Isolated diaphragm weakness and the diagnostic value of phrenic nerve stimulation

Acute onset, atraumatic, bilateral diaphragm paralysis due to isolated bilateral phrenic neuropathy is uncommon. Respiratory physicians should be alert to this disorder because it is associated with considerable morbidity and diagnosis is often delayed. These case reports highlight important aspects of the presentation, investigations and management of this disorder

Molecular Pathological Classification of Colorectal Cancer

Colorectal cancer (CRC) shows variable underlying molecular changes with two major mechanisms of genetic instability: chromosomal instability and microsatellite instability. This review aims to delineate the different pathways of colorectal carcinogenesis and provide an overview of the most recent advances in molecular pathological classification systems for colorectal cancer. Two molecular pathological classification systems for CRC have recently been proposed. Integrated molecular analysis by The Cancer Genome Atlas project is based on a wide-ranging genomic and transcriptomic characterisation study of CRC using array-based and sequencing technologies. This approach classified CRC into two major groups consistent with previous classification systems: (1) ∼16 % hypermutated cancers with either microsatellite instability (MSI) due to defective mismatch repair (∼13 %) or ultramutated cancers with DNA polymerase epsilon proofreading mutations (∼3 %); and (2) ∼84 % non-hypermutated, microsatellite stable (MSS) cancers with a high frequency of DNA somatic copy number alterations, which showed common mutations in APC, TP53, KRAS, SMAD4, and PIK3CA. The recent Consensus Molecular Subtypes (CMS) Consortium analysing CRC expression profiling data from multiple studies described four CMS groups: almost all hypermutated MSI cancers fell into the first category CMS1 (MSI-immune, 14 %) with the remaining MSS cancers subcategorised into three groups of CMS2 (canonical, 37 %), CMS3 (metabolic, 13 %) and CMS4 (mesenchymal, 23 %), with a residual unclassified group (mixed features, 13 %). Although further research is required to validate these two systems, they may be useful for clinical trial designs and future post-surgical adjuvant treatment decisions, particularly for tumours with aggressive features or predicted responsiveness to immune checkpoint blockade

The influence of contextual information regarding the breakdown of relationships and perpetrator-target sex composition on perceptions of relational stalking

The present study examines the influence of prior relationship (with contextual information regarding the breakdown of the relationship) and perpetrator-target sex composition on perceptions of relational stalking. The study employed an experimental 7 × 2 independent measures design, and the sample comprised 1,260 members of the community residing in Australia, the United Kingdom and the United States. Participants received one of 14 versions of a hypothetical scenario and responded to scale items concerning the situation described. The situation was perceived to be most serious when the perpetrator was a stranger or a physically violent ex-partner and least serious when the perpetrator was an ex-partner of an unfaithful target. Scenarios involving a male perpetrator and a female victim were also perceived to be more serious than scenarios involving a female perpetrator and a male target. It is apparent therefore that the context of the relationship breakdown and the sex of the perpetrator and target significantly influence perceptions of relational stalking

Hearing aid effectiveness after aural rehabilitation - individual versus group (HEARING) trial: RCT design and baseline characteristics

<p>Abstract</p> <p>Background</p> <p>Hearing impairment is the most common body system disability in veterans. In 2008, nearly 520,000 veterans had a disability for hearing loss through the Department of Veterans Affairs (VA). Changes in eligibility for hearing aid services, along with the aging population, contributed to a greater than 300% increase in the number of hearing aids dispensed from 1996 to 2006. In 2006, the VA committed to having no wait times for patient visits while providing quality clinically-appropriate care. One approach to achieving this goal is the use of group visits as an alternative to individual visits. We sought to determine: 1) if group hearing aid fitting and follow-up visits were at least as effective as individual visits, and 2) whether group visits lead to cost savings through the six month period after the hearing aid fitting. We describe the rationale, design, and characteristics of the baseline cohort of the first randomized clinical trial to study the impact of group versus individual hearing aid fitting and follow-up visits.</p> <p>Methods</p> <p>Participants were recruited from the VA Puget Sound Health Care System Audiology Clinic. Eligible patients had no previous hearing aid use and monaural or binaural air-conduction hearing aids were ordered at the evaluation visit. Participants were randomized to receive the hearing aid fitting and the hearing aid follow-up in an individual or group visit. The primary outcomes were hearing-related function, measured with the first module of the Effectiveness of Aural Rehabilitation (Inner EAR), and hearing aid adherence. We tracked the total cost of planned and unplanned audiology visits over the 6-month interval after the hearing aid fitting.</p> <p>Discussion</p> <p>A cohort of 659 participants was randomized to receive group or individual hearing aid fitting and follow-up visits. Baseline demographic and self-reported health status and hearing-related measures were evenly distributed across the treatment arms.</p> <p>Outcomes after the 6-month follow-up period are needed to determine if group visits were as least as good as those for individual visits and will be reported in subsequent publication.</p> <p>Trial Registration</p> <p>NCT00260663</p

Origin of Axial and Radial Expansions in Carbon Nanotubes Revealed by Ultrafast Diffraction and Spectroscopy

The coupling between electronic and nuclear degrees of freedom in low-dimensional, nanoscale systems plays a fundamental role in shaping many of their properties. Here, we report the disentanglement of axial and radial expansions of carbon nanotubes, and the direct role of electronic and vibrational excitations in determining such expansions. With subpicosecond and subpicometer resolutions, structural dynamics were explored by monitoring changes of the electron diffraction following an ultrafast optical excitation, whereas the transient behavior of the charge distribution was probed by time-resolved, electron-energy-loss spectroscopy. Our experimental results, and supporting density functional theory calculations, indicate that a population of the excited carriers in the antibonding orbitals of the nanotube walls drives a transient axial deformation in ∼1 ps; this deformation relaxes on a much longer time scale, 17 ps, by nonradiative decay. The electron-driven expansion is distinct from the phonon-driven dynamics observed along the radial direction, using the characteristic Bragg reflections; it occurs in 5 ps. These findings reveal the nonequilibrium distortion of the unit cell at early times and the role of the electron(phonon)-induced stress in the lattice dynamics of one-dimensional nanostructures

Current trends in the etiology and diagnosis of HPV-related head and neck cancers

Human papilloma virus (HPV) infection is a major risk factor for a distinct subset of head and neck squamous cell carcinoma (HNSCC). The current review summarizes the epidemiology of HNSCC and the disease burden, the infectious cycle of HPV, the roles of viral oncoproteins, E6 and E7, and the downstream cellular events that lead to malignant transformation. Current techniques for the clinical diagnosis of HPV-associated HNSCC will also be discussed, that is, the detection of HPV DNA, RNA, and the HPV surrogate marker, p16 in tumor tissues, as well as HPV-specific antibodies in serum. Such methods do not allow for the early detection of HPV-associated HNSCC and most cases are at an advanced stage upon diagnosis. Novel noninvasive approaches using oral fluid, a clinically relevant biological fluid, allow for the detection of HPV and cellular alterations in infected cells, which may aid in the early detection and HPV-typing of HNSCC tumors. Noninvasive diagnostic methods will enable early detection and intervention, leading to a significant reduction in mortality and morbidity associated with HNSCC

An Integrated Mission Approach to the Space Exploration Initiative Will Ensure Success

The direction of the American space program, as defined by President Bush and the National Commission on Space, is to expand human presence into the solar system. Landing an American on Mars by the 50th anniversary of the Apollo 11 lunar landing is the goal. This challenge has produced a level of excitement among young Americans not seen for nearly three decades. The exploration and settlement of the space frontier will occupy the creative thoughts and energies of generations of Americans well into the next century. The return of Americans to the moon and beyond must be viewed as a national effort with strong public support if it is to become a reality. Key to making this an actuality is the mission approach selected. Developing a permanent presence in space requires a continual stepping outward from Earth in a logical progressive manner. If we seriously plan to go and to stay, then not only must we plan what we are to do and how we are to do it, we must address the logistic support infrastructure that will allow us to stay there once we arrive. A fully integrated approach to mission planning is needed if the Space Exploration Initiative (SEI) is to be successful. Only in this way can a permanent human presence in space be sustained. An integrated infrastructure approach would reduce the number of new systems and technologies requiring development. The resultant horizontal commonality of systems and hardware would reduce the direct economic impact of SEI while an early return on investment through technology spin-offs would be an economic benefit by greatly enhancing our international technical competitiveness. If the exploration, development, and colonization of space is to be affordable and acceptable, careful consideration must be given to such things as return on investment'' and commercial product potential'' of the technologies developed. 7 refs., 3 figs

An Integrated Mission Planning Approach for the Space Exploration Initiative

This report discusses a fully integrated energy-based approach to mission planning which is needed if the Space Exploration Initiative (SEI) is to succeed. Such an approach would reduce the number of new systems and technologies requiring development. The resultant horizontal commonality of systems and hardware would reduce the direct economic impact of SEI and provide an economic benefit by greatly enhancing our international technical competitiveness through technology spin-offs and through the resulting early return on investment. Integrated planning and close interagency cooperation must occur if the SEI is to achieve its goal of expanding the human presence into the solar system and be an affordable endeavor. An energy-based mission planning approach gives each mission planner the needed power, yet preserves the individuality of mission requirements and objectives while reducing the concessions mission planners must make. This approach may even expand the mission options available and enhance mission activities

An Integrated Mission Planning Approach for the Space Exploration Initiative

A fully integrated energy-based approach to mission planning is needed if the Space Exploration Initiative (SEI) is to succeed. Such an approach would reduce the number of new systems and technologies requiring development. The resultant horizontal commonality of systems and hardware would reduce the direct economic impact of SEI and provide an economic benefit by greatly enhancing our international technical competitiveness through technology spin-offs and through the resulting early return on investment. Integrated planning and close interagency cooperation must occur if the SEI is to achieve its goal of expanding the human presence into the solar system and be an affordable endeavor. An energy-based mission planning approach gives each mission planner the needed power, yet preserves the individuality of mission requirements and objectives while reducing the concessions mission planners must make. This approach may even expand the mission options available and enhance mission activities

An integrated mission planning approach for the space exploration initiative

A fully integrated energy-based approach to mission planning is needed if the Space Exploration Initiative (SEI) is to succeed. Such an approach would reduce the number of new systems and technologies requiring development. The resultant horizontal commonality of systems and hardware would reduce the direct economic impact of SEI and provide an economic benefit by greatly enhancing our international technical competitiveness through technology spin-offs and through the resulting early return on investment. Integrated planning and close interagency cooperation must occur if the SEI is to achieve its goal of expanding the human presence into the solar system and be an affordable endeavor. An energy-based mission planning approach gives each mission planner the needed power, yet preserves the individuality of mission requirements and objectives while reducing the concessions mission planners must make. This approach may even expand the mission options available and enhance mission activities