bluuebunny/crossref_metadata_2025 huggingface dataset:
Proenkephalin, an Opioid System Surrogate, as a Novel Comprehensive Renal Marker in Heart Failure
Authors: Emmens Johanna E. , ter Maaten Jozine M. , Damman Kevin , van Veldhuisen Dirk J. , de Boer Rudolf A. , Struck Joachim , Bergmann Andreas , Sama Iziah E. , Streng Koen W. , Anker Stefan D. , Dickstein Kenneth , Lang Chim C. , Metra Marco , Samani Nilesh J. , Ng Leong L. , Voors Adriaan A.
Published: May 2019

Background:

PENK (proenkephalin) is a stable surrogate for enkephalins, endogenous opioid peptides, which exert cardiodepressive effects and improve renal function. PENK has been associated with heart failure (HF) severity and renal dysfunction. We therefore hypothesized that PENK could be associated with deterioration of kidney function and could have a role as a novel renal marker in HF.

Methods and Results:

In 2180 patients with HF of a large multicenter cohort (BIOSTAT-CHF [A Systems Biology Study to Tailored Treatment in Chronic Heart Failure]), the relationship between PENK and clinical variables, plasma and urinary biomarkers, and clinical end points was established. Data were validated in a separate cohort of 1703 patients with HF. PENK was elevated (>80 pmol/L, 99th percentile) in 1245 (57%) patients. Higher PENK was associated with more advanced HF and glomerular and tubular dysfunction. The strongest independent predictor of PENK was estimated glomerular filtration rate. Others were plasma NGAL (neutrophil gelatinase–associated lipocalin) and NT-proBNP (N-terminal pro-B-type natriuretic peptide; all
P
<0.001). Using correlation heatmaps and hierarchical cluster analyses, PENK clustered with estimated glomerular filtration rate, creatinine, NGAL, galectin-3, and urea. Higher PENK was independently associated with increased risk of deterioration of kidney function between baseline and 9 months (odds ratio, 1.29 [1.02–1.65] per PENK doubling;
P
=0.038; defined as >25% decrease in estimated glomerular filtration rate) and mortality (hazard ratio, 1.23 [1.07–1.43] per doubling;
P
=0.004). Analyses in the validation cohort yielded comparable findings.

Conclusions:

Higher PENK levels are associated with more severe HF, with glomerular and tubular renal dysfunction, with incidence of a deterioration of kidney function, and with mortality. These findings suggest that the opioid system might be involved in deteriorating kidney function in HF.
Nurse‐Led Heart Failure Clinics Are Associated With Reduced Mortality but Not Heart Failure Hospitalization
Authors: Savarese Gianluigi , Lund Lars H. , Dahlström Ulf , Strömberg Anna
Published: May 2019

Background

Follow‐up in a nurse‐led heart failure (
HF
) clinic is recommended in
HF
guidelines, but its association with outcomes remains controversial, with previous studies including few and highly selected patients. Thus, large analyses of “real‐world” samples are needed. Aims were to assess: (1) independent predictors of and (2) prognosis associated with planned referral to nurse‐led
HF
clinics.

Methods and Results

We analyzed data from the SwedeHF (Swedish
HF
Registry) using multivariable logistic regressions to identify independent predictors of planned referral to a nurse‐led
HF
clinic and multivariable Cox regressions to test associations between planned referral and outcomes (all‐cause death,
HF
hospitalization, and their composite). Of 40 992 patients, 39% were planned to be referred to a follow‐up in a nurse‐led
HF
clinic. Independent characteristics associated with planned referral were shorter duration of
HF
, clinical markers of more‐severe
HF,
such as lower ejection fraction, higher New York Heart Association class and N‐terminal pro‐B‐type natriuretic peptide, and lower blood pressure, as well as cohabitating versus living alone, male sex, fewer comorbidities, and more use of
HF
treatments. After adjustments, planned referral to a nurse‐led
HF
clinic was associated with reduced mortality and mortality/
HF
hospitalization, but not
HF
hospitalization alone.

Conclusions

In this nation‐wide registry, 39% of our identified
HF
cohort was planned to be referred to a nurse‐led
HF
clinic. Planned referral reflected more‐severe
HF
, but also sex‐ and family‐related factors, and it was independently associated with lower risk of death, but not of
HF
hospitalization.
Yentl's Bikini: Sex Differences in STEMI
Authors: Gulati Martha
Published: May 2019

See Article
Stehli et al
Two Projects of Christian Ethics: Clement, Paed. I 1 and Strom. II 2, 4-6
Authors: Havrda Matyáš
Published: May 2019

The prologue of Clement’s Pedagogue is re-examined against the backdrop of the divisions of ethics in Philo of Larissa, Eudorus, and Seneca. Apart from shedding light on the prologue as a project of practical ethics, new observations about Seneca’s terminology are made and a hitherto unnoticed parallel in Strabo adduced. Turning to Stromateis II 2, 4-6, the paper argues that it plays the role of an introduction to theoretical ethics, which covers the rest of the extant Stromateis, being designed for the sake of prospective teachers of Christian doctrine.
Philosophia Ancilla Theologiae: Plotinus’ Definition of Sensible Substance and its Adaptation in John Philoponus’ Arbiter
Authors: Krausmüller Dirk
Published: May 2019

This brief article discusses one particular aspect of John Philoponus’ Christology, his understanding of nature or substance. It makes the case that Philoponus adapted Plotinus’ definition of sensible substance because it helped him defend the notion that the incarnated Word is one single nature but nevertheless has two sets of natural qualities.
Testing, Accountability, and School Improvement
Authors: Loeb Susanna , Byun Erika
Published: May 2019

The provision of public schooling in the United States has primarily been the states’ responsibility, but states generally lack the capacity to manage day-to-day school operations. Thus, states delegate responsibility to districts while maintaining some oversight. Forms of oversight include regulations and political and market-based accountability. However, these can only do so much in holding schools accountable for providing high-quality schooling. Administrative accountability based on student outcomes and school process measures presents an alternative to complement other accountability mechanisms. Standardized measures of performance used for administrative accountability can better align curriculum with state standards, improve quality, and signal the skills that society wishes for students to build. However, they can be counterproductive if they are not reliable, valid, or comprehensive. We suggest in this article that no measure is perfect and that the usefulness of test-based accountability depends on whether the measures enhance educational opportunities and reflect shared goals with reliability, validity, and comprehensiveness.
Classroom Assessment to Support Teaching and Learning
Authors: Shepard Lorrie A.
Published: May 2019

Classroom assessment includes both formative assessment, used to adapt instruction and help students to improve, and summative assessment, used to assign grades. These two forms of assessment must be coherently linked through a well-articulated model of learning. Sociocultural theory is an encompassing grand theory that integrates motivation and cognitive development, and it enables the design of equitable learning environments. Learning progressions are examples of fine-grained models of learning, representing goals, intermediate stages, and instructional means for reaching those goals. A model for creating a productive classroom learning culture is proposed. Rather than seeking coherence with standardized tests, which undermines the learning orientation of formative assessment, I propose seeking coherence with ambitious teaching practices. The proposed model also offers ways to minimize the negative effects of grading on learning. Support for teachers to learn these new assessment practices is most likely to be successful in the context of professional development for new curriculum and standards.
Public Ideas: Their Varieties and Careers
Authors: Hallett Tim , Stapleton Orla , Sauder Michael
Published: May 2019

In light of ongoing concerns about the relevance of scholarly activities, we ask, what are public ideas and how do they come to be? More specifically, how do journalists and other mediators between the academy and the public use social science ideas? How do the various uses of these ideas develop over time and shape the public careers of these ideas? How do these processes help us understand public ideas and identify their various types? In addressing these questions, we make the case for a sociology of public social science. Using data from newspaper articles that engage with seven of the most publicly prominent social science ideas over the past 30 years, we make three contributions. First, we advance a pragmatic, cultural approach to understanding public ideas, one that emphasizes fit-making processes and applicative flexibility. Second, we define public ideas: social science ideas become public ideas when they are used as objects of interest (being the news), are used as interpretants (making sense of the news), and ebb and flow between these uses as part of an unfolding career. Third, we construct a typology of public ideas that provides an architecture for future research on public social science.
Enhancement of Consonant Recognition in Bimodal and Normal Hearing Listeners
Authors: Yoon Yang-Soo , Riley Britteny , Patel Henna , Frost Amanda , Fillmore Paul , Gifford Rene , Hansen John
Published: May 2019

Objectives:

The present study investigated the effects of 3-dimensional deep search (3DDS) signal processing on the enhancement of consonant perception in bimodal and normal hearing listeners.

Methods:

Using an articulation-index gram and 3DDS signal processing, consonant segments that greatly affected performance were identified and intensified with a 6-dB gain. Then consonant recognition was measured unilaterally and bilaterally before and after 3DDS processing both in quiet and noise.

Results:

The 3DDS signal processing provided a benefit to both groups, with greater benefit occurring in noise than quiet. The benefit rendered by 3DDS was the greatest in binaural listening condition. Ability to integrate acoustic features across ears was also enhanced with 3DDS processing. In listeners with normal hearing, manner and place of articulation were improved in binaural listening condition. In bimodal listeners, voicing and manner and place of articulation were also improved in bimodal and hearing aid ear–alone conditions.

Conclusions:

Consonant recognition was improved with 3DDS in both groups. This observed benefit suggests 3DDS can be used as an auditory training tool for improved integration and for bimodal users who receive little or no benefit from their current bimodal hearing.
Cochlear Implant Surgery Through Round Window Approach Is Always Possible
Authors: Bae Seong-Cheon , Shin You-Ree , Chun Young-Myoung
Published: May 2019

Objectives:

The benefit of round window (RW) approach for cochlear implant (CI) has been well studied. Because the RW represents a natural door to scala tympani, it facilitates precise electrode insertion. Atraumatic electrode insertion can also be performed without drilling the cochlear lateral wall. However, the RW approach has several limitations. The purpose of this study is to describe successful CI surgeries utilizing the RW approach except for severe cases of temporal bone anomaly. The authors’ successful surgical solution for cases involving difficult RW access is also described.

Materials and Methods:

We retrospectively analyzed 377 consecutive surgeries of cochlear implantation performed between June 2010 and December 2018 by a single experienced surgeon. Standard and alternative procedures were used according to anatomical variations. Standard procedures included modified techniques of mastoidectomy in the RW approach, opening of facial recess, exposure of RW membrane, and electrode insertion. Difficult cases involving severe rotated cochlea or hypoplastic mastoid were successfully treated with RW insertion using alternative procedures such as external auditory canal (EAC) wall mobilization and endomeatal approach.

Results:

We performed CI surgery through a reproducible RW technique in two cases involving endomeatal approach and three cases of EAC mobilization. Other cases were treated using the standard procedure.

Conclusion:

Cochlear implant surgery through RW is reliable, safe, and effective. The RW technique is reproducible via several surgical procedures in most CI cases. Identification and safe exposure of RW membrane is a prerequisite for successful electrode insertion in cochlear implant surgery.
Sublingual Immunotherapy Attenuates Nasal Symptoms Upon Allergen Exposure in Murine Allergic Rhinitis Model via an Induction of IL-10 producing T cells in Submandibular Lymph Node
Authors: Qu Yinfei , Yamada Takaya , Aoi Noriaki , Morikura Ichiro , Fuchiwaki Takafumi , Hotta Yukie , Prokopakis Emmanuel , Kawauchi Hideyuki
Published: May 2019

Objective:

Sublingual immunotherapy has been considered to be a painless and effective therapeutic treatment of patients with allergic rhinitis. Its mechanism of action has been elucidated, but there are still controversies among many reports between clinical efficacy and laboratory data. Therefore, its mechanism of action needs to be investigated further by using promising animal models such as rodents and monkeys.

Materials and Methods:

Bearing this in mind, in our present study, we successfully constructed an effective murine model for sublingual immunotherapy (SLIT) in allergic rhinitis in which mice were sublingually administered ovalbumin (OVA), followed by intraperitoneal (ip) sensitization and intranasal (i.n.) challenge of OVA.

Results:

To summarize our experimental data, nasal symptoms such as sneezing and nasal rubbing of sublingually treated mice were significantly attenuated in accordance with lower specific IgE antibodies in sera. Histological analysis of eosinophil recruitment in nasal mucosae reveals less allergic inflammation in sublingually treated mice. Interleukin-10 (IL-10) production and IL-10–specific mRNA gene expression of cultured submandibular lymph node (SMLN) cells with OVA, obtained from sublingually treated mice, were significantly higher than those of mice without sublingual treatment.

Conclusion:

These results demonstrate that sublingually introduced antigens can actually attenuate nasal symptoms in a murine allergic rhinitis model upon allergen exposures. Furthermore, our immunological data might indicate an important role of IL-10 producing T cells in SMLN to control nasal allergic reaction.
Pyridoxine Preferentially Induces Auditory Neuropathy Through Mitochondrial Dysfunction and Endoplasmic Reticulum Stress-Mediated Apoptosis
Authors: Park Channy , Lim Hyewon , Moon Sung K. , Park Raekil
Published: May 2019

Objectives:

Auditory neuropathy due to toxicity mechanism of pyridoxine has not yet been fully documented. Therefore, the present study explored a direct mechanism underlying the effects of pyridoxine on auditory neuropathy in organ of Corti (OC) explants ex vivo and cochlear neuroblast cell line, VOT-33 in vitro.

Methods:

Primary OC explants containing spiral ganglion neurons and cultured VOT-33 cells were treated with pyridoxine.

Results:

In nerve fiber of primary OC explants, pyridoxine decreased staining for NF200, a neuro-cytoskeletal protein. We also found that pyridoxine-induced VOT-33 apoptosis, as indicated by accumulation of the sub-G0/G1 fraction, caspase-3 activation, and PARP cleavage. In addition, pyridoxine induced reactive oxygen species (ROS) generation and alteration of mitochondrial membrane potential transition (MPT), including Bcl-2 family protein expression and consequently Ca2+ accumulation and changes of endoplasmic reticulum (ER) stress-related protein expression such as phospho-PERK, caspase-12, Grp78, and CHOP.

Conclusion:

Pyridoxine preferentially induced severe cell death on nerve fiber in primary OC explants and markedly increased apoptotic cell death via mitochondria-mediated ER stress in VOT-33 cells.
Intratympanically Delivered Steroids Impact Thousands More Inner Ear Genes Than Systemic Delivery
Authors: Trune Dennis R. , Shives Katherine D. , Hausman Fran , Kempton J. Beth , MacArthur Carol J. , Choi Dongseok
Published: May 2019

Objectives:

Glucocorticoids are given for sensorineural hearing loss, but little is known of their molecular impact on the inner ear. Furthermore, in spite of claims of improved hearing recovery with intratympanic delivery of steroids, no studies have actually documented the inner ear molecular functions that are enhanced with this delivery method.

Methods:

To assess steroid-driven processes in the inner ear, gene chip analyses were conducted on mice treated systemically with the glucocorticoids prednisolone or dexamethasone or the mineralocorticoid aldosterone. Other mice were given the same steroids intratympanically. Inner ears were harvested at 6 hours and processed on the Affymetrix 430 2.0 Gene Chip for expression of its 34 000 genes. Results were statistically analyzed for up or down expression of each gene against control (untreated) mice.

Results:

Analyses showed approximately 17 500 genes are normally expressed in the inner ear and steroids alter expression of 55% to 82% of these. Dexamethasone changed expression of 9424 (53.9%) inner ear genes following systemic injection but 14 899 ear genes (85%) if given intratympanically. A similar pattern was seen with prednisolone, as 7560 genes were impacted by oral delivery and 11 164 genes (63.8%) when given intratympanically. The mineralocorticoid aldosterone changed expression of only 268 inner ear genes if given orally, but this increased to 10 124 genes (57.9%) if injected intratympanically. Furthermore, the glucocorticoids given actually impacted more inner ear genes via the mineralocorticoid receptor than the glucocorticoid receptor.

Conclusions:

Thousands of inner ear genes were affected by steroids, and this number increased significantly if steroids were delivered intratympanically. Also, the impact of glucocorticoids on inner ear mineralocorticoid functions is more substantial than previously known. Thus, the application of therapeutic steroids for hearing loss needs to be reassessed in light of their more comprehensive impact on inner ear genes. Furthermore, simply ascribing the efficacy of steroids to immunosuppression no longer appears to be warranted.
Pathophysiologic Findings in the Human Endolymphatic Sac in Endolymphatic Hydrops: Functional and Molecular Evidence
Authors: Kim Sung Huhn , Nam Gi-Sung , Choi Jae Young
Published: May 2019

Background:

The endolymphatic sac (ES) is a cystic structure situated on the posterior fossa dura and is connected to the luminal space of the vestibular organ through the endolymphatic duct, which branches into the utricular and saccular ducts. Unlike the cochlea and vestibule, the ES does not contain sensory epithelium in its luminal space, and a single layer of epithelial cells line the luminal surface area. The ES in the inner ear is thought to play a role in the regulation of inner ear homeostasis, fluid volume, and immune reaction. If these functions of the ES are disrupted, dysfunction of the inner ear may develop. The most well-known pathology arising from dysfunction of the ES is endolymphatic hydrops, characterized by an enlarged endolymphatic space due to the accumulation of excessive endolymphatic fluid. Although, molecular identities and functional evidence for the roles were identified in animal studies, basic studies of the human ES are relatively uncommon compared with those using animal tissues, because of limited opportunity to harvest the human ES.

Methods:

In this study, molecular and functional evidence for the role of the human ES in the development of endolymphatic hydrops are reviewed.

Results and Conclusions:

Although evidence is insufficient, studies using the human ES have mostly produced findings similar to those of animal studies. This review may provide a basis for planning further studies to investigate the pathophysiology of disorders with the finding of endolymphatic hydrops.
Survival Outcomes for Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck
Authors: Sullivan Christopher Blake , Andresen Nicholas S. , Kendell Nicholas , Al-Qurayshi Zaid , Pagedar Nitin A.
Published: May 2019

Objectives:

Survival outcomes for advanced non-melanoma skin cancers of the head and neck treated with surgical resection are not well described in the literature. We aimed to describe outcomes for T3 and T4 cutaneoous squamous cell carcinoma of the head or neck treated with surgical resection at 1 tertiary academic medical center.

Methods:

We analyzed a retrospective cohort of patients diagnosed with T3 or T4 cutaneous squamous cell carcinoma (SCC) of the head or neck from 2005 to 2016 treated with definitive surgical resection. Survival outcomes were examined using Kaplan-Meier analysis, and multivariate analysis was completed with Cox proportional hazard model.

Results:

Forty-three patients met inclusion criteria. The mean age at diagnosis was 74.7 years (SD = 10.2), and 34 (79.1%) patients were male. Twelve (27.9%) patients were immunosuppressed. Radical resection, defined as temporal bone resection, orbital exenteration, calvarial resection, mandibulectomy, or maxillectomy, was performed in 25 (58.1%) cases. Final surgical margins were positive in 19 (44.2%) cases. Patients with tumors of the scalp/neck had a 1-year survival probability of 85.7%, and the probability of survival 1 year after a neck dissection was greater than 93%.

Conclusion:

Anatomical subsites, specifically scalp/neck tumors, tended to have worse overall survival. Positive final margins tended to indicate a worse prognosis, and overall survival and recurrence were not significantly different among patients who underwent radical surgical resection compared to soft tissue resection.
Effect of Therapeutic Interchange on Medication Changes Between Admission and Discharge
Authors: Popp Ryan A. , Lusk Kathleen A. , Glaess Shelley S. , Burkett Donna , Attridge Rebecca L.
Published: May 2019

Background: Therapeutic interchange (TI) is the dispensing of an alternative medication within the same class as the original medication. TI often occurs in hospitals; however, failure to return patients to their original medications may increase the risk of adverse effects following hospital discharge. Objective: The purpose of this study was to evaluate the relationship between TI and discharge medication changes, hospital readmission rates, and emergency department visit rates following hospital discharge. Methods: Patient demographic and medication data were collected retrospectively for patients admitted to a nonprofit, acute care hospital. The primary outcome was the relationship between TI and the rate of discharge medication changes. Secondary outcomes included types of discharge medication changes and the relationship between TI and both hospital readmissions and emergency department visits following hospital discharge. Results: A total of 497 patients accounting for 1072 medications were included; 21.2% of home medications were interchanged following admission, and 21.8% of home medications were changed at discharge. TI increased the incidence of discharge medication changes by 70% (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.22-2.37, P = .0021). Cardiovascular agents were most likely to be changed at discharge (26%), and gastrointestinal agents were most likely to be interchanged (65%). Psychotropic agents were least likely to be changed at discharge (12%) or interchanged (7%). Neither TI nor discharge medication changes were predictive of 30-, 60-, or 90-day hospital readmission or emergency department visits following discharge. Conclusion and Relevance: This study was the first to examine the effects of TI on post-discharge outcomes. Despite being associated with an increased rate of discharge medication changes, the presence of TI did not correlate with hospital readmission or emergency department visit rates. This study supports the safety of TI.
Feeling the Pulse: Towards Production Expansion of Pulses in India
Authors: Tripathi Ashutosh Kumar
Published: May 2019

Rising price of pulses is a matter of great concern for nutrition in India, which is home to the largest number of malnourished people in the world. The paper outlines policy strategies that can help in increasing the production of pulses and thereby making it available at affordable prices. The paper looks into neglect of pulses in agriculture policies that hampers farmers’ incentives to promote investment, technology and productivity. The analysis suggests for better incentives to farmers growing pulses in the form of higher minimum support prices, reflecting the true economic benefit of growing pulses coupled with a strong procurement network across the country. An action on technological front with focus on increasing yield levels thereby, reducing cost of production can be a game changer in pulse production.
Chinese Engagement of Zimbabwe and the Limits of Elite Agency
Authors: Chipaike Ronald , Bischoff Paul Henri
Published: May 2019

This article contends that Zimbabwe’s agency in its engagement with China has been limited and at best circumscribed. This owes to factors such as indifference by state authorities to cooperation with civil society actors in negotiating with Chinese actors, the desperation of the The Zimbabwe African National Union – Patriotic Front regime in the face of isolation by erstwhile partners as well as the opacity and secrecy that characterizes significant areas of the Zimbabwe–China relationship. The pressing need for critical institutions such as parliament to play independent oversight roles as well as the creation of space for civil society watchdog functions are highlighted as key enablers if Zimbabwean agency is to generate positive gains from the country’s engagement with China.
Gamification: A Pilot Study in a Community College Setting
Authors: O’Connor Patrick , Cardona Josué
Published: May 2019

Gamification has been used as a tool to increase engagement with businesses, build group cohesion, and improve student motivation in Grades K-12. Part of its appeal is in developing autonomy in the “player,” and part of its appeal is in participating regularly in a structured progress ladder where the customer, student, or employee can predict how present actions can lead to future rewards. Currently, research in applying gamification to undergraduate courses is sparse, which is surprising given the overlap between higher education and game design; students and players both follow rules, participate voluntarily, engage with a feedback loop, and work toward a goal. This study applied game design principles via gamification to an undergraduate General Psychology course at a community college. Results indicate better motivation, improved exam scores, a stronger sense of autonomy, and a desire within students to have more courses offered in this manner. However, final course grades showed no significant difference compared with traditionally designed courses. Implications for future research are discussed.
Hospital Clown Narratives in Pediatric Palliative Care
Authors: Santarpia Alfonso , Romani-Cesaro Marjorie , Simonds Caroline
Published: May 2019

The goal of this qualitative research was to achieve a deeper psychological understanding of professional hospital clown work with hospitalized children during their end-of-life care period. Using a statistical text analysis with a co-occurrence strategy we showed several narrative categories from a clown’s perspective: “Tragic metamorphosis,” “Meditating on the mystery,” “An ultimate poetic atmosphere,” “Interconnectedness and interrelatedness of all things,” “An emotional catalyst,” “The deep need to say goodbye,” “Ethical guidance values.” We will interpret the narratives categories according to humanistic/existential framework as the theoretical base. The clown addresses those aspects of healing that are not well developed in modern Western medicine, the treatment of the whole person. The clown embraces human nature as physical, emotional, cognitive, and spiritual.
Extending the Reach of Pediatric Emergency Preparedness: A Virtual Tabletop Exercise Targeting Children’s Needs
Authors: So Marvin , Dziuban Eric J. , Franks Jessica L. , Cobham-Owens Karen , Schonfeld David J. , Gardner Aaron H. , Krug Steven E. , Peacock Georgina , Chung Sarita
Published: May 2019

Objectives:

Virtual tabletop exercises (VTTXs) simulate disaster scenarios to help participants improve their emergency-planning capacity. The objectives of our study were to (1) evaluate the effectiveness of a VTTX in improving preparedness capabilities specific to children’s needs among pediatricians and public health practitioners, (2) document follow-up actions, and (3) identify exercise strengths and weaknesses.

Methods:

In February 2017, we conducted and evaluated a VTTX facilitated via videoconferencing among 26 pediatricians and public health practitioners from 4 states. Using a mixed-methods design, we assessed participants’ knowledge and confidence to fulfill targeted federal preparedness capabilities immediately before and after the exercise. We also evaluated the degree to which participants made progress on actions through surveys 1 month (n = 14) and 6 months (n = 14) after the exercise.

Results:

Participants reported a greater ability to identify their state’s pediatric emergency preparedness strengths and weaknesses after the exercise (16 of 18) compared with before the exercise (10 of 18). We also observed increases in (1) knowledge of and confidence in performing most pediatric emergency preparedness capabilities and (2) most dimensions of interprofessional collaboration. From 1 month to 6 months after the exercise, participants (n = 14) self-reported making progress in increasing awareness for potential preparedness partners and in conducting similar pediatric exercises (from 4-7 for both).

Conclusions:

Participants viewed the VTTX positively and indicated increased pediatric emergency preparedness knowledge and confidence. Addressing barriers to improving local pediatric emergency preparedness—particularly long term—is an important target for future tabletop exercises.
The Effect of Narrow Reading on L2 Learners’ Perceptions
Authors: Chang Anna C-S , Renandya Willy A.
Published: May 2019

The study investigated L2 learners’ perceptions of narrow reading. Thirty-two students finished four sets of graded readers organized by the same author with the same genre and same title, or random texts. After finishing each set of three graded readers, the students answered an eight-item questionnaire and wrote their reading feedback. Linear mixed effect models were used to analyse the data gathered from the questionnaire, taking the participants as the random effect variable, and four forms of text organization, reading time order, language proficiency, and the reading text sequence as fixed effect variables. The two 10-week treatments revealed that text organization and language proficiency have significant effects on the students’ perceptions, while reading time order and text sequences do not. Students’ written feedback indicated that all texts were interesting except the texts of the same titles which were boring for having to be read three times. Students’ written feedback provided valuable information for selecting reading texts. Implications of the study are discussed.
Who Are the Squatters? Challenging Stereotypes through a Case Study of Squatting in the Dutch City of Leiden, 1970-1980
Authors: van der Steen Bart , van Rooden Charlotte , Snoep Merel
Published: May 2019

This article investigates the development of squatting and house occupations in the Dutch city of Leiden during the 1970s to challenge stereotypical images of squatting and squatter protest in the Netherlands and beyond. Based on a historical analysis of 344 newspaper articles on squatting in the middle-sized city of Leiden from 1970 to 1980, this research not only shows the diversity of the squatter population and the ways in which the authorities responded to their actions—thus challenging the radical, confrontational, and metropolitan nature of squatting—but also analyzes how squatters were portrayed and how and why their image changed over time.
Acute Effects of Antileukotrienes on Sinonasal Polyposis and Sinusitis
Authors: Parnes Steven M. , Chuma Andrew V.
Published: May 2019

Recently, leukotrienes have been implicated in the mediation of bronchoconstriction and inflammatory changes in asthma. Leukotriene levels have also been shown to be elevated in patients with asthma as well as in those with sinonasal polyposis and sinusitis. The leukotriene synthesis inhibitor zileuton and the leukotriene receptor antagonist zafirlukast have been shown to produce subjective and objective improvements in patients with mild to moderate asthma. Given these findings, we evaluated the efficacy of these two medications in controlling sinonasal polyposis and their associated symptoms.

We treated 40 patients diagnosed with sinonasal polyposis and sinusitis with either zileuton or zafirlukast. No other change was made in their standard therapy. Outcome measures included subjective interviews and questionnaire responses, as well as office endoscopic examinations and chart reviews.

At study's end, 36 patients were available for evaluation. Twenty-six had taken zafirlukast, five had taken zileuton, and five others had switched from zafirlukast to zileuton. Overall, 26 patients (72%) experienced subjective improvement in their symptomatology after starting their medication. Statistically significant improvement was noted with respect to headache, facial pain and pressure, ear discomfort, dentalgia, purulent nasal discharge, postnasal drip, nasal congestion and obstruction, olfaction, and fever. An objective alleviation, or at least stabilization, of sinonasal polyposis was seen in 50% of the patients. Four patients (11%) discontinued their medication because of side effects.

We conclude that antileukotrienes might play a significant role in controlling polyposis and symptoms secondary to sinonasal disease, and they might be a viable alternative to long-term oral steroid therapy and repeated surgical debridement.
Standardized Measurements of Radiographic Films of the Frontal Sinuses: An Aid to Identifying Unknown Persons
Authors: De Andrade Quintanilha Ribeiro Fernando
Published: May 2019

Many methods have been used to identify unknown persons. The most common is the study of fingerprints, which is one of the few methods in which data can be stored and retrieved in a precise and cost-effective manner.

The asymmetry of the frontal sinuses has stimulated several attempts to identify persons by analyzing measurements of the sinuses obtained from plain x-ray films. However, an objective and reproducible method has not been achieved.

The objective of this paper is to report on a method of making standardized measurements of the frontal sinuses on radiographs and storing the resultant information in a computer databank. To test the system, the author made new measurements on 100 x-rays and entered the results into a computer databank that contained information on earlier measurements of the same 100 x-rays and on 400 others. With the aid of the databank, the author was able to rapidly and accurately match each new measurement with the earlier measurement. The author concludes that such a system is a simple and cost-effective method of establishing the identification of unknown persons for whom frontal sinus x-rays exist.
Pneumosinus Dilatans: A Report of Three new Cases and Their Surgical Management
Authors: Klossek Jean-Michel , Dufour Xavier , Toffel Paul , Fontanel Jean-Pierre
Published: May 2019

Pneumosinus dilatans is a rare pathology that primarily involves the frontal sinus. We report three new cases, with special attention given to the pathophysiology and histologic data. Surgical management is reported.
Fibrous Dysplasia of the Temporal Bone: Report of a Case and a Review of its Characteristics
Authors: Papadakis Chariton E. , Skoulakis Charalambos E. , Prokopakis Emmanuel P. , Nikolidakis Antonios A. , Bizakis John G. , Velegrakis George A. , Helidonis Emmanuel S.
Published: May 2019

Fibrous dysplasia is an uncommon benign disorder of unknown etiology. It represents a disturbance of normal bone development—specifically a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone.

Because fibrous dysplasia shows a predilection for the facial and cranial bones, where it causes deformity and dysfunction, the disease is of particular interest to the otolaryngologist. In this paper, we report a case of fibrous dysplasia of the temporal bone, the first symptom of which was a mixed hearing loss. We discuss the characteristic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of secondary sensorineural hearing loss.
Dislocation and Hypertrophy of the Medial Head of the Clavicle: An Unusual Late Complication of Radical Neck Dissection
Authors: Shreif Jamal A. , Evans Peter Rhys
Published: May 2019

We report three cases of a rare late complication of neck dissection: anterior dislocation and hypertrophy of the sternal head of the clavicle manifesting as a hard lump in the lower neck. We describe the mode of presentation, etiology, and methods of prevention.
Nasal Foreign Body: Removal of an Open Safety Pin from the Left Nostril
Authors: Salley Lawton H. , Wohl Daniel L.
Published: May 2019

We describe the case of a woman who presented with an open safety pin lodged in her left nostril. An attempt to remove the pin with the patient under local anesthesia was not successful. Removal was eventually accomplished in the operating room with the patient under general anesthesia.
Yolk Sac Tumor of the Temporal Bone: Report of a Case
Authors: Frank Thomas C. , Anand Vinod K. , Subramony Charu
Published: May 2019

Yolk sac tumor (endodermal sinus tumor) is rarely encountered in the temporal bone. Facial nerve paralysis can be a primary manifestation of this condition. Histologically, the tumor can be difficult to diagnose, although elevated levels of alpha fetoprotein can facilitate its identification.

In this report, we describe the case of an 18-month-old girl who developed peripheral VIIth nerve palsy and a polypoid mass in the left external ear canal 3 months following myringotomy. Computed tomography and magnetic resonance imaging revealed that the tumor involved the left external ear canal, middle ear space, and mastoid air cells. Biopsies were consistent with a yolk sac tumor. Special staining demonstrated that only a very few tumor cells were positive for alpha fetoprotein, despite the markedly elevated level of alpha fetoprotein in her serum. The patient was treated with chemotherapy, which included cisplatin, etoposide, and bleomycin. Within a period of weeks, she experienced a complete reversal of her left VIIth nerve palsy, a marked decrease in her serum alpha fetoprotein levels, and a dramatic resolution of the tumor as demonstrated radio graphically. Such a successful chemotherapeutic response in this case argues against surgical intervention in other cases, particularly in view of the risk of serious complications with surgery.
Professionalism, Where are You?
Authors: Loh Kelvin
Published: May 2019

The practice of medicine continues to evolve in ways that are not always compatible with good patient care, and physicians now control less and less of their practices. One of the casualties of the new health economics is the concept of professionalism, which becomes more difficult to adhere to in the face of restrictions placed by outside forces. Nevertheless, physicians can maintain a sense of professionalism despite all the difficulties. Indeed, we must do so in order to remain true to our ideals.
Loratadine/Pseudoephedrine for Nasal Symptoms in Seasonal Allergic Rhinitis: A Double-Blind, Placebo-Controlled Study
Authors: McFadden Edith A. , Gungor Anil , Ng Bernard , Mamikoglu Bülent , Moinuddin Rizwan , Corey Jacquelynne
Published: May 2019

In this double-blind, placebo-controlled, crossover, parallel study, we treated 20 adults who had seasonal allergic rhinitis with once-daily fixed-combination loratadine/pseudoephedrine sulfate to observe its effect on relieving symptoms, primarily nasal congestion. Acoustic rhinometry detected a trend toward improvement in nasal patency, although the difference between pre- and post-treatment measures was not statistically significant. Endoscopic inferior turbinate photography documented that treatment led to statistically significant reductions in the amount of nasal edema and nasal secretions. The results of a quality-of-life questionnaire suggested that treatment alleviated nasal and ocular symptoms of rhinoconjunctivitis. An analysis of subjective visual analog scale scores showed a trend toward improvement in most but not all nasal symptoms. We conclude that once-a-day fixed-combination loratadine/pseudoephedrine is effective in relieving nasal congestion in patients with seasonal allergic rhinitis.
Pneumoparotid: A Case Report and Review of its Pathogenesis, Diagnosis, and Management
Authors: Huang Patti C. , Schuster David , Misko Glen
Published: May 2019

Pneumoparotid is considered to be a rare entity, but the diagnosis might not be as uncommon as reported. We report a case in which computed tomography incidentally revealed air in the parotid ducts bilaterally. Treatment is aimed at the elimination of predisposing and causative factors, but because our patient denied any symptoms or precipitating factors and had a benign presentation, no immediate intervention was initiated.
Indirect Laryngeal Surgery in the Clinical Voice Laboratory: The Renewal of a Lost Art
Authors: Hogikyan Norman D. , Pynnonen Melissa
Published: May 2019

Since the advent of precision instruments and safe techniques for direct laryngoscopic surgery under general anesthesia, indirect laryngeal surgery has become very uncommon. A review of the recent literature finds that few authors advocate indirect surgery under topical anesthesia, and many otolaryngologists dismiss this technique as being either of only historical interest or an idiosyncratic method practiced only by a handful of clinicians. The societal mandate for cost-effective healthcare and the availability of relatively low-cost, high-quality endoscopes and video equipment warrant a renewed and broader interest in this type of surgery. In this article, we review a series of 27 indirect surgical procedures performed under topical anesthesia in the clinical voice laboratory. We discuss the indications, outcomes, advantages, and disadvantages of this surgery, and we present a brief analysis of its cost-effectiveness. We conclude that indirect laryngeal surgery in the clinical voice laboratory is an effective, safe, efficient, and less costly alternative to some procedures routinely performed under general anesthesia.
Spontaneous Cerebrospinal Fluid Leakage and Middle Ear Encephalocele in Seven Patients
Authors: Patel Rakesh B. , Kwartler Jed A. , Hodosh Richard M. , Baredes Soly
Published: May 2019

Isolated cases of spontaneous cerebrospinal fluid (CSF) leakage with and without middle ear encephalocele have been reported. These leaks are usually accompanied by episodes of recurrent meningitis, hearing loss, or chronic headache. In this article, we report seven new cases of spontaneous CSF leakage. Six of these patients had conductive hearing loss and serous otitis media, and three had recurrent meningitis. Prior to a definitive diagnosis, six patients had received myringotomy tubes, which produced profuse clear otorrhea. Three patients had positive beta-2 transferrin assays. Computed tomography and magnetic resonance imaging confirmed a defect in the temporal bone tegmen. A combined transmastoid and middle fossa surgical approach with a three-layer closure was used to repair the tegmen defect. All patients had a lumbar drain placed prior to surgery. In addition to describing the seven new cases, we review the history of CSF leakage and discuss diagnostic methods, surgical findings, and our recommendations for management.
Intralingual Dermoid Cysts: A Report of Two New Cases
Authors: Myssiorek David , Lee James , Wasserman Patricia , Lustrin Elizabeth
Published: May 2019

Dermoid cysts of the oral cavity are rare. When they do occur, the most common site is the floor of the mouth. Intralingual dermoid cysts are even more rare, and until now, there were only 15 such reports in the English-language literature. In this article, we describe two additional cases. Magnetic resonance imaging is extremely helpful in establishing a differential diagnosis. Surgical excision is recommended to correct deglutition and speech problems. Its rarity notwithstanding, dermoid cyst should be considered in the differential diagnosis of tongue masses in the younger population.
The Role of Radioactive Iodine in Salivary Gland Dysfunction
Authors: Newkirk Kenneth A. , Ringel Matthew D. , Wartofsky Leonard , Burman Kenneth D.
Published: May 2019

The use of radioactive iodine has become an important adjunct to the treatment of thyroid cancer. Many normal tissues—including salivary glands, gastrointestinal mucosa, gonads, and lactating breast tissue—have the ability to concentrate radioactive iodine under normal circumstances. Although the mechanism is just beginning to be elucidated, it is this ability that might contribute to the immediate and long-term complications associated with radioactive iodine treatment. In some patients, the salivary complications can be permanent and might compromise daily functioning. In this article, we examine the salivary gland complications associated with radioactive iodine therapy, and we suggest potential protective mechanisms to circumvent these problems.
Facial Nerve Paralysis following Repair of the External Ear Canal with Ionomeric Cement
Authors: Granström Gösta , Holmquist Jörgen , Tjellström Anders
Published: May 2019

A 20-year-old man developed a complete facial nerve paralysis following surgical reconstruction of the posterior ear canal with ionomeric cement. The paralysis developed gradually during the second and third postoperative weeks. Six weeks following the complete removal of the cement, the facial nerve recovered completely. The literature contains reports of diffusion of aluminum ions, which can reach toxic levels in tissue fluid and adjacent bone as the cement hardens. This side effect has been reported to cause an inflammatory response in the dura and brain and has led to fatalities. To our knowledge, there has been no other report of an ionomeric cement having a direct toxic effect on peripheral nerve transmission. Because ionomeric cements are used routinely in otosurgery, especially in canal reconstructions where the proximity to the facial nerve is evident, it is important to use caution when introducing ionomeric cements into near-nerve anatomic locations.