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The development of high-performance lubricants to decrease engine friction and then reduce fuel consumption remains a major challenge for oil manufacturers. Viscosity index improvers (VIIs) are additives used for decades to reduce the dependency of the lubricant's viscosity on temperature to maintain an acceptable lubrication in harsh conditions. Distinction between VIIs and thickeners in realistic engine conditions is of primary interest for oil manufacturers in order to optimize the formulation process. In this context, rheological studies can provide clear insights into the actual effect of such polymeric additives. The behavior of a simplified automotive lubricant is investigated at different temperatures and high pressure and high shear stress and modeling of the properties is proposed. Various polymers of different molecular weights and conformations were mixed in a hydrocracked mineral base oil. The viscosity variations with temperature, pressure, and shear stress, obtained from specific rheometers, were then represented by different models, namely, a Vogel-Fulcher-Tamman expression, a modified Williams-Landel-Ferry correlation, and a Carreau-Yasuda equation. Different rheological responses were observed and allowed the distinction between VIIs and thickeners under different temperature and pressure conditions. The hydrodynamic radii analysis provided an explanation of the rheological responses but also highlighted the limits of the Carreau-Yasuda equation when applied to VIIs. Therefore, the Zhang expression, based on the Maxwell model and applied here to low viscoelastic solutions, is proposed as an appropriate alternative. [ABSTRACT FROM AUTHOR]

The study reported here deals with elastohydrodynamic point contacts and it is focused on the influence of contact ellipticity. In five velocity–load reference cases, ellipticity was varied from slender to wide configurations, including the circular contact. For each case, Hertzian pressure, Hertzian area, load, and entrainment velocity were kept constant while the ellipticity was varied by changing the curvature radii. In this context, the maximum central film thickness did not occur for the infinitely wide contact, but for a slender configuration close to the circular case. Moreover, the minimum film thickness reached its optimum for a wide but finite elliptical contact. For low ellipticity ratios, specific film thickness features were obtained. In particular, very high central/minimum film thickness ratios are found. The cause of these behaviors was found in the change of the convergent shape. When the ellipticity was varied, the Poiseuille flows parallel and transverse to the entrainment direction were significantly modified and these modifications were quantitatively analyzed for the different cases. The competition between the Couette and the Poiseuille flows was totally different between the narrow and the wide elliptical contact, and this change was responsible for the film thickness variations with ellipticity. Ellipticity also had an effect on friction as it influenced the maximum pressure which in turn impacts the fluid viscosity. [ABSTRACT FROM AUTHOR]

Research in elastohydrodynamic lubrication (EHL) was, at its very beginning, essentially numerical, and even analytical. This area has, however, significantly evolved due to the necessity of validating the first models experimentally. Moreover, it soon became clear that the elastohydrodynamic (EHD) problem would be a topic of much more complex nature than the basic one involving perfectly smooth surfaces, Newtonian fluid, isothermal flow, etc. The experimental approach was the natural choice to make progress in offering the possibility of comparisons, first at the global level of the contact and, over time, at higher and higher spatial resolutions. The in situ analysis of elastohydrodynamic contacts was launched and everyone knows how much its contribution to the field has been and remains important. The present paper takes the task of reviewing the different in situ experimental techniques that have proven to be able to map the key-parameters in living EHD contacts. They are presented both in chronological order and according to the physical mechanism behind them, namely electrical, optical and acoustic methods. A last section presents some opportunities and recommendations for future works, with the aim to improve further our understanding of EHL. [ABSTRACT FROM AUTHOR]

In this study, tribochemical reactions of borate ester additives on steel surfaces were simulated experimentally by gas phase lubrication. Trimethylborate (TMB) was employed as a model molecule of the borate chemical function. TMB was introduced under gas phase up to 5 hPa in a new tribometer dedicated to gas phase lubrication. Friction tests were conducted at room temperature. In order to identify the nature of the generated tribofilm, X-ray photoelectron spectroscopy (XPS) and Auger electron spectroscopy (AES) analyses were carried out inside and outside the track of the tested samples. The results showed a reduction of the friction coefficient down to 0.2 by increasing the TMB gas pressure. This reduction in friction was induced by the formation of a tribofilm of iron oxide partially digested by a borate glass network. The reduction in friction was attributed to the formation of the borate glass. The digestion of abrasive iron oxides by the borate glass was purported to be responsible for the reduction in the wear. The tribochemical reaction of TMB on steel surfaces is discussed in relation to the hard and soft acid base (HSAB) principle. [ABSTRACT FROM AUTHOR]

Objective: To review a single-center experience with hearing rehabilitation in patients with neurofibromatosis type 2 (NF2) and to describe the auditory outcomes of cochlear implants (CIs) and auditory brainstem implants (ABI) in this population., Study Design: Retrospective case series., Setting: Tertiary referral center., Patients: Twelve adult patients with NF2 who received a CI (n = 10) and/or an ABI (n = 5) between 2000 and 2021., Interventions: Insertion of a CI and/or an ABI in NF2 patients with bilateral vestibular schwannomas (VSs)., Main Outcome Measures: Patients' demographic data, treatment history, hearing evolution, hearing rehabilitation methods, implant details, and auditory outcomes after implantation., Results: Among those who received a CI, five patients had a stable untreated VS, one patient underwent a cochlear nerve preserving surgery, and four patients received radiotherapy treatments. Six patients became regular users of their device. The median open-set sentence recognition scores were as follows: 0.5% preoperatively, 60% at 1 year postoperatively, and 80% on the most recent audiological evaluation. All patients with an ABI were implanted concomitantly with VS surgical excision, and three of them also received radiotherapy treatments. The median open-set sentence recognition scores were as follows: 4% preoperatively, 26% at 1 year postoperatively, and 0% on the most recent evaluation. Three patients became regular ABI users., Conclusion: Despite major technological advances, auditory outcomes with ABIs remain deceiving. Considering the overall improvement in postoperative auditory performances provided by CIs compared with ABIs, cochlear implantation standouts as a primary mean of hearing rehabilitation in NF2 patients., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2023, Otology & Neurotology, Inc.)

Non-contact temperature measurement at the nanoscale by photoluminescence using a nano-sensor in a confined fluid has been performed in the present work. Upconversion lanthanide-doped nanoparticles applied to ratiometric thermometry could be considered as a self-referenced nanosensor. Gadolinium orthovanadate (GdVO 4 ) nanoparticles doped with Yb 3+ and Er 3+ were synthesized and then dispersed in an ester-based fluid. Rheological measurements show that the viscosity of the dispersed NP suspension remains unchanged up to a shear rate of 10 -4 s -1 at 393 K. The NP suspension allows luminescence intensity ratio (LIR) thermometry up to 473 K with a relative sensitivity of 1.17% K -1 with a NIR laser. Then, the temperature calibration by coupling the high pressure (1.08 GPa max) confirmed the applicability of NPs as a thermosensor in a variable pressure environment. According to these results, the fluid containing GdVO 4 :Yb 3+ /Er 3+ nanoparticles can be used for temperature sensing in a pressurized environment for further application in tribology.

Objectives: Cytomegalovirus (CMV) infection is the most common intrauterine viral infection, affecting approximately 0.5-2.5% of all live births in the world. The majority of patients are asymptomatic at birth, but several clinical consequences are related to this infection, including neurosensory hearing loss. The cochlear implant is the treatment of choice when the hearing loss is severe to profound. Compare the audiological evolution after cochlear implant surgery in a group of children born with congenital CMV infection compared to a control group of children born with a genetic cause of congenital hearing loss. Determine prognostic factors predicting the outcome of patients with congenital hearing loss secondary to CMV infection following cochlear implantation., Methods: Our retrospective study aimed at the analysis of 48 patients with cochlear implants, 25 patients with congenital CMV, and 23 patients in the control group with cochlear cause of hearing loss, who were matched for gender, age of onset, and type of hearing loss. Primary outcomes are auditory evolution with the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and the multimedia audiologic test (MAT). Secondary outcomes are evaluation of prognostic factors for the CMV group, like MRI severity sign, antiviral treatment, and neuropsychological disorder., Results: For the MAT, the results are 73.9% in the CMV group and 81.6% in the control group (P = .03). For the IT-MAIS, the results are 29.3/40 in the CMV group and 29.2/40 in the control group (P = .96). In the CMV group, the children treated with antiviral treatment have IT-MAIS difference of 28.5/40 compared to 23.2/40 for the children without antiviral treatment (P = .03). We found a little trend in the correlation between auditory results and the presence of neuropsychological disorders, but there are no statistically significant results., Conclusion: The results of the audiological tests in the CMV group allow an adequate functioning, even if lower than in the control group. There are benefits of implantation in patients with CMV, and audiological results are still satisfactory for proper functioning. CMV patients enjoy superior results in terms of hearing, with antiviral treatment.

Since its emergence in China, the COVID-19 pandemic has spread rapidly around the world. Faced with this unknown disease, public health authorities were forced to experiment, in a short period of time, with various combinations of interventions at different scales. However, as the pandemic progresses, there is an urgent need for tools and methodologies to quickly analyze the effectiveness of responses against COVID-19 in different communities and contexts. In this perspective, computer modeling appears to be an invaluable lever as it allows for the in silico exploration of a range of intervention strategies prior to the potential field implementation phase. More specifically, we argue that, in order to take into account important dimensions of policy actions, such as the heterogeneity of the individual response or the spatial aspect of containment strategies, the branch of computer modeling known as agent-based modeling is of immense interest. We present in this paper an agent-based modeling framework called COVID-19 Modeling Kit (COMOKIT), designed to be generic, scalable and thus portable in a variety of social and geographical contexts. COMOKIT combines models of person-to-person and environmental transmission, a model of individual epidemiological status evolution, an agenda-based 1-h time step model of human mobility, and an intervention model. It is designed to be modular and flexible enough to allow modelers and users to represent different strategies and study their impacts in multiple social, epidemiological or economic scenarios. Several large-scale experiments are analyzed in this paper and allow us to show the potentialities of COMOKIT in terms of analysis and comparison of the impacts of public health policies in a realistic case study., (Copyright © 2020 Gaudou, Huynh, Philippon, Brugière, Chapuis, Taillandier, Larmande and Drogoul.)

Objective: This prospective longitudinal cohort study at six tertiary referral centers in Canada and Denmark describes the clinical efficiency and surgical safety of cochlear implantation with the Oticon Medical Neuro cochlear implant system, including the Neuro Zti implant, the EVO electrode array, and the Neuro One sound processor., Methods: Patients were adult cochlear implant candidates with bilateral sensorineural hearing loss., Results: The mean HINT scores in quiet pre-operatively and at 3, 6, and 12 months post-activation were 13%, 58%, 67%, and 72%, respectively, and in noise (+10 dB SNR) 13%, 46%, 53%, and 59%, respectively. The mean improvement from baseline to 6 months post-activation was 54% in quiet and 40% in noise. The surgical major complication incidence rate was 0% and the post-surgical major complication incidence rate (until 12 months post-activation) was 4%. There was no adverse event that was fatal, that required explantation, or that resulted in sound processor nonuse, and no implant failure., Conclusion: Cochlear implantation with the Oticon Medical Neuro system enables speech identification both in quiet and in noise and audiologic outcomes continue to improve in the year following activation. No substantial adverse events occurred during the surgical implantation procedure and during the 12 months post-activation.

Background: Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity., Methods: Eligible participants were newly diagnosed patients with stage III or IV squamous cell carcinoma of the mouth, oropharynx, hypopharynx, or larynx and scheduled to be treated by concurrent chemoradiation (CCR). Patients with asymmetric hearing were not eligible. The planed treatment included cisplatin 100 mg/m 2 at days 1, 22 and 43. A baseline pre-treatment complete audiometric evaluation (pure tone at frequencies ranging from 0.5 to 14 kHz, bone conduction at 0.5-4 kHz and DPOAEs) was performed. Adverse effects were noted according to CTCAE. On the day before the beginning of CCR, eligible and consenting patients were randomized to receive a trans-tympanic injection of the gel either in the left ear or in the right ear. A final post-treatment complete audiometric evaluation was scheduled to be performed 1 month after the end of CCR by audiologists kept blind to the ear assignment. For the main outcome, the permanent threshold shift (PTS) in decibel (dB) was calculated as the difference between the final and baseline measures at all pure tone frequencies at 0.5-14 kHz for each patient and for each ear. The main outcome was assessed blindly in a mixed linear model with the PTS as the dependent variable and intervention, frequency, their interaction and radiation dose to the cochlea as independent variables., Results: Between January 2015 and April 2016, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.3 dB less for treated ears compared to control ears. Although not statistically (p = 0.61) nor clinically significant, the difference was in favor of the treated ears for all frequencies between 3 and 10 kHz., Conclusions: Our trial suggests that STS deposited on the round window was safe for the middle and inner ears. More work is needed to improve the efficacy of trans-tympanic injections of cisplatin antidotes., Trial Registration: ClinicalTrials.gov, NTC02281006 , Registered 3 November 2014.

Objectives: To demonstrate the efficacy of cochlear implantation for management of a severe single-sided deaf tactical unit officer. Showing that hearing improvement provided by cochlear implantation was sufficient for him to return to work as a police tactical officer., Methods: Case report., Results: A 43 years-old man working as a tactical unit officer suffered from a work-related severe single-sided hearing loss. He tried unsuccessfully many types of hearing aids including a contralateral routing of sound (CROS) system and a bone conduction hearing aid with a headband. He was finally treated with cochlear implantation which provided enough localization and hearing abilities for a complete return to work as a tactical unit officer., Discussion: This case report demonstrates that cochlear implantation was very successful for a patient suffering from severe single-sided hearing loss. The current literature demonstrates benefits from cochlear implant over CROS and osseointegrated devices in unilateral hearing loss. Nevertheless, literature does not report any case of patient suffering from single-sided deafness that received a cochlear implant and a complete bilateral hearing rehabilitation that allowed him to return to work as a police tactical officer., Conclusion: Cochlear implantation was the only effective treatment to provide our patient enough localization and hearing abilities for a complete return to work as a police tactical officer. As no consensus has been established about selection criteria for cochlear implantation in single-sided deafness, we suggest that the patient's occupation should be considered when reviewing his candidacy for cochlear implantation.

Objective: To compare scala vestibuli versus scala tympani cochlear implantation in terms of postoperative auditory performances and programming parameters in patients with severe scala tympani ossification., Study Design: Retrospective case-control study., Setting: Tertiary referral center., Patients: One hundred three pediatric and adult patients who underwent cochlear implant surgery between 2000 and 2016. Three groups were formed: a scala vestibuli group, a scala tympani with ossification group, and a scala tympani without ossification group. Patients were matched based on their age, sex, duration of deafness, and side of implantation (ratio of 1:2:2)., Interventions: Postoperative evaluation of auditory performances and programming parameters following intensive functional rehabilitation program completion., Main Outcome Measures: Multimedia adaptive test (MAT), hearing in noise test (HINT SNR +10 dB, HINT SNR +5 dB, and HINT SNR +0 dB), impedances, neural response telemetry thresholds (NRT), neural response imaging thresholds (NRI), comfortable levels (C-levels), and threshold levels (T-levels) were compared between groups., Results: Twenty-one patients underwent scala vestibuli cochlear implantation: 19 adults and two children. Auditory performances were similar between groups, although sentence recognition in a noisy environment was slightly higher in the scala vestibuli group. Impedance values were also higher in the scala vestibuli group, but all other programming parameters were similar between groups., Conclusions: We present the largest series of patients with scala vestibuli cochlear implantation. This approach provides at least comparable auditory performances without having any deleterious effects on programming parameters. This viable and useful insertion route might be the primary surgical alternative when facing partial cochlear ossification.

A new in situ technique for temperature and pressure measurement within dynamic thin-film flows of liquids is presented. The technique is based on the fluorescence emission sensitivity of CdSe/CdS/ZnS quantum dots to temperature and pressure variations. In this respect, the quantum dots were dispersed in squalane, and their emission energy dependence on temperature and pressure was calibrated under static conditions. Temperature calibration was established between 295 K and 393 K showing a temperature sensitivity of 0.32 meV K -1 . Pressure calibration was, in turn, conducted up to 1.1 GPa using a diamond anvil cell, yielding a pressure sensitivity of 33.2 meV GPa -1 . The potential of CdSe/CdS/ZnS quantum dots as sensors to probe temperature and pressure was proven by applying the in situ technique to thin films of liquids undergoing dynamic conditions. Namely, temperature rises have been measured in liquid films subjected to shear heating between two parallel plates in an optical rheometer. In addition, pressure rises have been measured in a lubricated point contact under pure rolling and isothermal conditions. In both cases, the measured values have been successfully compared with theoretical or numerical predictions. These comparisons allowed the validation of the new in situ technique and demonstrated the potential of the quantum dots for further mapping application in more complex and/or severe conditions., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Controlling and predicting the tribological behavior of dry lubricants is a necessity to ensure low friction, long life, and low particle generation. Understanding the tribochemistry of the materials as a function of the environment is of primary interest as synergistic effects exist between the mechanics, the physicochemistry, and the thermodynamics within a contact. However, in most studies the role of the coating internal contaminants in the process is often discarded to the benefit of a more common approach in which the performances of the materials are compared as a function of different atmospheric pressure environments. The study focuses on the understanding of the tribochemical processes occurring between the materials and their internal contaminants inside an AISI440C contact lubricated by a MoS 2 /Ti coating. Time-of-flight secondary ion mass spectrometry is used to study at the molecular level, the material before and after friction. Friction tests with different durations are performed in ultrahigh vacuum at the macroscale to stay relevant to the real application (space). The adsorption/desorption of gaseous species during friction is monitored by mass spectrometry to ensure reliable study of the tribochemical processes inside the contact. The study shows that a competition exists between the Ti- and MoS 2 -based materials to create the appropriate lubricating materials via (i) recrystallization of MoS 2 materials with creation of a MoS x O y material via reactions with internal contaminants (presumably H 2 O), (ii) reaction of Ti-based materials with internal contaminants (mostly H 2 O and N 2 ). The biphasic material created is highly similar to the one created in both humid air and dry N 2 environments and providing low friction and low particle generation. However, the process is incomplete. The study thus brings insight into the possibility of controlling friction via a rational inclusion of reactants in a form of contaminants to control the tribochemical processes governing the low friction and long life.

Purpose This study aims to explore the structural aspects (roles, responsibilities and reporting) of dyad leadership in one health-care organization (HCO). Design/methodology/approach The perceptions of 32 leaders (17 physician leaders and 15 dyad co-leaders) in formal leadership positions (six first-level with formal authority limited to teams or divisions, 23 middle-level with wider departmental or program responsibility and three senior-level with institution-wide authority) were obtained through focus groups and surveys. In addition, five senior leaders were interviewed. Descriptive statistics was used for quantitative data, and qualitative data were analyzed for themes by coding and categorization. Findings There are a large number of shared responsibilities in the hybrid model, as most activities in HCOs bridge administrative and professional spheres. These span the leadership (e.g. global performance and quality improvement) and management (e.g. human resources, budgets and education delivery) domains. The individual responsibilities, except for staff and physician engagement are in the management domain (e.g. operations and patient care). Both partners are responsible for joint decision-making, projecting a united front and joint reporting through a quadrat format. The mutual relationship and joint accountability are key characteristics and are critical to addressing potential conflicts and contradictions and achieving coherence. Practical implications Clarity of role will assist development of standardized job descriptions and required competencies, recruitment and leadership development. Originality/value This is an original empirical study presenting an integrated view of dyad leaders and senior leadership, meaningful expansion of shared responsibilities including academic functions and developing mutual relationship and emphasizing the central role of stability generating management functions.

Introduction: Preservation of residual hearing in cochlear implantation is a main concern for patients and otologists. New electrode arrays as well as development of minimally invasive technique have allowed the expansion of indication criteria for cochlear implantation. The loss of residual low-frequency hearing is thought to be the result of many factors. Opinions differ in regards with the electrodes array characteristics, the surgical implantation technique and the pharmacological therapy used., Objective: The aim of this research is to analyze the available information pertaining to hearing preservation with cochlear implantation., Results: Both cochleostomy and round window approaches are adequate, but should rely on the anatomic position of the round window membrane. No electrode design had a higher rate of hearing preservation, either a standard or shorter length was used, or a straight or contoured array. The speed of insertion has a significant impact on hearing preservation and vestibular function. A slow insertion should be used for all cochlear implant insertion, hearing preservation or not. However, the optimal speed of insertion is still unclear. Moreover, the use of steroids regardless of the route or the timing, along with intraoperative topical steroids, had a positive impact on hearing preservation., Conclusion: Classic atraumatic insertion maneuvers, very slow and delicate insertion and the use of intraoperative corticosteroids improve hearing outcomes. Whichever the surgeon's preferences, all surgical modifications are aimed at the same goal: protection of the delicate intracochlear structures with preservation of residual low-frequency hearing to improve speech perception abilities., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective and Importance: To report a case of partial extraction of the electrode array during revision cochlear implant surgery and to discuss the surgical management of this rare complication. Clinical presentation The safety of revision cochlear implant surgery has long been demonstrated. Only five cases of partial extraction of the electrode array with intracochlear retention have been reported in the literature. In this report, we describe the case of a 12-year-old boy with post-meningitis deafness who suffered this complication., Intervention: Despite intracochlear retention of four electrodes, the surgical team was able to perform partial insertion of a Med-El compressed array: a total of 8 electrodes out of 12 were implanted in the same scala tympani. Five months after the surgery, the patient had access for the first time to open-set speech recognition. He could recognize 77% of open-set sentences in silence compared to 14% after initial implant activation. Seven months after the surgery, the patient was implanted in his contralateral ear with a Med-El Pulsar split array and now benefits from bilateral auditory stimulation., Conclusion: Partial insertion of a compressed array represents a viable option when facing incomplete extraction of a cochlear implant electrode array. Indeed, our patient's audiologic performance improved significantly and the results seem to surpass those obtained with partial insertion of a conventional electrode array.

Silicon nanoparticles (Si NPs) with a diameter size ranging from 4 to 8 nm were successfully fabricated. They exhibit a visible photoluminescence (PL) due to the quantum confinement effect. Chemical functionalization of these Si NPs with alkyl groups allowed to homogeneously disperse them in nonpolar liquids (NPLs). In comparison to most of literature results for Si NPs, an important PL peak position variation with temperature (almost 1 meV/K) was obtained from 303 to 390 K. The influence of the liquid viscosity on the peak positions is also presented. These variations are discussed considering energy transfer between nanoparticles. The high PL thermal sensitivity of the alkyl-capped Si NPs paves the way for their future application as nanothermometers.

Background: We conducted a retrospective case review of patients with mastoid cavity and active or inactive chronic otitis media (COM) who underwent cochlear implantation and ear obliteration in a single-stage procedure. The objectives of this review are to assess the rates of complications and postoperative infections and to evaluate post-implantation audiologic performance., Materials and Methods: All patients with COM and mastoid cavity, associated or not with active disease, who undergo cochlear implantation and obliteration of the ear as a single-stage procedure from November 2004 to April 2013, were included in the review. All the complications were recorded. Open-set sentence scores were used to evaluate the audiologic gain after implantation., Results: Twenty-seven patients were included in our review: Ten with active COM and seventeen with inactive COM. Overall, nine patients (9/27) presented post-operative complications (7/9 were minor): three were amongst active COM patients (30%) as compared to six amongst inactive COM patients (35%), which included the two major complications. A mean gain of 55.9% on open-set sentence scores was obtained after cochlear implantation., Discussion: We found that complications rate of the one-stage cochlear implantation was higher in patients with COM than in global implant population, but most complications were minors and there was no statistical difference between active and inactive COM. In addition, these patients had audiologic scores similar to those found in patients with normal temporal bone anatomy., Conclusion: Cochlear implantation performed as a one-stage procedure could be considered as an option of treatment to avoid staging in patients with active and inactive COM. Although these patients need a regular follow-up, they present good post-implantation audiometric scores.

Objectives: To standardize the information for families of children having functional surgery for middle ear malformations, we describe the audiometric results of the subgroup of patients with the most favorable anatomic conditions: viable auditory canal, intact tympanic membrane, mobile stapes, and corresponding to a Jahrsdoerfer score of 8 or higher., Study Design: Case series, tertiary referral center., Methods: Charts of patients undergoing functional surgery for congenital middle ear malformations were reviewed for demographic data, preoperative Jahrsdoerfer score, ossicular chain status, type of ossiculoplasty, and audiometric data before and 6 months postsurgery., Results: Eighteen consecutive interventions were performed on 13 patients (average age of 9 years, 8 girls and 5 boys) between 2004 and 2011. The ossiculoplasties performed were as follows: incus repositioning (4), double-layer tragal cartilage (5), intact native chain reconstruction (3), and partial ossicular prosthesis (6). Mean air bone gap (ABG) was 40.8 ± 12.4 dB preoperatively and 20.9 ± 12.9 dB postoperatively (p < 0.0001). Preoperative and postoperatively mean air conduction PTA thresholds were 49.9 ± 9.5 and 30.0 ± 14.1 dB, respectively (p < 0.0001). All ears operated on except one had air conduction improvement. There were no complications., Conclusion: Functional surgery for congenital middle ear malformations gives variable hearing outcomes. In this study, with the most favorable anatomic conditions, 12 ears (67%) of 18 had air conduction improvement below 30 dB.

Objectives/hypothesis: To propose guidelines in the management of a profound bilateral sensorineural hearing loss after bacterial meningitis., Study Design: Retrospective chart review., Patients: All 40 postmeningitic cochlear implantation surgeries performed between August 1987 and April 2007., Methods: Descriptive analysis of data on the cause of meningitis, preoperative imaging evaluation, age at implantation, time elapsed between meningitis and implantation, and relevant surgical findings., Results: Twenty-seven children and 13 adults with postmeningitic deafness were implanted. Mean age was 3 years 8 months for the children and 44 years and 10 months for the adults. The mean time delay between meningitis and surgery was 2 years 1 month for children and 28 years for adults. Eighteen children (67%) were implanted within a year. Labyrinthitis ossificans was evidenced at surgery in 62% of patients. Intraoperative cochlear ossification was classified according to the scale described by Smullen and Balkany (2005). Stage II ossification was seen in 3 patients within 49 days, with 1 of them as soon as 21 days. There was a partial insertion in 9 patients secondary to ossification. Open-set speech discrimination was achieved by 37% of the children (10 of 27) and 23% of the adults (3 of 13)., Conclusion: We recommend early cochlear implantation for patients with bilateral profound deafness secondary to meningitis.

In May 2009, 17 senior health leaders from Canada travelled to Sweden as part of a Canadian College of Health Service Executives study tour. This paper provides an overview of the tour, outlines a number of health service reform practices in Sweden and proposes five "lessons learned" with regard to the practice of leading reform. Knowledge of the current Swedish practices of "leading change" based on the itinerary shows that a patient-centred vision, when combined with effective leadership practice, can bring about significant change. Ongoing dialogue between the Swedish and Canadian leaders provided the substance for this paper.

Staphylococcus aureus (60 p. 100) and Candida albicans (50 p. 100) were mostly found in 73 cases of diaper dermatitis. They were present together in 16 out of these 73 cases. This study enables us to think this is a matter of opportunistic infection. Staphylococcus aureus (75 p. 100) and beta-hémol. Streptococcus A (28 p. 100) were found in 40 children with impetigo contagiosa. They were present together in 7 out of the 40 cases. Nephritis was never found either in those cases or in other 93 cases of pyodermitis.