bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Retention and Complication Rates of Large‐Bore (Paparella II) and Small‐Bore Middle Ear Ventilating Tubes
Authors: Klingensmith Mark R. , Strauss Melvin , Conner George H.
Published: July 2017

Large‐bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large‐bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.
Location of the Vibratory Segment in Tracheoesophageal Speakers
Authors: Wetmore Stephen J. , Ryan Stephenie P. , Montague James C. , Krueger Kathleen , Wesson Kathleen , Tirman Robert , Diner Wilma
Published: July 2017

The Singer‐Blom tracheoesophageal puncture procedure for surgical‐prosthetic voice restoration has proved to be a viable option for alaryngeal speech rehabilitation. Following tracheoesophageal puncture, occlusion of the tracheostoma shunts pulmonary air through the Blom‐Singer prosthesis into the cervical esophagus. The pulmonary air passing through the cervical esophagus and into the hypopharynx causes a portion of the upper alimentary tract to vibrate in a manner similar to that of the pharyngoesophageal segment during the production of esophageal speech. To study the location and shape of the vibratory segment in tracheoesophageal speakers, videofluoroscopy and simultaneous voice recording were performed with 16 patients. To analyze the vibratory segment(s), photographs were made of the videotaped image white it was stopped during the patients' production of the /a/ sound. The most frequent location of the vibratory segment was in the lower third of the neck, which corresponds to cervical vertebrae C5 through C7. Five of the subjects had two separate vibratory segments and two other subjects had long vibratory segments. The vibratory segment(s) in tracheoesophageal speakers was found to be similar to the vibratory segment(s) in esophageal speakers.
Auditory and Vestibular Function in Hyperbaric Oxygen
Authors: Marsh Roger R. , Lambertsen Christian J. , Schwartz Daniel M. , Clark James M. , Wetmore Ralph F.
Published: July 2017

The therapeutic value of high partial pressures of oxygen is limited by the toxicity of oxygen. Pulmonary damage, visual impairment, and convulsions are known hazards during hyperoxic exposure, but dose‐effect relationships have not been quantified for specific organs or functions. As part of an integrated study of organ oxygen tolerance in man (Predictive Study V of the Institute for Environmental Medicine), auditory and vestibular function was evaluated in man before, during, and after exposure to 100% oxygen at 3 atmospheres absolute pressure for 2 to 3.5 hours. No alterations in hearing or equilibrium were detected, suggesting that ototoxicity is not a factor that would limit exposure under these conditions.
Effect of Spinal Cord Transection on Spontaneous Activity Recorded from Type I Neurons of the Medial Vestibular Nucleus in Compensated Hemilabyrinthectomized Gerbils
Authors: Clegg Thomas J. , Perachio Adrian A.
Published: July 2017

Spontaneous activity was recorded from type I neurons of the medial vestibular nuclei (MVN) in unanesthetized, decerebrate gerbils to determine the effect of spinal cord transection on compensation following labyrinthectomy. Immediately after labyrinthectomy there was an increase in activity of type I neurons on the intact side and an absence of activity on the injured side. Following compensation from labyrinthectomy, the distribution and activity rates approximated those of nonlabyrinthectomized animals. Spinal cord transection resulted in an increase in activity in type I MVN neurons contralateral to the labyrinthectomy in compensated animals and bilaterally in nonlabyrinthectomized animals. These results illustrate that type I neurons apparently are under an indirect inhibitory control from both the contralateral labyrinth and the spinal cord. In compensated animals spinal cord inhibition exists only on the intact side. This suggests that the symmetry in type I activity bilaterally in the compensated animal is in part the result of asymmetric spinal cord input.
Normal Nasal Resistance
Authors: Pallanch John F. , McCaffrey Thomas V. , Kern Eugene B.
Published: July 2017

Eighty normal adults without nasal symptoms were studied to determine normal nasal resistance values and the variation of nasal resistance in normal adults. A microprocessor‐based system for collection and analysis of transnasal pressure and flow was used to obtain nasal resistance values. Unilateral and total transnasal pressure and flow values were determined before and after decongestion of the nose with 1% phenylephrine spray. The distribution of the 80 resistance values was found to be skewed to the right. Log transformation of the resistance values was the best method to normalize their distribution. The mean and variation of normal nasal resistance are reported at flows of 0.1 and 0.2 L/sec, at pressures of 0.5 and 1 cm H2O, and at radii of 1, 2, and 3 on the pressure‐flow curve.
Streptomycin treatment in Meniere's disease
Authors: Moretz William H. , Shea John J. , Orchik Daniel J. , Emmett John R. , Shea JOhn J.
Published: July 2017

Streptomycin treatment in Meniere's disease has traditionally been used for control of vertigo in patients with severe bilateral involvement or unilateral involvement in the only hearing ear. Guidelines for use that have worked at the Shea Clinic are presented. in addition, a special case is discussed in which this form of therapy has been used for treatment of fluctuant hearing loss in a patient with Meniere's disease.
Mucociliary Function Following Sinus Mucosal Regeneration
Authors: Benninger Michael S. , Schmidt Jonathan L. , Crissman John D. , Gottlieb Cary
Published: July 2017

To evaluate sinus mucosal regeneration and cilia motility after surgical removal, 15 rabbits underwent unilateral removal of maxillary sinus mucosa. The opposite sinus served as an unoperated control. After 10 weeks, specimens were taken for examination from all operated on and control sinuses. Light, dark‐field, and electron microscopy were performed. Mucosa from eight of the 15 sinuses operated on showed ciliary regeneration by light microscopy; six of these exhibited motile cilia on dark‐field examination. Histopathologic findings of marked fibrosis, decreased seromucinous glands, and significant inflammation were commonly present in the sinuses operated on. Electron microscopy revealed frequent abnormalities, including complex and edematous cilia and fewer than normal cilia per unit area compared to controls. The dark‐field, light, and electron microscopic findings of the regenerated, post‐surgical mucosa are discussed.
Endoscopic CO2 Laser Arytenoidectomy for Postintubation Glottic Stenosis
Authors: Lim Romeo Y.
Published: July 2017

Extended endotracheal intubation for assistive respiration can lead to cricoarytenoid joint fixation and subsequent bilateral midline vocal cord fixation—thus, complete glottic stenosis. Endoscopic CO2 laser arytenoidectomy was performed on 10 patients for bilateral midline vocal cord fixation caused by prolonged translaryngeal endotracheal intubation because of central nervous system respiratory insufficiency resulting from various causes. Eight of these patients had concomitant cricopharyngeal myotomy for associated severe upper pharyngeal dysphagia. All of these patients had successful return of airway, voice, and swallowing functions. The advantages of the CO2 laser for endoscopic arytenoidectomy are its facility, hemostasis, precision, and minimal scarring.
Control of Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia
Authors: Siegel Michael B. , Keane William M. , Atkins Joseph P. , Rosen Marc R.
Published: July 2017

Twenty‐nine patients were admitted to Pennsylvania Hospital between March 1984 and July 1990 with a diagnosis of epistaxis and hereditary hemorrhagic telangiectasia. Data were obtained through a retrospective review of the charts of these patients. Patients were treated for epistaxis with the CO2 laser, neodymium:aluminum garnet laser with a wavelength of 1064 nm (Nd‐Yag), Nd‐Yag laser with a wavelength of 532 nm (KTP), septodermoplasty, or any combination of these procedures. Patients under‐went an average of 2.5 procedures each. Overall, 25 of 29 patients reported their symptoms had greatly improved with therapy. The average length of time without the need for further surgical intervention was 16.3 months for the Nd‐Yag laser and 11.7 months for the KTP laser. Septodermoplasty using buccal mucosal grafts allowed patients to avoid additional procedures for 24.4 months, which was twice as long as for standard septodermoplasty using split‐thickness skin grafts. Although no therapy completely resolves the epistaxis, laser therapy combined with septodermoplasty enables the patients to gain excellent control of the epistaxis for several years.
Cranial Nerve Preservation in Lesions of the Jugular Fossa
Authors: Jackson C. Gary , Cueva Roberto A. , Thedinger Britt A. , Glasscock Michael E.
Published: July 2017

The most significant objection to the proposal of lateral transtemporal cranial base surgery for the treatment of jugular foramen tumors is the perceived lasting morbidity attendant to aggregate cranial nerve loss. As techniques become more standardized and earlier diagnosis generates smaller tumors for treatment, outcome has become more predictable. Surgery has become the recognized management preference for these cranial base lesions. The purpose of this article is to assess the role of surgery in the treatment of jugular foramen lesions, as well as to review some of the technical highlights of conservation surgery, its clinical prerequisites, and reasonable expectations. We review 100 lateral skull base surgical cases of lesions involving the jugular foramen. The majority of these lesions—77 of 100—were paragangliomas. For these glomus tumors, cranial nerve preservation correlated well to tumor size and location. The diversity of the remaining 23 cases prevented any substantive conclusions.
The Caldwell‐Luc Procedure in 1991
Authors: Blitzer Andrew , Lawson William
Published: July 2017

In the pre‐antibiotic era, George Caldwell and Guy Luc both designed an operation to remove infected polypoid tissue from the maxillary antrum, as well as to provide drainage and ventilation of the sinus. With the development of antibiotics and the surgical endoscopes, many of the former indications for the Caldwell‐Luc procedure have changed. However, the Caldwell‐Luc procedure still offers optimal exposure for decompression of Grave's ophthalmopathy, pterygomaxillary space surgery, management of some maxillary trauma, removal of antral foreign bodies, repair of some oral‐antral fistulae, management of maxillary osteomyelitis and benign maxillary tumors, and irreversible mucosal disease and endoscopic surgical failures.
Management of the Thyroid Isthmus in Tracheostomy: A Prospective and Retrospective Study
Authors: Calhoun Karen H. , Weiss Raymond L. , Scott Bruce , Guendert Denise , Hokanson James A.
Published: July 2017

The thyroid isthmus is often encountered while a tracheostomy is being performed. This study details retrospective and prospective comparison of electrocautery division of the isthmus with older techniques. In this study, electrocautery division of the thyroid isthmus during tracheostomy is faster and as safe as other techniques with respect to blood loss, perioperative complications, and airway outcome.
Epidemiologic Issues Related to Nasopharyngeal Radium Exposures
Authors: Shore Roy E.
Published: July 2017

A number of topics are discussed related to the potential for and pitfalls in undertaking epidemiologic studies of the late effects of nasopharyngeal radium irradiation. The available evidence indicates that linear extrapolation of risk estimates from high‐dose studies is a reasonable basis for estimating risk from radium exposure or other situations in which the radiation exposures were fairly low and fractionated. Epidemiologic study of populations given nasopharyngeal radium irradiation is worthwhile scientifically if several criteria can be met. It is very Important that any such study has adequate statistical power, which is a function of the doses to the organs of interest and the radiation risk coefficients for those organs, as wed as the available sample size. If the organ doses are low, a prohibitively large sample size would be required. Other problems with low‐dose studies include the likelihood of false‐positive results when a number of health end points are evaluated and the impact of dose uncertainties, small biases, and confounding factors that make the interpretation uncertain. Cluster studies or studies of self‐selected cohorts of irradiated patients are not recommended because of the potential for severe bias with such study designs. The ability to define subgroups of the population who have heightened genetic susceptibility may become a reality in the next few years as genes conferring susceptibility to brain cancers or other head and neck tumors are identified; this scientific advance would have the potential to alter greatly the prospects and approaches of epidemiologic studies.
Feasibility of an Epidemiologic Study of Submariners Who Received Radium Irradiation Treatment
Authors: Kang Han K.
Published: July 2017

Thousands of World War II veterans reportedly received nasopharyngeal irradiation with radium‐tipped applicators for treatment of middle ear pressure problems known as aerotitis media. Because of concerns about adverse health effects of radiation exposure, including the increased risk of head and neck cancer, the feasibility of identification of a large number of veterans with documented exposure for an epidemiologic study was investigated. The irradiation treatments were found to have occurred at the New London Naval Medical Research Department, at several Naval Hospitals, and aboard ships during the period from 1945 to 1952. Documentation of the treatment on veterans' medical records was sparse and inconsistent. Only 8 of 668 records reviewed were found to have evidence of the radium treatment: 7 from 33 self‐reported veterans and 1 from 635 names on submarine school class rosters and submarine muster rolls. There appears to be no practical way to identify from military service and medical records a large number of submariners who received the treatment.
Navy Review of Nasopharyngeal Radium Treatments of Submarine Candidates
Authors: George Capt J. D.
Published: July 2017

From approximately 1945 through 1960 nasopharyngeal radium treatments were used to treat barotrauma incurred during submarine escape training by submarine candidates. Concern has been expressed that the treatments placed submarine candidates at significantly Increased risk of having brain cancer develop. The concern is based on brain cancer incidence rates reported in a study of Washington County children. Using comparable populations' risk coefficients and secondary brain tumor incidence rates, the excess number of brain cancers per 10,000 subjects during the 42.5 years after treatment was calculated to be 0.5 to 2.8 cases and 1 case, respectively. Personnel records of a sample of those treated and others whose treatment status was unknown were reviewed to determine the feasibility of an epidemiologic study to confirm the cancer risk. The records indicated treatments were not consistently documented to confirm who was treated. In addition, social security numbers are not known to aid in determination of vital status. In conclusion, nasopharyngeal irradiation does not appear to pose a significant risk to submariners, and it is not feasible to use the submariner population to do a meaningful epidemiologic Study to Clarify the cancer risk.
Neurodevelopmental Outcome of Infant Cardiac Transplant Recipients
Authors: Suddaby Elizabeth C , Samango-Sprouse Carole , Vaught Donna R , Custer Deborah A
Published: July 2017

Normal growth and development are indicators of the success of infant cardiac transplantation. The clinical transplant coordinator must be aware of age-appropriate milestones in gross motor, fine motor, language, cognitive, and social skills, so that accurate assessment and early intervention can be instituted. In this review of five cases, gross motor development was the only category with consistently lower scores. Gross motor development did improve in the two cases tested more than once. Length of hospitalization before and after transplantation and use of sedative medications during the waiting period may have affected developmental outcome scores.
Evaluating a Successful Coroner Protocol
Authors: Jaynes Christopher L , Springer James W
Published: July 2017

The coroner release rates for the service of a particular organ procurement organization were evaluated through a retrospective analysis, which included the year before (1991), the year during (1992), and the year after (1993) the adoption of a formal protocol for coroner's cases. In 1991, 22 of 55 (40%) coroner cases were denied for donation by the coroner. In 1992 and 1993, 12 of 55 (22%) and 9 of 56 (16%) coroner cases, respectively, were denied for donation. More significantly, in 1991, 4 of 6 (67%) cases of homicidal gunshot wound to the head were denied for donation by the coroner, whereas only 1 of 13 (8%) such cases were denied in 1993. Also in 1991 all closed head injuries (two) from falls were denied for donation by the coroner, whereas in 1993 1 of 8 (12%) closed head injuries was denied for donation. Finally, all 4 of 4 nonaccidental traumas (ie, child abuse) were denied in 1991, but 1 of 2 were released in both 1992 and 1993. Further education and awareness efforts could reduce the rates of coroner denial even more significantly.
Returning to Work after Liver Transplant: Experiencing the Roadblocks
Authors: Thomas Debera Jane
Published: July 2017

Liver transplant has been the treatment of choice for people with end-stage liver disease since the mid-1980s. The theme of returning to work after liver transplantation emerged from the data of a phenomenological study examining the lived experience of people with liver transplants. Thirteen liver recipients were interviewed using a semistructured approach. Only one of the first nine participants was able to return to work after the transplant; therefore, the last four participants were purposely chosen because they had been able to return to work. The possibility of losing health insurance benefits and disability benefits prevented many participants from working. Those able to return to work had professional careers that afforded them flexibility in their work schedule. Some implications for health professionals lie in the area of healthcare and health insurance policy change. Avenues for health insurance reform could be explored in an effort to empower the transplant recipient.
The Case against More Public Education to Promote Organ Donation
Authors: Verble Margaret , Worth Judy
Published: July 2017

The organ procurement community has always considered public education a primary challenge. According to conventional wisdom, greater awareness generated by public education will lead to more donated organs. This notion may be based on faulty assumptions about public education and about the relationship between awareness and behavior. Public education, as the primary focus for the organ procurement community, should be abandoned. Increased efforts in professional education and basic research are more appropriate endeavors for organ procurement organizations.
Analysis of Donor versus Nondonor Demographics
Authors: Schaeffer Margaret J , Johnson Emily , Suddaby Elizabeth C , Suddaby Steven C , Brigham Lori E
Published: July 2017

A retrospective analysis of the demographic features of all potential organ donors over a 3-year period (1994–1996) at one organ procurement organization was conducted. The potential donor pool of 495 people was 42% female and 58% male, with a slight difference in consent by gender. The mean income difference between donors and nondonors was less than $3000 per year (obtained from zip code census data). Educational achievement affected donation at the lowest educational levels. Cause of death influenced donation, with motor vehicle crash victims donating more often. The strongest factor in consent for donation was ethnicity; whites were more likely to donate than were other ethnic groups. The combination of gender, ethnicity, and cause of death improved the probability of determining a positive outcome to 63%. Demographic information on donors and nondonors can increase public and professional understanding as well as influence decision making to improve donation.
Determining Preferred Educational Methods for Neurological Surgery Residents regarding Organ Donation
Authors: Taylor Gloria , McGaw Lin Johnson
Published: July 2017

Design and implementation of professional education, especially physician education, continues to challenge procurement professionals. At the request of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, the United Network for Organ Sharing undertook a project to develop educational materials for neurological surgery residents. A survey tool was developed and administered on site at 11 neurological surgery residency programs in the United States. The survey explored the types of learning environments, teaching methods, educational resources, and audiovisual aids that neurological surgery residents typically experience during their residency programs. In addition, the survey sought to uncover the residents' informational needs regarding organ and tissue donation presentations as well as their educational program preferences. Based on our findings, neurological surgery residents prefer presentations that are brief and to the point, that are easily understood, that require no reading, that contain limited important information, and that always include food.
Identifying Donor Concerns to Increase Live Organ Donation
Authors: Hiller Janet , Sroka Myrna , Weber Rebecca , Morrison Ann S , Ratner Lloyd E
Published: July 2017

Increasing organ donation from live donors is a means to increase the pool of kidneys available for transplantation. To increase the number of live kidney donors, the major concerns of donors must be determined and addressed. This article describes the health and socioeconomic concerns of 61 live kidney donors from the Johns Hopkins Institutions between February 1, 1995 and December 1, 1997. Seventy-five percent of donors reported they had concerns, the most common ones being the effect of donation on their future health, how many work days they would miss, the ability to return to the same activities, and the pain they would experience. Other reported concerns consisted of fear of dying, the risks to a future pregnancy with one kidney, the fear that a son or daughter may need a kidney in the future, and the impact of donation on the family health insurance premium. Interventional strategies including the use of the laparoscopic donor nephrectomy procedure are offered to address these concerns.
Pregnancy Outcomes in 10 Female Pancreas-Kidney Recipients
Authors: McGrory Carolyn H , Radomski John S , Moritz Michael J , Armenti Vincent T
Published: July 2017

Female recipients of pancreas-kidney transplants may have an increased chance for pregnancy, because transplantation often restores fertility. Data on pregnancy after pancreas-kidney transplantation were analyzed by the National Transplantation Pregnancy Registry at US transplant centers. Ten recipients who were on cyclosporine-based immunosuppression were studied. A total of 15 pregnancies had resulted, of which 12 were live births. Among the 12 newborns, prematurity and low birth weight occurred in 75% and 83% of the cases, respectively. Three had complications associated with prematurity. Two thirds of the infants were delivered by cesarean section. All children are developing well with no apparent residual problems. During pregnancy, hypertension and urinary tract infections occurred frequently among recipients. Two recipients had three subsequent graft losses within 2 years of giving birth; however, both were successfully retransplanted. Successful pregnancy is possible for female pancreas-kidney recipients.
Islamic Views on Organ Donation
Authors: Syed Jaffer
Published: July 2017

As medical technology continues its advance, the use of organ transplantation for the palliation and cure of chronic diseases is rising. However, many barriers to organ donation exist, including religious ones. It has long been known that Muslims in North America tend not to donate organs. In the past this tendency has been attributed to religious prohibitions even though cultural views may also play a strong role. The purpose of this article is to explore and define the Islamic religious opinion on organ donation and transplantation to enhance healthcare professionals' understanding of Islamic views concerning brain death and organ donation. It is hoped that this knowledge and understanding may benefit both patients and caregivers in the North American healthcare setting.
New Strategies Using ‘Low-Dose’ Mycophenolate Mofetil to Reduce Acute Rejection in Patients following Kidney Transplantation
Authors: Ulsh Paula J. , Yang Harold C. , Holman Michael J. , Ahsan Nasimul
Published: July 2017

Context

Tacrolimus, microemulsion cyclosporine (Neoral), and mycophenolate mofetil (MMF) at 2 and 3 grams daily have demonstrated superior immunosuppressive properties in several recent clinical trials involving solid-organ transplants. An effective immunosuppression may be maintained with lower doses of MMF administered with either tacrolimus or microemulsion cyclosporine.

Objective

To compare tacrolimus plus “low-dose” MMF-based immunosuppressive regimen (TMBIR) with Neoral plus “low-dose” MMF-based immunosuppressive regimens (NMBIR) among kidney transplant recipients.

Design

Prospective, randomized study.

Patients

53 consecutive adult recipients of kidney transplant. Both groups (TMBIR and NMBIR) were equally matched on demographic characteristics.

Interventions

Participants were randomized to receive orally either tacrolimus (0.08 mg/kg twice daily) (n=27) or Neoral (4 mg/kg twice daily) (n=26). Both regimens were started before surgery and continued when allograft demonstrated no postoperative acute tubular necrosis. Both groups received similar “low-dose” MMF (500 mg twice daily) and prednisone (2 mg/kg/day to taper off after 1 year). Switch from tacrolimus to Neoral or vice versa was allowed after refractory rejection or serious adverse events.

Main Outcome Measure

Acute rejection and patient and graft survival 1 year following kidney transplant.

Results

One-year patient survival rates were 88.9% for the TMBIR group and 100% for the NMBIR group; 1-year graft survival rates were 88.9% for the TMBIR group and 96.1% for the NMBIR group. No significant differences were found in the incidence of biopsy-confirmed acute rejection (14.8% TMBIR vs 23% NMBIR). Steroid-resistant rejections requiring cytolytic antibody therapy were higher in the NMBIR group (50% vs 25%). Three patients crossed over from NMBIR to TMBIR for refractory rejections and 1 patient crossed over from TMBIR to NMBIR for new onset seizure. Three episodes of cytomegalovirus infection were observed in the TMBIR group. Other adverse events were similar in both groups.

Conclusions

Both tacrolimus and microemulsion cyclosporine combined with “low-dose” MMF and corticosteroids provide effective immunosuppression and have similar adverse events in kidney transplant recipients.
Issues in Cyclosporine Drug Substitution: Implications for Patient Management
Authors: Bartucci Marilyn Rossman
Published: July 2017

Substantial improvements in short-term and long-term outcomes for kidney transplant recipients have resulted from better use of existing immunosuppressive agents and newer treatment options. Calcineurin inhibitors (eg, cyclosporine and tacrolimus) remain the foundation of immunosuppressive therapy. These agents are considered critical-dose drugs because of their narrow therapeutic range, variable pharmacokinetics, formulation-dependent bioavailability, and negative clinical consequences of underdosing or overdosing. With the recent introduction of a new cyclosporine formulation, concern exists that current bioequivalence guidelines for generic approval may not provide adequate assessment of the safety and efficacy of critical-dose drugs. Transplant experts at 2 recent conferences recommended more rigorous criteria for bioequivalence testing of critical-dose drugs and adoption of consistent drug substitution practices. Additional recommendations included specifying the intended formulation and instituting appropriate monitoring whenever formulations are switched. A summary of the outcomes of these conferences and practice implications for transplant coordinators is discussed.
Nerve Transplantation: A Father's Final Gift
Authors: Fabian Tami , Lohmann Kathryn
Published: July 2017

Offering the option of organ and tissue donation to grieving families may seem stressful, but asking the question may provide a positive means to extend care to the bereaved family and help others in return. Many donor families have said donation was an opportunity to make some sense out of a senseless situation and to relieve some of the grief they experienced. This article presents a case that started with such a discussion by ICU nurses in one of our donor hospitals, and ended with successful organ and tissue recovery and transplantation. As “routine” as this may sound, it was anything but routine—it made history.
Utilization of Donated Lungs in Australia: 1989–1997
Authors: Armstrong Gregory T.
Published: July 2017

Lung and heart-lung transplantation was first undertaken in Australia in the late 1980s and early 1990s. Although detailed data are available on Australian lung transplantation outcomes, little data are available regarding the utilization of donated lungs. This study examines donated lung utilization rates and considers various factors that may affect these rates. Australian donation and transplantation data were analyzed for the years 1989 through 1997. Results showed that 24% of overall donors were lung donors. The percentage of donors from whom at least 1 lung was transplanted increased from 6% in 1989 to 36% in 1997. Heart-lung transplantation rates changed little (2%-9%), whereas bilateral lung transplantation increased from 1% to 23% of donors. Single-lung donors accounted for 32% of lung donors in 1997. Uniform basic donor criteria and management guidelines, simple allocation mechanisms, and cooperative retrieval have evolved during this time. Close collaboration at the time of donation between units, coordinators, and ICUs has allowed early retrieval from well-managed donors.
Ethical Analysis of Organ Recovery Denials by Medical Examiners, Coroners, and Justices of the Peace
Authors: Shafer Teresa J. , Schkade Lawrence L. , Siminoff Laura A. , Mahoney Timothy A.
Published: July 2017

Context

Despite its pivotal nature, until the early 1990s the role of medical examiners, coroners, and justices of the peace was largely ignored in discussions of the critical shortage of organs for transplantation in the United States. These officials have the right to determine, from a medico-legal perspective, whether a deceased person can be an organ donor. Thus, they play an important role in the donation process. Using a principles-based ethical framework, this article examines the problem of nonrecovery of life-saving organs for transplantation in the United States because a medical examiner or other official denies recovery.

Objective

The goals of organ donation and the collection of forensic evidence are not mutually exclusive. An analysis of the ethical principles and obligations of beneficence, respect for autonomy, and justice reveals that medical examiners and other officials could probably, after appropriate review, release all cases under their jurisdiction for organ donation.

Conclusion

Medical examiners, coroners, and justices of the peace could assume a leadership role, working together on public policy with medical, social, and legal groups, spearheading efforts to stop the loss of organs due to official denials, up to and including state and federal regulation and legislation. Beyond their professional obligations, as agents of a social institution, medical examiners and other officials have the more general ethical responsibility of promoting the public health and welfare and of reinforcing societal consensus that transplantation is a social good which should be optimized through formal and informal activities.
Experimental study on the effects of feed rate and tool geometries on tool wear in diamond cutting of sinusoidal microstructured surfaces
Authors: Zhou M , Zhang H J , Huang S N , Chen S J , Cheng K
Published: July 2017

Tool wear in diamond cutting of sinusoidal microstructured surfaces with a fast tool servo (FTS) may be quite different from that in the conventional diamond turning process, as the depth of cut changes periodically along the contour of the cutting surface and diamond tools with a sharp point tip are used. According to a theoretical analysis of the machining of sinusoidal surfaces, feed rate is a key cutting parameter affecting tool wear. In the current paper, a series of controlled cutting tests of LY12 aluminium alloy with different feed rates was executed on a two-axis bench-type ultra-precision turning machine equipped with an FTS device. The machined surface quality and dynamic cutting forces were measured and analysed. Tool wear patterns were investigated for various feed rates. It is essential to discuss the cutting stress borne by the diamond tool in the cutting of sinusoidal surfaces, since transformation of diamond to graphite induced by high pressure has been proved in previous works. The maximum normal stress acting on the rake face was deduced from measured dynamic cutting forces. Micro-Raman spectroscopy was adopted for analysing materials on tool tips. The experimental results showed that graphite appeared at the tool tip for some feed rates in the cutting of sinusoidal surfaces. The effects of tool geometry on tool wear are also shown.
Case Report: Recurrent Mucoepidermoid Carcinoma of the Tongue in Adult Female Patient With Lung Cancer
Authors: Rubin Arielle , Davis John , Jreije Karim , Wu Henry , Oppenheimer Randy
Published: July 2017

There is a steady rise in incidence of malignant salivary gland tumors in the United States, with mucoepidermoid carcinoma (MEC) the most frequent. Although 40% of MECs are found in the parotid gland, these lesions possess the capacity to develop anywhere along the aerodigestive tract. Here, we present a case of recurrent tongue MEC in a young adult female patient with history of lung malignancy and multiple brain metastases. Without a universally accepted management protocol for recurrent MECs, the current clinical practice uses tumor grade, location, and clinical progression to determine both prognosis and goals of care. The patient had transoral laser excision of the first MEC lesion in 2013. Her tongue MEC recurred 3 years later with 2 distinct lesions. One was discovered on physical examination and computed tomography and the other diagnosed intraoperatively 1 month later. These lesions were located on a previously unaffected portion of dorsal tongue base. These lesions were completely excised in the operating room. The patient currently remains on chemotherapy. This underscores the importance for developing a guideline that delineates the most efficacious surveillance and treatment plans for recurrent MECs.
Dietary Phytoestrogens and Bone Health
Authors: Cassidy Aedin
Published: July 2017

The role of soy phytoestrogens in preserving bone health has to date not been studied in large randomised controlled studies. These bioactive naturally occurring compounds are viewed as potential selective oestrogen receptor modulators based on their structural similarity to oestradiol, in vitro mechanisms of action and hormonal effects in human subjects. Much of the evidence for a role in bone health has stemmed from animal data, as most of the available human studies are of short duration and have used either bone biomarkers or bone mineral density as end point measures. However, recent data from a long-term study suggest these compounds have a bone conserving effect in menopausal women but to accurately examine the relative importance of these compounds for bone health in postmenopausal women an assessment of consumption on fracture rates will be critical.
The Pathology of Dementia
Authors: Esiri Margaret M
Published: July 2017

Dementia is a clinical, social and economic problem worldwide as a consequence of increased longevity, and is the commonest condition leading to institutional care. Four conditions, alone or in combination, account for about 95% of cases of dementia: Alzheimer's disease, cerebrovascular disease, Parkinson's disease and frontal lobe dementia. The pathological changes occurring within the brain in these conditions will be discussed and compared to those resulting from the normal aging process.
Measurement of Bone Mineral Density
Authors: Peel Nicola
Published: July 2017

The development of techniques to measure BMD enables individuals at high risk of osteoporotic fracture to be identified, and their response to treatment to be ascertained. Measurement of the spine and proximal femur by DXA is currently the gold standard technique, but peripheral skeletal measurements using QUS and x-ray based techniques are under evaluation. At the present time measurements should be targeted to individuals within high risk categories in whom knowledge of BMD may influence management. Further development of both diagnostic and therapeutic strategies will require modification of current practice in the future.
An Economic Analysis of the Management of Alzheimer's Disease in the United Kingdom
Authors: Manca Andrea , Davies Linda
Published: July 2017

Alzheimer's disease is a chronic and progressive disorder mainly affecting people aged over 65 years. Dementia and Alzheimer's disease affect a substantial proportion of the UK population in this age group, and their number is expected to increase dramatically over the next 20 years. At the moment there is no cure for Alzheimer's disease, though people suffering from this disorder use a significant proportion of health and social services. The burden of dementia and Alzheimer's disease has been investigated in several studies. The recent introduction of new drugs for the treatment of Alzheimer's disease has increased the interest in managing the disease. However, the few studies to assess the value for money of these new treatments are ambiguous in their conclusions. More detailed analyses specifically comparing cost and outcomes associated to the use of alternative treatments for the management of people with Alzheimer's disease are therefore required.
The Dynamic Seat as an Angular Motion Cuing Device
Authors: Osgood Robert K. , Taylor Kelly , McClurg Terrence
Published: July 2017

The role of advanced motion cuing devices as an alternative to platform motion simulation has been debated for several years. The dynamic seat nas been shown to be an effective device for providing task-critical onset motion information on the roll axis, provided that proper attention is given to the drive laws. Since it is difficult to extrapolate the benefit derived from the dynamic seat to an operationally-realistic task environment, the dynamic seat project has initiated a series of studies that lead to motion cuing in a multi-axis aerial refueling task. In this experiment, twelve subjects controlled a compensatory tracking task in roll only, pitch only, and a combined task condition. Operator performance was evaluated between four levels of drive algorithm across axis. Significant differences in tracking performance were found both within axis and between algorithm. In addition, the rank ordering of the treatment means were consistent with previous findings in our laboratory.
The Helmet-Mounted Display as a Tool to Increase Productivity during Space Station Extravehicular Activity
Authors: Shepherd C. K.
Published: July 2017

While the debate continues about the safety and applicability of heads-up displays (HUDs) and helmet-mounted displays (HMDs) in the aeronautical environment (as demonstrated in the July, October, and November 1987 issues of the Human Factors Society Bulletin), a voice-controlled HMD is being designed as the core of the information system for the new Space Station Extravehicular Mobility Unit (EMU). This paper describes the human factors issues that suggest the HMD will be a safe and desirable tool for Space Station extravehicular activity (EVA). Also, it briefly outlines a Macintosh-based voice-interactive rapid prototyping system that is being used at the NASA Johnson Space Center for simulating and evaluating the HMD's ability to enhance astronaut productivity in the EVA setting.
Guidelines for the Use of Programmable Display Pushbuttons on the Space Station's Telerobot Control Panel
Authors: Stuart Mark A. , Smith Randy L. , Moore Ervette P.
Published: July 2017

This investigation focused on the establishment of guidelines concerning the use of programmable display pushbuttons (PDPs) on a telerobot control panel. The method taken was to study two groups of subjects performing a simulated Remote Manipulator System (RMS)-like task on micro computer prototypes. Subjects were divided between those who had RMS-simulator experience and those who didn't. The computer prototypes contained simulations of two different control panels — one which used PDPs and one which used single-function pushbuttons.

Data analysis revealed that there was a statistically significant ( p < 0.05) increase in the number of commands issued in the non-PDP control panel and that subjects rated the PDP control panel significantly higher on two of five scaled questionnaire items. Based on these findings, as well upon the results of responses to open-ended questionnaire items, a preliminary list of guidelines concerning the use of PDPs was developed.
Perception of Real and Simulated Motion in the Auditory Modality
Authors: Strybel Thomas Z.
Published: July 2017

Future head-coupled display systems will include auditory spatial information in order to direct the pilot's attention to critical events in the environment. It is anticipated that such a system will provide dynamic as well as static auditory location information. This report reviews current research in the area of auditory motion perception, particularly as it applies to the development of simulated 3–dimensional auditory space.
A Virtual Display System for Conveying Three-Dimensional Acoustic Information
Authors: Wenzel Elizabeth M. , Wightman Frederic L. , Foster Scott H.
Published: July 2017

A three-dimensional auditory display could take advantage of intrinsic sensory abilities like localization and perceptual organization by generating dynamic, multidimensional patterns of acoustic events that convey meaning about objects in the spatial world. Applications involve any context in which the user's situational awareness is critical, particularly when visual cues are limited or absent; e.g., air traffic control or telerobotic activities in hazardous environments. Such a display would generate localized cues in a flexible and dynamic manner. Whereas this can be readily achieved with an array of real sound sources or loudspeakers, the NASA-Ames prototype maximizes flexibility and portability by synthetically generating three-dimensional sound in realtime for delivery through headphones. Psychoacoustic research suggests that perceptually-veridical localization over headphones is possible if both the direction-dependent pinna cues and the more well understood cues of interaural time and intensity are adequately synthesized. Although the realtime device is not yet complete, recent studies at the University of Wisconsin have confirmed the perceptual adequacy of the basic approach to synthesis.
Virtual Interface Environment Workstations
Authors: Fisher S.S. , Wenzel E.M. , Coler C. , McGreevy M.W.
Published: July 2017

A head-mounted, wide-angle, stereoscopic display system controlled by operator position, voice and gesture has been developed at NASA's Ames Research Center for use as a multipurpose interface environment. This Virtual Interface Environment Workstation (VIEW) system provides a multisensory, interactive display environment in which a user can virtually explore a 360—degree synthesized or remotely sensed environment and can viscerally interact with its components. Primary applications of the system are in telerobotics, management of large-scale integrated information systems, and human factors research. System configuration, research scenarios, and research directions are described.
Using Mission Decomposition Tools in Advanced Cockpit Applications
Authors: Stollings Michael N. , Edwards Richard E. , Rankin William L.
Published: July 2017

This paper describes an interactive, computer-based Mission Decomposition Tool (MDT) developed as part of the Cockpit Automation Technology Program sponsored by the Air Force System Command's Human Systems Division. The purpose of this tool is to improve the efficiency of the crewstation design process. Specific activities supported by the MDT include generation and decomposition of Air-to-Air and Air-to-Ground mission scenarios; generation of mission event timelines; and post-flight analysis. Mission generation/decomposition involves the laydown of maps, map features (streams, roads, etc.), threats, targets, and waypoints. The mission event timeline is generated automatically when a mission is flown and may be edited to ensure that unique mission activities are included. Post-flight analysis options include plots of threat exposure, terrain masking, terrain following, terrain clearance, discrete mission events, and aircraft performance data. The MDT strengthens the connection between analysis and test and evaluation activities in the areas of mission planning, pilot briefing, simulation set-up, performance assessment, and post-flight analysis.
Human Factors Issues in Aircraft Maintenance
Authors: Majoros Anthony E.
Published: July 2017

Aircraft present significant challanges to the people who maintain them. Time pressure, the complexity of aircraft systems, the need to adhere to minute detail, and cramped working spaces generally interact to create a difficult work setting. Due to the cognitive, biodynamic, and endurance demands of this work, human capacities and limitations are important variables in civil and military aviation maintenance. The critical nature of these variables is indicated in a variety of emerging research issues.
A Fuzzy Set Analysis of Skill, Rule and Knowledge-Based Workload
Authors: Moray Neville , Kruschelnicky Eugene , Eisen Paul , Money Laura , Turksen I. B.
Published: July 2017

Using fuzzy measures of task difficulty the effect of combining different aspects of a task on the overall task workload was explored. A complete set of combination rules is provided, of the general form “if the skill-based component is slightly difficult, the rule-based moderately difficult, and the knowledge-based slightly difficult, then the task as a whole is moderately difficult.” Fuzzy linguistic variables provide an adequate systematic framework for such combined judgments.