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Objective: This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature.Methods: A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment.Results: A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children.Conclusions: In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions.

Compacting soil has an adverse effect on soil properties, decreases crop productivity, and subsequently reduces farm income. Low tire inflation pressure (LTP) help in managing soil compaction and protecting the soil environment; however, there is scant economic data available on LTP in US Midwest farming systems. Hence, a 3‐year study investigated the effects of LTP, compared to tires inflated to the standard tire inflation pressure systems, on crop yield and farm economy for a typical maize/soybean rotation. The effect of the two tire inflation pressure systems was factorialized with three tillage systems: deep tillage (DT, 450 mm), shallow tillage (ST, 100 mm), and no‐till systems. The results showed that LTP systems increased maize (Zea mays) yield by 4.51% (2017) and 2.70% (2018) and soybean (Glycine max) by 3.70% in 2018. Annual earnings for both 200‐ and 800‐ha farms increased for all tillage systems with LTP tires based on a partial budget analysis. The payback periods for LTP tires were very short, ranging from 0.32 years for DT on an 800‐ha farm to 1.18 years for ST on a 200‐ha farm. The net present value of the higher returns with LTP tires was substantial, especially for the DT system. This study shows a strong economic benefit from investments in LTP tires on silty clay loam soils in the US Midwest. Low tire inflation pressure (LTP) increased crop yield and farm income.Per hectare annual earnings in LTP tires increased by $42/ha and $45/ha for 200‐ and 800‐ha farms for maize/soybean cropping systems.The benefit of LTP tires was more consistent when associated with the deep tillage system.The payback period for LTP tires at the current grain and tire prices is less than 2‐years.The LTP tires are profitable even if grain prices are much lower than the current level.

Objectives: To perform a systematic review of otolaryngologic presentation rates to emergency department settings before and after lockdown due to the COVID-19 pandemic.Sources: PubMed, Scopus, and CINAHL.Methods: A systematic search was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing otolaryngologic presentations to emergency department and rapid access clinic settings both in the before-lockdown and after-lockdown periods. The start of after-lockdown period varied based on initiation of lockdown, ranging from March 1st to June 1st of 2020 across general emergency department studies.Results: A total of 14 studies were included in this review. About 10 were general emergency departments, 3 were specifically pediatric emergency departments, and 1 study focused on the geriatric population (>65 years). A total of 13 790 patients were included, with 9446 in the before-lockdown period (68.5%) and 4344 in the after-lockdown period (31.5%). Meta-analysis of proportions for otolaryngologic presentations across general emergency departments was performed. Comparison of weighted proportions found significant differences between before-lockdown and after-lockdown presentation rates for infectious etiologies, tonsillitis specifically, foreign bodies, non-infectious airway issues, and epistaxis among these studies.Conclusions: The increased proportions of various non-infectious presentations (eg, epistaxis, foreign bodies, and airway issues) following lockdown might be associated with proportional decreases in infectious pathologies, given decreased social contact to prevent SARS-CoV-2 transmission. Overall, it is important for otolaryngologists to recognize what presentations might more commonly be seen and require evaluation and potential intervention in light of a global pandemic.

Purpose: Policing scholars have largely ignored the workgroup dynamics of police command staffs. These officers work closely at the top of police organizations, promoting strategic objectives and overseeing significant changes. As leaders, emotional regulation is critical to the maintenance of internal and external relationships. Only a few research studies address emotional intelligence (EI) among police leaders. The current study combines these two issues to examine whether emotionally intelligent leaders report better perceptions of workgroup fit with their respective command staffs. Design/methodology/approach: Using a survey of 304 United States (US) command staff officers attending the Federal Bureau of Investigation (FBI) National Academy (NA), the authors apply person-environment fit theory and test several hypotheses using structural equation modeling. Findings: Command staff officers with better EI report significantly better perceptions of workgroup fit, suggesting that they may be better equipped to navigate the command staff workgroup dynamics in this complex environment that demands high emotional regulation. Workgroup fit was also significantly higher among higher ranking officers and among officers racialized as White. Originality/value: Few studies have addressed perceptions of workgroup fit among command staff officers, and little attention has been given to the concept of EI. The authors add to these two important areas of research and provide evidence that emotional intelligence is an important characteristic for leaders when considering how well command staffs work together. This finding may have implications for the efficacy of agencies to facilitate change efforts or to carry out daily operations.

To examine the volume, topics, and reporting trends in the published literature of randomized clinical trials for pharmacologic pain management of pediatric tonsillectomy and adenotonsillectomy and to identify areas requiring further research. PubMed (National Library of Medicine and National Institutes of Health), Scopus (Elsevier), CINAHL (EBSCO), and Cochrane Library (Wiley). A systematic search of four databases was conducted. Only randomized controlled or comparison trials examining pain improvement with a pharmacologic intervention in pediatric tonsillectomy or adenotonsillectomy were included. Data collected included demographics, pain‐related outcomes, sedation scores, nausea/vomiting, postoperative bleeding, types of drug comparisons, modes of administration, timing of administration, and identities of the investigated drugs. One hundred and eighty‐nine studies were included for analysis. Most studies included validated pain scales, with the majority using visual‐assisted scales (49.21%). Fewer studies examined pain beyond 24 h postoperation (24.87%), and few studies included a validated sedation scale (12.17%). Studies have compared several different dimensions of pharmacologic treatment, including different drugs, timing of administration, modes of administration, and dosages. Only 23 (12.17%) studies examined medications administered postoperatively, and only 29 (15.34%) studies examined oral medications. Acetaminophen only had four self‐comparisons. Our work provides the first scoping review of pain and pediatric tonsillectomy. With drug safety profiles considered, the literature does not have enough data to determine which treatment regimen provides superior pain control in pediatric tonsillectomy. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of posttonsillectomy pain. The heterogeneity in study design and comparisons weakens the conclusions of potential systematic reviews and meta‐analyses. Future directions include more noninferiority studies of unique comparisons and more studies examining oral medications given postoperatively. For pediatric patients requiring tonsillectomy or adenotonsillectomy, there are many randomized controlled trials examining pain management. However, this scoping review shows a continued need for research in this domain. Specifically, there is a need to standardize reporting methods, study common drugs, and study the efficacy and safety of oral drugs given postoperatively and after 24 h postsurgery. This novel scoping review highlights the heterogeneity of research in pediatric posttonsillectomy pain management.Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of pediatric posttonsillectomy pain. This novel scoping review highlights the heterogeneity of research in pediatric posttonsillectomy pain management. Even common drugs like acetaminophen and ibuprofen require further research for optimizing the treatment of pediatric posttonsillectomy pain.

I. Introduction II. The Small Business Innovative Research Program and Small Business Technology Transfer Program Overview A. SBIR/STTR Solicitations B. SBIR/STTR Solicitation Evaluation Factors--Phase I C. SBIR/STTR Solicitation Evaluation Factors--Phase [...]

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Using a sample of frontline police officers from several mid-sized municipal police departments in the United States, this study explores the relationships between frontline police officers’ self-legitimacy, organizational fit, moral alignment with policed communities, and attitudes toward democratic policing principles. Using partial least squares structural equation modeling, the analysis frames democratic policing using a formative latent construct to test several hypotheses. The results support a direct positive relationship between self-legitimacy and attitudes toward democratic policing, and suggest the relationship is partially mediated by officers' perceptions of moral alignment with their policed communities. The results further demonstrate that self-legitimacy is significantly related to organizational fit, but organizational fit does not appear to mediate the relationship between self-legitimacy and attitudes toward democratic policing.

Purpose: The purpose of this study is to explore the impacts coronavirus disease 2019 (COVID-19) had on US police academies’ production of police recruits. Design/methodology/approach: The study used a national online survey of police academy directors in the USA, followed by purposive, semi-structured interviews of select academy directors. A combination of quantitative and qualitative data is combined in a mixed methods approach. Findings: The findings suggest that academies experienced a range of impacts related to COVID-19. These impacts lead to more questions concerning how academies and state-level governing boards responded not only to pandemic-related challenges, but also to their willingness to accept more online and alternative curriculum delivery strategies. Originality/value: Police academies are a required step in the production of new police recruits in the USA, but researchers have paid little attention to how academies operate. While exploratory, this study provides some insights into how this aspect of policing weathered the COVID-19 pandemic, and offers suggestions for future research, as well as policy implications.

Abstract: Prevention and early recognition remain critical factors in the treatment of foreign body inhalation in children. Accidental inhalation of both organic and nonorganic foreign body material continues to be [...]

Purpose: Police officer perceptions of their own legitimacy can be important in shaping aspects of their performance and other organizational outcomes. The current study uses person-environment fit theory to assess the effects of value congruence with top managers, immediate supervisors and coworkers on officers' perceptions of self-legitimacy. Design/methodology/approach: The study used a cross-sectional survey of nearly 250 front-line police officers from seven municipal police departments in Michigan, Indiana and Kentucky to examine the effects of perceived value congruence on officers’ self-legitimacy. A hierarchical model of fit is assessed using structural equation modeling. Findings: Findings demonstrate that value congruence positively relates to officers’ reported self-legitimacy, suggesting that officers who perceive greater similarity in values with others in the organization will express more confidence in their authority. Originality/value: Our findings add to research on police officers’ self-legitimacy, and the use of a hierarchical model of person-environment fit might offer implications for future research on police culture.

Objectives: Analyze the differences in length of stay, cost, disposition, and demographics between syndromic and non-syndromic children undergoing multi-level sleep surgery.Methods: Children with sleep disordered breathing or obstructive sleep apnea that had undergone sleep surgeries were isolated from the 1997 to 2012 editions of the Kids’ Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Children were then classified as syndromic or non-syndromic and stratified by level of sleep surgery (tonsillectomy & adenoidectomy, tonsillectomy & adenoidectomy plus other site surgery, other site surgery). Length of stay and cost were reported with Kruskal–Wallis one-way analysis of variance, disposition with binomial logistic regression, and demographics with chi-square.Results: Syndromic children compared to non-syndromic children were more likely to have surgery beyond just tonsillectomy & adenoidectomy and also had a longer length of stay, higher total cost and non-routine disposition (all P< .001). Syndromic children undergoing tonsillectomy and adenoidectomy plus other site surgery had a longer length of stay compared to syndromic children undergoing tonsillectomy & adenoidectomy (6.00 days vs 3.63 days, P< .001). However, no similar statistically significant difference in length of stay was found in non-syndromic children (2.01 days vs 2.87 days, P> .05).Conclusion: The potential risks/benefits need to be weighed carefully before undertaking sleep surgery in syndromic children. They experience a longer length of stay, higher cost, and non-routine disposition when compared to non-syndromic children. This is especially true when considering the transition from tonsillectomy & adenoidectomy to tonsillectomy & adenoidectomy plus other site surgery, as syndromic children experience a longer length of stay and non-syndromic children do not.

Objectives: The goal of this study is to describe the 30-day postoperative sequelae of pediatric choanal atresia repair and identify predictive factors for adverse events.Study Design: The American College of Surgeons’ National Surgery Quality Improvement Program-Pediatric (NSQIP-P) database was searched between January 2012 and December 2015 to identify pediatric patients status post choanal atresia repair. Postoperative outcomes included surgical site complications, readmissions, and total length of stay.Results: A total of 178 children underwent choanal atresia repair. The overall complication rate was 6.2%, while the 30-day readmission rate was 15%. Patients with CHARGE had a longer mean duration of hospitalization (26.91 days vs 8.05 days, P= .013). Additionally, patients ≤10 days of age had longer duration of hospitalization (17.84 days vs 9.24 days, P≤ .001) and higher readmission rates (33.30% vs 10.1%, P= .001). Among the nonsyndromic cohort, ventilator dependence was a predictor of postoperative complications (odds ratio [OR] = 16.08, P< .001), higher readmission rates (OR = 5.46, P= .002), and a longer hospital stay (OR = 18.69, P< .001).Conclusion: Analysis of the 2012-2015 NSQIP-P data set reveals that patients with a diagnosis of CHARGE and those ≤10 days of age have a longer duration of hospitalization. Increased risk of postoperative complications and longer duration of hospitalization were both influenced by chronic steroid use and ventilator dependence.

The subglottis is a narrow region of the pediatric airway that is exquisitely susceptible to the development of airway stenosis. The incidence of acquired subglottic stenosis in the setting of prolonged intubation has significantly decreased because of improved endotracheal tube management protocols. Advances in otolaryngology interventions, such as balloon dilation and endoscopic cricoid split techniques, may allow the avoidance of tracheostomy in patients with mild to moderate subglottic stenosis. However, patients with severe subglottic stenosis are often tracheostomy dependent. Open surgical techniques to treat severe disease, such as laryngotracheal reconstruction and cricotracheal resection, offer high rates of tracheostomy decannulation.

Objectives: A minority of children undergoing cochlear implantation (CI) are admitted overnight postoperatively, but there are little data on prognostic indicators. Our goal is to review national data to identify variables associated with admission and identify effects on outcomes.Methods: We analyzed data from the 2012-2015 American College of Surgeons’ National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) program use files. The CI patients were identified by CPT code. Demographics, comorbidities, anesthesia time, total operation time, 30-day complications, and 30-day readmission were compared between ambulatory and admitted patients.Results: A total of 2943 CI patients were included, with 17.2% of these admitted post implantation. Single variable analysis revealed multiple factors associated with admission post implantation. Multivariable analysis showed patients with asthma were 2.2 times (P< .001; odds ratio [OR] = 1.484-3.227) and those with structural central nervous system (CNS) abnormalities 2.1 times (P< .001; OR = 1.584-2.706) more likely to be admitted. Younger age (P= .002; OR = 0.995-0.999) and longer operation time (P< .001; OR = 1.003-1.006) were weak predictors. Two hundred sixteen patients lacked any factors but were still admitted. They had similar outcomes to ambulatory healthy patients.Conclusion: We identified factors associated with admission post-CI and higher readmission rates. Asthma and CNS abnormalities are strong predictors of admission post implantation. Forty-two percent of admitted patients lack any of these factors and have comparable outcomes to corresponding ambulatory patients.

The laryngopharyngeal reflux (LPR) is difficult to diagnose and treatment depends on the complications ranging for which parents need to support and encourage the child.

Multiple techniques for auricular reconstruction for microtia have been described. Reconstruction using autologous costal cartilage continues to be the most widely implemented technique for repair. Recreation of a three-dimensional framework mimicking the curves and contours of a normal ear, while also maximizing stability, is crucial in reconstructing the auricle. Additionally, soft tissue management, although generalized in approach, is specific to each patient and greatly influences surgical outcomes. In the present article, we discuss the Nagata technique for auricular reconstruction, a 2-staged technique using costal cartilage grafts to rebuild the auricle. [ABSTRACT FROM AUTHOR]

IMPORTANCE: The use of health care resources in patients with velopharyngeal insufficiency undergoing sphincter pharyngoplasty is unknown. OBJECTIVES: To examine the use of health care resources by patients with velopharyngeal insufficiency who have undergone sphincter pharyngoplasty and investigate whether patients with 22q11.2 deletion syndrome (22qDS) had a longer length of stay, increased cost of admission, and higher number of complications. DESIGN, SETTING, AND PARTICIPANTS: Using data from the Kids’ Inpatient Database for January 1 to December 31, 2012, we retrospectively analyzed all patients undergoing pharyngoplasty for velopharyngeal insufficiency. In addition, patients were analyzed according to whether or not they had 22qDS. Data were analyzed from January 1 to December 31, 2012. MAIN OUTCOMES AND MEASURES: Total cost of admission, length of stay, number of procedures, and number of complications. RESULTS: There were 687 patients: 90 with 22qDS (mean [SD] age, 6.4 [2.7] years; 43 males and 47 females) and 597 without 22qDS (mean [SD] age, 7.5 [4.1] years; 326 males and 271 females). In both groups, patients were predominantly white, had private insurance, were treated in a children’s hospital, and were from either the West or Midwest. The median length of stay (2.0 [interquartile range (IQR), 1.0-3.9] vs 1.0 [IQR, 1.0-2.0] days; 95% CI, 1.0-2.0) and total cost of admission ($9269.24 [IQR, $6800.65-$13 189.25] vs $6936.95 [IQR, $5036.71-$9054.98]; 95% CI, $6791.83-$7542.47) were higher for the group with 22qDS than those without 22qDS, while there was no significant difference in the number of procedures performed. In addition, the median number of diagnoses (5.0 [IQR, 3.0-9.0] vs 3.0 [IQR, 2.0-5.0]; 95% CI, 3.0-4.0) and number of chronic conditions (3.0 [IQR, 2.0-5.0] vs 2.0 [IQR, 1.0-2.0]; 95% CI, 2.0-2.0) were higher for the group with 22qDS than those without 22qDS. Furthermore, results of a multiple regression model showed that 22qDS was positively associated with both length of stay (B = 0.92; 95% CI, 0.59-1.24) and total cost (B = $3458.78; 95% CI, $2051.09-$4866.46). CONCLUSIONS AND RELEVANCE: This study demonstrates that patients with 22qDS undergoing sphincter pharyngoplasty for velopharyngeal insufficiency have more complex medical conditions and require more health care resources than patients without 22qDS.

Automated program modification underlies two successful research areas — genetic improvement and program repair. Under the generate-and-validate strategy, automated program modification transforms a program, then validates the result against a test suite. Much work has focused on the search space of application of single fine-grained operators — copy, delete, replace, and swapat both line and statement granularity. This work explores the limits of this strategy. We scale up existing findings an order of magnitude from small corpora to 10 real-world Java programs comprising up to 500k LoC. We decisively show that the grammar-specificity of statement granular edits pays off: its pass rate triples that of line edits and uses 10% less computational resources. We confirm previous findings that deleteis the most effective operator for creating test-suite equivalent program variants. We go farther than prior work by exploring the limits of delete’s effectiveness by exhaustively applying it. We show this strategy is too costly in practice to be used to search for improved software variants. We further find that pass rates drop from 12–34% for single statement edits to 2–6% for 5-edit sequences, which implies that further progress will need human-inspired operators that target specific faults or improvements. A program is amenable to automated modificationto the extent to which automatically editing it is likely to produce test-suite passing variants. We are the first to systematically search for a code measure that correlates with a program’s amenability to automated modification. We found no strong correlations, leaving the question open.

IMPORTANCE: Surgical intervention is the main treatment alternative for patients with severe laryngomalacia. Supraglottoplasty offers effective treatment results not only for laryngomalacia but also for concurrent obstructive sleep apnea (OSA). OBJECTIVE: To quantify the objective outcomes of supraglottoplasty for laryngomalacia with OSA via polysomnography data in the pediatric population. DATA SOURCES: A comprehensive literature search of the PubMed database was performed on May 20, 2015, using the search terms supraglottoplasty, epiglottoplasty, aryepiglottoplasty, laryngomalacia, obstructive sleep apnea, Apnea-Hypopnea Index (AHI), children, and polysomnography. There were no date restrictions. STUDY SELECTION: The literature search identified English-language studies that used polysomnography to evaluate patients with laryngomalacia and OSA after supraglottoplasty. Two reviewers screened titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. DATA EXTRACTION: Numerical polysomnography data were extracted and compared among studies where appropriate. A fixed- or random-effects model was used, when appropriate, to analyze the data and calculate effect sizes. RESULTS: Four studies were included in various subsets of the meta-analysis. After supraglottoplasty, the Apnea-Hypopnea Index (AHI) improved by a mean of 12.5 points in 4 studies (95% CI, −21.14 to −3.78; P = .005), oxygen saturation as measured by pulse oximetry nadir by 9.49 in 4 studies (95% CI, 4.87–14.12; P &lt; .001), and Obstructive AHI by 21 points in 2 studies (95% CI, −50.3 to −8.29; P = .16). Twenty-nine of 33 children (88%) had residual disease. Patients 7 months and older had significant improvement in the AHI (P = .03). CONCLUSIONS AND RELEVANCE: Supraglottoplasty is an effective treatment modality for patients with laryngomalacia and OSA with objectively measurable benefits; however, patients will frequently have residual disease. Additional polysomnography after treatment is advised to ensure adequate resolution of the disorder.

OSA is associated with significant adverse outcomes with far-reaching health-care implications. OSA is much more common and severe in patients with Down syndrome (DS) than in the general population, yet there is a striking lack of literature in this area. In this review article, we have summarized the current state of knowledge and presented the available data on OSA in DS. The higher prevalence and severity of OSA in patients with DS may be related to unique upper airway anatomic features as well as increased risk for obesity, hypothyroidism, gastroesophageal reflux disease, and generalized hypotonia. Although many of the manifestations of OSA in patients with DS are similar to those seen in the general population, the relative morbidity is significantly higher. For individuals with DS who already face cognitive challenges, the added impact of OSA on cognitive function may hinder their ability to function independently and reach their full potential. Screening and evaluation for OSA should be done in children and adults with DS. Treatment of OSA in DS involves the use of CPAP, upper airway surgery, and dental appliances, along with weight-reduction strategies, nasal steroids, and oral leukotriene modifiers as adjunctive treatments. The treatment plan should be individualized for each patient with DS, taking into account age, comorbid conditions, and barriers to treatment adherence. Future research should aim to better characterize OSA, further evaluate neurocognitive outcomes, and evaluate the efficacy of treatments in patients with DS.

Background Prevalence of passive smoke exposure is relatively unknown in chronic rhinosinusitis (CRS). Previous studies have attempted to establish this relationship using subjective, questionnaire-based methodologies to assess smoke exposure, thus introducing the potential for error bias. The purpose of this study was to accurately determine the prevalence of passive smoke exposure in CRS and control patients using hair nicotine levels as a quantitative measure of cigarette smoke exposure.Methods Hair samples were obtained at time of surgery from 569 patients: 404 undergoing surgery for CRS and 165 controls undergoing surgery for repair of cerebrospinal fluid leak, removal of pituitary tumors, or adenoidectomy from 2007 to 2013. Patient charts were reviewed for reported smoking status. Hair nicotine was quantified using reversed-phase high-performance liquid chromatography. Nonsmoking patients were classified as passive smoke exposed or smoke naïve according to the hair nicotine results. Statistical analysis was performed to test for differences in demographic information and smoke exposure prevalence between CRS, CRS subtypes, and controls.Results The prevalence of passive smoke exposure in CRS as documented by hair nicotine was lower than previously reported subjective estimates. Passive smoke exposure rates were equivalent between those with CRS versus controls and significantly higher in children. Severity of passive smoke exposure was also equivalent between CRS subsets and controls. Annual passive smoke exposure prevalence did not change over time.Conclusion There is no clear evidence of avoidance of passive smoke exposure in the CRS population compared with controls. Passive smoke exposure also remained stable over time despite recent regional implementation of smoking bans. Given the constancy of exposure, it is critical that the impact of passive smoke on CRS exacerbation, outcomes, and pathophysiology be evaluated in large-scale clinical studies.

Context:Chorioamnionitis (CAM) affects many pregnancies complicated by preterm premature rupture of membranes (PPROM). Finding a serum factor that could accurately predict the presence of CAM could potentially lead to more efficient management of PPROM and improved neonatal outcomes.

A test on the case of a two year old child who presented to an emergency department with a sudden onset of drooling is presented which medical professionals can take to gain educational credits in the area of otolaryngology.

Partial cricotracheal resection (CTR) for the treatment of subglottic stenosis has been reported, in children, with decannulation rates of 90% for refractory grades 3 and 4 stenoses. In view of these findings, it has become imperative for pediatric otolaryngologists to add CTR to their surgical armamentarium for the management of severe subglottic stenosis. The authors have described preoperative evaluation, patient selection, operative technique, and possible complications of CTR in this article. [Copyright &y& Elsevier]

Blunt neck trauma is not common in children, but these injuries can be potentially life-threatening. Presenting symptoms and signs of laryngeal injuries are often subtle, and poor outcomes in regard to voice and airway function are associated with delayed diagnosis. The purpose of this report was to present a pediatric case that illustrates the subtle symptoms and signs of a laryngeal laceration. In this case, the appearance of the laryngeal laceration was similar to the glottis, highlighting the importance of developing airway management guidelines for blunt laryngeal injuries in children.

Background Stereotactic computer-aided surgery has provided the surgeon with a means to navigate more safely through diseased or surgically altered sinus anatomy. Accurate registration is vital to successful image-guided surgery. This study compared the accuracy and performance of three registration methods: fiducial, anatomic landmarks, and surface registration.Methods Ten fixed cadaveric heads underwent endoscopic computed tomography scan followed by middle meatal antrostomy and sphenoidotomy. Each registration method was performed, and the time required and mean registration error were recorded. Five anatomic sites were then identified and compared with the preoperative computed tomography images. The true distances between the known anatomic sites and the crosshair locations on the images were measured.Results Statistically significant differences were noted for mean registration error and time for registration. The mean ± SEM time for registration for the fiducial, surface, and landmark methods were 5 minutes 24 seconds ± 27 seconds, 1 minute 1 second ± 5 seconds, and 11 minutes 46 seconds ± 45 seconds, respectively. The mean ± SEM registration error for the fiducial, surface, and landmark methods were 0.48 ± 0.21 mm, 1.05 ± 0.06 mm, and 3.1 ± 0.25 mm, respectively. When the true accuracy of the three registration methods were compared, no significant difference was found between fiducial and surface registration. However, fiducial registration was significantly more accurate than landmark registration at all points. When compared with landmark registration, surface registration was statistically more accurate at all anatomic sites except for the sella turcica and optic nerve.Conclusion When the true accuracies of these methods were compared infixed cadaveric specimens, fiducial and surface registration were statistically similar but were found to be significantly more accurate than landmark registration. Furthermore, when time of registration, accuracy, and ease of use were considered, surface registration was found superior.

Introduction:Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic, minimally invasive pituitary surgery (MIPS) to our last 50 sublabial transseptal (SLTS) procedures.

CCSweep is a new method to automatically decompose multi-sweepable volumes into many-to-one sweepable volumes. Multi-sweepable volumes contain both multiple source and multiple target faces. In hexahedral mesh generation, most sweeping techniques handle many-to-one sweepable volumes that contain multiple source faces, but they are limited to volumes with only a single target face. Recent proposals to solve the multi-sweep problem have several disadvantages, including: indeterminate edge sizing or interval matching constraints, over-dependence on input mesh discretization, loop Boolean restrictions on creating only loops with even numbers of nodes, and unstable loop imprinting when interior holes exist. These problems are overcome through CCSweep. CCSweep decomposes multi-sweep volumes into many-to-one sweepable sub-volumes by projecting the target faces through the volume onto corresponding source faces. The projected faces are imprinted with the source faces to determine the decomposition of the solid. Interior faces are created to decompose the volume into separate new volumes. The new volumes have only single target faces and are represented in the meshing system as real, solid geometry, enabling them to be automatically meshed using existing many-to-one hexahedral sweeping approaches. The results of successful application of CCSweep to a number of problems are shown in this paper.

Introduction Cross-contamination of Venturi atomizers has been reported.Methods In phase I, 16 atomizers were sterilized and refilled with either 1% lidocaine or 0.1% Tyzine (day 0). During phase II, atomizers were wiped with isopropyl alcohol wipes between uses. In both phases, on days 7, 14, 21, and 28, the contents of the atomizer were sprayed onto two culture media. If a culture was found positive, cultures from the nozzle, lumen, and solution were taken and cultured in depth.Results Twelve lidocaine bottles and three Tyzine bottles were initially positive. There were more positive cultures from lidocaine bottles than Tyzine bottles at 2 weeks (p = 0.02). After wiping with isopropyl alcohol, contamination was significantly reduced in the lidocaine bottles at 2 weeks (p = 0.02).Conclusion Microbial contamination of questionable clinical significance may occur with nasal atomizers. Regardless of this significance, wiping the devices with isopropyl alcohol can eliminate microbial growth for a 2-week interval.

AbstractTwo research studies were conducted to determine if the benefits of studying print geographic maps along with related factual information (i.e., map, order, and edge effects) also apply to studying digital geographic maps with factual information. Both experiments confirm that the learning benefits associated with print maps also apply to digital maps. In addition, the studies reveal that a medium attribute associated with digital maps (computer rollover effect) provides learning advantages beyond what is possible with traditional maps due to the constraints of the print medium. The results are discussed in terms of recommendations for classroom teaching and education in general.

ObjectiveTo explore the possible relationship between gastroesophageal reflux and eustachian tube dysfunction in an animal model.

OBJECTIVE:This study investigated the role of late-phase allergy in the development of otitis media with effusion.METHODS:Brown Norway rats were sensitized to ovalbumin and later challenged transtympanically. Eustachian tube ventilatory function was assessed 2, 4, 8, 24, 28, and 32 hours postchallenge by measuring passive opening and closing pressures, active clearance of positive and negative middle ear pressure, and mucociliary clearance.RESULTS:The results demonstrate that exposure to transtympanic allergen induces eustachian tube dysfunction and subsequent formation of effusion. Allergic animals showed significant increases in passive and active opening pressures, as well as a decreased ability to actively clear middle ear pressure. Finally, the mucociliary was significantly impaired in all sensitized rats exposed to transtympanic allergen.CONCLUSION:These findings demonstrate that late-phase allergy leads to significant eustachian tube dysfunction and subsequent formation of effusion by impairing the ventilatory and clearance functions of the eustachian tube.

OBJECTIVE: To determine the effects of repeated pepsin/hydrochloric acid (HCl) exposure on the eustachian tube (ET).STUDY DESIGN AND SETTING: ET function was studied in 22 rats. Group I (control) rats received transtympanic phosphate buffered saline solution; groups II (0.5 mg/ml) and III (2.0 mg/ml) received transtympanic pepsin/HCl. Test solutions were applied on day 0 with ET function evaluated on days 1, 2, 3, and 7 after exposure. Each 7-day period represents 1 cycle; all groups underwent 4 cycles. ET function was evaluated using passive opening and closing pressure, and active clearance of positive and negative pressure tests.RESULTS: Rats exposed to pepsin/HCl had elevated passive opening pressures and a decreased ability to clear positive and negative pressure. A temporal relationship exists.CONCLUSION: The results suggest middle ear exposure to pepsin/HCl leads to ET dysfunction in rats, and that this dysfunction is enhanced with repeated exposures.SIGNIFICANCE: Gastroesophageal reflux may induce ET dysfunction.

Current hexahedral mesh generation techniques rely on a set of meshing tools, which when combined with geometry decomposition leads to an adequate mesh generation process. Of these tools, sweeping tends to be the workhorse algorithm, accounting for at least 50 per cent of most meshing applications. Constraints which must be met for a volume to be sweepable are derived, and it is proven that these constraints are necessary but not sufficient conditions for sweepability. This paper also describes a new algorithm for detecting extruded or sweepable geometries. This algorithm, based on these constraints, uses topological and local geometric information, and is more robust than feature recognition-based algorithms. A method for computing sweep dependencies in volume assemblies is also given. The auto sweep detect and sweep grouping algorithms have been used to reduce interactive user time required to generate all-hexahedral meshes by filtering out non-sweepable volumes needing further decomposition and by allowing concurrent meshing of independent sweep groups. Parts of the auto sweep detect algorithm have also been used to identify independent sweep paths, for use in volume-based interval assignment. Published in 2000 by John Wiley & Sons, Ltd.

Congenital elevation of the scapula (Sprengel deformity) is the most common congenital abnormality involving the scapula. In up to 50% of cases, there is an associated connection, which may be osseous, cartilaginous, or fibrous, between the scapula and the lower cervical spine. To date, there have been no reports of an osseous structure extending from the medial scapula to the clavicle and occipital region of the skull associated with Sprengel deformity.

A personal narrative is presented which explores the author's experience of attending the opening of the Southtown Theater on December 25, 1931.

ObjectiveAt the conclusion of the report, the readers should be able to recognize the rare complication of adenotonsillectomy of Grisel syndrome, discuss its pathogenesis, and provide early, effective treatment.

The article discusses impact of de-policing in the U.S. Topics discussed include a survey by Pew Research Center study on police officers who believed that fatal encounters between law enforcement and African American citizens have made policing more difficult, National Institute of Justice-sponsored study reported no connections between de-policing and increased violent crime among a sample of large U.S. cities, and law enforcement agencies have found it difficult to recruit minorities.