Search

This article discusses a surgical technique for repairing middle fossa cranial fossa semicircular canal dehiscence, which is a defect in the bone of the lateral skull base. The technique involves using a split thickness bone graft, pericranial pedicled flap, and hydroxyapatite for repair. The study reviewed the clinical records of 20 patients who underwent this technique and found that symptoms resolved completely in 35% of patients and partially in 65% of patients. No patients required revision surgery or developed new defects. The authors conclude that this technique is a safe and effective approach for repairing middle fossa cranial fossa semicircular canal dehiscence. [Extracted from the article]

Sensory impairments are common in older adult populations and have notable impacts on aging outcomes. Relationships between sensory and cognitive functions have been clearly established, though the mechanisms underlying those relationships are not fully understood. Given the growing burden of dementia, older adults with sensory deficits are an important and growing population to study in cognitive aging research. Yet, cognitive research sometimes excludes those with uncorrected significant/severe sensory deficits and often poorly or inconsistently assesses those deficits. Observational and interventional studies that exclude participants with sensory deficits will be limited in their generalizability to the narrower subset of the older adult population without vision or hearing impairment and may be missing an opportunity to study a growing population of older adults at higher risk of cognitive impairment. Strategies exist for adapting cognitive testing instruments, and inroads could be made into collecting normative data to inform ongoing research. Bringing together psychometricians with researchers who specialize in vision and hearing impairments could launch highly innovative research on both measurement methods and cognitive disease etiology, as sensory organs provide readily accessible neuronal and vascular beds that may show pathology earlier and elucidate innovative screening opportunities for early signs of cognitive disease. [ABSTRACT FROM AUTHOR]

Otolaryngology–head and neck surgery is in the first wave of residency training programs in Canada to adopt Competence by Design (CBD), a model of competency-based medical education. CBD is built on frequent, low-stakes assessments and requires an increase in the number of feedback interactions. The University of Toronto otolaryngology–head and neck surgery residents piloted the CBD model but were completing only 1 assessment every 4 weeks, which was insufficient to support CBD. This project aimed to increase assessment completion to once per resident per week using quality improvement methodology. Stakeholder engagement activities had residents and faculty characterize barriers to assessment completion. Brief electronic assessment forms were completed by faculty on residents' personal mobile devices in face-to-face encounters, and the number completed per resident was tracked for 10 months during the 2016–2017 pilot year. Response to the intervention was analyzed using statistical process control charts. The first bundled intervention—a rule set dictating which clinical instance should be assessed, combined with a weekly reminder implemented for 10 weeks—was unsuccessful in increasing the frequency of assessments. The second intervention was a leaderboard, designed on an audit-and-feedback system, which sent weekly comparison e-mails of each resident's completion rate to all residents and the program director. The leaderboard demonstrated significant improvement from baseline over 10 weeks, increasing the assessment completion rate from 0.22 to 2.87 assessments per resident per week. A resident-designed audit-and-feedback leaderboard system improved the frequency of CBD assessment completion. [ABSTRACT FROM AUTHOR]

Objectives: Medical three-dimensional (3D) printing, the fabrication of handheld models from medical images, has the potential to become an integral part of otolaryngology-head and neck surgery (Oto-HNS) with broad impact across its subspecialties. We review the basic principles of this technology and provide a comprehensive summary of reported clinical applications in the field.Methods: Standard bibliographic databases (MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and The Cochrane Central Registry for Randomized Trials) were searched from their inception to May 2018 for the terms: "3D printing," "three-dimensional printing," "rapid prototyping," "additive manufacturing," "computer-aided design," "bioprinting," and "biofabrication" in various combinations with the terms: "ptolaryngology," "head and neck surgery," and "otology." Additional articles were identified from the references of retrieved articles. Only studies describing clinical applications of 3D printing were included.Results: Of 5,532 records identified through database searching, 87 articles were included for qualitative synthesis. Widespread implementation of 3D printing in Oto-HNS is still at its infancy. Nonetheless, it is increasingly being utilized across all subspecialties from preoperative planning to design and fabrication of patient-specific implants and surgical guides. An emerging application considered highly valuable is its use as a teaching tool for medical education and surgical training.Conclusions: As technology and training standards evolve and as healthcare moves toward personalized medicine, 3D printing is emerging as a key technology in patient care in Oto-HNS. Treating physicians and surgeons who wish to stay abreast of these developments will benefit from a fundamental understanding of the principles and applications of this technology. Laryngoscope, 129:2045-2052, 2019. [ABSTRACT FROM AUTHOR]

Background Outpatient thyroidectomy has gained popularity due to improved resource utilization. Methods We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, CINAHL, Web of Science, and the Cochrane library. We included all studies examining the outcomes of outpatient thyroidectomy as compared with those of inpatient thyroidectomy. Risk of bias was assessed using the Newcastle-Ottawa scale. Postoperative complications (hematoma, hypocalcemia, and recurrent laryngeal nerve injury) and readmission/reintervention rates were compared. Results After screening 1665 records, 10 nonrandomized observational studies were included. There were fewer complication rates in the outpatient group than the inpatient group (relative risk [RR] 0.56; 95% confidence interval [CI] 0.37-0.83). There was no difference in readmission/reintervention rates (RR 0.60; 95% CI 0.33-1.09). Conclusion The results suggest outpatient thyroidectomy may be as safe as inpatient thyroidectomy in appropriately selected patients. The results are limited by high risk of bias. Well-designed prospective studies are necessary to further assess the safety of outpatient thyroidectomy. [ABSTRACT FROM AUTHOR]

In this letter, the image characteristics of CMOS image sensor (CIS) pixels using a vertical thin poly-Si channel (VTPC) transfer gate (TG) are established for the first time. The study of three-dimensional (3D) structures in the image sensor field has been started by 3D Flash memories. By adopting the poly-Si channel fabrication concept of 3D NAND flash memories—appropriately modified to fit the requirements of a TG in CIS pixel applications—the VTPC structure effectively suppresses the grain boundary effect. The VTPC-TG performance improves as the poly-Si channel becomes thinner. The possibility of implementing 3D pixel-based CIS is confirmed by applying the fabricated VTPC-TG to a mass-produced 1.12- \mu \textm BSI product, and using it to capture 5-Mpixel images. [ABSTRACT FROM PUBLISHER]

Background: Septal deviation is a condition of high prevalence, which ranges from 22% in newborns to 90% in adults. Surgical intervention is frequently considered in the management of patients with symptoms. Although many surgeons prefer either the endoscopic or the open approach to septoplasty, there is an ongoing debate regarding comparative outcomes between the two approaches. Objective: The purpose of this study was to systematically review the literature and provide pooled summary estimates to evaluate the efficacy and safety of open versus endoscopic septoplasty techniques. Methods: This study was registered with PROSPERO (CRD42014010730). MEDLINE, EMBASE, Google Scholar, CINAHL, Web of Science, and The Cochrane Central Registry for Randomized Trials were searched for relevant studies by using the following keywords in varying combinations: 'nasal septum,' 'nasal obstruction,' 'nasal cartilages,' 'nose,' 'nose diseases,' 'surgery,' 'nasal/septal deviation,' and 'septoplasty.' All the studies that compared open versus endoscopic septoplasty techniques for the management of symptomatic septal deviation were considered. Two reviewers independently extracted data by using a preestablished extraction form and performed quality assessment by using the Jadad and Newcastle Ottawa Scales. Weighted pooled estimates were calculated and reported, along with relative risks and 95% confidence intervals. Results: Fourteen studies met our inclusion criteria. When comparing open versus endoscopic septoplasty techniques, there was significant improvement in postoperative symptoms (i.e., nasal obstruction, headaches) (p < 0.05) in the endoscopic septoplasty group. There also were significantly fewer complications associated with the endoscopic septoplasty technique (p < 0.05). Based on the quality assessment, included studies were deemed at a moderate-to-high risk of bias. Conclusion: Our analysis indicated that endoscopic septoplasty may have some advantages over open septoplasty. However, our findings should be taken with caution given the poor quality of included studies. [ABSTRACT FROM AUTHOR]

Hand-held three dimensional models of the human anatomy and pathology, tailored-made protheses, and custom-designed implants can be derived from imaging modalities, most commonly Computed Tomography (CT). However, standard DICOM format images cannot be 3D printed; instead, additional image post-processing is required to transform the anatomy of interest into Standard Tessellation Language (STL) format is needed. This conversion, and the subsequent 3D printing of the STL file, requires a series of steps. Initial post-processing involves the segmentation-demarcation of the desired for 3D printing parts and creating of an initial STL file. Then, Computer Aided Design (CAD) software is used, particularly for wrapping, smoothing and trimming. Devices and implants that can also be 3D printed, can be designed using this software environment. The purpose of this article is to provide a tutorial on 3D Printing with the test case of complex congenital heart disease (CHD). While the infant was born with double outlet right ventricle (DORV), this hands-on guide to be featured at the 2015 annual meeting of the Radiological Society of North America Hands-on Course in 3D Printing focused on the additional finding of a ventricular septal defect (VSD). The process of segmenting the heart chambers and the great vessels will be followed by optimization of the model using CAD software. A virtual patch that accurately matches the patient's VSD will be designed and both models will be prepared for 3D printing. [ABSTRACT FROM AUTHOR]

Eccrine poroma is a benign adnexal tumor that originates from the uppermost portion of the intraepidermal eccrine duct. It usually presents as a solitary tumor. Histopathology shows a monomorphic proliferation of cuboidal cells, which radially extend from the basal layer to the dermis. Here, we present a rare multilesional eruption of eccrine poroma after chemotherapy and bone marrow stem cell transplantation for acute promyelocytic leukemia along with a description of clinical, pathological, and dermoscopic findings. [ABSTRACT FROM AUTHOR]

Background: Several options are available for the treatment of chronic rhinosinusitis (CRS), but disease control remains elusive for many patients. Recently, literature has emerged describing anti-IgE monoclonal antibody as a potential therapy for CRS. However, its effectiveness and safety are not well known. The purpose of this systematic review was to assess the effectiveness and safety of anti-IgE therapy and to identify evidence gaps that will guide future research for the management of CRS. Methods: Methodology was registered with PROSPERO (No. CRD42014007600). A comprehensive search was performed of standard bibliographic databases, Google Scholar, and clinical trials registries. Only randomized controlled trials assessing anti-IgE therapy in adult patients for the treatment of CRS were included. Two independent reviewers extracted data using a pre-defined extraction form and performed quality assessment using the Cochrane risk of bias tool and the GRADE framework. Results: Two studies met our inclusion criteria. When comparing anti-IgE therapy to placebo, there was a significant difference in Lund-McKay score (p = 0.04) while no difference was seen for percent opacification on computed tomography (CT). At 16 weeks, treatment led to a decrease in clinical polyp score. No significant difference was seen with regard to quality of life (Total Nasal Symptom Severity (TNSS), p < 0.21; Sinonasal Outcome Test 20 (SNOT-20), p < 0.60), and no serious complications were reported in either trial. Based on the quality assessment, studies were deemed to be of moderate risk of bias and a low overall quality of evidence. Conclusions: There is currently insufficient evidence to determine the effectiveness of anti-IgE monoclonal antibody therapy for the treatment of CRS. [ABSTRACT FROM AUTHOR]

Aesthetic surgery is known for its prolific introduction of new techniques, devices, and products. The implementation of any aesthetic innovation, however, may inadvertently expose patients to potential complications and adverse events. How do we decide whether a new technique or technology is superior--in both safety and effectiveness--compared with prevailing interventions? In this paper, we present some basic steps anchored in evidence-based surgery that aesthetic surgeons need to pursue in the adoption of a new technique, technology, or product. These steps include: (1) gaining familiarity with and understanding the levels of evidence; (2) performing an effective literature search; (3) formulating a critical appraisal of an article; (4) making the decision to adopt or reject; (5) recognizing the need for continued assessment; (6) acknowledging the need for education and credentialing; and (7) translation of the gathered knowledge. We hope that this paper will foster critical thinking and reduce the reliance on "photographic evidence" in aesthetic surgery literature. [ABSTRACT FROM AUTHOR]

Using a genetic screen in yeast we found that Mycobacterium tuberculosis PE-PGRS62 was capable of disrupting yeast vacuolar protein sorting, suggesting effects on endosomal trafficking. To study the impact of PE-PGRS62 on macrophage function, we infected murine macrophages with Mycobacterium smegmatis expressing PE-PGRS62. Infected cells displayed phagosome maturation arrest. Phagosomes acquired Rab5, but displayed a significant defect in Rab7 and LAMP-1 acquisition. Macrophages infected with M. smegmatis expressing PE-PGRS62 also expressed two- to threefold less iNOS protein when compared with cells infected with wild-type bacteria. Consistent with this, cells infected with a Mycobacterium marinum transposon mutant for the PE-PGRS62 orthologue showed greater iNOS protein expression when compared to cells infected with wild-type organisms. Complementation restored the ability of the mutant to inhibit iNOS expression. No differences in iNOS transcript levels were observed, suggesting that PE-PGRS62 effects on iNOS expression occurred post-transcriptionally. Marked differences in colony morphology were also seen in M. smegmatis expressing PE-PGRS62 and in the M. marinum transposon mutant,suggesting that PE-PGRS62 may affect cell wall composition. These findings suggest that PE-PGRS62 supports virulence via inhibition of phagosome maturation and iNOS expression, and these phenotypes may be linked to effects on bacterial cell wall composition. [ABSTRACT FROM AUTHOR]

We use proprietary data on intraday transactions at a futures brokerage to analyze how implied leverage influences trading performance. Across all investors, leverage is negatively related to performance, due partly to increased trading costs and partly to forced liquidations resulting from margin calls. Defining skill out‐of‐sample, we find that relative performance differentials across unskilled and skilled investors persist. Unskilled investors' leverage amplifies losses from lottery preferences and the disposition effect. Leverage stimulates liquidity provision by skilled investors, and enhances returns. Although regulatory increases in required margins decrease skilled investors' returns, they enhance overall returns, and attenuate return volatility. [ABSTRACT FROM AUTHOR]

The article presets five important things to know about glaucoma. These are the fact that glaucoma is the most common cause of irreversible blindness in the world, that glaucoma is an optic neuropathy that can lead to loss of visual field, that primary open-angle glaucoma leads to loss of vision, that patients need to undergo therapy or surgical interventions to slow the progression of open-angle glaucoma, and that acute angle-glaucoma is a medical emergency.

The growth of digital health has led to more app-based solutions entering the market which aim to provide therapeutic outcomes for a variety of diseases. This column explores the emerging field of digital therapeutics (DTx) as evidence-based and FDA-cleared digital interventions – setting them apart from the majority of commercially available solutions. In an effort to identify high quality and evidence-based options, medical and health science librarians can benefit from recognizing the qualifications of DTx, types of available DTx, and use cases for their patrons. [ABSTRACT FROM AUTHOR]

In crystalline materials, the presence of surfaces or interfaces gives rise to crystal truncation rods (CTRs) in their X‐ray diffraction patterns. While structural properties related to the bulk of a crystal are contained in the intensity and position of Bragg peaks in X‐ray diffraction, CTRs carry detailed information about the atomic structure at the interface. Developments in synchrotron X‐ray sources, instrumentation, and analysis procedures have made CTR measurements into extremely powerful tools to study atomic reconstructions and relaxations occurring in a wide variety of interfacial systems, with relevance to chemical and electronic functionalities. In this review, an overview of the use of CTRs in the study of atomic structure at interfaces is provided. The basic theory, measurement, and analysis of CTRs are covered and applications from the literature are highlighted. Illustrative examples include studies of complex oxide thin films and multilayers. [ABSTRACT FROM AUTHOR]

This article examines the use of mobile apps and the model of cross-regional communication in the app markets of Greater China and explores the influence of policy, capital, and culture on the mobile app consumption. The cross-regional degree (CRD) of mobile apps is used to measure the circulation of apps in different markets and to identify mobile apps and app producers capable of achieving cross-regional commercial success and of gaining market recognition in Greater China. The final samples include 1,124 mobile apps that ranked among the top 500 in at least two markets. The apps were coded according to market platform, firm age, price, producer listing status, producer location, app genre, and CRD. The consumption of apps in these markets is significantly influenced by policies, company capital, and local cultural tastes. Moreover, mainland China is isolated from other Greater China regions in terms of the app market. Compared with app producers in Hong Kong, Macau, and Taiwan, app producers in mainland China should consider more marketing strategies targeting audiences in other regions. [ABSTRACT FROM AUTHOR]

Biomarkers currently used in the aid for the diagnosis of Alzheimer's disease (AD) are cerebrospinal fluid (CSF) protein markers and brain neuroimaging markers. These biomarkers, however, either involve semi-invasive procedures or are costly to measure. Thus, AD biomarkers from more easily accessible body fluids, such as plasma, are very enticing. Using an aptamer-based proteomic technology, we profiled 1,129 plasma proteins of AD patients and non-demented control individuals. A 5-protein classifier for AD identification was constructed in the discovery study with excellent 10-fold cross-validation performance (90.1% sensitivity, 84.2% specificity, 87.9% accuracy, and AUC as 0.94). In an independent validation study, the classifier was applied and correctly predicted AD with 100.0% sensitivity, 80.0% specificity, and 90.0% accuracy, matching or outperforming the CSF Aβ42 and tau biomarkers whose performance were assessed in individual-matched CSF samples obtained at the same visit as plasma sample collection. Moreover, the classifier also correctly predicted mild cognitive impairment, an early pre-dementia state of the disease, with 96.7% sensitivity, 80.0% specificity, and 92.5% accuracy. These studies demonstrate that plasma proteins could be used effectively and accurately to contribute to the clinical diagnosis of AD. Although additional and more diverse cohorts are needed for further validation of the robustness, including the support of postmortem diagnosis, the 5-protein classifier appears to be a promising blood test to contribute diagnosis of AD. [ABSTRACT FROM AUTHOR]

Merkel cell carcinoma is a rare and aggressive skin malignancy. We discuss sentinel lymph node mapping which is a valuable decision aid for radiotherapy management and planning of treatment volumes as illustrated by four cases. [ABSTRACT FROM AUTHOR]

Describing user activity plays an essential role in ambient intelligence. In this work, we review different methods for human activity recognition, classified as data-driven and knowledge-based techniques.We focus on context ontologieswhose ultimate goal is the tracking of human behavior. After studying upper and domain ontologies, both useful for human activity representation and inference, we establish an evaluation criterion to assess the suitability of the different candidate ontologies for this purpose. As a result, any missing features, which are relevant for modeling daily human behaviors, are identified as future challenges. [ABSTRACT FROM AUTHOR]

Orthotopic liver transplantation (OLT) is the preferred treatment for selected patients with hepatitis B virus (HBV)-related liver disease. This study aimed to (i) define long-term outcomes following OLT for HBV; (ii) to quantify the incidence of HBV recurrence (rHBV) as it relates to anti-HBV treatment; and (iii) to determine outcomes for specific patient subgroups. We performed a retrospective chart review of 738 patients undergoing OLT between 1985 and 2010 at seven US transplant centers and divided the patients into 3 eras, 1985-1994, 1995-2004, and 2005-2010, based on hepatitis B immunoglobulin and antiviral therapies. In Era 3, female gender (p = 0.002), recurrent hepatocellular cancer (p < 0.001), and retransplantation (p = 0.01) were significantly associated with worse survival on multivariate analysis. Survival at three yr was poor for all ethnicities in Era 1, but significantly improved for all except black Americans by Era 3. Era 2 data showed a continued increase in rHBV from five to 10 yr (16.6%, 26.2%). In conclusion, while OLT outcomes have improved because of combination antiviral and immunoglobulin therapy, women and black Americans may not have realized an equal benefit. The rate of rHBV is significant even 10 yr post-transplant with survival affected. [ABSTRACT FROM AUTHOR]

People who the author would like to thank for their assistance in the creation of the 2013 issue of the journal "Climatic Change," are mentioned.

The construct of a radial basis function neural network (RBFNN) plays an important role in predicting performance. However, determining the optimal construct is difficult. A modified RBFNN integrated with correlation pruning algorithm-least squares regression (CPA-LSR) was proposed to optimize the number of hidden neurons as well as the weights and bias. First, an initial RBFNN was built by superposing each center to a training set point. This RBFNN was then trained. Next, CPA-LSR was applied to eliminate the redundant information of the initial network and to improve the predicting performance by optimizing the structure as well as the weights and bias. Finally, the developed naphtha dry point soft sensor and the industrial oxidation of p-xylene to terephthalic acid were employed to illustrate the performances of the modified RBFNNs. The result reveals an improvement in the predicting performances of the RBFNNs integrated with CPA-LSR. Conclusively, RBFNNs integrated with CPA-LSR are recommended because the redundant neurons are effectively eliminated, and the optimal structure of the RBFNN is obtained by CPA-LSR. Moreover, such RBFNNs are intuitive and eliminate the need for parameterization. [ABSTRACT FROM AUTHOR]

Within a smart environment, sensors have the ability to perceive changes of the environment itself and can therefore be used to infer high-level information such as activity behaviours. Sensor events collected over a period of time may contain several activities. The fundamental process of any automatic activity monitoring system is therefore to process streams of sensor events and detect occurrences of activities. In this study, we propose three segmentation algorithms to separate time series sensor data into segments to be further processed by an activity recognition algorithm. A preliminary evaluation of the approaches developed has been conducted on a data set collected from a single person living in an apartment over a period of 28 days. The results show that the proposed approaches can segment sensor data to detect activities and infer sensor segments to recognise activities with accuracies of 81.6, 81.6 and 82.9%, respectively. [ABSTRACT FROM AUTHOR]

Three hybrid data based model construction/pruning formula are introduced by using backward elimination as automatic postprocessing approaches to improved model sparsity. Each of these approaches is based on a composite cost function between the model fit and one of three terms of A-/D-optimality / (parameter 1-norm in basis pursuit) that determines a pruning process. The A-/D-optimality based pruning formula contain some orthogonalisation between the pruned model and the deleted regressor. The basis pursuit cost function is derived as a simple formula without need for an orthogonalisation process. These different approaches to parsimonious data based modelling are applied to the same numerical examples in parallel to demonstrate their computational effectiveness. [ABSTRACT FROM AUTHOR]

Contemporary medical imaging is becoming increasingly more quantitative. The emerging field of radiomics is a leading example. By translating unstructured data (i.e., images) into structured data (i.e., imaging features), radiomics can potentially characterize clinically useful imaging phenotypes. In this paper, an exploratory radiomics approach is used to investigate the potential association between quantitative imaging features and pulmonary function in CT images. Thirty-nine radiomic features were extracted from the lungs of 64 patients as potential imaging biomarkers for pulmonary function. Collectively, these features capture the morphology of the lungs, as well as intensity variations, fine-texture, and coarse-texture of the pulmonary tissue. The extracted lung radiomics data was compared to conventional pulmonary function tests. In general, patients with larger lungs of homogeneous, low attenuating pulmonary tissue (as measured via radiomics) were found to be associated with poor spirometry performance and a lower diffusing capacity for carbon monoxide. Unsupervised dynamic data clustering revealed subsets of patients with similar lung radiomic patterns that were found to be associated with similar forced expiratory volume in one second (FEV1) measurements. This implies that patients with similar radiomic feature vectors also presented with comparable spirometry performance, and were separable by varying degrees of pulmonary function as measured by imaging. [ABSTRACT FROM AUTHOR]

Lists the reviewers who contributed to IEEE Security & Privacy in 2014. [ABSTRACT FROM PUBLISHER]