People with dry age-related macular degeneration; views on certification of vision impairment in a primary care setting: An explorative qualitative study.

PURPOSE: Evidence supports the clinical decision-making ability of primary care optometrists with additional qualifications in the identification of eligibility criteria for the certification of vision impairment (CVI). Welsh Government policy is driving pathway change to enable these optometrists to perform CVI. This qualitative study explores the views of people with VI due to dry age-related macular degeneration (AMD) on this pathway change. METHODS: Nine people with VI due to dry AMD, attending Macular Society support groups, participated. Individual semi-structured interviews were conducted and analysed concurrently using thematic analysis. RESULTS: Five major themes were identified: (1) living with dry AMD, (2) experience of eye care provision, (3) knowledge of CVI, (4) provision of information and (5) CVI in primary care. Participants consistently highlighted the need for the provision of accessible information regarding the certification pathway, dry AMD and the optometrist's role in the provision of eye health care. Information needs to be available prior to the diagnosis of an eye disease, rather than only from the point of diagnosis or where the vision reaches the level required for certification. CONCLUSION: The findings support the provision of CVI within primary eye care while highlighting areas of importance in pathway development. These include the provision of accessible information prior to, at the point of and following the diagnosis of an eye condition. Information provided needs to extend to the awareness of the role of the optometrist in the provision of eye care, and public health awareness of modifiable risk factors, which will influence the possibility of disease development in later life. The findings provide information that will be useful to those responsible for the provision of CVI within primary care.

Development and pilot of a community low-vision, service-specific Patient-Reported Experience Measure.

PURPOSE: Patient-Reported Experience Measures (PREMs) act to identify the patient's objective experience while receiving care. PREM data can provide feedback to professionals on patients' personal experience of care processes, quality of care and insight into patient expectations. This can support service improvements and person-centeredness of care. Despite this, PREMs are not currently routinely collected for any primary eye care services in Wales, inclusive of the National Low Vision Service Wales (LVSW). The primary aim of this project was to develop and pilot a community low-vision, service-specific, PREM (LVSWPREM). METHODS: The development of the LVSWPREMs was performed in partnership with LVSW service users. Fourteen people attended three successive, 1.5-h online focus groups, and informed the development of a draft of LVSWPREMs inclusive of item generation and face validity. Following several rounds of iterative improvements based on the feedback gathered during the focus groups, LVSWPREM V4.0 was agreed upon and piloted for a period of 3 months within Hywel Dda University Health Board. Reliability of the final LVSWPREM V4.0 was assessed using Cronbach α. RESULTS: The final LVSWPREMs consisted of two parts: (1) LVSW-specific items and (2) a generic PREM tool approved by the Welsh Government for use across National Health Service Wales. Reliability analyses with item deletion were conducted for each construct separately using Cronbach α and were 0.94 and 0.63 for parts 1 and 2, respectively. CONCLUSION: The LVSWPREM is a validated, reliable tool, which can be used to provide information regarding patients' experience of accessing a community-based, low-vision service. Developed in partnership with people with vision impairment, it has the potential to be useful as a means of patient engagement and improvement in the delivery of high-quality healthcare.

Co-design of digital learning resources for care workers: reflections on the neurocare knowhow project.

Neurocare Knowhow is an online learning platform for care workers who support people with neurological conditions. Care workers often do not receive specialist training around neurological conditions and can experience anxiety and apprehension about caring for this group. Neurocare Knowhow aims to increase care workers' knowledge and confidence. Featuring flexible and personalisable digital features, in combination with documentary video and audio, it offers an alternative to traditional e-learning, moving away from longform didactic courses to flexible on-the-go learning. This co-design project worked closely with people with neurological conditions, their families, care workers and care organisation managers to validate the need and develop a proof of concept pilot. Co-design activity took place across multiple workshops in person and online. These gathered detailed insights into preferred features that support engaging online learning. The platform offers learning across diverse neurological conditions as a whole, with a focus on shared symptoms and challenges encountered by people with neurological conditions. Ongoing development to scale the pilot up to meet an anticipated national audience includes a focus on artificial intelligence to support searches at a moment of need and a range of personalisable features for individual and team learning.

Correcting rotational error in rectal cancer radiation therapy: Can planning target volume margins be safely reduced?

INTRODUCTION: The magnitude and impact of rotational error is unclear in rectal cancer radiation therapy. This study evaluates rotational errors in rectal cancer patients, and investigates the feasibility of planning target volume (PTV) margin reduction to decrease organs at risk (OAR) irradiation. METHODS: In this study, 10 patients with rectal cancer were retrospectively selected. Rotational errors were assessed through image registration of daily cone beam computed tomography (CBCT) and planning CT scans. Two reference treatment plans (TPR ) with PTV margins of 5 mm and 10 mm were generated for each patient. Pre-determined rotational errors (±1°, ±3°, ±5°) were simulated to produce six manipulated treatment plans (TPM ) from each TPR . Differences in evaluated dose-volume metrics between TPR and TPM of each rotation were compared using Wilcoxon Signed-Rank Test. Clinical compliance was investigated for statistically significant dose-volume metrics. RESULTS: Mean rotational errors in pitch, roll and yaw were -0.72 ± 1.81°, -0.04 ± 1.36° and 0.38 ± 0.96° respectively. Pitch resulted in the largest potential circumferential displacement of clinical target volume (CTV) at 1.42 ± 1.06 mm. Pre-determined rotational errors resulted in statistically significant differences in CTV, small bowel, femoral heads and iliac crests (P < 0.05). Only small bowel and iliac crests failed clinical compliance, with majority in the PTV 10 mm margin group. CONCLUSION: Rotational errors affected clinical compliance for OAR dose but exerted minimal impact on CTV coverage even with reduced PTV margins. Both PTV margin reduction and rotational correction decreased irradiated volume of OAR. PTV margin reduction to 5 mm is feasible, and rotational corrections are recommended in rectal patients to further minimise OAR irradiation.

A Systematic Review of Adherence Strategies for Adult Populations in Speech-Language Pathology Treatment.

PURPOSE: Speech-language pathologists (SLPs) often advise adult patients to complete at-home programs in order to improve outcomes. Despite this widespread practice, relatively little is known about treatment adherence. The purposes of this systematic review were to identify adherence strategies and adherence tracking methods used by adult populations that are commonly treated by SLPs (i.e., dysphagia, aphasia, traumatic brain injury, dysphonia, dysarthria), and to identify the efficacy of these strategies. METHOD: The systematic review was conducted in accordance with A Measurement Tool to Assess Systematic Reviews guidelines. A comprehensive literature search was performed in three databases (CINAHL, PubMed, and Web of Science). RESULTS: Of the 679 articles found, 18 were selected for analysis. Two thirds of the included articles received the second highest rating on the 5-point JAMA Quality Rating Scheme. Interventions designed to alter treatment adherence included (most to least frequent) computer programs, portable devices/phone apps, alarm reminders, instructional DVDs, check-ins from a clinician/volunteer, and wearable device. Adherence reporting methods included (most to least frequent) self-report diaries, computer program/app-aided collection, wearable device, and clinician/volunteer observation. Of the articles that reported practice frequency, 58% found that adherence strategies improved practice frequency as compared to control. Of the articles that reported treatment outcomes, 66% found that adherence strategies were associated with improved treatment outcomes as compared to control. CONCLUSIONS: The paucity of publications reviewed suggests that treatment adherence is considerably understudied in speech-language pathology. A clearer understanding of how to improve the design of adherence strategies could yield highly valuable clinical outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19393793.

Correlation Between EAT-10 and Aspiration Risk Differs by Dysphagia Etiology.

Agreement between self-reported dysphagic symptoms and actual swallowing physiology can vary widely across individuals. The Eating Assessment Tool-10 (EAT-10) is a self-report questionnaire commonly used to identify individuals with oropharyngeal dysphagia, but its interpretation for highly prevalent populations is poorly defined. Our primary objective was to determine if correlation strength between EAT-10 and Penetration-Aspiration Scale (PAS) scores differed by dysphagia etiology. Our secondary objective was to identify clinical factors that were associated with a mismatch between EAT-10 scores and videofluoroscopic findings. Outpatients with Parkinson disease (PD), stroke, and/or head and neck cancer (HNC) who completed EAT-10 and underwent videofluoroscopy were included (n = 203). EAT-10/PAS correlations were calculated by dysphagia etiology. We found that across the sample, higher EAT-10 scores were significantly correlated to higher PAS scores (rs = 0.31, p < 0.001). EAT-10 and PAS were moderately correlated in the HNC group (rs = 0.41, p < 0.001, n = 87), but correlations were modest in the PD (rs = 0.18, n = 41) and stroke groups (rs = 0.12, n = 59). Clinical characteristics of individuals with a "matched" profile (normal EAT-10 score and normal swallow physiology) and a "mismatched" profile (normal EAT-10 score and abnormal swallow physiology) were also compared. Individuals with a "mismatched" EAT-10/PAS profile appeared to be significantly older and had a worse Charlson Comorbidity Index than individuals with a "matched" profile. Within the HNC subgroup, EAT-10/PAS correlations for specific tumor sites, treatment types, and time since treatment are reported. Clinicians may consider these aspiration risk profiles when making recommendations for instrumented swallowing assessment.

High-Fidelity Simulation Improves Long-Term Knowledge of Clinical Swallow Evaluation.

Purpose Clinical swallow evaluation (CSE) is a critical skill that speech-language pathologists who manage swallowing impairment must learn. The objective of this mixed-methods study was to determine if using a human patient simulator (HPS) to train speech-language pathology graduate students in CSE improved knowledge, preparedness, and anxiety as compared to traditional instruction alone. Method This was a controlled trial with repeated measures. Participants included graduate students from two cohorts who were enrolled in a swallowing disorders course in consecutive academic years (n = 50). Students in the experimental group participated in a simulation experience in which they performed a CSE on an HPS, generated a treatment plan, and communicated in real time with the HPS, the patient's wife, and a nurse. Quantitative results included quizzes that measured short- and long-term CSE knowledge, and qualitative findings included written feedback from instructors and students. Results Students who participated in simulation training had significantly higher long-term quiz accuracy than the control group, but their short-term quiz scores did not differ. Student ratings of preparedness and anxiety did not differ between the two groups. Many students reported that they appreciated practicing the use of patient-friendly language and preferred clinical simulation over traditional teaching methods. Facilitators reported that simulation increased student engagement and critical thinking skills more than traditional teaching methods. Conclusions CSE simulation provided objective and subjective advantages over traditional teaching methods. Recommendations from students and instructors for improving the CSE simulation training are reported.

Training results in increased practitioner confidence and identification of depression in people with low vision: a mixed methods study.

PURPOSE: The prevalence of depression in people with low vision is high and often goes undiagnosed. There is the potential for those who provide low vision services to perform concurrent depression screening. However, prior training in depression identification and suitable referral pathways is required. The aims of this study were: (1) to assess the impact of a training programme on practitioners' confidence and behaviour in addressing depression in patients with low vision, and (2) to review the training programme and identify areas for further development. METHODS: A convergent mixed methods approach was used. Questionnaires were completed by practitioners pre-, immediately post- and 6 months post- training (n = 40) to assess practitioner confidence in approaching depression in patients with low vision. Qualitative interviews were performed with a subset of practitioners 6 months post-training (n = 9). Additionally, routine data from the Low Vision Service Wales (LVSW) database was used to determine the change in the number of practitioners identifying depression in patients, and the change in the number of patients identified at risk of depression 6 months post-training. RESULTS: Of the 148 practitioners who completed low vision assessments pre- and post-training, 28 (18.9%) documented risk of depression in their patients pre-training, which increased substantially to 65 (43.9%) post-training (p < 0.0001). Mixed methods analysis confirmed increased documentation of depressive symptoms by practitioners. Practitioner confidence increased following training, with 92.3% feeling more confident to approach emotional issues with patients and 92.2% intending to use the recommended screening tool to identify depression. Interviews provided insight into areas where confidence was still lacking. Quantitative questionnaires revealed that training content was considered appropriate by 91% of participants. Interviews confirmed these findings while expanding upon possibilities for programme improvement. CONCLUSIONS: Training for depression screening was found to be time-efficient and acceptable for LVSW practitioners and shown to increase practitioner confidence in the identification of depression. Additionally, the programme changed behaviour, resulting in an increase in the identification of depression in patients with low vision. However, this is a complex topic and ongoing development is required to embed depression screening as an integral part of low vision services.

Agreement between ophthalmologists and optometrists in the certification of vision impairment.

BACKGROUND/OBJECTIVES: The certification process to register patients as sight impaired or severely sight impaired is undertaken by consultant ophthalmologists, in the UK. We sought to assess the agreement between optometrists and a consensus panel, in identifying patient eligibility for certification, relative to the agreement between ophthalmologists and the consensus panel. METHODS: The consensus panel (4 consultant ophthalmologists and 3 optometrists with a formal accreditation in low vision), 30 consultant ophthalmologists and 99 low vision optometrists reviewed 40 randomly selected abridged cases. The eligibility outcomes from the ophthalmologists and the optometrists were compared with the consensus panel outcomes. RESULTS: For ophthalmologists and optometrists, the median (IQR) number of cases in which there was agreement with the consensus panel was 33.0 (31.0, 33.0) and 36.0 (34.0, 36.5), respectively. In severely sight impaired cases, the probabilities of agreeing on eligibility for certification were 76.0% (95% CIs 71.4%, 80.1%) for ophthalmologists and 61.8% (59.0%, 64.6%) for optometrists. In sight impaired cases, the corresponding values were 51.6% (46.7%, 56.4%) for ophthalmologists and 72.2% (69.8%, 74.5%) for optometrists. In cases of bilateral atrophic age-related macular degeneration (AMD), both groups were more likely to agree with the consensus panel and the differences between optometrists and ophthalmologists were less marked. CONCLUSIONS: Optometrists demonstrated a comparable agreement relative to ophthalmologists, with the consensus panel on the eligibility of randomly selected, abridged cases for certification. The findings support the clinical decision-making ability of low vision optometrists in the certification of patients with vision impairment and provide evidence in support of policy change to allow low vision optometrists to certify individuals with atrophic AMD.

Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study.

BACKGROUND: Undetected depression is common in people with low vision and depression screening has been recommended. However, depression screening is a complex procedure for which low vision practitioners need training. This study examined the integration of routine depression screening, using two questions, and referral pathways into a national low vision service in Wales at 6 months following practitioner training, and identified key barriers to implementation. METHODS: This pre-post single group study employed a convergent mixed methods design to collect quantitative questionnaire and qualitative interview data on low vision practitioners' clinical practice and perceived barriers to implementing depression screening. Forty practitioners completed questionnaires pre-, immediately post- and 6 months post-training and nine engaged in interviews 6 months post-training. Ordinal questionnaire scores were Rasch-transformed into interval-level data before linear regression analyses were performed to determine the change in scores over time and the association between perceived barriers and clinical practice. Thematic Analysis was applied to the interviews and the narrative results merged with the questionnaire findings. RESULTS: Before training, only one third of practitioners (n = 15) identified depression in low vision patients, increasing to over 90% (n = 37) at 6 months post-training, with a corresponding increase in those using validated depression screening questions from 10% (n = 4) to 80% (n = 32). Six months post-training, practitioners reported taking significantly more action in response to suspected depression (difference in means = 2.77, 95% CI 1.93 to 3.61, p < 0.001) and perceived less barriers to addressing depression (difference in means = - 0.95, 95% CI - 1.32 to - 0.59, p < 0.001). However, the screening questions were not used consistently. Some barriers to implementation remained, including perceived patient reluctance to discuss depression, time constraints and lack of confidence in addressing depression. CONCLUSIONS: The introduction of depression screening service guidelines and training successfully increased the number of low vision practitioners identifying and addressing depression. However, standardized screening of all low vision attendees has not yet been achieved and several barriers remain. Healthcare services need to address these barriers when considering mental health screening, and further research could focus on the process from the patients' perspective, to determine the desire for and acceptability of screening.

Mechanotransduction of vocal fold fibroblasts and mesenchymal stromal cells in the context of the vocal fold mechanome.

The design of cell-based therapies for vocal fold tissue engineering requires an understanding of how cells adapt to the dynamic mechanical forces found in the larynx. Our objective was to compare mechanotransductive processes in therapeutic cell candidates (mesenchymal stromal cells from adipose tissue and bone marrow, AT-MSC and BM-MSC) to native cells (vocal fold fibroblasts-VFF) in the context of vibratory strain. A bioreactor was used to expose VFF, AT-MSC, and BM-MSC to axial tensile strain and vibration at human physiological levels. Microarray, an empirical Bayes statistical approach, and geneset enrichment analysis were used to identify significant mechanotransductive pathways associated with the three cell types and three mechanical conditions. Two databases (Gene Ontology, Kyoto Encyclopedia of Genes and Genomes) were used for enrichment analyses. VFF shared more mechanotransductive pathways with BM-MSC than with AT-MSC. Gene expression that appeared to distinguish the vibratory strain condition from polystyrene condition for these two cells types related to integrin activation, focal adhesions, and lamellipodia activity, suggesting that vibratory strain may be associated with cytoarchitectural rearrangement, cell reorientation, and extracellular matrix remodeling. In response to vibration and tensile stress, BM-MSC better mimicked VFF mechanotransduction than AT-MSC, providing support for the consideration of BM-MSC as a cell therapy for vocal fold tissue engineering. Future research is needed to better understand the sorts of physical adaptations that are afforded to vocal fold tissue as a result of focal adhesions, integrins, and lamellipodia, and how these adaptations could be exploited for tissue engineering.

How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study.

BACKGROUND: Clinically significant depressive symptoms are prevalent in people attending low vision clinics and often go undetected. The Low Vision Service Wales (LVSW) plans to introduce depression screening and management pathways. Prior to implementation there is an unmet need to understand how eye care practitioners providing the service currently address depression with patients, and the characteristics and beliefs that influence their practice. METHODS: A mixed methods convergent design was employed. Twelve low vision practitioners were purposively selected to engage in individual semi-structured interviews which were analysed using thematic analysis. A further 167 practitioners were invited to complete a questionnaire assessing professional background, current practice, confidence and perceived barriers in working with people with low vision and suspected depression. Multiple regression analyses were performed to determine the characteristics related to the Rasch-transformed questionnaire scores. RESULTS: Of the 122 practitioners that responded to the questionnaire, 33% aimed to identify depression in patients, and those who were more confident were more likely to do so. Those who scored higher on the perceived barriers scale and lower on confidence were less likely to report acting in response to suspected depression (all p < 0.05). Three qualitative themes were identified; depression is an understandable response to low vision, patients themselves are a barrier to addressing depression and practitioners lacked confidence in their knowledge and skills to address depression. The qualitative data largely expanded the quantitative findings. CONCLUSIONS: Practitioners viewed their own lack of knowledge and confidence as a barrier to the identification and management of depression and expressed a need for training prior to the implementation of service changes. The study findings will help to inform the development of a training programme to support low vision practitioners and those working with other chronic illness in Wales, and internationally, in the identification and management of people with depression.

Insights Into Oropharyngeal Dysphagia From Administrative Data and Clinical Registries: A Literature Review.

Purpose: The call for data-driven health care has been bolstered by the digitization of medical records, quality initiatives, and payment reform. Administrative databases and clinical registries are increasingly being used to study oropharyngeal dysphagia and to facilitate data-driven decision making. The objective of this work was to summarize key findings, etiologies studied, data sources used, study objectives, and quality of evidence of all original research articles that have investigated oropharyngeal dysphagia or aspiration pneumonia using administrative or clinical registry data to date. Method: A literature search was completed in MEDLINE, Scopus, and Google Scholar (January 1, 1990, to February 1, 2017). Each study that met inclusion criteria was rated for quality of evidence on a 5-point scale. Results: Eighty-four research articles were included in the final analysis (n = 221-1,649,871). Over the past 20 years, the number of new publications in this area has quintupled. Most of the administrative database and clinical registry studies of dysphagia have been retrospective cohort studies and cross-sectional studies and limited to quality of evidence levels of 3-4. In these studies, much has been learned about risk factors for dysphagia and pneumonia in defined populations and health care costs and usage. Little has been gleaned from these studies regarding swallowing physiology or dysphagia management. Conclusions: Investigators are just beginning to develop the methods to study oropharyngeal dysphagia using administrative data and clinical registries. Future research is needed in all areas, from the fundamental issue of how to identify individuals with dysphagia with high sensitivity in these data sets to evaluating treatment effectiveness. Supplemental Material: https://doi.org/10.23641/asha.6066515.

Biomechanical Screening of Cell Therapies for Vocal Fold Scar.

Candidate cell sources for vocal fold scar treatment include mesenchymal stromal cells from bone marrow (BM-MSC) and adipose tissue (AT-MSC). Mechanosensitivity of MSC can alter highly relevant aspects of their behavior, yet virtually nothing is known about how MSC might respond to the dynamic mechanical environment of the larynx. Our objective was to evaluate MSC as a potential cell source for vocal fold tissue engineering in a mechanically relevant context. A vibratory strain bioreactor and cDNA microarray were used to evaluate the similarity of AT-MSC and BM-MSC to the native cell source, vocal fold fibroblasts (VFF). Posterior probabilities for each of the microarray transcripts fitting into specific expression patterns were calculated, and the data were analyzed for Gene Ontology (GO) enrichment. Significant wound healing and cell differentiation GO terms are reported. In addition, proliferation and apoptosis were evaluated with immunohistochemistry. Results revealed that VFF shared more GO terms related to epithelial development, extracellular matrix (ECM) remodeling, growth factor activity, and immune response with BM-MSC than with AT-MSC. Similarity in glycosaminoglycan and proteoglycan activity dominated the ECM analysis. Analysis of GO terms relating to MSC differentiation toward osteogenic, adipogenic, and chondrogenic lineages revealed that BM-MSC expressed fewer osteogenesis GO terms in the vibrated and scaffold-only conditions compared to polystyrene. We did not evaluate if vibrated BM-MSC recover osteogenic expression markers when returned to polystyrene culture. Immunostaining for Ki67 and cleaved caspase 3 did not vary with cell type or mechanical condition. We conclude that VFF may have a more similar wound healing capacity to BM-MSC than to AT-MSC in response to short-term vibratory strain. Furthermore, BM-MSC appear to lose osteogenic potential in the vibrated and scaffold-only conditions compared to polystyrene, potentially attenuating the risk of osteogenesis for in vivo applications.

Epithelial cells are active participants in vocal fold wound healing: an in vivo animal model of injury.

Vocal fold epithelial cells likely play an important, yet currently poorly defined, role in healing following injury, irritation and inflammation. In the present study, we sought to identify a possible role for growth factors, epidermal growth factor (EGF) and transforming growth factor-beta 1 (TGFß1), in epithelial regeneration during wound healing as a necessary first step for uncovering potential signaling mechanisms of vocal fold wound repair and remodeling. Using a rat model, we created unilateral vocal fold injuries and examined the timeline for epithelial healing and regeneration during early and late stages of wound healing using immunohistochemistry (IHC). We observed time-dependent secretion of the proliferation marker, ki67, growth factors EGF and TGFß1, as well as activation of the EGF receptor (EGFR), in regenerating epithelium during the acute phase of injury. Ki67, growth factor, and EGFR expression peaked at day 3 post-injury. Presence of cytoplasmic and intercellular EGF and TGFß1 staining occurred up to 5 days post-injury, consistent with a role for epithelial cells in synthesizing and secreting these growth factors. To confirm that epithelial cells contributed to the cytokine secretion, we examined epithelial cell growth factor secretion in vitro using polymerase chain reaction (PCR). Cultured pig vocal fold epithelial cells expressed both EGF and TGFß1. Our in vivo and in vitro findings indicate that epithelial cells are active participants in the wound healing process. The exact mechanisms underlying their roles in autocrine and paracrine signaling guiding wound healing await study in a controlled, in vitro environment.

Formulation and characterization of a porous, elastomeric biomaterial for vocal fold tissue engineering research.

OBJECTIVE: Biomaterials able to mimic the mechanical properties of vocal fold tissue may be particularly useful for furnishing a 3-dimensional microenvironment allowing for in vitro investigation of cell and molecular responses to vibration. Motivated by the dearth of biomaterials available for use in an in vitro model for vocal fold tissue, we investigated polyether polyurethane (PEU) matrices, which are porous, mechanically tunable biomaterials that are inexpensive and require only standard laboratory equipment for fabrication. METHODS: Rheology, dynamic mechanical analysis, and scanning electron microscopy were performed on PEU matrices at 5%, 10%, and 20% w/v mass concentrations. RESULTS: For 5%, 10%, and 20% w/v concentrations, shear storage moduli were 2 kPa, 3.4 kPa, and 6 kPa, respectively, with shear loss moduli being 0.2 kPa, 0.38 kPa, and 0.62 kPa, respectively. Storage moduli responded to applied frequency as a linear function. Mercury intrusion porosimetry revealed that all 3 mass concentrations of PEU have a similar overall percentage porosity but differ in pore architecture. CONCLUSION: Twenty-µm diameter pores are ideal for cell seeding, and a range of mechanical properties indicates that the lower [corrected] mass concentration PEU formulations are best suited for mimicking the viscoelastic properties of vocal fold tissue for in vitro research.

Mitogen-activated protein kinase phosphatase-1 promotes neovascularization and angiogenic gene expression.

OBJECTIVE: Angiogenesis is the formation of new blood vessels through endothelial cell sprouting. This process requires the mitogen-activated protein kinases, signaling molecules that are negatively regulated by the mitogen-activated protein kinase phosphatase-1 (MKP-1). The purpose of this study was to evaluate the role of MKP-1 in neovascularization in vivo and identify associated mechanisms in endothelial cells. APPROACH AND RESULTS: We used murine hindlimb ischemia as a model system to evaluate the role of MKP-1 in angiogenic growth, remodeling, and arteriogenesis in vivo. Genomic deletion of MKP-1 blunted angiogenesis in the distal hindlimb and microvascular arteriogenesis in the proximal hindlimb. In vitro, endothelial MKP-1 depletion/deletion abrogated vascular endothelial growth factor-induced migration and tube formation, and reduced proliferation. These observations establish MKP-1 as a positive mediator of angiogenesis and contrast with the canonical function of MKP-1 as a mitogen-activated protein kinase phosphatase, implying an alternative mechanism for MKP-1-mediated angiogenesis. Cloning and sequencing of MKP-1-bound chromatin identified localization of MKP-1 to exonic DNA of the angiogenic chemokine fractalkine, and MKP-1 depletion reduced histone H3 serine 10 dephosphorylation on this DNA locus and blocked fractalkine expression. In vivo, MKP-1 deletion abrogated ischemia-induced fractalkine expression and macrophage and T-lymphocyte infiltration in distal hindlimbs, whereas fractalkine delivery to ischemic hindlimbs rescued the effect of MKP-1 deletion on neovascular hindlimb recovery. CONCLUSIONS: MKP-1 promoted angiogenic and arteriogenic neovascular growth, potentially through dephosphorylation of histone H3 serine 10 on coding-region DNA to control transcription of angiogenic genes, such as fractalkine. These observations reveal a novel function for MKP-1 and identify MKP-1 as a potential therapeutic target.

Restructuring the vocal fold lamina propria with endoscopic microdissection.

OBJECTIVES/HYPOTHESIS: The purposes of this preclinical study were to investigate histologic and rheologic outcomes of Microendoscopy of Reinke's space (MERS)-guided minithyrotomy and to assess its instrumentation. STUDY DESIGN: Human cadaveric and in vivo animal study. METHODS: Three human cadaveric larynges were treated with MERS-guided placement of Radiesse VoiceGel and immediately evaluated histologically for biomaterial location. In the second part of this investigation, two scarred porcine larynges were treated with MERS-guided placement of HyStem-VF and rheologically evaluated 6 weeks later. Student t tests determined differences in viscoelastic properties of treated/untreated vocal folds. Sialendoscopes and microendoscopes were subjectively compared for their visualization capacity. RESULTS: MERS imaged the subepithelial area and vocal ligament, guiding both tissue dissection and biomaterial positioning. Sialendoscopes provided adequate visualization and feature incorporated working channels. Enhanced image clarity was created in a gas-filled rather than saline-filled environment, per rater judgment. Histological analysis revealed desirable biomaterial positioning with MERS. Per rheological analysis, viscoelastic properties of the MERS-treated porcine vocal folds compared to uninjured vocal folds 6 weeks following treatment did not statistically differ. CONCLUSIONS: MERS-guided laryngoplasty using sialendoscopes yielded satisfactory biomaterial positioning in the short-term and normalized rheologic tissue properties in the long-term, contributing to proof of concept for MERS in the treatment of scarring. Strengths of MERS include direct, real-time visualization of Reinke's space and an ability to manipulate surgical instruments parallel to the vocal fold edge while maintaining an intact epithelium. Future work will explore the clinical utility of MERS for addressing scarring, sulcus vocalis, and other intracordal processes.

Interactions of copper and pyrene on phytoremediation potential of Brassica juncea in copper-pyrene co-contaminated soil.

Phytoremediation which is a plant based remediation process is an emerging technology for treating inorganic (heavy metals) as well as organic pollutants. It may also be suitable for remediation of sites co-contaminated with heavy metals and organics which have become more prevalent. A glasshouse experiment was carried out to investigate the effect of 50 and 100 mg kg(-1) of copper or 250 and 500 mg kg(-1) of pyrene and the combined effect of copper and pyrene on the growth of Brassica juncea together with the uptake and accumulation of copper as well as dissipation of pyrene. Results showed a negative effect of copper-pyrene co-contamination on shoot and root dry matter and an inhibition of copper phytoextraction. Pyrene was significantly decreased in planted and non-planted soils accounting for 90-94% of initial extractable concentration in soil planted with B. juncea and 79-84% in non-planted soil which shows that the dissipation of pyrene was enhanced with planting. The occurrence of copper tended to increase the residual pyrene in planted soil, however in the presence of high concentration of Cu (100 mg kg(-1)), the residual pyrene concentration in soil were similar to those in unplanted soil. This may suggest that changes in the root physiology or rhizospheric microbial activity resulting from Cu stress could be an impediment to pyrene dissipation. The inhibition of Cu phytoextraction and degradation of pyrene by B. juncea under co-contamination may reduce the viability of phytoremediation in sites containing multiple pollutants.