bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecting Emerging Infectious Diseases: An Overview of the Laboratory Response Network for Biological Threats
Authors: Villanueva Julie , Schweitzer Beth , Odle Marcella , Aden Tricia
Published: November 2019

The Laboratory Response Network (LRN) was established in 1999 to ensure an effective laboratory response to high-priority public health threats. The LRN for biological threats (LRN-B) provides a laboratory infrastructure to respond to emerging infectious diseases. Since 2012, the LRN-B has been involved in 3 emerging infectious disease outbreak responses. We evaluated the LRN-B role in these responses and identified areas for improvement. LRN-B laboratories tested 1097 specimens during the 2014 Middle East Respiratory Syndrome Coronavirus outbreak, 180 specimens during the 2014-2015 Ebola outbreak, and 92 686 specimens during the 2016-2017 Zika virus outbreak. During the 2014-2015 Ebola outbreak, the LRN-B uncovered important gaps in biosafety and biosecurity practices. During the 2016-2017 Zika outbreak, the LRN-B identified the data entry bottleneck as a hindrance to timely reporting of results. Addressing areas for improvement may help LRN-B reference laboratories improve the response to future public health emergencies.
Implementation of the US Department of Health and Human Services Zika Specimen Repository and Its Effect on Zika Diagnostic Test Development, 2016
Authors: Petway Marla , Anderson Laura , Humes Rosemary , Sincock Stephanie , Kuhnert-Tallman Wendi , Miller Joseph , Wallace Rodney L.
Published: November 2019

This study describes the efforts and outcomes associated with the establishment of a clinical sample repository during the 2016 Zika virus epidemic. To overcome the challenge of limited access to clinical samples to support diagnostic test development, multiple US Department of Health and Human Services (HHS) agencies formed a partnership to create the HHS Zika Specimen Repository. In 2016-2017, the Biomedical Advanced Research and Development Authority and the Centers for Disease Control and Prevention collected patient specimens (4420 convalescent sera aliquots from 100 donors and 7171 plasma aliquots from 239 donors), confirmed Zika virus test results, assembled 1 panel for molecular testing (n = 25 sets) and 7 panels for serologic testing (n = 92), and distributed the panels to test developers. We manufactured 8 test panels and distributed 74 sets of panels to 32 commercial companies, public health partners, and research institutions. Manufacturers used these panels to generate data that supported 14 US Food and Drug Administration (FDA) emergency use authorizations and 1 FDA approval. To develop a repository that can respond immediately to future disease outbreaks, we recommend that organizations pre-position procedures, resources, and partnerships to optimize each partner’s contribution.
Newborn Screening for Inherited Metabolic Disorders: Early Identification and Long-Term Care for Patients in the Plain Community, Wisconsin, 2011-2017
Authors: Held Patrice K. , Rice Gregory M. , Kuhl Ashley , Drilias Nicoletta , Baker Mei , Deline James , Spicer Gretchen , Sandrock Claire , Seroogy Christine M. , Schwoerer Jessica Scott
Published: November 2019

The Plain community is the fastest-growing religious minority in Wisconsin. This community has a high incidence of genetic disorders, many of which are identifiable through newborn screening. We describe efforts by the Wisconsin Newborn Screening Program (WNSP) to improve health care in the Plain community by targeting early identification of, and intervention for, patients with inherited metabolic disorders. WNSP formed partnerships with families and health care providers to increase awareness of screening procedures and the intended benefits of screening, modify testing algorithms to enhance detection, and establish medical homes for patients with confirmed disorders. The estimated number of Plain newborns screened increased by 25.5% during the study period, from 547 in 2011 to 736 in 2017; 122 persons underwent carrier testing, and 143 newborns received second-tier testing. From 2014 to 2017, affected patients received 71 metabolic evaluations in their community medical home without travel to major health centers. This article demonstrates how a comprehensive public health program can help increase screening rates, enhance detection, and establish follow-up care in a hard-to-reach religious community. A key lesson learned was the importance of communication among all stakeholders to develop an effective public health program.
PulseNet and the Changing Paradigm of Laboratory-Based Surveillance for Foodborne Diseases
Authors: Kubota Kristy A. , Wolfgang William J. , Baker Deborah J. , Boxrud David , Turner Lauren , Trees Eija , Carleton Heather A. , Gerner-Smidt Peter
Published: November 2019

PulseNet, the National Molecular Subtyping Network for Foodborne Disease Surveillance, was established in 1996 through a collaboration with the Centers for Disease Control and Prevention; the US Department of Agriculture, Food Safety and Inspection Service; the US Food and Drug Administration; 4 state public health laboratories; and the Association of Public Health Laboratories. The network has since expanded to include 83 state, local, and food regulatory public health laboratories. In 2016, PulseNet was estimated to be helping prevent an estimated 270 000 foodborne illnesses annually. PulseNet is undergoing a transformation toward whole-genome sequencing (WGS), which provides better discriminatory power and precision than pulsed-field gel electrophoresis (PFGE). WGS improves the detection of outbreak clusters and could replace many traditional reference identification and characterization methods. This article highlights the contributions made by public health laboratories in transforming PulseNet’s surveillance and describes how the transformation is changing local and national surveillance practices. Our data show that WGS is better at identifying clusters than PFGE, especially for clonal organisms such as Salmonella Enteritidis. The need to develop prioritization schemes for cluster follow-up and additional resources for both public health laboratory and epidemiology departments will be critical as PulseNet implements WGS for foodborne disease surveillance in the United States.
Dorothy L. Sayers: apologist for her time – and ours?
Authors: Craske Jane
Published: November 2019

This article uses the work of Dorothy L. Sayers to look for hints towards appropriate apologetics in our own time. The range of engagement and modes of communication she uses are instructive and her work invites us to ponder the lines (or lack of them) between restatement and reformulation in theology, along with questions about the categorizing of theology and theologians.
Rowan Williams on incarnation
Authors: Ward Keith
Published: November 2019

Rowan Williams argues that the Incarnation sponsors a distinctive metaphysical view of God and the world. I agree, but query his basically Thomist account of the Incarnation. For Aquinas, essences are more real than particulars, causes must be like and greater than their effects, and the first cause must be a supreme essence without potentiality or change. But it may be that essences are merely possible states, and causes must have powers (potencies) to act. Therefore God, conceiving all possible states and having all possible powers, does contain potentials. One of these powers is the power to act as a particular causal agent in the world, which Dr Williams denies. I suggest that the Incarnation entails a particular causal divine act that adds something essential to the eternal Word, by changing the nature of the divine love, and realizing its potential as agape, love given to the truly other and imperfect.
Difficult texts: Exodus 3.14 – the name of God
Authors: Handley James
Published: November 2019

God revealed himself to Moses in the burning bush, as ‘I am who I am’. However, this verse presents significant difficulties in translation and understanding, which this article explores using the hermeneutics of Paul Ricoeur.
Gentrification, Geography, and the Declining Enrollment of Neighborhood Schools
Authors: Pearman Francis A.
Published: November 2019

This study examines patterns and relations between gentrification and urban schooling across U.S. cities using longitudinal data from 2000 to 2014. The first section presents new statistics on the incidence and distribution of gentrification occurring around urban schools in the United States as a whole. Of the roughly 20% of urban schools located in divested neighborhoods in the year 2000, roughly one in five experienced gentrification in their surrounding neighborhood by 2014. However, there exists considerable heterogeneity in the prevalence of gentrification across U.S. cities, with exposure rates ranging from zero in some cities to over 50% in others. The second section finds evidence that gentrification is associated with declining enrollment at neighborhood schools, especially when gentrifiers are White.
A hyper-elastic thermal aging constitutive model for rubber-like materials
Authors: Korba Ahmed G , Kumar Abhishek , Barkey Mark
Published: November 2019

Different phenomenological, empirical, and micromechanical constitutive models have been proposed to describe the behavior of incompressible isotropic hyper-elastic materials. Among these models, very few have accounted for the thermal aging effect on the model constants and parameters. This article introduces a new empirical constitutive hyper-elastic model for thermally aged hyper-elastic materials. The model named “the weight function based (WFB) model” considers the effect of aging temperature and time on its parameters. The WFB model formulation can facilitate fatigue analysis and lifetime prediction of rubber-like materials under aging conditions. The WFB model in this article defines all rubber-like material properties, such as fracture stretch, strength, and stiffness, by predicting the full stress–strain curve at any aging time and temperature. The WFB model was tested on natural rubber for uniaxial and biaxial loading conditions. More than 100 specimens were aged and tested uniaxially under various temperatures and aging times to extract the stress–strain behavior. The temperatures used in the test ranged from 76.7°C to 115.5°C, and the aging time ranged from 0 to 600 hours (hrs). A classical bulge test experiment was generated to extract the biaxial natural rubber material behavior. An ABAQUS finite element analysis model was created to simulate and verify the generated biaxial stress–strain curve. The proposed model represents the aging effect on the tested natural rubber under uniaxial and biaxial loading conditions with an acceptable error margin of less than 10% compared to experimental data.
Adaptive iterative learning control for unknown linear time-varying continuous systems
Authors: Afsharnia Fateme , Madady Ali , Menhaj Mohammad Bagher
Published: November 2019

This paper presents a novel model reference adaptive iterative learning control (ILC) for unknown continuous-time linear time-varying systems. The unknown time-varying parameters of the system are neither required to vary slowly nor to have known bounds. The system is not required to be minimum-phase, stable, controllable or observable. The input of the system is determined by a differentiator-free control law. The used reference model is time-invariant and first order and thus choosing its parameters is easily possible, even though, the system under control is high order and time variant. Almost all of the components of the system initial condition can be iteration variant. By introducing a novel kind of Lyapunov function the convergence of the proposed adaptive ILC (AILC) and achieving asymptotic tracking are proved. Also, by rigorous mathematical analysis and with the help of some mathematical key techniques such as Bellman-Gronwall lemma, it is shown that all signals and quantities in the closed-loop system are bounded in the sense of at least one norm. Finally, the effectiveness of the proposed method is verified by two simulation examples.
An adaptive second-order sliding-mode observer for permanent magnet synchronous motor with an improved phase-locked loop structure considering speed reverse
Authors: Zhan Yuan , Guan Jifu , Zhao Yufeng
Published: November 2019

An adaptive second-order sliding-mode observer based on Super-Twisting Algorithm (STA-SMO) to estimate rotor position and speed of permanent magnet synchronous motor (PMSM) is proposed in this paper. The advantages of the proposed observer algorithm are reflected in small chattering, high tracking accuracy, good robustness to parameters change and external disturbance in wide positive and reversal speed range. The Lyapunov stability of the system is proved. A new perturbation term form is employed and according to the stable condition of STA-SMO, the adaptive sliding-mode coefficients related to absolute value of estimated speed are deduced to guarantee the performance mentioned above in wide positive and negative speed range. In order to extract rotor position and speed in both speed range from the adaptive STA-SMO, an improved conventional phase-locked loop (IPLL), which is more accurate, is studied and its non-linear dynamics are analyzed in detail to prove the effectiveness of the IPLL theoretically. In the end, the effectiveness of the adopted adaptive second-order sliding-mode observer with IPLL structure is verified through simulations. Simulation results show that the position error and chattering of the proposed adaptive observer are decreased more than 25% and 50% compared with conventional SMO and STA-SMO in wide positive and negative speed range. Meanwhile, the proposed system still has good estimation performance and strong robustness with torque and parameters variation.
Phase division and transition modeling based on the dominant phase identification for multiphase batch process quality prediction
Authors: Tang Xiaochu , Li Yuan
Published: November 2019

Batch processes are carried out from one steady phase to another one, which may have multiphase and transitions. Modeling in transitions besides in the steady phases should also be taken into consideration for quality prediction. In this paper, a quality prediction strategy is proposed for multiphase batch processes. First, a new repeatability factor is introduced to divide batch process into different steady phases and transitions. Then, the different local cumulative models that considered the cumulative effect of process variables on quality are established for steady phases and transitions. Compared with the reported modeling methods in transitions, a novel just-in-time model can be established based on the dominant phase identification. The proposed method can not only consider the dynamic characteristic in the transition but also improve the accuracy and the efficiency of transitional models. Finally, online quality prediction is performed by accumulating the prediction results from different phases and transitions. The effectiveness of the proposed method is demonstrated by penicillin fermentation process.
Modeling and implementation of 1-D inverted magnetic needle system using a robust sliding mode controller
Authors: Suresh Kumar Pakala , Priyadarshan Hari , Harsha Simha MS
Published: November 2019

In this paper, we propose a novel problem in control systems area involving the control of a magnetic needle in the presence of an external magnetic field. A magnetic needle when restricted to rotate about a single axis in an external magnetic field, by pivoting its center will produce a stable and unstable equilibrium. Here, we present the detailed mathematical modeling of the 1-D inverted magnetic needle system and its control in the unstable equilibrium point. We use sliding mode controller (SMC) to achieve the control objectives. The simulation results are validated with the experimental results. For achieving a close match, we consider sensor and actuator nonlinearities. Further, its robust performance is compared with proportional-derivative (PD), proportional-integral-derivative (PID) controllers in the presence of system parameter uncertainty, disturbance, and sensor delay. We also study the effect of change in SMC parameters, proportional and derivative gains on the system performance. It is to be noted that the proposed experimental setup can be extended to a much more general and complex system, both in modeling as well as control design leading to a new benchmark problem in the control system.
The model-free adaptive cross-coupled control for two-dimensional linear motor
Authors: Zhang Baolin , Cao Rongmin , Hou Zhongsheng
Published: November 2019

In order to improve the contour error accuracy of two-dimensional linear motor, an improved cross-coupled control (CCC) scheme combining real-time contour error estimation and model-free adaptive control (MFAC) is proposed. The real-time contour error estimation method is based on CCC theory and coordinate transformation idea. It can accurately determine the contour error point of regular contour and avoid the influence of tracking error on the contour error. At the same time, for the design of two-axis error controller, only the input and output data generated by two-dimensional linear motor in reciprocating motion are used to design a multiple input multiple output-model-free adaptive control (MIMO-MFAC) algorithm, this algorithm avoids the dependence on accurate mathematical model and reduces the control difficulty. The experimental comparison showed that the proposed method improves the system tracking accuracy and contour accuracy, and verifies the proposed method correctness and effectiveness.
A deficit in using prosodic cues to understand communicative intentions by children with autism spectrum disorders: An eye-tracking study
Authors: Zhou Peng , Ma Weiyi , Zhan Likan
Published: November 2019

The present study investigated whether Mandarin-speaking preschool children with autism spectrum disorders (ASD) were able to use prosodic cues to understand others’ communicative intentions. Using the visual world eye-tracking paradigm, the study found that unlike typically developing (TD) 4-year-olds, both 4-year-olds with ASD and 5-year-olds with ASD exhibited an eye gaze pattern that reflected their inability to use prosodic cues to infer the intended meaning of the speaker. Their performance was relatively independent of their verbal IQ and mean length of utterance. In addition, the findings also show that there was no development in this ability from 4 years of age to 5 years of age. The findings indicate that Mandarin-speaking preschool children with ASD exhibit a deficit in using prosodic cues to understand the communicative intentions of the speaker, and this ability might be inherently impaired in ASD.
Modified tubeless anesthesia during endoscopy for assessment of head and neck cancers
Authors: Ku Peter K.M. , Tong Michael C.F. , Kwan Anne , van Hasselt Charles Andrew
Published: November 2019

We evaluated a modified technique of administering anesthesia without a tube and with spontaneous respiration during video-assisted tele-laryngo-tracheo-bronchoendoscopy (TLTBE). The endoscopy was performed as an alternative to rigid ventilatory bronchoscopy during screening for synchronous tumors in the tracheobronchial tree in patients who had head and neck malignancies. Thirty consecutive patients who required diagnostic panendoscopy were selected for this study. During direct-suspension laryngoscopy, anesthesia was delivered by administering intravenous bolus injections of propofol at 0.5 to 2 mg/kg every 5 to 10 minutes. A good view of the larynx, trachea, and main bronchi was obtained with a 50-cm 0° Hopkins telescope, which caused no obstruction of the airway. During laryngoscopy, arterial oxygen saturation levels, pulse rates, and blood pressures were stable in all patients. No apnea was associated with the use of propofol during any procedure, and we observed no intraoperative or postoperative complication in any patient. Video-assisted TLTBE is appropriate for patients with a grade 1 or 2 larynx, good cardiopulmonary function, and no significant airway obstruction. It is a safe and time-saving alternative to rigid ventilatory bronchoscopy for staging primary tumors and for screening for synchronous tumors in the respiratory tract.
Lack of night-to-night variability of sleep-disordered breathing measured during home monitoring
Authors: Davidson Terence M. , Gehrman Philip , Ferreyra Henry
Published: November 2019

The apnea-hypopnea index (AHI) is an important objective measure used in the diagnosis of sleep-disordered breathing. In affected patients, the AHI has been reported to vary across successive nights. We conducted a multichannel home sleep study on 44 patients with sleep-disordered breathing to determine whether the AHI does indeed vary and, if so, to quantify the degree of night-to-night variability. Of this group, 23 patients were tested for 3 consecutive nights and 21 were tested for 2 consecutive nights. Among the group as a whole, we found no statistically significant change in AHI across nights, although we did identify variations among individual patients.
Long-term Follow-up of a Multiloculated Arachnoid Cyst of the Middle Cranial Fossa
Authors: Cohen Marc A. , Cohen Noam A. , Moonis Gul , Kennedy David W.
Published: November 2019

Arachnoid cysts are benign intracranial lesions that are typically diagnosed incidentally. We describe the case of a 56-year-old man who presented with a multiloculated arachnoid cyst of the middle cranial fossa that extended into the sphenoid sinus. The lesion was identified on computed tomography of the head, which had been obtained for an unrelated investigation. However, establishing a definitive diagnosis proved to be difficult. Because the cyst had caused extensive skull base erosion, the patient was managed conservatively with close observation. We report the radiographic progression of this lesion during more than a decade of follow-up, and we review the literature pertaining to the presentation, pathophysiology, and treatment of arachnoid cysts.
Management of a type II nasoethmoid orbital fracture and near-penetration of the intracranial cavity with transnasal canthopexy
Authors: Young Philip A. , Rice Dale H.
Published: November 2019

Nasoethmoid orbital fractures are perhaps the most complicated aspect of craniomaxillofacial trauma. Involvement of the medial canthal tendon markedly increases the complexity of the repair. We report a case of type II nasoethmoid orbital fracture in a 32-year-old man that was managed without formal medial canthal tendon repair; instead, we used open reduction and internal fixation of the central fragment and the nasoethmoid complex. However, during the immediate postoperative period, we noted anterior and inferior displacement of the medial canthus. We took the patient back to the operating room to address the detachment. Revision surgery was successful, and at the 6-month follow-up, his medial canthi were completely symmetrical in all dimensions. We describe our intraoperative technique and measures to prevent complications that can help the surgeon intraoperatively. We also discuss an important point that has not been adequately addressed in the literature to date—that is, the fact that the use of the frontoethmoid suture line and the anterior ethmoid artery as a guide to the skull base can be inaccurate. Problems associated with this inaccuracy can be avoided by carefully reviewing preoperative computed tomography, which can help keep the surgeon from entering the intracranial cavity while fixing the medial canthal tendon during transnasal canthal repair.
Schwannoma of the Tonsil
Authors: Lee Byung-Joo , Wang Soo-Geun , Lee Jin-Choon , Lee Il-Woo
Published: November 2019

Between 25 and 48% of schwannomas have been reported to occur in the head and neck region; the acoustic nerve is involved in most cases. Schwannomas arising in the tonsil are extremely uncommon. We report a case of tonsillar schwannoma in a 23-year-old woman. We also review the literature on this rare entity.
Podcasting: Contemporary patient education
Authors: Abreu Daniel V. , Tamura Thomas K. , Sipp J. Andrew , Keamy Donald G. , Eavey Roland D.
Published: November 2019

Portable video technology is a widely available new tool with potential to be used by pediatric otolaryngology practices for patient and family education. Podcasts are media broadcasts that employ this new technology. They can be accessed via the Internet and viewed either on a personal computer or on a handheld device, such as an iPod or an MP3 player. We wished to examine the feasibility of establishing a podcast-hosting Web site. We digitally recorded pediatric otologic procedures in the operating room and saved the digital files to DVDs. We then edited the DVDs at home with video-editing software on a personal computer. Next, spoken narrative was recorded with audio-recording software and combined with the edited video clips. The final products were converted into the M4V file format, and the final versions were uploaded onto our hospital's Web site. We then downloaded the podcasts onto a high-quality portable media player so that we could evaluate their quality. All of the podcasts are now on the hospital Web site, where they can be downloaded by patients and families at no cost. The site includes instructions on how to download the appropriate free software for viewing the podcasts on a portable media player or on a computer. Using this technology for patient education expands the audience and permits portability of information. We conclude that a home computer can be used to inexpensively create informative surgery demonstrations that can be accessed via a Web site and transferred to portable viewing devices with excellent quality.
Clinical evaluation of piezoelectric ear surgery
Authors: Dellepiane Massimo , Mora Renzo , Salzano Francesco A. , Salami Angelo
Published: November 2019

We evaluated the use of piezoelectric surgery (Piezosurgery; Mectron Medical Technology; Carasco, Genoa, Italy) as a means of avoiding some complications of osteotomy and osteoplasty in otologic surgery, particularly in classic canal-wall-up mastoidectomy. Piezoelectric surgery is a recently developed system for cutting bone with microvibrations created by the piezoelectric effect. This effect occurs when an electric current is passed through certain ceramics and crystals, causing them to oscillate at ultrasonic frequencies. Our study population was made up of 20 adults with unilateral chronic otitis media. In all patients, piezoelectric surgery allowed for effective, precise, safe, easy, and rapid intraoperative management. In particular, the instrument's precision allowed surgeons to make exact, clean, and smooth cuts without causing any injury to adjacent soft tissue. No complications were noted. We conclude that the piezoelectric device is superior to conventionally rotating instruments for performing classic canal-wall-up mastoidectomy.
Management of recurrent epistaxis in an anticoagulated patient by temporarily closing the nares with sutures
Authors: Eng Chee-Yean , Yew Teck-Aun , Ng Wai-Siene , El-Hawrani Amged S.
Published: November 2019

We describe an unusual case of recurrent, refractory anterior epistaxis in an 86-year-old man with two mechanical heart valves who was on permanent warfarin therapy. His numerous episodes of epistaxis were incited by chronic nose-picking and strong nose-blowing, practices that he continued to engage in despite repeated medical advice to stop. Stopping his anticoagulation therapy was not considered as a management option because of an unacceptably high risk that this would lead to a thromboembolic event. Eventually, we temporarily sutured his nares closed, and his nosebleeds ceased. The suturing was performed in the ward with local anesthesia. This procedure was simple to perform, fairly well tolerated, easily reversible, and highly effective.
Multiple pilomatrixomas: Case report and literature review
Authors: Reddy Shashidhar Sadda , Gadre Swarupa A. , Adegboyega Patrick , Gadre Arun K.
Published: November 2019

Pilomatrixoma is a rare, benign, circumscribed, calcifying epithelial neoplasm that is derived from hair matrix cells. Multiple pilomatrixomas are uncommon. We describe a case of multiple pilomatrixomas in a 23-year-old black woman who presented with lesions on her face and back. Based on the results of the clinical examination, she was provisionally diagnosed with either calcified sebaceous cysts or calcified lymph nodes. She underwent surgical excision of the masses. On histopathology, the lesions were identified as pilomatrixomas. We attribute our original failure to diagnose this condition to our lack of familiarity with it. We discuss the presentation, differential diagnosis, and other characteristics of pilomatrixomas.
Duodenogastroesophageal reflux and its effect on extraesophageal tissues: A review
Authors: Blumin Joel H. , Merati Albert L. , Toohill Robert J.
Published: November 2019

We conducted a literature review to identify elements of duodenogastroesophageal reflux (DGER)—namely pancreatic fluids, hydrochloric acid, pepsin, and bile—as to the effects each has when refluxed to the extraesophageal structures. Further, we wished to acquaint clinicians with the possibilities that, in addition to hydrochloric acid, the other components of DGER are likewise contributing to disease in the extraesophageal areas. Our review included studies that have indicated reflux of the above mentioned components of DGER to the pharynx, larynx, tracheobronchial tree, oral cavity, nasopharynx, nose and sinuses, eustachian tube, and middle ear. Findings demonstrate that injury to the upper aerodigestive tract can occur from a variety of substances secreted from the stomach and duodenum. Treatment for DGER is nonspecific. We conclude that patients with an incomplete response to acid suppression may have significant involvement of pepsin, bile, or both. Future studies are needed to clarify the importance of these elements and to suggest more precise treatments.
Recurrent Post-Tympanostomy Tube Otorrhea Secondary to Aerobic Endospore-Forming Bacilli: A Case Report and Brief Literature Review
Authors: Jaber James J. , Kircher Matthew L. , Thorpe Eric , Porter Ryan G. , Leonetti John P. , Marzo Sam J.
Published: November 2019

We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.
A Case of Calcific Retropharyngeal Tendinitis: The Significance of an Early Diagnosis
Authors: Terao Kyoichi , Kusunoki Takeshi , Mori Kazunori , Murata Kiyotaka , Doi Katsumi
Published: November 2019

The clinical presentation of calcific retropharyngeal tendinitis, a rare entity, can mimic more serious disorders. We describe the case of a 35-year-old man who was referred to us for evaluation of a suspected retropharyngeal abscess. At presentation, the patient reported severe cervical pain and stiffness. He exhibited mild fever, torticollis, and a moderately elevated white blood count; no swelling of the retropharyngeal wall was observed. Based on the results of plain radiography and computed tomography (CT), we diagnosed the patient with calcific retropharyngeal tendinitis. He was treated with a 7-day course of a nonsteroidal anti-inflammatory drug and a 3-day course of a steroid, and he recovered well. We suggest that the true incidence of calcific retropharyngeal tendinitis is actually higher than what is generally believed because this diagnosis is frequently missed. Contrast-enhanced CT can aid in diagnosing calcific retropharyngeal tendinitis. CT should be performed in patients who present with nonspecific symptoms such as severe neck pain, sore throat, odynophagia, and mild fever.
Transoral Surgery Alone for Human-Papillomavirus–Associated Oropharyngeal Squamous Cell Carcinoma
Authors: Olsen Steven M. , Moore Eric J. , Laborde Rebecca R. , Garcia Joaquin J. , Janus Jeffrey R. , Price Daniel L. , Olsen Kerry D.
Published: November 2019

The aim of this retrospective study was to describe the oncologic and functional results of treating oropharyngeal squamous cell carcinoma with transoral robotic surgery and neck dissection as monotherapy. A review was performed, including all patients who underwent transoral robotic surgery and neck dissection as the only means of therapy for oropharyngeal carcinoma from March 2007 to July 2009 at a single tertiary care academic medical center. We reviewed all cases with ≥ 24-month follow-up. Functional outcomes included tracheostomy dependence and oral feeding ability. Oncologic outcomes were stratified by human papillomavirus (HPV) status and tobacco use and included local, regional, and distant disease control, as well as disease-specific and recurrence-free survival. Eighteen patients met study criteria. Ten patients (55.6%) were able to eat orally in the immediate postoperative period, and 8 (44.4%) required a temporary nasogastric tube for a mean duration of 13.6 days (range 3 to 24 days) before returning to an oral diet. No patient required placement of a gastrostomy tube, and all patients are tracheostomy-tube–free. Among the HPV-positive nonsmokers (12/18, 66.7%), Kaplan-Meier estimated 3-year local, regional, and distant control rates were 90.9%, 100%, and 100%, respectively. Kaplan-Meier estimated disease-specific survival and recurrence-free survival were 100% and 90.9%, respectively. No complications occurred.
Recurrent Pindborg Tumor of the Maxilla: A Case Report and Review of the Literature
Authors: Somayaji Gangadhara , Rajeshwary Aroor , Ramesh Sullia , Dinesh Sullia
Published: November 2019

We report a case of recurrent Pindborg tumor (calcifying epithelial odontogenic tumor) of the maxilla. The patient was a 34-year-old woman who had been previously diagnosed with Pindborg tumor and treated with curettage. She was subsequently referred to us for evaluation of nasal obstruction. Examination revealed the presence of a mass lesion in the right nasal cavity and right maxilla, which was identified as a recurrence of her earlier Pindborg tumor. The patient was treated with maxillectomy with orbital preservation. Pindborg tumor is a rare odontogenic tumor; when it does occur, it is more often seen in the mandible than in the maxilla. While this tumor is often treated with curettage alone, the aggressive nature of the recurrence in our patient necessitated radical surgery. We report this case to highlight the need to be suitably aggressive in treating these types of tumors in order to avoid recurrence.
Chondromyxoid Fibroma of the Mastoid Portion of the Temporal Bone: MRI and PET/CT Findings and Their Correlation with Histology
Authors: Oh Noeun , Khorsandi Azita S. , Scherl Sophie , Wang Beverly , Wenig Bruce M. , Manolidis Spiros , Jacobson Adam
Published: November 2019

We report a very rare case of a chondromyxoid fibroma of the mastoid portion of the temporal bone in a 38-year-old woman who presented with left-sided hearing loss. Magnetic resonance imaging identified an expansile mass in the left mastoid bone with a heterogeneous hyperintense signal on T2-weighted imaging and peripheral enhancement. Subsequent positron emission tomography/computed tomography identified erosive bony changes associated with hypermetabolism. The patient underwent an infra-temporal fossa resection with a suboccipital craniectomy/cranioplasty. We briefly review the aspects of this case, including a discussion of the differential diagnosis and the correlation between histologic and imaging findings.
Propranolol in the Treatment of Upper Airway Hemangiomas
Authors: de Moreno Lauren C. Anderson , Matt Bruce H. , Montgomery Gregory , Kim Young-Jee
Published: November 2019

Airway hemangiomas (AHs), which are common in infant airways, often cause significant upper airway obstruction. The various therapies used for AH have limitations and complications. Propranolol may have a potential role in its treatment, since it leads to regression or stabilization of cutaneous infantile hemangiomas. To date, only 4 previous case reports (7 patients) in which propranolol was used for AH have been published. Based on encouraging preliminary data on propranolol use for AH treatment, our goal was to further investigate propranolol as an effective initial treatment of upper AHs that cause significant obstruction symptoms. In this retrospective case series, we reviewed the medical records of 5 consecutive pediatric patients with AH (glottic and subglottic) treated with propranolol at a tertiary care children's hospital. All 5 patients were 2 months of age at the time of hemangioma diagnosis and had stridor and physical signs of severe upper airway obstruction. Hemangioma was diagnosed by flexible laryngoscopy or flexible bronchoscopy. All patients received propranolol 2 mg/kg/day and showed significant relief of obstruction symptoms within 24 hours of treatment initiation. All patients tolerated propranolol without significant cardiovascular complications. Outcomes from this case series, in conjunction with available case reports in the literature, suggest that propranolol is a safe initial treatment for symptomatic upper AH.
Airway Management in an Infant with Alobar Holoprosencephaly and Cebocephaly Associated with Maternal Diabetes Mellitus
Authors: Petersson Rajanya S. , Carey William A. , Thompson Dana M.
Published: November 2019

We report a case of alobar holoprosencephaly (HPE) and cebocephaly associated with uncontrolled maternal type 1 (insulin-dependent) diabetes mellitus. Alobar HPE is the most severe form of HPE. Patients with cebocephaly have ocular hypotelorism and a proboscis with a single, blind-ended nostril. Shortly after our patient was born, we were consulted for airway management, as the parents’ goal was to bringtheir child home. A tracheostomy tube was placed, and choanal atresia repair was eventually performed. The infant was never decannulated, however, and she died at the age of 9 months of acute respiratory distress syndrome secondary to an upper respiratory infection. To the best of our knowledge, this case represents the longest reported survival of an infant with alobar HPE and cebocephaly. Decisions regarding the care of these infants should be made in a collaborative, multidisciplinary fashion, with special attention paid to the primary caregivers’ goals of care.
Paraganglioma Presenting as Cholesterol Granuloma of the Petrous Apex
Authors: Heman-Ackah Selena E. , Huang Tina C.
Published: November 2019

We report the unique finding of a petrous apex cholesterol granuloma associated with a paraganglioma, also known as a glomus jugulare tumor, in a 52-year-old woman who presented to our department with pulsatile tinnitus, hearing loss, aural fullness, and disequilibrium. She had been treated for a petrous apex cholesterol granuloma 20 years earlier, at which time she had undergone drainage of the granuloma via subtotal petrous apicectomy. When she came to our facility approximately 20 years later, she had signs and symptoms consistent with a jugular paraganglioma, which was likely to have been present at the time of her initial presentation for the cholesterol granuloma. In fact, microscopic bleeding from the paraganglioma might have led to the formation of the cholesterol granuloma. The metachronous presentation of these two entities, which to our knowledge has not been reported previously in the literature, indicates the potential association of paragangliomas with the formation of cholesterol granulomas of the petrous apex.
Hemangiopericytoma of the Parapharyngeal Space
Authors: Fishero Brian A. , Guido Kelly M. , McGuff Howard S. , Heim-Hall Josefine M. , Miller Frank R.
Published: November 2019

Hemangiopericytomas of the head and neck are rarely found in the parapharyngeal space. We report the case of a 53-year-old woman who presented with a globus sensation in her throat. Imaging detected a left submucosal oropharyngeal mass that extended into the prestyloid parapharyngeal space. The tumor was surgically excised en bloc. Histopathologic examination identified it as a hemangiopericytoma. We discuss the diagnosis and management of this rare entity.
Practical Applications of In-Office Fiberoptic Transnasal Esophagoscopy in the Initial Evaluation of Patients with Squamous Cell Cancer of the Head and Neck
Authors: Dolan Robert W. , Anderson Timothy D.
Published: November 2019

We conducted a study to analyze the effectiveness of trans-nasal esophagoscopy (TNE) as an alternative to operative endoscopy (OE) for the evaluation of primary head and neck cancers and for the surveillance of synchronous esophageal cancers. Our study population was made up of 96 consecutively presenting patients—75 men and 21 women, aged 45 to 88 years (mean: 64)—who were treated at our institution for squamous cell cancer of the head and neck. Of this group, 42 patients had been evaluated with TNE and 54 with OE. More OEs were performed inpatients with an unknown primary (26 vs. 3). Incidental findings on TNE included 3 cases of gastritis, 2 cases each of hiatal hernia and esophagitis, 1 case of Barrett esophagus, and 1 inlet patch. No incidental findings were reported during OE. Primary cancers were biopsied by TNE through a port on the endoscope in 4 patients; 2 of these cancers were in the tongue base, 1 in the hypopharynx, and 1 in the aryepiglottic fold. After the initial visit, patients in the TNE group waited significantly fewer days for their endoscopy than did those in the OE group (median: 6.5 vs. 16; p < 0.05). Conversely, patients in the OE group waited significantly fewer days for treatment following endoscopy (median: 12 vs. 20; p < 0.05). However, there was no significant difference between the TNE patients and the OE patients in the total number of days comprising the their entire course of management, from the initial visit to definite treatment (median: 27.5 and 33 days, respectively; p = 0.7). We conclude that TNE is a reasonable alternative to OE for the initial screening for synchronous esophageal cancers inpatients with squamous cancers of the head and neck. OE is preferred for the initial workup of unknown primary cancers and for large tongue base cancers. The rate of detection of clinically relevant incidental findings is higher with TNE. Biopsy is possible during TNE for all subsites within the upper aerodigestive tract.
Rhinoscleroma as a Cause of Airway Obstruction
Authors: Goldberg Seth N. , Canalis Rinaldo F.
Published: November 2019

Two cases of rhinoscleroma presenting with airway obstruction are described to emphasize the continuing incidence of this disease and the need for proper techniques of diagnosis and management.
Benign Mesenchymoma
Authors: Carter Joseph B. , Brady Dennis
Published: November 2019

A case is presented, and the histogenesis and treatment of this unusual tumor are discussed.
Rhabdomyosarcoma of the Head and Neck
Authors: Perry Michael C. , Hakami Nasrollah
Published: November 2019

The experience of the Intergroup Rhabdomyosarcoma Study in the treatment of this relatively common pediatric malignancy is described, and the group's standardized staging system is outlined.
Complications of Posterior Epistaxis
Authors: Marks Herbert W.
Published: November 2019

A study of 106 patients requiring posterior packing found a 46 percent rate of complications, many of them major, suggesting the need for caution in treatment.
Neonatal Laryngeal Neurofibromatosis
Authors: Fitzgerald O'Connor Alec F. , Freeland Andrew P.
Published: November 2019

A unique case of neonatal laryngeal neurofibromatosis is reported. The presenting symptoms are related to upper-airway obstruction. The available literature is discussed.
Bilateral Antrochoanal Polyps
Authors: Sinha S. N. , Kumar Arun
Published: November 2019

Unilateral antrochoanal polyps are quite common, but reports of bilateral incidence are very rare.
Stapedectomy and the Labyrinthine Reaction in the Contralateral Ear
Authors: Podoshin L. , Gertner R. , Fradis M. , Ben-David J. , Weinstein H.
Published: November 2019

Exploring the relationship between stapedectomy and the labyrinthine reaction in the contralateral ear in 45 stapedectomized otosclerotic patients, the authors concluded that good operative results can be expected if the ear not operated on demonstrates hyperfunction after surgery, whereas there will be either a partial increase in hearing or no hearing gain when there is hypofunction of the opposite labyrinth.
Barriers to Weight Loss and Physical Activity, and Coach Approaches to Addressing Barriers, in a Real-World Adaptation of the DPP Lifestyle Intervention: A Process Analysis
Authors: Delahanty Linda M. , Trief Paula M. , Cibula Donald A. , Weinstock Ruth S.
Published: November 2019

Purpose

The purpose of this study is to identify barriers to weight loss and physical activity, as well as approaches used by coaches, in a real-world, community sample of adults with metabolic syndrome (at risk for type 2 diabetes) who participated in a Diabetes Prevention Program (DPP)–adapted weight loss intervention and compare findings to data from the screened and highly selected DPP sample.

Methods

SHINE (Support, Health Information, Nutrition, and Exercise) was a telephonic DPP adaptation. Primary care staff delivered the DPP curriculum, and lifestyle coaches provided monthly direction to achieve weight loss. For this substudy, barriers to weight loss and physical activity described by participants, as well as approaches coaches used to address them, were gathered. Groupings of barriers (DPP defined) were analyzed in relation to demographic characteristics and compared to data from the DPP sample.

Results

Top weight loss barriers were problems with self-monitoring, too little physical activity, internal thought/mood cues, vacation/holidays, and social cues. Percentages reporting a barrier were much higher in SHINE. Top physical activity barriers were problems with self-monitoring, access/weather, time management, aches/pains, and vacation/holidays. These did not correspond closely to DPP data. Coaches used problem solving, self-monitoring skills review, increased physical activity, and motivational strategies. SHINE coaches were more likely than DPP coaches to use alternative approaches.

Conclusions

Barriers to weight loss and physical activity in a community sample of persons at risk for diabetes occurred at much higher rates than in the highly screened DPP sample. Training coaches in a variety of patient-centered approaches may maximize their positive impact.
The robustness of eye–mouth index as an eye-tracking metric of social attention in toddlers
Authors: Souter Nicholas E. , Arunachalam Sudha , Luyster Rhiannon J.
Published: November 2019

Eye-tracking research on social attention in infants and toddlers has included heterogeneous stimuli and analysis techniques. This allows measurement of looking to inner facial features under diverse conditions but restricts across-study comparisons. Eye–mouth index (EMI) is a measure of relative preference for looking to the eyes or mouth, independent of time spent attending to the face. The current study assessed whether EMI was more robust to differences in stimulus type than percent dwell time (PDT) toward the eyes, mouth, and face. Participants were typically developing toddlers aged 18–30 months ( N = 58). Stimuli were dynamic videos with single and multiple actors. It was hypothesized that stimulus type would affect PDT to the face, eyes, and mouth, but not EMI. Generalized estimating equations demonstrated that all measures including EMI were influenced by stimulus type. Nevertheless, planned contrasts suggested that EMI was more robust than PDT when comparing heterogeneous stimuli. EMI may allow for a more robust comparison of social attention to inner facial features across eye-tracking studies.