Awake tracheal intubation using the Sensascope in 13 patients with an anticipated difficult airway

We present the use of the SensaScope, an S-shaped rigid fibreoptic scope with a flexible distal end, in a series of 13 patients at high risk of, or known to have, a difficult intubation. Patients received conscious sedation with midazolam or fentanyl combined with a remifentanil infusion and topical lidocaine to the oral mucosa and to the trachea via a trans-cricoid injection. Spontaneous ventilation was maintained until confirmation of tracheal intubation. In all cases, tracheal intubation was achieved using the SensaScope. The median (IQR [range]) insertion time (measured from the time the facemask was taken away from the face until an end-expiratory CO(2) reading was visible on the monitor) was 58 s (38-111 [28-300]s). In nine of the 13 cases, advancement of the SensaScope into the trachea was easy. Difficulties included a poor view associated with a bleeding diathesis and saliva, transient loss of spontaneous breathing, and difficulty in advancing the tracheal tube in a patient with unforeseen tracheal narrowing. A poor view in two patients was partially improved by a high continuous flow of oxygen. The SensaScope may be a valuable alternative to other rigid or flexible fibreoptic scopes for awake intubation of spontaneously breathing patients with a predicted difficult airway.

Enhanced Sensitivity by Nonuniform Sampling Enables Multidimensional MAS NMR Spectroscopy of Protein Assemblies

We report dramatic sensitivity enhancements in multidimensional MAS NMR spectra by the use of nonuniform sampling (NUS) and introduce maximum entropy interpolation (MINT) processing that assures the linearity between the time and frequency domains of the NUS acquired data sets. A systematic analysis of sensitivity and resolution in 2D and 3D NUS spectra reveals that with NUS, at least 1.5- to 2-fold sensitivity enhancement can be attained in each indirect dimension without compromising the spectral resolution. These enhancements are similar to or higher than those attained by the newest-generation commercial cryogenic probes. We explore the benefits of this NUS/MaxEnt approach in proteins and protein assemblies using 1-73-(U-C-13,N-15)/74-108-(U-N-15) Escherichia coil thioredoxin reassembly. We demonstrate that in thioredoxin reassembly, NUS permits acquisition of high-quality 3D-NCACX spectra, which are inaccessible with conventional sampling due to prohibitively long experiment times. Of critical importance, issues that hinder NUS-based SNR enhancement in 3D-NMR of liquids are mitigated in the study of solid samples in which theoretical enhancements on the order of 3-4 fold are accessible by compounding the NUS-based SNR enhancement of each indirect dimension. NUS/MINT is anticipated to be widely applicable and advantageous for multidimensional heteronuclear MAS NMR spectroscopy of proteins, protein assemblies, and other biological systems.

Evaluating Faculty Publications in Accounting Ph.D. Programs: The Author Affiliation Index as an Alternative

We propose a new model, the Author Affiliation Index (AAI), for examining journal quality, explain how the AAI is calculated, and report the resulting scores for 35 accounting and accounting-related journals. Next, we compare AAI journal rankings with those from other published studies and examine the correlations between them to show how the AAI can be used to evaluate relatively new journals, such as Accounting and the Public Interest, that are not included in extant ranking lists. By explaining its flexibility, we demonstrate that the AAI model can serve as a valuable tool for measuring journal quality and for meeting AACSB accreditation requirements for faculty groups as well as individual faculty. The AAI is based on the principle that as the percentage of authors in a journal who are accounting faculty at doctoral-granting institutions increases, the perceived value of that journal in terms of quality to Ph.D.-granting accounting programs also increases. Although our illustrations focus on the construction of this measure for use by Ph.D.-granting institutions, we describe how it can be adapted for use by other faculty groups.

Auditory Imagery and the Poor-Pitch Singer

The vocal imitation of pitch by singing requires one to plan laryngeal movements on the basis of anticipated target pitch events. This process may rely on auditory imagery, which has been shown to activate motor planning areas. As such, we hypothesized that poor-pitch singing, although not typically associated with deficient pitch perception, may be associated with deficient auditory imagery. Participants vocally imitated simple pitch sequences by singing, discriminated pitch pairs on the basis of pitch height, and completed an auditory imagery self-report questionnaire (the Bucknell Auditory Imagery Scale). The percentage of trials participants sung in tune correlated significantly with self-reports of vividness for auditory imagery, although not with the ability to control auditory imagery. Pitch discrimination was not predicted by auditory imagery scores. The results thus support a link between auditory imagery and vocal imitation.

Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients

PURPOSE: To describe anticipated health-related quality of life (HRQL) for different hypothetical strategies of febrile neutropenia (FN) management in adult cancer patients. METHODS: Seventy-eight adult cancer patients were enrolled. Our study considered four different hypothetical treatment strategies for FN: (1) entire inpatient management with intravenous (IV) antibiotics; (2) oral treatment at home after an initial observation in hospital with IV antibiotics; (3) entire outpatient management with IV antibiotics; and (4) entire outpatient management with oral antibiotics. Initially, patients were asked to rank the different treatment strategies for FN based on their personal preference. Subsequently, HRQL was rated using visual analog scale (VAS), time trade-off (TTO), and willingness-to-pay (WTP). RESULTS: Seventy-five percent of all respondents preferred an outpatient strategy for FN (36% oral, 21% intravenous, 18% early discharge). Further, outpatient strategies were associated with higher mean VAS scores (possible range 0-10) (oral: 6.1 (standard deviation (SD) 3.1); intravenous: 6.2 (SD 2.2); early discharge: 5.7 (SD 2.1)) as compared to inpatient care (5.3 (SD 2.9)). On the aggregate level, patients were willing to give up between 9 and 10 weeks of their life (TTO; corresponding to <1% of remaining life expectancy) and to pay between $255 and $327 Canadian dollars (WTP) to avoid treatment in hospital. CONCLUSIONS: Our study indicates that the majority of adult cancer patients would prefer an outpatient strategy for FN. However, patients' preferences vary substantially at the individual level. Implementation of outpatient strategies into routine clinical practice should consider this variability.