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Objectives: This retrospective cohort study uses endoscopic assessment of the pharyngeal phase of swallowing in infants with laryngomalacia, to ascertain the impact of infant positioning on airway compromise and fluid dynamics during breastfeeding. The study aims to identify whether modification of infant positioning at the breast may improve the possibility of safe, successful breastfeeding in infants with laryngomalacia and concurrent breastfeeding difficulty. Methods: Twenty-three infants referred for noisy breathing and difficulty feeding were assessed with flexible endoscopic evaluation of swallowing (FEES) during breastfeeding. All had endoscopically confirmed laryngomalacia. During FEES, observations were made of clinical signs of airway compromise as well as endoscopically observable anatomical features and swallowing dynamics during breastfeeding, including tongue base position, view of laryngeal inlet and vocal folds, dynamic supraglottic soft tissue collapse, timing of milk flow into pyriform fossae/hypopharynx relative to sucking, and presence of penetration and/or aspiration. If airway and/or swallowing compromise was present, the infant's initial position at the breast was altered from supine or semi lateral decubitus position to semi-prone, with a description of the clinical and endoscopically observable changes that subsequently occurred. Results: Signs of dynamic airway obstruction and/or compromised airway protection with swallowing were present in 20 of the 23 infants (87%) in their initial supine or semi lateral decubitus position. These 20 infants were repositioned to semi-prone, with improvement and/or resolution of stridor and an improved ability to maintain latch in all infants. Continued endoscopic evaluation following positional change was possible in 16 infants, identifying anterior positioning of the tongue base, reduced dynamic supraglottic tissue collapse, reduced volume of milk flow into pyriform fossae during pauses in sucking and resolution of penetration and aspiration. Conclusion: This study has shown how alteration of breastfeeding position to semi-prone may improve dynamic airway obstruction and reduce aspiration risk in infants with laryngomalacia. [ABSTRACT FROM AUTHOR]

Aim: To investigate the incidence and characteristics of complications arising from frenotomy for ankyloglossia (tongue-tie) in New Zealand.Methods: Prospective surveillance among hospital-based paediatricians of complications arising from frenotomy for ankyloglossia to children <1 year old was conducted by the New Zealand Paediatric Surveillance Unit for 24 months, from August 2016 to July 2018, inclusive.Results: A total of 16 cases of complications arising from frenotomy were reported. The overall average annual incidence rate was 13.9/100 000. Geographic variation was noted with a peak of 85.6/100 000 in one region. Complications reported: poor feeding (44%), respiratory events (25%), pain (19%), bleeding (19%) and weight loss (19%). Three children (19%) also had delayed diagnosis of an underlying medical condition initially overlooked in favour of treating their ankyloglossia, this has not previously been reported. The majority (75%) of cases required admission to hospital. Treatments given included supplementary feeds (44%), surgical intervention (25%), breastfeeding support (19%), analgesia (13%) and blood products (13%). A total of 25% of children had one or more frenotomies; 50% were treated for two or more of: 'anterior' ankyloglossia, 'posterior' ankyloglossia or 'lip tie'; 50% had their frenotomies performed out of the hospital. Dentists were the most common performing practitioner (31%).Conclusions: Frenotomy rates in New Zealand are unknown. Poor feeding, pain, bleeding, weight loss and delayed diagnosis of an alternative underlying medical condition are important complications that require hospital assessment and admission. Practitioners and parents/families need to be aware of these possibilities. Centralised guidelines with access to specialist second opinions should be developed. [ABSTRACT FROM AUTHOR]

As the climate crisis continues to alter temperature regimes and water availability, studying how animals regulate water balance grows in importance. We studied variation in water loss across the skin among body regions and its plasticity in response to humidity acclimation in Western Fence Lizards (Sceloporus occidentalis). We examined the effects of climatic and physiological variables on cutaneous evaporative water loss (CEWL) and compared CEWL rates among body regions (dorsum, ventrum, head, dewlap, and mite patch). The best model to explain baseline variation in log-transformed CEWL included: body region; lizard mass; ambient temperature, vapor pressure deficit (VPD), and solar radiation at the time of capture; body temperature, ambient temperature, and VPD at the time of CEWL measurement; and the interactions between body region and each of mass and VPD at the time of capture. These results demonstrate cutaneous osmoregulatory variability among lizards based on climate and body size and within individual lizards based on body region. We also tested CEWL plasticity in response to humidity acclimation. Lizards exposed to humid conditions for 8 d exhibited increased CEWL, and lizards exposed to dry conditions exhibited decreased CEWL compared to initial measurements. This is evidence for rapid and significant acclimatory responses of CEWL in response to changes in environmental humidity. Such variation and plasticity suggest that lizards possess a certain degree of ability for using osmoregulatory changes to respond to climate change. [ABSTRACT FROM AUTHOR]

While recent decades have seen a rapid rise in cases of infant tongue-tie and in surgery to correct it, a controversy is now raging over the condition. Opinion is especially divided over so-called posterior tongue-tie, a variant which is detected based on the "feel" of the sub-lingual space. Drawing on ethnographic research with clinicians in England, we clarify the professional and personal commitments involved in the controversy. Our analysis is informed by Douglas' theory of cultural representations (grid-group theory), in which ideas of what is natural and unnatural constitute central metaphors. [ABSTRACT FROM AUTHOR]

This article introduces the first of what will ultimately be two collections of case studies in archaeologist–responsible/responsive artifact collector collaboration. Focused on the United States, the articles in this issue of Advances in Archaeological Practice share the thoughts and experiences of archaeologists representing diverse employment sectors (compliance, agency, museum, and university), artifact collectors, and members of descendant communities. Research areas extend from California to Virginia and from Ohio to the Texas/Mexico border. The breadth of the writers' backgrounds and their focal regions reinforce the wide applicability of collaborative best practices. Every author explicitly treats two subjects: (1) the intersection of their work with the Society for American Archaeology's (SAA) recently published guidelines for ethical professional–collector collaboration, and (2) their own practical suggestions for establishing and nurturing those relationships. This introductory article provides an overview of each of the other contributions, notes how the contributions articulate with the SAA guidelines, and offers its own, mostly philosophical suggestions for prospective members of professional–collector collaborations. [ABSTRACT FROM AUTHOR]

Objective: Inhaled foreign bodies in children are common and may be complicated by secondary airway tract infection. The inhaled foreign body may act as carrier of infectious material and the aim of this study was to explore the bacterial species associated with aspirated foreign bodies in a cohort of children.Methods: Retrospective case series of 34 patients who underwent rigid laryngobronchoscopy because of foreign body aspiration. Each patient had a sample taken from tracheobronchial secretions during the procedure.Results: The average patient age was 31.2 months and the average hospital stay was 2.5 days. Of the foreign bodies 24 (71%) were organic in nature and 10 (29%) were non-organic. Twenty eight (82.3%) patients had mixed oropharyngeal flora organisms growth. Fifteen (44%) samples were positive for organisms other than oropharyngeal flora with the most common cultured organisms being: Streptococcus pneumonia (4/12%), Haemophilus influenza (4/12%), Moraxella catarrhalis (4/12%). Four samples (12%) grew a fungus; Candida albicans was cultured in 3 patients and Aspergillus glaucus was identified in one sample. Of the non-oropharyngeal organisms 7(47%) demonstrated antibiotic resistance with four having resistance to amoxycillin, two resistant to penicillin and one resistant to cotrimoxazole.Conclusion: Some children who present with aspirated foreign body may be complicated with secondary airway infection. Antibacterial treatment might be considered in some of these cases. The regimen of antibiotics should aim to cover oropharyngeal flora, S. pneumonia, H. influenza and Moraxella catarrhalis. [ABSTRACT FROM AUTHOR]