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We aimed to discern clinico-demographic predictors of large (≥8) tracheostomy tube size placement, and, secondarily, to assess the effect of large tracheostomy tube size and other parameters on odds of decannulation before hospital discharge.Factors determining choice of tracheostomy tube size are not well-characterized in the current literature, despite evidence linking large tracheostomy tube size with posttracheotomy tracheal stenosis. The effect of tracheostomy tube size on timing of decannulation is also unknown, an important consideration given reported associations between endotracheal tube size and probability of failed extubation.We collected information pertaining to patients who underwent tracheotomy at 1 of 10 U.S. health care institutions between 2010 and 2019. Tracheostomy tube size was dichotomized (≥8 and8). Multivariable logistic regression models were fit to identify predictors of (1) large tracheostomy tube size, and (2) decannulation before hospital discharge.The study included 5307 patients, including 2797 (52.7%) in the large tracheostomy cohort. Patient height (OR = 1.060 per inch; 95% CI 1.041-1.070) and obesity (1.37; 95% CI 1.189-1.579) were associated with greater odds of large tracheostomy tube; otolaryngology performing the tracheotomy was associated with significantly lower odds of large tracheostomy tube (OR = 0.155; 95% CI 0.131-0.184). Large tracheostomy tube size (OR = 1.036; 95% CI 0.885-1.213) did not affect odds of decannulation.Obesity was linked with increased likelihood of large tracheostomy tube size, independent of patient height. Probability of decannulation before hospital discharge is influenced by multiple patient-centric factors, but not by size of tracheostomy tube.

Background The Reflux Band, an external upper esophageal sphincter (UES) compression device, reduces esophago-pharyngeal reflux events. This study aimed to assess device efficacy as an adjunct to proton pump inhibitor (PPI) therapy in patients with laryngopharyngeal reflux (LPR). Methods This two-phase prospective clinical trial enrolled adults with at least 8 weeks of laryngeal symptoms (sore throat, throat clearing, dysphonia) not using PPI therapy at two tertiary care centers over 26 months. Participants used double dose PPI for 4 weeks in Phase 1 and the external UES compression device nightly along with PPI for 4 weeks in Phase 2. Questionnaire scores and salivary pepsin concentration were measured throughout the study. The primary endpoint of symptom response was defined as reflux symptom index (RSI) score ≤ 13 and/or > 50% reduction in RSI. Results Thirty-one participants completed the study: 52% male, mean age 47.9 years (SD 14.0), and mean body mass index (BMI) 26.2 kg/m2 (5.1). Primary endpoint was met in 11 (35%) participants after Phase 1 (PPI alone) and 17 (55%) after Phase 2 (Device + PPI). Compared to baseline, mean RSI score (24.1 (10.9)) decreased at end of Phase 1 (PPI alone) (21.9 (9.7); p = 0.06) and significantly decreased at end of Phase 2 (Device + PPI) (15.5 (10.3); p

Domestic and international crisis dynamics and management is often a difficult subject to teach to a group of high school or undergraduate-level students. Attempting to convey the sense of physical and mental duress that often exist during times of crisis is extremely difficult through conventional lecturing and discussion. In most cases, the best method to teach such lessons to a classroom of students is through in-class simulations such as Model United Nations, or Model Arab League among others. While teaching a course on U.S. National Security Policy at the University of Georgia, I designed a simulation of the U.S. national security apparatus in order to teach institutional design, decision-making, crisis dynamics and management, as well countless other lessons from material and lessons throughout the course. As part of the design of the simulation, I created positions and personalities for approximately 40 student to play that helped to provide students with essential background information for preparation as well as to make the interpersonal dynamics of the simulation as realistic as possible when compared to the same dynamics that we covered when learning about how U.S. national security policy is made and carried out. To accomplish this, I provided each student with a unique position assignment (i.e. President, Vice President, Secretary of State, U.S. Senator, etc.), their general position on the use of military force (which included categories such as a pure hawk, hawkish, moderate, dovish, or a pure dove), a brief description of the actor’s position to help students to conduct background research and to prepare position papers on their respective position prior to the simulation, the actor’s relationship with other actors (i.e. those who are their allies and who are their opponents during the simulation), and the actor’s particular area of expertise and what the basic expectations of their character during the simulation will be. During the actual simulation, the students are presented with a real-time national security crisis that begins as an energy security threat and evolves into a multifaceted crisis that operates within several domains simultaneously. These include domains such as global and domestic terrorism, economic crises and trade relationships, humanitarian interventions, weapons proliferation, energy security, among many others. The fundamental purpose of such a simulation is to place students in the position of real American policymakers to reinforce the lessons and activities covered over the duration of the course.