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This article describes the multi-disciplinary approach to rehabilitation of the laryngectomee followed by the Michigan Cancer Foundation-Wayne State University Laryngectomee Clinic. The program serves a patient population in excess of 100 each year in a total rehabilitation paradigm. The rehabilitation effort centers around an intensive speech rehabilitation program encompassing as much as 10 hours of speech therapy per week. This effort is supplemented by a professional staff including a psychologist, social work staff, audiologist, public health nurse, vocational rehabilitation specialist, and a trained laryngectomized esophageal speech teacher. The contribution of each member of the team and the benefits of a unified approach are described. [ABSTRACT FROM AUTHOR]

The anterior end of the zoospore of Ulothrix belkae has been examined in detail and is compared to Stigeoclonium and other filamentous green algae. The nature of the symmetry of green algal motile cells is discussed and the term, 180° rotational symmetry, is proposed to describe the type of arrangement of anterior end components seen in U. belkae, including the four basal bodies, rootlets and striated fibers. The four microtubular rootlets are cruciately arranged. A striated microtubule-associated component (SMAC) has a periodicity of 6.4 nm and extends with each 2-membered rootlet posteriorly into the cell. One 5-membered rootlet passes very near the eyespot. Phylogeny in green algal motile cells is discussed. [ABSTRACT FROM AUTHOR]

This study investigated the effect of socio-economic status upon selected oral communication skills of 198 children. Four sub tests of the Illinois Test of Psycho- linguistic Abilities and a portion of the Pre-School Inventory were administered to all subjects on an individual basis. The results showed that children from higher socio-economic backgrounds were more competent in certain areas investigated than were lower status children. The results obtained also indicated the test instruments employed tended to be sensitive to socio-economic status and distorted measurement of actual linguistic skill. [ABSTRACT FROM AUTHOR]

Background: Emotional intelligence (EI) can decrease physician burnout. EI and burnout were assessed in surgical residents through participation in Patient-Centric Resident Conferences (PCRCs), which incorporated patients in resident education. We hypothesized PCRCs would improve EI and reduce burnout., Methods: This was a single institution study of General Surgery residents from 2018 to 2019. Residents participated in standard didactic conferences and PCRCs. The Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) survey and an ACGME burnout survey were administered at three time points., Results: Higher EI scores correlated with lower burnout scores over three survey distributions (R 2 0.35, 0.39, and 0.68, respectively). EI and burnout scores did not change significantly over time. EI and burnout were not associated with conference attendance, meaning in work, or satisfaction with teaching., Conclusions: General Surgery resident EI and burnout scores were inversely correlated. Previously, PCRCs were shown to be associated with increased resident meaning in work. The current study demonstrates PCRCs did not have a significant impact on measures of resident EI or burnout. Further research is needed for EI and burnout in surgery., Competing Interests: Declaration of competing interest On behalf of all authors, the corresponding author states that there is no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Although non-accidental trauma continues to be a leading cause of morbidity and mortality among children in the United States, the underlying factors leading to NAT are not well characterized. We aim to review reporting practices, clinical outcomes, and associated disparities among pediatric trauma patients experiencing NAT., Methods: A literature search utilizing PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane was conducted from database inception until April 6, 2023. This review includes studies that assessed pediatric (age <18) trauma patients treated for NAT in the United States emergency departments. The evaluated outcome was in-hospital mortality rates stratified by race, age, sex, insurance status, and socioeconomic advantage., Results: The literature search yielded 2641 initial articles, and after screening and applying inclusion and exclusion criteria, 15 articles remained. African American pediatric trauma patients diagnosed with NAT had higher mortality odds than white patients, even when adjusting for comparable injury severity. Children older than 12 mo experienced higher mortality rates compared to those younger than 12 mo, although some studies did not find a significant association between age and mortality. Uninsured insurance status was associated with the highest mortality rate, followed by Medicaid and private insurance. No significant association between sex and mortality or socioeconomic advantage and mortality was observed., Conclusions: Findings showed higher in-hospital mortality among African American pediatric trauma patients experiencing child abuse, and in patients 12 mo or older. Medicaid and uninsured pediatric patients faced higher mortality odds from their abuse compared to privately insured patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: This narrative review aims to evaluate the efficacy of adjunct direct peritoneal resuscitation (DPR) in the treatment of adult damage control surgery (DCS) patients both with and without hemorrhagic shock, and its impact on associated outcomes., Methods: PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane were searched for relevant articles published through April 13th, 2023. Studies assessing the utilization of DPR in adult DCS patients were included. Outcomes included time to abdominal closure, intra-abdominal complications, in-hospital mortality, and ICU length of stay (ICU LOS)., Results: Five studies evaluating 437 patients were included. In patients with hemorrhagic shock, DPR was associated with reduced time to abdominal closure (DPR 4.1 days, control 5.9 days, p = 0.002), intra-abdominal complications including abscess formation (DPR 27 %, control 47 %, p = 0.04), and ICU LOS (DPR 8 days, control 11 days, p = 0.004). Findings in patients without hemorrhagic shock were conflicting. Closure times were decreased in one study (DPR 5.9 days, control 7.7 days, p < 0.02) and increased in another study (DPR 3.5 days, control 2.5 days, p = 0.02), intra-abdominal complications were decreased in one study (DPR 27 %, control 47 %, p = 0.04) and similar in another, and ICU LOS was decreased in one study (DPR 17 days, control 24 days, p < 0.002) and increased in another (DPR 13 days, control 11.4 days, p = 0.807)., Conclusion: In patients with hemorrhagic shock, adjunct DPR is associated with reduced time to abdominal closure, intra-abdominal complications such as abscesses, fistula, bleeding, anastomotic leak, and ICU LOS. Utilization of DPR in patients without hemorrhagic shock showed promising but inconsistent findings., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The lack of proper equipment to accommodate patients with high BMI can jeopardize the safety of the patients and medical staff. In this review, we aim to discuss the availability of obesity accommodations in the operating room, along with its impact, implications, and future recommendations., Methods: Four databases were searched for articles pertaining to surgical table dimensions and the implications for safety, with a special focus on patients with larger BMIs. Articles were separated into 4 categories: Existing OR Table Options, Safety Implications for Patients, Reported Adverse Events Associated with Operating Table Inadequacy, and Safety Implications for Medical Staff., Results: A total of 18 articles and documents were included in this review. Most of the literature that discusses surgical tables with higher weight capacity is specific only to weight loss surgeries. Operating table dimensions have changed little in the past 100 years and standard operating tables have weight limits of 500 pounds. Several case reports underline the hazards of inadequately sized surgical tables., Conclusions: This review demonstrates that a lack of proper equipment, such as surgical tables with adequate width and weight limits, can be a major contributor to the endangerment of bariatric surgical patients and the medical professionals who care for them. Further research and surgical innovation may be required to develop superior operating tables to address the unique concerns of this patient populations., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: This is a 10-year review of The Journal of Trauma and Acute Care Surgery (JTACS) literature related to health care disparities, health care inequities, and patient outcomes. A retrospective review of articles published in JTACS between January 1, 2013, and July 15, 2022, was performed. Articles screened included both adult and pediatric trauma populations. Included articles focused on patient populations related to trauma, surgical critical care, and emergency general surgery. Of the 4,178 articles reviewed, 74 met the inclusion criteria. Health care disparities related to gender (n = 10), race/ethnicity (n = 12), age (n = 14), income status (n = 6), health literacy (n = 6), location and access to care (n = 23), and insurance status (n = 13) were described. Studies published on disparities peaked in 2016 and 2022 with 13 and 15 studies respectively but dropped to one study in 2017. Studies demonstrated a significant increase in mortality for patients in rural geographical regions and in patients without health insurance and a decrease in patients who were treated at a trauma center. Gender disparities resulted in variable mortality rates and studied factors, including traumatic brain injury mortality and severity, venous thromboembolism, ventilator-associated pneumonia, firearm homicide, and intimate partner violence. Under-represented race/ethnicity was associated with variable mortality rates, with one study demonstrating increased mortality risk and three finding no association between race/ethnicity and mortality. Disparities in health literacy resulted in decreased discharge compliance and worse long-term functional outcomes. Studies on disparities in JTACS over the last decade primarily focused on location and access to health care, age, insurance status, and race, with a specific emphasis on mortality. This review highlights the areas in need of further research and funding in the Journal of Trauma and Acute Care Surgery regarding health care disparities in trauma aimed at interventions to reduce disparities in patient care, ensure equitable care, and inform future approaches targeting health care disparities., Level of Evidence: Systematic Review; Level IV., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Despite the increasing amount of evidence supporting its use, cell salvage (CS) remains an underutilized resource in operative trauma care in many hospitals. We aim to evaluate the utilization of CS in adult trauma patients and associated outcomes to provide evidence-based recommendations., Methods: A systematic review was conducted using PubMed, Google Scholar, and CINAHL. Articles evaluating clinical outcomes and the cost-effectiveness of trauma patients utilizing CS were included. The primary study outcome was mortality rates. The secondary outcomes included complication rates (sepsis and infection) and ICU-LOS. The tertiary outcome was the cost-effectiveness of CS., Results: This systematic review included 9 studies that accounted for a total of 1119 patients that received both CS and allogeneic transfusion (n = 519), vs allogeneic blood transfusions only (n = 601). In-hospital mortality rates ranged from 13% to 67% in patients where CS was used vs 6%-65% in those receiving allogeneic transfusions only; however, these findings were not significantly different ( P = .21-.56). Similarly, no significant differences were found between sepsis and infection rates or ICU-LOS in those patients where CS usage was compared to allogeneic transfusions alone. Of the 4 studies that provided comparisons on cost, 3 found the use of CS to be significantly more cost-effective., Conclusions: Cell salvage can be used as an effective method of blood transfusion for trauma patients without compromising patient outcomes, in addition to its possible cost advantages. Future studies are needed to further investigate the long-term effects of cell salvage utilization in trauma patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Though a circulation-airway-breathing (CAB) resuscitation sequence is now widely accepted in administering CPR over the airway-breathing-circulation (ABC) sequence following cardiac arrest, current evidence and guidelines vary considerably for complex polytraumas, with some prioritizing management of the airway and others advocating for initial treatment of hemorrhage. This review aims to evaluate existing literature comparing ABC and CAB resuscitation sequences in adult trauma patients in-hospital to direct future research and guide evidence-based recommendations for management., Methods: A literature search was conducted on PubMed, Embase, and Google Scholar until September 29, 2022. Articles were assessed for comparison between CAB and ABC resuscitation sequences, adult trauma patients, in-hospital treatment, patient volume status, and clinical outcomes., Results: Four studies met the inclusion criteria. Two studies compared the CAB and ABC sequences specifically in hypotensive trauma patients, one study evaluated the sequences in trauma patients with hypovolemic shock, and one study in patients with all types of shock. Hypotensive trauma patients who underwent rapid sequence intubation before blood transfusion had a significantly higher mortality rate than those who had blood transfusion initiated first (50 vs 78% P < 0.05) and a significant drop in blood pressure. Patients who subsequently experienced post-intubation hypotension (PIH) had increased mortality over those without PIH. overall mortality was higher in patients that developed PIH (mortality, n (%): PIH = 250/753 (33.2%) vs 253/1291 (19.6%), p < 0.001)., Conclusion: This study found that hypotensive trauma patients, especially those with active hemorrhage, may benefit more from a CAB approach to resuscitation, as early intubation may increase mortality secondary to PIH. However, patients with critical hypoxia or airway injury may still benefit more from the ABC sequence and prioritization of the airway. Future prospective studies are needed to understand the benefits of CAB with trauma patients and identify which patient subgroups are most affected by prioritizing circulation before airway management., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Abstract: The importance of diversity, equity, and inclusion (DEI) in trauma and acute care surgery (ACS) has become increasingly apparent in the field of medicine. Despite the growing diversity of the patient population, the surgical specialty has traditionally been dominated by White males. This involves increasing the representation of diverse individuals in leadership positions, professional societies, scholarships, graduate education, and practicing physicians. This opinion piece aims to address the gaps in the literature regarding DEI in trauma and acute care surgery and highlight the issues related to the workforce, gender gap, patient outcomes, and health services. To effectively guide DEI interventions, it is essential to capture patient-reported experience data and stratify outcomes by factors including race, ethnicity, ancestry, language, sexual orientation, and gender identity. Only then can generalizable findings effectively inform DEI strategies. Using validated measurement tools, it is essential to conduct these assessments with methodological rigor. Collaboration between health care institutions can also provide valuable insights into effective and ineffective intervention practices through information exchange and constructive feedback. These recommendations aim to address the multifactorial nature of health care inequities in trauma and ACS. However, successful DEI interventions require a deeper understanding of the underlying mechanisms driving observed disparities, necessitating further research., Level of Evidence: Level V., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patient-centric resident conferences (PCRCs) provide meaningful time to connect with and learn from patients. This qualitative study explores themes of patients' perioperative experiences from PCRCs through patient and resident perspectives., Methods: General Surgery residents participated in six PCRCs, which include condensed standard didactics to accommodate a patient panel regarding their perioperative experience. Panel transcripts and resident survey responses describing what they learned were coded using grounded theory methodology. Themes were evaluated and compared., Results: 76 identified codes were grouped into major categories: "Medical/Surgical Knowledge," "Patient Perspective," "Patient-Physician Relationship," and "Communication." Themes from resident responses predominantly paralleled patient discussion, with common themes including "impact of disease and surgery on patient" and "compassion/empathy." "Medical/surgical knowledge" was only present in resident responses while themes regarding quality of life were more frequent in patient transcripts., Conclusions: PCRCs are a valuable tool in resident education to understand patients' perioperative experiences. Themes from patient panels complement, but do not replace, information covered in didactic lectures., Competing Interests: Declaration of competing interest No authors have any conflicts of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: General Surgery residents have increasing obligations that limit time with patients. This affects the patient-physician relationship, decreases meaning in work and increases burnout. Patient-Centric Resident Conferences (PCRC) 1 incorporate patients in resident didactics to promote meaning in work and improve resident confidence in counseling and consenting patients for surgery., Design: Prospective cohort study of General Surgery residents who participated in standard didactic conferences (control) and modified conferences (PCRC) between 2017 and 2019. Control conferences covered a relevant surgical topic. PCRC had shortened didactics and discussions with patients who had undergone the relevant index operation. Pre- and postconference surveys measured teaching effectiveness, confidence in counseling and consenting, and resident perception of how well the conference supported their decision to pursue surgery. Survey data was compared using chi-squared tests. Qualitative data analysis used ground theory methodology., Setting: This study was performed by the Department of Surgery at Oregon Health and Science University in Portland, Oregon., Participants: All active General Surgery residents were asked to participate in conferences., Results: Eighty-one residents completed 136 surveys over 5 control conferences and 207 surveys over 7 PCRC. Residents reported increased confidence in counseling and consenting for surgery following control conferences (p < 0.0001) and PCRC (p < 0.0001). Residents' perception of effectiveness of teaching pathophysiology (p = 0.008) and operative steps (p = 0.013) was greater in control conferences whereas effectiveness of teaching surgical complications was greater in PCRC (p = 0.006). Resident responses indicated greater support for a surgical career following PCRC compared to control conferences (p = 0.013). Themes like "patient perspective," "impact on surgeon," and "psychological effects of surgery" were common in PCRC and rare in control conferences., Conclusions: PCRC were associated with stronger motivations for a surgical career and included patient-centered themes, which can enhance meaning in work. These conferences complement but do not replace standard didactics., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Previous data examining the effect of gender on surgical trainee autonomy is lacking. We hypothesized that female general surgery residents have less autonomy than males during laparoscopic cases., Methods: We retrospectively reviewed factors associated with level of guidance needed during laparoscopic procedures as reported on intraoperative procedure feedback forms and on FLS tasks from one institution from 2013 to 2016. Data collected included resident and attending gender, level of guidance needed, PGY level, case characteristics, resident intraoperative performance, and skills lab FLS performance. Univariate and multivariate analyses were performed using a mixed-effects regression model., Results: We analyzed data from 106 PGY1-PGY5 residents (51% Female) and 104 attendings (26% Female). Female resident gender was associated with more intraoperative guidance in univariate (p = 0.019) and multivariate analysis (p = 0.034). Technical performance between genders was similar., Conclusions: This study demonstrated gender-based inequality in intraoperative autonomy even after controlling for technical performance, PGY level, and case factors., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Competing Interests: The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government. Dr Jardine is a military service member. This work was prepared as part of her official duties. Title 17 USC 105 provides that “Copyright protection under this title is not available for any work of the United States government.” Title 17 USC 101 defines a US government work as a work prepared by a military service member or employee of the US government as part of that person's official duties.

Background: Tropomodulins are actin-capping proteins that regulate the stability of the slow-growing, minus-ends of actin filaments. The C. elegans tropomodulin homolog, UNC-94, has sequence and functional similarity to vertebrate tropomodulins. We investigated the role of UNC-94 in C. elegans intestinal morphogenesis., Results: In the embryonic C. elegans intestine, UNC-94 localizes to the terminal web, an actin- and intermediate filament-rich structure that underlies the apical membrane. Loss of UNC-94 function results in areas of flattened intestinal lumen. In worms homozygous for the strong loss-of-function allele, unc-94(tm724), the terminal web is thinner and the amount of F-actin is reduced, pointing to a role for UNC-94 in regulating the structure of the terminal web. The non-muscle myosin, NMY-1, also localizes to the terminal web, and we present evidence that increasing actomyosin contractility by depleting the myosin phosphatase regulatory subunit, mel-11, can rescue the flattened lumen phenotype of unc-94 mutants., Conclusions: The data support a model in which minus-end actin capping by UNC-94 promotes proper F-actin structure and contraction in the terminal web, yielding proper shape of the intestinal lumen. This establishes a new role for a tropomodulin in regulating lumen shape during tubulogenesis., (© 2014 Wiley Periodicals, Inc.)

Accurate positioning of the mitotic spindle is important for the genetic material to be distributed evenly in dividing cells, but little is known about the mechanisms that regulate this process. Here we report that two microtubule-associated proteins important for spindle positioning interact with several proteins in the sumoylation pathway. By two-hybrid analysis, Kar9p and Bim1p interact with the yeast SUMO Smt3p, the E2 enzyme Ubc9p, an E3 Nfi1p, as well as Wss1p, a weak suppressor of a temperature-sensitive smt3 allele. The physical interaction between Kar9p and Ubc9p was confirmed by in vitro binding assays. A single-amino-acid substitution in Kar9p, L304P disrupted its two-hybrid interaction with proteins in the sumoylation pathway, but retained its interactions with the spindle positioning proteins Bim1p, Stu2p, Bik1p, and Myo2p. The kar9-L304P mutant showed defects in positioning the mitotic spindle, with the spindle located more distally than normal. Whereas wild-type Kar9p-3GFP normally localizes to only the bud-directed spindle pole body (SPB), Kar9p-L304P-3GFP was mislocalized to both SPBs. Using a reconstitution assay, Kar9p was sumoylated in vitro. We propose a model in which sumoylation regulates spindle positioning by restricting Kar9p to one SPB. These findings raise the possibility that sumoylation could regulate other microtubule-dependent processes.

Objective: To study the influence of 10 min of cyclic twisting motion on abdominal and back muscle activities., Background: Repetitive (cyclic) occupational activity was identified by many epidemiological reports to be a risk factor for the development of work-related musculoskeletal disorders. Biomechanical and physiological confirmation, however, is lacking., Methods: Trunk muscle electromyography (EMG) was recorded while participants performed a continuous 10-min maximum lumbar cyclic twisting to the left, and maximum isometric twist to the left and right sides was measured before and after the exercise., Results: Abdominal muscles contracted symmetrically, independent of twisting direction. The left posterior muscles' integrated EMG (IEMG) decreased during the exercise, whereas the IEMG of the right posterior muscle increased. Simultaneously with increased antagonist coactivity level of the right posterior muscles after the exercise, decrease in maximal isometric left twisting torque was observed. The abdominal muscles did not exhibit any significant changes during the exercise. After the exercise, the right abdominals demonstrated a significant increase in effort, which was independent of the direction of the maximal effort isometric test., Conclusions: The change in muscle activity is attributed to neuromuscular compensation for the development of laxity and microdamage in the soft tissue (ligaments, discs, facet capsules, etc.) of the lumbar spine., Application: The results of this study increase understanding of the risk factors associated with low back disorder induced by labor-intensive occupations that involve cyclic lateral twisting.

Background: The epidemiology identifies cyclic lumbar loading as a risk factor for cumulative trauma disorder. Experimental biomechanical and physiological confirmation is lacking. The objective of this study was to asses the impact of different rest durations applied between periods of cyclic loading on the development of an acute lumbar disorder which, if continued to be subjected to loading, may develop into a cumulative disorder., Methods: Three groups of in vivo feline preparations were subjected to six sequential 10 min loading periods of cyclic lumbar flexion at 40 N with a frequency of 0.25 Hz applied to the L-4/5 level. The rest durations varied from 5 min in the first group, to 10 min in the second and to 20 min in the third. Reflexive EMG from the multifidi and lumbar displacement were used to identify significant (P<0.001) effects of time and rest duration for post-load EMG and displacement. Single-cycle test were performed hourly for 7 h post-loading to assess recovery. A model developed earlier was applied to represent the experimental data., Findings: The groups allowed 5 and 10 min rest exhibited an acute neuromuscular disorder expressed by a significant (P<0.001) delayed hyperexcitability 2-3 h into the 7 h recovery period with the intensity of the hyperexcitability significantly higher (P<0.001) for the group allowed only 5 min rest. The group allowed 20 min rest had a slow, uneventful recovery, free of delayed hyperexcitability., Interpretations: Occupational and sports activities requiring repetitive (cyclic) loading of the lumbar spine may be a risk factor for the development of a cumulative lumbar disorder and may require sufficient rest, as much as twice as long as the loading period, for prevention. Comparison to similar data for static lumbar loading shows that cyclic loading is more deleterious than static loading, requiring more rest to offset the negative effect of the repeated acts of stretch.

An attempt was made to test the hypothesis (McLeod et al. 1987; Smith et al. 1987) that a certain combination of direct current and alternating current magnetic field exposures at room temperature results in an increase in motility of a marine diatom (Amphora coffeaeformis) to a maximum value. Diatom motility increased as a function of calcium concentration in the medium, as reported by McLeod et al. (1987) and Smith et al. (1987). There was, however, no effect of the magnetic field exposures on diatom motility. The exposures employed 16-Hz magnetic fields with amplitudes of 21 or 29.7 microT (21 microT rms) as well as 21 microT (amplitude) fields at frequencies above and below the reported "resonance" frequency. All experiments were conducted double blindly, and each trial had its own positive control.

Objectives: Although ectopic atrial tachycardia is infrequent, it can be an important clinical challenge. We sought to define an alternative therapeutic approach to this refractory problem., Background: Radiofrequency energy catheter ablation has been used to treat a variety of ventricular and supraventricular arrhythmias but has not been proved efficacious in the management of ectopic atrial tachycardia., Methods: Ten patients (14 to 47 years of age) referred with refractory ectopic atrial tachycardia were studied. Mapping techniques included identification of earliest atrial activation, confirmation of concordance of P wave configuration during spontaneous tachycardia and pacing from the ablation catheter, and paced activation sequence mapping. The paced activation sequence mapping compared the activation sequence at multiple atrial sites during spontaneous tachycardia with that recorded during pacing from the ablation catheter. The catheter was steered to a point where pacing reproduced the spontaneous activation sequence., Results: Foci were right atrial in eight patients and left atrial in two. In 8 of 10 patients, 514 +/- 97 (SE) J and 5.7 +/- 2.3 (SD) J radiofrequency energy applications ablated the ectopic focus. Seven of these eight patients presented with one focus and one had two discrete and stable foci. Ablation was unsuccessful in two patients with multiple foci. No complications occurred. An arrhythmia focus recurred in two patients and one patient underwent successful repeat ablation. The other patient was managed medically. All seven patients with successful ablation are symptom free after 6.5 +/- 3.8 months., Conclusions: Our preliminary experience suggests that with the use of both paced activation sequence mapping and standard techniques, radiofrequency ablation of ectopic atrial tachycardia may be a safe and effective form of therapy.

The present study attempted to investigate the relationship between judged speech proficiency of cerebral palsied speakers and the following quantitative speech parameters: 1) the number of articulatory errors; 2) the intelligibility of the speech of the cerebral palsied; 3) mean vocal fundamental frequency; 4) variation of vocal fundamental frequency; 5) mean speech-sound pressure level; 6) variation of speech-sound pressure level; 7) word-per-minute speech rate. Secondarily, the study investigated the differences in the speech of the spastic and athetoid populations in terms of the parameters listed above.

Immediately following embryonic cleavage, the cells of Astrephomene have four equal-sized basal bodies, two of which are connected by a striated distal fibre and two striated proximal fibres. The four microtubular rootlets, which alternate between having 3/1 and 2 members, are arranged cruciately. The two basal bodies that are connected by the striated fibres then extend into flagella, while the two accessory basal bodies are now markedly shorter. At this stage the flagellar apparatus has 180 degrees rotational symmetry and is very similar to the flagellar apparatus of the unicellular Chlamydomonas and related algae. Development proceeds with a number of concurrent events. The basal bodies begin to separate at their proximal ends and become nearly parallel. Each striated proximal fibre detaches at one end from one of the basal bodies. Each half of the flagellar apparatus, which consists of a flagellum and attached basal body, an accessory basal body, two rootlets and a striated fibre (formerly one of the proximal striated fibres), rotates about 90 degrees, the two halves rotating in opposite directions. An electron-dense strut forms near one two-membered rootlet and grows past both basal bodies. During this time a fine, fibrous component appears between newly developed spade-like structures and associated amorphous material connected to each basal body. The basal bodies continue to separate as the distal fibre stretches and finally detaches from one of them. These processes result in the loss of the 180 degree rotational symmetry present in previous stages. Although the flagella continue to separate, there is no further reorganization of the components of the flagellar apparatus. In the mature cell of Astrephomene, the two flagella are inserted separately and are parallel. The four microtubular rootlets are no longer arranged cruciately. Three of the rootlets are nearly parallel, while the fourth is approximately perpendicular to the other three. A straited fibre connects each basal body to the underside of the strut. These fibres run in the direction of the effective stroke of the flagella and might be important either in anchoring the basal bodies or in the initiation of flagellar motion. Unlike the case in the unicellular Chlamydomonas, the two flagella beat in the same direction and in parallel planes. The flagella of a given cell may or may not beat in synchrony. The combination of this type of flagellar motion and the parallel, separate flagella appears to be suited to the motion of this colonial organism.