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Purpose: The purpose of this clinical focus article was to discuss the important relationship between executive function and language skills and to provide speech-language pathologists (SLPs) with strategies for promoting student success. Background and Method: The impact of executive function processes on language and literacy begins in the preschool years and becomes increasingly important from third grade onward. These executive function processes play a more dominant role when tasks require students to integrate and synthesize multiple linguistic and other subskills in order to read and comprehend, write, complete projects, and study for quizzes and tests. In this clinical focus article, we provide a brief overview of research-based executive function strategies that are beneficial for all learners and are essential for students with language weaknesses as well as learning and attention difficulties. We focus on the key executive function processes that are the foundation of academic performance, namely, goal setting, organizing and prioritizing, thinking and problem-solving flexibly, accessing information in working memory, and self-monitoring. We discuss a theoretical framework for understanding and promoting metacognition and executive function as part of assessment and treatment plans for SLPs. Finally, we address the importance of executive function strategies for improving students' effort, academic performance, and resilience. Conclusion: SLPs can promote student success by offering structured and systematic approaches to teaching executive function strategies.

Background The optimal analgesia method in video-assisted thoracoscopic surgery (VATS) remains controversial. Intercostal nerve blockade (ICNB) is limited by its duration of action. The erector spinae plane (ESP) block has the potential to provide satisfactory analgesia for VATS; however, the effectiveness of continuous ESP versus surgeon-performed ICNB has not been investigated. The objectives of this study were to establish feasibility of patient recruitment and follow-up before undertaking a fully powered randomized controlled trial (RCT); and, secondarily, to compare opioid usage, pain control, and sensory blockade. Methods This feasibility RCT was undertaken at St Joseph’s Hospital, Hamilton, Ontario, Canada, and included 24 patients (>18 years) having elective VATS with at least one overnight stay. Exclusion criteria were patient refusal, body mass index >40 kg/m2, contraindications to neuraxial analgesia techniques as per the American Society of Regional Anesthesia and Pain guidelines, known allergy to local anesthetics, language or comprehension barriers, procedures with a higher chance of open surgery, and regular opioid use for ≥3 months preoperatively. Patients underwent either continuous ESP (n=12) or surgeon-performed ICNB (n=12). All patients received routine intraoperative anesthesia care and multimodal analgesia. Feasibility criteria were recruitment rate of two patients/week and full follow-up in all patients in-hospital. We compared opioid consumption, postoperative pain scores (0–10 numerical rating scale), adverse events, patient satisfaction, and distribution of sensory blockade as clinical outcomes (secondary). Results Feasibility of primary outcomes was successfully demonstrated. Five patients had an epidural in anticipation of open surgery. Mean opioid consumption as equivalent morphine units was less in the ESP group over the first 24 h (mean difference, 1.63 [95% CI –1.20 to 4.45]) and 48 h (mean difference, 2.34 [95% CI –1.93 to 6.61]). There were no differences in adverse effects. Conclusions A fully powered RCT is feasible with modifications. Our results also suggest that continuous ESP is safe and can decrease opioid needs. However, it is important to consider procedures to improve compliance to protocol and adherence to assigned interventions. Trial registration Clinicaltrials.gov identifier: NCT03176667. Registered June 5, 2017.

This paper updates guidelines for effective treatments of children with specific types of acquired brain injury (ABI) published in 2007 with more recent evidence. A systematic search was conducted for articles published from 2006 to 2017. Full manuscripts describing treatments of children (post-birth to 18) with acquired brain injury were included if study was published in peer-reviewed journals and written in English. Two independent reviewers and a third, if conflicts existed, evaluated the methodological quality of studies with an Individual Study Review Form and a Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Strength of study characteristics was used in development of practice guidelines. Fifty-six peer-reviewed articles, including 27 Class I studies, were included in the final analysis. Established guidelines for writing practice recommendations were used and 22 practice recommendations were written with details of potential treatment limitations. There was strong evidence for family/caregiver-focused interventions, as well as direct interventions to improve attention, memory, executive functioning, and emotional/behavioural functioning. A majority of the practice standards and guidelines provided evidence for the use of technology in delivery of interventions, representing an important trend in the field.

Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI; triage and resource use–based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. High-users’ mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P < .001). Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users’ rates in the preintervention period. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. Pre- and post-intervention sample demographics and comorbidities were similar. The observed reductions in overall ED visit rates, particularly low-severity visits; highest reductions observed among high-users and the top quartile of occasional users; and the pattern of changes in emergency severity support a positive impact of the primary care intervention.

Introduction Scabies and impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease. Methods School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test. Results The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9–15). The prevalence of scabies was 22.4% (95% CI 20.2–24.7%) and active impetigo 9.7% (95% CI 8.3–11.4%); 68.2% of students had evidence of either active or healed impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2–12.4), p

Common practices associated with the use of cryopreserved hematopoietic progenitor cells (HPC) include measuring the viability of the thawed cells from a sample derived from the thawed product, and thawing cells at the patient's bedside out of concern for possible toxicity of DMSO in the post-thaw liquid cell suspension. The former practice carries the risk of discovering excess cell death when it is too late to correct, and the concomitant risk of non-engraftment. The latter practice carries all of the risks associated with manipulating cells in a non-controlled environment including risk of contamination and lack of suitable containment in the event of failure of a cryostorage container. In an effort to reduce risks associated with cell cryostorage, we are currently examining the validity of measuring CD34 viability from cells frozen in retention vials concomitantly with product freezing. We are also examining the stability of HPC being held in cryostorage medium from 1 to 24 hours post thaw. We present here our results from a pilot study performed on six bags of cells, previously identified for discard due to death of the intended recipients. Six bags of HPC and associated retention vials, frozen for 5 to 12 years, were selected at random from the pool of discarded products and de-identified per guidelines for discard of medical waste. CD34+ cells were identified using a modification of the ISHAGE method, and dead cells were identified by infiltration with the fluorochrome dye 7-AAD. CD34+ cells stored in retention vials were 94±11 percent viable, and CD34+ cells stored in bags were 96±7 percent viable. A Wilcoxan matched pairs test yielded p=0.6, indicating that these results were not different. Percent viable CD34+ cell recovery, relative to the known number of CD34+ cells per mL originally frozen, was determined immediately following thawing, and following 1, 2, 4 and 24 hours remining in thawed cryostorage medium, with recoveries (mean ± std. dev.) of 88 ± 31, 76 ± 33, 62 ± 28, 88 ± 41, and 49 ± 26 percent respectively. These preliminary results suggest that viable CD34 percent as measured from a retention vial may serve as a predictor of viability at thawing of it's associated product, and also that HPC held in cryostorage medium post thaw retain viability for at least four hours post thawing. Based on these results we are continuing these studies.

Electronic Patient Records have improved vastly the quality and efficiency of care delivered. However, the formation of single demographic database and the ease of electronic information sharing give rise to many concerns including issues of consent, by whom and how data are accessed and used. This paper examines the organizational and socio-technical issues related to privacy, confidentiality and security when employing electronic records within a maternity service hospital in England.A preliminary questionnaire was administered (n = 52), in total, 24 responses were received. Sixteen responses were from personnel in the information technology department, 5 from health information department and 3 from midwifery managers. This was followed by a semi-structured interview with representatives from the clinical and technological side.A number of issues related to information governance (IG) have been identified, especially breaches on sharing personal information without consent from the patients have been identified as one immediate challenge that needs to be fixed.There is an immediate need for more robust, realistic, built-in accountability both locally and nationally on data sharing. A culture of ownership and strict adherence to IG principles is paramount. Focused training in the area of data, information and knowledge sharing will bring in a balance of legitimate usage against the individual's rights to confidentiality and privacy.

Achieving sustainability involves complex processes of technology, people, institutions, and the environment. The sustainability challenge requires a combination of social, political, and technological efforts. This paper discusses processes for technological change in order to meet the sustainability challenge. These complex processes are found to be a suitable application for systems engineering and for systems architecture in particular. Based on a thorough review of the literature, an architecture framework is developed to support management of portfolios of sustainable technology projects. This architecture framework is validated through a case study process, providing enhancements and lessons learned. The full architecture framework construct and associated proposed implementation approaches are presented, demonstrating the need for and applicability of such systems engineering approaches to achieve sustainability. Lessons learned from case studies and development of representative architectures are also described. ©2012 Wiley Periodicals, Inc. Syst Eng 16

Mass evictions have been increasingly linked to large international events, often called mega-events, around the world. This article looks back at the residential redevelopment in Seoul that surged just prior to the 1988 Olympic Games there to better understand how large events bring about change in cities. When existing documentation of the new housing construction boom and a corresponding large-scale dislocation of urban poor residents via aggressive evictions in the mid-1980s are correlated with data from primary and secondary historical sources, there is incontrovertible evidence of a causal link between event hosting and forced evictions. However, the data goes on to reveal that large-scale clearance, evictions and demolitions occurred in Seoul over an extended period before the Olympics as well as long afterwards, which suggests that the Olympics was in fact part of a broader process and practice of urban transformation in Seoul. Without discounting the effect of event hosting in this case, this raises the question of what motivates both event hosting and residential redevelopment, and whether the event offers an opportunity to refine and further institutionalize certain practices. The article proposes taking a longer historical view of the practice of clearance, evictions and demolitions in order to foresee the dynamics of event hosting in a specific city and to inform event-related planning.

A series of Cr(III) dimers were synthesized from a parent compound [Cr 2 (μ-oxo) 2 (μ 1,2 -C 4 O 4 ) 2 (H 2 O) 4 ]·2H 2 O ( I ) by ligand substitution. The compounds have been analyzed using variable frequency EPR (9–110 GHz) and magnetic susceptibility as a function of field (0–9 T) and temperature (1.9–300 K) to obtain their electronic g -values, exchange energies, and zero-field parameters. The parent compound exhibits a broad maximum around 34 K characteristic of a dimer with antiferromagnetic coupling that fit the Van Vleck susceptibility model well. It was found that the maxima could be tuned from 34 to 80 K by ligand substitution of the waters. Each compound possesses a characteristic color spanning the range of teal to pink. The g -value of each compound was found to be ∼1.98 using spectral simulation. The DMSO derivative is water soluble and has a high LC 50 for PC3 cancer cells, suggesting its use as a magnetic resonance imaging agent. X-ray crystal structure of the DMSO derivative [Cr 2 (μ-oxo) 2 (μ 1,2 -C 4 O 4 ) 2 (C 2 H 6 SO) 4 ]·2H 2 O ( II ) revealed that the DMSO ligands are equatorial, and the squarate groups bridge the two chromiums. This is in contrast to the previously proposed structure of the parent compound where the water ligands were axial and the equatorial squarate groups did not bridge the chromiums. These compounds are interesting because of their ease of synthesis, and their wide range of magnetic behavior. The compounds are good probes into antiferromagnetic dimer exchange by controlling the ligand field surrounding the superexchange pathway present in the molecule.

The Mobility Rehabilitation Engineering Research Center at the Georgia Institute of Technology held its State of the Science Conference to address challenges in studying the health, activity and participation of wheelchair users. The purpose of this project was to collect and report seating and wheeled mobility research priorities.Invitations were sent to researchers, clinicians, policy makers, manufacturers, methodologists, wheelchair users and federal funding agency scientists. Invitees submitted their three most important wheeled mobility and seating issues. Submissions were blinded and collated into distinct topic areas with the most oft-mentioned topics comprising seven priority topics within each of the mobility and seating areas. Conference attendees voted on these topic areas, narrowing the priorities into four mobility and four seating/posture topics.The Wheeled Mobility research priorities included: impact of long term wheelchair use, relating activityparticipation to health outcomes, translating research into design, and impact of wheelchair design on function. The Seating/Posture research priorities included determining cushion adequacy, positioning abilities of cushions, long term impact of sitting, and impact of seatingmobility interventions.Significant areas of study remain to fully associate AT interventions and the health and everyday functioning of wheelchair users.

Listeriosis is a serious foodborne infection that disproportionately affects elderly adults, pregnant women, newborns, and immunocompromised individuals. Diagnosis is made by culturing Listeria monocytogenes from sterile body fluids or from products of conception. This report describes the investigations of two listeriosis pseudo-outbreaks caused by contaminated laboratory media made from sheep blood.

Background The introduction of central venous catheters has advanced medical care, particularly in hemato-oncology. However these can be associated with an increased thrombotic risk. Previous studies have compared the rate of thrombotic events between peripherally- inserted (PICCs) and long term skin tunneled catheters (LTSTCs) noting fewer complications associated with the latter, though this has rarely translated into clinical practice. The objectives of our study was to compare the cumulative incidence of thrombotic events between peripherally-inserted and long term skin tunneled venous catheters. Patients/methods We performed a retrospective, single center cohort analysis of patients with hematological malignancies who had either a PICC or LTSTC line inserted between January 2010 through January 2013. Cumulative incidences of thrombotic events were compared between the two groups, and post-thrombotic complications were also examined. Results 346 patients had a PICC inserted with cumulative incidence of symptomatic thrombosis of 5.8%, while 237 patients had a LTSTC inserted with a cumulative incidence of 1.7% (p = 0.003). Post-thrombotic complication rates, particularly infection, were higher in the PICC group compared to the LTSTC group (p = 0.597). Conclusions Our study showed that the incidence of thrombotic events in hemato-oncology patients was significantly lower in those who had a LTSTC compared to PICC line. As the use of central venous lines increases in hemato-oncology patient care, a randomized trial comparing PICCs and LTSTCs is necessary to address which venous access is most appropriate in this cohort of patients, with minimal risk of morbidity and mortality.

State purchasing data can provide valuable information, in combination with a systematic ranking methodology, for prioritizing environmentally preferable purchasing efforts. A team of researchers developed and applied a priority-setting tool for the State of California's Procurement Division, which considers purchase volume, environmental impacts, potential for improvement, and institutional factors such as existing state policies and upcoming contract renewals. Using state purchasing data, this method produced a ranked list of 58 product classes, divided into four general priority groups. The State of California selected three priority product classes for further analysis by the research team, leading to a list of recommended product brands. The process for developing a list of recommended general-purpose cleaners is described as an example.

Until 1996, international weapons inspection and arms control missions did not include sophisticated geophysical investigation. On-site inspections depended largely on visual observation, personal communication, and physical searches. As part of the first geophysical survey team to operate under international auspices, we were party to both the technical and the human challenges of using geophysical instruments in less-than-ideal circumstances. This article introduces our experience as “geophysical weapons inspectors.” Initially, the paper provides background to this unprecedented application of geophysics to an international monitoring regime. It then describes typical procedures and specific tasks and concludes with more personal reflections about our participation in this (to us) novel undertaking—one in which some of our geophysical colleagues are likely to be active in the future.

Background. The majority of patients with head and neck squamous cell carcinoma (HNSCC) who have a clinical N0 neck undergo neck dissection (ND) even though no lymph node metastases may be detected. With this background, our investigation critically analyzes the value of sentinel lymphadenectomy. Methods. Ninety patients with HNSCC, all staged with an N0 neck, underwent intraoperative 99mTc-radiolabeled detection of up to three hot nodes (SN1–3) during elective ND and primary site resection. Results. Sentinel lymphadenectomy (SN1–3) detected occult metastatic spread in 20 (22%) of 90 patients, whereas failure occurred in three of 90 patients. Metastatic spread was directed to level II in the majority (66.7%) of cases. If only the SN1 had been examined, the procedure would have failed in nine (39%) of 23 patients. Conclusion. Sentinel lymphadenectomy correctly identified the stage of metastatic disease in 97% of patients in cases in which up to three sentinel nodes were identified. If only the lymph node with the highest tracer activity had been excised, 39% of cancer-positive necks would have been missed. Selective ND identified metastatic disease in the additional 3% of patients. © 2004 Wiley Periodicals, Inc. Head Neck26: 603–611, 2004

Sixty-eight consecutive patients with infiltrating squamous cell carcinoma of the supraglottic larynx were referred to the senior author (R.K.D.) from January 1987 through December 1999. Forty-six patients (clinically staged T2) were selected to undergo endoscopic carbon dioxide laser supraglottic laryngectomy. Thirty-eight of these patients underwent planned postoperative irradiation. The other 8 patients were treated by surgery only, either because they had previously undergone irradiation or because they had refused postoperative irradiation. Eighteen cases (39%) were restaged from T2 to T3 on the basis of preepiglottic space invasion demonstrated on final pathology review. Primary site control was maintained in 97% of the combined-therapy patients and in all of the surgery-only patients without any salvage procedures. Regional control was attained in 96% of N0 patients treated with irradiation alone, and 91% of N+ patients treated with modified radical neck dissection and postoperative irradiation. The combined-therapy group had only a 3% gastrostomy dependency rate, no tracheotomy dependency, a 5% aspiration pneumonia rate, and an average onset of independent swallowing at less than 2 weeks.

Objective: To explain the significant difference between microlaryngoscopy with cordectomy and endoscopic vertical partial laryngectomy (EVPL), to describe the efficacy of EVPL on T 1 b and T 2 glottic squamous cell carcinoma, and to evaluate EVPL with postoperative irradiation in T 2 glottic cancer with impaired true vocal cord mobility. Study Design: Retrospective review. Methods: Twenty-six patients seen at the University of Utah Health Science Center between 1987 and 2000 with bilateral T 1 (T 1 b) or T 2 squamous cell carcinoma of the glottic larynx underwent EVPL. T 2 cancers were classified as follows: a = unilateral disease, b = bilateral disease; i = impaired mobility. T 1 b and T 2 a glottic cancer patients received surgery alone, whereas impaired mobility patients (T 2 ai + T 2 bi) patients received surgery followed by planned postoperative irradiation. Patients were assessed for primary site control, perioperative and long-term complications, and ultimate cancer control. Results: Survival in the total group was 88.5%, with local control at 92.3%. The two recurrent patients were salvaged by total laryngectomy. For the whole group, anterior commissure involvement was present in 57.7% (15 of 26). Thirteen T 2 (5 T 2 ai + 8 T 2 bi) carcinoma patients underwent combined therapy, with 8 (61.5%) of these patients having anterior commissure involvement. Two of these patients were upstaged at surgery, one to T 3 and one to T 4 . Local control was 84.5%. Thirteen patients were treated by surgery only, with five of these patients having failed previous irradiation. Survival was 92.3% and local control 100%. This group included two T 2 bi patients, two patients upstaged to T 4 on the basis of extension beyond the subglottis to the anterior wall of the trachea, 3 T 2 b, and 6 T 2 a patients. Anterior commissure involvement was seen in 7 (53.8%) of these patients. Conclusions: EVPL alone controlled all T 1 b and T 2 a glottic cancer patients, even in the presence of greater than 50% anterior commissure involvement. The significant difference between EVPL and classical microlaryngoscopy with cordectomy was carefully described. EVPL with planned postoperative irradiation resulted in an 85% local control rate in clinically staged T 2 ai and T 2 bi cancer patients, including the three upstaged patients.

This randomized, multicenter, open-label, five-way crossover study was conducted to assess patients’ preference for tablet formulations of sumatriptan (50 mg and 100 mg), naratriptan (2.5 mg), rizatriptan (10 mg), and zolmitriptan (2.5 mg) in the acute treatment of migraine and to identify determinants of preference. Patients treated one mild, moderate, or severe migraine with each triptan. The results show that sumatriptan 100 mg was significantly preferred over the random preference rate of 20% (p

Objective: To describe preliminary voice, speech, and swallowing outcomes in patients treated by endoscopic laser excision of laryngeal cancer with or without adjuvant radiation therapy. Study Design: Retrospective review. Methods: Seventeen surgically treated patients (five T2 glottic and 12 clinically staged T2 supraglottic squamous cell carcinomas) participated in the study. Self-ratings of voice (Voice Handicap Index) and swallowing (M. D. Anderson Dysphagia Inventory) were completed, as well as independent auditory-perceptual ratings of voice and speech recordings. Resuits: Although no significant difference between Voice Handicap Index, M. D. Anderson Dysphagia Inventory, and listener ratings was identified based on tumor site and irradiation status, there was a trend toward poorer outcomes in patients who received adjuvant radiation therapy. Whereas the patients having supraglottic cancer tended to report better voice but poorer swallowing outcomes, the glottic cancer group displayed the opposite pattern. Severity on Voice Handicap Index correlated significantly with listener severity ratings of speech, suggesting that the patients' perception of their voice handicap was similar to the listeners' judgments of their speech severity. Conclusions: The results suggest the following trends: 1) Adjuvant radiation therapy was associated with poorer outcomes for voice, speech, and swallowing and may be associated with more impairment than surgery alone and 2) poorer outcomes on voice and swallowing were observed for the glottic and supraglottic cancer groups, respectively. To bolster these preliminary findings, additional outcomes studies in patients treated with conservation therapy are needed.

Extensive-stage small cell lung cancer (ES-SCLC) remains a therapeutic challenge to the medical oncologists. We evaluated the triplet combination of paclitaxel (175 mg/m 2 over 1 h), ifosfamide (2.5 gm/m 2 over 1 h) and carboplatin (AUC=6 over 0.5 h) (PIC) all given on day 1 of a 21 day schedule. Thirty-five patients were entered with a median age of 59 years (range 40–79). The ECOG PS was 0–1 in 86%. A median of 6 cycles were delivered (range 1–6). The principal toxicity was neutropenia with 66% of patients experiencing grade 4 neutropenia. Only 9% of patients experienced febrile neutropenia. One treatment-related death (3%) due to neutropenic sepsis occurred. Non-hematologic toxicity was minimal. The overall response rate was 71% (15% complete response, 56% partial responses). Quality of life appeared to be stable across time. The median survival time was 9.5 months (95% confidence interval (CI), 6.7–13.2 months) with a 1- and 2-year survival rates of 43% (95% CI, 26–59%) and 16% (95% CI, 2–30%). PIC has activity in ES-SCLC and is associated with a response rate and survival profile similar to other combinations in this disease setting. This regimen has a tolerable toxicity profile and a favorable and convenient administration schedule.

Although a great deal of research exists regarding lamina propria composition, no report exists that relates gene expression in benign laryngeal lesions to phenotypic markers. In this study, messenger RNA profiles for extracellular matrix proteins — procollagen I, collagenase, elastase, fibronectin, fibromodulin, decorin, hyaluronic acid synthase 2, and hyaluronidase — were completed on 5 polyps and 4 Reinke's edema specimens. These genotypic profiles were correlated to a videostroboscopic parameter of mucosal wave stiffness, which was used as a measurement of phenotypic expression. Polyps, characterized by stiffer mucosal waves, had higher levels of gene expression, whereas stiffer mucosal wave scores for Reinke's edema were associated with lower gene activity levels. This study supports the hypothesis that there is a relationship between genotypic expression found in polyps and Reinke's edema and phenotype as defined by a loss of or a decreased mucosal wave. The study also gives clues as to the proteins responsible for the phenotype.