Can Symptoms Differentiate Between Chronic Adenoiditis and Chronic Rhinosinusitis in Pediatric Patients

The purpose of this article is to differentiate pediatric patients with chronic adenoiditis from those with chronic rhinosinusitis (CRS) based on presenting symptoms. A chart review from a tertiary care facility with pediatric patients who presented with suspected CRS from 2006 to 2014 was identified. We compared patient characteristics, clinical symptoms, duration of symptoms, and past medial history using univariate and multivariate logistic regression models. Based on recent literature, utilizing the computed tomography (CT) score, we identified those children with CRS versus those with chronic adenoiditis. Of the 99 pediatric patients included, 22 patients had diagnosis of adenoiditis and 77 had diagnosis of CRS. When purulent rhinorrhea was present with facial pain, CRS was statistically more prevalent than chronic adenoiditis (P = .017). Symptoms including cough (P = .022), rhinorrhea (P = .27), and facial pressure (P = .98) were not predictive of one diagnosis over the other. Past medical history of asthma or allergy was similar in both groups. Smoke exposure was associated with CT scores \u3e5 (odds ratio 2.4, 95% confidence interval, 0.799-7.182). We conclude that purulent rhinorrhea in the presence of facial pain is more indicative of CRS versus chronic adenoiditis. For all other children, an adenoidectomy without the need for a CT scan can be entertained

Transparency of law making and fiscal democracy in the Middle East

Fiscal democracy is the capacity of the legislature to make budgetary choices in response to the emerging needs of citizens. This study indicates that, in Middle Eastern countries, there are specific limitations to fiscal democracy in the process of law-making: most notably the lack of attention to financial impact assessments (FIAs). Without systematic FIAs, mandatory out-of-budget allocations are inadvertently included in public spending, as they do not require parliamentary approval within the regular budgeting process. The low level of effective citizens’ engagement in the process of law-making worsens the situation. Budgetary decisions are not well informed by national priorities and preferences. This study utilizes the dataset of the Open Budget Index (OBI) to measure the quality of the law-making process of the budget law in a sample of Middle Eastern countries. The study concludes with recommendations on mapping the law-making process to increase budget transparency

Simplifying External Load Data in NCAA Division-I Men\u27s Basketball Competitions: A Principal Component Analysis

The primary purpose was to simplify external load data obtained during Division-I (DI) basketball competitions via principal component analysis (PCA). A secondary purpose was to determine if the PCA results were sensitive to load demands of different positional groups (POS). Data comprised 229 observations obtained from 10 men\u27s basketball athletes participating in NCAA DI competitions. Each athlete donned an inertial measurement unit that was affixed to the same location on their shorts prior to competition. The PCA revealed two factors that possessed eigenvalues \u3e1.0 and explained 81.42% of the total variance. The first factor comprised total decelerations (totDEC, 0.94), average speed (avgSPD, 0.90), total accelerations (totACC, 0.85), total mechanical load (totMECH, 0.84), and total jump load (totJUMP, 0.78). Maximum speed (maxSPD, 0.94) was the lone contributor to the second factor. Based on the PCA, external load variables were included in a multinomial logistic regression that predicted POS (Overall model, p \u3c 0.0001; AUCcenters = 0.93, AUCguards = 0.88, AUCforwards = 0.80), but only maxSPD, totDEC, totJUMP, and totMECH were significant contributors to the model\u27s success (p \u3c 0.0001 for each). Even with the high significance, the model still had some issues differentiating between guards and forwards, as in-game demands often overlap between the two positions. Nevertheless, the PCA was effective at simplifying a large external load dataset collected on NCAA DI men\u27s basketball athletes. These data revealed that maxSPD, totDEC, totJUMP, and totMECH were the most sensitive to positional differences during competitions. To best characterize competition demands, such variables may be used to individualize training and recovery regimens most effectively

Assessment of Pediatric Middle Ear Effusions With Wideband Tympanometry.

OBJECTIVE: To determine if wideband tympanometry (WBT) can differentiate types of middle ear effusion (MEE): serous, mucoid, and purulent. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care children\u27s hospital. METHODS: Children who met American Academy of Otolaryngology-Head and Neck Surgery\u27s guidelines for ventilation tube insertion had WBT after anesthesia induction but before tympanotomy. MEE was categorized into 1 of 4 comparison groups: serous effusion, mucoid effusion, purulent effusion, or no effusion. WBT measurements were averaged to 16 one-third octave frequency bands, and comparison of the absorbance patterns for each MEE type was performed through a linear mixed effects model. RESULTS: A total of 118 children (211 ears) were included: 47 females (39.8%) and 71 males (60.2%). The mean age was 2.73 years (95% CI, 2.25-3.22); mean weight, 14.35 kg (95% CI, 12.85-15.85); and mean CONCLUSIONS: WBT has potential use to differentiate types of MEE and should be studied further as a tool for investigating how the natural history and management of serous and mucoid effusions may differ

Full-Body Photobiomodulation Therapy Is Associated with Reduced Sleep Durations and Augmented Cardiorespiratory Indicators of Recovery

Research is emerging on the use of Photobiomodulation therapy (PBMT) and its potential for augmenting human performance, however, relatively little research exists utilizing full-body administration methods. As such, further research supporting the efficacy of whole-body applications of PBMT for behavioral and physiological modifications in applicable, real-world settings are warranted. The purpose of this analysis was to observe cardiorespiratory and sleep patterns surrounding the use of full-body PBMT in an elite cohort of female soccer players. Members of a women’s soccer team in a “Power 5 conference” of the National Collegiate Athletic Association (NCAA) were observed across one competitive season while wearing an OURA Ring nightly and a global positioning system (GPS) sensor during training. Within-subject comparisons of cardiorespiratory physiology, sleep duration, and sleep composition were evaluated the night before and after PBMT sessions completed as a standard of care for team recovery. Compared to pre-intervention, mean heart rate (HR) was significantly lower the night after a PBMT session (p = 0.0055). Sleep durations were also reduced following PBMT, with total sleep time (TST) averaging 40 min less the night after a session (p = 0.0006), as well as significant reductions in light sleep (p = 0.0307) and rapid eye movement (REM) sleep durations (p = 0.0019). Sleep durations were still lower following PBMT, even when controlling for daily and accumulated training loads. Enhanced cardiorespiratory indicators of recovery following PBMT, despite significant reductions in sleep duration, suggest that it may be an effective modality for maintaining adequate recovery from the high stress loads experienced by elite athletes

Dimensionality Reduction Differentiates Sensitive Force-Time Characteristics from Loaded and Unloaded Conditions throughout Competitive Military Training

The purpose was to evaluate neuromuscular fatigue’s effect on unloaded and loaded countermovement jump (CMJ) force-time characteristics during high-intensity tactical training. Eighteen male and sixteen female Marines completed two maximal effort CMJs, in unloaded (PVC pipe) and loaded (10 kg weight vest and 20 kg barbell) conditions, prior to, and 24, 48, and 72 h after starting the 4-day event. The top three variables from three principal components (PC) were analyzed using mixed-effects modeling (PC1—concentric mean power, eccentric peak force, and modified reactive strength index; PC2—countermovement depth, eccentric mean power, and eccentric mean velocity; PC3—braking duration, jump height, peak power). Metrics from PC1 and PC3 were reduced across training and from both loading conditions. Metrics from PC2 were similarly affected by external loading but were less influenced by training-induced fatigue. Jump performances with the barbell and with shallower countermovement depths did not change throughout training. Thus, 20 kg loaded CMJs are stable neuromuscular measures suitable for tracking chronic training adaptations. Monitoring unloaded and 10 kg loaded CMJ performances, along with movement strategies (i.e., countermovement rates and depth), may help identify moments of accumulated fatigue to inform training and recovery adjustments and improve the sustainability of personnel

Decision Quality Among Parents Who Are Offered Ventilation Tube Insertion for Their Children.

OBJECTIVE: To develop a Decision Quality (DQ) tool to measure parents\u27 DQ concerning ventilation tube (VT) insertion in their children. METHOD: Parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic comparing a validated Decisional Conflict (DC) scale with a DQ instrument including Shared Decision-Making (SDM) scale, parental treatment goals, and knowledge about VT. RESULTS: Of 100 parent participants, 83% were mothers and 14% were fathers. 94% elected VT insertion, 6% elected monitoring or deferred the decision. 44% of the patients were \u3c18 \u3emonths, 42% were 19 months to 3 years, and the rest were older. The mean DC score was 8.26 out of 100 (95% CI 4.82-11.69), indicating low DC. Mean DQ score was 82.45 out of 100 (95% CI 80.18-84.72), including mean SDM of 87.71 (95% CI 83.53-91.88,), mean knowledge score of 87.5% (95% CI 84.56-91.59) and mean values score of 7.16 (95% CI 6.90-7.41). Comparisons between those who elected VT and those who did not showed that electors had lower DC scores (7.15 vs 24.74, CONCLUSIONS: DQ, as measured with this tool, was higher when parents chose to place tubes. Our DQ instrument has potential use for study of why parents may decline VT when their child meets criteria for them

Bleeding Complications After Transoral Robotic Surgery: A Meta-Analysis and Systematic Review.

Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post-TORS hemorrhage. Systematic Review and Metanlysis. A systematic review of the published literature using the Cochrane Handbook for Systematic Reviews of Interventions was performed and examined TORS, postoperative hemorrhage, and the use of prophylactic transcervical arterial ligation (TAL). A total of 13 articles were included in the analysis. To date, there have been 332 cases of hemorrhage following a total of 5748 TORS. The pooled median post-TORS hemorrhage rate was 6.47%. The overall incidence of minor and major hemorrhage was 5.29% and 2.90%. Patients with prior radiation (relative risk [RR] = 1.46, 95% confidence interval [CI] = 1.00-2.12), large tumors (RR = 2.11, 95% CI = 1.48-2.99), and those requiring perioperative coagulation (RR = 2.25, 95% CI = 1.54-3.28) had significantly higher relative risks of hemorrhage. There was no significant difference in the relative risk of overall hemorrhage with TAL. Looking at major hemorrhage, patients undergoing TAL had a large but insignificant relative risk reduction in post-TORS hemorrhage (RR = 0.40, 95% CI = 0.15-1.07). The incidence of post-TORS hemorrhage is low (5.78%), and for major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage it is even lower (2.90%). Large tumors, perioperative anticoagulation, and prior radiation were associated with significantly increased risk of post-TORS hemorrhage. TAL does not reduce the overall incidence of post-TORS hemorrhage but may lead to fewer severe hemorrhages. III Laryngoscope, 2020

Contextual Variation in External and Internal Workloads across the Competitive Season of a Collegiate Women’s Soccer Team

As sports technology has continued to develop, monitoring athlete workloads, performance, and recovery has demonstrated boundless benefits for athlete and team success. Specifically, technologies such as global positioning systems (GPS) and heart rate (HR) monitors have granted the opportunity to delve deeper into performance contributors, and how variations may exist based upon context. A team of NCAA Division I women’s soccer athletes were monitored during games throughout one competitive season. Individual athlete, positional groups, and team external and internal workloads were explored for differences based upon game location, opponent ranking, game result, and the final score differential. Game location and opponent ranking were found to have no effect on team-wide absolute or relative external workloads, whereas game result and score differential did. Internal workloads across the team tended to only vary by game half, independent of game context; however, the HR of defenders was determined to be higher during losses as compared to wins (p = 0.0256). Notably, the games that resulted in losses also represented the games with the fewest number of substitutions. These findings suggest high value in monitoring performance and workloads that are characteristic of varying, often multifaceted, contexts. It is hoped that this information can lead to more informed approaches to vital game-time and coaching decisions