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Objective: To identify the most common otolaryngologic causes of mortality in the 0 to 19 age group in the state of Massachusetts and to estimate the pediatric otolaryngologic mortality rate based on population data. Study Design: Population-based retrospective cohort study. Methods: The Massachusetts State Registry of Vital Records and Statistics electronic database was searched for all otolaryngology related causes of death from 1990 to 2002 for children aged 0 to 19. The individual death certificates were then reviewed, and a database of otolaryngology related pediatric deaths was created. Results: A total of 59 otolaryngology related deaths were identified in the pediatric population from 1990 to 2002. Eighty-one percent of deaths occurred because of airway compromise caused by infection, anatomic obstruction, or congenital anomaly. The remaining 19% of deaths occurred because of aspiration, nonairway infections, and malignant neoplasms. Ninety-five percent of deaths in the children under age 10 were caused by airway compromise. Six of seven deaths (86%) in the age 15 to 19 group occurred because of malignant neoplasms. The overall mortality rate caused by otolaryngologic causes was estimated to be 0.28 per 100,000 population. Conclusions: The overall mortality rate for otolaryngology related deaths is low in the pediatric population. The vast majority of deaths are caused by airway compromise, primarily because of laryngotracheobronchitis or other upper airway obstruction. In older children (ages 15–19), malignant head and neck neoplasms are the leading cause of otolaryngology related deaths.

Objectives. To endeavor to explain why some graduates of extracorporeal membrane oxygenation (ECMO) therapy develop sensorineural hearing loss (SNHL) whereas others do not, to study the variability seen in the degree of SNHL, to attempt to explain why some graduates with SNHL experience progressive worsening whereas others do not, and to describe the time course of the onset of SNHL on the basis of identified risk factors.Design. A retrospective chart review with proportional-hazards regression analysis to identify specific risk factors for SNHL from a list of patient and treatment variables.Setting. Children’s Hospital Boston, a pediatric tertiary-care facility and ECMO center.Patients. Neonatal ECMO graduates born in 1986–1994 who survived to discharge and underwent audiologic evaluations (n = 111) and a random sample of ECMO graduates who survived to discharge and did not undergo audiologic evaluations (n = 30).Outcome Measures. Audiologic data, including the presence or absence of SNHL, the severity of SNHL at the most recent evaluation, the stability or progressive worsening of hearing (with the first evaluation compared with the most recent evaluation), and the occurrence of delayed-onset SNHL.Results. Twenty-nine (26%) of 111 ECMO graduates who underwent audiologic testing had SNHL at the last evaluation. Of these 29 subjects with SNHL, 21 (72%) had progressive SNHL, of whom 14 (48%) had delayed-onset SNHL. The age of identification of SNHL ranged from 4 months to 8 years 11 months. Factors identified with proportional-hazards regression analyses as being associated significantly with the time to onset of SNHL were a primary diagnosis of congenital diaphragmatic hernia (hazard ratio: 2.60), length of ECMO therapy (hazard ratio: 7.18), and number of days children received aminoglycoside antibiotics (hazard ratio: 5.56). Kaplan-Meier “time-to-event” curves were constructed to illustrate the time course of onset of SNHL, as affected by each of the variables identified as significant risk factors.Conclusions. These findings illustrate the need for early, routine, audiologic evaluations throughout childhood for all ECMO graduates. Children at even greater risk for developing SNHL because of a history of congenital diaphragmatic hernia, prolonged ECMO therapy, and/or a lengthy course of aminoglycoside antibiotic therapy should be monitored even more closely throughout childhood, depending on the child’s individual risk indicators, as suggested here. On the basis of these risk indicators, efforts can be made to minimize the risk of hearing loss while a child is being treated with ECMO. In addition, these risk indicators can assist with counseling families of ECMO graduates regarding the child’s specific risk of developing SNHL and how it can be managed should it occur.

Choice of crops is limited in dry agro-ecosystems. Senna, Cassia angustifolia Vahl, a tropical medicinal plant, has potential as a dryland crop. This study was conducted to investigate gas exchange and leaf surface ultrastructural responses of senna to drought and foliar-applied nitrogen under greenhouse conditions. Drought was imposed cyclically as four, 1-wk spells by withholding water. Additional nitrogen was provided as a foliar treatment of 1% (w/v) urea at the end of each of first three drought cycles. Drought-stressed plants had the same net photosynthesis (P net ) as well-watered plants until the leaf water potential dropped below approximately -0.8 MPa. Leaf water potential of approximately - 2 MPa completely suppressed P net . Foliar nitrogen treatment increased P net > 30% in both water-stressed and well-watered plants. Intrinsic water use efficiency was unaffected by cyclic drought. Leaf area per plant increased 156% because of foliar nitrogen treatment in well-watered plants but remained unchanged in drought-stressed plants. Stomatal count per leaflet decreased 25% or more because of drought regardless of foliar nitrogen treatment on either abaxial or adaxial leaf surface. Foliar nitrogen treatment decreased adaxial but increased abaxial stomatal count regardless of drought treatment. Trichome count was more than eight times greater on the abaxial than the adaxial leaf surface under any treatment combination. Adaxial trichome number increased under drought, but decreased under nitrogen treatment. Abaxial trichome count increased because of drought only in plants deprived of nitrogen treatment. Maintenance of high carbon gain and water use efficiency, drought deciduousness, and plasticity in stomatal and trichome counts under both drought and nitrogen stress appeared to confer stress tolerance in senna.

Summary A quantitative census of woody taxa ≥ 2.0 cm diameter breast height (DBH) was performed within a contiguous 0.5 ha plot in a 167 ha wooded area of the 217 ha Forest Park in Queens County of New York City, USA. The census revealed a highly abundant non-native invasive tree, Amur corktree (Phellodendron amurense Rupr., Rutaceae) with no previous reporting on its ecology in NYC since its horticultural introduction to the park in 1935. The corktree is a dioecious, deciduous, compound leafed tree with deeply fissured corky bark and is native to Northern China, Korea and Japan. It is reported as shade-intolerant in Japan yet is shade-tolerant in this study of a New York City woodland. This study documents its movement into the canopy and up the ecological dominance hierarchy. Of the 22 sampled taxa (n = 771 trees), P. amurense ranked third in overall dominance behind Betula lenta and Quercus rubra with an importance value (IV) of 33.3%. At 20.5%, P. amurense ranked second in relative abundance with Betu...

Considering effects of physiological factors in failure of total hip arthroplasty, a numerical procedure was implemented for the three-dimesional (3D) shape optimization of femoral component of total hip replacements on the basis of remodeling objective functions. Design variables are the shape parameters, which define the femoral component geometry. The 3D design model was incorporated with 3D finite element analysis and a numerical optimization procedure. The main optimization goal was to reduce the potential for change of the bone morphology and to keep it close to the normal condition of an intact femur, by changing the geometry of the implant. Both local and global remodeling goals were examined. The results suggest a much more slender implant than is normally used would be required to minimize the remodeling potential. The results also demonstrated that the outcomes are indeed sensitive to whether the remodeling goal is treated as local or global.

Stalk lodging in maize results in significant yield losses. We have determined that cellulose per unit length of the stalk is the primary determinant of internodal strength. An increase in cellulose concentration in the wall might allow simultaneous improvements in stalk strength and harvest index. Cellulose formation in plants can be perturbed by mutations in the genes involved in cellulose synthesis, post-synthetic cellulose alteration or deposition, N-glycosylation, and some other genes with as yet unknown functions. We have isolated 12 members of the cellulose synthase (CesA) gene family from maize. The genes involved in primary wall formation appear to have duplicated relatively independently in dicots and monocots. The deduced amino acid sequences of three of the maize genes, ZmCesA10–12, cluster with the Arabidopsis CesA sequences that have been shown to be involved in secondary wall formation. Based on their expression patterns across multiple tissues, these three genes appear to be coordinately expressed. The remaining genes show overlapping expression to varying degrees with ZmCesA1, 7, and 8 forming one group, ZmCesA3 and 5 a second group, and ZmCesA2 and 6 exhibiting independent expression of any other gene. This suggests that the varying levels of coexpression may just be incidental except in the case of ZmCesA10–12, which may interact with each other to form a functional enzyme complex. Isolation of the expressed CesA genes from maize and their association with primary or secondary wall formation has made it possible to test their respective roles in cellulose synthesis through mutational genetics or transgenic approaches. This information would be useful in improving stalk strength.

A numerical procedure was implemented for the three-dimensional shape optimization of femoral component of total hip replacements. An algorithm was developed for defining the component geometry in terms of longitudinal and cross-sectional shape variables. The three-dimensional design model was combined with a non-linear 3-D finite element analysis and a numerical optimization procedure. An idealized femoral geometry and a frictional contact were used for bone-implant interfaces. The design objective was to reduce the shear stresses and the relative motion between implant and the surrounding bone along the interface region. The general trend in all design optimization was to produce a somewhat bulky implant with a more rectangular cross section. The outcome was more strongly affected by interface condition than choice of objective function.

Objective To describe the epidemiology, natural history, and treatment of epiglottitis in the Hemophilus influenzae type B (Hib) vaccine era. Design Ten-year retrospective study. Setting Tertiary-care children's hospital. Patients Nineteen patients with a discharge diagnosis of epiglottitis. Intervention As indicated by the presentation of the patient, including direct laryngoscopy, intubation, intravenous antibiotics, and steroids. Main outcome measures Presentation, management, and microbiology. Results Presenting symptoms included fever, drooling, and hot potato voice. Patients' ages ranged from 15.8 months to 17.5 (mean 8.9) years. From 1992 to 1997, the mean age was 5.8 years; from 1998 to 2002, the mean age was 11.6 years. Sixty-eight percent of patients were transferred from an outside hospital. A lateral neck radiograph was recorded in 84% of patients. Mean leukocyte count was 16,600. Direct laryngoscopy with intubation was performed in 79%; intubation was for an average of 3.5 days. H. influenzae was cultured in six patients, five of which had up-to-date immunizations. The most commonly administered antibiotics were ampicillin/sulbactam and ceftriaxone. Steroids were administered to 63% of patients. Complications included deep neck space infection (2), seizure (1), recurrent illness (1), and vocal granuloma (1). There were no deaths. Conclusion The demographics, causative organisms, and natural history of epiglottitis have changed substantially in the Hib vaccination era. The clinician evaluating and treating patients with epiglottitis should be aware of current trends.

The accumulation of damage and the associated degradation of the mechanical properties of cortical bone are postulated to contribute to age-, disease-, overuse-, and disuse-related skeletal fragilities. Therefore, gaining insight into the relationship between damage and degradation processes is essential in understanding the etiology of skeletal fractures. In investigating this relationship, the damage measure ideally needs to account for the size, the distribution density, and the orientation of microcracks. Existing measures of damage address the size and distribution density of microcracks; however, the orientation of cracks has not been well-investigated. Because the overall orientation of microcracks determines the material axis along which the greatest degradation will be experienced, we hypothesized that the incorporation of the relative orientation between microcracks and loading direction will improve the significance of the relationship between damage accumulation and material property degradation. A three-cycle damage protocol was used to induce tensile damage and to quantify the degradation of the elastic modulus of specimens from human donor femoral cortical bone (a 24-year-old and a 72-year-old man). Microcracks were evaluated by en bloc basic fuchsin staining of specimens after testing. The length (L(i)) and the orientation with respect to the loading direction (beta(i)) of each crack were quantified by a video microscopy system. Three damage measures were quantified for each specimen: the number of linear microcracks (Cr #), the sum of the crack lengths (SigmaL(i)) accounting for the microcrack size alone, and the sum of the projected crack length [SigmaL(Pi) = SigmaL(i)cos(beta(i))] accounting for both crack size and orientation. Inclusion of the orientation parameter improved the coefficient of determination between damage accumulation and the degradation of the elastic modulus: the coefficient of determination of the sum of the projected crack length (R(2) = 0.239) was 60% greater than that of the sum the projected crack length (R(2) = 0.149) and 33% greater than that of the number of linear microcracks (R(2) = 0.180). We conclude that microcrack orientation is an essential physical variable in the relationship between damage accumulation and degradation of mechanical properties of cortical bone tissue.

Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment.The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI)2 and obstructive apnea index (OAI)1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ])0.33 with ≥ 25% improvement from baseline.After 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P.05). Among these, the independent predictors were lower AHI and waist circumference percentile90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors.Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT.ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.

BACKGROUND AND OBJECTIVES: Polysomnography defines the pathophysiology of obstructive sleep apnea syndrome (OSAS) but does not predict some important comorbidities or their response to adenotonsillectomy. We assessed whether OSAS symptoms, as reflected on the Sleep-Related Breathing Disorders Scale of the Pediatric Sleep Questionnaire (PSQ), may offer clinical predictive value. METHODS: Baseline and 7-month follow-up data were analyzed from 185 participants (aged 5–9 years with polysomnographically confirmed OSAS) in the surgical treatment arm of the multicenter Childhood Adenotonsillectomy Trial. Associations were assessed between baseline PSQ or polysomnographic data and baseline morbidity (executive dysfunction, behavior, quality of life, sleepiness) or postsurgical improvement. RESULTS: At baseline, each 1-SD increase in baseline PSQ score was associated with an adjusted odds ratio that was ∼3 to 4 times higher for behavioral morbidity, 2 times higher for reduced global quality of life, 6 times higher for reduced disease-specific quality of life, and 2 times higher for sleepiness. Higher baseline PSQ scores (greater symptom burden) also predicted postsurgical improvement in parent ratings of executive functioning, behavior, quality of life, and sleepiness. In contrast, baseline polysomnographic data did not independently predict these morbidities or their postsurgical improvement. Neither PSQ nor polysomnographic data were associated with objectively assessed executive dysfunction or improvement at follow-up. CONCLUSIONS: PSQ symptom items, in contrast to polysomnographic results, reflect subjective measures of OSAS-related impairment of behavior, quality of life, and sleepiness and predict their improvement after adenotonsillectomy. Although objective polysomnography is needed to diagnose OSAS, the symptoms obtained during an office visit can offer adjunctive insight into important comorbidities and likely surgical responses.

1 IIIIIhe use of herbal products as medicinal remedies has increased greatly in the past decade. We are inundated with advertisements that tell us natural remedies will accomplish cures and imply that the term "natural" means free of side effects. Unfortunately, only a few of the herbal remedies have scientific data to back up their clinical benefits and some are known to be dangerous. Herbal teas remain an underinvestigated group of plant products.

Manual deflowering and leaf maturity were evaluated for effect on the yields of the bioactive sennosides A and B in Tinnevelly senna (Cassia angustifolia Vahl). Deflowering increased sennoside A and B concentration (percent dry weight) in leaves by 25%, the total leaf dry mass by 63%, and the harvest index by 22%, with the result that the sennoside A and B yield (grams) per plant doubled in response to deflowering. During the same time, net photosynthesis remained consistently lower in the deflowered plants. Youngest leaves had the greatest sennoside A and B concentration. A clone raised from cuttings of one seedling had lower sennoside A:B ratio than the plants raised from the seedlings. Although crop type and possibly environmental conditions influenced the sennoside A:B ratio, deflowering and leaf maturity had no effect. The sennoside A and B concentrations in the dried leaves of deflowered plants harvested in 1.5-hour intervals appeared to increase during the course of the day. Deflowering, harvesting of young leaves, and harvesting time of day constitute promising component technologies for field investigations.

In this report an integrated approach to the three-dimensional material optimization of femoral components of hip prostheses is described. The effectiveness of using reinforced fiber composites for the material optimization of hip implants has been demonstrated and general guidelines on some material design aspects of total hip replacement (THR), in terms of fiber volume fraction and fiber orientation angles, are provided. A modular program was developed to interface the optimization routine with the finite element code. In this study two cases of cemented and non-cemented THR were investigated. In both cases perfectly bonded interfaces were assumed. Two objective functions were defined based on interface failure criteria and bone adaptive remodeling to avoid interface disruption and to reduce the risk of bone loss. The overall results demonstrated the effectiveness of the technique, which can provide meaningful insights into the fiber-reinforced composite material design of orthopaedic implants.

Two studies have reported that young women with breast cancer face increased risk of early mortality if their first child was male rather than female. An immunological mechanism has been suggested. We sought to confirm these results in a larger, historical cohort study of 223 parous women who were aged45 years at breast cancer diagnosis during 1983-1987. Subjects were identified through the Maine Cancer Registry. Follow-up data were obtained from hospitals, physicians, and death certificates. Reproductive history data were obtained from the next of kin of the deceased women, birth certificates, physicians, hospitals, and lastly, subjects. With a 7-year follow-up, multivariate modeling found a lower mortality risk in women with a male first child (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32-0.81, log-rank comparison). The survival advantage remained for at least 13 years in women with a male firstborn. Thus, previous studies were not confirmed. Mortality risk in young women with breast cancer is not increased by having borne a male first child rather than a female first child.

Bacillus thuringiensis var. Kurstaki (BT) is a Gram-positive, sporulating, rod-shaped bacterium that is widely used as a microbial insecticide against a variety of lepidoptera targets, especially the Gypsy Moth, Lymantra dispar (Johnson et al. 1995). BT was first detected in 1902 in dying larvae of the Silkworm, Bombyx mori, and first used as an insecticide against lepidoptera in 1938 (Worthing et al. 1987). Microbial insecticides have long been thought to be a more effective and specific control of forest defoliators such as the Gypsy Moth and Western Spruce Budworm, Choristoneura occidentalis Freeman, than chemical pesticides such as malathion that kill a wide spectrum of arthropods. In agricultural systems, many of the nontarget arthropods are readily killed by chemical pesticides, including ‘‘useful’’ arthropods that prey upon harmful or target insect pests. Most students are aware of the injurious effects on nontarget organisms of the use of pesticides such as DDT to control insect pests. Man-made pesticides such as DDT were nearly responsible for the demise of many of our top food chain avian predators, including the eagle and osprey. It was Rachel Carson’s Silent Spring that first brought this to the attention of the American public. Since that time scientists have developed new insecticides that are more specific for controlling insect pests. The use of bacteria such

To describe the time-dependent nonlinear tensile behavior observed in experimental studies of cortical bone, a damage model was developed using two internal state variables (ISV’s). One ISV is a damage parameter that represents the loss of stiffness. A rule for the evolution of this ISV was defined based on previously observed creep behavior. The second ISV represents the inelastic strain due to viscosity and internal friction. The model was tested by simulating experiments in tensile and bending loading. Using average values from previous creep studies for parameters in the damage evolution rule, the model tended to underestimate the maximum nonlinear strains and to overestimate the nonlinear strain accumulated after load reversal in the tensile test simulations. Varying the parameters for the individual tests produced excellent fits to the experimental data. Similarly, the model simulations of the bending tests could produce excellent fits to the experimental data. The results demonstrate that the 2-ISV model combining damage (stiffness loss) with slip and viscous behavior could capture the nonlinear tensile behavior of cortical bone in axial and bending loading.

From 1982 to 1984, the authors conducted a population-based case-control study of lung cancer in men and women nonsmokers in New York State. In-person interviews were completed for 437 lung cancer cases (197 never smokers, 240 former smokers) and 437 matched population controls. Cases and controls were asked to report any history of physician-diagnosed nonmalignant lung disease; cases were more likely than controls to report such a history. Statistically significant associations were found for emphysema (odds ratio (OR) = 1.94, 95% confidence interval (CI) 1.10-3.43), chronic bronchitis (OR = 1.73, 95% CI 1.10-2.72), and the combined endpoint of emphysema, chronic bronchitis, or asthma (OR = 1.82, 95% CI 1.26-2.63). After adjustment for active and passive tobacco smoke exposure, emphysema, chronic bronchitis, and asthma (each condition and the combined endpoint) were significantly associated with lung cancer risk. The risk was more marked for squamous cell carcinomas and for subjects who were diagnosed at older ages, and it remained significant when surrogate interviews were excluded. These results are consistent with the hypothesis that certain prior lung conditions increase the risk of lung cancer in men and women nonsmokers.

Management of the pediatric airway is a crucial event in the care of critically ill infants and children. In a recent review of complications in pediatric anesthesia, the most common event was due to inadequate ventilation. 4 In the setting of a failed endotracheal intubation, invasive techniques in securing a difficult pediatric airway are limited by developmental differences in the anatomy of the child's airway. Methods used to secure an emergency airway in adults may not be applicable in the management of a neonate or infant due to anatomical and equipment-related factors. This article addresses these issues and suggests options for securing the pediatric airway after noninvasive techniques have been exhausted.

The purpose of this study was to compare the osseointegration of surface-blasted Ti6Al4V and CoCr implants in vivo. Ti6Al4V and CoCr rods blasted with 710 μm Al2O3 particles were bilaterally press-fit into the medullary space of distal femora of 24 rabbits. Evaluation was made radiographically, histologically, histomorphometrically (3, 6, and 12 weeks after implantation), and mechanically (12 weeks). Both Ti6Al4V and CoCr implants demonstrated good biocompatibility radiographically and histologically. Toluidine blue-stained sections revealed an osteoconductive effect of the blasted surface, and fluorochrome labeling analysis showed active bone formation at the bone–implant interface at as late as 12 weeks for both specimens. CoCr showed significantly lower interfacial shear strength than Ti6Al4V although the bone contact area with the implant surface was comparable and no intervening soft tissue at the bone–implant interface could be seen for either implant by scanning electron microscopy backscatter analysis. Unmineralized tissue (cartilage and osteoid) was observed more frequently on the CoCr surface than on the Ti6Al4V surface. These data show less osseointegration of CoCr implants with this blasted surface for this short period, possibly due to a slight difference in surface roughness and some negative effects of CoCr on bone attachment. © 1998 John Wiley & Sons, Inc. J. Biomed Mater Res, 42, 20–29, 1998.

Review of: "The Untold Story of Shiloh: The Battle and the Battlefield," by Timothy B. Smith, and "Shiloh: A Battlefield Guide," by Mark Grimsley and Steven E. Woodworth.

Part I-Food and Energy Security and Sustainable Agriculture Policy 1) Creative and Innovative Research - Our Only Hope for Achieving Sustainable Food and Energy Security. Gale A. Buchanan and Raymond L. Orbach 2) Moving Toward Energy Security and Sustainability in 2050 by Reconfiguring Biofuel Production. Stephen R. Hughes, Bryan R. Moser and William R. Gibbons. 3) Sustainability Standards Thomas P. Redick Part II-Soil and Water 4) Soil Degradation, Land Use and Sustainability Jerry L. Hatfield 5) Impact of Technology and Policy on Sustainable Agricultural Water Use and Food Security. Mahbub Alam, Greg Kruger, Sharon B. Megdal and David D. Songstad Part III-Sustainable and Secure Food Production 6) Turning the GM Battleship: The Tide of Popular Opinion and the Future of Genetically Modified Foods James E. McWilliams 7) Sustainable Production of Omega-3 Fatty Acids Jay Whelan, Ron Hardy, Rick Wilkes and Henry Valentin Part IV-Agronomic Implications 8) Achieving Sustainable Agriculture: Overview of Current and Future Agronomic Best Practices. Ravi P. Sripada, Pradip K. Das, Emilio S. Oyarzabal, Laura Grapes, Doug Griffith, Jennifer Luchte and David D. Songstad 9) Sustainable Agriculture and Soybean Breeding: Contribution of Soybean Yield Increase to Sustainable Agriculture. Duska Stojsin, Kevin W. Matson, Richard A. Leitz 10) Impact of Herbicide Tolerant Crops on Soil Health and Sustainable Agriculture Crop Production. S.H. Lee, D.E. Clay and S.A. Clay Part V-International Sustainable Agriculture and Food Security 11) The Role of Biotechnology in Sustainable Agriculture of the 21st Century: The Commercial Introduction of Bollgard II in Burkina Faso. Jeff Vitale and John Greenplate 12) The Borlaug Institute and Its Contributions to World Food and Economic Security Julie Borlaug, Josesph N. King, Linda Cleboski, Johanna Roman, Ma'ad Mohammed, Michael McWorter and Virginia M. Peschke 13) Water Efficient Maize for Africa (WEMA): An Example of a Public Private Partnership Sylvester Oikeh, Dianah Ngonyamo-Majee, Stephen I.N. Mugo, Kingstone Mashingaidze, Vanessa Cook and Michael Stephens Part VI-Chemicals 14) The Importance of Herbicides for Natural Resource Conservation in the U.S. Leonard Gianessi and Ashley Williams 15) The 4R-BMP Concept: Enhanced Nutrient Management for Agricultural Sustainability and Food and Energy Security Harold Reetz

Objectives:Evaluate the effect of increasing blood alcohol concentration (BAC) on the vestibular system as measured by abnormal body sway on posturography. Determine if there is a consistent level of BAC during which sway becomes adversely affected, as suggested by legal state limits of BAC for driving.Methods:Prospective study of 30 healthy adults randomized to alcohol versus no alcohol who consumed one beverage hourly followed by BAC measurement by BACtrack Select S80 Breathalyzer and posturography on both firm/soft surfaces with eyes open/closed. Primary outcome was dose-response rate of BAC on mean body sway. Nonlinear growth models were used to control for covariates.Results:The experimental (alcohol) group had 20 adults, and the control (no alcohol) group had 10 adults. BAC levels measured by breathalyzer ranged from 0 to 0.12. Overall analysis showed no statistically significant difference between male and female performance (P > 0.05). Increased alcohol consumption was associated with increased ab...

BACKGROUND In the 1980s, prostate specific antigen (PSA) came into wide use as a prostate carcinoma screening and detection method in the United States. Following the introduction of PSA, the age-adjusted incidence of prostate carcinoma reported by the Surveillance, Epidemiology, and End Results (SEER) program in the United States rose rapidly (from 84.4/100,000 in 1984 to 163/100,000 in 1991). When an increase in incidence is observed following the introduction of a screening method, a subsequent decrease in incidence may be expected as prevalent cases are removed from the population (a cull effect). Incidence rates may also fall due to factors such as decreased intensity of screening. The Utah Cancer Registry data were examined for a decrease in prostate cancer incidence. METHODS We tracked age-adjusted prostate carcinoma incidence trends from the population-based Utah Cancer Registry and compared them with rates from the SEER national registry. RESULTS A rapid and highly correlated rise in prostate carcinoma incidence has been observed in both SEER and Utah incidence rates between 1988 and 1991, the last year for which SEER data are available. In 1992, Utah incidence rates peaked at 236.2 per 100,000. In 1993 and 1994, Utah incidence rates fell to 195.0, and an estimated 164.0 per 100,000, respectively. CONCLUSIONS Population-based data from the Utah Cancer Registry indicates that the incidence of prostate carcinoma is decreasing rapidly after a similarly rapid increase. Cancer 1996;77:1342-8.

To study the complication rates of skin overgrowth, infection, and the need for revision surgery in longer length Baha™ abutments.Prospective observational cohort study compared with a retrospective historical control.After the University of Nebraska Medical Center (UNMC) Institutional Review Board approval was obtained, data was collected from a prospective 8.5-mm abutment study group of 21 subjects with informed consent from October 2011 through October 2012, and was compared to a retrospective 5.5-mm abutment historical cohort of 23 patients who had undergone Baha™ by the same surgeon from May 2010 to October 2011. Patient demographics, body mass index (BMI), smoking status, and wound complications (skin overgrowth, infection, the need for revision surgery) were statistically investigated and compared between the groups.Forty-four patients were studied. The groups were similar in smoking status, diabetes, and a female preponderance. The 8.5-mm abutment group was older (P = 0.012). The average BMI for both groups was classified as overweight and nearly obese (BMI 28.8). Rates of infection, skin overgrowth, and the need for revision surgery related to wound complications were significantly decreased in the longer 8.5-mm abutment group (P = 0.020, P = 0.012, P = 0.007, respectively). BMI did not correlate with decreased infection, skin overgrowth, and the need for revision surgery based on abutment length as hypothesized (P = 0.214, P = 0.206, P = 0.408).The 8.5-mm abutment lends to decreased complications postoperatively, including infection, skin overgrowth, and the need for revision surgery.3b.

For the very best and brightest asteroseismic solar-type targets observed by Kepler, the frequency precision is sufficient to determine the acoustic depths of the surface convective layer and the helium ionization zone. Such sharp features inside the acoustic cavity of the star, which we call acoustic glitches, create small oscillatory deviations from the uniform spacing of frequencies in a sequence of oscillation modes with the same spherical harmonic degree. We use these oscillatory signals to determine the acoustic locations of such features in 19 solar-type stars observed by the Kepler mission. Four independent groups of researchers utilized the oscillation frequencies themselves, the second differences of the frequencies and the ratio of the small and large separation to locate the base of the convection zone and the second helium ionization zone. Despite the significantly different methods of analysis, good agreement was found between the results of these four groups, barring a few cases. These results also agree reasonably well with the locations of these layers in representative models of the stars. These results firmly establish the presence of the oscillatory signals in the asteroseismic data and the viability of several techniques to determine the location of acoustic glitches inside stars., Comment: Accepted for publication in ApJ

The purpose of this study was to compare the host—bone response to hydroxyapatite/tricalcium phosphate (HA/TCP)-coated and noncoated titanium fibermetal implants placed in a load-sharing cancellous bone environment of the distal femurs of rabbits. The influence of implantation site was also investigated by comparing these intracancellous implants with intramedullary implants evaluated in a previous study. Three parameters were measured: percentage implant perimeter surface length in contact with new bone, percentage internal fibermetal surface length in contact with ingrown bone, and percentage of available pore space filled with bone. The HA/TCP coating significantly accelerated and increased bone ongrowth, new bone formation on the perimeter and internal surface of the implants. This effect was evident as early as 2 weeks after implantation. In contrast, there was no difference between HA/TCP-coated and noncoated implants in the bone ingrowth parameter, percentage of available pore space filled with bone, or pull-out strength. Scanning electron microscopy in the backscatter mode demonstrated that new bone formed directly onto the HA/TCP-coated fibers and did not usually form directly on noncoated fibers. Analysis of fluorochrome labeling revealed that bone formation in weeks 1 through 4 was primarily woven and there-after lamellar. Compared with intramedullary placement, intracancellous placement significantly accelerated the apposition of bone to the perimeter and internal surface of HA/TCP-coated implants and both accelerated and increased bone ingrowth as a percentage of available pore volume. These data show that the host response to titanium fibermetal implants is influenced both by HA/TCP coating and by the implantation site.

OBJECTIVES. Each case of a continuous series of invasive cervical cancer cases was studied with a structured review procedure conducted by an expert panel to assess the reason that it was not detected before it became invasive. METHODS. All cases of invasive cervical cancer diagnosed in a 5-year period among Connecticut residents were identified; a screening history and screening outcome were obtained for 72% (481 of 664). RESULTS. Two hundred fifty women (51.9%) had suboptimal screening. One hundred thirty-seven women (28.5%) had never had a screening test, and their mean age was greater than that of the rest of the study population (64.5 years vs 46.5 years). Of the 344 women who had ever had a Pap test, 113 (32.8%) had their last Pap test 5 or more years before their diagnosis of invasive cancer; 52 (15.1%) were not followed up properly; 33 (9.6%) had their last smear misread as normal; and 118 (34.3%) developed cervical cancer within 3 years of their last Pap test. CONCLUSIONS. Physicians, nurses, and other care providers need to ensure that woman have timely and accurate screening with proper follow-up, make increased efforts to reach older women, and improve quality control of Pap smear readings.

Retropatellar pain often accompanies malalignment syndromes and frequently is attributed to excessive patellofemoral contact stresses. Elevation (anterior displacement) of the tibial tubercle has been recommended to relieve these conditions. The degree to which patellar contact forces are decreased and the extent to which elevation alters medial-lateral forces have not been studied directly. We performed anterior translation of the tibial tubercle in knees from cadavers and measured the effect on the magnitude of the three-dimensional patellofemoral contact force with use of a specially designed 6-degrees-of-freedom force transducer, with the natural patellar articular surface in place. Measurements were made in nine knees (average age 67 years, range 46-92 years). The resultant contact force decreased linearly with increasing tubercle elevations of as much as 2.5 cm. The average reduction per centimeter of elevation was 17% of the force measured with no elevation. Elevation of the tubercle had an inconsistent effect on the medial-lateral component of the contact force. As the elevation was increased, six knees exhibited an increase in the medial-lateral component of the contact force acting medially on the knee and three knees exhibited a decrease in this force component. The results of this study show that, while elevation of the tubercle without medialization reduced the total contact force on the patella, the medial-lateral component of this force was altered in an unpredictable way.

Results of the direct in vitro measurement of the full three-dimensional representation of the patellofemoral contact force and the point of application on the patella of the resultant contact force for eleven normal knees are presented. The applied knee moment versus flexion angle pattern was similar to that experienced when rising from a chair. There was a wide variability of the details of the patellofemoral force interaction among the specimens tested. The magnitude of the resultant contact force increased approximately linearly with flexion angle for some knees while in others the force leveled off or decreased at higher flexion angles. The change in direction of the resultant contact force with respect to the patella was relatively small compared to the angular rotation of the patella. The medial-lateral component of the contact force exhibited substantial variability among knees. The direction of this force (medially or laterally directed) varied among knees and, in some knees, changed direction as a function of flexion angle. The point of application on the patella of the resultant contact force migrated superiorly from 20 to 90 deg flexion. Above 90 deg flexion this point tended to migrate inferiorly. The only significant and consistent effect of varying the direction of the quadriceps extension force was a change in the medial-lateral component of the contact force. In all cases, the tendency to sublux laterally increased when the extensor force was rotated 10 deg laterally and decreased when the extensor force was rotated 10 deg medially.

M IN IS E M IN A R S stapedectomies in the past were undoubtedly performed on ears with occult third window syndromes. We will present a review of superior SCD and other third window syndromes, with an emphasis on differentiating them from more common otologic diagnoses. Cases will be presented that illustrate how these syndromes should be included in the differential diagnosis of many common otologic presentations. SCD, the most common third window syndrome, will be discussed in detail, including diagnosis and treatment indications, options, and outcomes.

Objectives/Hypothesis Penetrating palatal trauma in children presents a diagnostic dilemma regarding the small but severe risk of injury to carotid vessels. Decisions regarding which children require computed tomography with angiography must be balanced against the risk of radiation-induced malignancy. Our objectives were to compare outcomes between children with and without computed tomography with angiography in the evaluation of palatal trauma and to identify thresholds where the ideal strategy changes in the management of children with palatal trauma through sensitivity analyses. Study Design Decision analytic techniques were used to compare management strategies for penetrating palatal trauma. Methods We assigned utilities to the following outcomes: 1) perfect health, 2) future malignancy, 3) carotid injury diagnosed by computed tomography with angiography, and 4) delayed diagnosis of stroke. We calculated outcomes when the risk of stroke ranged from 0.01% to 5.0% for a hypothetical cohort of 10,000 injured children. Results Not obtaining computed tomography with angiography is the optimal strategy when the stroke risk is less than 4.5%. In two-way sensitivity analyses that consider a range of probabilities of radiation-induced malignancy and stroke, not obtaining computed tomography with angiography on all patients dominates as a strategy until the risk of stroke exceeds 2.3%, and the risk of malignancy is under 0.24%. Routine imaging would introduce 20 additional malignancies for each additional stroke diagnosed. Conclusions Routine use of computed tomography with angiography for well-appearing children with palatal trauma should be reconsidered, as the risk of radiation-induced malignancy may outweigh the benefit of identifying the rare carotid injury. Level of Evidence 2b.

The immunodeficient child presents a unique challenge to the otolaryngologist, who must be able to recognize the early stages of immunodeficiency as well as be a consultant in later stages of the disease. Infection by HIV has brought about a new era both in the magnitude of immunodeficiency seen and in our understanding of the mechanisms of immune function. The current literature concerning HIV-infected children with manifestations in the head and neck is reviewed. Many similarities between HIV-infected children and other immunosuppressed patients have emerged, and salient features of immunodeficiency diseases of childhood are examined.

The relationship between patella alta and patellar subluxation may, in part, reflect the relationship between the height of the patella above the tibiofemoral joint line and the patellofemoral contact force. This study reports on the direct in vitro measurement of the patellofemoral contact force, and its point of application on the patella, as a function of patellar height. The contact force was measured by a specially designed six-degree-of-freedom force transducer under loading simulating rising from a chair. The magnitude of the resultant contact force increased significantly with superior displacement of the patella. The magnitude of the resultant contact force changed as much as 3% per millimeter of change in patellar height. The details of this response varied among the knees tested and depended on the original anatomical patellar height. For a high-riding patella, the onset of tendofemoral contact is delayed and the magnitude of the patellofemoral contact continues to increase with increasing flexion angle. Early onset of tendofemoral contact associated with a low-riding patella results in a concomitant reduction in the magnitude of the contact force. The medially directed component of the contact force acting on the patella resists lateral subluxation of the patella. This force component increased with superior displacement of the patella. This may explain in part the tendency for a high-riding patella to sublux. For all seven specimens tested the point of application of the resultant contact force migrated superiorly with inferior displacement of the patella.