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Disability is an important and often overlooked component of diversity. Individuals with disabilities bring a rare perspective to science, technology, engineering, mathematics, and medicine (STEMM) because of their unique experiences approaching complex issues related to health and disability, navigating the healthcare system, creatively solving problems unfamiliar to many individuals without disabilities, managing time and resources that are limited by physical or mental constraints, and advocating for themselves and others in the disabled community. Yet, individuals with disabilities are underrepresented in STEMM. Professional organizations can address this underrepresentation by recruiting individuals with disabilities for leadership opportunities, easing financial burdens, providing equal access, fostering peer-mentor groups, and establishing a culture of equity and inclusion spanning all facets of diversity. We are a group of deaf and hard-of-hearing (D/HH) engineers, scientists, and clinicians, most of whom are active in clinical practice and/or auditory research. We have worked within our professional societies to improve access and inclusion for D/HH individuals and others with disabilities. We describe how different models of disability inform our understanding of disability as a form of diversity. We address heterogeneity within disabled communities, including intersectionality between disability and other forms of diversity. We highlight how the Association for Research in Otolaryngology has supported our efforts to reduce ableism and promote access and inclusion for D/HH individuals. We also discuss future directions and challenges. The tools and approaches discussed here can be applied by other professional organizations to include individuals with all forms of diversity in STEMM., Competing Interests: Conflict of Interest: Author J-TF was employed by the company Bioglobe GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Purpose : To describe common risk factors in patients with Essential Skin Shrinkage (ESS) and identify corresponding histopathologic changes in lower eyelids. Methods : A case-control study was performed after an Internal Review Board approval was obtained. Consecutive patients who underwent surgical repair for ectropion with ESS of the lower eyelid were enrolled along with 10 control patients. Informed consent was obtained on all patients. Fitzpatrick skin type, history of sun exposure and non-melanoma skin cancer was obtained along with relevant physical exam findings. Skin samples obtained during surgical repair were evaluated by light microscopy for the extent of dermal actinic change. Statistical analysis was performed. Results : Sixteen study subjects and 10 control patients were enrolled. Subjects were found to be predominantly male, older than controls (p = 0.0011) and have Fitzpatrick skin type (FST) I or II while controls had type I, II or III (p = 0.0221). Hours of sun exposure reported by subjects ranged from 23,165 to greater than 125,000 h, versus 1,459 to 46,890 h in controls (p = 0.0002). Nine of 16 (56%) subjects had a history of skin cancer compared to only 3/10 controls (30%) (p = 0.2475). Histopathologic evaluation using the Fritschi scale for dermal actinic damage identified an average grade of 3.6 for subjects and 2.4 for controls (p = 0.0095). Conclusions : ESS is predominantly seen in male individuals with FST I or II and a history of extensive sun exposure. Histopathologic evaluation shows moderate to severe actinic damage. These individuals frequently have concomitant non-melanoma skin cancer.

Introduction: General public views about heart failure (HF) alone and in comparison with other chronic conditions are largely unknown; thus we conducted this survey to evaluate general public awareness about HF and HF disease burden relative to common chronic disease., Material and Methods: This was a cross-sectional survey during European Heart Failure Awareness Day 2011. People visiting the stands and other activities in 12 Slovenian cities were invited to complete a 14-item questionnaire., Results: The analysis included 850 subjects (age 56 ±15 years, 44% men, 55% completed secondary education or higher). Overall, 83% reported to have heard about HF, 58% knew someone with HF, and 35% believed that HF is a normal consequence of ageing. When compared to other chronic diseases, HF was perceived as less important than cancer, myocardial infarction, stroke and diabetes with only 6%, 12%, 7%, and 5% of subjects ranking HF as number 1 in terms of prevalence, cost, quality of life, and survival. A typical patient with HF symptoms was recognized by 30%, which was comparable to the description of myocardial ischemia (33%) and stroke (39%). Primary care physicians (53%) or specialists (52%) would be primary sources of information about HF. If experiencing HF, 83% would prefer their care to be focused on quality of life rather than on survival (14%)., Conclusions: Many participants reported to have heard about heart failure but the knowledge was poor and with several misbeliefs. Heart failure was perceived as less important than several other chronic diseases, where cancer appears as a main concern among the general public.

Aim: To discover novel [20(OH)D3] analogs as antiproliferative therapeutics., Materials and Methods: We studied in vitro liver microsome stability, in vivo toxicity using mice, vitamin D receptor (VDR) translocation, in vitro antiproliferative effect, CYP enzyme metabolism., Results: 20S- and 20R(OH)D3 had reasonable half-lives of 50 min and 30 min (average) respectively in liver microsomes. They were non-hypercalcemic at a high dose of 60 μg/kg. Three new 20(OH)D3 analogs were designed, synthesized and tested. They showed higher or comparable potency for inhibition of proliferation of normal keratinocytes and in the induction of VDR translocation from cytoplasm to nucleus, compared to 1,25(OH)2D3. These new analogs demonstrated different degrees of metabolism through a range of vitamin D-metabolizing CYP enzymes., Conclusion: Their lack of calcemic toxicity at high doses and their high biological activity suggest that this novel 20(OH)D3 scaffold may represent a promising platform for further development of therapeutically-useful agents.

A single pill daily fixed dose combination of Efavirenz, Emtricitabine, and Tenofovir Disoproxil Fumarate (EFV/FTC/TDF) provides a potent and convenient treatment option for HIV/AIDS. The components have been shown to be well tolerated and are effective in randomized controlled trials. A literature search revealed no case of hepatic failure reported with this drug combination. We here in describe the 1st case of acute hepatic failure developing after 3 months of treatment with EFV/FTC/TDF in a 41 year old African American male without pre-existing liver disease or risk factors.

Reduced expression of the metastasis suppressor NM23-H1 is associated with aggressive forms of multiple cancers. Here, we establish that NM23-H1 (termed H1 isoform in human, M1 in mouse) and two of its attendant enzymatic activities, the 3'-5' exonuclease and nucleoside diphosphate kinase, are novel participants in the cellular response to UV radiation (UVR)-induced DNA damage. NM23-H1 deficiency compromised the kinetics of repair for total DNA polymerase-blocking lesions and nucleotide excision repair of (6-4) photoproducts in vitro. Kinase activity of NM23-H1 was critical for rapid repair of both polychromatic UVB/UVA-induced (290-400 nm) and UVC-induced (254 nm) DNA damage, whereas its 3'-5' exonuclease activity was dominant in the suppression of UVR-induced mutagenesis. Consistent with its role in DNA repair, NM23-H1 rapidly translocated to sites of UVR-induced (6-4) photoproduct DNA damage in the nucleus. In addition, transgenic mice hemizygous-null for nm23-m1 and nm23-m2 exhibited UVR-induced melanoma and follicular infundibular cyst formation, and tumor-associated melanocytes displayed invasion into adjacent dermis, consistent with loss of invasion-suppressing activity of NM23 in vivo. Taken together, our data show a critical role for NM23 isoforms in limiting mutagenesis and suppressing UVR-induced melanomagenesis., (©2011 AACR.)

Chronic bacterial prostatitis (CBP) is characterized by intense clinical symptoms, frequent relapse episodes and poor quality of life. Aggressive antibacterial therapy is warranted to eradicate the causative pathogens and to achieve a permanent cure. We administered a "switch-therapy" protocol to 30 patients showing severe CBP symptoms and two or more relapse episodes in the previous 12 months. Patients received intravenous azithromycin (500 mg/day) and ciprofloxacin (800 mg/day) for 3 days, followed by oral ciprofloxacin (1 g/day) for 25 days.Twenty-seven (90%) patients showed pathogen eradication at test-of-cure (TOC) visit. Five cases of infection relapse were detected at follow-up. At the TOC visit, 25 patients (83%) showed mild/absent symptoms, measured with the NIH-chronic prostatitis symptom index.These results indicate the efficacy of a "switch-therapy" protocol, based on combined azithromycin and ciprofloxacin. Comparative studies on larger CBP patient populations are warranted to confirm these encouraging results.

Background: Chronic obstructive pulmonary disease (COPD) frequently coexists in patients with chronic heart failure (CHF) and is a key factor for beta blocker underprescription and underdosing. This study compared effects of bisoprolol and carvedilol in patients with both conditions., Methods: This was a randomized open-label study, of bisoprolol and carvedilol during initiation and uptitration to target or maximal tolerated dose. Pulmonary function testing, 12-lead electrocardiogram, and N-terminal pro brain natriuretic peptide were measured at baseline and follow-up., Results: We randomized 63 elderly patients (73 ± 9 years, 81% men, left ventricular ejection fraction 33 ± 7%) with mild to moderate CHF (54% New York Heart Assocation class II) and moderate to severe COPD (76% Global initiative for chronic Obstructive Lung Disease stage 2). Target dose was tolerated by 31 (49%) patients and 19 (30%) patients experienced adverse events during follow-up (19% bisoprolol, 42% carvedilol, p = 0.045). Study medication had to be withdrawn in 8 (13%) patients (bisoprolol: 2 due to hypotension, 1 due to bradycardia; carvedilol: 2 due to hypotension and 1 due to wheezing, dyspnoea, and oedema, respectively). Forced expiratory volume in 1(st) second significantly increased in bisoprolol (1561 ± 414 ml to 1698 ± 519 ml, p = 0.046) but not carvedilol (1704 ± 484 to 1734 ± 548, p = 0.44) group. Both agents reduced heart rate (bisoprolol: 75 ± 14 to 68 ± 10, p = 0.007; carvedilol 78 ± 14 to 72 ± 12, p = 0.016) and had no effect on N-terminal pro brain natriuretic peptide., Conclusions: Beta blockers frequently caused adverse events, and thus 49% of patients could tolerate the target dose. Bisoprolol induced demonstrable improvement in pulmonary function and caused less adverse events., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Linear immunoglobulin A bullous dermatosis (LABD) is an immune-mediated subepidermal blistering disease that can be triggered by drug exposures, most notably, vancomycin. The authors report of a case of a 72-year-old man who developed LABD after a course of moxifloxacin. To the authors' knowledge, there is no other case of LABD caused by moxifloxacin in the medical literature.

Unlabelled: The objectives of this prospective, observational cohort study were to examine current practice of analgesia in adults with acute abdominal pain presenting to emergency department (ED), to assess patient-physician agreement on pain severity, and to measure patients' satisfaction with pain management., Methods: Emergency room nurse assessed initial patient's and physician's ranking on a 0-100mm visual analogue scale (VAS) as well as patient's VAS rankings 5min, 15min, and 60min after starting treatment for pain, and on discharge. In patients who received no therapy VAS scores were assessed 5min, 15min, and 60min after initial examination, and on discharge. Patient's satisfaction with pain management on discharge from ED was assessed using a four-point categorical scale in which 1=completely unsatisfied, 2=mostly unsatisfied, 3=mostly satisfied, and 4=completely satisfied., Results: A total of 185 patients were enrolled. Patients' mean initial VAS was higher than physicians' (76+/-20mm, vs. 59+/-20mm, p<0.001). Physician's VAS > or = 60mm was the sole independent predictor of receiving analgesic therapy (p<0.001). On discharge from ED, 111 patients (60%) were predominantly satisfied with analgesia (satisfaction score > or = 3). Drug titration (p=0.026) and decrease in VAS score > or = 20mm between initial and discharge score (p<0.001) independently predicted patients' satisfaction., Conclusions: Patients with acute abdominal pain rated pain significantly higher than physicians who's pain estimation in turn tailored analgesia. Only 60% of patients were satisfied with analgesia. Analgesic drug titration and a decrease of > or = 20mm on VAS predicted patients' satisfaction.

The authors report 3 picture-word interference experiments in which they explore some properties of the agreement process in speech production. In Experiment 1, Croatian speakers were asked to produce utterances in which the noun's gender value had an impact on the selection of gender-marked freestanding morphemes (pronouns) while ignoring the presentation of same- or different-gender distractor words. In Experiments 2 and 3, Croatian speakers were asked to name the same pictures using noun phrases in which the noun's gender value surfaced as an inflectional suffix. Different-gender distractors interfered more than same-gender distractors (the gender congruency effect) in Experiment 1, but not in Experiments 2 and 3. These contrasting results show that the cause of the gender congruency effect is not at the level where lexical-grammatical information is selected but at the level of selection of freestanding morphemes., (((c) 2003 APA, all rights reserved))

The aim of this paper is to present the topographical/anatomical conditions that protect the posterior fossa from posterior fossa hematoma (PFH) resulting from contrecoup mechanisms and to point out the value of neuroradiological findings in determining force direction and transition. The biomechanism of this clinical entity also plays an important role in correct forensic interpretation. Generally, PFH are rare. In our series, they occurred exclusively as a result of forces applied to the occipital region. However, their appearance as a result of contrecoup mechanisms is exceptional. Considering the particular anatomical traits that protect the posterior fossa from the force transition of fronto-occipital (F-O) direction we put forth seven hypotheses which should explain the low incidence of PFH. Between 1989 and 1998, we treated 523 patients with intracranial hematomas caused by blunt trauma. Among them were 30 patients with PFH. All of them sustained an occipital bone fracture, confirming the coup lesion. In conclusion, it is difficult to determine clinically whether forces in the F-O direction could produce PFH as a result of contrecoup mechanism. That could be only proven in vivo by neuroradiological findings.

The mechanism of decomposition of peroxynitrite (OONO(-)) in aqueous sodium phosphate buffer solution at neutral pH was investigated. The OONO(-) was synthesized by directly reacting nitric oxide with superoxide anion at pH 13. The hypothesis was explored that OONO(-), after protonation at pH 7.0 to HOONO, decomposes into (1)O(2) and HNO according to a spin-conserved unimolecular mechanism. Small aliquots of the concentrated alkaline OONO(-) solution were added to a buffer solution (final pH 7.0-7.2), and the formation of (1)O(2) and NO(-) in high yields was observed. The (1)O(2) generated was trapped as the transannular peroxide (DPAO(2)) of 9, 10-diphenylanthracene (DPA) dissolved in carbon tetrachloride. The nitroxyl anion (NO-) formed from HNO (pKa 4.5) was trapped as nitrosylhemoglobin (HbNO) in an aqueous methemoglobin (MetHb) solution. In the presence of 25 mM sodium bicarbonate, which is known to accelerate the rate of decomposition of OONO(-), the amount of singlet oxygen trapped was reduced by a factor of approximately 2 whereas the yield of trapping of NO(-) by methemoglobin remained unaffected. Because NO(3)(-) is known to be the ultimate decomposition product of OONO(-), these results suggest that the nitrate anion is not formed by a direct isomerization of OONO(-), but by an indirect route originating from NO(-).

Malignancies are common in the digestive tube, although with unequal distribution among segments. The aim of this paper was to compare available interpretations of the low cancer incidence in the small bowel and high in the large bowel. Supposed mechanisms include relatively small bacterial population, large secretion of liquid and rapid transit in the small bowel. Small bowel mucosa is the main absorptive part of the digestive tube with absorption rates for various nutrients so high that they can even be considered as clearances from the intestinal content. Consequently, these nutrients are not present in the large bowel. An alternative explanation is that an absorbable protective substance from the intraluminal content, might protect the mucosa from malignant transformations. It can be speculated that if there are any cytoprotective substances in the digested food their effect would be expressed mostly in the absorptive small intestine, leaving the large bowel mucosa unprotected. Vitamin B12 might be a possible candidate for this role. Cobalamin molecules are initially bound to haptocorrin (Hc) in the stomach, but in the small intestine B12 is transferred to intrinsic factor (IF) after the action of pancreatic trypsin on Hc. Cobalamin-IF complexes are absorbed in the terminal ileum leaving only a small fraction of B12 to enter the large bowel. We have tried to summarize available data regarding cancer incidences in digestive tube, segmental length and transit times of tube content. Cancer density is calculated as incidence per length and transit speed as length per transit time. Cancer incidences for seven intestinal segments were considered low if they were below one case per 100 000 inhabitants annually, while the low cancer density meant less than six cases per 100 000 inhabitants per metre. For instance, transverse colon was considered as a high cancer incidence place (2.15 cases), with low cancer density (4.3 cases/m). Transit speed more than 0.3 metre/hour was associated with low cancer incidences (accuracy 0.85) and low cancer density segments (accuracy 1.00). Cobalamin availability showed similar distribution, available in low incidence segments and unavailable in high incidence segments. Experimental studies are needed to quantify B12 availability in the large bowel and to determine whether small amounts of B12-IF or, perhaps, B12-haptocorrin complexes are absorbed by the small bowel mucosa. Without that, no cytoprotective effects of B12 in the digestive tube can be expected., (Copyright 2000 Harcourt Publishers Ltd.)

We have been determining the GGT IE isoenzyme in patients with hepatitis A and B with decomposed liver cirrhosis, with obstructive hepatitis caused by the gall stones. In patients with hepatitis A and B the IE is located between albumin and betaglobulin, as well as in patients with obstructive hepatitis caused by the gall stones; in the latter partly between Alpha 1 and Alpha 2 globulin. In patients with decompensated liver cirrhosis (37.7% of the patients) there was IE activity 100% in Alpha 2 globulin area; in 6.25% of patients the activity was in the prealbumin area. In patients with secondary liver tumors we got a rather high increase of the GGT IE activity in Alpha 1 globulin area, in 77.7% of the patients even 80 to 100%. In some patients with disease progression we noticed the GGT IE activity in Beta globulin area. The results in primary liver malignomas were different. In 68.5% of the patients the GGT IE activity dominated in Alpha 1 globulin area.