Effects of Presbyphagia on Oropharyngeal Swallowing Observed during Modified Barium Swallow Studies.

OBJECTIVES: Understanding how aging impacts swallowing can help differentiate typical from atypical behaviors. This study aimed to quantify age-related swallowing alterations observed during a modified barium swallow study. DESIGN: Cross-sectional study. SETTING: Adult fluoroscopy suite in a metropolitan hospital at an academic center. PARTICIPANTS: 195 healthy adults distributed across 3 age categories: 21-39; 40-59; 60+ years. MEASUREMENTS: 17 physiologic components of swallowing across three functional domains (oral, pharyngeal, esophageal), including summed composite scores (Oral Total [OT] and Pharyngeal Total [PT]), from the validated and standardized Modified Barium Swallow Impairment Profile. RESULTS: Most components (65%) demonstrated no impairment (scores of "0"). The odds of a worse (higher) score increased significantly with age for: Tongue Control during Bolus Hold, Hyolaryngeal Movement, Laryngeal Closure, Pharyngeal Contraction, and Pharyngoesophageal Segment Opening. OT and PT scores for 40-59-year-olds were worse than the youngest group (p=.01 and p <.001, respectively). Adults 60+ years had significantly worse PT scores among all groups (p-values <.01). CONCLUSION: Oropharyngeal swallowing physiology evolves as healthy adults age and should be considered during clinical decision-making.

Production of photoionized plasmas in the laboratory with x-ray line radiation.

In this paper we report the experimental implementation of a theoretically proposed technique for creating a photoionized plasma in the laboratory using x-ray line radiation. Using a Sn laser plasma to irradiate an Ar gas target, the photoionization parameter, ξ=4πF/N_{e}, reached values of order 50ergcms^{-1}, where F is the radiation flux in ergcm^{-2}s^{-1}. The significance of this is that this technique allows us to mimic effective spectral radiation temperatures in excess of 1 keV. We show that our plasma starts to be collisionally dominated before the peak of the x-ray drive. However, the technique is extendable to higher-energy laser systems to create plasmas with parameters relevant to benchmarking codes used to model astrophysical objects.

Prospective, controlled study of an intervention to reduce errors in neonatal antibiotic orders.

OBJECTIVE: To evaluate the effectiveness of an interactive computerized order set with decision support (ICOS-DS) in preventing medication errors in neonatal late-onset sepsis (LOS). STUDY DESIGN: Prospective, controlled comparison of error rates in antibiotic orders for neonates admitted to the Medical University of South Carolina neonatal intensive care unit with suspected LOS (after postnatal day of life 3) prior to (n=153) and after (n=146) implementation of the ICOS-DS. Antibiotic orders were independently evaluated by two pharmacists for prescribing errors, potential errors and omissions. Prescribing errors included>10% overdoses or underdoses, inappropriate route, schedule or antibiotic, drug-drug or drug-disease interactions, and incorrect patient demographics. Potential errors included misspelled drugs, leading decimals, trailing zeroes, impractical doses and error-prone abbreviations. Multiple errors and omissions in an order were counted individually. RESULTS: Overall error rate per order decreased from 1.7 to 0.8 (P<0.001) and potential error rate from 1.0 to 0.06 (P<0.001). The reduction in omission error rate per order from 0.2 to 0.1 was not significant (P=0.17). The prescribing error rate per order increased from 0.4 to 0.7 (P=0.03) because of the use of incorrect patient weights (P<0.001). Renal dysfunction was significantly associated with an increased risk of prescribing errors (odds ratio=3.7, P=0.01) which was not significantly different for handwritten versus ICOS-DS orders (P=0.15). CONCLUSIONS: The ICOS-DS significantly improved the quality of neonatal LOS antibiotic orders although the use of incorrect patient weights was increased. In both groups, orders for patients with renal dysfunction were at risk for prescribing errors. Further evaluation of interventions to promote medication safety for this population is needed.

A SEMI-PARAMETRIC BAYESIAN MODEL OF INTER- AND INTRA-EXAMINER AGREEMENT FOR PERIODONTAL PROBING DEPTH.

Periodontal probing depth is a measure of periodontitis severity. We develop a Bayesian hierarchical model linking true pocket depth to both observed and recorded values of periodontal probing depth, while permitting correlation among measures obtained from the same mouth and between duplicate examiners' measures obtained at the same periodontal site. Periodontal site-specific examiner effects are modeled as arising from a Dirichlet process mixture, facilitating identification of classes of sites that are measured with similar bias. Using simulated data, we demonstrate the model's ability to recover examiner site-specific bias and variance heterogeneity and to provide cluster-adjusted point and interval agreement estimates. We conclude with an analysis of data from a probing depth calibration training exercise.

In-depth plasma-wave heating of dense plasma irradiated by short laser pulses.

We investigate the mechanism by which relativistic electron bunches created at the surface of a target irradiated by a very short and intense laser pulse transfer energy to the deeper parts of the target. In existing theories, the dominant heating mechanism is that of resistive heating by the neutralizing return current. In addition to this, we find that large amplitude plasma waves are induced in the plasma in the wake of relativistic electron bunches. The subsequent collisional damping of these waves represents a source of heating that can exceed the resistive heating rate. As a result, solid targets heat significantly faster than has been previously considered. A new hybrid model, capable of reproducing these results, is described.

Tandem autologous vs autologous plus reduced intensity allogeneic transplantation in the upfront management of multiple myeloma: meta-analysis of trials with biological assignment.

We utilized meta-analysis to compare tandem autologous (TA) hematopoietic SCT (auto-HSCT) or single auto-HSCT followed by reduced intensity conditioning (RIC), allogeneic (AR) hematopoietic SCT in the upfront management of patients with multiple myeloma (MM). A comprehensive search strategy of published and unpublished reports utilized the following entry criteria: newly diagnosed patients, first autologous transplantation in both arms, use of an RIC regimen and assignment to TA or AR based exclusively on the availability of an HLA matched donor. Six trials were identified yielding 1192 subjects in TA and 630 in AR. Patients in AR had higher likelihoods of TRM (relative risk (RR)=3.3, 95% confidence interval (CI)=2.2-4.8) and CR (RR=1.4, 95% CI=1.1-1.8). OS was not different in the first 36 months (hazard ratio (HR)=1.15, 95% CI=0.91-1.45) or after (HR=0.74, 95% CI=0.53-1.04) 36 months from assignment. Similar findings were seen for PFS. When compared with TA in the upfront management of MM, AR is associated with higher TRM and CR without improvement in PFS or OS.

A comparison of three tests to detect general clustering of a rare disease in Santa Clara County, California.

Statistical tests to detect clustering of a rare disease investigate whether an observed spatial pattern of cases appears to be due to chance alone. Heterogeneous population density and the geographic structure of the data under consideration complicate the ability to make comparisons of different tests. Further, interpretation of test results depends on the nature of the test used and what feature of the data it is designed to detect. With these issues in mind, we compare three recent tests for assessing general clustering among cases where the population is distributed heterogeneously across the study area, namely those of Besag and Newell, Turnbull et al. and Tango. We compare these methods using 1981 incidence data for severe cardiac birth defects from Santa Clara County, California.

Efficacy of linoleic acid administered rectally as monoglyceride.

The potential of the rectal route for administration of essential fatty acids (EFA) as monoglyceride (MG) was investigated. EFA-deficient rats were supplemented with 14 mg linoleic acid/day for 3 days. Supplementation was either by oral administration as corn oil, orally as corn oil-derived MG or rectally as MG. The patterns of polyunsaturated fatty acids (PUFA) in liver and serum lipids, characteristic of EFA deficiency, were altered in the direction of normalcy in similar magnitude by all modes of supplementation, indicating that the rectal route may be useful for administration of EFA. The amounts of phospholipids (PL) and free fatty acids (FFA) in liver changed by all modes of administration. The magnitude of change of total PL and of FFA in liver depended upon the chemical form in which linoleic acid was administered and the route of administration, indicating that these factors affect lipid metabolism.

Dietary fats containing concentrates of cis or trans octadecenoates and the patterns of polyunsaturated fatty acids of liver phosphatidylcholine and phosphatidylethanolamine.

The effects of the mixed cis- 18:1 isomers and mixed trans- 18:1 isomers present in partially hydrogenated soybean oil (PHSO) upon the patterns of polyunsaturated fatty acids (PUFA) in liver phosphatidylcholine (PC) and phosphatidylethanolamine (PE) were studied in rats fed concentrates of cis- 18:1 or trans- 18:1 isomers isolated as triacylglycerides from PHSO. The cis- 18:1 and trans- 18:1 concentrates were fed at levels equal to those present in PHSO fed at 17.9% of the diet. All diets contained the required amounts of both linoleic and linolenic acids. The trans- 18:1 concentrate was found to suppress the levels of 20:4 omega 6 and 20:3 omega 9, and to increase the levels of 18:2 omega 6 and 20:5 omega 3 in PC and PE. The cis- 18:1 concentrate suppressed 20:4 omega 6 in PC, 20:5 omega 3 in PC and PE, and 18:2 omega 6 in PC, but increased the levels of 20:4 omega 6 in PE, and 20:3 omega 9 in PC and PE. The cis- 18:1 concentrate was more effective than the trans concentrate in suppressing 22:6 omega 3. The trans- 18:1 concentrate was more effective in suppressing 20:4 omega 6. The trans- 18:1 isomers appear to modify PUFA metabolism by inhibition of PUFA synthesis, whereas the cis- 18:1 isomers appear to complete with 2-position fatty acyl transfer and to inhibit omega 3 PUFA acylation.

The influence of rifampin on quinidine and digoxin.

Serum drug concentration data from the first of the two patients described herein suggest that rifampin may directly increase the metabolism of quinidine and thereby negate the influence of quinidine on the serum digoxin concentration (SDC). Data on the second patient suggest that rifampin may directly increase the metabolism of digoxin producing lower SDC values. In both cases, the discontinuation of rifampin therapy appears to have allowed reversion toward prerifampin metabolism of both quinidine and digoxin.

Suppression of arachidonic acid in lipids of rat tissues by dietary mixed isomeric cis and trans octadecenoates.

The influence of dietary isomeric cis and trans octadecenoic fatty acids (ICTO) on the metabolism of polyunsaturated fatty acids in rat tissues was studied by feeding a defined diet rich in partially hydrogenated soybean oil. Experimental and control animals received equal and more than adequate amounts of linoleic and linolenic acids. The total phospholipid (PL) fatty acids of liver, heart, testis, brain and sciatic nerve, and the fatty acids of liver triacylglyceride, cholesteryl ester and individual PL classes were analyzed by capillary gas chromatography. The content of arachidonic acid in the total fatty acids of liver lipids of ICTO-fed rats was found to be lower than those from control rats by the following amounts (in percent): total PL, 35; phosphatidylcholine, 50; phosphatidylinositol, 35; phosphatidylserine 26; phosphatidylethanolamine, 12; cholesteryl ester, 55; and tryglyceride 75. PL 18:2 omega 6 and 20:3 omega 6 levels were elevated, suggesting inhibition of the desaturase-elongase enzymes involved in synthesis of arachidonic acid. Synthesis of 20:5 omega 3 and 20:3 omega 9 was accentuated by the ICTO diet, suggesting an omega 6 series-specific inhibition. A nearly perfect negative correlation between cis 12-18:1 and arachidonic acid was found in liver PL.

Accumulation and depletion of trans octadecenoic acid in rat peripheral nerve phospholipid.

The accumulation and depletion of trans 18:1 acids in the sciatic nerve phospholipids was studied in rats fed a diet containing 18% partially hydrogenated soybean oil of which 45% was trans 18:1. The nerve phospholipid of rats fed partially hydrogenated soybean oil beginning at weaning age reached a maximum incorporation of trans 18:1 or 0.8% in 4 weeks; whereas the nerve phospholipid of 18-day-old pre-weanling pups of mothers fed the partially hydrogenated soybean oil diet since their weaning contained 3.3% trans 18:1. The trans content decreased rapidly after the weaning of these second-generation rats to a steady-state level 50% higher than the maximum level reached in the first generation. Upon removal of partially hydrogenated soybean oil from the diet, the trans 18:1 of nerve phospholipid decreased much more slowly than from liver or heart phospholipid. Essential fatty acid deficiency had no influence on incorporation or removal of trans 18:1 in nerve phospholipid. The accumulation and depletion of trans 18:1 in nerve phospholipid of second-generation partially hydrogenated soybean oil-fed rats paralleled the changes of polyunsaturated fatty acids and was quite different from the changes observed in 18:0 and cis 18:1. Polyunsaturated fatty acids increased in nerve phospholipid from second but not first-generation rats fed partially hydrogenated soybean oil and declined rapidly when partially hydrogenated soybean oil was removed from the diet.

Perturbation of the metabolism of essential fatty acids by dietary partially hydrogenated vegetable oil.

Rats were fed purified diets containing (i) partially hydrogenated soybean oil as source of isomeric octadecenoic acids, (ii) hydrogenated coconut oil as source of saturated fatty acids, and (iii) a low level of corn oil as low-fat control. All diets contained 18% of the linoleate requirement. Rat liver and heart phospholipids were analyzed by gas/liquid chromatography for fatty acids, and liver, microsomes were assayed for desaturase (acyl-CoA, hydrogen-donor: oxidoreductase, EC 1.14.99.5) activities. Products of desaturation reactions measured analytically provided more information with greater statistical significance than did the enzymatic assays. Rats fed isomeric octadecenoic acids showed more severe essential fatty acid deficiency than did saturated-fat and control groups. The suppression of linoleate metabolites was largely due to decreased delta 5 and delta 6 desaturase activities. At several levels of linoleate, the deficiency was more severe at the higher level of isomeric octadecenoic acids. Increasing the intake of linoleate to 7.5% of calories did not suppress deposition of isomeric unsaturated acids in tissue lipids.

Effects of experimental diabetes on the essential fatty acid-deficient rat.

An evaluation of the EFAD syndrome in rats rendered diabetic with either alloxan or streptozotocin was performed. Diabetic rats fed an EFA-deficient diet for 7 or 13 weeks were less severely EFA-deficient than were nondiabetic rats fed EFA-deficient diet, as judged by dermal symptoms or by biochemical parameters such as the ratio of 20:3 omega 9/20:4 omega 6 (T/T ratio) and total fatty acids derived from linoleic acid. The T/T ratios of liver PL of diabetic EFA-deficient rats were lower than those of deficient control rats, and the ratios varied inversely with the blood glucose concentrations. The product/precursor ratios, arachidonic acid/linoleic acid, in liver PL were higher in diabetic deficient rats than in deficient control rats. Analysis of liver and heart PLs revealed higher arachidonic acid levels in the diabetic deficient rats than in the EFA-deficient controls, perhaps because of different growth rates. The activities of the delta 5, delta 6, and delta 9 desaturases were evaluated in liver microsomal systems. The delta 9 desaturase was depressed in diabetic rats in agreement with literature reports. The delta 6 desaturase, however, was slightly increased. The relative levels of delta 5, delta 6 and delta 9 desaturation products in liver and heart PLs did not parallel the measured desaturase activities of liver microsomes.

Effect of dietary protein level upon essential fatty acid (EFA) deficiency.

Rats were fed EFA-low diets containing vitamin-free casein varying from 5 to 40% and were assessed for severity of EFA deficiency by growth response, dermal symptoms and by the biochemical lesion of elevated triene/tetraene ratio in heart and liver lipids. The dermal signs of EFA deficiency increased in severity at levels of protein above 30%. The biochemical lesion of elevated triene/tetraene ratio in liver phospholipids was most severe at the lower protein levels. The two measures of EFA deficiency thus respond to different functions of EFA. Protein deficiency may thus increase the EFA requirement as measured by the biochemical criteria.

Intensification of essential fatty acid deficiency in the rat by dietary trans fatty acids.

Two studies were conducted using male rats to assess the effect of trans fatty acids upon essential fatty acid (EFA) deficiency. In the first study 5% corn oil (CO), hydrogenated coconut oil (HCNO) or margarine stock (MS, partially hydrogenated soybean oil) were fed, and the levels of trans fatty acids in tissue lipids were measured. The trans fatty acids present in MS were found to intensify EFA deficiency and to be retained in tissue lipids to a high degree, especially in heart phospholipids (PL). In the second study, as the level of trans fatty acids increased in the diet, increasingly higher levels of trans fatty acids were deposited in the heart PL. As dietary trans acid increased, a decrease in total omega 6 fatty acids, and a decrease in the sum of 18:2 omega 6 + 20:4 omega 6 - 20:3 omega 9 fatty acids in heart PL occurred, both criteria indicating a shift toward an increasing EFA deficiency state. Studies of delta 5 desaturase activity of liver microsomes in selected groups showed an increase in the conversion of 20:3 omega 6 to 20:4 omega 6 as the trans fatty acid level in the diet increased.

Striated muscle in the pineal gland of swine.

Striated muscle fibers (or cells) were observed in three of the six swine pineal glands. The muscle fibers occurred in clusters of several fibers about the parenchymal blood vessels. They were in general poorly developed, lacked regular cross striations and were not readily recognized histologically. The muscle fibers were, however, easily identified on electron microscopy because of the myofilaments they contain. In most of the muscle fibers, the myofilaments were arranged in ill-defined, disorderly bundles and rarely formed well-defined myofibrils and sarcomeres. The sarcotubular system was also poorly developed and triads were sparse and randomly scattered. Leptomeres were observed in several muscle fibers. The source of the muscle fibers in the pineal glands is not well understood and, whatever the source may be, the muscle fibers seem to remain poorly developed in the pineal glands.

Characterization of miniature pig kidney cells and their resistance to chlamydial infection.

A miniature pig kidney cell line has been established from porcine fetuses taken aseptically by hysterectomy and maintained for more than 50 passages in Eagle's minimal essential medium containing 10% heat-inactivated newborn calf serum. Cell transfers were performed each week. Primary and serially passaged cells were found to be highly refractory to infection by Chlamydia trachomatis strains TW-3, Bour, and LGV 440L and Chlamydia psittaci strains meningopneumonitis and 6BC and insusceptible to poliovirus type 1. The cells were susceptible to vesicular stomatitis virus and herpes simplex type 1 virus. Identity of the cells was established by cytotoxicity, isozyme, and cytogenetic studies.