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Background Radioiodine and Tc-99 m pertechnetate scans are routinely relied upon to detect metastasis in papillary thyroid cancer; false-positive scans are relatively rare. To our knowledge, no published reports exist of sarcoidosis causing such selectively false-positive scans. Methods We present a case of a 41-year-old woman with known metastatic papillary thyroid cancer (T1bN1aMx) in whom sarcoidosis-affected cervical and mediastinal lymph nodes demonstrated uptake of thyroid-targeting radionuclides. Only the minority of these nodes demonstrated radionuclide uptake, raising the suspicion of adjacent or coexisting sarcoid and metastatic involvement. Selective uptake of thyroid-targeted radionuclides by isolated sarcoidosis is, to our knowledge, a previously undocumented occurrence. Results Biopsies of uptake-negative mediastinal nodes revealed sarcoidosis. Pathology from a subsequent neck dissection excising uptake-positive cervical nodes also showed sarcoidosis, with no coinciding malignancy. Conclusions We document a case of sarcoidosis causing a selectively false-positive thyroid scintigraphy scan. It is useful for clinicians to be aware of potential false-positives and deceptive patterns on radionuclide scans when managing patients with both well-differentiated thyroid cancer and a co-existing disease affecting the nodal basins draining the thyroid gland.

Objectives Little evidence exists to guide surgeons in the management of the sublingual glands (SLG) not macroscopically involved by squamous cell carcinoma of the floor of mouth and oral tongue. This study aims to determine the frequency with which the SLG is invaded, to identify variables predicting for SLG invasion and the morbidity associated with it's resection in entirety. Study design: Retrospective cohort study. Methods: A review of 164 patients treated for oral cavity cancer at a tertiary institution with a large volume of head and neck malignancy was performed. Demographic data, rates of surgical complications and follow up information was recorded. Pathologic review of resected material in this group yielded 134 specimens in the region of the SLG. A detailed analysis of 63 specimens in which the SLG was included was carried out. Results: The median age was 58 years, mean follow up was 2.2 years, and there were 44 males and 19 females. Seventeen cases (27%) demonstrated histopathological SLG invasion. In patients with SLG involvement, this was evident at the time of surgery in 15 patients (88%). Microscopic SLG invasion, without macroscopic evidence at surgery, was present in only 4.2% of patients undergoing SLG resection. Clinical and pathological T stage (p = 0.023 and 0.005) and tumor thickness (p = 0.015) predicted for SLG invasion. Total SLG resection significantly increased the post-operative wound complication rate from 14% in patients without SLG resection to 25% (p = 0.05). Conclusion: Total SLG resection in early stage and thin squamous cell carcinoma of the floor of mouth and oral tongue provides minimal oncologic benefit and is associated with increased perioperative morbidity due to neck wound complications.

Mineralogy is usually the first geology course taken by students above the 100 level, and as such it is a vital building block for geology curricula. In recent years the number of mineralogists has declined, the relevance of the field has been questioned, and as a result the course has often been taught by less than enthusiastic non-specialists in the field. We believe that the key to restructuring mineralogy involves setting reasonable, prioritized course goals and employing (at least) four modern pedagogical learning methods: spiral learning, inquiry-based learning, concept maps, and use of interactive models and visualization. We present here a revised mineralogy curriculum that benefits from reflections on appropriate content and on these new learning methods and teaching styles.

Background The use of pre-operatively applied topical tissue expansion tapes have previously demonstrated increased rates of primary closure of radial forearm free flap donor sites. This is associated with a reduced cost of care as well as improved cosmetic appearance of the donor site. Unfortunately, little is known about the biomechanical changes these tapes cause in the forearm skin. This study tested the hypothesis that the use of topically applied tissue expansion tapes will result in an increase in forearm skin pliability in patients undergoing radial forearm free flap surgery. Methods Twenty-four patients scheduled for head and neck surgery requiring a radial forearm free flap were enrolled in this prospective self-controlled observational study. DynaClose tissue expansion tapes (registered Canica Design Inc, Almonte, Canada) were applied across the forearm one week pre-operatively. Immediately prior to surgery, the skin pliability of the dorsal and volar forearm sites were measured with the Cutometer MPA 580 (registered Courage-Khazaka Electronic GmbH, Cologne, Germany) on both the treatment and contralateral (control) arms. Paired t-tests were used to compare treatment to control at both sites, with p Results There was a statistically significant increase in pliability by a mean of 0.05 mm (SD = 0.09 mm) between treatment and control arms on the dorsal site (95% CI [0.01, 0.08], p = 0.018). This corresponded to an 8% increase in pliability. In contrast, the volar site did not show a statistically significant difference between treatment and control (mean difference = 0.04 mm, SD = 0.20 mm, 95% CI [−0.04, 0.12], p = 0.30). Conclusions This result provides evidence that the pre-operative application of topical tissue expansion tapes produces measurable changes in skin biomechanical properties. The location of this change on the dorsal forearm is consistent with the method of tape application. While this increase in skin pliability may account for the improved rate of primary donor site closure reported using this technique, the results did not reach our definition of clinical significance.

This study investigated attitudinal changes experienced by elementary students studying a second language and presents the development of an attitudinal assessment instrument, its reliability, and a summary of findings from initial administrations of the inventory. The primary purpose of this study was to compare attitudinal differences between elementary students (K-5) involved in a regular Foreign Language in the Elementary Schools (FLES) program with their peers who were not provided with additive foreign language curriculum. Results from the study showed that students participating in FLES programs had positive attitudes relating to school, perceived difficulty in language acquisition, perceived desirability of foreign language study, cultural views, and student self-esteem and confidence levels in relation to their academic achievement in comparison with their non-FLES peers. The conclusions of this study suggest that FLES programs provide students with improved motivation to participate, to persist, and to succeed in second language study.

Background The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has markedly increased over the last three decades due to newly found associations with human papillomavirus (HPV) infection. Primary radiotherapy (RT) is the treatment of choice for OPSCC at most centers, and over the last decade, the addition of concurrent chemotherapy has led to a significant improvement in survival, but at the cost of increased acute and late toxicity. Transoral robotic surgery (TORS) has emerged as a promising alternative treatment, with preliminary case series demonstrating encouraging oncologic, functional, and quality of life (QOL) outcomes. However, comparisons of TORS and RT in a non-randomized fashion are susceptible to bias. The goal of this randomized phase II study is to compare QOL, functional outcomes, toxicity profiles, and survival following primary RT (± chemotherapy) vs. TORS (± adjuvant [chemo] RT) in patients with OPSCC. Methods/Design The target patient population comprises OPSCC patients who would be unlikely to require chemotherapy post-resection: Tumor stage T1-T2 with likely negative margins at surgery; Nodal stage N0-2, ≤3 cm in size, with no evidence of extranodal extension on imaging. Participants will be randomized in a 1:1 ratio between Arm 1 (RT ± chemotherapy) and Arm 2 (TORS ± adjuvant [chemo] RT). In Arm 1, patients with N0 disease will receive RT alone, whereas N1-2 patients will receive concurrent chemoradiation. In Arm 2, patients will undergo TORS along with selective neck dissections, which may be staged. Pathologic high-risk features will be used to determine the requirement for adjuvant radiotherapy +/- chemotherapy. The primary endpoint is QOL score using the M.D. Anderson Dysphagia Inventory (MDADI), with secondary endpoints including survival, toxicity, other QOL outcomes, and swallowing function. A sample of 68 patients is required. Discussion This study, if successful, will provide a much-needed randomized comparison of the conventional strategy of primary RT vs. the novel strategy of primary TORS. The trial is designed to provide a definitive QOL comparison between the two arms, and to inform the design of an eventual phase III trial for survival outcomes. Trial registration NCT01590355

Due to significant differences in healthcare structure between the United States and Canada, there are unique barriers to adopting new medical technology in Canada. In this article, we describe our experience developing a transoral robotic surgery (TORS) program at Western University. Specifically, we outline the steps that were necessary to obtain institutional and multidisciplinary team approval, financial support, as well as surgeon and allied healthcare personnel training. This experience can potentially be used as a roadmap for other Canadian institutions pursuing a TORS program.

This study examined acute systolic (SBP) and diastolic (DBP) blood pressure responses within passive and modified proprioceptive neuromuscular facilitation (PNF) stretching techniques. Nonhypertensives (N = 60) were assigned to one of three treatment groups. Group 1 employed an antagonist passive stretch (APS), 6-sec maximal voluntary isometric contraction (MVIC) of the antagonist, and subsequent APS. Group 2 employed an APS, a 6-sec MVIC of the antagonist, submaximal concentric contraction of the agonist, and APS. Group 3 was similar to Group 2, with the deletion of an MVIC prior to the concentric contraction. Blood pressures were obtained during rest, baseline following passive stretch, and at the end of the three phases of the PNF technique. Range of motion (ROM) data were collected for baseline and treatment in terminal hip flexion for each group. All PNF treatments were effective for increasing ROM. One or two trials of PNF improve ROM and avoid increasing SBP, while a third trial increases SBP. Key words: flexibility, nonhypertensives, pressor response, range of motion

Background The purpose of this study was to prospectively assess clinical outcomes in patients undergoing a new method of donor site management for radial forearm free flaps. Methods 177 patients underwent reconstruction of ablative defects of the head and neck using a radial forearm free-flap. All patients had topical tissue expansion tapes applied to their forearms preoperatively. Closure rates, healing time and complications associated with the technique were assessed. Results Ninety-five percent of patients had their donor sites closed primarily with a locally harvested full thickness skin graft. Complications related to the tissue expansion device included a loss of device adhesion (19.3%) requiring reapplication and minor pruritic reactions (4.1%). Conclusions This system of donor site management has resulted in a significant reduction in the requirement of a split thickness skin graft for coverage of the donor site in a radial forearm free flap without any significant economic cost or patient morbidity.

To test the hypothesis that using Listerine mouthwash prior to administration of topical nasal lidocaine will result in improved pain and comfort outcomes during flexible nasolaryngoscopy (FNL).Randomized, controlled trial.A total of 120 patients were randomized to receive a combination of either treatment or placebo mouthwash followed by treatment or placebo nasal spray prior to an FNL examination.Pain and discomfort using a 100 mm visual analogue scale.The use of lidocaine significantly reduced pain (p = .011) and discomfort (p = .008) compared to placebo nasal spray. Using Listerine prior to administration of lidocaine resulted in the largest reductions. Patients having an extended nasal examination reported more pain (p = .001) and discomfort (p = .03) levels while demonstrating a greater benefit of topical lidocaine compared to those undergoing a primary laryngeal examination (p.001).Using Listerine prior to application of lidocaine nasal spray reduces the pain and discomfort of FNL. This effect was most clinically significant in patients undergoing an extended or full bilateral nasal examination.

Motivated by recent reports decrying the state of elementary science teaching in the United States, a science enrichment program has been instituted to stimulate science interest in elementary-age children and to provide preservice elementary teachers with additional science teaching experience. After one and a half years, our data indicate that children feel science at school is boring because they usually learn science only from a textbook and/or they don't feel challenged. Most of these children enjoy the more challenging Saturday Science QUEST courses because they are engaged in hands-on explorations and receive more attention from their instructors. Course descriptions, preservice teacher experiences, program maintenance, and feedback from children and parents are provided.