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OBJECTIVE There is a paucity of data regarding financial trends for procedural reimbursements in otolaryngology. The purpose of this study was to evaluate monetary trends in Medicare reimbursement rates for the 20 most commonly billed otolaryngology procedures from 2000 to 2019. STUDY DESIGN Analysis of physician reimbursement. METHODS The American Academy of Otolaryngology-Head and Neck Surgery database was queried to determine the 20 most performed otolaryngology procedures. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was utilized to assess each of the top 20 most utilized Current Procedural Terminology (CPT) codes in otolaryngology, and reimbursement data was extracted. All monetary data was adjusted for inflation to 2019 U.S. dollars using changes to consumer price index. Average annual and total percentage change in reimbursement were calculated based on adjusted values for all included procedures. RESULTS After adjusting for inflation, the average reimbursement for the total 20 procedures decreased by 37.63% from 2000 to 2019. The greatest single mean decrease was seen in CPT code 61782 for stereotaxis procedures on the skull, meninges, and brain (-59.96%), whereas the smallest mean decrease was in CPT code 30520 for septoplasty (-1.50%). From 2000 to 2019, the adjusted reimbursement rate for the combined procedures decreased by an average of 2.33% each year. CONCLUSION Medicare reimbursement for included procedures has decreased from 2000 to 2019. Increased awareness and consideration of these trends will be important for policy makers, hospitals, and surgeons in order to assure continued access to meaningful otolaryngology care in the United States. LEVEL OF EVIDENCE 4 Laryngoscope, 131:496-501, 2021.

Gibberella circinata (anamorph Fusarium circinatum) is a harmful fungus infecting pine trees that has been subject to European Union emergency phytosanitary measures since 2007. This fungus is spread over long distances primarily via pine seeds, consequently reliable detection tools and methods are needed to test pine seed lots imported and marketed in the EU. Several detection methods are available in the scientific literature but very limited validation data is available. For that purpose, one European EUPHRESCO project called ‘Gibcir-Diagseed’ was launched, involving 10 countries. This project aimed to select and validate one or more diagnostic procedures targeting this pest via inter-laboratory tests, as well as a suitable sampling method. Performance criteria were calculated for three procedures chosen by participants: isolation followed by morphological characterization, isolation followed by conventional PCR and biological enrichment followed by real-time PCR. The results showed that all three procedures provided acceptable performance criteria but also demonstrated that none of them could generate 100% of correct results. Regarding the sampling issue, the National Plant Protection Organizations consultation enabled an agreement to be reached on the number of seeds to be tested: 400 per sample, for a 95% confidence level that an infection of at least 1% will be detected. Etude de performance des procedures de diagnostic pour l'identification et la detection de Gibberella circinata dans les semences de pin dans le cadre d'un projet EUPHRESCO Gibberella circinata (anamorphe Fusarium circinatum) est un champignon pathogene infectant les pins qui fait l'objet de mesures phytosanitaires d'urgence au sein des pays de l'Union europeenne depuis 2007. Ce champignon est dissemine sur des distances importantes essentiellement par le biais de semences de pin. Par consequent, des outils et des methodes de detection fiables sont necessaires pour tester les lots de semences de pin importes et commercialises dans l'Union europeenne. Plusieurs methodes de detection sont decrites dans la litterature scientifique mais il y a peu de donnees de validation disponibles. A cet effet, un projet europeen EUPHRESCO nomme « Gibcir-Diagseed » a ete lance en impliquant 10 pays. Ce projet vise a selectionner et valider une ou plusieurs procedures ciblant cet organisme au travers de tests inter-laboratoires, en meme temps qu'une methode d’echantillonnage adaptee. Des criteres de performance ont ete calcules pour trois procedures de diagnostic choisies par les participants: isolement suivi de la caracterisation morphologique, isolement suivi d'une PCR conventionnelle, et enrichissement biologique suivi par une PCR en temps reel. Les resultats ont montre que les trois procedures avaient des criteres de performance acceptables mais ont egalement demontre qu'aucune d'entre elles ne pouvait generer 100% de resultats corrects. Au sujet de l’echantillonnage, la consultation des Organisations Nationales de la Protection des Vegetaux a permis d'atteindre un consensus sur le nombre de semences a tester: 400 par echantillon, pour detecter un niveau d'infection d'au moins 1% avec un niveau de confiance de 95%. Иccлeдoвaниe кaчecтвa тecтиpoвaния диaгнocтичecкиx пpoцeдyp пo идeнтификaции и выявлeнию Gibberella circinata в ceмeнax cocны в paмкax пpoeктa EUPHRESCO Gibberella circinata (aнaмopфнaя cтaдия Fusarium circinatum) являeтcя вpeдным гpибoм, зapaжaющим cocнy, кoтopый являeтcя oбъeктoм чpeзвычaйныx фитocaнитapныx мep Eвpoпeйcкoгo Coюзa (EC) c 2007 г. Этoт гpиб pacпpocтpaняeтcя нa бoльшиe paccтoяния, пpeждe вceгo c ceмeнaми cocны, и пoэтoмy нeoбxoдимы нaдeжныe cpeдcтвa oбнapyжeния и мeтoды, пoзвoляющиe пpoвepять пapтии ceмян cocны, кoтopыe импopтиpyютcя и пpoдaютcя в EC. B нayчнoй литepaтype дaeтcя oпиcaниe нecкoлькиx мeтoдoв oбнapyжeния, oднaкo cyщecтвyют лишь oгpaничeнныe дaнныe o вaлидaции. C этoй цeлью был пpeдпpинят пpoeкт EC EUPHRESCO пoд нaзвaниeм “Gibcir-Diagseed”, в кoтopый былo вoвлeчeнo 10 cтpaн. Этoт пpoeкт нaцeлeн нa oтбop и вaлидaцию oднoй или бoлee пpoцeдyp для идeнтификaции этoгo вpeднoгo opгaнизмa пyтeм тecтиpoвaния в нecкoлькиx лaбopaтopияx, a тaкжe пoдxoдящий мeтoд oтбopa oбpaзцoв. Кpитepии кaчecтвa aнaлизa были пoдcчитaны для тpex пpoцeдyp, выбpaнныx yчacтникaми: выдeлeниe c пocлeдyющeй xapaктepизaциeй мopфoлoгии, изoляция c пocлeдyющим oбычным ПЦP и биoлoгичecкoe oбoгaщeниe c пocлeдyющим ПЦP в peaльнoм вpeмeни. Peзyльтaты пoкaзaли, чтo вce тpи пpoцeдypы oбecпeчили пpиeмлeмыe кpитepии кaчecтвa, нo тaкжe пpoдeмoнcтpиpoвaли, чтo ни oдин из ниx нe мoг дaть 100%-yю пpaвильнocть peзyльтaтoв. B oтнoшeнии oтбopa oбpaзцoв, кoнcyльтaция c нaциoнaльными opгaнизaциями пo кapaнтинy и зaщитe pacтeний пoзвoлилa бы пpийти к coглaшeнию пo кoличecтвy тecтиpyeмыx ceмян: 400 в кaждoм oбpaзцe, для 95%-гo дoвepитeльнoгo ypoвня, пpи кoтopoм бyдeт выявлятьcя, пo кpaйнeй мepe, 1%-нaя зapaжeннocть.

An iterative procedure for the frequency domain evaluation of control effects in nonlinear loops is introduced. The article focuses on ship seakeeping control, to attenuate ship motions. There is no model of the ship, only CFD tabulated data. The proposed procedure could be used for design or empirical tuning of a controller. The actuators have angle and rate limits. In the case of a ship, the actuators are submerged moving wings: flaps, fins and T-foil. The control evaluation procedure uses a describing function approach. The paper considers amplitude and rate saturation in series. The results are validated with experiments using a scaled ship in a towing tank facility. Copyright © 2010 John Wiley & Sons, Ltd.

Currently, skin cells or tissues intended for therapeutical or cosmetic applications are typically cultured using standard in vitro culture techniques. The avian chorioallantoic membrane (CAM) has been traditionally used for many years to assess angiogenesis of exogenous substances. Avian embryos have also been used to generate viruses for vaccine development. Most of the uses of the avian CAM cultures are typically conducted in ovo. However, xenobiotic cultures of ex ovo avian embryos and explanted organs, tissues or cells from human or other mammalian origin have not been used in the past with the explicit purpose of achieving the appropriate extent of expansion, differentiation or vascularization required for therapeutic or cosmetic implantation into humans or animals. Here, a novel method of xenobiotic skin culture was developed that can be employed for wound healing studies or for tissue engineering applications to sustain the culture of live skin explants through the benefit of a xenobiotic vascularization. The method uses fertile Japanese quail (Cortunix cortunix japonica) eggs. The eggs were incubated for at least 3 days in ovo using a static egg incubator. On day 3 the egg is opened under sterile conditions through the air chamber and placed in a cylindrical culture dish slightly larger than the overall diameter of the egg yolk. The embryo was then cultured at 37 °C for an additional 24 to 48 hours until a well-vascularized CAM covers the entire surface of the culture dish. Next, fragments of skin were placed directly over the CAM. The cultures were continued for 8 days and then the skin explants were transferred to new CAMs. These changes, every 8 days, were done at least five times allowing the skin to be maintained in culture for several weeks without apparent damage in viability. The skin fragments remained viable and capable of reepithelialization when wounded. Skin explants from both mouse and human were successfully cultured in this manner. Because immunological response cannot occur in the embryonic culture environment, it was possible to xenotransplant skin fragments without risk of rejection. The ensuing embryonic vessels developed into the xenotransplanted skin and generated a permeable vascular network that provided oxygen and nutrients necessary to ensure viability and promote proliferation and differentiation. Viability of the explants was evaluated by immunohisto chemical methods using proliferation and apoptosis markers (Caspase-3, BrdU, and PCNA). Vascularization was assessed using species-specific anti endothelial antibodies (anti-PECAM human and mouse and QH1 and QH2 monoclonal antibodies). The new method described herein has the distinct advantage of sustaining live, functional skin cultures by means of a rich vascular supply that provides cells with nutrients and oxygen.

Biomass growth, micronucleus induction, and antioxidative stress enzymes (superoxide dismutase, peroxidase, glutathione reductase, and catalase) were investigated simultaneously in the Vicia faba plant exposed to cadmium in solution. The biomass lowest-observed-effect concentration (LOEC) value was 2,000 μM Cd2+. In the shoots, enzymic activities increased without concentration–response relationships. In the roots, after an initial increase, activities of all enzymes showed negative concentration-response relationships. A significant increase in micronucleus induction was observed at 20 μM Cd2+. Regarding sensitivity, our results showed that biomass endpoint was less sensitive than micronucleus induction, which was less sensitive than antioxidative enzyme activities. The increase of antioxidant stress enzyme activities in response to cadmium exposure may be taken as evidence for an enhanced detoxification capacity of V. faba plants toward reactive oxygen species (and derivatives) that might be generated in the stressed plants. Concomitant micronucleus induction may be also interpreted as a consequence of oxidative stress, upholding the view that cadmium-induced DNA damage is, to some extent, via generation of reactive (intermediate) oxygen species.

Somatostatin receptors type 2 (sst2) are expressed in high concentration on numerous neudoendocrine tumors. The successful use of radiolabeled somatostatin analogs in imaging promoted further studies in utilizing them in radiopeptide therapy. The somatostatin analog [90Y–DOTA–D-Phe1–Try3]octreotide (DOTATOC) (DOTA: 1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetraacetic acid) possesses favorable characteristic for its therapeutic use; shows high affinity for sst2, moderately high affinity for sst5, and intermediate affinity for sst3; high hydrophilicity; stable and facile labeling with 111 In and 90 Y. In this article we report our experience with 90Y–DOTATOC in neuroendocrine tumors. Eighty-seven patients with neuroendocrine tumors were treated with a cumulated activity ranging from 7.4 to 20.2 GBq. Most patients responded with stabilization of disease (48%); however, objective responses were observed in 28% of patients (5% complete response). No major acute reactions were observed up to the activity of 5.55 GBq per cycle. The dose limiting was bone marrow toxicity and the maximal tolerated dose was defined as 5.18 GBq. © 2003 Wiley Periodicals, Inc. Biopolymers (Pept Sci) 66: 393–398, 2002

Summary Two 3-week-old Limousin x Retinta calves from extensive farms in the south of Spain died suddenly. Microscopic examination of the spleen and lymph nodes revealed an intense lymphoid proliferation; the germinal centres were prominent and were surrounded by areas of haemorrhage. Parasitic forms, similar to Koch's bodies, were observed in only a small number of lymphoid cells and macrophages. In the myocardium a severe myocarditis was found. Inflammatory cells were in close contact with damaged myocytes, sometimes surrounding fragments of cells. In some areas the vessels had intraluminal deposits of fibrin. The endothelial damage and thrombosis may have contributed to the damage observed in the myocytes, together with the cytotoxic mechanism associated with the presence of an intense inflammatory infiltrate. The active multiplication of parasites may be due to the age of the animals and their breed, since they are not an autochthonous breed and present low resistance to infection.

Bone marrow samples from pigs infected with the highly virulent Malawi983 or moderately virulent Dominican Republic (DR978) isolates of African swine fever virus were studied by means of a double labelling immunohistochemical technique which stained the major structural protein VP73 of the virus and megakaryocytes simultaneously. In pigs infected with the highly virulent Malawi983 isolate, 2.2 per cent of megakaryocytes were VP73+ five days after inoculation, and at six and seven days 2.5 and 9.5 per cent of megakaryocytes were VP73+. Some infected and uninfected megakaryocytes showed pyknosis and karyorrhexis, particularly at seven days after inoculation. However, in comparison with uninfected pigs, the number of megakaryocytes decreased only at seven days after inoculation. In pigs infected with the moderately virulent DR978 isolate, only 0.2 per cent of megakaryocytes were VP73+ at eight days after inoculation. However, at eight, nine and 10 days after inoculation the total number of megakaryocytes was significantly lower (P

Twelve miniature pigs were infected experimentally with the moderately-virulent Spanish isolate of African swine fever virus E75. The disease was reproduced acutely and subacutely, and six days after infection the animals showed severe clinical and pathological signs characterised by diffuse haemorrhages in lymphoid and non-lymphoid organs. An immunohistopathological study, using two different methods, and a monoclonal antibody (mAb) (18BG3) were used to analyse the distribution of the virus protein 73 (VP73) and IgM and IgG. VP73 was observed primarily in cells of the mononuclear phagocyte system, and in many megakaryocytes, some tubular epithelial cells of the kidneys, tonsillar epithelium, some hepatocytes, and in a few endothelial cells and neutrophils in the later stages of the infection. The histological findings and the distribution of VP73 and IgM and IgG indicated that the virus caused haemorrhagic lesions through its effect on various haemostatic mechanisms.

Summary Ostertagiosis in Fighting-bull Calves In this paper, an outbreak of ostertagiosis in fighting-bull calves is described. Of 95 calves, 12 were affected and 10 died. Grossly, the abomasal mucosa was aedematous and showed multiple whitish tiny nodules. Differential diagnoses at a macroscopic level included parasitation by E. gilruthi. However, histologically the presence of Ostertagia spp. larvae in the lumen of the gastric glands was confirmed. The inflammatory reaction observed in the abomasal mucosa, together with the clinical picture, correspond to type-II ostertagiosis, with metaplasia, hyperplasia, dilatation, and parasitic forms in the gastric glands. Resumen En este trabajo se presenta la descripcion de un brote de ostertagiosis en terneros de la raza Toro de lidia. De un total de 95 animales se afectaron 12 animales de los que murieron 10. Macroscopicamente, la mucosa abomasal presentaba el tipico aspecto de ‘cuero repujado’, lo que indicaba una posible infestacion por parte de Ostertagia spp., aunque habia que descartar la parasitacion por E. gilruthi que tambien afecta a ganado vacuno y que, macroscopicamente, produce una lesion similar; sin embargo, histologicamente se comprobo la presencia de larvas de Ostertagia spp., en la luz de las glandulas gastricas. El tipo de reaccion inflamatoria observada en la mucosa abomasal parece indicativo, junto con el cuadro clinico, de una ostertagiosis tipo II, describiendo las alteraciones morfologicas que sufren las glandulas gastricas en este tipo de parasitacion.

Some facets of our robotics research require the simulation of a mobile vehicle to study navigation and control problems. We have developed a 3-D animated graphical simulation of the movement of a wheeled vehicle under interactive control of the computer user. The article describes the mathematical formulation of the dynamics and the programming procedure to display the vehicle movement. Besides the possible use of our program for robotics education, the aspects covered by this article could be useful for motivating mechanics and graphics programming.

Core and organ temperatures in the rat have been found to be subject to regular periodic oscillations (with a frequency of ca 12 cycles per day, i.e. 143 mu Hz) within set limits, by using a chronic thermocouple implant procedure. These cycles consisted of consecutive warming (the temperature increased steadily) and cooling periods (the temperature decreased regularly). There were sustained temperature differences between several tissues and that of the aortic blood (core temperature), higher for brown adipose tissue, kidney and liver, and lower for muscle, white adipose tissue and skin. Organ blood flows and cardiac output were measured by a radioactive microsphere retention method applied to unanaesthetized rats. Blood flow measurements were done on unaware rats (see Methods), during either the warming or cooling phases. During the warming phases, there was a higher blood flow across the brown adipose tissue, kidney and skin, with a cardiac output about twice that found in the cooling periods. The haemodynamic changes observed, as well as the organ temperature differences observed with respect to the blood, suggest that periodic changes in blood flow are an essential part of the operation of the thermogenic system.

Strong evidence has recently been found against the use of fecal coliforms as indicator organisms of fecal contamination in tropical waters due to their indigenous nature in pristine waters. There is a great need for the development of more rapid, accurate, and low-cost techniques for determining bacteriological water quality. Coliphages seem to be an excellent alternative. We have developed a method to analyze large volumes of pristine water, which we compared to a commonly used direct method. It involves the filtration of water through positively charged filters and a virus-elution step. The eluent is then mixed with culture medium, a host bacterium, and incubated. We sampled pristine tropical rivers, water collected from bromeliads (epiphytic vegetation), sewage-contaminated waters, and marine waters. Concentrations of indicator bacteria were higher than recommended levels for recreational waters, including bromeliad waters. Indicators levels were higher in bromeliad waters than in sewage-contaminated rivers. Phages were isolated only from waters being used for recreational purposes and from sites known to be contaminated with domestic sewage, but not from pristine or bromeliad waters. These results suggest that there is a correlation between the presence of coliphages and fecal contamination. This further suggests that coliphages may be reliable indicators of fecal contamination in the environment.

(2000). AN OPTIMIZED PREPARATION OF 2,3-DIHYDRO-1-METHYL-4-OXONAPHTHALENE-1-CARBOXYLIC ACID. Organic Preparations and Procedures International: Vol. 32, No. 3, pp. 298-301.

Pyracantha spp. (firethorn) are grown mainly for their display of red, orange or yellow fruit in the autumn and winter and is also used as a hedge plant. In 2001 and 2002, two samples of berries of Pyracantha (both orange berry varieties) from Hampshire (RHS/10715/01) and from North Yorkshire (RHS/13308/02), showing signs of rotting, were received at the advisory service of the Royal Horticultural Society. The symptoms observed were brown/black spots that enlarged, with the whole berry eventually turning black and shrivelled. Whole clusters of berries were affected but the symptoms were only observed on berries produced on the lower branches of the Pyracantha shrubs. A Phytophthora species was isolated following the baiting of the affected berries in apple fruit and plating on P 10 VP selective medium (Erwin & Ribeiro, 1996). Sporangia were produced and zoospores released in pond water, following floating of the apple baits. Phytophthora syringae was identified using morphological characteristics and confirmed by DNA sequencing. Sporangia formed sympodially, were semipapillate, ovoid, noncaducous with average dimensions of 41 x 25 μm. Hyphal swellings were produced abundantly in chains. The fungus was homothallic and the antheridia, where apparent, were paragynous. Oogonia (average diameter 28 pm), with plerotic oospores, were produced readily on carrot agar (CA) medium (Ribeiro, 1978). On 2-week-old CA plates, the antheridium was obscured by a knot of hyphae. The identification of the isolate RHS/10715/01 was confirmed by direct sequencing of the ITS region using primers ITS 6 and ITS 4, as described by Cooke et al. (2000). The nucleotide sequence obtained (accession number AY611644) was almost identical (with only two base substitutions) to Phytophthora syringae strains IMI296829 (AF266803), CBS132.23 (AF380146) and PDR115773A (AY423302). Koch's postulates were fulfilled by floating berries from P. coccinea x P. rogersiana (an orange-fruited hybrid) in a suspension of zoospores (2-3 x 10 6 spores mL -1 ) at room temperature. The berries were wounded before infection, by producing a slit with a scalpel into the fruits. As a control, wounded berries were also floated in filtered pond water. Black spots started appearing on the fruits at 10 days postinfection and the fungus was re-isolated from the infected tissues by baiting with apples. A wound was necessary for successful infection. The control berries did not develop any symptoms. Phytophthora syringae has a fairly wide host range and is known to cause fruit rot on Citrus, Pyrus and Malus (Erwin & Ribeiro, 1996). This is, however, the first report of this disease on Pyracantha in the UK and also worldwide.

Since 1998, a serious foliar disease has affected box (Buxus) plants in the UK. The symptoms are dark brown spots on the leaves, which eventually coalesce to cover the whole leaves, and black streaks on the stems and defoliation. The black streaks appear to progress from the bottom to the top of plants. In severe cases, complete leaf loss has been observed but until now no tree death has been recorded. At the Royal Horticultural Society, we have consistently isolated a species of the fungus Cylindrocladium from 30 Buxus samples showing the blight symptoms, mainly on B. sempervirens `Suffruticosa'. Samples were obtained from Central Scotland and the Borders regions, the north, Midlands, East Anglian, south-west and south-east regions of England. We observed the same symptoms and isolated the same species of Cylindrocladium associated with the same symptoms on native B. sempervirens at Box Hill, Surrey, cultivated B. sempervirens, several varieties of B. sempervirens and B. sinica. We have reports of the fungus and the disease on different varieties of B. microphylla (R. Cook, Central Science Laboratory, York, UK, personal communication). The disease is widespread throughout the UK. The Cylindrocladium species we found on Buxus is very often associated with a second pathogen, Volutella buxi (teleomorph Pseudonectria rousseliana), the cause of volutella blight (Strouts & Winter, 1994). Although very little has been published on volutella blight, the causal organism is usually regarded as a wound pathogen, causing dieback on clipped box (Moore, 1959; S. Archer, Imperial College, London, UK, personal communication). The two diseases also occur independently. Inoculation assays on detached shoots and on 2.5year-old plants of B. sempervirens `Suffruticosa', with a conidial suspension (1±3 £ 10 spores per mL) of Cylindrocladium, isolated from diseased B. sempervirens `Suffruticosa' from Kent and Lincolnshire, produced symptoms typical of box blight. Humidity was kept high until the development of the symptoms (7±10 days after inoculation) and was necessary for successful infection. The pathogen was successfully reisolated from the infected leaves, fulfilling Koch's postulates. We attempted to identify the species through morphological characterization of the anamorph stage following the keys of Crous & Wingfield (1994) and Schoch et al. (1999), as well as sequencing of the ITS region using the primers ITS1 and ITS4 (White et al., 1990). Sporulating cultures on carnation leaf agar (Crous & Wingfield, 1994) had conidiophores with stipe extensions terminating in ellipsoidal vesicles with pointed apices closely similar to C. mexicana (Schoch et al., 1999). The width of the vesicle and conidia characteristics also fit the description of C. mexicana. However, comparison of the sequence of the ITS region with other sequences available in the GenBank data base did not reveal a 6-bp deletion in the ITS2 region found in C. mexicana, a trait found so far only in C. floridanum. These sequencing and morphological data suggest that the Cylindrocladium sp. isolated from Buxus does not conform fully to the characteristics of Cylindrocladium species already published.

Staining and histochemical methods, immunocytochemical and electron microscopy were used to individualize the somatotropic or GH cells in the adenohypophyseal pars distalis of the kid. They are found in a sagittal section throughout the pars distalis constituting 34% of the hypophyseal cell population. They are 12.37 micron in size and have as an ultrastructural characteristic secretory spherical granules of a large size (males, 391 nm and females, 427 nm) which are very electrodense.