A binning scheme is proposed for D→K+π−π−π+ phase space that will improve the sensitivity of a B−→DK− analysis to the angle γ of the Cabibbo-Kobayashi-Maskawa Unitarity Triangle. The scheme makes use ...of amplitude models recently reported by the LHCb collaboration. Assuming that a four-bin scheme optimised on the models retains a similar sensitivity when applied in data, it is estimated that the statistical uncertainty on γ from the B-meson sample so far collected by the LHCb experiment will be as low as 5 degrees. This will be one of the most precise results available for any single decay mode in a B−→DK− measurement. Quantum-correlated DD¯ data accumulated by the CLEO-c experiment are analysed to provide first constraints on the coherence factors and average strong-phase differences in the four bins, which are necessary inputs for the measurement. These constraints are compared with the predictions of the model, and consequences for the measurement of γ are discussed.
Adult respiratory distress syndrome (ARDS) has a high mortality rate and consumes considerable health care resources. It is not clear whether specimens obtained from open lung biopsy (OLB) in ARDS ...provide a specific diagnosis, alter therapy, or affect outcome. This meta-analysis attempts to determine whether OLB is safe, provides a specific diagnosis, changes therapy, or affects survival.
A computerized search was performed of Medline and PubMed from January 1988 to December 2012 of English language studies of acute respiratory failure and diffuse pulmonary infiltrates that evaluated OLB in primarily adult mechanically ventilated patients. Of 194 abstracts retrieved, 64 articles were reviewed; 130 articles were excluded because they did not evaluate OLB. After applying the selection criteria, 24 articles were included.
OLB in ARDS provided a specific diagnosis in 84% of patients and altered management in 73%. Hospital mortality was 43%. The complication rate for OLB in ARDS was 22%, but death from OLB was rare.
OLB in ARDS is a potentially productive procedure that provides a specific diagnosis and leads to a change in management in high proportions of patients. ARDS has a high mortality rate, which OLB does not appear to increase. Owing to a lack of randomized controlled trials, a survival advantage of OLB in ARDS could not be demonstrated.
We report the first observation of the spontaneous polarization of Λ and Λover ¯ hyperons transverse to the production plane in e^{+}e^{-} annihilation, which is attributed to the effect arising from ...a polarizing fragmentation function. For inclusive Λ/Λover ¯ production, we also report results with subtracted feed-down contributions from Σ^{0} and charm. This measurement uses a dataset of 800.4 fb^{-1} collected by the Belle experiment at or near a center-of-mass energy of 10.58 GeV. We observe a significant polarization that rises with the fractional energy carried by the Λ/Λover ¯ hyperon.
Objectives/Hypothesis
To create a model of the anatomic distribution, recurrence, and growth patterns of recurrent respiratory papillomatosis (RRP).
Study Design
Prospective, multi‐institutional ...cohort study.
Methods
Adult patients with a diagnosis of RRP evaluated between August 1, 2018 and February 1, 2021 at six participating centers were invited to enroll. At each office or operating room encounter, laryngologists recorded the location and size of RRP lesions using a 22‐region schematic. A generalized linear mixed effects model was used to compare region variations in lesion prevalence and recurrence.
Results
The cohort comprised 121 patients: 74% were male, 81% had been diagnosed with adult‐onset RRP, and a plurality (34%) had undergone 0 to 3 RRP interventions prior to enrollment. Across the study period, the odds of a lesion occurring in the glottis was significantly higher (odds ratio OR: 26.51; 95% confidence interval CI: 11.76–59.75, P < .001) compared with all other areas of the larynx and trachea. Within the true vocal folds, the membranous vocal folds had significantly higher odds (OR: 6.16; 95% CI: 2.66–14.30, P < .001) of lesion occurrence compared to the cartilaginous vocal folds. Despite these strong trends in lesion distribution, there were no differences in the odds of lesion recurrence, growth, or in the time to recurrence, between anatomic subsites.
Conclusions
RRP lesions are most likely to occur in the glottis, particularly the membranous vocal folds, compared with other regions of the larynx or trachea. However, all lesions demonstrate similar behavior with respect to recurrence, growth, and time to recurrence regardless of anatomic location.
Level of Evidence
3 Laryngoscope, 132:2403–2411, 2022
The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial ...domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder.
Retrospective between-subject, non-experimental design.
Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions.
There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures.
This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.
Objective:
Cricoid chondronecrosis is a rare entity that has significant consequences for patients. Reports of its occurrence are scattered in the literature and currently there is no comprehensive ...review to help guide providers.
Methods:
A case report from our institution is presented. A review of available literature is then provided with assessment of risk factors, signs and symptoms at presentation, laryngeal exam findings, radiologic findings, and surgical techniques.
Results:
Twenty-four cases of cricoid chondronecrosis were reviewed from the literature. Patient age ranged from 8 months to 76 years. A history of endotracheal intubation for various reasons was present in all but two cases, and duration of intubation ranged from 6 hours to 28 days. Patients presented with airway compromise in all but two cases—one asymptomatic patient with prior tracheostomy and another with dysphagia after radiation. Dysphonia (n = 6) and dysphagia (n = 3) were less commonly present. Subglottic stenosis (n = 19) was the most common exam finding followed by vocal fold impairment (n = 11). When CT scan findings were reported, fragmentation of the cartilage and/or hypodensity of the central lamina were described in all but one case. Interventions ranged from observation on antibiotics and steroids to surgical therapies including tracheostomy, dilation, and posterior cricoid split, with or without stent placement.
Conclusions:
Cricoid chondronecrosis is a serious, rare entity that can occur even after a short period of endotracheal intubation. Providers must have a high level of suspicion in patients that present with upper airway dyspnea with a history of prior intubation.
Level of evidence:
Level 4
Background: The Diagnostic Interview for Social and Communication Disorders (DISCO) is a schedule for the diagnosis of autistic spectrum and related disorders and assessment of individual needs. It ...enables information to be recorded systematically for a wide range of behaviours and developmental skills and is suitable for use with all ages and levels of ability. In addition to helping the clinician to obtain a profile of each individual's pattern of development and behaviour, the DISCO also enables identification of specific features found in autistic spectrum disorders that are relevant for use with established diagnostic systems. Method: This paper describes the historical background of the DISCO, outlines its structure and reports the results of an inter‐rater reliability study with parents of 82 children aged 3 to 11 years with autistic spectrum disorder, learning disability, language disorder or typical development. Results: Inter‐rater reliability for the items in the interview was high (kappa coefficient or intra‐class correlation at .75 or higher). This level of agreement was achieved for over 80% of the interview items.
Host nitric oxide (NO⋅) production is important for controlling intracellular bacterial pathogens, including Salmonella enterica serovar Typhimurium, but the underlying mechanisms are incompletely ...understood. S. Typhmurium 14028s is prototrophic for all amino acids but cannot synthesize methionine (M) or lysine (K) during nitrosative stress. Here, we show that NO⋅-induced MK auxotrophy results from reduced succinyl-CoA availability as a consequence of NO⋅ targeting of lipoamide-dependent lipoamide dehydrogenase (LpdA) activity. LpdA is an essential component of the pyruvate and α-ketoglutarate dehydrogenase complexes. Additional effects of NO⋅ on gene regulation prevent compensatory pathways of succinyl-CoA production. Microarray analysis indicates that over 50% of the transcriptional response of S. Typhimurium to nitrosative stress is attributable to LpdA inhibition. Bacterial methionine transport is essential for virulence in NO⋅-producing mice, demonstrating that NO⋅-induced MK auxotrophy occurs in vivo. These observations underscore the importance of metabolic targets for antimicrobial actions of NO⋅.
EXECUTIVE SUMMARY Professional identity formation (PIF) involves internalizing and demonstrating the behavioral norms, standards, and values of a professional community, such that one comes to ...“think, act and feel” like a member of that community. Professional identity influences how a professional perceives, explains, presents and conducts themselves. This report of the 2020-2021 AACP Student Affairs Standing Committee (SAC) describes the benefits of a strong professional identity, including its importance in advancing practice transformation. Responding to a recommendation from the 2019-2020 SAC, this report presents an illustrative and interpretative schema as an initial step towards describing a pharmacist’s identity. However, the profession must further elucidate a universal and distinctive pharmacist identity, in order to better support pharmacists and learners in explaining and presenting the pharmacist’s scope of practice and opportunities for practice change. Additionally, the report outlines recommendations for integrating intentional professional identity formation within professional curricula at colleges and schools of pharmacy. Although there is no standardized, single way to facilitate PIF in students, the report explores possibilities for meeting the student support and faculty development needs of an emerging new emphasis on PIF within the Academy.
We present measurements of partial branching fractions of inclusive semileptonic B → Xuℓ+ νℓ decays using the full Belle dataset of 711 fb−1 of integrated luminosity at the Υ(4S) resonance and for ℓ ...= e, μ. Inclusive semileptonic B → Xuℓ+ νℓ decays are Cabibbo-Kobayashi-Maskawa (CKM) suppressed and measurements are complicated by the large background from CKM favored B → Xcℓ+ νℓ transitions, which have a similar signature. Using machine learning techniques, we reduce this and other backgrounds effectively, while retaining access to a large fraction of the B → Xuℓ+νℓ phase space and high signal efficiency. We measure partial branching fractions in three phase-space regions covering about 31% to 86% of the accessible B → Xuℓ+νℓ phase space. The most inclusive measurement corresponds to the phase space with lepton energies of EBℓ > 1 GeV, and we obtain ΔB ( B → Xuℓ+νℓ) = (1.59 ± 0.07 ± 0.16) × 10−3 from a two-dimensional fit of the hadronic mass spectrum and the four-momentum-transfer squared distribution, with the uncertainties denoting the statistical and systematic error. We find |Vub| = (4.10 ± 0.09 ± 0.22 ± 0.15) × 10−3 from an average of four calculations for the partial decay rate with the third uncertainty denoting the average theory error. This value is higher but compatible with the determination from exclusive semileptonic decays within 1.3 standard deviations. In addition, we report charmless inclusive partial branching fractions separately for B + and B 0 mesons as well as for electron and muon final states. No isospin breaking or lepton flavor universality violating effects are observed.
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