bluuebunny/crossref_metadata_2025 huggingface dataset:
Free‐exciton absorption in bulk CdTe: temperature dependence
Authors: Horodyský P. , Hlídek P.
Published: December 2005

The absorption spectra in the free‐exciton region were measured on micrometer‐thick samples of bulk CdTe crystals. Analysis of the Urbach tail showed that the absorption edge is dominated by the free‐exciton transitions even at room temperature. The temperature dependence of the fundamental energy gap was obtained from the free‐exciton resonance from 4 K to 500 K. The value of 1.526 eV is proposed for the energy gap at 300 K. A comparison with the temperature dependencies of other works is given. (© 2006 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
The Yakubovich–Kalman–Popov lemma and stability analysis of dynamic output feedback systems
Authors: Johansson Rolf , Robertsson Anders
Published: December 2005

This paper presents theory related to stability analysis and stability criteria relevant for observer‐based feedback control systems. To this purpose, a special formulation of the Yakubovich–Kalman–Popov (YKP) lemma is provided. We exploit that controllability is not necessary for existence of Lur'e–Lyapunov functions as used in stability criteria. Constructive means for dynamic output feedback stabilization, positivity, factorization and passivity are provided. Copyright © 2005 John Wiley & Sons, Ltd.
Practical optimal control of fed‐batch bioreactors for the waste water treatment
Authors: Betancur Manuel J. , Moreno Jaime A. , Moreno‐Andrade Iván , Buitrón Germán
Published: December 2005

Optimal operation of fed‐batch bioreactors is an important practical issue. Since control actions are saturation‐limited, the optimal control consists usually of both singular and bang–bang arcs. However, its realization requires good model knowledge and also the measurement of all state variables, requirements rarely satisfied in real applications. In this paper a method is proposed, for a class of bioreactors, to robustly optimize the operation when few measured variables are available and the model is uncertain. Such control law is justified and its properties analysed. The case of a bioreactor for treating toxicants in a waste water treatment plant is thoroughly studied, and experimental results in a lab‐scale bioreactor are presented. The method can be also applied for other applications, as in biotechnology. Copyright © 2005 John Wiley & Sons, Ltd.
The Outcome of Cervical Exploration for Asymptomatic and Symptomatic Patients with Primary Hyperparathyroidism
Authors: Abbas Jaber S. , Hashem Suzan I. , Faraj Walid G. , Khalifeh Mohammad J. , Horani Mukbil H. , Salti Ibrahim S.
Published: December 2005

This study examined the success and safety of cervical exploration in patients with primary hyperparathyroidism (HPT). The presentation, pathologic findings, and outcome of patients with asymptomatic primary HPT were compared with those with symptomatic disease. Records of patients undergoing cervical exploration for primary HPT from January 1993 until December 31, 2003, were reviewed. Information collected consisted of preoperative symptoms, calcium and parathormone (PTH) levels, imaging studies, operative findings, pathology, and outcome of the patients. The groups with asymptomatic and symptomatic primary HPT were compared. In all, 139 patients were studied; 31 (22.3%) were asymptomatic (group I), and 108 (77.7%) had symptoms (group II). The two groups were also comparable regarding mean age, sex, and the yield of the imaging studies. The mean preoperative serum calcium level was comparable in the two groups (11.1mg/dl versus 11.3 mg/dl). However, PTH levels were significantly lower in group I than in group II (142 pg/dl versus 283 pg/dl, P = 0.01). The weight of the adenoma was also significantly less in group I than in group II (1082 mg versus 1679 mg P = 0.079). The outcome of the surgical exploration was comparable in the two groups with an immediate success rate close to 98% and a long‐term success rate of 95.4%. Cervical exploration and parathyroidectomy in patients with primary HPT is a safe procedure with a high success rate and favorable outcome.
Predicting Postoperative Mortality in Patients Undergoing Colorectal Surgery
Authors: Slim Karem , Panis Yves , Alves Arnaud , Kwiatkowski Fabrice , Mathieu Pierre , Mantion Georges
Published: December 2005

Well‐known and suitable instruments for surgical audit are the POSSUM and P‐POSSUM scoring systems. But these scores have not been well validated across the countries. The objective of the present study was to assess the predictive value of scores for colorectal surgery in France. Patients operated on for colorectal malignant or diverticular diseases, whether electively or on emergency basis, within a 4‐month period were included in a prospective multicenter study conducted by the French Association for Surgery (Association Française de Chirurgie, AFC). The main outcome measure was postoperative in‐hospital mortality. Independent factors leading to death were assessed by multivariate logistic regression analysis (AFC‐index). The ratio of expected versus observed deaths was calculated, and the predictive value of the POSSUM and P‐POSSUM scores were analyzed by the receiver operating characteristic (ROC) curve. A total of 1426 patients were included. The in‐hospital death rate was 3.4%. Four independent preoperative factors (AFC‐index) have been found: emergency surgery, loss of more than 10% of weight, neurological disease history, and age > 70 years. POSSUM had a poor predictive value; it overestimated postoperative death in all cases. P‐POSSUM had a good predictive value, except for elective surgery, where it overestimated postoperative death twofold. The predictive value of the AFC‐index was also good. It had the same sensitivity and specificity as the P‐POSSUM. POSSUM has not been validated in France in the field of colorectal surgery. P‐POSSUM was as predictive as the AFC‐index which is a simpler instrument based on four clinical parameters (without any mathematical formulas).
Clinical Significance of Metastasis to the Central Compartment from Papillary Microcarcinoma of the Thyroid
Authors: Ito Yasuhiro , Tomoda Chisato , Uruno Takashi , Takamura Yuuki , Miya Akihiro , Kobayashi Kaoru , Matsuzuka Fumio , Kuma Kanji , Miyauchi Akira
Published: December 2005

We previously demonstrated that for papillary microcarcinoma (PMC), (1) patients with lateral lymph node metastasis detected on preoperative ultrasonography (US) are more likely to develop recurrence, and (2) dissection of the lateral compartment does not improve the prognosis of patients without US‐detectable lateral metastasis. In this study, we focused on metastasis from PMC to the central compartment. We investigated the clinical significance of lymph nodes in the central compartment using the same series of 600 patients as used in the previous study. Ultrasound‐diagnosed central node metastasis could be found in 30 patients (20.0%). Although the specificity of US for detecting central node metastasis was 99.1%, sensitivity was only 10.9%. Neither US‐diagnosed nor pathologically confirmed central node metastasis affected the disease‐free survival (DFS) rate of PMC patients. Furthermore, in cases where PMC was located only in one lobe, central node dissection in the contralateral lobe did not improve the DFS rate. These findings suggest that, for PMC, (1) US is an insensitive technique for detecting the central node metastasis, (2) the presence of central node metastasis is unrelated to DFS of patients, and (3) when performing lobectomy for PMC involving only one lobe, dissection of the central compartment in the contralateral lobe is optional.
Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?
Authors: Saidi Reza F. , ReMine Stephen G. , Dudrick Paul S. , Hanna Nader N.
Published: December 2005

Patients with metastatic gastric cancer are currently not considered operative candidates and are most often offered systemic therapy. Palliative resection of the primary tumor has been considered irrelevant to the outcome and has been recommended only for palliation of symptoms. We have examined the role of palliative gastrectomy and its impact on survival in patients with stage IV gastric cancer at initial diagnosis between 1990 and 2000. A total of 105 patients with stage IV disease were identified during this period; 81 of them (77.1%) had no resection, and 24 (22.9%) underwent palliative gastric resection. Mean survival in those without resection who received chemotherapy (with or without radiation) treatment was 5.9 months (95% confidence interval 4.2–7.6). For those with resection and adjuvant therapy, mean survival time was 16.3 months (95% confidence interval 4.3–28.8 months). Kaplan‐Meier survival analysis showed significantly better survival in those with resection and adjuvant therapy (log‐rank test, P = 0.01). Mortality and morbidity rates associated with palliative resection were 8.7% and 33.3%, respectively, which did not differ statistically from the 3.7% and 25.3% in patients who underwent curative gastrectomy during same period of time. However, the length of hospitalization (22 versus 16 days) was significantly higher compared with those without stage IV disease. These data suggest that palliative resection combined with adjuvant therapy may improve survival in a selected group of patients with stage IV gastric cancer. Palliative gastrectomy plus systemic therapy should be compared with systemic therapy alone in a randomized trial.
Results of Preoperative Lymphoscintigraphy for Breast Cancer Are Predictive of Identification of Axillary Sentinel Lymph Nodes
Authors: Marchal Frédéric , Rauch Philippe , Morel Olivier , Mayer Jean Claude , Olivier Pierre , Leroux Agnès , Verhaeghe Jean Luc , Guillemin François
Published: December 2005

The aim of this study was to identify the variables associated with successful peroperative sentinel lymph node (SLN) localization. We studied 201 patients with T1, T2, N0 invasive breast cancer who underwent a SLN procedure from 1999 to 2003. Of these 201 patients, 55 underwent peritumoral and 146 underwent periareolar radioisotope injection before the blue dye injection. All patients were operated on by breast conservative surgery and axillary dissection after SLN biopsy. Age, weight, menopausal status, previous biopsy, localization of the tumor, results of lymphoscintigraphy, site of radiotracer injection, tumor size, tumor grade, experience of surgeons, and the number of invaded axillary nodes were analyzed to determine whether they had any significant correlation with successful identification of SLN. Variables found to have a statistically significant influence on the SLN identification rate and on preoperative lymphoscintigraphy identification were introduced into a univariate and multivariate logistic regression model. In multivariate analysis, successful lymphoscintigraphy (P < 0.0001) and the absence of metastatic axillary nodes (P < 0.005) were associated with successful identification of SLNs. The peritumoral injection of radiotracer (P < 0.001), patient age > 60 years (P < 0.003), and localization of the tumor in the upper outer quadrant (P < 0.004) were associated with failure of lymphoscintigraphic visualization of SLN. The technique of SLN detection thus appears to be better for patients with low risk of invaded axillary lymph nodes.
Significance of Extensive Surgery Including Resection of the Pancreas Head for the Treatment of Gallbladder Cancer—From the Perspective of Mode of Lymph Node Involvement and Surgical Outcome
Authors: Sasaki Ryoko , Itabashi Hidenori , Fujita Tomohiro , Takeda Yuichiro , Hoshikawa Koichi , Takahashi Masahiro , Funato Osamu , Nitta Hiroyuki , Kanno Senji , Saito Kazuyoshi
Published: December 2005

The present study aimed to clarify the efficacy of extensive surgery, including pancreas head resection, for more complete lymphadenectomy in the treatment of gallbladder carcinoma. The study involved retrospective analyses of 65 consecutive patients with gallbladder carcinoma who underwent surgical resection between 1982 and 2003. Of these 65 patients, 41.5% displayed node‐positive disease and among them 23.1% had positive para‐aortic nodes. Of six node‐positive 5‐year survivors, five underwent pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy. The 5‐year survival rates were 76.2% for pN0, 30.0% for pN1, 45.8% for pN2, and 0% for pM1[lymph], respectively. Significant differences existed in survival rates. Postoperative recurrence was observed in 24.1% (13/54) of patients who underwent R0 resection. Of the four patients who displayed lymph node recurrence, two had pericholedocal and/or posterior pancreatoduodenal lymph node metastasis at the time of surgery and underwent pancreas‐preserving regional lymphadenectomy. These results suggest that extensive resection, including resection of the pancreatic head, is effective in selected patients with up to pN2 lymph node metastasis, as long as complete removal of the cancer can be achieved. Pancreatoduodenectomy combined with S4aS5 hepatic subsegmentectomy should be considered when lymph node metastasis is obvious and the patient is in good condition.
Changing Treatment Strategy for Gastrinoma in Patients with Zollinger‐Ellison Syndrome
Authors: Imamura Masayuki , Komoto Izumi , Ota Shuichi
Published: December 2005

We overviewed the recent development of curative surgery for gastrinoma that has been rapidly improved since the development of new localization techniques, especially the selective arterial secretagogue injection test (SASI test) and somatostatin receptor scintigraphy (SRS). A number of new pathological findings of gastrinomas in patients with Zollinger‐Ellison syndrome have been accumulated in accordance with the increase of curative resection of gastrinomas, and these new findings also have contributed to the progress of the treatment strategy for grastrinomas.
Host defense inNicrophorus quadripunctatusagainst brood parasitism byPtomascopus morio(Coleoptera: Silphidae: Nicrophorinae)
Authors: Suzuki Seizi , Nagano Masahiro
Published: December 2005

Few studies have been conducted on the host defenses of insects against brood parasitism. We investigated whether the silphid beetlePtomascopus morio, a brood parasite of related silphid speciesNicrophorus concolor, can also parasitize another silphid speciesNicrophorus quadripunctatusand the manner in whichN. quadripunctatusdefends itself against parasitism. Successful brood parasitism under natural conditions was not observed at the time of year whenP. morioandN. quadripunctatusare both reproductively active. Follow‐up experiments revealed thatP. morioattempts to oviposit nearN. quadripunctatusnests, but is rarely successful if adult hosts are present. WhenP. moriolarvae were experimentally introduced toN. quadripunctatusbroods, someP. moriolarvae survived when the host and parasite larvae were at the same stage. We concluded thatN. quadripunctatusdefends itself against brood parasitism in two ways: (1) potential brood parasites are repelled, thus limiting their access to the resource; and (2) the young of the parasitic species are killed.
Root aerobic respiration and growth characteristics of three Typha species in response to hypoxia
Authors: Matsui Tomomi , Tsuchiya Takayoshi
Published: December 2005

The responses of root aerobic respiration to hypoxia in three common Typha species were examined. Typha latifolia L., T. orientalis Presl, and T. angustifolia L. were hydroponically cultivated under both aerobic and hypoxic growth conditions to measure root oxygen consumption rates. Hypoxia significantly enhanced the root aerobic respiration capacity of the two deep‐water species, T. orientalis and T. angustifolia, while it did not affect that of the shallow‐water species, T. latifolia. T. angustifolia increased its root porosity and root mass ratio, while T. latifolia increased its root diameter under the hypoxic growth conditions. The relative growth rates in biomass of T. orientalis and T. angustifolia were 59 and 39% higher, respectively, under the hypoxic growth conditions than under the aerobic growth conditions. In contrast, that of T. latifolia did not differ between the two conditions. In T. orientalis and T. angustifolia, enhanced root aerobic respiration rates under the hypoxic growth conditions would have increased the nutrient uptake, and thus higher relative growth rates were obtained. For the deep‐water species, T. orientalis and T. angustifolia, the root aerobic respiration capacity was enhanced, probably in order to maintain the generation of respiratory energy under hypoxia.
Self-help with minimal therapist contact for obsessive–compulsive disorder: a review
Authors: Mataix-Cols David , Marks Isaac M.
Published: December 2005

Though there are effective psychological and drug treatments for obsessive–compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.
Cigarette smoking in long-term schizophrenia
Authors: Salokangas R.K.R. , Honkonen T. , Stengård E. , Koivisto A.-M. , Hietala J.
Published: December 2005

Purpose

Cigarette smoking is a great health problem and prevalent among subjects with schizophrenia. Our aim was to investigate the prevalence and associations of cigarette smoking in patients with long-term schizophrenia.

Methods

Seven hundred and sixty schizophrenia patients were interviewed and their cigarette smoking was recorded.

Results

Smoking was more prevalent men than in women patients. In logistic regression analysis, male gender, duration of illness (DUI) from 10 to 19 years, being divorced or separated, lower education and high daily doses of neuroleptics (DDN) associated significantly with regular smoking. Heavy smoking associated, in men, with hospital treatment.

Conclusions

In schizophrenia patients, smoking is associated with long DUI, high DDN and institutional care. Interventions for cessation and/or reduction of cigarette smoking should be a part of the treatment for patients with schizophrenia.
Temperament, character and symptoms of anxiety and depression in the general population
Authors: Jylhä Pekka , Isometsä Erkki
Published: December 2005

Few studies have investigated the relationship of temperament and character, as conceptualized in the Temperament and Character Inventory–Revised (TCI-R), to symptoms of depression and anxiety in the general population. In this study a random sample of subjects (20 to 70 years), in two Finnish cities, were surveyed with the TCI-R, Beck Depression and Anxiety Inventories, plus questions related to diagnosed lifetime mental disorders, health care use for psychiatric reasons during the past 12 months, and history of mental disorders in first-degree relatives. Altogether 347 subjects (38.6%) responded. Of the TCI-R dimensions, Harm Avoidance correlated with symptoms of depression (rs
= 0.555, p < 0.001), anxiety (rs= 0.560, p < 0.001), self-reported lifetime mental disorder (rs = 0.272, p< 0.001), health care use for psychiatric reason during the past 12 months (rs = 0.241, p< 0.001) and family history of mental disorder (rs = 0.202, p<0.001). Self-directedness correlated negatively with symptoms of depression (rs = -0.495, p< 0.001), anxiety (rs = -0.458, p < 0.001), lifetime mental disorder (rs = 0.225, p< 0.001) and health care use (rs = -0.135, p = 0.013). Overall, Harm Avoidance and Self-directedness seem to associate moderately with depressive and anxiety symptoms, and somewhat predict self-reported use of health services for psychiatric reasons, and lifetime mental disorder. High harm avoidance may associate with a family history of mental disorder.
Use of Ultra‐High‐Resolution Data for Temporal Bone Dissection Simulation
Authors: Wiet Gregory J. , Schmalbrock Petra , Powell Kimerly , Stredney Don
Published: December 2005

OBJECTIVES

For the past 5 years, our group has been developing a virtual temporal bone dissection environment for training otologic surgeons. Throughout the course of our development, a recurring challenge is the acquisition of high‐resolution, multimodal, and multi‐scale data sets that are used for the visual as well as haptic (sense of touch) display. This study presents several new techniques in temporal bone imaging and their use as data for surgical simulation.

METHODS

At our institution (OSU), we are fortunate to have a high‐field (8 Tesla) magnetic resonance imaging (MRI) research magnet that provides an order of magnitude higher resolution compared to clinical 1.5T MRI scanners. Magnetic resonance imaging has traditionally been superb at delineating soft tissue structure, and certainly, the 8T unit does indeed do this at a resolution of 100‐200 μm3. To delineate the bony structure of the mastoid and middle ear, computed tomography (CT) has traditionally been used because of the high signal‐to‐noise ratio delineating bone signal from air and soft tissue. We have partnered with researchers at other institutions (CCF) to make use of a “microCT” that provides a resolution of 214 × 214 × 390 micrometers of bony structure.

RESULTS

This report provides a description of the 2 methodologies and presentation of the striking image data capable of being generated. See images presented.

CONCLUSIONS

Using these 2 new and innovative imaging modalities, we provide an order of magnitude greater resolution to the visual and haptic display in our temporal bone dissection simulation environment.
Sialoscopy in Cases of Unclear Swelling of the Major Salivary Glands
Authors: Koch Michael , Zenk Johannes , Bozzato Alessandro , Bumm Klaus , Iro Heinrich
Published: December 2005

OBJECTIVE

Sialoscopy has developed into an important diagnostic and therapeutic tool for diseases of the major salivary glands.

STUDY DESIGN AND SETTING

We evaluated 103 patients with chronic swelling of the major salivary glands. Routine diagnostic measures revealed no clear diagnosis. The findings of 109 sialoscopies are described. A semi‐rigid endoscope (with a diameter of 1.1 mm and 2 integrated working channels) was used for sialoscopy, 51.5% of the cases in Warthon's duct and 48.5% in Stensen's duct.

RESULTS

Pathologic findings resulted in 83.0% of the submandibular and in 96% of the parotid ducts. Obstruction neither due to sialolithiasis nor stenosis was observed in 56.3%, whereas sialolithiasis was observed in 20.3% of the patients. In 36 (35%) patients, an interventional sialoscopy was performed.

CONCLUSIONS

In cases of invisible salivary duct obstruction, especially in those with low mineralized calculi, strictures, stenoses, or postinflammatory changes, sialoscopy gives immediate and direct information about causal pathologies. Moreover, further therapy can be planned within the same procedure.

EBM RATING

C
Comparison of the Effectiveness and Safety of Radiofrequency Turbinoplasty and Traditional Surgical Technique in Treatment of Inferior Turbinate Hypertrophy
Authors: Cavaliere Matteo , Mottola Giampiero , Iemma Maurizio
Published: December 2005

OBJECTIVES

Inferior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Many different techniques are currently available. We prospectively evaluate the safety and effectiveness of radiofrequency volumetric tissue reduction (RFVTR) compared with the traditional surgical technique.

METHODS

The study was conducted on 3 groups of 75 patients with symptoms and signs of nasal obstruction associated with inferior turbinate hypertrophy refractory to medical therapy. In group A, the turbinoplasty (TP) was performed using the classical surgical submucosal resection; in group B, the RFVTR was applied to inferior turbinate; and group C patients were not treated and served as control subjects. Nasal endoscopy, visual analogue scale (VAS), anterior active positional rhinomanometry, and saccharin tests were used to assess treatment outcomes at the end of week 1 and months 1 and 3 after surgery.

RESULTS

Turbinate edema and secretions decreased significantly (P < 0.05) in groups A and B from 1 month after surgery. The secretions in group A increased temporarily on the seventh day after surgery. Concerning the nasal obstruction and related symptoms, significant improvement was observed at 1 month after treatment in all patients (P < 0.05) and continued up to 3 months after surgery (P < 0.0001). Rhinomanometric measurements demonstrated a significant nasal flow increase at 3 months (P < 0.0001). The nasal mucociliary transport time increased in group A at week 1. The difference among the 3 groups at month 1 was observed not significant.

CONCLUSION

In this study, we demonstrated that both RFVTR and TP are effective in improving nasal obstruction and related nasal symptoms. In support of the RFVTR, different factors are important: it can be performed in local anaesthesia; it does not require a nasal package; it does not cause either a change of mucociliary function or an increase of secretions and crusts; and the patient can be discharged immediately after treatment. Therefore, we suggest that the RFVTR offers an efficient, gentle, and function‐maintaining alternative to TP. However, because of the short follow‐up, future investigations are needed for a more exhaustive evaluation of equivalency of the 2 turbinate procedures.

EBM RATING: B‐2
Cricoid Palpability as a Selection Criterion for Bedside Tracheostomy
Authors: Husein Omar F. , Massick Douglas D.
Published: December 2005

OBJECTIVE

To prospectively evaluate the significance of cricoid cartilage palpability as a selection criterion for bedside tracheostomy and to prospectively compare a cohort of patients undergoing bedside tracheostomy with another cohort receiving operating room tracheostomy.

STUDY DESIGN/SETTING

Prospective trial comparing 2 cohorts of patients receiving tracheostomies at a tertiary care center (university hospital). In all, 220 consecutive intubated patients selected for elective tracheostomy were enrolled. Of them, 134 patients had palpable cricoid cartilage and underwent open surgical tracheostomy at the bedside. The remaining 68 patients received open surgical tracheostomies in the operating room. Demographic data, patient anatomic features, and perioperative complications were prospectively recorded. There were no statistically significant differences in age, gender, reason for admission, indication for tracheostomy, Acute Physiology and Chronic Health Evaluation II score, number of days intubated, or time required to perform the procedure for those patients whose tracheostomies were performed in the operating room versus the intensive care unit.

RESULTS

Patients with a palpable cricoid cartilage had a significantly reduced perioperative complication rate compared with those without a palpable cricoid cartilage (2% vs 22%, P < 0.001). Comparison of cervical girth, mental‐to‐sternum distance, and thyroid‐notch‐to‐sternum distance showed no significant difference between the 2 groups and did not further define selection criteria.

CONCLUSION

This investigation prospectively confirms the safety of bedside tracheostomy placement in properly selected patients. Complication incidences are defined for open surgical tracheostomy at the bedside and in the operating room. Palpability of the cricoid cartilage has significant value as a selection criterion for bedside tracheostomy.

SIGNIFICANCE

These findings will aid in the development of protocols and pathways for surgical airway management in critically ill patients to maximize cost‐effective, high‐quality care.

EBM RATING: B‐2
Effects of Cytomegalovirus (CMV) Related Deafness on Pediatric Cochlear Implant Outcomes
Authors: Lee Daniel J. , Lustig Lawrence , Sampson Margaret , Chinnici Jill , Niparko John K.
Published: December 2005

OBJECTIVE

Human cytomegalovirus (CMV) is a commonly recognized viral cause of perinatal sensorineural hearing loss. CMV‐infected infants are also at risk for developmental neurological deficits. This retrospective study assesses the impact of CMV‐induced deafness on pediatric cochlear implant outcomes.

STUDY DESIGN AND SETTING

Thirteen patients from the Johns Hopkins pediatric cochlear implant database were identified with CMV‐related deafness. A retrospective review of the medical records of the Johns Hopkins Hospital was performed.

RESULTS

The mean age at implantation was 5.6 years. Follow‐up audiometric data ranged from 6 to 48 months postoperatively. Mean speech perception scores were 4.5 (out of 6) following implantation.

CONCLUSION

We have shown that cochlear implants can provide useful speech comprehension to patients with CMV‐related deafness. Speech recognition scores were within the range established by our overall pediatric implant population.

SIGNIFICANCE

This observation underscores the importance of a multidisciplinary rehabilitation program following implantation in these patients at risk for cognitive delay.

EBM RATING

C
Targeted Intra‐Arterial Chemoradiation for Advanced Tonsil Cancer
Authors: Naidu Srikanth I. , Vieira Francisco , Samant Sandeep , Vang Meng C. , Wan Ajim Y. , Robbins Thomas K.
Published: December 2005

OBJECTIVES

To determine the effects of combined radiation and targeted, intra‐arterial (IA) cisplatin infusions (RADPLAT) in patients with advanced squamous cell carcinoma (SCC) of the tonsil.

STUDY DESIGN AND SETTING

Prospective study of treatment outcomes and toxicity of patients enrolled on the RADPLAT protocol, with specific analysis of patients with advanced SCC of the tonsil.

RESULTS

Thirty patients with advanced tonsil carcinoma (17 T4, 12 T3, 1 T2) were enrolled, and 24 of 30 patients completed at least 3 IA cisplatin infusions and a minimum of 63 Gy or radiation therapy (minimum therapy). Two‐year estimated overall and disease‐specific survival was 42% and 50%, respectively, for all 30 patients (intent‐to‐treat group) and 49% and 58%, respectively, for the minimum therapy subgroup. The 2‐year estimated local and regional disease control was 87% and 90%, respectively, for the intent‐to‐treat group, and 100% and 90% for the minimum therapy subgroup. Functional organ preservation was achieved in 92% of patients.

CONCLUSIONS

Locoregional disease control achieved with this regimen appears to be significantly improved over that described in the literature for similarly staged tonsil cancer. Survival, on the other hand, remains comparable.

EBM RATING

C
Hydroxyapatite Cement in Craniofacial Reconstruction
Authors: Verret D.J. , Ducic Yadranko , Oxford Lance , Smith Jesse
Published: December 2005

OBJECTIVES

To evaluate the long‐term efficacy of hydroxyapatite cement in craniofacial reconstruction, specifically examining the role (if any) of radiation, implant location, and cement type.

STUDY DESIGN

A retrospective chart review was conducted of all patients presenting to the senior surgeon (Y.D.) for craniofacial reconstruction from September 1997 to April 2004.

METHODS

Data were collected including type of cement used, size of defect, complications, need for removal of cement, reason for defect, and pathologic results of examination of removed cements.

RESULTS

One hundred two patients were identified who underwent craniofacial reconstruction with hydroxyapatite cements, 7 of whom required complete implant removal (6 Norian and 1 Mimix), and 4 (2 Norian and 2 Bone source) of whom required partial implant removal for foreign body reaction. Five of the removals were in patients who underwent postoperative radiation.

CONCLUSIONS

Hydroxyapatite cements are safe in craniofacial reconstruction. The highest risk of implant infection comes from reconstruction in the area of the frontal sinus, immediately beneath coronal incisions, and in patients who receive postoperative radiation treatment. Based on our results, there does appear to be a statistically significant difference in rates of infection and foreign body reaction between the different types of hydroxyapatite cement. We would not recommend implantation of this material in contact with the frontal sinus. Caution should be exercised when it is placed directly beneath an incision or in patients receiving postoperative radiation, particularly if a boost dose is given.

EBM RATING

C
Measurement of Morphologic Changes Induced by Trauma with the Use of Coherence Tomography in Porcine Vocal Cords
Authors: Nassif Nader A. , Armstrong William B. , de Boer Johannes F. , Wong Brian J.F.
Published: December 2005

BACKGROUND AND OBJECTIVE

To evaluate the ability of optical coherence tomography (OCT) (a noncontact, high‐resolution imaging technique that generates detailed cross‐sectional images of tissue structure) to image and document acute response to trauma in the larynx.

MATERIALS AND METHODS

Porcine larynges were dissected to expose the vocal cords. Vocal cords were imaged with 1310 nanometer (nm) light source with a bandwidth of 75 nm at 1 frame/second (s). Vocal cord injuries were simulated by applying topical phenolic acid, injecting titanium dioxide into the submucosa, and carbon dioxide laser irradiation.

RESULTS

The epithelium, basement membrane, and lamina propria were clearly delineated, and the effect of each intervention could be monitored as lesions progressed. The OCT image corresponded closely with histology.

CONCLUSION

OCT is a powerful imaging tool with the potential for use in real time and has potential for multiple clinical applications in the larynx.
Audiometric Patterns and Prognosis in Sudden Sensorineural Hearing Loss in Southern Taiwan
Authors: Chang Ning‐Chia , Ho Kuen‐Yao , Kuo Wen‐Rei
Published: December 2005

OBJECTIVES

To investigate factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL).

STUDY DESIGN AND SETTING

This is a retrospective study of patients with SSNHL hospitalized at an academic medical center. All patients in this study were treated with prednisolone and dextran. We compared a new 7‐pattern classification for audiometric pattern and prognosis analysis with Sheehy classification.

RESULTS

We analyzed 148 affected ears in 146 patients. Occurrence of SSNHL was associated with changes in season. The best prognosis was with the midtone pattern of the 7‐pattern classification and with the low‐tone pattern of Sheehy classification. The older patients, those with vertigo, or those treated after 6 days had a poor prognosis. There was no significant association between ESR level and prognosis.

CONCLUSIONS

SSNHL patients with midtone loss have the best prognosis. This study of the audiometric patterns and prognostic factors of SSNHL allow us to better predict its outcome.

EBM RATING: B‐2
Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial
Authors: Philippi Heike , Faldum Andreas , Schleupen Angela , Pabst Bianka , Jung Tatjana , Bergmann Holger , Bieber Imke , Kaemmerer Christine , Dijs Piet , Reitter Bernd
Published: December 2005

The aim of this study was to assess the therapeutic efficacy of osteopathic treatment in infants with postural asymmetry. A randomized clinical trial of efficacy with blinded videoscoring was performed. Sixty‐one infants with postural asymmetry aged 6 to 12 weeks (mean 9wks) were recruited. Thirty‐two infants (18 males, 14 females) with a gestational age of at least 36 weeks were found to be eligible and randomly assigned to the intervention groups, 16 receiving osteopathic treatment and 16 sham therapy. After a treatment period of 4 weeks the outcome was measured using a standardized scale (4–24 points). With sham therapy, five infants improved (at least 3 points), eight infants were unchanged (within 3 points), and three infants deteriorated (not more than −3 points); the mean improvement was 1.2 points (SD 3.5). In the osteopathic group, 13 infants improved and three remained unchanged; the mean improvement was 5.9 points (SD 3.8). The difference was significant (p=0.001). We conclude that osteopathic treatment in the first months of life improves the degree of asymmetry in infants with postural asymmetry.
INTRODUCTION
Authors: Cohen Andrew I.
Published: December 2005

The essays in this volume constitute a symposium on the work of Joel Feinberg. Ten leading scholars in ethics, legal philosophy, and social and political philosophy offer a glimpse of the scope and impact of Feinberg's work. They address issues such as a theory of rights, antipaternalism, an account of action and omission, and the legal enforcement of morals.
FEINBERG'S TWO CONCEPTS OF RIGHTS
Authors: Wellman Christopher Heath
Published: December 2005

This article argues that there is a fundamental tension between Joel Feinberg's theory of the nature of rights and his account of what types of beings are potential right-holders. In explaining this tension, I argue that Feinberg actually adopts two competing concepts of rights. Clearly, Feinberg must choose between these two theories, but I suggest that both are attractive and that neither view can be selected as either “correct” or “incorrect” on the grounds of either logical consistency or even straightforward conceptual analysis. In the end, one's preference between these two concepts of rights depends upon competing values, values about which reasonable people can disagree.
FEINBERG AND THE FAILURE TO ACT
Authors: Smith Patricia
Published: December 2005

In Chapter 4 of his famous work, Harm to Others, Joel Feinberg, with characteristic clarity and insight, outlined the major problems associated with analyzing the foundations of responsibility for the failure to act. In that chapter he made a number of controversial claims supported by arguments that have generated debate ever since he made them in 1984. His analysis led him to conclude that liability (or responsibility) for the failure to act falls within the moral limits of the criminal law in cases in which a random bystander could easily rescue a seriously imperiled stranger.
JOEL FEINBERG AND THE JUSTIFICATION OF HARD PATERNALISM
Authors: Arneson Richard J.
Published: December 2005

Joel Feinberg was a brilliant philosopher whose work in social and moral philosophy is a legacy of excellent, even stunning achievement. Perhaps his most memorable achievement is his four-volume treatise on The Moral Limits of the Criminal Law, and perhaps the most striking jewel in this crowning achievement is his passionate and deeply insightful treatment of paternalism. Feinberg opposes legal paternalism, the doctrine that “it is always a good reason in support of a [criminal law] prohibition that it is probably necessary to prevent harm (physical, psychological, or economic) to the actor himself.” Against this doctrine Feinberg asserts that when an agent's sufficiently voluntary choice causes harm to herself or risk of harm to herself, this category of harm-to-self is never a good reason in support of criminal law prohibition of that type of conduct.
Kinky profiles: Effects of soil surface heating upon vertical dust concentration profiles in the Channel Country of western Queensland, Australia
Authors: Butler H. J. , McTainsh G. H. , Hogarth W. L. , Leys J. F.
Published: December 2005

In rangelands, unlike cultivated fields, soil surface conditions and vegetation cover are far from uniform. Field measurements taken within rangeland environments show that the shape of vertical dust concentration profiles can vary significantly between wind erosion events. Regression fits used to analyze vertical dust concentration profiles are therefore better for some events than others. Such variability has usually been explained as experimental error (or noise) or as a result of the nonuniformity of surface conditions. A computer simulation model (DSism) is used to examine this variability in terms of wind erosion processes. Analysis of these simulation results together with field observations shows that nonuniformity in surface conditions alone cannot explain variations observed in the vertical dust concentration profiles. These same simulations suggest that much of the variability in vertical dust concentration profiles is the result of thermal heating of the soil surface.
Quantifying hydrological and tidal influences on groundwater discharges into coastal waters
Authors: Prieto Carmen , Destouni Georgia
Published: December 2005

In coastal aquifers the dynamic mixing zone between intruding seawater and fresh groundwater constitutes a zone of salinity transition that may supply brackish groundwater along with chemical tracers and nutrients to coastal waters. Tidal influence has been proposed as a possible mechanism for enhancement of recirculated seawater, total submarine groundwater discharge (SGD), and associated tracer loading through salinity transition zones into coastal waters. We show that tidal oscillation may, for relatively low SGD cases, considerably increase the average recirculated seawater component of total SGD relative to nontidal conditions. High SGD cases, however, are dominated by and require large fresh groundwater flow components also under tidal conditions; this result is obtained from a wide range of different groundwater simulation scenarios and is supported by direct comparison with field data from different reported high‐SGD sites in the world. For cases with hydrologically limited fresh groundwater flow directly into the sea we propose that observed excessive coastal loading of groundwater‐derived tracers may be the result of large groundwater flow and transport into unmonitored coastal stream reaches, in addition to SGD.
Impact of phytoplankton on the biogeochemical cycling of iron in subantarctic waters southeast of New Zealand during FeCycle
Authors: McKay R. M. L. , Wilhelm S. W. , Hall J. , Hutchins D. A. , Al‐Rshaidat M. M. D. , Mioni C. E. , Pickmere S. , Porta D. , Boyd P. W.
Published: December 2005

During austral summer 2003, we tracked a patch of surface water infused with the tracer sulfur hexafluoride, but without addition of Fe, through subantarctic waters over 10 days in order to characterize and quantify algal Fe pools and fluxes to construct a detailed biogeochemical budget. Nutrient profiles characterized this patch as a high‐nitrate, low‐silicic acid, low‐chlorophyll (HNLSiLC) water mass deficient in dissolved Fe. The low Fe condition was confirmed by several approaches: shipboard iron enrichment experiments and physiological indices of Fe deficiency (Fv/Fm < 0.25, Ferredoxin Index < 0.2). During FeCycle, picophytoplankton (0.2–2 μm) and nanophytoplankton (2–20 μm) each contributed >40% of total chlorophyll. Whereas the picophytoplankton accounted for ∼50% of total primary production, they were responsible for the majority of community iron uptake in the mixed layer. Thus ratios of 55Fe:14C uptake were highest for picophytoplankton (median: 17 μmol:mol) and declined to ∼5 μmol:mol for the larger algal size fractions. A pelagic Fe budget revealed that picophytoplankton were the largest pool of algal Fe (>90%), which was consistent with the high (∼80%) phytoplankton Fe demand attributed to them. However, Fe regenerated by herbivory satisfied only ∼20% of total algal Fe demand. This iron regeneration term increased to 40% of algal Fe demand when we include Fe recycled by bacterivory. As recycled, rather than new, iron dominated the pelagic iron budget (Boyd et al., 2005), it is highly unlikely that the supply of new Fe would redress the imbalance between algal Fe demand and supply. Reasons for this imbalance may include the overestimation of algal iron uptake from radiotracer techniques, or a lack of consideration of other iron regeneration processes. In conclusion, it seems that algal Fe uptake cannot be supported solely by the recycling of algal iron, and may require an Fe “subsidy” from that regenerated by heterotrophic pathways.
Smooth bumps in H/V curves over a broad area from single‐station ambient noise recordings are meaningful and reveal the importance of Q in array processing: The Boumerdes (Algeria) case
Authors: Guillier B. , Chatelain J.‐L. , Hellel M. , Machane D. , Mezouer N. , Ben Salem R. , Oubaiche E. H.
Published: December 2005

Single‐station H/V curves from ambient noise recordings in Boumerdes (Algeria) show smooth bumps around 1 and 3 Hz. A complementary microtremor study, based on two 34 and 134‐meter aperture arrays, evidences that these bumps are indeed real peaks produced by two strong VS contrasts at 37 and 118 meters depth, strongly smoothed by very high S‐wave attenuation in the two sedimentary layers. These two H/V bumps, observed over a broad area, are meaningful and reveal the importance of Q in S‐wave velocity modeling from microtremor array data processing. It also appears that Tertiary rocks should be, at least in some cases, taken into account, together with the Quaternary sediments, to explain single‐station H/V frequency peaks, and therefore that considering only the first 30 m of soil for VS amplification evaluation, as usually recommended, sometimes leads to flaky results by artificially eliminating non‐explained low‐frequency peaks from the analysis.
Bering Strait throughflow and the thermohaline circulation
Authors: Hu Aixue , Meehl Gerald A.
Published: December 2005

In this study, we employ a global coupled climate model to show that the Bering Strait is important to the variations of the thermohaline circulation. Three experiments are analyzed, a present day control run, and two freshwater hosing runs. Results show that as the thermohaline circulation weakens due to freshwater forcing in the northern North Atlantic, the Bering Strait throughflow weakens, and even reverses its direction, and the export of the Arctic freshwater into the northern North Atlantic is reduced, or the Arctic even takes freshwater from the latter, thus helping the thermohaline circulation to recover relatively quickly after the end of the freshwater hosing.
Effect of subgrid cloud‐radiation interaction on climate simulations
Authors: Wu Xiaoqing , Liang Xin‐Zhong
Published: December 2005

The mosaic representation of subgrid cloud‐radiation interaction is implemented in the radiation scheme of the NCAR Community Climate Model version 3 (CCM3) to investigate its impacts on global climate simulations. It is found that the CCM3 with the modified radiation scheme enables the use of more realistic cloud amounts as well as cloud water contents while producing net radiative fluxes closer to observations. The improved vertical distribution of cloud water path based on the cloud‐resolving model (CRM) simulations increases the radiative heating in the upper troposphere over the tropics, which reduces the long‐standing cold bias in the temperature field. Consequently, not only the representation of cloud‐radiation interactions is more physically consistent and accurate, but also the climate simulations are significantly affected and improved.