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The etiologic role of fungi in chronic rhinosinusitis remains controversial. The purpose of this review is to further our understanding of molecular immunologic pathways activated by fungi and clinical trials of antifungals in severe subtypes of asthma and allergic fungal rhinosinusitis.Various fungal components such as protease and chitin are capable of eliciting a type 2 innate and adaptive immune response. However, definitive studies on the etiologic role of fungi in chronic rhinosinusitis (CRS) is dependent on the development of a fungi-induced murine model of CRS. Short of this model, extrapolations of observations and results from clinical trials in fungi-induced asthma subtypes support a key role of fungi in the pathophysiology of allergic fungal rhinosinusitis and possibly other CRS endotypes.Fungi plays a key role in the pathophysiology of several subtypes of chronic inflammatory respiratory diseases. However, a fungi-induced murine model of CRS is needed to explicitly investigate the molecular pathways and potential therapeutic targets.

A nonlinear reaction-diffusion partial differential equation occurring in models of transient controlled-potential experiments in electroanalytical chemistry is investigated analytically and numeri...

The purpose of this study was to explore the use of immersive and interactive virtual reality (VR) for analgesia, anxiety reduction, and overall satisfaction in patients undergoing outpatient postoperative debridements.Randomized crossover-controlled trial.Academic outpatient clinic.Adult patients who had functional endoscopic sinus surgery and skull base surgery and were undergoing office-based postoperative nasal endoscopy and debridement were recruited and followed for 2 consecutive office visits. Participants were randomized to receive either the control or experimental analgesia for the first postoperative visit (PO1) and crossed over into the opposite treatment arm during the second postoperative visit (PO2). Outcomes included procedural pain, anxiety and satisfaction scores, procedural time, and reflexive head movements per minute (RHM).Eighty-two participants were recruited. At PO1, 39 received standard analgesia, and 43 received an immersive VR experience. At PO1, the VR group experienced significantly less anxiety (VR technology holds promise as a nonpharmacologic analgesic and anxiolytic intervention for otolaryngology office-based procedures. Further study of VR use in other procedures is warranted.1, randomized controlled trial.

Purpose The pandemic related to the novel coronavirus (COVID-19) has led to a decrease in communicable diseases due to social distancing and mask-wearing. How have the prevalence of otitis media (OM) and its associated procedures changed during the pandemic? Study design Retrospective Cohort Study. Methods This is a retrospective cohort study using the Pediatric Health Information System® (PHIS) database, which consists of 48 children's hospitals. Regions were defined according to PHIS rules. We compared proportion of OM to total diagnoses codes, and collected mastoiditis, and MT placements from all encounters through January 1, 2019-June 31, 2021. Results In April 2020, there was a decrease in mean proportion of OM cases per 100 hospital visits (7 v. 2, p

In this study, we developed a predictive model of in vivo stent based drug release and distribution that is capable of providing useful insights into performance. In a combined mathematical modelling and experimental approach, we created two novel sirolimus-eluting stent coatings with quite distinct doses and release kinetics. Using readily measurable in vitro data, we then generated parameterised mathematical models of drug release. These were then used to simulate in vivo drug uptake and retention. Finally, we validated our model predictions against data on drug kinetics and efficacy obtained in a small in vivo evaluation. In agreement with the in vivo experimental results, our mathematical model predicted consistently higher sirolimus content in tissue for the higher dose stents compared with the lower dose stents. High dose stents resulted in statistically significant improvements in three key efficacy measures, providing further evidence of a basic relationship between dose and efficacy within DES. However, our mathematical modelling suggests a more complex relationship is at play, with efficacy being dependent not only on delivering an initial dose of drug sufficient to achieve receptor saturation, but also on the consequent drug release rate being tuned to ensure prolonged saturation. In summary, we have demonstrated that our combined in vitro experimental and mathematical modelling framework may be used to predict in vivo DES performance, opening up the possibility of an in silico approach to optimising the drug release profile and ultimately the effectiveness of the device.

Starting from a hand-drawn contour plot, this note develops a set of intersecting and contiguous circles whose perimeter, upon extending appropriately to three dimensions, can be seen to be a natural mathematical representation of the Wheatley heart valve.

OBJECTIVES/HYPOTHESIS No studies have evaluated the impact of the types of frontal sinus surgery (FSS) on objective olfaction scores. This study evaluated olfactory function and quality of life (QOL) in chronic rhinosinusitis (CRS) patients before and after total ethmoidectomy with frontal sinusotomy (FS). STUDY DESIGN Prospective cohort study. METHODS A prospective study of adult CRS patients undergoing FSS (Draf 2 or Draf 3 procedures) was conducted at a tertiary care center. Primary outcomes included brief smell identification test (BSIT) and sinonasal outcome test-22 (SNOT-22), which were assessed during preoperative evaluation, 6 to 9 weeks postoperatively, and 12 to 24 weeks postoperatively. Normosmia was defined as BSIT ≥9. Statistical significance was determined using the Wilcoxon signed-rank test with α = .05. RESULTS Thirty-eight patients followed up 12 to 24 weeks after FSS. The differences between baseline and long-term outcomes for BSIT (6.11 vs. 8.24, P = .00034) and SNOT-22 (55.49 vs. 24.32, P

OBJECTIVE Burnout is defined as work-related emotional exhaustion, depersonalization, and decreased sense of accomplishment. Virtual reality (VR) has emerged as an effective treatment modality for various conditions related to anxiety, however, few studies have assessed its role for stress management in residents. We hypothesize that VR-based mindfulness meditation can reduce resident burnout in real-world settings. STUDY DESIGN Prospective randomized crossover trial. METHODS Resident participants completed the validated Maslach Burnout Inventory (MBI). One group used a VR-based meditation app; the second group received no intervention. After a 2-month rotation, all subjects completed an MBI and crossed over to the other arm. Wilcoxon rank-sum tests were used to compare MBI scores before and after intervention, and to compare results by gender and postgraduate year. Mann-Whitney U tests were used to assess qualitative differences between participants. RESULTS Eighteen residents completed the study. Five participants were female and 13 were male. Weekly use of VR-guided meditation and paced breathing was associated with a significant decrease in emotional exhaustion (P = .009), and on subgroup analysis, male gender specifically was associated with a decrease in emotional exhaustion (P = .027). In the post-intervention survey, 42.9% subjects reported that VR encouraged them to employ paced breathing techniques, 71.4% reported that they would use the technology if regularly available, and 21.4% reported they would use paced breathing in the future. CONCLUSION VR-based therapy may serve as a successful tool in stress management and reduce the rate of burnout among otolaryngology residents. LEVEL OF EVIDENCE NA Laryngoscope, 131:1972-1976, 2021.

Introduction Significant charge disparities exist across New York State (NYS). Race and income are associated with increased charges. To determine risk factor, we correlate hospital charges for pituitary surgery with socioeconomic factors. Additionally, we identify patients at risk for increased hospital charges and provide insight into cost-effective practices. Methods Retrospective cohort study of the Statewide Planning and Research Cooperative System (SPARCS) database from the NYS Department of Health was conducted. The SPARCS database was reviewed. Patients who underwent transsphenoidal pituitary surgery from 1995 to 2015 were identified. Income and urban status were referenced from U.S. census data. Linear regression was performed to analyze the effect of sociodemographic factors, comorbidities, and complications on hospital charges while controlling for length of stay. Results A total of 9,373 patients were identified. Black (10.8%, p Conclusion Patients incurring higher chargers were more likely to have a smoking history, hypertension, hypothyroidism, and comorbidities. The determinants of this analysis may provide insight into barriers to patient access and cost improvement strategies. In addition, this emphasizes the need for future studies to create a risk stratification model, similar to those in other fields.

OBJECTIVES/HYPOTHESIS The purpose of this study was to compare timing of procedure, patient characteristics, outcomes, and charges for patients who underwent percutaneous versus surgical tracheostomy. STUDY DESIGN Retrospective cohort study. METHODS A retrospective analysis was performed for all patients who underwent tracheostomy in 2015 to 2016 in New York State. Patients were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes and stratified to the type of tracheostomy performed. The primary outcome of interest was mortality at index stay. Secondary outcomes of interest included length of stay and total hospitalization charges. RESULTS Of the 8,682 patients, 2,488 (28.7%) underwent percutaneous and 6,194 (71.3%) underwent surgical tracheostomy. At hospitals where both procedures were performed, percutaneous tracheostomy patients were older, had more comorbidities, and had lower income (P

Our aim is to simulate a nonlinear system of ODEs describing the flow in smectic liquid crystals. The nonlinear system is first linearized. We present a direct approach to compute the exact analytic solution of this linear system and use this solution as a starting profile in the Matlab package bvpsuite2.0 to obtain the approximate solution to the nonlinear system. Although, the solution of the nonlinear system has steep boundary layers and therefore is difficult to resolve, we demonstrate that bvpsuite2.0 can cope with the problem and provide an approximation with reasonable accuracy.

Intracranial meningiomas are the most commonly diagnosed brain tumor in the United States. With increasing incidence, efficient allocation of limited health care resources is a critical component of emerging value-based models of care. The purpose of this study was to evaluate the effect of patient and hospital variables on metrics of value-based care.The Statewide Planning and Research Cooperative System database was queried for records of patients undergoing intracranial meningioma surgery in New York State from 1995 to 2015. Multivariate logistic regression was used to investigate the effect of hospital volume and patient demographics on 30-day readmissions, 30-day mortality, prolonged length of stay (pLOS), and excess hospital charges.Among the 14,239 patients included, 10,252 (72%) cases were performed at high-volume centers (HVC) (75th percentile). HVC were associated with lower rates of readmissions, mortality, and pLOS, but higher hospital charges. In the multivariate analysis, HVC had reduced odds of pLOS (odds ratio, 0.56; P0.0001) and 30-day mortality (odds ratio, 0.39; P0.0001). Patient variables associated with adverse outcomes in the multivariate model included advanced age, male gender, higher Charlson Comorbidity Index, lower socioeconomic status (low income, Medicaid, and Medicare insurance), black race, and Hispanic ethnicity. These populations were more likely to undergo treatment at lower-volume centers.This statewide population analysis of readmissions, mortality, length of stay, and hospital charges after intracranial meningioma surgery identified patient predictors of adverse outcomes. These determinants may be used by hospitals to develop improved systems of care in at-risk populations.

BACKGROUND Prolonged length of stay (pLOS), disease-related complications, and 30-day readmissions are important quality metrics under the Affordable Care Act. The purpose of our study was to investigate the effect of patient-level and hospital-level factors on these outcomes for patients admitted for transsphenoidal pituitary surgery. METHODS The Statewide Planning and Research Cooperative System (SPARCS) database was queried to investigate 30-day readmissions and pLOS for transsphenoidal pituitary surgery in New York from 1995 to 2015. Multivariate logistic regression, adjusting for patient and hospital characteristics, was performed to assess the effect of these variables on the outcomes of interest. RESULTS A total of 9950 patients underwent transsphenoidal pituitary surgery; 7122 (72%), 2394 (24%), and 434 (4%) patients were treated at high-volume, medium-volume, and low-volume centers, respectively. Patient factors associated with treatment at high-volume centers (HVCs) included: top income quartile, private insurance, urban residence, and white or Asian race (p 65 years, elevated Charlson comorbidity index (CCI) scores, bottom income quartile, Medicaid and Medicare insurance, rural residence, black race, and Hispanic ethnicity (p < 0.05). Variables predictive of prolonged hospitalizations in our multivariable model included black race, Hispanic ethnicity, Medicaid insurance, low income, female gender, LVC, and comorbidities (panhypopituitarism, hypothyroidism, diabetes insipidus [DI], visual disturbances, CCI) while predictors of readmissions included Asian race, female gender, and comorbidities (Cushing syndrome, DI, CCI). CONCLUSION Patients undergoing transsphenoidal pituitary surgery at HVCs have shorter hospitalizations, fewer postoperative electrolyte abnormalities, and lower charges; however, socioeconomic factors may influence access to quality care.

Background Penetrating Extremity Trauma (PET) may result in arterial injury, a rare but limb- and life-threatening surgical emergency. Accurate and timely diagnosis is vital to enable potential intervention and prevent significant morbidity. Objectives Using a systematic review/meta-analysis approach, we determined the utility of Physical Examination (exam), Ankle-Brachial Index (ABI), and Ultrasonography (US) in the diagnosis of arterial injury in ED patients who have sustained PET. We applied a test-treatment threshold model to determine which evaluations may obviate CT Angiography (CTA). Methods We searched PUBMED, EMBASE, and SCOPUS from inception to November 2016 for studies of ED patients with PET. We included studies on adult and pediatric subjects presenting to the ED with PET. We defined the reference standard to include CTA, catheter angiography, or surgical exploration. When low-risk patients did not undergo the reference standard, trials must have specified that patients were observed for at least 24 hours. We used the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) to evaluate bias and applicability of the included studies. We calculated positive and negative Likelihood Ratios (LR+ and LR-) of exam (“hard” signs of vascular injury), US, and ABI. Using established CTA test characteristics (sensitivity 96.2%, specificity 99.2%) and applying Pauker-Kassirer method, we developed a test-treatment threshold model (testing threshold: 0.14%, treatment threshold: 72.9%). Results We included 8 studies (n=2,161, arterial injury prevalence: 15.5%). Studies had variable quality with most at high risk for partial and double verification bias. Some studies investigated multiple index tests: Exam (hard signs) was investigated in 3 studies (n=1,170), ABI in 5 studies (n=1,040), and US in 4 studies (n=173). Due to high heterogeneity (I2 >75%) of the results, we could not calculate LR+ or LR- for hard signs or LR+ for ABI. The weighted prevalence of arterial injury for ABI was 14.3% and LR- was 0.59 (95% CI 0.48-0.71) resulting in a post-test probability of 9% of arterial injury. Ultrasonography (US) had weighted prevalence of 18.9%, LR+ 35.4 (95% CI 8.3-151), and LR- 0.24 (95% CI 0.08-0.72); post-test probabilities for arterial injury were 89% and 5% after a positive or negative US, respectively. The post-test probability of arterial injury with positive US (89%) exceeded the CTA treatment-threshold (72.9%). The post-test probabilities of arterial injury with negative US (5%) and normal ABI (9%) exceeded the CTA testing-threshold (0.14%). Normal exam (no hard or soft signs) with normal ABI had a combined LR- of 0.01 (95% CI 0.0-0.10) resulting in an arterial injury post-test probability of 0%. Conclusions In PET patients, a positive US may obviate CTA. In patients with a normal exam (no hard or soft signs) and a normal ABI, arterial injury can be ruled out. However, a normal ABI or negative US cannot independently exclude arterial injury. Due to large study heterogeneity, we cannot make recommendations when hard signs are present or absent or when ABI is abnormal. In these situations, the physician should use clinical judgment to determine the need for further observation, CTA or catheter angiography, or surgical exploration. This article is protected by copyright. All rights reserved.

This work is concerned with time-dependent axisymmetric free surface flows of Oldroyd-B fluids for any value of β, the ratio of solvent to total viscosities. The Oldroyd-B constitutive equation is dealt with by employing a novel technique to calculate the conformation tensor while an EVSS transformation allows the solution of the momentum equations coupled with the free surface stress conditions: this avoids numerical instabilities that can arise when using small values of β. The convergence of this new methodology is verified on pipe flow and also by comparing results from the literature for the time-dependent impacting drop problem. This approach is then used to predict the time-dependent free surface flow after a viscoelastic drop impacts a solid surface for β values in the range [0, 1]. The impacting drop problem is investigated for polymer solutions containing a small solvent contribution ( β ⟶ 0 ) or without any solvent viscosity ( β = 0 ). In addition, a study of the bouncing drop problem for different values of β, Weissenberg and Reynolds numbers is undertaken.

This paper is concerned with a diffusion-controlled moving boundary problem in drug dissolution, in which the moving front passes from one medium to another for which the diffusivity is many orders of magnitude smaller. The classical Neumann similarity solution holds while the front is passing through the first layer, but this breaks down in the second layer. Asymptotic methods are used to understand what is happening in the second layer. Although this necessitates numerical computation, one interesting outcome is that only one calculation is required, no matter what the diffusivity is for the second layer.

In recent years, there has been a move away from the use of static in vitro two-dimensional cell culture models for testing the chemical safety and efficacy of drugs. Such models are increasingly being replaced by more physiologically relevant cell culture systems featuring dynamic flow and/or three-dimensional structures of cells. While it is acknowledged that such systems provide a more realistic environment within which to test drugs, progress is being hindered by a lack of understanding of the physical and chemical environment that the cells are exposed to. Mathematical and computational modelling may be exploited in this regard to unravel the dependency of the cell response on spatio-temporal differences in chemical and mechanical cues, thereby assisting with the understanding and design of these systems. In this paper, we present a mathematical modelling framework that characterizes the fluid flow and solute transport in perfusion bioreactors featuring an inlet and an outlet. To demonstrate the utility of our model, we simulated the fluid dynamics and solute concentration profiles for a variety of different flow rates, inlet solute concentrations and cell types within a specific commercial bioreactor chamber. Our subsequent analysis has elucidated the basic relationship between inlet flow rate and cell surface flow speed, shear stress and solute concentrations, allowing us to derive simple but useful relationships that enable prediction of the behaviour of the system under a variety of experimental conditions, prior to experimentation. We describe how the model may used by experimentalists to define operating parameters for their particular perfusion cell culture systems and highlight some operating conditions that should be avoided. Finally, we critically comment on the limitations of mathematical and computational modelling in this field, and the challenges associated with the adoption of such methods.

Importance Thirty-day readmission rates have been suggested as a marker for quality of care. By investigating the factors associated with readmissions in all otolaryngology subspecialties we provide data relevant for the development of risk stratification systems to improve outcomes. Objective To establish the association of surgical and hospital volume and patient characteristics with 30-day readmission rates to guide the development of otolaryngology-specific risk stratification models. Design, Setting, and Participants A retrospective cohort study including adult patients who underwent inpatient otolaryngology surgery in New York State between 1995 and 2015 was conducted using the Statewide Planning and Research Cooperative System (SPARCS). Regression techniques were used to describe relationships of patient-level factors, hospital, and surgeon volume to 30-day readmission rates in New York State. Main Outcomes and Measures The main outcome measures were patient-, surgeon-, and hospital-level risk factors for readmission. Secondary outcome measures were rate of readmissions by subspecialty procedure and by diagnosis on readmission. Results We identified 254 257 cases of otolaryngology surgery (147 065 women [58%], mean [SD] age 50 [17] years). The 30-day readmission rate was 6%. In a multivariable model, odds ratios (ORs) identified Medicaid insurance (OR, 1.46; 99% CI, 1.36-1.57), Medicare insurance (OR, 1.32; 99% CI, 1.24-1.42), bottom quartile income (OR, 1.08; 99% CI, 1.01-1.15), patient comorbidities measured by the Charlson Comorbidity Index (CCI) (CCI >1; OR, 2.31; 99% CI, 2.16-2.47), length of stay (LOS) (LOS >10 days; OR, 2.29; 99% CI, 2.00-2.45), rhinology (OR, 1.37; 99% CI, 1.24-1.51), laryngology (OR, 1.98; 99% CI, 1.62-2.43), and head and neck cancer (OR, 1.27; 99% CI, 1.17-1.37) procedures as readmission predictors. High-volume surgeons were protective of 30-day readmission (OR, 0.67; 99% CI, 0.635-0.708) relative to low volume. Hospital volume was not significantly associated to readmissions. The most common causes of readmission included wound- (2682 patients, 18%), respiratory- (1776 patients, 12%), cardiovascular- (1210 patients, 8%), and volume- (1089 patients, 7%) related disorders. Conclusions and Relevance This study evaluated the combined effects of patient-, surgeon-, and hospital-level factors on 30-day readmission after otolaryngology surgery. Socioeconomic factors, patient comorbidities, surgeon volumes, and procedure were significantly associated with 30-day readmission. Though the cause of 30-day readmission is multifactorial, a large portion is driven by socioeconomic factors. Addressing these disparities at the system level is necessary to address the described readmission disparities. The development of risk-stratification models based on patient-, procedure-, and surgeon-level factors may help facilitate resource distribution.

We present a numerical method for solving the Giesekus model without solvent viscosity. This paper is concerned with incompressible two-dimensional free surface flows and employs the finite difference method to solve the governing equations. The methodology involves solving the momentum equation using the implicit Euler scheme and an implicit technique for computing the pressure condition on the free surface. The nonlinear Giesekus constitutive equation is computed by a second order Runge–Kutta method. A novel analytic solution for channel flow is developed and is used to verify the numerical technique presented herein. Mesh refinement studies establish the convergence of the method for complex free surface flows. To demonstrate that the technique can deal with complicated free surface flows, the time-dependent flow produced by a fluid jet flowing onto a rigid surface is simulated and the influence of the parameter α on the jet buckling phenomenon is investigated. In addition, the simulation of the extrudate swell of a Giesekus fluid was carried out and the effect of the parameter α on the flow was similarly examined.

BACKGROUND Current delivery of patient education is done during the clinic visit, where physicians or clinic staff have limited time for each patient. One potential solution is to provide a multimedia surgical care tour delivered to patients throughout the perioperative period. The purpose of the study is to evaluate the effectiveness of this surgical care tour in enhancing patient knowledge and satisfaction after functional endoscopic sinus surgery (FESS). METHODS A total of 121 patients were enrolled and a double-blinded randomized controlled trial was initiated. Patients in the experimental group received 4 educational videos and automated reminders to take medications. The control group received a sham platform. Patients were randomized by MEDUMO software, and physicians, clinic staff, and patients were blinded. Patient satisfaction was measured by Consumer Assessment of Healthcare Providers and Systems (CAHPS) Surgical Care Survey Version 2.0. Patient knowledge was graded by the blinded surgeon and clinic staff. Fischer's exact test and 2-tailed independent samples Student t test were used to compare the satisfaction and patient knowledge outcomes, respectively. RESULTS Patients in the experimental group were more likely to answer "Yes, definitely" to "Did these pictures drawings models or videos help you better understand your condition and its treatment?" (95.7% vs 74.1%, p = 0.011). The mean ± standard deviation clinic staff assessment of patient knowledge was 3.04 ± 1.05 in the control group and 3.68 ± 1.41 in the experimental group (p = 0.043). CONCLUSION A multimedia surgical care tour was developed and has promising effects on patient satisfaction and knowledge after FESS.