bluuebunny/crossref_metadata_2025_split huggingface dataset:
On the Realism of the Rain Microphysics Representation of a Squall Line in the WRF Model. Part II: Sensitivity Studies on the Rain Drop Size Distributions
Authors: Planche Céline , Tridon Frédéric , Banson Sandra , Thompson Gregory , Monier Marie , Battaglia Alessandro , Wobrock Wolfram 
Published: May 2019

Abstract
A comparison between retrieved properties of the rain drop size distributions (DSDs) from multifrequency cloud radar observations and WRF Model results using either the Morrison or the Thompson bulk microphysics scheme is performed in order to evaluate the model’s ability to predict the rain microphysics. This comparison reveals discrepancies in the vertical profile of the rain DSDs for the stratiform region of the squall-line system observed on 12 June 2011 over Oklahoma. Based on numerical sensitivity analyses, this study addresses the bias at the top of the rain layer and the vertical evolution of the DSD properties (i.e., of Dm and N0*). In this way, the Thompson scheme is used to explore the sensitivity to the melting process. Moreover, using the Thompson and Morrison schemes, the sensitivity of the DSD vertical evolution to different breakup and self-collection parameterizations is studied. Results show that the DSDs are strongly dependent on the representation of the melting process in the Thompson scheme. In the Morrison scheme, the simulations with more efficient breakup reproduce the DSD properties with better fidelity. This study highlights how the inaccuracies in simulated Dm and N0* for both microphysics schemes can impact the evaporation rate, which is systematically underestimated in the model.
Role of Phosphorylcholine-Specific Immunoglobulin M in Acute Upper Respiratory Tract Infections
Authors: Ohori Junichiro , Jimura Tomohiro , Kurono Yuichi 
Published: May 2019

Objectives: The aim of this study was to clarify the role of serum phosphorylcholine (PC)–specific immunoglobulin M (IgM) as a natural antibody against infectious diseases. Methods: The relationship between serum PC-specific IgM level and C-reactive protein level or white blood cell counts was examined in patients with severe upper respiratory tract infections (ie, acute epiglottitis and peritonsillar abscess). Results: PC-specific IgM level was significantly negatively correlated with C-reactive protein level and white blood cell count. In addition, C-reactive protein level and white blood cell count was significantly lower in women than in men, whereas PC-specific IgM level was significantly higher in women. Conclusions: PC-specific IgM is suggested to have protective and suppressive effects against the progression of infectious and inflammatory reactions. Higher levels of PC-specific IgM in women might be one of the reasons why the incidence and severity of acute epiglottitis and peritonsillar abscess are lower in women.
Cortical and subcortical changes in resting-state functional connectivity before and during an episode of postoperative delirium
Authors: Oh Jooyoung , Shin Jung Eun , Yang Kyu Hyun , Kyeong Sunghyon , Lee Woo Suk , Chung Tae-Sub , Kim Jae-Jin 
Published: May 2019

Objective: Delirium is an acute brain failure related to uncertain problems in neural connectivity, including aberrant functional interactions between remote cortical regions. This study aimed to elucidate the underlying neural mechanisms of delirium by clarifying the changes in resting-state functional connectivity induced by postoperative delirium using imaging data scanned before and after surgery. Method: Fifty-eight patients with a femoral neck fracture were preoperatively scanned using resting-state functional magnetic resonance imaging. Twenty-five patients developed postoperative delirium, and 14 of those had follow-up scans during delirium. Eighteen patients without delirium completed follow-up scans 5 or 6 days after surgery. We assessed group differences in voxel-based connectivity, in which the seeds were the posterior cingulate cortex, medial prefrontal cortex and 11 subcortical regions. Connections between the subcortical regions were also examined. Results: The results showed four major findings during delirium. Both the posterior cingulate cortex and medial prefrontal cortex were strongly connected to the dorsolateral prefrontal cortex. The posterior cingulate cortex had hyperconnectivity with the inferior parietal lobule, whereas the medial prefrontal cortex had hyperconnectivity with the frontopolar cortex and hypoconnectivity with the superior frontal gyrus. Connectivity of the striatum with the anterior cingulate cortex and insula was increased. Disconnections were found between the lower subcortical regions including the neurotransmitter origins and the striatum/thalamus in the upper level. Conclusions: Our findings suggest that cortical dysfunction during delirium is characterized by a diminution of the anticorrelation between the default mode network and task-positive regions, excessive internal connections in the posterior default mode network and a complex imbalance of internal connectivity in the anterior default mode network. These dysfunctions can be attributed to the loss of reciprocity between the default mode network and central executive network associated with defective function in the salience network, which might be closely linked to aberrant subcortical neurotransmission-related connectivity and striato-cortical connectivity.
Continuing competency in ethical decision making: An interpretive description of occupational therapists’ perspectives
Authors: VanderKaay Sandra , Jung Bonny , Letts Lori , Moll Sandra E. 
Published: May 2019

Background. Competency in ethical decision making is a criterion for ethical practice, and it is expected to advance with ongoing professional development. However, research exploring continuing competency needs of occupational therapists regarding ethical decision making is limited. Purpose. The purpose of this study was to explore potential gaps and directions for development related to continuing competency in ethical decision making from the perspective of practicing occupational therapists. Method. Interpretive description informed secondary data analysis of professional narratives from a grounded theory study regarding ethical decision making. In-depth interviews were conducted with a purposive sample of 18 occupational therapists. Data analyses focused on identifying gaps and future directions regarding continuing competency. Findings. Two main themes regarding gaps were identified: “I didn’t have the knowledge” and “I don’t have anybody.” Education, tool development, and ethics mentorship were identified directions for development. Implications. Findings advance understanding of continuing competency needs of occupational therapists regarding ethical decision making.
Dialogic Consensus as the Moral Philosophical Basis for Shared Decision-making
Authors: Walker Paul 
Published: May 2019

Shared decision-making is important and beneficial for patients. Practically, this requires that we explore the values of the patient and the clinician and then consider available treatment options. The aim is to maximize the good of the patient in the context of their illness. Hence, clinical consultations are situations in which we can, and should, draw upon moral philosophical precepts. One such precept, which can fortify the foundations of shared decision-making, is a process of inclusive, noncoercive, and reflective dialogue, which aims at reaching a consensual decision as to what is best for the patient in their situation. Summary: Shared decision making is important and helpful for patients. This is based upon having a conversation about values and what is important. We can base that conversation on principles of moral philosophy, via a process termed “dialogic consensus”.
Territory and Public Policy in Brazil
Authors: Cezar Kilma Gonçalves , do Nascimento Elimar Pinheiro 
Published: May 2019

A new, territorial focus, replacing the regionalization of the past. emerged in state planning in Brazil between 1950 and 1970 and again between 1995 and 2010. From the traditional conception of the region predominant throughout the twentieth century, a shift occurred in public policy making to application of the notion of differentiated territories, with two dominant perspectives: one based on the economic potentials of territories, under the Fernando Henrique Cardoso government, and the other, under the Lula government, based on the concept of socially vulnerable territories. The causes of this change have to do with the reduction of the importance of regional inequality in favor of social inequality, with the risk of separatism being replaced by the loss of social cohesion. The new territorial focus in government planning seemed to point to a loss of power of regional oligarchies, but this practice was interrupted for political reasons in 2007. Um novo foco territorial, substituindo a regionalização do primeiro período, ocorreu no planejamento estatal entre os anos 1950–1970 e 1995–2010. Da concepção tradicional de região, predominante ao longo do século XX, migrou-se para o uso da noção de territórios diferenciados nas políticas públicas, com duas noções dominantes: a primeira, baseada nas potencialidades econômicas dos territórios, no governo Fernando Henrique Cardoso, e a segunda, baseada na concepção de territórios socialmente vulneráveis, no governo Lula. As razões para esta transformação tem como fundamento a perda da principalidade da desigualdade regional em favor da desigualdade social; o risco do separatismo foi subtituido pelo da perda da coesão social. O novo foco territorial no planejamento governamental parecia indicar uma perda de poder das oligarquias regionais. Esta prática, porém, foi interrompida por razões de ordem política a partir de 2007.
Otorhinolaryngology Emergency Unit Care: The Experience of a Large University Hospital in Italy
Authors: Gallo Andrea , Moi Rossana , Minni Antonio , Simonelli Marilia , De Vincentiis Marco 
Published: May 2019

We recorded the symptoms and disposition of every patient who visited the otorhinolaryngology emergency department at our hospital in Rome, Italy, during 1996. During that time, our ENT specialists saw 21,548 patients. Only 311 of these patients (1.4%) required immediate hospitalization, while another 2,391 patients (11.1%) received treatment and were released. The other 18,846 patients (87.5%) did not have any pathology or condition that qualified as an actual emergency, and they were examined and released, often with a prescription or instructions for home care. These patients could have easily been treated by a family physician. The fact that emergency care in Italy is rendered free of charge (unlike ambulatory care, for which fees are charged) provides patients with a strong incentive to misuse the system. Such overutilization drives up the cost of health care and stretches the capacity of the medical staff. Steps need to be taken to redirect patients who misuse emergency services to seek medical care in ambulatory care centers.
Factors Associated with Post-tonsillectomy Hemorrhage
Authors: Collison Patrick J. , Mettler Bret 
Published: May 2019

Despite the otolaryngologist's most diligent efforts to prevent it, hemorrhage is the most common, albeit sporadic, significant complication of tonsillectomy. For this retrospective study of post-tonsillectomy hemorrhage rates, we examined the charts of 430 consecutive tonsillectomy patients who had been operated on by one of two general otolaryngologists at our institution. The two surgeons used the same removal technique (cold dissection and snare), but slightly different methods of hemostasis. We found that the overall bleeding rate was 4%; the primary (<24 hr) hemorrhage rate was 0.23%, and the secondary rate was 3.7%. Factors that were positively correlated with postoperative bleeding were the patient's sex, the time of year the surgery was performed, the length of the procedure, the amount of blood lost during surgery, and the use of intraoperative vasoconstrictors and steroids. However, we believe the use of steroids can probably be discounted as a causative factor. The χ2 test was used to determine statistical significance. None of the 21 patients who were operated on for peritonsillar abscess experienced any delayed postoperative bleeding. The mean decrease in hemoglobin was 2.3 grams; the lowest postoperative level was 6.6 grams. The highest incidence of delayed bleeding occurred on the eighth postoperative day. Two patients required transfusions, and both recovered without any adverse consequences. It appears that one controllable variable in preventing delayed bleeding following tonsillectomy and adenoidectomy might be related to certain details of hemostatic technique. Vasoconstrictors and “field” cauterization might be associated with an increased temporal and spatial application of coagulating current. Although this technique is very effective in preventing primary hemorrhage, it does result in a deeper and more extensive zone of necrosis and the exposure of more and larger vessels when sloughing of the eschar occurs.
Intracranial Placement of a Nasogastric Tube after Complex Craniofacial Trauma
Authors: Sacks Alan David 
Published: May 2019

The complication of intracranial placement of a nasogastric tube in patients with complex facial and skull base fractures is rarely seen. A case report of a patient with complex craniofacial injury after trauma in whom a computerized tomogram scan showed passage of a nasogastric tube via a fracture of the anterior cranial fossa floor into the skull vault is presented. This case stresses the caution to be exercised in the emergency room resusitation of patients with craniofacial injury requiring nasogastric tube placement.
Multichannel Cochlear Implantation with Percutaneous Pedestal
Authors: Parkin James L. , Parkin Matthew J. 
Published: May 2019

In a prospective study by Cohen et al,3 the superiority of multi channel cochlear implant patient performance over single-channel cochlear implant performance was demonstrated. The Ineraid system described in this paper includes a percutaneous pedestal which has had a satisfactory patient experience. Only one pedestal removal has been necessary because of specific pedestal problems. Other less serious pedestal problems decrease in frequency with increasing time post-implantation. The auditory performance indicates significant commu nication skills improvement in patients with multichannel cochlear implants.
Surgical Treatment and Rehabilitation of Prelingually and Perilingually Deafened Children and Adults with the Nucleus Multichannel Cochlear Implant
Authors: García Juan Manuel , de Otero Clemencia Barón , García Jorge , Peñaranda Augusto , Niño Claudia , Campos Silvia 
Published: May 2019

We began our program in September 1992, using the Nucleus 22 Channel Cochlear Implant. To date, we have operated on four patients, one child with congenital hearing loss, two prelinguistically deaf adults and one perilingually deaf adult. Our results have shown a significant increase in auditory and speech reception and perception skills in the child. The perilingually deaf adult is able to understand speech in open set speech discrimination testing and, although we do not expect open set speech discrimination in the prelinguistically deaf adults, to date their results have been satisfactory. The two prelingually deaf adults are in an audiological rehabilitation program. Their response in prosodic aspects of speech and lipreading ability with sound have improved significantly. The only surgical complication was an infection of the flap in the child, but it was treated satisfactorily with I.V. penicillin.
Ionomeric Cement – A Bone Glue for Device Fixation
Authors: Rüdel Christiana , Zöllner Werner 
Published: May 2019

Ionocap®, an ionomeric cement, is a new bone replacement material. Its generic name is polymaleinate ionomer, and it is an inert standardized biomaterial which is offered in a two component system. Since 1988 the ionomeric cement has been evaluated clinically in different situations. Its unique properties of biocompatibility, biostability and permanent adherence to bone make this new material very useful in head and neck surgery.
When is Isolated Vertigo a Harbinger of Stroke?
Authors: Rao T. Hemanth , Libman Richard B. 
Published: May 2019

Isolated vertigo is usually a distressing though benign clinical entity. Recently, however, it has been recognized that in a subset of patients isolated vertigo may be a harbinger of vertebrobasilar stroke. Recognition of this “at risk” subgroup may be difficult. Brainstem auditory evoked potentials (BAEPs) are usually normal in patients with vertigo from labyrinthine disease. We describe a patient with isolated vertigo, in whom BAEPs were abnormal, and who subsequently developed an anterior inferior cerebellar artery territory infarct. BAEP testing might lead to early recognition of those patients at risk for catastrophic stroke, and prompt appropriate investigation and treatment to prevent this outcome.
Dysphagia in Patients with Three Different Etiologies of Salivary Gland Dysfunction
Authors: Rhodus Nelson L. , Moller Karlind , Colby Steven , Bereuter Janna 
Published: May 2019

Dysphagia is a common complaint from patients with salivary gland dysfunction (SGD). The purpose of this study was to assess and compare dysphagia in three patient groups with SGD: primary Sjögren's syndrome (SS-1); secondary Sjögren's syndrome with systemic lupus erythematosus (SS-2-SLE) and a group of patients who had post-irradiation therapy (PIT) (for head and neck cancer xerostomia) and a matched control group. Subjects diagnosed with SS-1 (n=7); SS-2-SLE (n=7) and PIT (n=7) were selected for the study. An age-sex-matched group of control subjects (n=7) was selected for comparison. Dysphagia assessments, including videofluoroscopy, were performed. Subjective evaluations were recorded on a calibrated 10-cm visual analog scale. The results indicated a significiant difference in the DS as compared to the WBS for all SGD groups and for both DS and WBS in each SGD group as compared to controls. Videofluoroscopy also yielded significantly prolonged pharyngeal transit times (PTT) in all SGD groups as compared to controls. Subjective results indicated a greater degree of dysphagia symptoms in all of the SGD groups (p<0.001). Conclusions from this study indicate clinically significant dysphagia in patients with SS-1, SS-2-SLE and PIT as compared to a control population.
Postoperative Bleeding in Tonsillectomy Patients
Authors: Szeremeta Wasyl , Novelly Norman J. , Benninger Michael 
Published: May 2019

A three-year retrospective study was performed on 494 patients to compare the effects of two techniques of tonsillectomy, with respect to rates of postoperative bleeding. One surgeon performed primarily mechanical dissections, while the other primarily performed electrocautery dissections. Intraoperative blood loss was assessed and correlated to the age and gender of the patient and to the size of the tonsil. Postoperative bleeding was seen in 2.8% of patients who underwent electrocautery tonsillectomy and in 7.6% of patients who underwent mechanical tonsillectomies. Patients undergoing electrocautery dissection lost an average of 37 ml of blood intraoperatively, whereas those undergoing mechanical dissection lost 105 ml. Mechanical tonsillectomies exhibited higher intraoperative blood loss than electrocautery tonsillectomies. A higher rate of postoperative bleeding was seen in mechanical tonsillectomies, but this difference was lost when peritonsillar abscesses were removed from the study.
Cicatricial Pemphigoid of the Larynx: A Case Report of Surgical Treatment
Authors: El-Sayed Yousry , Al-Muhaimeed Hamad 
Published: May 2019

Although laryngeal stenosis caused by cicatricial pemphigoid (CP) is a well documented entity, reports about its surgical treatment are scant. This may be due to the reluctance of the surgeons to excise the scarring, knowing the recurrent nature of the disease. In this paper we report a case of severe laryngeal stenosis caused by CP which necessitated a tracheostomy. When the disease had stabilized, laryngeal airway was restored following open surgical excision and stenting. The historic, clinical, histologic, immunopathologic and therapeutic features of CP are presented with special reference to the laryngeal lesions.
Early Postoperative Otorrhea after Tympanostomy Tube Placement: A Comparison of Topical Ophthalmic and Otic Drops
Authors: Charnock David R. 
Published: May 2019

In a retrospective review of the incidence of early postoperative otorrhea, we compared cortisporin otic suspension with sulfacetamide/prednisolone ophthalmic drops and found them to be approximately equally effective. The beneficial effect of topical otic and ophthalmic antibiotic drops after tympanoplasty tube placement has already been well documented. It is therefore suggested that the potentially more comfortable and theoretically less ototoxic ophthalmic drop be used to decrease the incidence of early postoperative otorrhea.
Laser-Assisted Uvulopalatoplasty: Long-Term Results with a Treatment for Snoring
Authors: Coleman Jack A. 
Published: May 2019

We present a retrospective analysis of the initial results of our institution's evaluation of a new procedure designed to help relieve snoring, as well as having the potential to assist in the treatment of obstructive sleep apnea. The ambulatory, in-office CO2 laser procedure is performed with a local anesthetic. It is a serial procedure that achieves the same end-result as conventional uvulopalatopharyngoplasty, but without many of the associated problems. The indications for the procedure are reviewed, and detailed technical aspects of its performance, including use of new instrumentation, are discussed. Detailed analysis of the first 20 patients to undergo the procedure in the United States is presented. This is the first series of patients presented in the American literature who have undergone this procedure and who have had long-term follow-up of more than five years. A 90% success rate was achieved. The complication rate, patient tolerance, relative costs, indications and contraindications are discussed.
Assessment of the Indoor Environment in Respiratory Allergy
Authors: Sarpong Sampson B. , Corey Jacquelynne P. 
Published: May 2019

Many types of allergens may be present in the indoor environment and may lead to sensitization and respiratory allergy. Common indoor allergens include dust mites, animal dander, cockroach exposure and molds. Exposure to indoor pollutants, such as tobacco smoke, wood-burning stoves or fireplaces and chemical sprays, can precipitate and exacerbate symptoms. An allergic reaction in the airways caused by natural exposure to allergens has been shown to lead to an increase in inflammatory reaction, increased airway hyperresponsiveness and increased eosinophils in bronchoalveolar lavage. Other research has demonstrated that asthma symptoms correlate with levels of domestic dust mite and cockroach exposure. In the case of dust mites, ending exposure results in symptomatic relief.
Management of Neurofibromatosis Type 2
Authors: Bance Manohar , Ramsden Richard T. 
Published: May 2019

Neurofibromatosis type 2 (NF2), an as-yet incurable disease that predisposes patients to multiple intracranial and spinal tumors, requires a team approach to treatment, because of its multisystem nature. Included on the team should be neuro-otologists, neurosurgeons, ophthalmologists, geneticists, audiologists, speech therapists and other rehabilitative personnel, including counselors, psychologists and, occasionally, psychiatrists. The challenge is to arrive at a treatment strategy that preserves useful hearing and quality of life without increasing the risk of complications to the facial nerve or compromising neurologic status. Choosing the best treatment approach involves considering a complex set of competing factors that affect various aspects of the patient's outcome.