Child abuse and fabricated or induced illness in the ENT setting: a systematic review

Background Child maltreatment is persistently under-recognised. Given that a third of maltreated children may return with serious or fatal injuries, it is imperative that otolaryngologists who are in frequent contact with children are able to detect maltreatment at first presentation. Objective of review This review aims to identify ENT injuries, signs or symptoms that are indicative of physical abuse or fabricated or induced illness (child maltreatment). Type of review Systematic review. Search strategy An all-language search, developed in Medline Ovid and consisting of 76 key words, was conducted of published and grey literature across 10 databases from inception to July 2015, for primary observational studies involving children aged <18 years. Evaluation method Each relevant article underwent two independent reviews with full critical appraisal, applying strict quality standards. Results Of the 2448 studies identified and screened, 371 underwent full review, resulting in 38 included studies that detailed 122 maltreated children. Pharyngeal perforations (n = 20) were the most frequent abusive ENT injury, predominantly affecting neonates and infants, presenting with dysphagia, drooling, haemoptysis and surgical emphysema. At least 52% of children with abusive pharyngeal injuries had additional co-existent injuries. The majority of ear injuries were inflicted to the external ear (n = 11) and included auricular deformity, abrasions, petechiae, lacerations and burns. Fabricated or induced illness cases presented most commonly with recurrent, unexplained otorrhoea or ENT lesions that failed to heal despite appropriate therapy. Conclusions All clinicians should be familiar with the signs of child maltreatment. Pharyngeal injuries, or injuries to the external ear, presenting in young children without an explicit history of witnessed injury should prompt a child protection referral for full evaluation. Likewise, children who present with recurrent, or apparently intractable symptoms and signs despite appropriate treatment, should raise the possibility of fabricated or induced illness, and discussion with a child protection specialist is advised. Early recognition of possible child maltreatment and instigation of appropriate safeguarding measures are essential to prevent repetition and escalation of injury. This is of paramount importance to otolaryngologists, who have the potential to identify these children in their practice

A critical edition of the linguistic dictionary Tahḏīb Al-Khawāṣ Min Durrat Al-Ghawwāṣ a critical edition by Ibn Manẓūr, 711/1311

After studying this linguistic dictionary in manuscript: Al-Tahḏīb by Ibn Manẓūr, I realised the importance of studying and editing the manuscript. This research on Tahḏīb and the development of lexical studies and linguistics led me to note the strong relationships between classical and modern studies especially in Arabic linguistics. Here we can follow the developments of texts and the ideas behind them, both in dictionaries of different schools and in general linguistic works, from the beginnings of the study of the Arabic language, tracing the influence of Arabic studies on that of some eastern and western languages in the mediaeval period. Arabic grammar was developed by treating problems in spoken language. People were in need of rules to help them acquire correct style, to be able to understand the meaning of Qur’ān and Ḥadīth. The scholars, whose work has influenced present-day Arab linguistics and grammatical theory, based their studies on Qur’ānic texts and quotations taken from early poetry. The method of study was generally inductive. Moving from the particular to the general, the scholars discussed various language phenomena in booklets and books concerned with texts, listing words which they had heard from Arabs employing their own local usages and dialects. These indexes became the data of the lexicons and linguistic books. From the first study of Arabic, the linguists dealt with Al-Laḥn, the phenomena affecting the pronunciation of Arabic, observing the errors in the speech of the ordinary people, of the educated people, and even of the scholars. Al-Durrah by Al-Ḥarīrī was one of the most famous works in Arabic linguistics. To treat the scholars' errors rather than those of the ordinary people, it follows no system or method in its structure. Ibn Manẓūr had to classify its lexical items and to arrange them on his Lisān Al-Arab system, with a special critical approach. Some books written before Al-Durrah had the same aim to note Al-Laḥn. In Al-Durrah we can follow the train of those books, which dealt with linguistic materials, especially Adab Al-Kātib by Ibn Qutaiba which we consider an ancient precursor of Al-Durrah and on the other hand of Al- Tahḏīb, the dictionary which we are here editing for the first time

Designing and implementing a novel single IFFT scrambling PAPR reduction scheme in OFDM systems using FPGA with hardware co-simulation

This paper presents a novel low complexity technique for reducing the peak-to-average power ratio (PAPR) in orthogonal frequency division multiplexing systems followed by an efficient hardware co-simulation implementation of this technique by using a Xilinx system generator on field programmable gate array. In this technique, the output of inverse fast Fourier transforms (IFFT) is partitioned into M subblocks, which are subsequently interleaved. Then, a new optimization scheme is introduced in which only a single two phase sequence need to be applied. Unlike the conventional partial transmit sequence (C-PTS) which needs M-IFFT blocks and WM−1 iterations, the proposed technique requires only a single IFFT block and M iterations. These features significantly reduce processing time and less computation that leads to reduced complexity. Simulation results demonstrate that the new technique can effectively reduce the complexity up to 99.95% compared with the conventional PTS (C-PTS) technique and yields good PAPR performance. The good PAPR performance arises from the effect of both the data interleaving and the new optimization technique. Through the comparison of performance between simulation and hardware, it is distinctly illustrated that the designed hardware block diagram is as workable as the simulation, and the difference of the result is only 0.1 dB

Adaptive cancellation of localised environmental noise

Noise cancellation systems are useful in applications such as speech and speaker recognition systems where the effects of environmental noise have to be taken into considerations. A robust method for the cancellation of localised noise in noisy speech signals using subband decomposition and adaptive filtering is presented and described in this paper. The subband decomposition technique is based on low complexity octave filters that split the noisy speech input into subsidiary bands. A thresholding technique is then applied to the subbands to determine the presence or absence of environmental noise. This is used to control an adaptive filter which only responds to the noisy parts of the speech spectrum hence localising the adaptation process only on these segments. The Normalised Least Mean Squares algorithm (NLMS) is used for the adaptation process. A comparison with a similar system without localising the environmental noise shows the superior performance of the proposed system. It has been shown to perform better in terms of computational costs and convergence rate when compared to a system that does not take advantage of the information regarding the presence or absence of noise in a specific part of the speech spectrum. More than 35 dB of noise has been eliminated in less iterations than in conventional approach which needs longer time to reach steady state

A novel low complexity high efficiency hybrid PAPR reduction for OFDM systems

In this paper, we propose a novel hybrid multiplicative-additive technique to reduce the peak-to-average power ratio (PAPR) in orthogonal frequency division multiplexing (OFDM) systems. This technique consists of two inverse fast Fourier transform (IFFT) blocks. The input symbols of the first IFFT are the mapped symbols, whereas the input symbols of the second IFFT are the summations of the absolute value of the real part of the outer signal constellation points and zeros symbols. First, the output of the two IFFT blocks is partitioned into four subblocks, which are subsequently used to rearrange the subblocks with padding zeros in a specific manner. Then, a new optimization scheme is introduced, in which only a single two-phase sequence and four iterations needs to be applied. Numerical analysis shows that the hybrid proposed technique achieves better bit error rate (BER) and PAPR reduction performance than partial transmit sequences (PTS) multiplicative technique and tone reservation (TR) additive PAPR technique. The other salient feature of this scheme is that no side information (SI) is needed which increases transmission efficiency

A hermite interpolated LUT for RF power amplifiers

Digital predistortion is one of the most widely used techniques to linearize a power amplifier (PA) to reduce the error vector magnitude (EVM) distortion and spectral regrowth. By far, the lookup table (LUT) predistorters are most frequently used scheme to mitigate the effects of non-linear power amplifier. In this paper, a new algorithm of joint-polynominal LUT predistorter which attains the best linearization performance is proposed. The algorithm employs the hermite interpolation LUT, which has a higher accuracy of interpolation. Simulation results show that the proposed method provides a better rejection of EVM distortion and an improvement of 30-40% of adjacent channel leakage ratio (ACLR) for the wideband code division multiple access at a minimal memory usage

Efficiency of osseodensification versus screw expansion technique for augmentation of narrow alveolar ridges: A comparative clinical study

Background: Alveolar ridge expansion is proposed when the alveolar crest thickness is ≤5 mm. The screw expansion technique has been utilized for many years to expand narrow alveolar ridges. Recently, the osseodensification technique has been suggested as a reliable technique to expand narrow alveolar ridges with effective width gain and as little surgical operating time as possible. The current study aimed to compare osseodensification and screw expansion in terms of clinical width gain and operating time. Materials and methods: Forty implant osteotomies were performed in deficient horizontal alveolar ridges (3–5 mm). A total of 19 patients aged 21–59 years were randomized into two groups: the screw expansion group, which involved 20 osteotomies performed by screw expander drills, and osseodensification group, which comprised 20 osteotomies achieved by osseodensification drilling technique. One millimetre below the alveolar bone crest was measured with a bone caliper at two intervals (before implant osteotomy and after implant osteotomy), and operating time was assessed. Results: Before expansion, the mean alveolar ridge width was 4.20 ± 0.71 mm in the osseodensification group and 4.52 ± 0.53 mm in the screw-expansion group. No statistically significant difference in alveolar bone width before expansion was found between the groups (P > 0.05). After the expansion of the alveolar ridge with osseodensification or screw expansion techniques, the average ridge width was 5.48 ± 0.57 mm in the osseodensification group and 5.71 ± 0.53 mm in the screw-expansion group. Difference in width gain postoperatively between the groups was 0.09 mm, which was not statistically significant (P > 0.05). According to operating time, osseodensification consumed 6.21 ± 0.55 minutes, and screw expansion required 16.32 ± 0.60 minutes for a single implant with a significant difference between the groups (P < 0.0001). Conclusion: Alveolar bone expansion by osseodensification showed comparable width gain and less surgical operating time compared with expansion by screw expansion technique

An animal tissue simulation assessing three directional displacement forces on five common tracheostomy securing techniques

Introduction Several methods of securing a tracheostomy tube have been described in the literature including using ties or tapes around the neck and suturing the plastic flange to the neck in various ways. However, there are no wet lab-based studies to objectively determine the force required to displace the tracheostomy tube using different securing techniques. Ours is the first animal tissue simulation study published in the literature. Methods A simulated tracheostomy stoma was created on a sheep neck model. A tracheostomy tube was inserted into the stoma and secured using various methods. Tension tests were conducted to significantly displace the tube from the stoma. Each technique was repeated six times on different sheep necks. All results were analysed using SPSS®. Results Repeat measurements indicated that the largest displacement forces come from an oblique direction while the lowest force values were found at the lateral angle. Averages of displacement showed that medially placed sutures required the largest forces in comparison with other securing methods. Wilcoxon signed-rank testing indicated that medial and continuous suture security resists displacement at forces that otherwise displace flange and interrupted sutures. Conclusions This study has shown that any type of securing suture requires a greater displacement force than the strap of the tracheostomy tube holder alone. Medially placed sutures require a greater displacement force than those placed laterally. Displacement in the lateral direction requires the least force in comparison with movement at perpendicular or oblique angles

Sensitivity of human papillomavirus-positive and -negative oropharyngeal cancer cell lines to ionizing irradiation

Human papillomavirus‑positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) has increased in incidence and has a much better prognosis than HPV‑negative (HPV‑) OPSCC with radiotherapy alone, but exactly why is unknown. The present study therefore aimed to further examine the sensitivity and possible changes in gene expression of several HPV+ and HPV‑ OPSCC, including various novel cell lines, upon ionizing irradiation (IR). Previously established HPV+ UM‑SCC‑47, UPCI‑SCC‑90, CU‑OP‑2, CU‑OP‑3 and HPV‑ UM‑SCC‑4, UM‑SCC‑6, UM‑SCC‑74a, UM‑SCC‑19 and newly established CU‑OP‑17 and CU‑OP‑20, characterised here, were subjected to 0‑6 Gy. Surviving fractions of each cell line were tested by clonogenic assays, and irregularities in cell cycle responses were examined by flow cytometry, while changes in gene expression were followed by mRNA sequencing. HPV+ OPSCC cell lines showed greater variation in sensitivity to ionizing irradiation (IR) and tended to be more sensitive than HPV‑ OPSCC cell lines. However, their IR sensitivity was not correlated to the proportion of cells in G2 arrest, and HPV‑ cell lines generally showed lower increases in G2 after IR. Upon IR with 2 Gy, mRNA sequencing revealed an increase in minor HPV integration sites in HPV+ cell lines, and some changes in gene expression in OPSCC cell lines, but not primarily those associated with DNA repair. To conclude, HPV+ OPSCC cell lines showed greater variation in their sensitivity to IR, with some that were radioresistant, but overall the HPV+ OPSCC group still tended to be more sensitive to IR than the HPV‑ OPSCC group. In addition, HPV+ OPSCC lines were more frequently in G2 as compared to HPV‑ cell lines, but the increase in G2 arrest upon IR in HPV+ OPSCC was not correlated to sensitivity to IR. Increases in minor HPV integration sites and changes in gene expression were also demonstrated after irradiation with 2 Gy

Energy efficient CF-OFDM scheme with single IFFT modulator for broadband wireless devices

In many low-cost mobile device applications, the drawback of high crest factor (CF) may outweigh all the potential benefits of broadband communication systems. Orthogonal frequency division multiplexing (OFDM) is considered to be one of the important multicarrier standards in broadband communication systems. However, high CF is the major problem of OFDM, which may have a deleterious effect on battery lifetime on broadband wireless devices. Therefore, applying a low-complexity high-efficiency technique in recent communications standard will significantly reduce the complexity of those systems and bring down the cost of the system. In this paper, a novel scrambling CF reduction scheme to reduce the CF in OFDM systems is proposed. In this scheme, two re-ordering methods are proposed. Then, a new optimization scheme is introduced in which only a single two-phase sequence need to be applied. Unlike the conventional-partial transmit sequence (C-PTS) scheme which needs Q-IFFT modulators, the proposed scheme requires only a single IFFT modulator. This feature significantly reduces processing time and less computation that leads to reduced complexity. Simulation results demonstrate that the proposed scheme can effectively reduce the complexity compared with the conventional and latest CF reduction scheme and yields good CF performance