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Respiratory syncytial virus (RSV) infection in infancy is associated with increased risk of asthma, except in those with allergic disease at the time of infection. Using house dust mite allergen, we examined the effect of pre-existing atopy on postviral airway disease using Sendai virus in mice, which models RSV infection in humans. Sendai virus drives postviral airway disease in nonatopic mice; however, pre-existing atopy protected against the development of airway disease. This protection depended upon neutrophils, as depletion of neutrophils at the time of infection restored the susceptibility of atopic mice to postviral airway disease. Associated with development of atopy was an increase in polymorphonuclear neutrophil–dendritic cell hybrid cells that develop in Th2 conditions and demonstrated increased viral uptake. Systemic inhibition of IL-4 reversed atopic protection against postviral airway disease, suggesting that increased virus uptake by neutrophils was IL-4 dependent. Finally, human neutrophils from atopic donors were able to reduce RSV infection of human airway epithelial cells in vitro, suggesting these findings could apply to the human. Collectively our data support the idea that pre-existing atopy derives a protective neutrophil response via potential interaction with IL-4, preventing development of postviral airway disease.

Porous tin dioxide is an important low-cost semiconductor applied in electronics, gas sensors and biosensors. Here we present a versatile template-assisted synthesis of nanostructured tin dioxide thin films using cellulose nanocrystals (CNCs). We demonstrate that structural features of CNC-templated tin dioxide films strongly depend on the precursor composition. The precursor properties were studied by using low-temperature nuclear magnetic resonance spectroscopy of tin tetrachloride in solution. We demonstrate that it is possible to optimize the precursor conditions to obtain homogeneous precursor mixtures and therefore highly porous thin films with pore dimensions in the range of 10 – 20 nm (A (BET) = 46 – 64 m(2) g(-1), measured on powder). Finally, by exploiting the high surface area of the material we developed a resistive gas sensor based on CNC-templated tin dioxide. The sensor shows high sensitivity to carbon monoxide (CO) in ppm concentrations and low cross-sensitivity to humidity. Most importantly, the sensing kinetics is remarkably fast; both the response to the analyte gas and the signal decay after gas exposure occur within few seconds, faster than in standard SnO(2)-based CO sensors. This is attributed to the high gas accessibility of the very thin porous film.

Objective Despite increased physician’s awareness and improved diagnostic and serological testing in the recent years, the interval between the initial symptoms and the diagnosis of Systemic lupus erythematosus (SLE) is still very long. Our aim was to study this delay and its association to the outcome of the disease. Methods Information on demographics, onset of first symptoms, first physicians visit and time of diagnosis was assessed by self-reported questionnaires among SLE patients in Germany (LuLa cohort, n = 585) in the year 2012. Disease activity (Systemic Lupus Activity Questionnaire; SLAQ), disease related damage (Brief Index of Lupus Damage; BILD), health related quality of life (Short Form 12) and fatigue (FSS) were chosen as proxies for outcome. Linear regression analysis was used to analyze the association of the delay in diagnosis to the outcome, adjusted for age, disease duration and sex. Results Mean duration between the onset of symptoms and the diagnosis of SLE was 47 months (SD 73). The longer the time to diagnosis, the higher the disease activity (β = 0.199, p Conclusion In systemic lupus erythematosus, longer time to diagnosis was associated with worse outcome. Concepts in care with the intention to shorten the time to diagnosis are needed to improve the long-term outcome of the disease.

SUMMARY Objective Vocal cord paralysis may result from surgical complications, trauma, tumor, or unknown causes. When both cords are affected, paramedian fixation can lead to life-threatening obstruction. Current treatments, including tracheostomy, cordotomy, and arytenoidectomy, compromise speech and swallow function to maintain a safe airway. To preserve all three critical laryngeal functions, Otolaryngologists need a solution for bilateral vocal cord paralysis that restores motion. This study uses implantable electromagnet technology to create dynamic vocal cord movement in a proof-of-concept, preliminary model. Methods A prototype was constructed from a neodymium disk magnet and cylindrical solenoid electromagnet coupled to a battery and 3-way switch. The disk magnet was implanted in an ex vivo porcine larynx model lateral to the arytenoid, affixed with suture. The electromagnet was seated in a window cut in the thyroid cartilage. Results By driving current in two directions through the electromagnet, the vocal cord was successfully moved towards and away from the electromagnet. The neutral vocal fold opening was 5.8 mm, and the maximal opening was 7.7 mm, representing a 31.4% increase in the cross-sectional area of the glottis. Conclusion This model demonstrated proof of concept of a magnetic laryngeal reanimation device. The full device will include a respiratory effort sensor and implantable processor to time the action of the magnets with respirations. There is currently no effective treatment to re-establish vocal cord motion in patients with vocal cord paralysis. This system has the potential to give patients with bilateral vocal cord paralysis a surgical option to restore vocal cord motion.

Journal of materials chemistry / A 9(8), 4831-4840 (2021). doi:10.1039/D0TA11096E, Published by Royal Soceity of Chemistry, London [u.a.]

OBJECTIVES/HYPOTHESIS Interaction with voice recognition systems, such as Siri™ and Alexa™, is an increasingly important part of everyday life. Patients with voice disorders may have difficulty with this technology, leading to frustration and reduction in quality of life. This study evaluates the ability of common voice recognition systems to transcribe dysphonic voices. STUDY DESIGN Retrospective evaluation of "Rainbow Passage" voice samples from patients with and without voice disorders. METHODS Participants with (n = 30) and without (n = 23) voice disorders were recorded reading the "Rainbow Passage". Recordings were played at standardized intensity and distance-to-dictation programs on Apple iPhone 6S™, Apple iPhone 11 Pro™, and Google Voice™. Word recognition scores were calculated as the proportion of correctly transcribed words. Word recognition scores were compared to auditory-perceptual and acoustic measures. RESULTS Mean word recognition scores for participants with and without voice disorders were, respectively, 68.6% and 91.9% for Apple iPhone 6S™ (P

In this article, we note that despite being a multimodal phenomenon, turn-taking has still been investigated mostly as being unimodal. Based on theoretical positions emphasizing that communication is organized jointly by interaction partners, we identify the challenge of assessing human sequential behavior that is (a) spread across different modalities and (b) co-constructed with a partner. By analyzing a corpus of mother-child dyads with Cross Recurrence Quantification Analysis and Frequent Pattern Mining, we offer novel steps toward understanding multimodal turn-taking.

Objective Our aim was to study the quality of medical care in patients with systemic lupus erythematosus (SLE) to understand gaps and to analyze the association with outcome of the disease. Methods Information on demographics and medical care was assessed by self-reported questionnaires among SLE patients (LuLa cohort, 2011, n = 580). In total, 21 aspects of medical care were analyzed. Univariate analysis selected 10 predictor variables for further analysis: (1) urine examination and (2) blood test in the previous year, (3) taking antimalarials, (4) taking vitamin D and calcium if the dosage of prednisolone was greater than 7.5 mg/day, counseling regarding (5) lipid metabolism, (6) vaccination, and (7) blood pressure, and treatment of the comorbidities (8) hypertension, (9) osteoporosis and (10) lipid metabolism disorder. The association of these 10 items with the outcome of the disease, assessed in 2015, was analyzed by linear regression analysis, adjusted for age, disease duration and sex. Results On average six of the 10 items were met (±1.7). Receiving more clinical care in 2013 was predictive for low disease activity (SLAQ, p = 0.024, β = –0.104, corr. R2 = 0.048), low progress in disease-related damage (Delta Brief Index of Lupus Questionnaire, p = 0.048, β = –0.132, corr. R2 = 0.036) and high health-related quality of life (SF-12 physical, p = 0.035, β = 0.100, corr. R2 = 0.091) in 2015. Conclusion Our study illustrates a link between the quality of care and the SLE outcome parameters disease activity, disease-related damage and quality of life. Consistent considerations of these care parameters, which are recommended in several management guidelines, could therefore be a good approach to improve the outcome of patients with SLE.

Atomically thin layers of transition metal dichalcogenides (TMDC) have exceptional optical properties, exhibiting a characteristic absorption and emission at excitonic resonances. Due to their extreme flexibility, strain can be used to alter the fundamental exciton energies and line widths of TMDCs. Here, we report on the Stokes shift, i.e. the energetic difference of light absorption and emission, of the A exciton in TMDC mono- and bilayers. We demonstrate that mechanical strain can be used to tune the Stokes shift. We perform optical transmission and photoluminescence (PL) experiments on mono- and bilayers and apply uniaxial tensile strain of up to 1.2% in MoSe2 and WS2 bilayers. An A exciton red shift of -38 meV/% and -70 meV/% is found in transmission in MoSe2 and WS2, while smaller values of -27 meV/% and -62 meV/% are measured in PL, respectively. Therefore, a reduction of the Stokes shift is observed under increasing tensile strain. At the same time, the A exciton PL line widths narrow significantly with -14 meV/% (MoSe2) and -21 meV/% (WS2), demonstrating a drastic change in the exciton-phonon interaction. By comparison with ab initio calculations, we can trace back the observed shifts of the excitons to changes in the electronic band structure of the materials. Variations of the relative energetic positions of the different excitons lead to a decrease of the exciton-phonon coupling. Furthermore, we identify the indirect exciton emission in bilayer WS2 as the ΓK transition by comparing the experimental and theoretical gauge factors.

Empirical researchers using qualitative comparative analysis (QCA) can work with crisp, multivalue, and fuzzy sets. The relative advantages of crisp and multivalue sets have been discussed in the QCA literature. There has been little reflection on the more frequent decision between crisp and fuzzy sets for which there often is no theoretical guidance. A review shows that researchers often prefer fuzzy over crisp sets, sometimes because they contain more information. This meets with the argument that fuzzy sets produce more conservative consistency measures and constitute tougher tests. In my article, I demonstrate analytically and with data from published QCA studies that the relationship between crisp sets, fuzzy sets, and the consistency score is ambiguous. It depends on the distribution of cases whether the consistency value is more or less conservative for fuzzy sets than for crisp sets. I outline the implications of the ambiguous relationship for empirical research.

Objective The aim of this study was to identify factors associated with impaired work productivity and impaired daily activities in patients with systemic lupus erythematosus (SLE). Methods The LuLa study is a longitudinal patient-reported study. Beyond sociodemographic data, work productivity, daily activities and fatigue, several other clinical outcome parameters (e.g. mental health–related quality of life and physical functioning, disease activity, damage and pain) were surveyed with validated questionnaires. The effects of confounders on work productivity (WPAI 2) and daily activity domains (WPAI 4) were studied by multivariate regression analysis. Results A total of 585 patients completed the questionnaire of whom 259 were employed and analysed. The median impairment in work productivity (WPAI 2) was 20% (Q1–3 0–40), and the median impairment in daily activities (WPAI 4) was 30% (Q1–3 10–50%). Multivariate regression analysis revealed that fatigue, pain, disease activity and health-related quality of life affected WPAI 2 and 4. Furthermore, we observed distinct synergistic effects of fatigue, disease activity and pain on both work productivity and daily activities: a higher impact of fatigue was associated with the reported extent of pain or disease activity. Conclusion In employed patients with SLE, impaired work productivity and impaired daily activities were frequently reported. Fatigue, pain, disease activity and health-related quality of life demonstrated a detrimental impact, with a synergistic effect of fatigue, disease activity and pain. Hence, both optimized pain management and targeted immunomodulatory therapy are important for preserving active participation in life among patients with fatigue.

The recent surge of interest in explainability in artificial intelligence (XAI) is propelled by not only technological advancements in machine learning but also by regulatory initiatives to foster transparency in algorithmic decision making. In this article, we revise the current concept of explainability and identify three limitations: passive explainee, narrow view on the social process, and undifferentiated assessment of explainee’s understanding. In order to overcome these limitations, we present explanation as a social practice in which explainer and explainee co-construct understanding on the microlevel. We view the co-construction on a microlevel as embedded into a macrolevel, yielding expectations concerning, e.g., social roles or partner models: typically, the role of the explainer is to provide an explanation and to adapt it to the current level of explainee’s understanding; the explainee, in turn, is expected to provide cues that direct the explainer. Building on explanations being a social practice, we present a conceptual framework that aims to guide future research in XAI. The framework relies on the key concepts of monitoring and scaffolding to capture the development of interaction. We relate our conceptual framework and our new perspective on explaining to transparency and autonomy as objectives considered for XAI.

In 2019 first reports about a new human coronavirus emerged, which causes common cold symptoms as well as acute respiratory distress syndrome. The virus was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and severe thrombotic events including deep vein thrombosis, pulmonary embolism, and microthrombi emerged as additional symptoms. Heart failure, myocardial infarction, myocarditis, and stroke have also been observed. As main mediator of thrombus formation, platelets became one of the key aspects in SARS-CoV-2 research. Platelets may also directly interact with SARS-CoV-2 and have been shown to carry the SARS-CoV-2 virus. Platelets can also facilitate the virus uptake by secretion of the subtilisin-like proprotein convertase furin. Cleavage of the SARS-CoV-2 spike protein by furin enhances binding capabilities and virus entry into various cell types. In COVID-19 patients, platelet count differs between mild and serious infections. Patients with mild symptoms have a slightly increased platelet count, whereas thrombocytopenia is a hallmark of severe COVID-19 infections. Low platelet count can be attributed to platelet apoptosis and the incorporation of platelets into microthrombi (peripheral consumption) and severe thrombotic events. The observed excessive formation of thrombi is due to hyperactivation of platelets caused by the infection. Various factors have been suggested in the activation of platelets in COVID-19, such as hypoxia, vessel damage, inflammatory factors, NETosis, SARS-CoV-2 interaction, autoimmune reactions, and autocrine activation. COVID-19 does alter chemokine and cytokine plasma concentrations. Platelet chemokine profiles are altered in COVID-19 and contribute to the described chemokine storms observed in severely ill COVID-19 patients.In 2019 wurden erste Berichte über ein neuartiges Coronavirus bekannt, welches bei Menschen Erkältungssymptome aber auch ein akutes Lungenversargen (ARDS) auslösen kann. Das Virus wurde als SARS-CoV-2 eingeordnet und schwere Thrombosen, wie z.B. tiefe Venenthrombosen und Lungenembolien, sowie Mikrothromben als zusätzliche Symptome identifiziert. Herzinfarkte, Myokarditis sowie Schlaganfälle wurden ebenfalls beobachtet. Als einer der Hauptmediatoren der Thrombusbildung wurden Thrombozyten schnell zu einem Fokus der SARS-CoV-2 Forschung. Blutplättchen können wahrscheinlich direkt mit SARS-CoV-2 interagieren und es wurde gezeigt das sich Viruspartikel im Zytosol von Thrombozyten befinden können. Thrombozyten können darüber hinaus die Aufnahme des Virus erleichtern, indem sie die subtilisin-like proprotein convertase furin sezernieren, welche das Spike Protein von SARS-CoV-2 Viren spaltet und dadurch die Bindungskapazität des Proteins an zelluläre Rezeptoren erhöht. Die Thrombozytenzahl wird durch eine Covid-19 Infektion beeinflusst. Patienten mit milden Symptomen zeigen leicht erhöhte Thrombozytenwerte, wohingegen eine Thrombozytopenie ein wichtiges Merkmal einer schweren Erkrankung ist. Diese geringe Thrombozytenzahl kann auf eine erhöhte Apoptose sowie den Einschluss von Thrombozyten in Mikrothromben (peripherer Verbrauch) oder massive Thrombosen zurückgeführt werden. Die beobachtete massive Bildung von Thromben erfolgt auf Grund einer Covid-19 induzierten Hyperaktivierung von Thrombozyten. Verschiedene Faktoren können Thrombozyten während einer Covid-19 Infektion aktivieren, dazu zählen Hypoxie, Gefäßschäden, Entzündungsmarker, NETosis, direkte SARS-CoV-2 Interaktionen, Autoimmunreaktionen sowie eine autokrine Aktivierung. Zudem verändert Covid-19 die Chemokin- und Zytokin-Konzentrationen im Blutplasma. Auch das Chemokin Profil von Thrombozyten ist in Covid-19 Patienten verändert und trägt stark zu dem in schwer kranken Patienten beobachteten Chemokinsturm bei.

Platelets play a significant role in atherothrombosis. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is critically involved in the regulation of LDL metabolism and interacts with platelet function. The effect of PCSK9 in platelet function is poorly understood. The authors of this article sought to characterize platelets as a major source of PCSK9 and PCSK9’s role in atherothrombosis. In a large cohort of patients with coronary artery disease (CAD), platelet count, platelet reactivity, and platelet-derived PCSK9 release were analyzed. The role of platelet PCSK9 on platelet and monocyte function was investigated in vitro. Platelet count and hyper-reactivity correlated with plasma LDL in CAD. The circulating platelets express on their surface and release substantial amounts of PCSK9. Release of PCSK9 augmented platelet-dependent thrombosis, monocyte migration, and differentiation into macrophages/foam cells. Platelets and PCSK9 accumulated in tissue derived from atherosclerotic carotid arteries in areas of macrophages. PCSK9 inhibition reduced platelet activation and platelet-dependent thrombo-inflammation. The authors identified platelets as a source of PCSK9 in CAD, which may have an impact on LDL metabolism. Furthermore, platelet-derived PCSK9 contributes to atherothrombosis, and inhibition of PCSK9 attenuates thrombo-inflammation, which may contribute to the reported beneficial clinical effects.

Technological advancements in machine learning affecting humans' lives on the one hand and also regulatory initiatives fostering transparency in algorithmic decision making on the other hand drive a recent surge of interest in explainable AI (XAI). Explainability is discussed as a solution to sociotechnical challenges such as intelligent software providing incomprehensible decisions or big data enabling fast learning but becoming too complex to fully comprehend and judge its achievements. With explainable AI, more insights into the functions, decisions, and usefulness of algorithms are expected. If an explanation is successful, it results in an understanding. Current XAI research is centering around one-way interaction from which solutions to achieve understanding are derived. In the presentation, I will point to an important resource for achieving understanding that has been overlooked so far: the interaction with the addressee [1]. Whereas in current XAI research, the addressee (explainee) is mostly seen as a passive receiver, I argue that the explainee can provide an active and crucial contribution to the process of understanding resulting in the explanation being tailored to a particular form of understanding and thus gaining on relevance. Within the co-constructive view [1], both partners scaffold and monitor each other-perpetuating, thus, the process of explaining as a joint endeavor toward a goal. I argue that such an endeavor can be implemented in explainable and interactive AI.

BACKGROUND Measurement of hemoglobin A1c (HbA1c) in the blood is integral to and essential for the treatment of patients with diabetes mellitus. HbA1c reflects the mean blood glucose concentration over the preceding 8 to 12 weeks. Although the clinical value of HbA1c was initially limited by large differences in results among various methods, the investment of considerable effort to implement standardization has brought about a marked improvement in analysis. CONTENT The focus of this review is on the substantial progress that has been achieved in enhancing the accuracy and, therefore, the clinical value of HbA1c assays. SUMMARY The interactions between the National Glycohemoglobin Standardization Program and manufacturers of HbA1c methods have been instrumental in standardizing HbA1c. Proficiency testing using whole blood has allowed accuracy-based assessment of methods in individual clinical laboratories that has made an important contribution to improving the HbA1c measurement in patient samples. These initiatives, supported by the efforts of the IFCC network, have led to a continuing enhancement of HbA1c methods. Many of the factors that previously influenced HbA1c results independently of blood glucose have been eliminated from most modern methods. These include carbamylation, labile intermediates, and common hemoglobin variants. Nevertheless, some factors (e.g., race and aging) may alter HbA1c interpretation, but whether these differences have clinical implications remains contentious. HbA1c has a fundamental role in the diagnosis and management of diabetes. Ongoing improvements in HbA1c measurement and quality will further enhance the clinical value of this analyte.

Purpose As imaging technology improves and more thyroid nodules and malignancies are identified, it is important to recognize factors associated with malignancy and poor prognosis. Vitamin D has proven useful as a prognostic tool for other cancers and may be similarly useful in thyroid cancer. This study explores the relationship of Vitamin D to papillary thyroid carcinoma stage while accounting for socioeconomic covariates. Materials and methods The medical records of all patients who underwent thyroidectomy at one institution between 2000 and 2015 were reviewed. Subjects with non-papillary thyroid cancer pathology, prior malignancy, and without Vitamin D levels were excluded. The remaining 334 patient records were examined for cancer stage, Vitamin D levels, Vitamin D deficiency listed in history, and demographic and comorbid factors. Results Vitamin D laboratory values showed no significant relationship to cancer stage (p = 0.871), but patients with Vitamin D deficiency documented in the medical record were more likely to have advanced disease (28.6% versus 14.7%; p = 0.028). The patients with documented Vitamin D deficiency also had lower 25-hydroxyvitamin D nadirs (21.5 ng/mL versus 26.5 ng/mL, p = 0.008) and were more likely to be on Vitamin D supplementation (92.6% versus 41.8%, p Conclusions The results suggest that Vitamin D deficiency may have value as a negative prognostic indicator in papillary thyroid cancer and that pre-operative laboratory evaluation may be less useful. This is important because Vitamin D deficiency is modifiable. While different racial subgroups had different rates of Vitamin D deficiency, neither race nor socioeconomic status showed correlation with cancer stage.

Background The aim of this study was to evaluate the clinical and radiographic success of arthrolysis surgery and the risk of progression of osteoarthrosis at the ankle joint. Materials and methods In a retrospective clinical and radiological study, with a minimum follow-up of 24 months, the pain level and quality of living were evaluated. Results Following arthrolysis of the ankle joint, 16% of patients required ankle fusion within 2 years. Women had a higher quality-of-life in terms of Foot Function Index. Younger patients scored higher in both quality-of-life and function scores. Radiographic osteoarthrotic changes and the specific follow-up interval did not correlate with clinical outcome. Conclusion Fewer than 20% of patients required ankle fusion. Female gender and young age had a positive impact. Preoperative radiography and the postsurgical interval are poorly predictive for the progression of osteoarthrosis.

The development of high-performance Li7La3Zr2O12 (LLZO)-based all-solid-state lithium batteries (SSLB) is usually hampered by highly resistive interfaces due to the need for sintering at elevated temperatures to form ionic diffusion paths through the grains. Many strategies have been proposed to solve the problem but the achievements have been limited. Herein, a new design principle is introduced, based on co-sintering crystalline LCO and Ta-substituted LLZO instead of using the more reactive Li–Co–O precursors and Al-substituted LLZO, which allows the fabrication of high specific areal density and low cell area resistance without the interface modification of LLZO-based SSLB. Detailed studies using micro-Raman and EDS mapping revealed that the well-sintered interfaces are free from detrimental secondary phases. To demonstrate that a true bulk-type SSLB can be constructed by this straightforward strategy, the material loading for a composite positive electrode was increased to about 10 times that in previous reports, which resulted in a high areal capacity of 1.63 mA h cm−2 (i.e. 110 mA h g−1) when discharged with a current density of 50 μA cm−2. It also allows one to discharge the fabricated SSLB at a very high current density of 500 μA cm−2 at 50 °C due to the minimized cell areal resistance. The new fabrication strategy for the LLZO-based SSLB paves the way for achieving SSLB with high safety and energy density.

Supplemental Digital Content is available in the text., Objective: Patients with coronary artery disease (CAD) are at increased risk for cardiac death and respiratory failure following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Platelets are crucially involved in pathogenesis of CAD and might also contribute to pathophysiology of SARS-CoV-2 infection. Approach and Results: We enrolled a cohort of 122 participants from February 2020 to July 2020 including 55 patients with preexisting CAD and acute SARS-CoV-2 infection (CAD-SARS-CoV-2positive), 28 patients with CAD and without SARS-CoV-2 (CAD-SARS-CoV-2negative), and 39 healthy controls. Clinical and cardiac examination of the CAD-SARS-CoV-2positive group included blood sampling, echocardiography, and electrocardiography within 24 hours after hospital admission. Phenotyping of platelets was performed by flow cytometry; plasma levels of chemokines were analyzed by ELISA. Respiratory failure of patients was stratified by the Horovitz index as moderately/severely impaired when Horovitz index

Objectives: This study compares hospital-generated online ratings to patient-generated online ratings in academic otolaryngology and evaluates physician factors influencing these results. Methods: Websites of academic otolaryngologists were assessed for inclusion of hospital-generated Press Ganey surveys. Corresponding scores on Healthgrades and Vitals.com were identified via internet search. Hospital ratings were compared with patient-generated ratings, including score, demographics, and number of ratings. All data was collected between July 15th 2019 and August 22nd 2019. Results: 742 academic otolaryngologists with hospital-generated ratings were identified. Mean hospital-generated rating was significantly higher ((4.70, 95% CI 4.69-4.72) than patient-generated rating (Vitals:4.26, 95% CI 4.18-4.34, and Healthgrades:4.02, 95% CI 3.87-4.18; P 20) was associated with male gender, professor ranking, and >30 years in practice ( P 30+ years in practice ( P = .023). Across all platforms, comprehensive otolaryngologists and neurotologists/otologists were rated lower in comparison to other specialties (PGS: P Conclusion: Hospital-generated ratings yield higher mean scores than patient-generated platforms. Between sources, Healthgrades.com scores were lower than those of Vitals.com . Professors with >30 years of practice generated more reviews in patient-generated ratings, and these physicians were generally rated lower. Access to patient-generated ratings is universal and physicians should be aware of variability between online rating platforms as scores may affect referrals and practice patterns.

In 2019, COACh, an organization dedicated to developing equitable opportunities in science and engineering, contracted with NIST to design and implement a data-driven study to examine the causes of inequity in promotions and develop draft recommendations. This document compiles reports of that work. A companion report by Maya Noviski, NIST GCR 21-030 Supporting Women and Under-Represented Minorities in the Sciences: Implementing Equitable Approaches to organizational Change summarizes scholarly literature that informed final recommendations. The work began with listening sessions with NIST scientific staff and administrators (mainly ZPs and ZTs), which revealed that many employees held strong views about promotion opportunities and process. This was followed by analyses of NIST personnel actions from 2000 to 2019. (Reports in Part I.) In contrast to views often expressed in the listening sessions and implicit in the wording of the call for proposals, extensive statistical analyses found little evidence that women were disadvantaged in promotions or salaries. A survey of ZP employees supported these conclusions. (Reports in Part II.) However, extensive statistical analyses and examination of open-ended comments indicated less than half of the employees believed that the promotion criteria were understood by employees or appropriate for the NIST mission or their unit or that the promotion process was fair. The concerns were more often expressed by those at lower pay bands. Within bands, gender differences in views were minimal. Focus groups with ZP staff and Group Leaders, as well as interviews with ZT staff, confirmed the conclusions from the HR data and survey and provided examples of issues with the promotion criteria and process. Direct quotes informed our conclusions and expanded our recommendations for change. (Reports in part III.) The recommendations are designed to help develop a more transparent promotion process that is seen as fair and equitable by all staff (Part IV). Appendices include material for leaders implementing change or those interested in replicating the work.

Background Hemoglobin C, D Punjab, E or S trait can interfere with hemoglobin A1c (HbA1c) results. We assessed whether they affect results obtained with 15 current assay methods. Methods Hemoglobin AA (HbAA), HbAC, HbAD Punjab, HbAE and HbAS samples were analyzed on 2 enzymatic, 4 ion-exchange HPLC and 9 immunoassay methods. Trinity Premier Hb9210 boronate affinity HPLC was the comparative method. An overall test of coincidence of least-squared linear regression lines was performed to determine if HbA1c results were statistically significantly different from those of HbAA samples. Clinically significant interference was defined as >6% difference from HbAA at 6 or 9% HbA1c compared to Premier Hb9210 using Deming regression. Results All methods showed statistically significant effects for one or more variants. Clinically significant effects were observed for the Tosoh G11 variant mode (HbAD), Roche b 101 (HbAC and HbAE) and Siemens DCA Vantage (HbAE and HbAS). All other methods (Beckman Coulter B93009 and B00389 on DxC700AU, and Unicel DxC, Ortho Clinical Vitros 5.1, Roche cobas c 513, Siemens Dimension RxL and Vista, and Enzymatic on Advia and Atellica, Tosoh G8 5.24 and 5.28, and GX) showed no clinically significant differences. Conclusions A few methods showed interference from one or more variants. Laboratories need to be aware of potential HbA1c assay interferences.

The social sciences are currently witnessing a trend toward multi‐method research (MMR). However, many important issues have not been sufficiently addressed so far. The focus of this paper is case selection for process tracing on the basis of regression results, which is the main point of intersection between the two methods. Based on a review, we first show that the current empirical and methodological literature does not fully appreciate the implications of modeling uncertainty and non‐robust quantitative results. The major problem is that non‐robust regression results may lead to invalid choices and faulty inferences. We develop a novel selection procedure that takes these issues into account and improves causal inference in MMR., Reproduction material available at: https://doi.org/10.17605/OSF.IO/6U8RX This work was funded by the Deutsche Forschungsgemeinschaft (DFG) as part of funding for the Sfb 597 Transformations of the State., {"references":["Rohlfing, Ingo and Peter Starke (2013): Building on Solid Ground: Robust Case Selection in Multi-Method Research. Swiss Political Science Review 19 (4): 492-512."]}

Discrimination is generally conceived of as a feature of protectionism and the source of retaliatory spirals. In this paper, I argue that this perspective on trade discrimination is conceptually and empirically deficient. The extent of discrimination is almost exclusively considered with respect to the form of cooperation, that is, the number of countries that cooperate. This view disregards the fact that the bargaining approach also determines the extent to which a country can discriminate in concession-making. By neglecting the bargaining method, the existing literature tends to underestimate the prevalence of discriminatory treatment in international trade and in periods of liberalization in particular. Furthermore, a case study of the government procurement negotiations at the Uruguay Round shows that discrimination between countries and items may go along with and actually promote liberalization. On the basis of these insights, I make a first step toward a better understanding of discrimination by developing a baseline model explaining liberalization through discrimination., {"references":["Rohlfing, Ingo (2009): Discrimination in International Trade: A Different Perspective. Acta Politica 44 (2): 192-210."]}

Metals : open access journal 10(11), 1523 (2020). doi:10.3390/met10111523 special issue: "Special Issue "New Science Based Concepts for Increased Efficiency in Battery Recycling" / Speial Issue Editor: Prof. Dr. Bernd Friedrich, Guest Editor", Published by MDPI, Basel

Nowadays, smartphones and tablet computers are very common in European families. Consequently, such devices are frequently available for young children from a very early age. Engaging with these new technologies at home or at a childcare center offers a range of opportunities to promote children’s literacy competencies using e-books and storybook apps. In this chapter, we aim to outline how the use of digital media can address and motivate children, and in particular, children in need of literacy support. To this end, we review the current literature and results of relevant studies. First, we try to identify reasons why children differ consistently in their reading comprehension skills, how such differences develop in early childhood, and which groups are in additional need of support. Then, we discuss children’s digital home learning environments and the possibilities of reading with digital media in early childhood. Finally, we conclude by discussing practical implications for the use of digital media with children in educational contexts.

This paper reports experience teaching an undergraduate Requirements Engineering (RE) course organized around a Human-Cyber-Physical System (H-CPS) project called SafeWalk. This project, based on a NASA astronaut’s jetpack, gave students practical experience developing RE skills. Using the SafeWalk project helped the students learn the RE discovery, specification, analysis and evolution techniques they need to be practitioners in the growing field of H-CPS.

BackgroundLeg length discrepancy (LLD) after total hip arthroplasty (THA) is a known source of complications and a leading cause of litigation (J Bone Joint Surg Br 87:155–157, 2005). There are limited studies investigating surgical approach combined with the use of fluoroscopy intraoperatively and their potential effects on LLD after THA. The purpose of this study was to compare the direct anterior (DA) approach utilizing a fluoroscopic overlay technique and anterolateral (AL) approach and their potential effect on LLD.MethodsWe retrospectively reviewed 121 patients who had undergone primary THA from September 1, 2016 to November 1, 2018 by either DA or AL approach by two separate surgeons. Leg length discrepancies were measured on pre-operative post-anesthesia care unit (PACU) and on post-operative low anterior/posterior (AP) pelvis plain radiographs by two investigators blinded to each other’s measurements. To confirm inter-observer and intra-observer reliability between LLD measurements amongst investigators, a Pearson correlation test was performed. The primary outcome measurement was leg length discrepancy (LLD).ResultsWe observed LLD > 1.0 cm and LLD > 1.5 cm in the DA and AL groups. The DA approach group showed a mean LLD of 4.5 mm against 7.76 mm in the AL group (p 1 cm (28%vs. 8%,p = 0.0037) and LLD > 1.5 cm (7%vs. 0%,p = 0.0096). The LLD measurements showed strong correlation in terms of inter-observer (r = 0.95) and intra-observer reliability (r = 0.99) between the two investigators (p ConclusionIn our patient cohort, the DA approach with fluoroscopic overlay technique had less LLD in comparison with the AL approach, suggesting that intraoperative fluoroscopic use does have an impact on LLD.

We perform absorption and photoluminescence spectroscopy of trions in hBN-encapsulated WSe$_2$, WS$_2$, MoSe$_2$, and MoS$_2$ monolayers, depending on temperature. The different trends for W- and Mo-based materials are excellently reproduced considering a Fermi-Dirac distribution of bright and dark trions. We find a dark trion, $\rm{X_D^-}$ 19 meV $\textit{below}$ the lowest bright trion, $\rm{X}_1^-$ in WSe$_2$ and WS$_2$. In MoSe$_2$, $\rm{X_D^-}$ lies 6 meV $\textit{above}$ $\rm{X}_1^-$, while $\rm{X_D^-}$ and $\rm{X}_1^-$ almost coincide in MoS$_2$. Our results agree with GW-BSE $\textit{ab-initio}$ calculations and quantitatively explain the optical response of doped monolayers with temperature., Comment: 16 pages including supporting information, 4 figures in the main text, 10 figures in the supporting information

ObjectiveTo determine whether maternal cardiovascular disease (CVD) risk factors predict preterm birth.DesignCase control.SettingCalifornia hospitals.Participants868 mothers with linked demographic information and biospecimens who delivered singleton births from July 2009 to December 2010.MethodsLogistic regression analysis was employed to calculate odds ratios for the associations between maternal CVD risk factors before and during pregnancy (including diabetes, hypertensive disorders and cholesterol levels) and preterm birth outcomes.Primary outcomePreterm delivery status.ResultsAdjusting for the other maternal CVD risk factors of interest, all categories of hypertension led to increased odds of preterm birth, with the strongest magnitude observed in the pre-eclampsia group (adjusted OR (aOR), 13.49; 95% CI 6.01 to 30.27 for preterm birth; aOR, 10.62; 95% CI 4.58 to 24.60 for late preterm birth; aOR, 17.98; 95% CI 7.55 to 42.82 for early preterm birth) and chronic hypertension alone for early preterm birth (aOR, 4.58; 95% CI 1.40 to 15.05). Diabetes (types 1 and 2 and gestational) was also associated with threefold increased risk for preterm birth (aOR, 3.06; 95% CI 1.12 to 8.41). A significant and linear dose response was found between total and low-density lipoprotein (LDL) cholesterol and aORs for late and early preterm birth, with increasing cholesterol values associated with increased risk (likelihood χ2 differences of 8.422 and 8.019 for total cholesterol for late and early, and 9.169 and 10.896 for LDL for late and early, respectively). Receiver operating characteristic curves using these risk factors to predict late and early preterm birth produced C statistics of 0.601 and 0.686.ConclusionTraditional CVD risk factors are significantly associated with an increased risk of preterm birth; these findings reinforce the clinical importance of integrating obstetric and cardiovascular risk assessment across the healthcare continuum in women.

The concept of Adaptive Resolution Change (ARC) in video coding is already known from former international standards such as MPEG-4 [1]. However, in MPEG-4 linear filters are used for upsampling, which is crucial to coding video at varying resolution. With the rise of machine learning-based super-resolution methods in the last decade, powerful algorithms outperforming conventional upsampling methods were developed. This contribution introduces an ARC concept using un-coded areas within a frame of a video sequence and a Dictionary Learning (DL)-based Super-Resolution (SR) scheme. In this concept, a frame contains a picture at different resolution levels, which are spatially separated by the use of slices and tiles. Generally, a tile can be marked as coded or un-coded. Slices which do not hold any coded tiles are omitted from the bitstream. Thus, only one resolution level needs to be coded, while the other is generated at the decoder side. At the encoder a rate-distortion decision is made in order to decide, which resolution level should be coded. Simulation results show that gains with respect to the Versatile Video Coding (VVC) standard in development can be achieved at low bitrates.

OBJECTIVES/HYPOTHESIS Electronic health records have brought many advantages but also placed a documentation burden on the provider during and after the clinic visit. Some otolaryngologists have countered this challenge by employing clinical scribes. This project aimed to better understand the influence of scribes on patient experience in the otolaryngology clinic. STUDY DESIGN Retrospective cohort survey study. METHODS Patients presenting to the otolaryngology clinic for new and follow-up appointments were recruited to complete surveys about their experience. RESULTS A total of 153 patients completed the survey, and 96 of those patients (62.7%) interacted with a scribe. Patient satisfaction was not significantly associated with participation of the scribe (P = .668). Similarly, patient rating of their physician on a scale of 1 to 10 was not associated with scribe involvement (P = .851). The patients who did interact with a scribe responded that the scribe positively impacted the visit 77.1% of the time. Participation of a resident, primary language other than English, and use of interpreter were associated with lower satisfaction (P = .004, P

The efficiency of photoelectrochemical tandem cells is still limited by the availability of stable low band gap electrodes. In this work, we report a photocathode based on lithium doped copper(II) oxide, a black p-type semiconductor. Density functional theory calculations with a Hubbard U term show that low concentrations of Li (Li0.03Cu0.97O) lead to an upward shift of the valence band maximum that crosses the Fermi level and results in a p-type semiconductor. Therefore, Li doping emerged as a suitable approach to manipulate the electronic structure of copper oxide based photocathodes. As this material class suffers from instability in water under operating conditions, the recorded photocurrents are repeatedly misinterpreted as hydrogen evolution evidence. We investigated the photocorrosion behavior of LixCu1−xO cathodes in detail and give the first mechanistic study of the fundamental physical process. The reduced copper oxide species were localized by electron energy loss spectroscopy mapping. Cu2O grows as distinct crystallites on the surface of LixCu1−xO instead of forming a dense layer. Additionally, there is no obvious Cu2O gradient inside the films, as Cu2O seems to form on all LixCu1−xO nanocrystals exposed to water. The application of a thin Ti0.8Nb0.2Ox coating by atomic layer deposition and the deposition of a platinum co-catalyst increased the stability of LixCu1−xO against decomposition. These devices showed a stable hydrogen evolution for 15 minutes.

Purpose Our aim was to study the delay from the onset of symptoms to the diagnosis of systemic lupus erythematosus (SLE) and its association to the outcome of the disease. Methods Information on demographics, onset of first symptoms, first physicians visit and time of diagnosis was assessed by self-reported questionnaires among SLE patients in Germany in 2010 (LuLa cohort, n=585). Disease activity (Systemic Lupus Activity Questionnaire; SLAQ), disease related damage (Brief Index of Lupus Damage; BILD) and health related quality of life were chosen as relevant proxies for outcome. Linear regression analysis was used to analyze the association to the outcome of the disease, adjusted for age, disease duration and sex. Results Mean reported duration between the onset of symptoms and the diagnosis of SLE was 45.7 months (SD 72.6), including a mean duration of 13.2 month (SD 40.9) between the onset of symptoms and the first physicians visit. In our cohort, the mean disease duration was 17.7 years (SD 7.89). A delayed diagnosis was associated with high disease activity (SLAQ, p Conclusion The time to diagnosis was associated with a worse outcome in systemic lupus erythematosus, assessed by self-reported questionnaires for disease activity, disease-related damage and quality of life, unaffected by the organ involvement at the time of diagnosis. An early diagnosis should therefore be strived to improve the long-term outcome of the disease. German Clinical Trial Register, www.germanctr.de, DRKS00011052 Acknowledgement The LuLa study is supported by unrestricted grants from GlaxoSmithKline and UCB Pharma.

In this paper we propose an approach for learning low dimensional optimized feature space with minimum intra-class variance and maximum inter-class variance. We address the problem of high-dimensionality of feature vectors extracted from neural networks by taking care of the global statistics of feature space. Classical approach of Linear Discriminant Analysis (LDA) is generally used for generating an optimized low dimensional feature space for single-labeled images. Since, image retrieval involves both multi-labeled and single-labeled images, we utilize the equivalence between LDA and Canonical Correlation Analysis (CCA) to generate an optimized feature space for single-labeled images and use CCA to generate an optimized feature space for multi-labeled images. Our approach correlates the projections of feature vectors with label vectors in our CCA based network architecture. The neural network minimize a loss function which maximizes the correlation coefficients. We binarize our generated feature vectors with the popular Iterative Quantization (ITQ) approach and also propose an ensemble network to generate binary codes of desired bit length for image retrieval. Our measurement of mean average precision shows competitive results on other state-of-the-art single-labeled and multi-labeled image retrieval datasets., 14 pages, 7 figures

Previous studies have found that narrative input conveyed through different media influences the structure and content of children's narrative retellings. Visual, televised narratives appear to elicit richer and more detailed narratives than traditional, orally transmitted storybook media. To extend this prior work and drawing from research on narrative elaboration, the current study's main goal was to identify the core plot component differences (the who, what, where, when, why, and how of a story) between children's retellings of televised versus traditional storybook narratives. However, because children also differ individually in their IQ, we further incorporated this variable into our analysis of children's narrative retellings. For our purpose, a novel coding schema was developed, following and extending the existing narrative elaboration approaches. Participants were 46 typically developing children aged 4-5 years from Germany. The current study incorporated two narrative input conditions to which children were randomly assigned: in the video condition, children watched a non-verbal, visually conveyed, televised story from a DVD; and in the book condition, children read the story with an adult and experienced an orally conveyed version in the form of a book with minimal accompanying pictures. In both conditions, the same story was conveyed. After including IQ as a covariate in our analyses, results show that the children from the video condition gave significantly more elaborated retellings, particularly across the who, what, and where (sub-)components. Differences between the conditions in the component when, how and why did not reach statistical significance. Our findings indicate that different media types entail differential cognitive processing demands of a story, resulting in type-specific memories and narratives. The effect of different medial conditions was significant and persisted when individual differences in cognitive development were considered. Consequences for children's development, education, and interaction with and within today's digital world are discussed. Copyright © 2020 Crawshaw, Kern, Mertens and Rohlfing.

Inter-frame prediction plays an important role in video coding by predicting the current frame from previously encoded pictures, called reference pictures. In the case of camera motion, the content of a current frame could be very different from its reference pictures and may consequently lead to a more difficult Motion Compensation (MC). The main idea of this paper is to process the input 2D video sequence in order to estimate the 3D geometry of the scene and then employ this data to virtually synthesize "geometrically compensated" reference pictures. Since these virtual reference pictures are more similar to the current frame, motion estimation and consequently coding efficiency could be enhanced. The proposed method is tested over six different video sequences and around 11% bitrate reduction is achieved compared to the High Efficiency Video Coding (HEVC) standard.

Objective The European League Against Rheumatism and the American College of Rheumatology jointly embarked on a new classification criteria for systemic lupus erythematosus (SLE) project. Its first phase involved generation of a broad set of items potentially useful for classification of SLE. This study was undertaken to add the patient perspective to an expert Delphi approach and an early patient cohort study. Methods A national cross-sectional study was conducted. A self-report questionnaire was published in the “Schmetterling” (Butterfly), the quarterly journal of the German SLE patient association. Individuals with SLE were asked to anonymously complete the questionnaire, which asked for demographic details, organ manifestations, autoantibodies and symptoms. Results A total of 339 completed questionnaires out of 2498 were returned, a response rate of 13.6%; 83.2% reported they were ANA positive and 81.7% reported joint, 66.1% skin and 33.0% renal involvement. For the time before and in the first year after their SLE diagnosis, the majority reported fatigue (89.4%), joint pain (86.7%), photosensitivity (79.4%) and myalgia (76.1%). Of interest, more than half of the patients reported fever as an early symptom (53.7%). Conclusion For a Caucasian European SLE patient population, the overall characteristics suggest meaningful representation. While many symptoms were reported as expected, the high percentage of patients reporting fever and the significant number of patients with unexpected gastrointestinal complaints are of particular interest. These data add to the information on early SLE symptoms informing the development process of new SLE classification criteria.

Objectives Vaccinations are an important measure to prevent infections in immunocompromised patients. The knowledge of vaccination coverage and reasons for non-vaccination in patients with SLE is scarce. The aim of this study was to assess coverage rates of selected vaccinations in a representative sample of SLE patients and to identify predictors for non-vaccination. Methods In 2013, information on selected vaccinations (coverage, application and reservations) and on demographics, clinical parameters and health beliefs was assessed by means of a self-reported questionnaire among a representative sample of SLE patients in Germany (LuLa cohort). Results Five hundred and seventy-nine patients participated. Vaccination status was primarily checked by their general practitioner (57.3%). Of all the patients, 24.9% did not get their vaccination status checked at all, 16.1% had generally been advised against the use of vaccinations by a physician, and 37.5% stated that they had rejected vaccinations themselves. Their main reasons were fears of developing a lupus flare (21.8%) or adverse events (13.5%). A greater belief by patients in the doctor controlling one's health and the general benefit of medication prevented the rejection of vaccines. Vaccination coverage was low for all recorded vaccinations (tetanus 65.8%, influenza 45.2%, pneumococcus 32.2% and meningococcus 6.1%). Older age was predictive of receiving influenza and pneumococcal vaccination. The same applies for CSs >7.5 mg for receiving influenza vaccination. Conclusion Vaccination coverage in SLE patients is poor and reflects insufficient implementation of national and international recommendations. Rheumatologists need to recognize patients' reservations against vaccinations, to communicate their importance and safety and to give individual recommendations to patients and their health-care providers. Trial registration German Clinical Trials Register, www.germanctr.de, DRKS00011052.

Background: Recent evidence suggests that increasing dietary intake of minerals reduces the risk of dementia. This study aimed to examine the relationship between potassium and diagnosis of mild cognitive impairment (MCI) in a sample of older Mexican-Americans from rural and urban populations. Methods: The sample was formed of a total of 139 participants with MCI and 371 normal controls from two independent cohorts: a rural cohort (Facing Rural Obstacles to Healthcare Now through Intervention, Education and Research [Project FRONTIER]) and an urban cohort (the Health and Aging Brain among Latino Elders [HABLE] study). Serum electrolytes examined were sodium and potassium. Age and education were entered in the model as covariates. Results: Across both cohorts, the Project FRONTIER (OR = 3.1; p = 0.01) and the HABLE Project (OR = 2.0; p = 0.04), the results indicated that serum potassium levels significantly increased the risk of diagnosis of MCI. Conclusion: Our finding suggested a link between serum potassium levels and a diagnosis of MCI in Mexican-Americans. The results of this study support a previous research which has suggested that the risk factors for MCI may vary by ethnicity.

The role of autologous stem cell transplantation (autoSCT) as consolidating treatment for peripheral T-cell lymphoma (PTCL) is unsettled. The aim of this analysis was to investigate the impact of autoSCT in the upfront setting by intent-to-treat and to study salvage strategies after relapse. Retrospective follow-up of all patients aged 18-70 years and treated at our institution for ALK-PTCL diagnosed between 2001 and 2014. Of 117 eligible patients, diagnosis was PTCL-NOS in 34, ALCL ALK- in 31, AITL in 28, and other PTCL in 24 patients. Disregarding 20 patients who received first-line treatment externally, upfront autoSCT was not intended in 34 due to comorbidity, higher age, low IPI, physician's decision or unknown reasons (nITT), while intent-to-transplant (ITT) was documented in 63 patients. ITT was not associated with significant benefits for 5-year progression-free survival (PFS) and overall survival (OS) with 46 and 23% in the ITT group vs. 42 and 25% in the nITT group, even after multivariate adjustment for confounders. Altogether, 91 of all 117 patients relapsed or progressed. Thirty-one patients managed to proceed to salvage allografting and achieved a 5-year OS of 52%. In contrast, all 7 patients receiving salvage autoSCT relapsed and died, and only 3 of the 51 patients not eligible for SCT salvage survived. In this study, a significant benefit of intending first-line autoSCT over non-transplant induction in patients with ALK-PTCL did not emerge. Most patients fail first-line treatment and have a poor outlook if salvage alloSCT cannot be performed.

Light-driven water electrolysis at a semiconductor surface is a promising way to generate hydrogen from sustainable energy sources, but its efficiency is limited by the performance of available photoabsorbers. Here we report the first time investigation of covalent organic frameworks (COFs) as a new class of photoelectrodes. The presented 2D-COF structure is assembled from aromatic amine-functionalized tetraphenylethylene and thiophene-based dialdehyde building blocks to form conjugated polyimine sheets, which π-stack in the third dimension to create photoactive porous frameworks. Highly oriented COF films absorb light in the visible range to generate photoexcited electrons that diffuse to the surface and are transferred to the electrolyte, resulting in proton reduction and hydrogen evolution. The observed photoelectrochemical activity of the 2D-COF films and their photocorrosion stability in water pave the way for a novel class of photoabsorber materials with versatile optical and electronic properties that are tunable through the selection of appropriate building blocks and their three-dimensional stacking.

BACKGROUND: The purpose of this study was to examine the cost differences between preoperative and postoperative placement of gastrostomy tubes (G-tubes) in patients with head and neck cancer. METHODS: We conducted a retrospective chart review of patients with aerodigestive tract cancers from 2010 to 2015. Data included inpatient and postdischarge costs, demographics, tumor characteristics, surgical treatment, length of stay (LOS), time spent in the intensive care unit (ICU), and readmissions. RESULTS: Five hundred ninety patients were included in this study. There was a $7624 inpatient cost savings (P = .002) for those G-tubes placed preoperatively ($26 060) versus postoperatively ($33 754). Postdischarge costs did not differ significantly between groups (P = .60). There was a $9248 total costs savings (P = .009) for those patients with G-tubes placed preoperatively ($39 751) versus postoperatively ($48 999), despite patients with preoperative G-tubes having lower body mass index (BMI; P = .009), higher Association of Anesthesiologist (ASA) class (P = .02), more preoperative radiation (P < .001), and more free tissue transfer reconstruction (P = .007). CONCLUSION: There is potential for savings by placing G-tubes preoperatively, possibly driven by decreased LOS, despite data suggesting that patients with G-tubes placed preoperatively are higher risk.

Background The most common head and neck paraganglioma is the carotid body paraganglioma. Treatment of carotid body tumors is primarily surgical, and uncontrolled growth leads to cranial nerve deficits and more morbid resection. Methods A 60-year-old man was referred for evaluation of carotid body tumor, and workup revealed an internal carotid artery (ICA) aneurysm within the known mass. Results Interventional Radiology performed angiogram and stenting across aneurysm with interval dramatic reduction in size of mass, and surgery was avoided altogether. Conclusions Surgical resection is indicated for carotid body paragangliomas when the patient can tolerate the surgery and when the tumor was not very advanced. This patient had a small tumor that initially appeared easily resectable. Failure to detect the ICA aneurysm before resection may have resulted in devastating vascular injury and possible stroke or death. Identification of underlying vascular pathology is essential for safe treatment and should be prioritized, especially considering this case.