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Obstructive sleep apnea (OSA) is a chronic breathing disorder characterized by intermittent sleep state-dependent upper airway (UA) collapse. The tongue comprises the primary UA dilator muscle and plays an essential role in the pathogenesis of OSA. We examined whether tongue stiffness measurement using ultrasound (US) shear wave elastography (SWE) is useful for predicting the existence of OSA. Forty-six participants (20 healthy controls and 26 patients with OSA) underwent transcutaneous submental SWE using a US system. Quantification with a shear modulus of 0-200 kPa was recorded during normal breathing and Muller's maneuver (MM). Polysomnography was used as the reference standard. Mid-sagittal tongue stiffness was significantly higher in awake patients with OSA than in controls during normal breathing and the MM (p < 0.0001). The posterior third of the tongue in patients with OSA had the highest value of shear modulus during the MM (p < 0.001). With cut-offs of 27.6 and 35.2 kPa for the whole tongue and posterior third during the MM, respectively, the sensitivity obtained was 69.2% and 76.9%, and the specificity was 85% and 95%, respectively, for detecting OSA. The corresponding areas under the receiver operating characteristic curve were 0.82 and 0.88, respectively. US SWE may have the potential for non-invasive tongue stiffness measurement in OSA.

Background: Competency-based medical education has emerged as a mainstream method for educating and assessing the next generation of physicians. This study aims to initiate and examine the preliminary results of an integrated Traditional Chinese Otolaryngology Milestone Project in Taiwan. Methods: This prospective study enrolled 18 participants in an academic hospital setting from July 2017 to August 2019. Participants included twelve attending and six resident physicians. Using the Integrated Traditional Chinese Otolaryngology Milestones (ITCOM), five biannual evaluations involved independent self-assessments by the resident doctors, which the chief resident and attending physicians independently reevaluated. A Kruskal–Wallis test was used to compare the results of the five assessments. Results: The average scores of attained milestones for the five assessments were as follows for residents PGY1– PGY6: PGY1 (1.48 ± 0.24; 1.69 ± 0.10, P = 0.01), PGY2 ( 1.24 ± 0.12; 1.51 ± 0.23; 1.75 ± 0.06; 1.98 ± 0.21; 2.47 ± 0.18 , P < 0.0001), PGY3 (2.19 ± 0.24; 2.36 ± 0.25; 2.80 ± 0.19; 2.96 ± 0.24; 3.33 ± 0.23, P < 0.0001), PGY4 (2.68 ± 0.17; 2.96 ± 0.09; 3.35 ± 0.13; 3.58 ± 0.10; 4.17 ± 0.08, P < 0.0001), PGY5 (3.07 ± 0.24; 3.38 ± 0.12; 3.58 ± 0.10; 4.05 ± 0.09, P < 0.0001) and PGY6 ( 3.30 ± 0.27; 3.61 ± 0.28; 4.22 ± 0.20, P = 0.0001). The score results for patient care, medical knowledge, and professionalism were more likely to indicate heightened attainment of milestone levels as the program progressed. However, the curves of the score results for system-based practice, problem-based learning and improvement, and interpersonal and communication skills were more horizontal, showing that the milestones might indicate a better performance than expected, even in residents with low training seniority. Conclusions: The results of the five biannual assessments revealed that all resident physicians demonstrated a significant improvement. Further study involving large-scale participants and multiple institutions is warranted.

OBJECTIVES Hyperoxia could lead to a worse outcome after cardiac arrest. Few studies have investigated the impact of oxygenation status on patient outcomes following extracorporeal cardiopulmonary resuscitation. We sought to delineate the association between oxygenation status and neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. DESIGN Retrospective analysis of a prospective extracorporeal cardiopulmonary resuscitation registry database. SETTING An academic tertiary care hospital. PATIENTS Patients receiving extracorporeal cardiopulmonary resuscitation between 2000 and 2014. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 291 patients were included, and 80.1% were male. Their mean age was 56.0 years. The arterial blood gas data employed in the primary analysis were recorded from the first sample over the first 24 hours in the ICUs after return of spontaneous circulation. The mean PaO2 after initiation of venoarterial extracorporeal membrane oxygenation was 178.0 mm Hg, and the mean PaO2/FIO2 ratio was 322.0. Only 88 patients (30.2%) demonstrated favorable neurologic status at hospital discharge. Multivariate logistic regression analysis indicated that PaO2 between 77 and 220 mm Hg (odds ratio, 2.29; 95% CI, 1.01-5.22; p = 0.05) and PaO2/FIO2 ratio between 314 and 788 (odds ratio, 5.09; 95% CI, 2.13-12.14; p < 0.001) were both positively associated with favorable neurologic outcomes. CONCLUSIONS Oxygenation status during extracorporeal membrane oxygenation affects neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. The PaO2 range of 77 to 220 mm Hg, which is slightly narrower than previously defined, seems optimal. The PaO2/FIO2 ratio was also associated with outcomes in our analysis, indicating that both PaO2 and the PaO2/FIO2 ratio should be closely monitored during the early postcardiac arrest phase for postextracorporeal cardiopulmonary resuscitation patients.

The aim of this study was to analyze the information needs of lung cancer patients from diagnosis until first treatment follow-up. Sixty-nine participants with lung cancer were recruited from Ditmanson Medical Foundation Chia-Yi Christian Hospital in Midwest Taiwan. The Modified Toronto Informational Needs Questionnaire (TINQ) was used to assess information needs during visits to the outpatient oncology department. Generalized estimating equations were applied to compare changes in information needs over time and to examine correlates of information needs of lung cancer patients. The greatest concern of lung cancer patients was the cancer itself and access to recovery information. The need for information regarding food selection and social welfare resources was also high. However, the means of information needs for each domain significantly decreased over time. Demographic information (age, gender, disease stage, current treatment, education, work status, and having children) was significantly associated with information needs over time. The need for "disease-related information" remained high regardless of disease stage. Oncology nurses can use the results of this study to better address the information needs of patients in an effort to fill knowledge gaps between patients and healthcare providers. Further studies are needed to explore the use of an appropriate instrument, like that used in this study, to identify newly-diagnosed lung cancer patients' difficulties, concerns, and target interventions to improve their quality of life.

In this paper we highlight three distinct approaches to studying rumor dynamics-volume, exposure, and content production. Expanding upon prior work, which has focused on rumor volume, we argue that considering the size of the exposed population is a vital component of understanding rumoring. Additionally, by combining all three approaches we discover subtle features of rumoring behavior that would have been missed by applying each approach in isolation. Using a case study of rumoring on Twitter during a hostage crisis in Sydney, Australia, we apply a mixed-methods framework to explore rumoring and its consequences through these three lenses, focusing on the added dimension of exposure in particular. Our approach demonstrates the importance of considering both rumor content and the people engaging with rumor content to arrive at a more holistic understanding of communication dynamics. These results have implications for emergency responders and official use of social media during crisis management.

A 6-step auditing process was developed to detect unlikely nutrient values in a Nutrient Composition Data Bank for Foods (NCDBF) in Taiwan. Preference was given to finding errors in the database, rather than to determining significant differences in the biological characteristics of the individual nutrients. There were 239 compositionally similar subgroups categorized within the NCDBF. The coefficient of variation ( CV ) of nutrient values for each subgroup provided the first-order sorting instrument. Nutrient CV s were ranked in rows for food subgroup ( x ) and in columns for nutrient type ( y ) and their product ( x , y ) in descending order. When the rank was in the top 2 or the product was ≤20, the Excel “cell” was regarded as a “ hit ”. The “ hit rate ” (2.6%, 777 hits /29,424 pieces of information) of the computerized analysis was verified through an expert panel review to provide a “ satisfied hit rate ( SHR )” (agreed errors/total food group hits ). The mean SHR was 14.9% (range: 1.4%–37.6%) for the various food groups. The computerized process performed with a 38-fold increase in likelihood of error detection compared with what manual assessment alone would have produced. This low-cost approach could be applied in various jurisdictions or with other digitized food composition tables.

Realistic pavement stresses induced by moving wheel loads were examined in granular base layers, and the significant effects of rotation of principal stress axes were addressed for a proper characterization of unbound aggregate behavior. Granular material resilient moduli are commonly determined at the centerline of wheel loading without taking into account the effects of moving wheel loads and the constantly rotating field principal stress states. Differences that exist between field- and laboratory-applied stress states were identified by comparing the field stresses simulated using a nonlinear axisymmetric finite element program, GT-PAVE, with the stress states commonly used in the standard resilient modulus test procedure, AASHTO T294-94. Three sets of complete triaxial test data obtained from testing aggregates under various realistic in situ stress paths caused by moving wheel loading were analyzed. Eight different granular material modulus models were developed from the experimental test data to include the applied mean stress, the applied shear stress, and the slope of stress path loading. Because of the complex loading regimes followed in the laboratory tests, characterization models that simultaneously analyzed the static and dynamic components of the applied mean and deviator stresses produced a high degree of accuracy. Models that consider the stress path slope variations predict the best stress path dependency of aggregate behavior caused by moving wheel loads. Such advanced models that allow for the effects of principal stress rotation better describe the granular material behavior under the actual field loading conditions.

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) isoenzymes from surgical esophageal and gastric mucosa were compared by agarose isoelectric focusing. Two prominent ADH forms, designated mu 1 (equivalent to the recently reported mu-form) and mu 2, were expressed in all the 15 esophagus specimens studied, whereas only four of seven examined gastric specimens exhibited a weak to moderately strong mu 1-ADH activity band on the isoelectric focusing gels. pI values of the esophageal mu 1-ADH and mu 2-ADH, and the liver pi-ADH were determined to be 8.61, 8.13, and 8.90, respectively. mu-ADHs exhibited high Km for ethanol (12 mM) and low sensitivity to 4-methylpyrazole inhibition. ALDH3 (BB form) and ALDH1 were the major high- and low-Km aldehyde dehydrogenase in the esophagus, respectively. The ADH and ALDH activities were determined at pH 7.5 to be 751 +/- 78 and 29.9 +/- 3.0 nmol/min/g tissue, respectively (measured at 500 mM ethanol or at 200 microM acetaldehyde; mean +/- SEM; N = 15). The esophageal ADH activity was approximately 4-fold and the ALDH activity 20% that of the stomach enzyme. Because the presence of high activity and high Km mu-ADHs as well as low-activity ALDH1 were found in human esophageal mucosa, it is suggested that there may exist an accumulation of intracellular acetaldehyde during alcohol ingestion. This reactive and toxic metabolite may be involved in the pathogenesis of alcohol-induced esophageal disorders.