International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

The Bifurcated Frontal Sinus

Objectives Frontal sinus anatomy is complex, and multiple variations of ethmoid pneumatization have been described that affect the frontal outflow tract. In addition, the lumen proper of the frontal sinus may exist as 2 separate parallel cavities that share an ipsilateral outflow tract. This variant has not been previously described and may have implications for surgical management. Study Design Case series. Setting Tertiary rhinology practice. Subjects and Methods Cases with radiographic and intraoperative findings of separate parallel tracts within a unilateral frontal sinus were identified from a consecutive series of 186 patients who underwent endoscopic sinus surgery between May 2015 and July 2016. Data were recorded including sinusitis phenotype, coexisting frontal cells, and extent of surgery. Results Ten patients (5.4%) were identified with computed tomography scans demonstrating bifurcation of the frontal sinus into distinct medial and lateral lumens. All cases were treated with Draf 2a or 2b frontal sinusotomy with partial removal of the common wall to create a unified ipsilateral frontal ostium. Eleven sides had a coexisting ipsilateral agger nasi cell, 7 had a supra-agger cell, 8 had a suprabullar cell, and 1 had a frontal septal cell. There were no significant complications. Conclusion The bifurcated frontal sinus is an anatomic variant that the surgeon should recognize to optimize surgical outcomes. Failure to do so may result in incomplete clearance of the sinus and residual disease. The bifurcated sinus may occur with other types of frontal sinus cells and may be safely treated with endoscopic techniques

An efficient high frequency drive circuit for GaN power HFETs

The requirements for driving gallium nitride (GaN) heterostructure field-effect transistors (HFETs) and the design of a resonant drive circuit for GaN power HFET switches are discussed in this paper. The use of wideband III-nitride (such as GaN) devices today is limited to telecom and low-power applications. The current lack of high-frequency high-power drivers prevents their application in power converters. The proposed circuit is based upon resonant switching transition techniques, by means of an LC tag, to recover part of the power back into the voltage source in order to reduce the power loss. This circuit also uses level shifters to generate the zero and negative gate-source voltages required to turn the GaN HFET on and off, and it is highly tolerant to input-signal timing variances. The circuit reduces the overall power consumed in the driver and thus reduces the power loss. This is particularly important for high-frequency driver operation to take full advantage, in terms of efficiency, of the superior switching speed of GaN devices. In this paper, the topology of the low-power-loss high-speed drive circuit is introduced. Some simulation results and preliminary experimental measurements are discussed

A resonant drive circuit for GaN power MOSHFET

The rapid development of the research on Gallium Nitride semiconductor material and the unique properties of GaN (such as high electron mobility and saturation velocity, high sheet carrier concentration at hetero-junction interfaces, high breakdown voltages, and low thermal- impedance) make the material promising in high-power, high-temperature applications. Accordingly, a design for a drive circuit for GaN switches is increasingly in demand. Until now, however, specific gate drivers for GaN switches are not available yet. In this paper, a new resonant drive circuit for GaN power MOSHFET switches is discussed. This circuit employs a resonant LC tag to recover part of the power back into the voltage source in order to reduce the power loss. It also applies a topology which can increase the voltage level relative to the energy supply, generate the zero and negative gate-source voltages required to turn the GaN MOSHFET on and off, and make the circuit highly tolerant to input signal timing variance. This function reduces the overall power consumed in the driver and thus reduces the power loss. This is particularly important for high-frequency driver operation, to take full advantage of the superior switching speed of GaN devices. In this paper, the topology of the low-power-loss, high-speed drive circuit will be introduced and the simulation results will be discussed

Longitudinal trends in enrollees’ employment and student status after Medicaid expansion

Abstract Background Medicaid community engagement requirements previously received federal approval in 12 states, despite limited data on their impact on enrollees’ employment-related activities. Our objective was to assess longitudinal changes in enrollees’ employment and student status after implementation of Michigan’s Medicaid expansion. Methods Longitudinal telephone survey of Michigan Medicaid expansion enrollees in 2016 (response rate [RR] = 53.7%), 2017 (RR = 83.4%), and 2018 (N = 2,608, RR = 89.4%) serially assessing self-reported employment or student status. Survey responses were benchmarked against statewide changes in assessed similar low-income adults in the U.S. Census Bureau Current Population Survey. We used mixed models with individual random effects to assess changes in the proportion of enrollees who were employed or students by year. Results Most respondents had incomes < 100% FPL (61.7% with 0–35% of the federal poverty level [FPL], 22.9% with 36–99% FPL, and 15.4% with 100–133% FPL), 89.3% had at least a high school diploma/equivalent, and they ranged in age (39.6% age 19–34, 34.5% age 35–50, 25.9% age 51–64). Employment or student status increased significantly among Michigan Medicaid expansion respondents, from 54.5% in 2016 to 61.4% in 2018 (P < 0.001), including among those with a chronic condition (47.8% to 53.8%, P < 0.001) or mental health/substance use disorder (48.5% to 56.0%, P < 0.001). In contrast, the statewide proportion of low-income non-elderly adults who were employed or students did not change significantly (from 42.7% in 2016 to 46.0% in 2018, P = 0.57). Conclusions Medicaid expansion, absent a community engagement requirement, was associated with increased employment and related activities. The role of Medicaid in providing safety-net coverage to individuals during times of economic stress is likely to grow.http://deepblue.lib.umich.edu/bitstream/2027.42/173785/1/12913_2022_Article_7599.pd

Numerical study of GaN-on-Si HEMT breakdown instability accounting for substrate and packaging interactions

The electron and hole impact-ionization coefficients in AlxGa1-xN have been calibrated through a Chynoweth law by using a Monte Carlo theoretical study and experimental data at different ambient temperatures. The model has been used to investigate the breakdown characteristics in AlGaN/GaN HEMTs. The concurrent effect of charge trapping in the GaN buffer and impact-ionization generation in the device failure mechanism has been studied by simulating the off-state breakdown under a dc stress. The sensitivity of the AlGaN/GaN HEMT to parasitic charging in molding compound has been investigated by incorporating the passivation and encapsulation layers in the TCAD setup and implementing the conductivity losses in the mold compound at high temperature

Geographic Variation in Medicaid Acceptance Across Michigan Primary Care Practices in the Era of the Affordable Care Act.

Coverage and access have improved under the Affordable Care Act, yet it is unclear whether recent gains have reached those regions within states that were most in need of improved access to care. We examined geographic variation in Medicaid acceptance among Michigan primary care practices before and after Medicaid expansion in the state, using data from a simulated patient study of primary care practices. We used logistic regression analysis with time indicators to assess regional changes in Medicaid acceptance over time. Geographic regions with lower baseline

Sensitivity and Specificity of Cetuximab-IRDye800CW to Identify Regional Metastatic Disease in Head and Neck Cancer

Purpose: Comprehensive cervical lymphadenectomy can be associated with significant morbidity and poor quality of life. This study evaluated the sensitivity and specificity of cetuximab-IRDye800CW to identify metastatic disease in patients with head and neck cancer. Experimental Design: Consenting patients scheduled for curative resection were enrolled in a clinical trial to evaluate the safety and specificity of cetuximab-IRDye800CW. Patients (n = 12) received escalating doses of the study drug. Where indicated, cervical lymphadenectomy accompanied primary tumor resection, which occurred 3 to 7 days following intravenous infusion of cetuximab-IRDye800CW. All 471 dissected lymph nodes were imaged with a closed-field, near-infrared imaging device during gross processing of the fresh specimens. Intraoperative imaging of exposed neck levels was performed with an open-field fluorescence imaging device. Blinded assessments of the fluorescence data were compared to histopathol-ogy to calculate sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). Results: Of the 35 nodes diagnosed pathologically positive, 34 were correctly identified with fluorescence imaging, yielding a sensitivity of 97.2%. Of the 435 pathologically negative nodes, 401 were correctly assessed using fluorescence imaging, yielding a specificity of 92.7%. The NPV was determined to be 99.7%, and the PPV was 50.7%. When 37 fluorescently false-positive nodes were sectioned deeper (1 mm) into their respective blocks, metastatic cancer was found in 8.1% of the recut nodal specimens, which altered staging in two of those cases. Conclusions: Fluorescence imaging of lymph nodes after systemic cetuximab-IRDye800CW administration demonstrated high sensitivity and was capable of identifying additional positive nodes on deep sectioning