional trigger (P = .05). After multivariable adjustment, anxiety (OR = 1.13; 95% CI, 1.01-1.26; P = .03) was associated with TSCM status but depression was not (OR = 0.94; 95% CI, 0.83-1.05; P = .29). Conclusions In comparison with a control group with ACS, patients who presented with TSCM have higher levels of anxiety but not depression.

Objective While patients with primary progressive aphasia (PPA) typically present with predominant language impairment, behavioural symptoms, such as apathy, are often under-recognised. We aimed to systematically characterise apathy across the three recognised subtypes of PPA, plus atypical right-lateralised presentations of semantic dementia, and to evaluate the impact of apathy on carer burden and psychological wellbeing. Methods Baseline assessments from 114 PPA patients were included: 31 left semantic dementia (left SD) 16 right semantic dementia (right SD), 30 progressive nonfluent aphasia (PNFA) and 37 logopenic progressive aphasia (LPA). Clinician (Neuropsychiatric Inventory; NPI) and carer rated (Cambridge Behavioural Inventory; CBI, Frontal Systems Behaviour Scale; FrSBe) measures were used to quantify symptoms of apathy, and carer burden and psychological wellbeing were determined using the Zarit Burden Interview and Depression, Anxiety and Stress Scale. Results On the NPI, symptoms of apathy were present in 39% left SD, 56% right SD, 33% PNFA and 43% LPA patients. Multiple regression analysis revealed that 17.9% of the variance in carer burden was uniquely explained by scores on carer rated measures of apathy (CBI, FrSBe), even after accounting for diagnosis, disease duration, and cognitive and language impairment. Conclusions Apathy is much more common than current diagnostic criteria for PPA would suggest, though the severity of apathy is similar across patient groups. Increased awareness and routine assessments of apathy symptoms are needed, together with targeted pharmacological and behavioural interventions. Moreover, as apathy substantially contributes to carer burden in PPA, psychoeducation addressing behavioural symptoms may be beneficial.

The current clinical diagnostic criteria for Alzheimer’s disease (AD) recognize an atypical, non-amnestic presentation of AD, characterized by prominent executive dysfunction. Increasing evidence, however, indicates that the clinical phenotype of this so-called “frontal-variant” of AD (fv-AD) includes behavioral symptoms and deficits in social cognition, together with disproportionate frontal lobe atrophy. As these features resemble those characteristic of behavioral-variant frontotemporal dementia (bvFTD), differential diagnosis can be challenging. Here, we report a case of fv-AD who met clinical diagnostic criteria bvFTD, but had in vivo amyloid neuroimaging evidence of AD pathology. We compare this case against two individuals who were clinically diagnosed with bvFTD and early-onset AD, with in vivo amyloid neuroimaging confirmation of pathology. We highlight the challenges in differential diagnosis by contrasting their behavioral, cognitive and structural neuroimaging findings.

Purpose To measure the degree of meibomian gland (MG) dropout in the lower eyelid determined by analysis of images obtained from the LipiView II (LVII) and the Keratograph 5M (K5M). Methods The inferior eyelid of each participant was imaged in a random order using both devices. All images were subjectively assessed by a single-masked investigator to determine the extent of MG loss using the Arita 4-point meiboscore grading scale. The images were also semi-objectively analyzed with ImageJ to calculate the percentage of MG dropout, by tracing around the non-glandular area and the total exposed area of the lower lid. Results Twenty participants (mean age 37 years, range 23–60, 60% female) completed the study. A significant difference in meiboscore (mean ± SD) was obtained between the LVII and the K5M (1.43 ± 0.78 vs. 1.90 ± 0.81, Z = 3.25, p = 0.001). The meiboscore 95% limit of agreement (LOA) ranged from −1.88 to +0.93. A significant difference was found with mean ImageJ percentage dropout between the LVII and the K5M (31.5% vs 43.4%, t = −4.8, p = 0.00003). The percentage dropout 95% LOA ranged from −42.79% to +19.06%. Conclusions LVII images had significantly lower meiboscores and less percentage MG dropout. Varying amounts of dropout were observed between the devices due the amount of eyelid that was typically everted and because of differences in image quality. These results indicate that these devices should not be used interchangeably to evaluate MG dropout.

Purpose: The purpose was to compare the effect of the repeated usage of two care systems (one hydrogen peroxide cleaning and disinfecting system and one polyaminopropyl biguanide (PHMB) containing multi-purpose system) with silicone hydrogel contact lenses worn for three months on a daily wear modality. A specific aspect of interest was of the effect of the care systems on contact lens wettability. Methods: Seventy-four symptomatic contact lens wearers, habitually wearing either ACUVUE® OASYS® (n = 37) or PureVision™ (n = 37), constituted the study population. The study was a two-arm prospective, investigator-masked, bilateral study of three-month duration to evaluate the effects of CLEAR CARE® compared with renu® fresh™. The subjects were randomized to one of the two lens care systems. Contact lens wettability and surface cleanliness were assessed with the Tearscope and reported in terms of pre-lens non-invasive break-up time (PL-NIBUT) and visible deposits. Baseline assessments at enrollment were with the subjects’ own contact lenses worn for at least 6 h when using their habitual PHMB-preserved care system and at the dispensing visit with new contact lenses. At the follow-up visits, the contact lenses were worn for at least 6 h, and were at least 11 days old for ACUVUE® OASYS® and 25 days old for PureVision™. Results: The results obtained showed that: (i) with CLEAR CARE®, a significant improvement in contact lens wettability was recorded compared with the habitual care system at the three-month follow-up visit (mean median PL-NIBUT 5.8 vs. 4.0 s, p

Objectives: To increase awareness of wire brush bristle ingestion, review the literature relating to wire brush bristle ingestion, and describe an algorithm for management of wire brush bristle foreign bodies as well as a technique for bedside removal. Methods: The authors present a case of an accidental wire bristle ingestion that was successfully treated with bedside removal and describe a successful bedside technique for removal. For the literature review, the PubMed journal database and Google Scholar were queried using the search terms wire bristle, wire brush, grill brush, and grill bristle. Results: Twenty-three wire brush ingestions with upper aerodigestive presentations were identified in the medical literature. Bedside visualization was attempted in 10 patients and successful in 5. The foreign body was able to be removed at the bedside in 3 of these patients. Two patients were managed conservatively. The authors developed an algorithm for management based on these literature findings. Conclusion: Wire brush bristle ingestion is increasingly common in the literature, and a definitive algorithm does not exist for management. The authors present an algorithm for management and describe a technique for successful removal at the bedside.

Objective: This study aimed to study the mobile phone addiction behavior and awareness on electromagnetic radiation (EMR) among a sample of Malaysian population. Methods: This online study was conducted between December 2015 and 2016. The study instrument comprised eight segments, namely, informed consent form, demographic details, habituation, mobile phone fact and EMR details, mobile phone awareness education, psychomotor (anxious behavior) analysis, and health issues. Frequency of the data was calculated and summarized in the results. Results: Totally, 409 respondents participated in the study. The mean age of the study participants was 22.88 (standard error = 0.24) years. Most of the study participants developed dependency with smartphone usage and had awareness (level 6) on EMR. No significant changes were found on mobile phone addiction behavior between the participants having accommodation on home and hostel. Conclusion: The study participants were aware about mobile phone/radiation hazards and many of them were extremely dependent on smartphones. One-fourth of the study population were found having feeling of wrist and hand pain because of smartphone use which may lead to further physiological and physiological complication.

Smartwatches are growing in usage, yet they come with the additional challenge of regulating their usage during the taking of academic tests. However, it is unclear how effective they are at actually allowing students to cheat. We conducted an experiment that examines the use of smartwatches for cheating on Multiple-Choice Questions (MCQ) and Short Answers (SA) with either Pictures/Text shown on the watch to aid students. Our results indicate that smartwatches are neither efficient nor have a high usability rating for cheating. However, students are able to score higher on Multiple-Choice Questions compared to Short Answers. We use the cheating paradigm as an example to understand the perceived usability and appropriation of smartwatches in an academic setting. We provide suggestions that help to deter cheating in an academic setting. Our study contributes to the research on academic integrity and the growing demand of wearable technologies.

Background Further validation of the risk indicators / predictors for peri-implant diseases is required to allow clinicians and patients to make informed decisions and optimize dental implant treatment outcomes. The aim of this study was to build prediction models, using Chi-square automatic interaction detection (CHAID) analysis, to determine which systemic-, patient-, implant-, site-, surgical- and prostheses-related risk indicators had more impact on the onset of peri-implant diseases. Methods A retrospective analysis of 200 patients who received implant-supported prostheses between 1998 and 2011 was conducted to evaluate the prevalences and risk indicators for peri-implant mucositis and peri-implantitis. The data were further analyzed using CHAID to produce two predictive models. Results The prevalence of peri-implant mucositis was 20.2% and 10.2% for patients and implants, respectively, while the prevalence of peri-implantitis was 10.1% at the patient level and 5.4% at the implant level. CHAID decision tree analysis identified three predictors (history of treated periodontitis, absence of regular supportive peri-implant maintenance, and use of bone graft) for peri-implant mucositis and three predictors (smoking, absence of regular supportive peri-implant maintenance, and placement of ≥2 implants) for peri-implantitis. Conclusions Within the limitations of this study, CHAID decision tree analysis identified the most plausible risk indicators and provided two predictive models for use in a particular university setting that would allow early detection and ensure appropriate care and maintenance of patients at high risk of peri-implant diseases.

Acute infection is known to induce strong anti-tumor immune responses, but clinical translation has been hindered by the lack of an effective strategy to safely and consistently provoke a therapeutic response. These limitations are overcome with a novel treatment approach involving repeated subcutaneous delivery of a Klebsiella-derived investigational immunotherapeutic, QBKPN. In preclinical models of lung cancer, QBKPN administration consistently showed anti-cancer efficacy, which was dependent on Klebsiella pre-exposure, but was independent of adaptive immunity. Rather, QBKPN induced anti-tumor innate immunity that required NK cells and NKG2D engagement. QBKPN increased NK cells and macrophages in the lungs, altered macrophage polarization, and augmented the production of cytotoxic molecules. An exploratory trial in patients with non-small cell lung cancer demonstrated QBKPN was well tolerated, safe, and induced peripheral immune changes suggestive of macrophage polarization and reduction of PD-1 and PD-L1 expression on leukocytes. These data demonstrate preclinical efficacy, and clinical safety and tolerability, for this cancer immunotherapy strategy that exploits innate anti-tumor immune mechanisms.

Many people use public transit on a recurring basis to travel for work, school, or other activities. Yet rides can be isolating despite encountering the same people on a regular basis. We designed City Explorer, a city exploration transit game, to provide transit riders with a channel to strengthen the sense of community. In City Explorer, players collect points as they ride public transit. They can complete route-specific challenges and collaborate with other riders to multiply points by riding the same route. Players can also create geo-tagged posts to describe and share community-related information. We share our design requirements, followed by details of game features, and our implementation of City Explorer.

Despite accruing evidence for relative preservation of episodic memory in the semantic variant of primary progressive aphasia (previously semantic dementia), the neural basis for this remains unclear, particularly in light of their well-established hippocampal involvement. We recently investigated the Papez network of memory structures across pathological subtypes of behavioural variant frontotemporal dementia and demonstrated severe degeneration of all relay nodes, with the anterior thalamus in particular emerging as crucial for intact episodic memory. The present study investigated the status of key components of Papez circuit (hippocampus, mammillary bodies, anterior thalamus, cingulate cortex) and anterior temporal cortex using volumetric and quantitative cell counting methods in pathologically-confirmed cases with semantic variant of primary progressive aphasia (n = 8; 61-83 years; three males), behavioural variant frontotemporal dementia with TDP pathology (n = 9; 53-82 years; six males) and healthy controls (n = 8, 50-86 years; four males). Behavioural variant frontotemporal dementia cases with TDP pathology were selected because of the association between the semantic variant of primary progressive aphasia and TDP pathology. Our findings revealed that the semantic variant of primary progressive aphasia and behavioural variant frontotemporal dementia show similar degrees of anterior thalamic atrophy. The mammillary bodies and hippocampal body and tail were preserved in the semantic variant of primary progressive aphasia but were significantly atrophic in behavioural variant frontotemporal dementia. Importantly, atrophy in the anterior thalamus and mild progressive atrophy in the body of the hippocampus emerged as the main memory circuit regions correlated with increasing dementia severity in the semantic variant of primary progressive aphasia. Quantitation of neuronal populations in the cingulate cortices confirmed the selective loss of anterior cingulate von Economo neurons in behavioural variant frontotemporal dementia. We also show that by end-stage these neurons selectively degenerate in the semantic variant of primary progressive aphasia with preservation of neurons in the posterior cingulate cortex. Overall, our findings demonstrate for the first time, severe atrophy, although not necessarily neuronal loss, across all relay nodes of Papez circuit with the exception of the mammillary bodies and hippocampal body and tail in the semantic variant of primary progressive aphasia. Despite the longer disease course in the semantic variant of primary progressive aphasia compared with behavioural variant frontotemporal dementia, we suggest here that the neural preservation of crucial memory relays (hippocampal→mammillary bodies and posterior cingulate→hippocampus) likely reflects the conservation of specific episodic memory components observed in most patients with semantic variant of primary progressive aphasia.

Collaboration is a core component of work activities amongst flight attendants as they work to promote onboard safety and a high level of customer service. Yet we know little of how flight attendants collaborate and whether or not technology adequately supports their practices. Through an interview study with flight attendants, we explored their collaborative practices and processes and how technology aided such practices. While technologies like interphones and flight attendant call buttons acted as collaboration tools, we identified instances where the usability and functionality of these devices were the main barriers for maintaining efficient communication, situation awareness, and information exchange. Our findings inform the design of future technologies for enhancing communication and collaboration in an aircraft setting amongst flight attendants with an emphasis on real time information access and direct communication between flight attendants regardless of their location.

The principal objective of this investigation was to assess the symptomatic relief associated with eyelid hygiene using Blephaclean eye pads, a cosmetic product, to manage anterior blepharitis or Meibomian gland dysfunction (MGD) associated with dry eye complaints.The investigation was a bilateral, prospective, interventional open label investigation of 3-month duration. The test population was made up of dry eye sufferers with at least mild symptoms (Ocular Surface Disease Index [OSDI] ≥13) who presented with mild to moderate anterior blepharitis or MGD. Eyelid hygiene was intensive (twice a day) for the initial 3 weeks and a maintenance regimen (once a day) for the remainder of the study. At each visit, a detailed assessment of symptomatology was carried out. The assessment included the reporting of overall symptomatology with the OSDI questionnaire, of comfort and specific symptoms at the end of the day on 100-point visual analog scales and of specific MGD-related symptoms on forced choice 5-point scales.Forty subjects aged 22 to 74 years (54±15 years) were enrolled, of whom 39 completed the investigation. The product usage revealed good overall compliance throughout the study. The results revealed significant improvement in symptomatology. A significant (P0.001) decrease in overall symptomatology was recorded (Mean OSDI: baseline=30, day 21=18, day 90=19; Symptomatic status: baseline 100%, day 21 55%, day 90 54%) associated with significant (P0.001) increase in the end of day comfort (Mean score: baseline=56, day 21=67, day 90=67) and decrease in end of day dryness (Mean score: baseline=55, day 21=42, day 90=41).The results showed that eyelid hygiene with Blephaclean wipes by subjects with anterior blepharitis or MGD significantly decreased their associated symptomatology and increased their ocular comfort. The data confirmed the efficiency of the clinical methodology, put forward of 3 weeks of intensive use (twice a day) of eyelid wipes followed by maintenance use (once a day); that approach achieved a rapid symptomatic improvement that was maintained over time.

Multidrug-resistant Acinetobacter baumannii infection has presented a global medical challenge. The antibiograms of paired colistin-susceptible and -resistant strains revealed increased susceptibility of colistin-resistant strains to most tested antibiotics, including those that are active against only gram-positive bacteria. Synergy between colistin and rifampicin was observed in the colistin-susceptible strains. The ability to form biofilm in the colistin-resistant strains was significantly lower (P

Objective : Preclinical medical student electives are prevalent at medical schools across the United States, but the range of electives available and their impact on medical student education are not well described in the literature. The objective of this article is to review the literature relating to preclinical medical student electives and their impact on medical student educational outcomes. Methods : We reviewed studies that met the following criteria: English-language articles describing preclinical US-based medical electives. We used PubMed journal databases and limited our search for the time period 1999–2014. We excluded electives based in other countries or electives designed for third or fourth year students. Data abstracted included the topic of the elective, qualitative descriptions of the electives, and any associated surveys or exam data associated with the electives. Data were synthesized using descriptive tables sorting electives by broad topic. Reported outcomes and statistical methods were analyzed to assess study quality. Results : We found a wide range of subjects taught in the form of preclinical medical school electives. We identified electives in clinical skills, the humanities, student lifestyle, specialty-specific electives, and an assortment of other miscellaneous electives. Surveys and exams administered to students showed that the electives were universally well received by students. Of the 37 electives identified, 15 electives used quantitative objective assessments, such as knowledge exams, while the remaining tended to use student self-reported results. Conclusions : Preclinical medical student electives are prevalent at medical schools across the United States and have a significant impact on medical student education. Keywords: humanities; education; medical student; electives; undergraduate; preclinical; curriculum (Published: 11 May 2015) Citation: Med Educ Online 2015, 20: 26615 - http://dx.doi.org/10.3402/meo.v20.26615 To access the supplementary material for this article, please see Supplementary files under ‘Article Tools’

Purpose Random item generation (RIG) involves central executive functioning. Measuring aspects of random sequences can therefore provide a simple method to complement other tools for cognitive assessment. We examine the extent to which RIG relates to specific measures of cognitive function, and whether those measures can be estimated using RIG only. Method Twelve healthy older adults (age: M = 70.3 years, SD = 4.9; 8 women and 4 men) and 20 healthy young adults (age: M = 24 years, SD = 4.0; 12 women and 8 men) participated in this pilot study. Each completed a RIG task, along with the color Stroop test, the Repeatable Battery for the Assessment of Neuropsychological Status, and the Peabody Picture Vocabulary Test–Fourth Edition (Dunn & Dunn, 2007). Several statistical features extracted from RIG sequences, including recurrence quantification, were found to be related to the other measures through correlation, regression, and a neural-network model. Results The authors found significant effects of age in RIG and demonstrate that nonlinear machine learning can use measures of RIG to accurately predict outcomes from other tools. Conclusions These results suggest that RIG can be used as a relatively simple predictor for other tools and in particular seems promising as a potential screening tool for selective attention in healthy aging. Supplemental Material https://doi.org/10.23641/asha.14963904

Visual and auditory systems interact at both cortical and subcortical levels. Studies suggest a highly context-specific cross-modal modulation of the auditory system by the visual system. The present study builds on this work by sampling data from 17 young healthy adults to test whether visual speech stimuli evoke different responses in the auditory efferent system compared to visual non-speech stimuli. The descending cortical influences on medial olivocochlear (MOC) activity were indirectly assessed by examining the effects of contralateral suppression of transient-evoked otoacoustic emissions (TEOAEs) at 1, 2, 3 and 4 kHz under three conditions: (a) in the absence of any contralateral noise (Baseline), (b) contralateral noise + observing facial speech gestures related to productions of vowels /a/ and /u/ and (c) contralateral noise + observing facial non-speech gestures related to smiling and frowning. The results are based on 7 individuals whose data met strict recording criteria and indicated a significant difference in TEOAE suppression between observing speech gestures relative to the non-speech gestures, but only at the 1 kHz frequency. These results suggest that observing a speech gesture compared to a non-speech gesture may trigger a difference in MOC activity, possibly to enhance peripheral neural encoding. If such findings can be reproduced in future research, sensory perception models and theories positing the downstream convergence of unisensory streams of information in the cortex may need to be revised.

There is evidence that the link between obesity and cardiovascular disease might relate to inflammation in both fat tissue and the arterial wall. F-18-FDG uptake on PET is a surrogate marker of vessel wall inflammation. The aim of the study was to measure FDG uptake in both regions using PET and identify links between adipose and arterial inflammation. Included in the study were 173 cardiovascular patients who were prospectively imaged with FDG PET/CT. Arterial FDG uptake was measured in the carotid arteries and ascending aorta. The same was done in fat tissue in the neck, the presternal region (both subcutaneous) and the pericardium. FDG uptake was quantified as average maximal target-to-background ratio (meanTBRmax). Multivariate regression analyses were performed to identify significant associations between arterial and adipose tissue FDG uptake and clinical variables as given by the standardized correlation coefficient (beta). FDG uptake values in all fat tissue regions were highly predictive of vascular FDG uptake in both the carotids (beta 0.262, p

1. Carol Glaser, DVM, MD* 2. Paul Lewis, MD† 3. Stephanie Wong, DVM‡ 1. 2. *Viral and Rickettsial Disease Laboratory, California Department of Health Services, Berkeley, CA. 3. 4. †Assistant Professor of Pediatrics, Division of Infectious Diseases, Oregon Health Sciences University, Portland, OR. 5. ‡Tufts University School of Veterinary Medicine, Grafton, MA. Zoonoses are diseases that can be transmitted from animals to humans. They can be acquired via insect vectors, food, and direct or indirect contact with animals. More than 250 zoonoses have been described, and they are caused by a wide variety of pathogens, including viruses, rickettsia, bacteria, fungi, and parasites. Some of the diseases are rare, such as rabies and plague; others, such as cat-scratch disease, are common. The transmission of zoonotic diseases is both diverse and dynamic. Although illnesses such as salmonellosis and campylobacteriosis are by far the most common zoonotic infections in humans and are transmitted most often by food, there is a small risk of acquiring illness from pets and wildlife. Because many pet- and wildlife-related zoonoses are acquired via fecal-oral or direct contact routes, the inquisitive nature of children puts them at a higher risk for infection than adolescents and adults. It is important for pediatricians to be aware of zoonoses, especially those related to direct pet contact, because approximately 56% of United States households contain at least one pet. Pet ownership has many psychological and social benefits and should not be discouraged, with the exception of households that contain immunocompromised individuals or children younger than age 5 years, which should not have reptiles because of the risk of salmonellosis. This review discusses the epidemiology, animal reservoirs, transmission, clinical syndromes, laboratory features, treatment, and prevention of toxoplasmosis, rabies, cat-scratch disease, Lyme disease, and rat-bite fever. Additionally, brief overviews of animal bites and enteric infections are presented, as are tables on zoonoses related to dogs, cats, rodents, birds, and exotic pets (Table 1⇓ ); animal bite-related zoonoses (Table 2⇓ ); and vector-borne diseases (Table 3⇓ ). View this table: Table 1. Pet-related Zoonoses View this table: Table 2. Animal Bite-related Zoonoses View this table: Table 3. Vector-borne Diseases ### EPIDEMIOLOGY/ETIOLOGY Toxoplasmosis has a worldwide distribution. The seroprevalence in women of childbearing …

Fetal alcohol exposure (FAE) can lead to a variety of behavioral and physiological disturbances later in life. Understanding how alcohol (ethanol, EtOH) affects fetal brain development is essential to guide the development of better therapeutics for FAE. One of EtOH's many pharmacological targets is the γ-aminobutyric acid type A receptor (GABAAR), which plays a prominent role in early brain development. Acute EtOH potentiates inhibitory currents carried by certain GABAAR subtypes, whereas chronic EtOH leads to persistent alterations in GABAAR subunit composition, localization and function. We recently introduced a flavonoid compound, dihydromyricetin (DHM), which selectively antagonizes EtOH's intoxicating effects in vivo and in vitro at enhancing GABAAR function as a candidate for alcohol abuse pharmacotherapy. Here, we studied the effect of FAE on physiology, behavior and GABAAR function of early adolescent rats and tested the utility of DHM as a preventative treatment for FAE-induced disturbances. Gavage administration of EtOH (1.5, 2.5, or 5.0 g/kg) to rat dams on day 5, 8, 10, 12, and 15 of pregnancy dose-dependently reduced female/male offspring ratios (largely through decreased numbers of female offspring) and offspring body weights. FAE (2.5 g/kg) rats tested on postnatal days (P) 25-32 also exhibited increased anxiety and reduced pentylenetetrazol (PTZ)-induced seizure threshold. Patch-clamp recordings from dentate gyrus granule cells (DGCs) in hippocampal slices from FAE (2.5 g/kg) rats at P25-35 revealed reduced sensitivity of GABAergic miniature inhibitory postsynaptic currents (mIPSCs) and tonic current (Itonic) to potentiation by zolpidem (0.3 μM). Interestingly, potentiation of mIPSCs by gaboxadol increased, while potentiation of Itonic decreased in DGCs from FAE rats. Co-administration of EtOH (1.5 or 2.5 g/kg) with DHM (1.0 mg/kg) in pregnant dams prevented all of the behavioral, physiological, and pharmacological alterations observed in FAE offspring. DHM administration alone in pregnant rats had no adverse effect on litter size, progeny weight, anxiety level, PTZ seizure threshold, or DGC GABAAR function. Our results indicate that FAE induces long-lasting alterations in physiology, behavior, and hippocampal GABAAR function and that these deficits are prevented by DHM co-treatment of EtOH-exposed dams. The absence of adverse side effects and the ability of DHM to prevent FAE consequences suggest that DHM is an attractive candidate for development as a treatment for prevention of fetal alcohol spectrum disorders.

Objectives:Otolaryngology residents learn important skills as medical students, but typically not binocular microscopy. This study aims to 1) evaluate instructional methods teaching medical student...