bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Language Barriers on Stroke Care and Outcomes
Authors: Shah Baiju R. , Khan Nadia A. , O’Donnell Martin J. , Kapral Moira K.
Published: February 2015

Background and Purpose—

Language barriers may lead to poor quality of care, particularly for conditions like acute stroke for which diagnosis and treatment decision making rely on taking an accurate patient history. The purpose of this study was to determine the impact of patient language barriers on quality of stroke care and clinical outcomes.

Methods—

This retrospective cohort study used data from the Registry of the Canadian Stroke Network. All Ontario patients who were admitted with acute stroke or transient ischemic attack between July 2003 and March 2008 were selected. Mortality, stroke outcomes, in-hospital complications, quality of care, and disposition were compared between those without (n=12 787) and with (n=1506) language barriers, which was defined based on the patient’s preferred language. Hierarchical multivariable regression models determined the effect of language barriers, independent of baseline covariates.

Results—

Patients with language barriers had better 7-day mortality than those without (7.0% versus 9.2%; OR, 0.69; 95% CI, 0.57–0.82;
P
<0.001). However, they were more likely to be discharged with a moderate-to-severe neurological deficit (65.9% versus 51.5%; OR, 1.25; 95% CI, 1.15–1.35). In-hospital complication rates did not differ, and quality of care indicators generally favored patients with language barriers.

Conclusions—

Patients who had language barriers had reduced mortality and better performance on some quality of care measures. These differences existed despite adjustment for many potential confounders, including ethnicity, prognostic factors, and stroke characteristics.
Ethnic Persecution
Authors: Mang Pum Za
Published: February 2015

The world has praised Burma for certain social, economic and political reforms taking place in central Burma since 2011 and the present administration continues to assure the world that the process of democratization and liberalization in the country is irreversible. However, the Christian Kachin in the northern corner of Burma continue to face greater oppression, persecution and brutalization which has been terribly but freely perpetrated and perpetuated by the Burmese army since June 2011. The main thesis of this article is that the church in Burma is entrusted with the divine mandate, authority and obligation to responsibly show their firm solidarity with their Kachin brothers and sisters persecuted by the Burmese military. It is the mission of the church to defend the oppressed against injustice, oppression and violence and to encourage an active and prophetic stance toward creating justice and equality between ethnic groups in the country.
Cold Pool and Precipitation Responses to Aerosol Loading: Modulation by Dry Layers
Authors: Grant Leah D. , van den Heever Susan C.
Published: February 2015

The relative sensitivity of midlatitude deep convective precipitation to aerosols and midlevel dry layers has been investigated in this study using high-resolution cloud-resolving model simulations. Nine simulations, including combinations of three moisture profiles and three aerosol number concentration profiles, were performed. Because of the veering wind profile of the initial sounding, the convection splits into a left-moving storm that is multicellular in nature and a right-moving storm, a supercell, which are analyzed separately.

The results demonstrate that while changes to the moisture profile always induce larger changes in precipitation than do variations in aerosol concentrations, multicells are sensitive to aerosol perturbations whereas supercells are less so. The multicellular precipitation sensitivity arises through aerosol impacts on the cold pool forcing. It is shown that the altitude of the dry layer influences whether cold pools are stronger or weaker and hence whether precipitation increases or decreases with increasing aerosol concentrations. When the dry-layer altitude is located near cloud base, cloud droplet evaporation rates and hence latent cooling rates are greater with higher aerosol loading, which results in stronger low-level downdrafts and cold pools. However, when the dry-layer altitude is located higher above cloud base, the low-level downdrafts and cold pools are weaker with higher aerosol loading because of reduced raindrop evaporation rates. The changes to the cold pool strength initiate positive feedbacks that further modify the cold pool strength and subsequent precipitation totals. Aerosol impacts on deep convection are therefore found to be modulated by the altitude of the dry layer and to vary inversely with the storm organization.
Clare’s Law, or the national Domestic Violence Disclosure Scheme
Authors: Grace Jamie
Published: February 2015

Clare’s Law has been a PR success for the police in England and Wales—the police have engaged directly with the media over the national roll-out of the Domestic Violence Disclosure Scheme. But the precise operation of the Scheme, at a doctrinal level, is unclear, and warrants further scrutiny (and, I would argue, reform) before a crisis of confidence in the Scheme is precipitated by a challenge by way of judicial review. Human rights case law concerning the procedural rights of (suspected) domestic violence perpetrators is the medium through which this piece explores the manner in which the Scheme currently operates on the basis of Home Office guidance and policy.
Ten years on
Authors: Sjölin Catarina
Published: February 2015

As the clock ticked over from 30 April to 1 May 2004 the Sexual Offences Act 20031 came into force and the Sexual Offences Act 19562 was repealed, fundamentally changing the law on sexual offences in England and Wales. Perhaps the most major changes were in respect of consent. This article examines the changes the Act made to three aspects of consent: the provision of a statutory definition, the effect of deception of C on the validity of C’s consent and the role of D’s belief in C’s consent. To this end the article considers the pre-SOA 2003 law on consent, the impetus and proposals for reform, the Act and how it has been implemented by the courts, and finally how the Act could be improved to provide greater clarity substantively and procedurally to achieve the aims which lay behind the reform of consent in the first place.
Short-Term Existential Psychotherapy in Primary Care
Authors: Rayner Mark , Vitali Diego
Published: February 2015

Existential Experimentation is a short-term integrative psychological therapy intervention. It is based on the recent government initiative focusing on recovery and thus integrates central ideas from existential theory, utilizes a phenomenological methodology, and applies considerations of human potential from humanistic psychology to support recovery and aim for well-being. This work explores the outcomes of a systematic application of this approach to working-age adults referred for a psychological intervention for depression and/or anxiety in terms of (a) reducing depression and/or anxiety symptomatology, (b) reducing the level of perceived psychological distress, and (c) reducing the need for psychological services. The sample consisted of working-age adults referred to primary care by their general practitioner. The patients’ relevant symptomatology was assessed at every contact using Patient Health Questionnaire-9 and Generalized Anxiety Disorder–7, and the level of psychological distress was monitored using CORE-OM. Pre–post effect sizes were evaluated using Cohen’s d. Patients’ access to psychological services was monitored at 6 and 12 months after discharge. The large effect sizes expressed show that this therapeutic approach operates effectively in reducing the symptomatology of depression and/or anxiety, while promoting significantly low relapse and dropout rates.
Educational Choice and Cultural Capital: Examining Social Stratification within an Institutionalized Dialogue between Family and School
Authors: Barg Katherin
Published: February 2015

This article analyses the impact of social class on families’ and teachers’ decision-making within an institutionalized family–school dialogue in France. The dialogue decides which upper secondary school track a student will attend and consists of three main steps: (1) family’s school track request; (2) staff meeting’s subsequent school track proposition; and (3) family’s optional rejection of the staff’s proposition. Using national longitudinal data, I find that parents’ cultural capital importantly mediates secondary effects (i.e. social class effects that remain after controlling for school performance) on families’ requests and their rejections of staffs’ propositions. Social class effects on staffs’ propositions are accounted for by families’ requests and student school performance. Moreover families and teachers appear to choose grade retention to avoid enrolment in a lower track.
Academic Knowledge and Contemporary Poverty: The Politics of Homelessness Research
Authors: Farrugia David , Gerrard Jessica
Published: February 2015

This article explores the field of homelessness research in relation to the dynamics of contemporary inequality and governmentality, arguing that the dominant perspectives within this field have developed in ways that can converge with the demands of neoliberal governance. The article discusses the causal focus of much homelessness research, the emergence of the ‘orthodoxy’ of homelessness research and new approaches emphasising subjectivity and arguing for a ‘culture of homelessness’. We suggest that homelessness has been constructed as a discrete analytical object extraordinary to the social relations of contemporary inequality. The authority to represent homelessness legitimately has been constituted through positioning ‘the homeless’ outside of a community of valorised and normatively legitimate subjectivities. The article concludes with reflections on an alternative politics of homelessness research that moves towards a critical engagement with the position of homelessness within the structural dynamics of late modernity.
Redefining Intersectionality Theory Through the Lens of African American Young Adolescent Girls’ Racialized Experiences
Authors: Harrison Lisa
Published: February 2015

The research presented uses intersectionality theory as a lens to study the racial identity construction of four African American young adolescent girls. The findings suggest that race was largely situated in a Black–White discourse for the girls in the study. When limited information was provided in home, school, and community settings, the participants made meaning from dominant discourses about race and identity, although glimpses of critical thinking about race did occur. In conclusion, the potential of including youth identity within intersectionality theory to broaden the utility of the theory itself and also for making meaning of and advocating for marginalized adolescents is discussed.
The Pitfalls and Promise of Focus Groups as a Data Collection Method
Authors: Cyr Jennifer
Published: February 2015

Despite their long trajectory in the social sciences, few systematic works analyze how often and for what purposes focus groups appear in published works. This study fills this gap by undertaking a meta-analysis of focus group use over the last 10 years. It makes several contributions to our understanding of when and why focus groups are used in the social sciences. First, the study explains that focus groups generate data at three units of analysis, namely, the individual, the group, and the interaction. Although most researchers rely upon the individual unit of analysis, the method’s comparative advantage lies in the group and interactive units. Second, it reveals strong affinities between each unit of analysis and the primary motivation for using focus groups as a data collection method. The individual unit of analysis is appropriate for triangulation; the group unit is appropriate as a pretest; and the interactive unit is appropriate for exploration. Finally, it offers a set of guidelines that researchers should adopt when presenting focus groups as part of their research design. Researchers should, first, state the main purpose of the focus group in a research design; second, identify the primary unit of analysis exploited; and finally, list the questions used to collect data in the focus group.
Reimagining a Community
Authors: McClendon Muriel C.
Published: February 2015

This essay examines a work stoppage that was planned by Norwich’s worsted weaver apprentices in 1610, but that never took place. In depositions taken after the plot was revealed, the apprentices told local authorities that their aim in leaving their work was to call attention to the problem of laborers in the industry that had not served apprenticeships, but were nevertheless hired to work as journeymen. This dramatic and unusual action that the apprentices took was the result of a confluence of particular circumstances in early Stuart Norwich. The combination of a difficult local economy, the impact of nonapprenticed laborers on their future prospects, and the eruption of plague in 1609-1610 drove the apprentices to imagine and try to create a new role for themselves in the weaving trade and in urban society. Their efforts, although ineffective, nevertheless reveal the imaginable limits of social politics between apprentices and their masters.
Living Stones
Authors: Jütte Daniel
Published: February 2015

This article investigates the metaphor of the “living house” and its concrete ramifications on everyday life in late medieval and early modern Europe. For premodern Europeans, the house was an actor that occupied an important and natural role in their social life and in the urban space in which they lived. Human attributes were explicitly assigned to the house: it had a name and life story, displayed bodily features, and was invested with a specific individuality. This article examines the historical origins of this metaphor and why it became particularly powerful in the early modern period. The author then surveys the various expressions of the anthropomorphic understanding of the house, as reflected both in the architectural theory and the popular discourse of the time. The final part addresses the question of why and when this notion of the house as actor began to decline.
a + (b1) Professor–Student Rapport + (b2) Humor + (b3) Student Engagement = (Ŷ) Student Ratings of Instructors
Authors: Richmond Aaron S. , Berglund Majken B. , Epelbaum Vadim B. , Klein Eric M.
Published: February 2015

Teaching effectiveness is often evaluated through student ratings of instruction (SRI). Research suggests that there are many potential factors that can predict student’s perceptions of teaching effectiveness such as professor–student rapport, student engagement, and perceived humor of the instructor. Therefore, we sought to assess whether undergraduate student’s perceptions of professor–student rapport, student engagement, and humor predict scores on retrospective SRIs. The findings suggest that professor–student rapport is the largest predictor (54% of variance) of scores on SRIs, while humor and student engagement were significant, but minor predictors of SRIs. Since SRIs are often used by administration to determine hiring, promotions, and tenure decisions for faculty, understanding what predicts SRIs is important to both faculty and administrators of higher education.
The thermal output evaluation of radiant heating panels by experiment
Authors: Shin Dae Uk , Shin Mi Su , Rhee Kyu Nam , Ryu Seong Ryong , Jeong Chang Ho , Yeo Myoung Souk , Kim Kwang Woo
Published: February 2015

The purpose of this study is to make the target condition of experimental assessment based on the standard EN1264. To achieve this purpose, the characteristic errors, which are caused by characteristics of experimental setup and prevent the results from meeting the target condition, should be removed. This study proposes an experimental setup and suggests a control strategy based on standard EN1264. For the specifications of the experimental setup, the essential equipment and the configuration of the heat production system were deduced. For a proper control strategy, possible control strategies were derived by investigating the control-related factors such as reference points and control algorithms, and the most proper control strategy was validated by experimental assessment.

Practical application: This study presents an experimental assessment to evaluate the thermal output of radiant floor heating systems based on the standard EN1264 referenced by ISO11855-2:2012. The proposed experimental assessment method will be able to supplement ISO11855-2:2012 and contribute to the development of thermally effective radiant heating panels. Therefore, it is expected that the results will be helpful to researchers for indoor environment, heating, ventilating, and air conditioning engineers, system manufacturers, and those who want to analyze the thermal output of radiant floor heating panels based on ISO 11855-2:2012.
A Review of SimuMCAT
Authors: Sie Haskell
Published: February 2015

This article reviews the software package SimuMCAT that simulates unidimensional and multidimensional computerized adaptive testing with various types of items (dichotomous/polytomous) and loading structures (simple-/complex-structured). In addition, the software allows users to choose from five different item selection procedures, two stopping rules for variable-length tests, as well as test constraints to satisfy test blueprint and limit item exposure.
Efficacy of Glutamine‐Enriched Nutrition Support for Patients With Severe Acute Pancreatitis
Authors: Yong Li , Lu Qi‐Ping , Liu Sheng‐Hui , Fan Hu
Published: February 2015

Background: Plasma glutamine (Gln) level has been negatively correlated with the severity of severe acute pancreatitis (SAP). Although Gln is widely used today, the results of individual randomized controlled trials of Gln‐enriched nutrition support for patients with SAP are conflicting. Methods: PubMed, EMBASE, HighWire, Cochrane Central Register of Controlled Trials, Wanfang, China Journals Full‐Text Database, and the Chinese Biomedical Literature Database were searched. Literature published before June 2014 was searched. Randomized controlled trials investigating the comparison of conventional and Gln‐enriched nutrition support were included; a random effect model using Rev Man 5.2 software was chosen to complete this meta‐analysis. The count data were analyzed using the risk ratio (RR) and 95% confidence interval (CI), and the measurement data were analyzed using the standard mean difference or weighted mean difference and 95% CI. Heterogeneity analyses were conducted by I2 test; publication bias analyses were conducted by Begg test. Results: Ten studies were eventually chosen for analysis, including 218 patients who received conventional methods (control group) and 215 patients who received Gln‐enriched nutrition support (experimental group). Compared with the control group, Gln is helpful in elevating the albumin level, decreasing C‐reaction protein (standard mean difference = 1.01, −1.89; 95% CI: 0.50 to 1.51, −3.23 to −0.56; P < .05), decreasing the incidence of infectious complication and mortality (RR = 0.62, 0.36; 95% CI: 0.46 to 0.83, 0.16 to 0.83; P < .05), and shortening the hospital stay length (weighted mean difference [WMD] = −3.89; 95% CI: −4.98 to −2.81; P < .05) without increasing expenses (WMD = −0.16; 95% CI: −1.34 to 1.02; P > .05). Intravenous infusion manifested more advantages by decreasing the incidence of infectious complications and mortality. Conclusions: Gln‐enriched nutrition support is superior to conventional methods for SAP, and intravenous infusion may be a better choice for drug administration.
Impact of an Intravenous Magnesium Shortage on Potassium Doses in Adult Surgical Patients Receiving Parenteral Nutrition
Authors: Scherkenbach Lisa A. , Kraft Michael D. , Stout Stephen M. , Dorsch Michael P. , Chen Xinwei , Tran Hong‐Diem , Pleva Melissa R.
Published: February 2015

Background: Shortages of parenteral nutrition (PN) components have been common in recent years. Effects on patient management and outcomes have not been well documented. This study aimed to determine the effect of a parenteral magnesium shortage, and an institutional decision to omit magnesium from adult PN, on magnesium and potassium doses and serum concentrations. Materials and Methods: This was a retrospective cohort study of adult surgical patients during two 6‐month periods: prior to the magnesium shortage (2011) and during the shortage (2012). The relation between study period and electrolyte doses was evaluated by unadjusted and adjusted mixed models, while the relation between study period and hypokalemia and hypomagnesemia exposure was evaluated by Student's t tests and multiple linear regression. Results: During the shortage, patients received more supplemental magnesium (0.11–0.12 mEq/kg/d, P < .0001) but received less total daily magnesium (0.08–0.09 mEq/kg/d, P < .0001) and had greater exposure to hypomagnesemia (9.6–14.2 h·mcg/dL/h, P < .05 for all comparisons except multivariate analysis in a matched subpopulation). Patients received similar amounts of potassium in PN (0.06–0.08 mEq/kg/d less, P < .05 for full cohort but P > .05 for matched cohort), in supplemental doses (0.01–0.05 mEq/kg/d less, P > .05), and in total (0.07–0.14 mEq/kg/d less, P > .05), and they had similar exposure to hypokalemia. Conclusion: Daily magnesium doses were lower and hypomagnesemia exposure was greater during the shortage, but the differences were numerically small and their clinical significance was questionable. Potassium doses and hypokalemia exposure were not higher during the shortage. This supports the strategy of omitting magnesium from PN of select patients and supplementing as clinically necessary.
Psychometric Properties of the French Version of the Short Form of the Coopersmith Self-Esteem Inventory Among Adolescents and Young Adults
Authors: Potard Catherine , Amoura Camille , Kubiszewski Violaine , Le Samedy Mathieu , Moltrecht Brigitte , Courtois Robert
Published: February 2015

We examined the psychometric qualities of the Short Form of the Coopersmith Self-Esteem Inventory (SF-CSEI) in a large sample of French adolescents and young adults. A 25-item French version was administered to 1,362 participants (561 aged below 16 years and 801 aged 16–25 years). Participants also completed other scales to measure construct validity (e.g., Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, and General Health Questionnaire). Factorial analysis yielded evidence for a structure with three first-order factors for the SF-CSEI: personal, social, and family-derived self-esteem. The internal consistency of the questionnaire’s different dimensions was satisfactory (Cronbach’s α = .68–.77). Pearson’s correlation coefficients showed that the SF-CSEI had moderate to high correlations with convergent measures ( r = .19–.73) and constructs related to self-esteem ( r = −.23–.65). Psychiatric patients ( n = 67) scored significantly lower than a control group. Test–retest reliability was good for some of the factors, especially at 5 weeks and 1 year ( r = .29–.79). The French version of the SF-CSEI appears to be a useful instrument, with a cross-culturally stable factorial structure.
Copyright and musicians at the digital margins
Authors: Phillips Tom , Street John
Published: February 2015

While there is research into consumer attitudes to copyright and downloading, and the music industry has made clear its own views in evidence to the Hargreaves Review and other forums, relatively little is known about musicians’ attitudes to copyright. This article reports on those musicians who are negotiating the new terrain created by digitization and its accompanying business models. Are their attitudes to copyright simply determined by their financial self-interest and a sense of ownership of their music, or do they see copyright as a restriction of their creative freedom? Using the results of a questionnaire and semi-structured interviews with UK musicians, we show how a variety of factors – including generic conventions, knowledge and experience, and wider social values – contribute to attitudes to copyright. Although knowledge of, and interest in, copyright can be driven by financial self-interest, other considerations are in play. These findings have, as we explain, implications both for copyright policy and for an understanding of creative practice in a digital economy. If the assumption is that copyright is designed to serve the interests and facilitate the creativity of musicians, this view is not always shared by the intended beneficiaries.
Battle for control? Copyright, football and European media rights
Authors: Boyle Raymond
Published: February 2015

The position of copyright in the arena of sports content rights and property rights of sporting organizations is a highly contested area of legal and commercial interest in the digital age. At its core is the issue of whether copyright can be incorporated into sports rights contracts as it has been for many years. This article identifies the ramifications of this debate for the existing business models for both rights holders (Football Association (FA) Premier League, Union of European Football Associations (UEFA)) and broadcasters. Drawing on interviews with key stakeholders, this research analyses the strategic responses of pan-European broadcasters in the field, and key football content rights holders at both the national and European level. How will these developments affect both the pan-European and national markets for football rights? How does copyright law affect live and recorded games and what are the implications for the wider European audio-visual sector of changes in the rights regime for European cultural content?
MRSA Nasal Abscess after Elective Septorhinoplasty
Authors: Perry Katherine , Trujillo Oscar , Wright Richard J. , Ambro Bryan T.
Published: February 2015

Objective

Present a case of an MRSA nasal abscess after elective septorhinoplasty. Discuss the role for MRSA screening and decolonization prior to elective septorhinoplasty.

Method

The case of a patient who underwent elective septorhinoplasty complicated by a nasal abscess is reviewed. Current literature regarding MRSA surgical site infections and role for preoperative decolonization are discussed.

Results

A 33‐year‐old man with nasal airway obstruction underwent functional septorhinoplasty. Mupirocin coated intranasal splints were placed, and he received 7 days of oral cephalexin. Six days postoperatively he presented with a nasoseptal abscess. He was taken to the OR for washout. Six months postoperatively he underwent revision septorhinoplasty. He was treated preoperatively with intranasal mupirocin and chlorhexidine body washes for 2 weeks. He experienced no further infectious complications. Despite MRSA being a well‐documented cause of surgical infections, there are few reports of such infections in septorhinoplasty. There are no guidelines regarding the role of MRSA screening and decolonization before septorhinoplasty.

Conclusion

Despite the well‐documented role of MRSA in surgical site infections in other specialties, such infections following septorhinoplasty are extremely rare with only one previously published case. We present a case of a nasoseptal abscess causing significant morbidity following elective functional septorhinoplasty. This case highlights the need for research and guidelines regarding the utility of MRSA screening and decolonization prior to elective septorhinoplasty.
Features of Patients with Eagle Syndrome
Authors: Herrera‐Hernandez Alvaro A. , Diaz‐Perez Julio A. , Aranda‐Valderrama Paola , Barajas‐Gamboa Juan S. , Reddy Abhinay
Published: February 2015

Objective

Eagle syndrome is a rare syndrome in which pain occurs cervico‐facially, due to the mineralization of the styloid process. We evaluated the features of Eagle syndrome in a Colombian (Latin American) population.

Method

We described the clinical and pathological features of 5 patients with Eagle syndrome, and conducted a discussion of this disorder during an observational study from 2005 to 2008, with targeted sampling of patients with Eagle syndrome in the Centers of Head and Neck Surgery in Bucaramanga, Colombia.

Results

The patients collectively consulted for sore throat and referred otodinia. Two patients had pain at the opening of the oral cavity, and no patient had foreign body sensation or syncope. On physical examination the patients had great tenderness from bimanual palpations on the postero‐inferior face of the palatine tonsil. All patients underwent computed tomography and elongation of the styloid process was found. The patients underwent resection of the styloid process externally and endorally in 2 cases and in 3 cases respectively; none of them presented with disease recurrence after a mean follow‐up period of 11.4 months.

Conclusion

In conclusion, this rare disease must be considered in the differential diagnosis of cervical‐facial pain, through imaging, plain radiography, or computed tomography. Treatment can be surgical or nonsurgical, although surgery is recommended.
Free Flap Reconstruction of Endoscopic Skull Base Defects
Authors: Kamal Sally M. , Cho Andrew , Jacobson Joel P. , Shahlaie Kiarash , Luu Quang C.
Published: February 2015

Objective

1) Propose a novel technique using free tissue transfer to reconstruct large endoscopic skull base surgery defects. 2) Demonstrate the anatomic feasibility of this technique.

Method

Two cadaver heads and forearms were obtained with permission from the university body donation program. Anterior skull base defects were created from planum sphenoidale to the frontal recess. Radial forearm free flaps were then harvested using standard techniques, taking care to preserve maximum length of the pedicle vessels.

Results

To inset the flap, a maxillary antrostomy was performed. An incision was made in the gingivolabial sulcus of the upper lip and extended laterally and inferiorly. Subperiosteal dissection was performed, and an anterior maxillotomy created. Dissection was then performed through the incision over the mandible. A cervical incision was then made. A subcutaneous tunnel was created. The pedicle was tunnelled through the cervical incision, through the maxillotomy and maxillary antrostomy, and then inset by draping the skin paddle over the skull base defect. This provided ample coverage of the defect and the pedicle length comfortably spanned the course of dissection.

Conclusion

As expanded endonasal approaches develop, so too must skull base reconstruction techniques. Vascularized tissue is ideal, especially in patients with extensive prior surgery and radiation. A vascularized free flap is a feasible option for reconstruction of large anterior skull base defects.
FV‐Guided Surgery Improves Outcome in HGD and Early Oral Cancer
Authors: Durham J. S. , Poh Catherine , Anderson Donald W. , Berean Ken , Williams Michelle , MacAulay Calum E. , Rosin Miriam P.
Published: February 2015

Objective

1) Become aware of the role of intraoperative fluorescence visualization in assessing subclinical changes at surgical margins in patients presenting with severe dysplasia and carcinoma in situ (HGD) or squamous cell carcinoma (SCC). 2) Understand the effectiveness of FV‐guided surgery in reducing locoregional recurrence and improving overall survival.

Method

A retrospective review was conducted from September 1, 2004, to August 31, 2009, identifying 246 patients (SCC 132; HGD 114) presenting to the BCCA. Surgery was done under FV guidance in 149 patients while 97 were treated conventionally. Outcome measures included pathology‐proven local recurrence, regional failure, and death.

Results

There was no significant difference between FV and control groups in age, smoking habit, lesion anatomic site, diagnosis, tumor size, and previous cancer history. There were more females in the FV group (51% vs 33%, P =. 006). Time to outcome curve was estimated by the Kaplan‐Meier method. With an average of 40 months follow‐up, the FV group shows significantly lower local recurrence (7% vs 38%), regional failure (6% vs 23%), and death (5% vs 20%), and significant longer time to recurrence (P <. 0001), regional failure (P =. 0007), and death of disease (P =. 004).

Conclusion

The data strongly suggest that use of FV for surgical margin guidance can significantly improve outcomes in early stage oral cancer and HGD. An ongoing 5‐year multicenter phase III randomized surgical trial (COOLS), funded by Terry FoResearch Institute, has been established to validate the results of this study.
Head and Neck Cancer Surgery in the Elderly
Authors: Genther Dane J. , Gourin Christine G.
Published: February 2015

Objective

With increased life expectancy, there is a growing awareness of the effect of comorbidity on physiologic reserves in elderly surgical patients. We sought to determine the relationship between advanced comorbidity on in‐hospital mortality, postoperative complications, length of hospitalization, and costs in elderly patients undergoing head and neck cancer (HNCA) surgery.

Method

Discharge data from the Nationwide Inpatient Sample for 36,948 patients aged 65 years and older who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003 to 2008 were analyzed using cross‐tabulations and multivariate regression. Frail elderly patients were defined as having comorbidity scores of 2 or higher.

Results

Frail elderly patients were more likely to be ≥80 years of age (OR 1.2, P =. 035) and more likely to require transfer to a short‐term hospital (OR = 3.7, P <. 001), transfer to another facility (OR = 2.5, P <. 001), or home health care (OR = 1.4, P <. 001). After controlling for all other variables, frail elderly patients were more likely to develop an acute medical complication (OR = 3.9, P <. 001) and had an increased risk of in‐hospital mortality (OR = 3.9, P <. 001). There was no significant association between frail elderly status and postoperative surgical complications; however, frail elderly status was associated with significantly increased length of hospitalization and hospital‐related costs.

Conclusion

Advanced comorbidity in elderly HNCA surgical patients is associated with increased short‐term mortality and morbidity, length of hospitalization, hospital‐related costs, and advanced care following discharge, which may pose a significant challenge to health care reform as the elderly population increases in the future.
Hyperparathyroidism in a Colombian City
Authors: Herrera‐Hernandez Alvaro A. , Diaz‐Perez Julio A. , Barajas‐Gamboa Juan S. , Aranda‐Valderrama Paola , Reddy Abhinay
Published: February 2015

Objective

Hyperparathyroidism has a variable presentation. Clinical manifestations, histopathology, and treatment of patients with hyperparathyroidism in Bucaramanga City, Colombia, were analyzed.

Method

A descriptive study was conducted.

Results

Twenty‐five patients (F:M ratio 1.5:1) with age ranging from 14 to 81 years (mean, 52.1 ± 18.15 years) were analyzed. Skeletal/osseous manifestations (100%), renal calculi (66%), muscle weakness (40%), and pruritus (24%) were the most common symptoms with mean duration of 24.2 months. Biochemical features included hypercalcemia (total corrected calcium 13.83 mg/dL), and high parathyroid hormone (mean, 1095.7). Twelve of 25 patients had primary hyperparathyroidism, 11 out of 25 secondary hyperparathyroidism, and 2 had tertiary hyperparathyroidism. A single patient had multinodular thyroid goiter. Parathyroidectomy was performed by Kocher’s incision in 21 out of 25 cases and minimally invasive open approach in 4 out of 25 cases. The following types of interventions have been performed: tumor resections (15/25), subtotal parathyroidectomies (6/25), and total parathyroidectomies (4/25). A total thyroidectomy was performed in the patient with associated thyroid disease (1/25). Histopathological examination revealed parathyroidian adenoma in 40% of patients, parathyroidian hyperplasia in 48%, and parathyroidian carcinoma in 4%. All symptoms and hypercalcemia resolved with the treatment. Such complication was observed in a case of hungry bone syndrome. No patients died within 15 months of follow‐up.

Conclusion

We described the clinical and histopathological features of patients with hyperparathyroidism in Colombia. Although pathologic features of parathyroid carcinoma are diagnostically reliable, those of the more commonly encountered lesions of adenoma and hyperplasia may be overlapping and, therefore, indistinctive, more so if only a single gland is available for examination.
Hypopharyngeal and Esophageal Injury after ACDF
Authors: Wu Vivian F. , Andersen Peter E. , Ching Alexander , Wax Mark K. , Schindler Joshua S.
Published: February 2015

Objective

To evaluate presenting symptoms, workup, and management of hypopharyngeal and esophageal injury associated with ACDF.

Method

We performed a retrospective review of consecutive cases in an academic institution. Inclusion criteria included patients with esophageal injury and dysphagia after ACDF who presented to otolaryngology clinics from January 2006 to July 2011 (N = 10). Outcomes reviewed include time to presentation, presenting symptoms, repair method, and oral intake status.

Results

Four of 10 patients presented with dysphagia, hoarseness, neck pain, or abscess within a week after ACDF. Three of 10 presented >1 year after ACDF with abscess, aspiration pneumonia, or stridor. Three of 10 had delay in diagnosis (>1 year between presentation and final diagnosis). Fusion plate removal occurred in 9 out of 10 patients. Conservative treatment was successful in 3 out of 10 who had no esophageal injury or only small perforation on endoscopy. One of 10 underwent successful repair with SCM flap. Six of 10 underwent free tissue transfer (1 required salvage SCM flap, 2 had persistent fistula). On posttreatment MBS, 4 out of 10 had asymptomatic diverticulums. Seven of 10 patients were taking PO at 1 week‐9 months posttreatment.

Conclusion

In patients with a history of ACDF and dysphagia, clinicians should maintain a high index of suspicion for morbid complications such as esophageal perforation. Greater than 3 months of mild‐moderate dysphagia should prompt evaluation with MBS whereas severe symptoms may indicate MBS/CT/endoscopy. Majority of patients will need fusion plate removed and will resume oral intake.
Hypopharyngeal Cancers Requiring Reconstruction
Authors: Joshi Poonam , Nair Sudhir , D’Cruz Anil K.
Published: February 2015

Objective

1) The type of reconstructions used; 2) complication rates; 3) duration of hospital stay; 4) perioperative mortality; and 5) disease‐free interval. In this retrospective analysis, we audit the hypopharyngeal cancers that required some form of tissue augmentation for pharyngeal reconstruction after primary surgery.

Method

Retrospective analysis of predominantly hypopharyngeal cancer patients who underwent surgery at the Tata Memorial Hospital, between 2005 and 2010. Of the total 390 patients, 103 required some form of pharyngeal reconstruction. The mean age of this population was 56 years with a male to female ratio of 4:1.

Results

Fifty‐three patients had reconstruction with pectoralis major myocutaneous flap. Thirty‐two had gastric pull up, 12 had free jejunum, and 6 had free radial artery forearm flap. The mean hospital stay was 22 days. While the overall perioperative mortality was 10% (10/103), majority (6/10) had GPU as part of treatment. A total of 18% of patients had re‐explorations, 6% had flap failures, and 23% had pharyngocutaneous fistula. Twenty percent had stricture of neopharynx and 44% had tracheostomal stenosis. The mean disease‐free intervals for all patients were 12 months and 11 months with close or involved margins.

Conclusion

The choice of reconstruction should be decided preoperatively based on the overall health status of the patient. Patients undergoing GPU have higher mortality rates. Low preoperative albumin level is an indicator for perioperative mortality (P value equal to. 02). Final HPR margin status may influence disease‐free interval.
Intravascular Papillary Endothelial Hyperplasia Presenting as a Lateral Neck Mass
Authors: Tracy Jeremiah C. , Wein Richard O.
Published: February 2015

Objective

1) To present an abnormal presentation of intravascular papillary endothelial hyperplasia (IPEH) as a lateral neck mass. 2) Discuss typical pathologic and radiographic findings associated with IPEH.

Method

Case presentation representing a patient who presented with a lateral neck mass. The ultimate pathologic diagnosis was IPEH, a rare benign condition. The typical radiographic and pathologic characteristics of this rare entity are presented and discussed.

Results

IPEH is a proliferation of vascular endothelial cells that typically presents as a subcutaneous mass. In the aerodigestive tract it may also present as a tender submucosal nodule or a bluish, raised mucosal lesion. The mass manifested in IPEH represents an exaggerated growth response by endothelial cells as they respond to an inciting stimulus. It may present in a normal blood vessel, a vascular malformation, or in response to trauma. IPEH occurs in the setting of recannalization after thrombosis. IPEH shares many clinical and histopathologic features with angiosarcoma. It is important to differentiate this benign proliferative process from malignant disease.

Conclusion

IPEH is a rare cause of a slowly growing neck mass. This condition is not a true neoplasm but rather reactive hyperplasia of the vascular endothelium. Diagnosis is based on micropathology and it is important to differentiate it from angiosarcoma. The primary curative management of these lesions is surgical excision.
Retained Crossbow Bolt after Penetrating Facial Trauma
Authors: Shah Manan U. , Ambro Bryan T. , Sridhara Shankar , Wolf Jeffrey S.
Published: February 2015

Objective

1) Describe a challenging case of removal of a retained crossbow bolt from the maxillofacial region. 2) Review the surgical management techniques. 3) Review of the literature on crossbow injuries to the head and neck.

Method

Case report is of a unique mechanism of penetrating maxillofacial trauma with retained foreign body threatening airway and neurovascular injury. Pertinent literature is reviewed.

Results

A 31‐year‐old man presented after being shot twice in the head with crossbow bolts. He was stable on clinical evaluation, and CT revealed an 8.5‐cm retained crossbow bolt extending from the right infratemporal fossa through the pterygopalatine fossa, traversing the nasopharynx with the tip just medial to the left mandibular ramus. There was no apparent vascular injury on CT angiogram. After awake tracheostomy for airway control, the bolt was removed by mandibular swing approach combined with nasal endoscopic assistance. Postoperative course was uneventful and follow‐up showed excellent wound healing without complications.

Conclusion

Otolaryngologists often encounter penetrating injuries and retained foreign bodies to the maxillofacial region. The unique shape of a crossbow bolt, along with threat of airway and neurovascular injury, created a management challenge. Herein we discuss various surgical approaches and review the literature on crossbow injuries to the head and neck.
Juvenile Angiofibroma: The “Anchorage” Concept
Authors: Andrade Jose S. C. , Andrade Nilvano A.
Published: February 2015

Objective

To present the Anchorage Concept, a set of characteristics shown by juvenile nasopharyngeal angiofibroma (JNA) that hinder the surgical resection and contribute to intraoperative complications and incomplete excisions.

Method

Case series consisting of 46 JNAs in the past 10 years (2001‐2011) and including tumors I to IIIb in Radowski staging classification. Surgical technique varied according to tumor stage and included exclusive endoscopic surgery, external access and combined, with or without preoperative embolization.

Results

Multiplicity of vascular pedicles: The maxillary artery, JNA’s principal irrigation source, commonly presents as an extension of the lesion, laterally positioned. This characteristic makes vascular clipping difficult and demands a careful surgical dissection next to the external carotid vascular trunk. Besides its main vascular trunk, JNA has many other vascular pedicles which become an anchoring factor and provoke intraoperative bleeding. Vector and growth angles: During its growth, JNA may dispose vectors that form angles in relation to nasal cavity. Sometimes, these angles are 90° shaped. From its origin at the upper margin of the sphenopalatine foramen, JNA grows forward and backward into the nasal cavity and maxillary sinus, upward into the sphenoid, laterally toward the pterygopalatine fossa, and inferiorly toward the infratemporal fossa, via the pterygomaxillary fissure.

Conclusion

The Anchorage Concept must be taken into account in the management of JNA. Knowledge of these points is of great value to facilitate the removal of the tumor, which persists being a surgical challenge in most cases.
Minimally Invasive Directed Parathyroidectomy Is Effective
Authors: Sadeghi Nader , Joshi Arjun S. , Terry Valentine , Knoll Stanley
Published: February 2015

Objective

1) To evaluate the outcome of minimally invasive targeted parathyroidectomy (TP) in managing primary hyperparathyroidism. 2) To report on the predictive value of preoperative imaging in success of targeted parathyroid exploration.

Method

Prospective noncontrolled cohort study of 208 patients with primary hyperparathyroidism managed in a single academic institution from 2002 to 2011. Patients underwent targeted parathyroidectomy based on preoperative parathyroid sestamibi scan and sonography. Intraoperative rPTH assay was used to determine success and extent of exploration. Follow‐up serum calcium levels were obtained.

Results

Of the 208 patients with primary hyperparathyroidism, data were available for 202. One hundred seventy‐seven underwent targeted parathyroidectomy (89%), 25 underwent bilateral exploration (11%). Of the 202 patients, follow‐up calcium data were available for 170 (162 targeted, 8 bilateral explorations). There was a total of 4 out of 170 (2%) recurrences or failed explorations. Of the 4 recurrences, 2 were in targeted and 2 in the bilateral exploration group. Targeted parathyroidectomy was successful in 159 out of 161 (99%) for first‐time explorations. Following negative or false‐positive imaging, bilateral exploration carried a failure rate of 25% (2/8).

Conclusion

Targeted parathyroidectomy following preoperative localization studies with parathyroid sestamibi scan and sonography is highly effective for primary hyperparathyroidism with a success rate of 99%. Among patients with negative or false positive imaging, bilateral exploration carries a failure rate of 25%.