Extrinsic lipoid pneumonia due to chronic polyethylene glycol consumption: A case report.

Extrinsic lipoid pneumonia (ELP) results from the aspiration of lipid-containing substances. Tissue or cell histopathology after Oil-Red-O staining can confirm the diagnosis, which requires proper tissue handling and preparation during bronchoscopy. Here, we report a case of ELP in a quadriplegic patient with a long history of dysphagia and polyethylene glycol consumption. Computed tomography (CT) of the chest revealed multiple, progressively enlarging, fat-attenuated, nodular pulmonary lesions. Bronchoscopy with bronchoalveolar lavage (BAL) and a transbronchial forceps biopsy confirmed the diagnosis of lipoid pneumonia. We discuss the clinical, radiological, and pathological features of ELP and highlight the preparatory steps required for obtaining a successful diagnosis.

Effect of pregnancy on the uterine vasoconstrictor response to exercise in rats.

A major maternal adaptation in pregnancy is the large increase in uteroplacental blood flow that supplies the growing fetus with oxygen and nutrients. The impact of gestation on the dynamic uterine vasoconstrictor response to exercise in the rat, a common model for pathophysiological disorders in pregnancy remains unknown. We hypothesized that rats exhibit a robust uterine vasoconstrictor response to acute exercise that is attenuated in late pregnancy. Pregnant (P, N = 12) and nonpregnant (NP, N = 8) rats were instrumented chronically with a ultrasonic transit-time flowprobe and carotid arterial catheter to directly measure uterine artery blood flow (UtBF) and blood pressure (BP), respectively, at day 20 of gestation for 5 min of treadmill exercise (7 m/min; 6% grade). Preexercise UtBF [P, 2.1 (SD1.6) vs. NP, 0.5 (SD0.3) mL/min P < 0.01) and uterine artery conductance (UtC) [P, 2.1(SD1.7) vs. NP, 0.4 (SD0.2) mL/min × mmHg(-1) × 10(-2), P < 0.01] were higher in pregnant rats, whereas preexercise BP was lower in the pregnant rats [P, 111 (SD13) vs. NP, 126 (SD13) mmHg, P = 0.02]. Preexercise heart rate was similar [P, 457 (SD30) vs. NP, 454 (SD42), P = 0.3]. Exercise initiated rapid and sustained decreases in UtBF [Δ-47% (SD12)] and UtC [Δ-49% (SD12)] that were attenuated in the pregnant rats [UtBF, Δ-25% (SD20) and UtC, Δ-30% (SD20), P = 0.02]. The BP and heart rate responses to exercise were unaffected in late pregnancy (interaction term, P = 0.3). In rats, dynamic exercise induces a uterine vasoconstrictor response that is blunted during late gestation, a response that we observed previously in pregnant rabbits.

Prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in Ixodes scapularis (Acari: Ixodidae) nymphs collected in managed red pine forests in Wisconsin.

Changes in the structure of managed red pine forests in Wisconsin caused by interacting root- and stem-colonizing insects are associated with increased abundance of the blacklegged tick, Ixodes scapularis Say, in comparison with nonimpacted stands. However, the frequency and variability of the occurrence of tick-borne pathogens in this coniferous forest type across Wisconsin is unknown. Red pine forests were surveyed from 2009 to 2013 to determine the prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in questing I. scapularis nymphs. Polymerase chain reaction analysis revealed geographical differences in the nymphal infection prevalence (NIP) of these pathogens in red pine forests. In the Kettle Moraine State Forest (KMSF) in southeastern Wisconsin, NIP of B. burgdorferi across all years was 35% (range of 14.5-53.0%). At the Black River State Forest (BRSF) in western Wisconsin, NIP of B. burgdorferi across all years was 26% (range of 10.9-35.5%). Differences in NIP of B. burgdorferi between KMSF and BRSF were statistically significant for 2010 and 2011 and for all years combined (P < 0.05). NIP ofA. phagocytophilum (human agent) averaged 9% (range of 4.6-15.8%) at KMSF and 3% (range of 0-6.4%) at BRSF, and was significantly different between the sites for all years combined (P < 0.05). Differences in coinfection of B. burgdorferi and A. phagocytophilum were not statistically significant between KMSF and BRSF, with an average of 3.4% (range of 1.7-10.5%) and 2.5% (range of 0-5.5%), respectively. In 2013, the density of infected nymphs in KMSF and BRSF was 14 and 30 per 1000m2, respectively, among the highest ever recorded for the state. Differences in the density of nymphs and NIP among sites were neither correlated with environmental factors nor time since tick colonization. These results document significant unexplained variation in tick-borne pathogens between coniferous forests in Wisconsin that warrants further study.

A comparative study of professional student stress.

A study was conducted involving a group of 290 medical and dental students to directly compare perceived stress levels encountered during their education. A modified questionnaire based on Garbee et al.'s Dental Environmental Stress survey was provided to the students by either email or paper. The purpose of the investigation was to determine if the sources of stress reported by medical and dental students, both male and female, were due to common factors. A multivariate statistical analysis was also conducted to measure stress differences by year in school. Through factor analysis, the survey question responses were grouped into five causal categories: academic performance, faculty relations, patient and clinic responsibilities, personal life issues, and professional identity. The overall findings show that dental students had greater levels of stress than medical students in three of the five categories. The only category in which medical students demonstrated greater stress levels than dental students was in professional identity. Measures of comparative levels of stress between male and female students for either profession did not demonstrate any significant differences. Stress levels related to clinical work varied significantly between the type of professional student and his or her year in school.

Experimental comparison of tracking algorithms in the presence of aircraft boundary-layer distortions for emulated free-space laser communication links.

We report experiments comparing different focal plane array (FPA) tracking algorithms for emulated laser communication links between an aircraft and spacecraft. The links include look-angle-dependent phase disturbances caused by boundary-layer turbulence replicated by using a deformable mirror. Impairments from platform jitter, atmospheric scintillation, and propagation delay are also included. We study a hyperhemispherical dome geometry that provides a large field of regard but generates boundary-layer turbulence. Results from experiments comparing peak and centroid FPA tracking algorithms in various environments show that power delivered to the optical fiber varies with algorithm and look angle. An improvement in steady-state fiber-coupled power of up to 1.0 dB can be achieved through appropriate choice of algorithm. In a real system, this advantage could be realized by implementing a tracking processor that dynamically changes its tracking algorithm depending on look angle and other parameters correlated to boundary-layer turbulence.

Effect of gestational stage on uterine artery blood flow during exercise in rabbits.

We tested the hypothesis that the uterine artery vasoconstrictor response to graded exercise during early gestation would be similar to the nonpregnant (NP) state and would be attenuated at mid and term gestation. Responses to graded treadmill exercise were measured in six female New Zealand White rabbits in the NP state and at day 10, day 20, and day 28 (term) of gestation. Uterine artery blood flow (UtBF) was measured continuously with a Transonic flow probe. Rabbits performed a graded exercise test to voluntary exhaustion (maximal exercise) starting at 7 m/min, 7% grade. UtBF and uterine artery conductance (UtC) decreased similarly during graded exercise (P < 0.01) in the NP state [at maximal exercise: -40% (SD 20) for UtBF and -45% (SD 14) for UtC] and at day 10 of gestation [at maximal exercise: -48% (SD 17) for UtBF; -56% (SD 14) for UtC]. In contrast, there was little change in UtBF or UtC during graded exercise at day 20 [at maximal exercise: -4% (SD 17) for UtBF, P < 0.05 vs. NP; -16% (SD 12) for UtC, P < 0.01 vs. NP] and at day 28 [At maximal exercise: +7% (SD 15) for UtBF, P < 0.01 vs. NP; -2% (SD 24) for UtC, P < 0.01 vs. NP], indicating substantial attenuation of the uterine artery vasoconstrictor response to exercise. At rest, UtC responses to graded doses of intravenous phenylephrine were unaffected by the stage of gestation, which suggests that uterine artery responsiveness to alpha(1)-adrenoreceptor stimulation is preserved through gestation. Normal pregnancy in the rabbit is associated with attenuation of the uterine artery vasoconstrictor response to graded exercise that develops by mid gestation.

The challenges of emotional labor and emotional dissonance for the hospital phlebotomy team.

Competitive pressures are forcing hospital leaders to closely examine the role of direct caregivers in improving the level of satisfaction for the treatment and services received by patients. Often, the clinical laboratory's sole representative in bedside care is the phlebotomist. Despite the physical and behavioral challenges presented by difficult patients, laboratory managers expect phlebotomists to perform their duties in a consistently efficient and friendly manner. However, time constraints often prevent phlebotomists from engaging in lengthy conversations with their patients to build trust or convey compassion. Balancing task requirements with people skills prompts phlebotomists to develop coping strategies that emphasize professional demeanor, the display of skillful technical judgment, and the creation of an image of personal concern for the patient's illness and well-being. While these behaviors may or may not be authentic, the patient's perception of the behavior is genuine. Caregivers who perform procedures directly on patients, such as phlebotomists, must be able to find the right balance of scripted, authentic, and projected behaviors to satisfy patient expectations and maintain their own level of job satisfaction. The inability of the phlebotomist to handle high levels of emotional dissonance may lead to burnout, job dissatisfaction, and increased personnel turnover.

Student learning preferences and teaching implications.

One of the most serious challenges that dental educators face today is improving the level of student satisfaction with the curriculum and learning environment. To determine whether a particular teaching method might enhance student satisfaction with the learning process, a learning preference survey linked to sensory modalities was given to students in the four classes of the Temple University School of Dentistry. New Zealand educator Neil Fleming developed the survey called VARK (an acronym for Visual, Aural, Read/Write, and Kinesthetic) in 1998. The purpose of this study was to measure the distribution of learning preference mean scores of the dental students and note any significant differences among classes, gender, and a sample population determined using 31,243 participants on the VARK website. Results clearly demonstrate that the dominant preference distributions for the two populations (dental student and sample population) are different. In particular, the proportions of learners who selected visual or kinesthetic are significantly different for the two populations, while the proportions of learners who selected aural or read/write are not significantly different. Dental students prefer visual learning at a higher percentage and kinesthetic learning at a lower percentage than the sample population measured in the VARK website. Inter-class differences varied, and gender differences were not significant. The distribution of dental student scores shows a preference for instructors who use strong visual presentations and facilitate note-taking during lectures. Dental educators should be aware of these differences in order to explore opportunities for making the educational experience more productive and enjoyable.