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The proposed cross-sectional survey of a non-clinical college sample investigated (1) whether two forms of mental health self-stigma (i.e., mental illness self-stigma and psychological distress self-stigma) were positively associated with psychological distress and (2) whether mindfulness mediated the association between mental health self-stigma and psychological distress. University students participated in an online survey. The results of the study revealed that both mental illness self-stigma and psychological distress self-stigma were positively associated with psychological distress, and that mindfulness partially mediated these associations. Additional analyses revealed that mindfulness moderated the association between psychological distress self-stigma and psychological distress. Mindfulness is an important variable for understanding mental health self-stigma and its association with psychological distress. Future studies should investigate the role of mindfulness in this association further.

Growth and extensive urbanisation of the human population has been accompanied by increased manufacture and use of chemical compounds. To classify the fate and behaviour of these compounds in the environment, a series of international standardised biodegradation screening tests (BSTs) were developed over 30 years ago. In recent years, regulatory emphasis (e.g. REACH) has shifted from measuring biodegradation towards prioritisations based on chemical persistence. In their current guise, BSTs are ineffective as screens for persistence. The marine BST OECD 306 in particular is prone to high levels of variation and produces a large number of fails, many of which can be considered false negatives. An ECETOC funded two-day workshop of academia, industry and regulatory bodies was held in 2015 to discuss improvements to the marine BSTs based on previous research findings from the Cefic LRI ECO11 project and other foregoing studies. During this workshop, methodological improvements to the OECD 306 test were discussed, in addition to clarifying guidance on testing and interpretation of results obtained from marine BSTs (such as pass criteria, lag phases, freshwater read across and complex substances). Methodologically: (i) increasing bacterial cell concentrations to better represent the bacterial diversity inherent in the sampled environments; and (ii) increasing test durations to investigate extended lag phases observed in marine assessments, were recommended to be validated in a multi-institutional ring test.

This group case study describes the course of an eight-session mindfulness-based intervention (MBI) for nonclinical, yet psychologically distressed, individuals in a university setting. The present MBI was adapted from mindfulness-based cognitive therapy (MBCT), which was initially developed for treatment-resistant depressed patients. The treatment rationale and its application to a university population are discussed and the protocol is described session-by-session along with the therapeutic process of change targeted in each session. Treatment feasibility, acceptance, and patient satisfaction are reviewed in consideration of outcome and process of change variables as captured by quantitative and qualitative data. The complicating factors, accessibility, and barriers of the group format, and treatment implications of MBIs are considered within the context of an ethnically diverse university sample. Furthermore, we provide recommendations for clinicians in university settings, highlighting how MBIs can be used as a transdiagnostic treatment for stress, anxiety, and depressogenic thinking in ethnically diverse populations.

Congenital anomalies of the head and neck manifest from errors in its complex embryology developing into mature structures. These abnormalities may herald at birth or become evident later in life, even to the tenth decade. The results of aberrant development may be difficult to diagnose, but knowledge of the relevant embryological pathways is key to identification and successful treatment. This chapter reviews the anomalies of the embryonic neck tissues: the branchial apparatus, skin and adnexal tissues, mesoderm, and skeleton.

Current biodegradation screening tests are not specifically designed for persistence assessment of chemicals, often show high inter- and intra-test variability, and often give false negative biodegradation results. Based on previous studies and recommendations, an international ring test involving 13 laboratories validated a new test method for marine biodegradation with a focus on improving the reliability of screening to determine the environmental degradation potential of chemicals. The new method incorporated increased bacterial cell concentrations to better represent the microbial diversity; a chemical is likely to be exposed in the sampled environments and ran beyond 60 days, which is the half-life threshold for chemical persistence in the marine environment. The new test provided a more reliable and less variable characterization of the biodegradation behavior of five reference chemicals (sodium benzoate, triethanolamine, 4-nitrophenol, anionic polyacrylamide, and pentachlorophenol), with respect to REACH and OSPAR persistence thresholds, than the current OECD 306 test. The proposed new method provides a cost-effective screening test for non-persistence that could streamline chemical regulation and reduce the cost and animal welfare implications of further higher tier testing.

This chapter discusses bias in diagnostic decision making within the Diagnostic Statistical Manual of Mental Disorders (DSM) and its use. More specifically, we address three aspects of DSM and psychiatric diagnosis that make clinicians and researchers vulnerable to making a biased diagnostic decision. These are (a) value-laden, and yet vague, concepts of mental disorder, upon which the entire DSM nosology is based; (b) criterion biases, biases within diagnostic criteria for specific disorders themselves; and (c) clinician bias, bias unfolding in a clinician–client interaction. We then argue that great attention should be paid to the intersection of psychiatric diagnosis and diversity, where the mismatch of a client’s social contingencies with a clinician’s social contingencies are likely to unfold. Finally, we recommend further clarification and examination of bias in psychiatric diagnosis in order to best understand it and how diagnostic decision making may be linked to clinical competency so that we may position ourselves to better serve the clients who seek our help.

Purpose The primary purpose of this study was to report the prevalence of femoral head articular damage in patients with a central acetabular osteophyte (CAO) that was identified during hip arthroscopy and compare it with that in a matched control group without a CAO. A secondary purpose was to identify rates of coexisting intra-articular pathology in both patient groups. Methods Intraoperative data were collected prospectively on all hip arthroscopy patients at our institution between 2008 and 2015. The inclusion criteria for this study were CAOs identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement. The exclusion criteria were Tonnis grade greater than 0, previous hip conditions, and prior surgical interventions. The matched control group was selected based on sex, age ± 5 years, body mass index, and Workers' Compensation claim at a 3:1 ratio and comprised patients who underwent hip arthroscopy for a labral tear and/or femoroacetabular impingement without a CAO. The size and location of labral tears and chondral lesions were recorded in square millimeters with a 5-mm probe and by the clock-face method. Results The CAO group consisted of 126 patients, who were matched to 378 patients in the control group. Femoral and acetabular chondral damage grades were significantly different between the 2 groups ( P 2 in the CAO group and 1.7 cm 2 in the control group. The mean size of acetabular chondral damage was 1.7 cm 2 in the CAO group and 1.2 cm 2 in the control group. Both femoral and acetabular chondral damage sizes were significantly larger in the CAO group ( P ≤ .007). The prevalence of ligamentum teres tears was significantly different between the 2 groups ( P P = .625). Conclusions This study showed that patients with CAOs had a significantly higher prevalence of femoral chondral damage and ligamentum teres tears than matched controls. Level of Evidence Level III, comparative study.

Introduction Herbal medicine and other forms of complementary and alternative medicine (CAM) are used to treat symptoms of psychiatric disorders in the United States, including anxiety and mood problems. In Traditional Tibetan Medicine anxiety and depression are commonly treated with an herbal compound known as Agar-35. Objective The objective of this pilot study was to explore whether Agar-35 tea would improve anxiety, affect, stress, and rumination. Methods Undergraduate psychology students ( N =14) were randomized to drink either Agar-35 tea ( n =6) or placebo tea ( n =8) for 7 nights. Results The results indicated that Agar-35 significantly reduced participants' negative affect compared to placebo, U = 6.0, p = .019, effect size, r = .63. Further, Agar-35 also reduced anxiety (trending toward significance), U = 10.0, p = .071, effect size, r = .48. Conclusion In accordance with its use in Tibetan Medicine, these preliminary findings suggest that Agar-35 may benefit aspects of psychological health.

Background Long segment tracheobronchial stenosis is a rare congenital anomaly that can also occur in combination with abnormal bronchial arborization. Long segment tracheal reconstruction in the setting of a supernumerary bridging bronchus has been reported; however, these repairs can be particularly complex. We present our experience using the bridging bronchus to augment long segment tracheal stenosis with a side-to-side tracheobronchoplasty. Methods Four patients with complex long segment tracheobronchial stenosis involving a bronchus suis (right upper lobe bronchus) and a bridging bronchus presented with refractory respiratory distress requiring urgent tracheal reconstruction. Patient 1 was initially managed with modified slide tracheoplasty and tracheostomy. Patients 2, 3, and 4 were managed with single-stage procedures. All patients underwent definitive long segment tracheobronchoplasty consisting of a side-to-side anastomosis between the bridging bronchus and the right upper lobe bronchus. Results Age at surgery was 569, 69, 24, and 142 days, respectively. Weight at surgery was 9.3, 4.3, 2.7, and 5.9 kg. All patients were weaned from mechanical ventilation at 84, 13, 47, and 8 days after side-to-side tracheobronchoplasty. All patients were alive and free from tracheostomy at follow-up of 6.7, 3.8, 2.7, and 0.5 years. Conclusions Side-to-side tracheal reconstruction is feasible in severe cases of long segment tracheal stenosis with a right upper lobe bronchus and a bridging bronchus. This technique can be successfully applied in high-risk patients and in the neonatal period and can provide excellent midterm results.

Purpose To report clinical outcomes in patients with borderline dysplasia undergoing an arthroscopic technique of labral seal restoration with minimal acetabular rim resection and capsular plication. Methods Patients younger than 40 years with a lateral center-edge angle of 18° greater and 25° or less and 2-year follow-up after undergoing an arthroscopic technique of labral seal restoration with minimal rim resection (≤2 mm) and capsular plication (3-5 sutures placed in an oblique orientation to create an imbrication and inferior shift) were included. Patients underwent arthroscopy for symptoms that had marginal improvement with a minimum 6-week structured physical therapy program. Patients with a Tonnis grade of 1 or greater, a center-edge angle of 17° or less, and Legg-Calve-Perthes disease were excluded. The following patient-reported outcomes (PROs) were recorded prospectively but retrospectively reviewed: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score–Sports-Specific Subscale, and Hip Outcome Score–Activities of Daily Living. The visual analog scale score, patient satisfaction score, complications, and revision procedures were also recorded. A 2-tailed paired t test was used to analyze change in preoperative to postoperative PRO scores. Significance was defined as P Results During the study period, 232 hip arthroscopies were performed in patients with a lateral center-edge angle between 18° and 25°. The inclusion criteria were met by 59 procedures. Of these procedures, 55 (93.2%) were available for follow-up. The labrum was repaired, debrided, and reconstructed in 37 procedures, 17 procedures, and 1 procedure, respectively. The iliopsoas was released in 34 procedures, the ligamentum teres was debrided in 29, and femoral osteoplasty was performed in 32. At 2-year follow-up, there was significant improvement in the mean scores of all PROs compared with baseline. Mean improvements for the modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, and Non-Arthritic Hip Score were 20.7, 17.5, 27.6, and 20.0, respectively. There was significant improvement in the visual analog scale score at 2 years, decreasing by 3.16 compared with baseline, and the mean patient satisfaction score was 8.09, with 83.6% of patients achieving a good to excellent result (patient satisfaction score ≥7). No complications were related to the procedure, and 6 patients (11%) required revision procedures (4 for labral retear, 1 for painful iliopsoas internal snapping, and 1 for removal of a symptomatic loose body). Conclusions Arthroscopic intervention that encompasses minimal rim resection, restoration of labral function, and capsular plication significantly improves outcomes in patients with borderline dysplasia who do not warrant a periacetabular osteotomy. Level of Evidence Level IV, therapeutic case series.

IMPORTANCE: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. OBJECTIVE: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. DESIGN, SETTING, PARTICIPANTS: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. MAIN OUTCOMES AND MEASURES: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. RESULTS: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, −15.0 [95% CI, −22.2 to −7.8]; P

Currently available OECD biodegradation screening tests (BSTs) are not particularly suited for persistence screening. Their duration can be much less than international half-life thresholds for persistence and they are variable and stringent, therefore prone to false negatives. The present study extended test durations beyond 28 days and increased biomass concentrations for marine BSTs to better represent the microbial diversity inherent in the sampled environment. For this so-called environmentally relevant BST (erBST) marine cell concentrations were nominally increased 100-fold by tangential flow filtration. The marine erBST was validated against a standard BST using five 14C labeled reference compounds with a range of biodegradation potentials (aniline, 4-fluorophenol, 4-nitrophenol, 4-chloroaniline and pentachlorophenol) in a modified OECD 301B test. A full mass balance was collated to follow chemical fate in the tests. The erBST was more accurate and less variable than the comparator BST in assigning the reference compounds to their expected biodegradation classifications (non-persistent or potentially persistent). According to the REACH non-persistence criterion of ≥60% biodegradation over 60 days, the erBST correctly classified 60% of chemical replicates according to their expected biodegradation classification and had a coefficient of variation of 21% between replicates. In contrast, the BST correctly assessed 40% of reference chemicals in regards to their expected biodegradation classification with a coefficient of variation of 36%. All non-persistent chemicals showed increased degradation in the erBST, except for 4-chloroaniline, which did not degrade in either BST or erBST. Both tests showed no false positive results, correctly classifying the negative control pentachlorophenol as potentially persistent. Next, it is recommended to further validate the marine erBST in an inter-laboratory study incorporating different seawater sources to fully assess its variability and reliability.

Background: As hip arthroscopy has expanded in popularity and volume, more information is needed about indications for the procedure and the predictive factors of clinical outcomes. Purpose: To evaluate clinical outcomes of hip arthroscopy in a prospective study and to analyze the cohort to identify factors that are predictive of improvement. Study Design: Case-control study; Level of evidence, 3. Methods: Data were collected prospectively on all patients undergoing hip arthroscopy between February 2008 and June 2012. We included all patients undergoing hip arthroscopy who agreed to participate and who completed 4 patient-reported outcome (PRO) instruments at a minimum 2-year follow-up: the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sport-Specific Subscale. The NAHS was selected as our primary outcome instrument. All patients with any previous hip conditions were excluded. We analyzed 34 preoperative and intraoperative variables using bivariate and multivariate analyses compared with NAHS. Results: The cohort consisted of 1038 patients with a mean follow-up of 30.1 months (range, 24.0-61.2 months). Mean age was 36.4 years (range, 13.2-76.4 years). All postoperative PRO scores showed significant improvement ( P < .001) at 2 years compared with preoperative scores. Bivariate analysis identified 15 variables (7 categorical and 8 continuous) and multivariate analysis identified 10 variables that were predictive of 2-year postoperative NAHS. Preoperative NAHS, preoperative HOS-ADL, preoperative mHHS, age, duration of symptoms, body mass index (BMI), and revision hip arthroscopy were identified as predictive factors in both bivariate and multivariate analyses. The predictive value of preoperative NAHS was accentuated for patients with higher BMI. Conclusion: This study reports favorable clinical outcomes in the largest cohort of hip arthroscopies with a minimum 2-year follow-up in the literature to date. Factors identified as predictive in both bivariate and multivariate analyses included preoperative NAHS, HOS-ADL, and mHHS; age; duration of symptoms; BMI; and revision hip arthroscopy. These predictive factors may be useful to the clinician in determining prognosis and operative indications for hip arthroscopy.

Horner syndrome results from an interruption of the oculosympathetic pathway. Patients with Horner syndrome present with a slightly droopy upper lid and a smaller pupil on the affected side; less commonly, there is a deficiency of sweating over the brow or face on the affected side. This condition does not usually cause vision problems or other significant symptoms, but is important as a warning sign that the oculosympathetic pathway has been interrupted, potentially with serious and even life-threatening processes. The oculosympathetic pathway has a long and circuitous course, beginning in the brain and traveling down the spinal cord to exit in the chest, then up the neck and into the orbit. Therefore, this syndrome with unimpressive clinical findings and insignificant symptoms may be a sign of serious pathology in the head, chest, or neck. This clinical review discusses how to identify the signs, confirm the diagnosis, and evaluate the many causes of Horner syndrome.

The role of radiofrequency energy (RFE) devices has been minimally studied in hip arthroscopy. The purpose of this study was to determine the role of RFE devices in hip arthroscopy through a systematic review of the literature. We searched the PubMed database using the following Medical Subject Heading terms: hip arthroscopy, hip radiofrequency, thermal capsulorrhaphy, thermal chondroplasty and radiofrequency debridement. Two authors independently reviewed the literature and included articles based on predetermined inclusion criteria. We excluded review, technique and experimental articles. After title and abstract review, we selected 293 articles for full-text review. Ten articles met the inclusion and exclusion criteria. For the included articles, a total of 305 hips underwent arthroscopy with concomitant RFE treatment at a mean age of 25.7 years. Eight articles presented patient-reported outcome (PRO) instruments, one study did not report an outcome instrument but utilized an evaluation of postoperative range of motion (ROM) and 1 year magnetic resonance image (MRI) and computed tomography (CT) imaging. The remaining article measured only the ROM pre- and postoperatively. Only one of the articles reviewed reported complications. Current evidence on the safety and indications for use of RFE devices in hip arthroscopy is insufficient. The literature shows mixed results regarding its use in hip arthroscopy. Although the use of thermal energy is not without risk, if used judiciously and appropriate precautions are taken to avoid damage to adjacent tissues, those devices can be useful for the treatment of certain intra-articular hip pathologies arthroscopically.

Lateral hip pain along with tenderness of the greater trochanter has been associated with greater trochanteric pain syndrome. Radiographically, this has been associated with gluteus medius pathology on magnetic resonance imaging. This has led some surgeons to conclude that abductor pathology is a primary cause of lateral hip pain. Failure of conservative treatment in the setting of gluteus medius pathology may lead to surgical intervention. In some patients a focal tear of the gluteus medius cannot be visualized and likely represents more diffuse tendinopathy. In these patients we propose micropuncture of the greater trochanter. Similar procedures have shown effectiveness in the elbow and shoulder by eliciting a healing response. Our experience suggests that trochanteric micropuncture at the insertion of the gluteus medius tendon can be effectively performed endoscopically for gluteus medius tendinopathy.

Comprehensive assessment of environmental biodegradability of pollutants is limited by the use of low throughput systems. These are epitomized by the Organisation for Economic Cooperation and Development (OECD) Ready Biodegradability Tests (RBTs), where one sample from an environment may be used to assess a chemical's ability to readily biodegrade or persist universally in that environment. This neglects the considerable spatial and temporal microbial variation inherent in any environment. Inaccurate designations of biodegradability or persistence can occur as a result. RBTs are central in assessing the biodegradation fate of chemicals and inferring exposure concentrations in environmental risk assessments. We developed a colorimetric assay for the reliable quantification of suitable aromatic compounds in a high throughput biodegradation screening test (HT-BST). The HT-BST accurately differentiated and prioritized a range of structurally diverse aromatic compounds on the basis of their assigned relative biodegradabilities and quantitative structure-activity relationship (QSAR) model outputs. Approximately 20 000 individual biodegradation tests were performed, returning analogous results to conventional RBTs. The effect of substituent group structure and position on biodegradation potential demonstrated a significant correlation (P0.05) with Hammett's constant for substituents on position 3 of the phenol ring. The HT-BST may facilitate the rapid screening of 100 000 chemicals reportedly manufactured in Europe and reduce the need for higher-tier fate and effects tests.

Background: Leukemic infiltration of the optic nerve is relatively rare. While previously described in acute leukemia, the infiltration in our case represents central nervous system (CNS) metastasis of Burkitt-type lymphoma that developed as a complication of solid-organ transplantation, resulting in a bilateral infiltrative optic neuropathy with sequential, bilateral central retinal artery occlusion (CRAO) and devastating vision loss. Methods: The medical record, serial ophthalmic examination findings, clinical course, and imaging including magnetic resonance imaging (MRI), fundus photographs, and fluorescein angiography of a single patient were retrospectively reviewed. Results: MRI demonstrated multifocal cortical and leptomeningeal CNS involvement, including the left optic nerve. Serial fundus examination/photography and fluorescein angiography showed that despite urgent whole-brain irradiation and systemic chemotherapy, CNS disease progressed to bilateral optic nerve infiltration and CRAO with no light perception vision in both eyes. Conclusion: CRAO can occur as a devastating and irreversible complication of lymphoproliferative optic nerve infiltration.

Standard OECD biodegradation screening tests (BSTs) have not evolved at the same rate as regulatory concerns, which now place an increased emphasis on environmental persistence. Consequently, many chemicals are falsely assigned as being potentially persistent based on results from BSTs. The present study increased test duration and increased inoculum concentrations to more environmentally relevant levels to assess their impact on biodegradation outcome and intratest replicate variability for chemicals with known environmental persistence. Chemicals were assigned to potential persistence categories based on existing degradation data. These more environmentally relevant BSTs (erBSTs) improved the reliability of persistence assignment by reducing the high variability associated with these tests and the occurrence of failures at low inoculum concentrations due to the exclusion of specific degraders. Environmental fate was determined using a reference set of

Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS).Twenty-one children, median age 5 months (35 days to 11 years) and weight 5.0 (2.3 to 28.0) kg have undergone anterior tracheal suspension for severe tracheobronchomalacia through median sternotomy; 15 for inability to ventilate despite mechanical respiratory support, 3 for intermittent ALTEs without mechanical respiratory support, and 3 for recurrent respiratory admissions. Nine procedures were performed as isolated ATS and 12 procedures were combined with at least 1 of the following: repair of ventricular septal defect; vascular ring; atrioventricular canal; tracheal reconstruction or arterial-pexy. Level of respiratory support was graded at preoperative (preop), discharge, and follow-up, and respiratory clinical status was graded at preop and follow-up. Median follow-up was 30.0 months (2.0 to 57.0 months).There was no mortality. Both level of respiratory support and the clinical status improved at all time points studied compared with preoperative score (p0.001) after ATS. Whether ATS was performed in isolation or combined with other procedures did not impact these findings.Anterior tracheal suspension is feasible and appears effective in dramatically improving respiratory clinical status. Tracheal suspension is applicable to a wide range of anatomic variants. Additional study is needed to characterize long-term functional outcomes.

Objective Identify laryngoscopic and functional outcomes of infants with vocal fold immobility (VFI) following patent ductus arteriosus (PDA) ligation and identify predictors of recovery. Methods Retrospective review of patients with VFI following PDA ligation from 2001 to 2012 at a single institution. Inclusion criteria were: (1) PDA ligation as only cardiac surgical procedure; (2) left VFI documented by laryngoscopy; (3) minimum follow up 120 days, with at least 2 laryngoscopies performed. Resolution of VFI was determined at follow-up laryngoscopy. Univariate logistic regression models were used to identify variables associated with VFI recovery. Results 66 subjects were included with median follow up of 3.0 (±2.1) years. The mean gestational age was 24.5 ± 1.4 weeks, mean birth weight 673 ± 167 g, and mean age at procedure was 18.6 ± 14.3 days. Patients presented with respiratory symptoms (39%), dysphonia (78%) and dysphagia (55%). Resolution of VFI was observed in 2/66 (3%) patients. Recovery was documented at 20 days and 11 months respectively. Respiratory symptoms, dysphagia, and dysphonia persisted at last follow up in 11%, 47%, and 20% of patients. Conclusions VFI associated with ligation of the ductus arteriosus has a low rate of recovery. Clinical symptoms frequently persist, and as such regular follow-up by otolaryngologists to mitigate morbidity is indicated.

Objectives Office-based lower airway endoscopy (OLAE) is not a widespread practice in children due to concerns about its safety and efficacy. In 2003, we reported on OLAE in 105 children presenting with airway symptoms and found it both safe and effective as a diagnostic tool. The current study is a follow-up to the 2003 study that reports on an additional 122 pediatric patients who received OLAE with special attention to the safety and efficacy of the procedure. Methods A retrospective review at a tertiary–quaternary pediatric institution of 122 consecutive pediatric patients in which an airway lesion, by history and initial physical exam, was determined to be present at the level of the supraglottic larynx to the carina. In all patients, airway endoscopy was performed in the office using flexible fiberoptic laryngoscopy (FFL) and the endoscope was passed beyond the glottis to assess the lower airway, including the subglottis, trachea, and carina. The diagnoses were recorded and the number of times each diagnosis was encountered as well as the percent of patients who had each diagnosis was calculated. All cases requiring operating room procedures for further diagnosis or therapy were assessed for office-based and operating room diagnostic agreement. The ease of performing the lower airway assessment and the ease with which the subglottis, trachea, and carina were visualized were graded. An assessment for complications was also performed. Results There were no complications with OLAE in any of the 122 patients. The percent of patients rated as having good visualization of anatomic structures were: 97% for visualization of the subglottis, 98% for visualization of the trachea, and 92% for visualization of the carina. In 93% of the cases the procedure was easily performed. There was excellent correlation between OLAE and operative endoscopy. Conclusion OLAE continues to be a safe, efficacious, and cost-effective tool for the diagnosis of lower airway pathology in pediatric patients.

Caution, alkyl acyl azides can rapidly decompose with heat to release large amounts of nitrogen. Care should be taken during handling: do not attempt to convert neat and avoid handling neat.

Background The risk of optic disc haemorrhages on visual outcome in idiopathic intracranial hypertension (IIH) is unknown. We report the type and frequency of optic disc haemorrhages and other funduscopic abnormalities at baseline in the study eye of the 133 subjects enrolled in the Idiopathic Intracranial Hypertension Treatment Trial completing 6 months of follow-up. Methods We reviewed optic disc photographs to tabulate the frequency and type of optic disc haemorrhages, other funduscopic abnormalities and papilloedema grades of the study eye at baseline and analyse if their presence is associated with a poor visual outcome. Results 27.2% of subjects had nerve fibre layer haemorrhages in at least one eye. Five of seven, 71% of subjects that met criteria for treatment failure, had nerve fibre layer haemorrhages in at least one eye (Fisher9s exact test: p=0.02). There was a good correlation between presence of nerve fibre layer haemorrhages and Frisen grade (Spearman9s correlation, p=0.002; r=0.271). Subjects with nerve fibre layer haemorrhages had a higher cerebrospinal fluid pressure (40.0 mm water, p=0.04). There was poor correlation between nerve fibre layer haemorrhages at baseline and the perimetric mean deviation change at 6 months. Cotton wool spots were present in 4% of subjects, exudates in 3% and pseudodrusen in 4%. Conclusions Nerve fibre layer haemorrhages are common in patients with IIH with mild visual loss and correlate with the severity of the papilloedema. They occur more frequently in treatment failure subjects and therefore may be associated with poor visual outcomes. Trial registration number NCT01003639, Post-results.

Purpose To compare the acetabular component size relative to the patient's native femoral head size between conventional THA (CTHA) approach and robotic-arm assisted THA (RTHA) to infer which of these techniques preserved more acetabular bone. Methods Patients were included if they had primary osteoarthritis (OA) and underwent total hip replacement between June 2008 and March 2014. Patients were excluded if they had missing or rotated postoperative anteroposterior radiographs. RTHA patients were matched to a control group of CTHA patients, in terms of preoperative native femoral head size, age, gender, body mass index (BMI) and approach. Acetabular cup size relative to femoral head size was used as a surrogate for amount of bone resected. We compared the groups according to 2 measures describing acetabular cup diameter ( c) in relation to femoral head diameter ( f): (i) c-f, the difference between cup diameter and femoral head diameter and (ii) ( c-f)/ f, the same difference as a fraction of femoral head diameter. Results 57 matched pairs were included in each group. There were no significant differences between groups for demographic measures, femoral head diameter, or acetabular cup diameter (p>0.05). However, measures (i) and (ii) did differ significantly between the groups, with lower values in the RTHA group (pConclusions Using acetabular cup size relative to femoral head size as an approximate surrogate measure of acetabular bone resection may suggest greater preservation of bone stock using RTHA compared to CTHA. Further studies are needed to validate the relationship between acetabular cup size and bone loss in THA.

The primary purpose of this review article is to discuss the role of diagnostic, corticosteroid, hyaluronic acid (HA) and platelet rich plasma (PRP) in the treatment of osteoarthritis (OA) and femoroacetabular impingement (FIA). These treatments play an important biological role in the non-operative management of these conditions. Two independent reviewers performed an search of PubMed for articles that contained at least one of the following search terms pertaining to intra-articular hip injection-local anaesthetic, diagnostic, ultrasound, fluoroscopic, image guided, corticosteroid, HA, PRP, OA, labral tears and FAI. Seventy-two full text articles were suitable for inclusion. There were 18 articles addressing the efficacy of diagnostic intra-articular hip injections. With respect to efficacy in OA there were 25 articles pertaining to efficacy of corticosteroid, 22 of HA and 4 of PRP. There were three articles addressing the efficacy of biologics in FAI. Diagnostic intra-articular hip injections are sensitive and specific for differentiating between intra-articular, extra-articular and spinal causes of hip symptoms. Ultrasound and fluoroscopy improves the precision of intra-articular positioning of diagnostic injections. Corticosteroids are more effective than HA and PRP in alleviating pain from hip OA. A higher dose of corticosteroids produces a longer benefit but volume of injection has no significant effect. Intra-articular corticosteroids do not increase infection rates of subsequent arthroplasty. There is currently limited evidence to warrant the routine use of therapeutic injections in the management of labral tears and FIA.

A major dilemma confronting religious educators in the utilization of short stories, film, and other emerging forms of narratives is the question of how to evaluate their “religiousness.” This can present dilemmas in the selection, analysis, and comparison of narratives for the purposes of teaching Religious Education. This article forwards useful characteristics for doing so by: (1) constructing a cross-disciplinarian conceptual framework for the comparison and analysis of religious stories, (2) extrapolating three characteristics from this conceptual framework (morality, dramatization, and verticality), and (3) using these characteristics in examining and comparing the religious elements of two short stories: Andre Dubus' “A Father's Story,” and Flannery O'Connor's “A Good Man is Hard to Find.”

A strategy for the facile alpha-amination of carboxylic acid menthyl esters is described. The resulting diastereomers, readily separable, can be individually carried on to each enantiomer of the FMOC alpha-amino acid. A variety of unnatural side chains were compatible with this approach. The menthyl ester was easily removed from the FMOC alpha-amino acid without racemization.

BACKGROUND Clinical factors such as size and location, but also surgeon experience and comfort level, may influence decisions in reconstructive methods. OBJECTIVE To survey a select group of surgeons for their reconstructive choices for a moderate-sized upper lip defect. METHODS Surveys were mailed to 313 facial plastic surgeons. Survey recipients were asked to rank reconstructive preferences for a specific upper lip defect. Response choices were correlated to predictor variables such as surgeon experience and comfort level. RESULTS Survey response was 45.6%. Cheek advancement flap was the first choice in 34.4%, followed by Abbe flap (31.2%), myocutaneous rotation flap (20.5%), and nasolabial flap (13.9%), with the nasolabial flap being statistically the least popular (p

This discussion reviews the common causes of Horner's syndrome, with emphasis on case reports from the past several years. Much of the recent literature concerns the use of apraclonidine as a diagnostic test for Horner's syndrome, possibly as an alternative for the current gold standard of cocaine eye drops. This new literature is discussed in the context of the current standards for clinical diagnosis.

Purpose: Children with V3 cutaneous infantile hemangiomas (IH) and PHACE syndrome have a high incidence for airway hemangioma, 29% and 52%, respectively. Therefore, a clinical evaluation for these high-risk children is essential. We report our experience with in-office lower airway evaluation (OLAE) in these high-risk children. Results: Since 2003, 5 children with IH of the V3 cutaneous distribution and 3 children with PHACE syndrome underwent OLAE. Average age of presentation was 2.75 months. Two children had stridor at initial evaluation, and 1 child had subglottic hemangioma. This child was evaluated serially with OLAE to monitor disease progression and treatment response. A total of 10 upper tracheoscopies were performed on the 8 patients without respiratory complications. Conclusion: An airway evaluation is essential to evaluate and manage this high-risk population. Typically, operative endoscopy requires general anesthesia. However, in these high-risk children, we have performed OLAE without sedation to evaluate the trachea. High-speed recording and playback is essential in this method. Our series demonstrates that awake OLAE is possible and may be a safe technique to evaluate and monitor disease progression in these high-risk patients. These patients avoided general anesthesia and delay in diagnosis and did not incur any complications during or after OLAE.

To assess 2-year clinical outcomes of patients who underwent hip arthroscopy for central acetabular osteophytes (CAO) treated with central acetabular decompression (CAD), and to compare these outcomes with those of a matched control group.Data were prospectively gathered for patients undergoing CAD during hip arthroscopy from February 2008 to July 2012. All patients were assessed pre- and postoperatively at 3 months, 1 year, and 2 years with modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and visual analog scale (VAS) for pain. Patient satisfaction (0 to 10) was collected. A matched control group of patients without CAOs who did not undergo CAD was selected on a 1:3 ratio.Forty-nine hips were included in the CAD group and 147 in the control group. The mean change in patient-reported outcome (PRO) scores at 2-year follow-up in the CAD group for modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, Non-Arthritic Hip Score, and VAS was 11.0, 19.6, 15.2, 21.4, and -2, respectively. The mean change in PRO scores at 2-year follow-up in the control group was 17.0, 19.8, 24.0, 20.9, and -2.75, respectively. All improvements in PRO scores for both groups were statistically significant compared with the data collected preoperatively (P.001). There was no statistically significant difference in postoperative PRO scores and VAS between the groups. Postoperative patient satisfaction at the latest follow-up was 7.14 and 7.60 for CAD and control groups, respectively.This study showed that patients with a CAO treated with CAD during hip arthroscopy had favorable outcomes at minimum 2 years postoperatively. Furthermore, the study group showed similar PRO scores and VAS to the control group. We conclude that CAD is a viable treatment option for CAO, yielding clinical improvement at short-term follow-up.Level III, prospective comparative study.

To perform a proper labral repair, most surgeons use anchors to secure the labrum to the acetabular bone. We aim to describe a technique for labral repair with a knotless tensionable suture anchor. This technique uses a looped suture configuration, allowing selective tensioning of the repair to maintain the anatomic suction seal of the hip. The use of this technique is easily reproducible and reduces the surgical time compared with previous techniques.

The labrum of the hip is recognized as being important to the stability of the hip and a major cause of hip pain. Damage to the labrum may result in increased joint stress and articular damage. Labral damage is often treated through various methods, among them simple stitch repair, base refixation, and debridement. Labral reconstruction becomes necessary when the labrum is too damaged to salvage, which renders labral repair improbable and labral debridement ineffective. In contrast to other methods that have been described for this treatment, our technique uses a semitendinosus allograft as a graft source, allowing for arthroscopic hip labral reconstruction. This technique has many advantages and is easily reproducible. It has shown promising results in patients with labral damage. The purpose of this article is to detail the step-by-step surgical technique of labral reconstruction using a semitendinosus allograft, in addition to the indications, pearls, and pitfalls of the technique.