bluuebunny/crossref_metadata_2025 huggingface dataset:
Policy and Politics: Two recent examples in Western Australia
Authors: Jackson Judge Hal
Published: January 2011

In a state known for consistently high incarceration rates, especially of Aboriginal people, the Labor governments of the 1980s created two criminologically based research or advisory bodies. The paper looks at the background and history of each — the State Government Advisory Committee on Young Offenders and the Crime Research Centre (and the lessons learned therefrom in light of policy making decisions, both by the Labor Government which created them and its successor, the Liberal Government of Richard Court). The first was composed largely of high ranking judicial, police and bureaucratic members, high profile community members and skilled research staff. Its fate was sealed by its insistence on independence. The second is university-based with a statistical and research focus. Independently funded, it survives but what effect has it had? The author was at one time a member of the Committee and a member of the Advisory Board of the Centre.
In the Frame: Crime and the Limits of Representation
Authors: Young Alison
Published: January 2011

Recent research in criminology has taken up the question of the representation of crime. This article seeks to show, by means of a case study, that the question of representation should be addressed less in terms of its correspondence to reality, but rather in terms of its own structures. These structures enable us to see how crime is staged as a problem in and of cultural representation. The case study analysed is that of the James Bulger case in Britain: the murder of a two year old boy by two 10 year old boys, the ensuing trial and sentencing of the boys for murder and abduction. The article analyses three themes which were prominent in the media reports (representations of the nature of childhood; the maternal relation; and the paternal figure). The article also demonstrates, by means of an analysis of the reliance upon a technology of the image in the case, that there are limits to representation: as the desire or demand for representation seeks to see the event of abduction and murder, that event can only be represented as lack or absence.
Issues In Drug Offender Diversion: A Review of the Court Diversion Service in Western Australia
Authors: Rigg Jeremy , Indermaur David
Published: January 2011

This article examines the implementation and operation of a bail programme introduced to divert drug using offenders from prison in Perth, Western Australia. Changes in the number, type and source of offenders referred to the programme are described, as are the perceptions of programme staff, judges, magistrates, corrections officers and legal workers. Although the programme was generally regarded as useful, a number of issues requiring attention were identified. It was concluded that there is a need for restatement of procedural guidelines and for an evaluation of the outcomes of the programme in terms of its originally stated aims of diverting drug using offenders from imprisonment.
Reconstructing Theory: Explaining Aboriginal Over-Representation in the Criminal Justice System in Canada
Authors: LaPrairie Carol
Published: January 2011

This paper 1 attempts to explain the vulnerability of aboriginal people to involvement in the criminal justice system in Canada. It argues that one of the most important factors is a decline in interdependency among people in aboriginal communities. This has come about as the result of historical processes (such as colonisation and the creation of the reserve system) which have reproduced mainstream social structure without accompanying institutional development. This has been exacerbated by cultural dislocation and the decline of informal mechanisms of social control. The end result is socially stratified communities where limited resources and resource distribution create large groups of disadvantaged people, a growing youth sub-culture with few legitimate outlets or opportunities, decontextualised exposure to the mass media, and the lack of cultural and social resources to assist in identity formation which support pro-social values. Three factors are most conducive to a crime problem. The first is the large group of marginalised and non-integrated people in communities because of the uneven distribution of resources; the second is that reserves are not generally integrated into mainstream Canadian society (because of historical practices of exclusion and the second class status ascribed to aboriginal people) and the resulting alienation is most prominent in those with the fewest connections to mainstream society; and the third is that exposure to dysfunctional family life and childhood abuse (in addition to other factors conducive to criminal behaviour) have profoundly negative effects on individual development. The most marginalised groups in communities are most affected by these factors. When these groups leave reserves they have few tools for survival or for gaining status or integration into mainstream society. In the urban setting, the lack of education, employment skills, coupled with substance abuse problems and histories of family violence and dysfunction, lead to negative peer associations and the adoption of antisocial and pro-criminal attitudes. There is a growing problemof marginalised people leaving reserves to live in urban areas.
The Role of Legal Coercion in the Treatment of Offenders with Alcohol and Heroin Problems
Authors: Hall Wayne
Published: January 2011

This article discusses the ethical justification for, and reviews the American evidence on the effectiveness of, treatment for alcohol and heroin dependence that is provided under legal coercion to offenders whose alcohol and drug dependence has contributed to the commission of the offence with which they have been charged or convicted. The article focuses on legally coerced treatment for drink-driving offenders and heroin-dependent property offenders. It outlines the various arguments that have been made for providing such treatment under legal coercion, namely: the over-representation of alcohol and drug dependent persons in prison populations; the contributory causal role of alcohol and other drug problems in the offences that lead to their imprisonment; the high rates of relapse to drug use and criminal involvement after incarceration; the desirability of keeping injecting heroin users out of prisons as a way of reducing the transmission of infectious diseases such as HIV and hepatitis; and the putatively greater cost-effectiveness of treatment compared with incarceration. The ethical objections to legally coerced drug treatment are briefly discussed before the evidence on the effectiveness of legally coerced treatment for alcohol and other drug dependence is reviewed. The evidence, which is primarily from the USA, gives qualified support for some forms of legally coerced drug treatment, provided that these programs are well resourced, carefully implemented, and their performance is monitored to ensure that they provide a humane and effective alternative to imprisonment. Expectations about what these programs can achieve also need to be realistic.
Regulating Markets for Stolen Property
Authors: Freiberg Arie
Published: January 2011

Each year, in Australia, property estimated to be valued at between two and three billion dollars is stolen from homes, shops, cars, factories and warehouses. Little of this property is recovered and returned to its owners or retained by burglars and thieves for their personal use. The remainder is sold or bartered, but the nature and extent of the re-distributional system for stolen property is little understood.

This article is an attempt to understand property as a market for goods and services, which, like any other market, is subject to the influences of supply and demand and government regulation. First, it aims to analyse the interactions between the parties in marketing terms by regarding the participants not as individual burglars, thieves, receivers and accessories, as but as suppliers, distributors, retailers and purchasers. Secondly, it argues that current public knowledge of markets for stolen goods and their dynamics are impoverished. Finally, it suggests that a broad range of regulatory strategies can be brought to bear on these markets in order to influence the behaviour of actors within them.
Community Conferencing and the Fiction of Indigenous Control
Authors: Cunneen Chris
Published: January 2011

The paper analyses the use of community conferencing for young people in various jurisdictions in Australia in the light of its impact in Indigenous communities. It argues that the manner in which these programs have been introduced has ignored Aboriginal rights to self-determination and has grossly simplified Indigenous mechanisms for resolving conflicts. In most jurisdictions, community conferencing has reinforced the role of state police and done little to ensure greater control over police discretionary decision-making. The changes have also been introduced in the context of more punitive law and order policies, including mandatory minimum imprisonment terms and repeat offender legislation for juveniles. The end result is likely to be greater bifurcation of the juvenile justice system along racialised boundaries, with Indigenous youth receiving more punitive outcomes.
Policing, Accountability and Citizenship in the Market State
Authors: Davids Cindy , Hancock Linda
Published: January 2011

This paper investigates trends in the reform agenda for Victoria Police. These include the implementation of the concept of user pays, outsourcing of ‘non–core’ services, expanded privatisation, corporate sponsorship, customer service, flatter management structures, fixed term contracts for senior officers, and performance targets — changes identified with 1990s economic rationalism, managerialism and the market model.

With implications for similar trends internationally, the paper unpacks what these reforms mean in terms of relationships between the community and police (including services, management, and organisation). It raises questions related to what constitutes core tasks of the state, state accountability to the public, public safety, the social costs of economic rationalism, managerialism and the microeconomic reforms of the 1990s. These signal shifts in governance, and changes in the relationship between the citizen and the state.
Crime, Rurality and Community
Authors: Hoggt Russell , Carrington Kerry
Published: January 2011

Criminology has tended to treat crime as predominantly an urban phenomenon. A review of the available, albeit rather limited, empirical evidence regarding crime and law and order in rural New South Wales (NSW) raises some doubts about the urban-centric focus of criminology and opens up a range of other interesting questions concerning the differential social construction of crime problems in some rural localities, in particular the tendency to racialise questions of crime and law and order. Rather than simply developing an empirical and theoretical account of urban/rural differences, however, the paper suggests a conceptual framework for local and regional studies drawing on the work of Norbert Elias and Robert Putnam.
Dangerous Places and the Unpredictable Stranger: Constructions of Fear of Crime
Authors: Lupton Deborah
Published: January 2011

This article presents findings from a predominantly qualitative study on fear of crime among a group of Australians, using individual interviews and focus groups.The discussion focuses on the ways in which the partici-pants identified particular spatial and temporal dimensions of crime, and identifies the social groups and individuals upon which people projected their fear. Feelings of fear are dynamic and contextual, constantly subject to reassessment and change depending on such factors as the time of day or night, individuals' past experiences of crime, their familiarity and experi-ence with an area, the presence or absence of others in a particular location at a particular time, and circuits of localised knowledges. Feelings of uncertainty and loss of control were central to the identification of dangerous places and dangerous others.The participants' fear tended to be in relation to the figure of the 'unpredictable stranger' — someone who is Other to one's Self, an individual who does not share one's own approach to life, one's principles and sensibilities.
Criminology, Genocide and the Forced Removal of Indigenous Children from their Families
Authors: Cunneen Chris
Published: January 2011

This article argues that understanding the nature of genocide in its various manifestations goes to the core of developing a ‘postcolonial’ criminology. Ultimately, the fact of genocide involves a re-theorising of the ‘colonial question’ in criminology. It involves a shift in the focus from Indigenous people as the object of inquiry usually as offenders, to the survivors of systematic crimes against humanity. Certainly in the Australian context, the greatest crime that has been committed on the continent since European conquest was genocide. Genocide also demands a rethinking of the criminalization process, particularly in relation to ‘crimes of the state’. How can the state be held responsible? What form can responsibility take, and what type of reparations are commensurate with the nature of the offence?

Genocide against Indigenous peoples also inevitably leads us to the issue of preventing human rights abuses and respecting the existing and emerging rights of Indigenous peoples. The cultural and physical survival of Indigenous peoples is ultimately dependent on self-determination. Again this poses quite specific questions for criminological theory and practice. How do we theorise the interrelationships between Indigenous modes of governance and law, with imposed extraneous models, and what are the policy implications of those interrelationships? The questions that are raised imply a very different approach to one which continually sees Indigenous people as a function of offending, imprisonment and so forth.
Beyond Story Grammar
Authors: Urbach Jennifer
Published: December 2010

Literacy is a socially constructed ideology (Barton & Hamilton, 1998; Street, 1995). Current representations reduce literacy to standards, skill testing, and the five components of reading (NICHD, 2000). This view of literacy discounts the knowledge and skills of many students. This article examines the oral story of Aisha, an African American first grader, through traditional and nontraditional measures. The findings highlight two contrasting perspectives of Aisha’s story: One that views the story as weak and below grade level and another that highlights her rich literacy abilities. This study argues that it is important to consider the social and historical features that may influence children’s stories. A definition of literacy that recognizes and values the continuum of literacy experiences is advocated in this article.
Teacher Quality in Michigan
Authors: Gawlik Marytza Anne , Kearney C. Philip , Addonizio Michael F. , LaPlante-Sosnowsky Frances
Published: December 2010

Most of the low-performing schools and students are in urban districts where poverty is high, where large proportions of students have limited English proficiency, and where students perform poorly on achievement tests. Moreover, urban districts face numerous challenges, including attracting teachers to their schools and optimizing their hiring, transfer, and retention policies so that they bring the best available teachers to the classroom setting. What’s now needed is an understanding of how schools differ on the qualifications of their teachers and the mechanisms driving these differences. In this article, the authors use the Detroit metropolitan region as a case study in order to (a) determine whether there is teacher sorting across schools and districts, and (2) identify which schools and districts have the least qualified teachers.
Development and Psychometric Evaluation of the School Bullying Scales: A Rasch Measurement Approach
Authors: Cheng Ying-Yao , Chen Li-Ming , Liu Kun-Shia , Chen Yi-Ling
Published: December 2010

The study aims to develop three school bullying scales—the Bully Scale, the Victim Scale, and the Witness Scale—to assess secondary school students’ bullying behaviors, including physical bullying, verbal bullying, relational bullying, and cyber bullying. The items of the three scales were developed from viewpoints of bullies, victims, and witnesses. Two samples of Taiwanese secondary students participated in the test development, one for item revision and the other for validation. Samples 1 and 2 consisted of 860 and 3,941 students, respectively. Rasch techniques were applied to assess model—data fit of the three scales. The results indicated that the correlations of person measures from viewpoints of bullies, victims, and witnesses were between .78 and .83; the person separation reliabilities of the measures from the Bully Scale, the Victim Scale, and the Witness Scale were .86, .87, and .94, respectively. The person measures from the three scales were positively correlated with external variables— antisocial behaviors, depression, anxiety, and perception of school safety.The orderings of item difficulties of the three scales were also validated across different samples.
Potential Benefits and Costs of Concurrent Task Engagement to Maintain Vigilance
Authors: Atchley Paul , Chan Mark
Published: December 2010

Objective: The objective of this study was to investigate the nature of concurrent task interference during a vigilance task and to determine whether a concurrent task improves performance with decreased vigilance.

Background: Research has repeatedly shown that engaging in a cell phone conversation while driving increases the risk of getting into crashes. At the same time, it has also been found that task monotony could lead to an increase in crash risk. There is evidence that suggests that engaging in a concurrent task reduces the effects of monotony, leading to an improvement in vigilance task performance.

Method: A monotonous drive in a driving simulator was used to investigate the effects of a concurrent verbal task. Three task conditions were used: no verbal task, continuous verbal task, and late verbal task.

Results: When engaged in a secondary verbal task, drivers showed improved lane-keeping performance and steering control when vigilance was lowest.

Conclusion: A strategically placed concurrent task can improve performance when vigilance is at its lowest.

Application: There is potential for the design of a countermeasure system that can be strategically activated by an automated system monitoring driver performance.
The Effect of Concurrent Bandwidth Feedback on Learning the Lane-Keeping Task in a Driving Simulator
Authors: de Groot Stefan , de Winter Joost C. F. , García José Manuel López , Mulder Max , Wieringa Peter A.
Published: December 2010

Objective: The aim of this study was to investigate whether concurrent bandwidth feedback improves learning of the lane-keeping task in a driving simulator.

Background: Previous research suggests that bandwidth feedback improves learning and that off-target feedback is superior to on-target feedback. This study aimed to extend these findings for the lane-keeping task.

Method: Participants without a driver’s license drove five 8-min lane-keeping sessions in a driver training simulator: three practice sessions, an immediate retention session, and a delayed retention session 1 day later. There were four experimental groups ( n = 15 per group): (a) on-target, receiving seat vibrations when the center of the car was within 0.5 m of the lane center; (b) off-target, receiving seat vibrations when the center of the car was more than 0.5 m away from the lane center; (c) control, receiving no vibrations; and (d) realistic, receiving seat vibrations depending on engine speed. During retention, all groups were provided with the realistic vibrations.

Results: During practice, on-target and off-target groups had better lane-keeping performance than the nonaugmented groups, but this difference diminished in the retention phase. Furthermore, during late practice and retention, the off-target group outperformed the on-target group. The off-target group had a higher rate of steering reversal and higher steering entropy than the nonaugmented groups, whereas no clear group differences were found regarding mean speed, mental workload, or self-reported measures.

Conclusion: Off-target feedback is superior to on-target feedback for learning the lane-keeping task.

Application: This research provides knowledge to researchers and designers of training systems about the value of feedback in simulator-based training of vehicular control.
The Effect of Prior Task Loading on Mental Workload
Authors: Morgan Justin F. , Hancock Peter A.
Published: December 2010

Objective: This study examined how transitions in task demand during a driving and navigation task manifested themselves as delayed adaptation in driver mental workload.

Background: A delayed reaction to changes in demand levels, termed hysteresis, has been identified in a number of settings. However, little research has specifically examined the driving task for hysteresis effects.

Method: A total of 32 drivers completed drives while using a navigation system that would fail within the drive. Subjective mental workload was recorded prior to and following system failure as well as at the conclusion of the drive.

Results: Results indicated that a gradual reduction in overall mental workload across trials and a lagged recovery to reduction in task demand was present within trials. Analysis of the mental workload subscales within trials indicated that this effect was produced by the mental effort component of workload.

Conclusion: A moderate hysteresis effect is present in mental workload transitions within the driving task. Although subjective mental workload decreases across trials, the magnitude of the lagged recovery within trials remains unchanged.

Application: Scaling of in-vehicle information is beneficial with respect to driver mental workload. Display and communication technologies designers should consider not only the immediate task demand but also the driver’s task demand history when determining what and how to provide information.
An Assessment of Long-Term Risk of Recidivism By Adult Sex Offenders: One Size Doesn’t fIt All
Authors: Parent Geneviève , Guay Jean-Pierre , Knight Raymond A.
Published: December 2010

Numerous instruments are available to clinicians for evaluating sex offenders’ reoffense risk. Although they have demonstrated effectiveness in predicting recidivism significantly better than unstructured clinical evaluation, little is known about their predictive accuracy in subgroups of sexual offenders or in the long term. This study was undertaken to evaluate the predictive accuracy of nine instruments (VRAG, SORAG, RRASOR, Static-99, Static-2002, RM2000, MnSOST-R, SVR-20, PCL-R) among three groups of sexual offenders across a 15-year follow-up period. The results indicate that these instruments yielded marginal to modest predictive accuracy for sexual recidivism. A more detailed study of aggressor subgroups indicated that in both the short and the long term, these instruments were more effective at predicting the sexual recidivism of child molesters and the violent and nonviolent recidivism of rapists. Finally, although mixed offenders sexually reoffend more often and more rapidly than do rapists or child molesters, firm conclusions cannot be drawn because of the small number of mixed offenders in the sample.
Using State Unemployment Insurance Data to Track Student Postsecondary Outcomes
Authors: Curran Neild Ruth , Boccanfuso Christopher
Published: December 2010

Despite the proliferation of data about student performance, secondary school educators have had difficulty accessing data on their former students’ post—high school employment and earnings in the formal economy. This article describes how one community used state unemployment insurance data, merged with student record data, to investigate the early labor market outcomes of dropouts and graduates. The authors explain how they merged the data and present findings from the descriptive research questions that were addressed with these data.
Extensive Neck Node Metastases (N3) in Head and Neck Squamous Carcinoma
Authors: Jones Andrew S. , Goodyear Paul W. , Ghosh Samit , Husband David , Helliwell Tim R. , Jones Terry M.
Published: December 2010

Objective

Head and neck squamous cell carcinoma (HNSCC) patients with N3 neck disease at presentation are the minority. Prognosis for such patients is poor, but there is disagreement about which treatment policy is best adopted. The aim of this study was to identify which groups of patients are best offered radical treatment, examining factors of association, prognosis, and survival.

Study Design

Prospective cohort study.

Setting

Regional tertiary head and neck cancer unit.

Subjects and Methods

Data were collected prospectively from patients treated for HNSCC with N3 nodal disease between 1975 and 2005. The data collected included age, sex, tumor TNM stage, histological grade, treatment, and survival. Odds ratio was used to calculate whether each parameter was statistically significant. Tumor‐specific and observed survival curves were also calculated.

Results

A total of 275 patients had N3 disease. Multivariate analysis confirmed that advanced disease at the primary site (odds ratio = 4.6, P =. 0261) mitigated against curative treatment. Comparison of tumor‐specific survival between curative and palliative treatment strategies suggests that aggressive treatment is associated with greatly improved survival (median survival = 1.45 years, 95% confidence interval [CI] = 1.23‐1.67 years; 5‐year survival = 26.6%, CI = 17.14%‐36.06%) compared with those treated palliatively (median survival = 3.18 months, CI = 3.06‐3.30 months; no 5‐year survivors; P <. 0001).

Conclusion

A major factor in determining treatment strategies for N3 disease HNSCC is the extent of disease at the primary site. These data suggest that aggressive treatment of the neck improves survival and should be considered in these patients.
Fixation Methods in Pediatric Cochlear Implants
Authors: Alexander Nathan S. , Caron Eric , Woolley Audie L.
Published: December 2010

Objective

To review 3 techniques of cochlear implant (CI) fixation used by a single surgeon for the fixation of 320 consecutive CIs in a pediatric population and associated complications.

Study Design

Case series with chart review.

Setting

Tertiary referral children’s hospital.

Subjects and Methods

Patients receiving CIs between July 1995 and July 2009 were reviewed. Clinical information obtained included age at implant, implant type, duration of follow‐up, method of implant fixation (intraosseous suture ligature, prolene mesh with titanium screws, and a small periosteal pocket with periosteal sutures), and postoperative complications of fixation (migration or extrusion).

Results

Three hundred twenty consecutive CIs were reviewed: 64 of which were bilateral (42 staged, 22 concurrent). The median age at implantation was 3.6 years (range, 8 months to 20 years). Manufacturers included Cochlear (223) and Advanced Bionics Corporation (97). Median follow‐up was 26 months (range, 1 month to 12.7 years). The intraosseous suture ligation method of fixation was used for 182 CIs. Ninety‐eight CIs were fixed using a small piece of polypropylene mesh and titanium screws. Forty implants were secured by using a tight periosteal pocket and placing the suture through the periosteum and soft tissue to collar the receiver in a modified well. No complications of device migration or extrusion were noted, nor were there any intracranial complications. Device failure occurred in 13 (4%) patients requiring explantation and reimplantation, but these were unrelated to surgical technique or fixation.

Conclusions

This study illustrates that with an evolution toward less invasive and less complex methods of fixation, there has not been an associated increase in fixation‐related complications.
Pediatric Chronic Rhinosinusitis Histopathology
Authors: Berger Gilead , Kogan Tatiana , Paker Miki , Berger‐Achituv Sivan , Ebner Yaniv
Published: December 2010

Objective

To compare the histopathology and immunohistochemistry of pediatric and adult chronic rhinosinusitis (CRS).

Study Design

Cross‐sectional study.

Setting

University‐affiliated hospital.

Patients and Methods

Inflamed sinus‐mucosal samples of 16 children (mean age, 11.6 ± 2.9 years) with refractory CRS who underwent endoscopic sinus surgery were studied. Twenty‐nine diagnosis‐matched adults served as controls. Study analysis covered sinus computed tomography (CT) scores, general pathologic features, eosinophil and T‐lymphocyte population, and thickness and integrity of the epithelium.

Results

Children had a lower CT score than adults did (P =. 005). The inflammatory response of the children, which differed greatly from that of adults, was dominated by cellular infiltration of the lamina propria with chronic inflammatory cells and fibrosis (8/16 had extensive fibrosis); eosinophils were scanty. Adult CRS was characterized by polypoid mucosa and eosinophilia (type A) or glandular hyperplasia (type B). Extensive fibrosis was shown in adult type‐B patients (7/13). Assessment of eosinophils in the lamina propria showed marginal statistical significance between children and adults (P =. 065). This difference was accentuated when pediatric and adult type A were compared (14.6 ± 25.3 vs 121.5 ± 174.2 cell/mm2; P =. 043). Complete epithelial shedding was less significant in children (9.4% ± 8.2% vs 25.4% ± 15.1%; P <. 001). The number of lamina propria and epithelial T lymphocytes was similar.

Conclusions

The marked differences in the inflammatory response of children and adults with CRS may attest to different pathophysiologic pathways. The significantly reduced epithelial shedding in children is probably associated with diminished tissue eosinophilia. Extensive fibrosis was found in half of adult type‐B patients; similar findings were found in children.
Initial Experience With a Multidisciplinary Strategy for Initiation of Propranolol Therapy for Infantile Hemangiomas
Authors: Cushing Sharon L. , Boucek Robert J. , Manning Scott C. , Sidbury Robert , Perkins Jonathan A.
Published: December 2010

Objectives

To outline a safe, standardized protocol for outpatient initiation of propranolol therapy for infantile hemangiomas.

Study Design

Retrospective review.

Setting

Academic tertiary care pediatric hospital.

Subjects and Methods

Forty‐nine infantile hemangioma patients were offered propranolol therapy and included in the study. Any patients requiring hospital admission were excluded. Screening consisted of cardiology evaluation, including electrocardiography and, when indicated, echocardiography. Target initiation dose was 2 to 3 mg/kg/d divided into 3 doses. Blood pressure and heart rate were initially monitored at baseline and 1 and 2 hours in clinic following initial dosing. A 3‐hour time point was later added. Families received standardized instructions regarding home heart rate monitoring, side effects, and fasting.

Results

Outpatient propranolol therapy was safely initiated in 39 of 44 patients (89%). Five patients required brief admission: 1 with clinical signs/symptoms of heart failure, 3 having airway involvement, and 1 for social reasons. Propranolol administration transiently reduced blood pressure; the maximal decrease occurred at 2 hours, prompting addition of a 3‐hour time point to ensure recovery. No patients exhibited symptomatic hypotension, bradycardia, or heart failure.

Conclusions

In most children with infantile hemangiomas, propranolol therapy can be safely initiated as an outpatient. Careful cardiovascular evaluation by an experienced clinician is essential for pretreatment evaluation, inpatient admission (when necessary), blood pressure and heart rate monitoring following initial dosing, and parent education. This standardized multidisciplinary outpatient initiation plan reduces the cost of initiating therapy compared with inpatient strategies while still providing appropriate monitoring for potential treatment complications. Further evaluation of propranolol therapy efficacy at the current dosing and duration of treatment continues.
PACU PTH Facilitates Safe Outpatient Total Thyroidectomy
Authors: Houlton Jeffrey J. , Pechter William , Steward David L.
Published: December 2010

Objective

To determine if a serum parathyroid hormone (PTH)–based discharge algorithm can be used to safely facilitate outpatient total thyroidectomy.

Study Design

Case series with chart review of consecutive total and completion thyroidectomies performed by the senior author from March 2008 to November 2009.

Setting

An academic tertiary care center.

Subjects and Methods

At the authors’ institution, patients undergoing total or completion thyroidectomy are subject to a same‐day discharge algorithm that incorporates postanesthesia care unit rapid PTH as the major discharge criterion. Patients with PTH >30 pg/mL are eligible for same‐day discharge without supplementation, patients with PTH between 20 and 30 pg/mL are eligible for discharge but receive calcium supplementation, and patients with PTH <20 pg/mL are observed overnight (23 hours) with calcium and vitamin D supplementation.

Results

One hundred eighty patients (mean age, 48.9 years; 83.3% female) underwent total (77.2%) or completion (22.7%) thyroidectomy with or without node dissection. Forty‐two percent were performed with minimally invasive video‐assisted (MIVA) technique. Seventy‐six percent (137/180) of patients had a PTH >20 pg/mL, meeting the PTH discharge criterion. Sixty‐nine percent (95/137) of eligible patients were discharged on the same day (53.1% of total). Ten percent of discharge‐eligible patients were admitted due to drain placement. Of the 95 patients undergoing outpatient surgery, none were admitted, seen, or called for symptoms of hypocalcemia in the postoperative period. All 180 patients were eucalcemic at postoperative day (POD) 7 and POD 30 office visits. No patients were hypoparathyroid at POD 30. No significant difference in postoperative hypoparathyroidism existed between completion versus total thyroidectomy (11.1% vs 22.2%, P =. 28) or MIVA versus standard technique (P =. 37).

Conclusion

A PTH‐based discharge algorithm can safely facilitate outpatient total or completion thyroidectomy, with minimal risk of clinically significant outpatient hypocalcemia.
Compliance and Quality of Life in Patients on Prescribed Voice Rest
Authors: Rousseau Bernard , Cohen Seth M. , Zeller Amy S. , Scearce Leda , Tritter Andrew G. , Garrett C. Gaelyn
Published: December 2010

Objectives

To determine patient compliance with voice rest and the impact of voice rest on quality of life (QOL).

Study Design

Prospective.

Setting

University hospital.

Subjects and Methods

Demographics, self‐reported compliance, QOL impact on a 100‐mm visual analog scale (VAS), and communication methods were collected from 84 participants from 2 academic voice centers.

Results

Of 84 participants, 36.9% were men, 63.1% were women, and 64.3% were singers. The mean age of participants was 47.2 years. The mean duration of voice rest was 8.8 days (range, 3‐28), and the median was 7 days. Overall compliance was 34.5%. Postoperative voice rest patients were more compliant than non‐postoperative patients (42.4% vs 16.0%, P =. 04, χ2). Voice rest had an impact on QOL (mean ± SD, 68.5 ± 27.7). Voice rest also had a greater impact on singers than nonsingers (mean VAS 77.2 vs 63.6, P =. 03, t test) and on those age <60 years than those age ≥60 years (mean VAS 74.4 vs 46.7, P <. 001, t test). More talkative patients and those with longer periods of voice rest had worse QOL scores (Spearman correlation = 0.35, P =. 001 and Spearman correlation = 0.24, P =. 03, respectively). Restrictions in personal and social life were noted in 36.9% of patients, 46.4% were unable to work, 44.0% felt frustrated, and 38.1% reported feeling handicapped while on voice rest.

Conclusions

Given poor patient compliance and the significant impact of voice rest on QOL, further studies are warranted to examine the efficacy of voice rest and factors that may contribute to patient noncompliance with treatment.
Medical Malpractice and Corticosteroid Use
Authors: Nash John J. , Nash Amanda G. , Leach Matthew E. , Poetker David M.
Published: December 2010

Objective

To analyze malpractice litigation trends related to the administration of corticosteroids and the reported complications.

Study Design

Retrospective.

Setting

Tertiary medical center.

Subjects and Methods

The WESTLAW database was reviewed from March 1996 to November 2008. Data were compiled on the demographics of the defendant, plaintiff, expert witness specialty, allegation, complication, indication for steroids, verdict, and judgment.

Results

Eighty‐three cases met inclusion criteria and were selected for review. The most common conditions for which steroids were prescribed were pain (23%), asthma or another pulmonary condition (20%), a dermatologic condition (18%), a nondermatologic autoimmune condition (17%), and allergies (6%). Allegation of negligent use was the most common reason for a suit being filed (65%), followed by lack of proper informed consent (36%), failure to diagnose or misdiagnosis (22%), multiple allegations (25%), and wrongful death (4%). Verdicts for the defendant predominated (59%), whereas 24 cases (29%) were found for the plaintiff, and 10 cases (12%) settled out of court. The range of monetary awards was from $25 000 to $8.1 million. Complications reported were often multiple and included avascular necrosis (39%), mood changes (16%), visual complaints (14%), and infectious complications (14%). Three cases involved otolaryngologists.

Conclusion

Although other specialties were more often involved in suits, otolaryngologists frequently prescribe corticosteroids and must be diligent in explaining potential side effects of steroids. The informed consent process, documentation, and close monitoring of patients are critical to avoid potential litigation.
Association of Obstructive Sleep Apnea and Auditory Dysfunctions in Older Subjects
Authors: Hwang Juen‐Haur , Chen Jin‐Cherng , Hsu Chuan‐Jen , Liu Tien‐Chen
Published: December 2010

Objective

Determine the association between obstructive sleep apnea (OSA) and auditory dysfunction in older subjects.

Study Design

Cross‐sectional study.

Setting

Hospital volunteer helpers undergoing questionnaire, morphometry measurement, auditory examinations, and polysomnography between 2008 and 2009.

Subjects and Methods

In total, 224 subjects older than 50 years were randomly sampled for above evaluation and testing. The effects of OSA on the peripheral auditory function, represented by averaged pure‐tone threshold of low frequencies (PTA‐low) and high frequencies (PTA‐high), and central auditory function, shown by pitch pattern sequence (PPS scores), were analyzed.

Results

The mean ± SD age was 61.2 ± 6.7 years. OSA was confirmed in 6 of 98 women (6.1%) and 28 of 126 men (22.2%). After adjusting for age, gender, and other variables, OSA did not show a significant positive association with PTA‐low or PTA‐high for all subjects. Conversely, there was a significant negative association between OSA and PPS scores for all subjects, even after adjusting for age, gender, and other variables. When OSA and central obesity together were taken into account in the multivariate linear regression analysis, OSA still showed significant association with PPS score for all subjects.

Conclusion

OSA is independently associated with poorer central auditory function in older subjects.
Toll‐Like Receptor 2 Gene Polymorphisms in a Korean Population
Authors: Park Chan‐Soon , Cho Jin‐Hee , Park Yong‐Jin
Published: December 2010

Objective

To investigate the role of single‐nucleotide polymorphisms (SNPs) in the gene encoding Toll‐like receptor (TLR) 2 in Korean patients with chronic rhinosinusitis (CRS) and controls.

Study Design and Setting

A case‐control study.

Subjects and Methods

Subjects (N = 214) were all adults (>20 years old) and were divided into patients with CRS (n = 106) and controls (n = 108). Five SNPs (rs1898830, rs3804099, rs3804100, R677W, and rs5743708) were selected and genotyped in a case‐control study with the single‐base‐pair primer extension (SNaPshot) assay.

Results

The case‐control study revealed that 2 SNPs in TLR2, rs3804099 (odds ratio [OR] = 2.88; 95% confidence interval [CI] = 1.17‐7.09; P =. 022) and rs3804100 (OR = 3.76; 95% CI = 1.42‐9.96; P =. 008), showed significant differences in minor allele frequency between CRS patients and controls. These 2 SNPs were correlated with CRS risk in Korean patients.

Conclusions

Two SNPs in TLR2 may be associated with increased risk of CRS in Korean subjects.
Differences in Cochlear Nerve Cross‐Sectional Area between Normal Hearing and Postlingually Deafened Patients on MRI
Authors: Herman Björn , Angeli Simon
Published: December 2010

Objectives

To demonstrate that parasagittal constructive interference in steady state (CISS) magnetic resonance imaging (MRI) can be used to accurately measure cochlear nerve cross‐sectional area and thereby evaluate for statistically significant differences in the cochlear nerve cross‐sectional areas of postlingually deafened and normal‐hearing adults.

Study Design

Cross‐sectional study.

Setting

Tertiary care medical center.

Subjects and Methods

Parasagittal CISS MRIs of postlingually profoundly deafened cochlear implant candidates and normal‐hearing patients at a tertiary care academic medical center between 2006 and 2009 were retrospectively identified. Two independent and blinded investigators measured the cochlear nerve height and width and calculated the cross‐sectional area [π(H/2)(W/2)] at the fundus of the internal auditory canals. Measurements of both investigators were analyzed for reliability and agreement with an Altman plot, and deafened patient measurements were compared with results of the normal‐hearing patients via Wilcoxon rank sum tests.

Results

The cochlear nerve cross‐sectional area of postlingually deafened patients (mean ± SD = 0.61 ± 0.16 mm2) was less than normal‐hearing patients (0.94 ± 0.28 mm2). The difference was statistically significant (P =. 002). There was good agreement between independent observer measurements.

Conclusion

Parasagittal CISS MRI can be used to measure the cochlear nerve with good interobserver agreement, and there is a significant difference between the cross‐sectional area of postlingually deafened and normal‐hearing adults. The cross‐sectional area may correlate with residual spiral ganglion cells and provide a prognostic indicator for post–cochlear implant performance, which is the focus of our ongoing research.
Preliminary Study on the Stability of Beta‐2 Transferrin in Extracorporeal Cerebrospinal Fluid
Authors: Bleier Benjamin S. , Debnath Indranil , O’Connell Brendan P. , Vandergrift W. Alexander , Palmer James N. , Schlosser Rodney J.
Published: December 2010

Objective

Detection of beta‐2 transferrin in rhinorrhea fluid is a sensitive and specific method for the diagnosis of a cerebrospinal fluid (CSF) leak. Patients may be asked to collect this fluid at home to obtain an adequate volume for detection, and thus the age and storage conditions of these specimens may be variable upon analysis. The purpose of this study is to understand how age, storage temperature, and exposure to mucus affect the ability to detect beta‐2 transferrin in CSF.

Study Design

Case series with planned data collection.

Setting

Tertiary care university hospital.

Subjects and Methods

This study consists of 6 patients undergoing endoscopic CSF leak repair. CSF was collected directly from a lumbar drain (n = 4) or from nasal drainage (n = 2). Specimens were stored at 4°C (n = 3) or room temperature (n = 3). Samples were tested for the presence of beta‐2 transferrin for up to 7 days using standard immunofixation electrophoresis techniques.

Results

Beta‐2 transferrin was detected in all specimens through day 7 regardless of storage temperature or collection site (95% exact binomial confidence interval of 0%‐46%).

Conclusions

Beta‐2 transferrin remains detectable in extracorporeal CSF for up to 7 days regardless of storage at room temperature or exposure to nasal mucus. Negative detection in patient specimens up to a week old is therefore not likely to be caused by protein degradation.
The Effects of Potential Neuroprotective Agents on Rat Facial Function Recovery Following Facial Nerve Injury
Authors: Vakharia Kalpesh T. , Lindsay Robin W. , Knox Christopher , Edwards Colin , Henstrom Doug , Weinberg Julie , Hadlock Tessa A. , Heaton James T.
Published: December 2010

Objective

To evaluate whether a series of pharmacologic agents with potential neuroprotective effects accelerate and/or improve facial function recovery after facial nerve crush injury.

Study Design

Randomized animal study.

Setting

Tertiary care facility.

Methods

Eighty female Wistar‐Hannover rats underwent head restraint implantation and daily conditioning. Animals then underwent unilateral crush injury to the main trunk of the facial nerve and were randomized to receive treatment with atorvastatin (n = 10), sildenafil (n = 10), darbepoetin (n = 20), or a corresponding control agent (n = 40). The return of whisking function was tracked throughout the recovery period.

Results

All rats initiated the return of whisking function from nerve crush by day 12. Darbepoetin‐treated rats (n = 20) showed significantly improved whisking amplitude and velocity across the recovery period, with several days of significant pairwise differences vs comparable control rats (n = 16) across the first 2 weeks of whisking function return. In contrast, rats treated with sildenafil (n = 10) and atorvastatin (n = 10) did not show significant improvement in whisking function recovery after facial nerve crush compared to controls. By week 8, all darbepoetin‐treated animals and comparable nerve crush control animals fully recovered whisking function and were statistically indistinguishable.

Conclusion

Among the 3 potentially neuroprotective agents evaluated, only darbepoetin administration resulted in accelerated recovery of whisking parameters after facial nerve crush injury. Further efforts to define the mechanism of action and translate these findings to the use of darbepoetin in the care of patients with traumatic facial paralysis are needed.
Improving Hearing in Stapedectomy With Intraoperative Auditory Brainstem Response
Authors: Hsu Griffith S.
Published: December 2010

Objective

To determine the efficacy of using intraoperative auditory brainstem response (ABR) in improving immediate hearing results of patients undergoing primary laser stapedotomy.

Study Design

Case series with chart review.

Setting

Community hospital.

Subjects and Methods

The study included 32 consecutive patients, with 34 ears undergoing primary stapedotomy by a single surgeon at a single institution using a single prosthesis design. Intraoperative ABR was performed at the beginning of each surgery and after the stapes prosthesis was inserted. Surgical adjustments were made if initial ABR results did not demonstrate hearing improvement. ABR then was repeated at the conclusion of the procedure. Audiometry was performed postoperatively in all patients.

Results

There were 22 left ears and 12 right ears studied. Two patients underwent bilateral staged surgery. Eight patients, or 23% of the group, had intraoperative adjustments made to improve hearing results. Hearing was improved in 33 of 34 ears, or 97%. The surgical revision rate was 3%. The average preoperative air‐bone gap (ABG, calculated as an average from 250, 500, and 1000 Hz) was 29.0 dB HL in the left ear group and 26.6 dB HL in the right ear group. The average postoperative ABG was 9.9 dB HL in the left ear group and 9.4 dB HL in the right ear group. All patients had postoperative audiometric results consistent with final intraoperative ABR results.

Conclusion

Intraoperative ABR may significantly improve immediate hearing results in patients and greatly reduce the need for revision surgery.