Dynamic acousto-elasticity (DAE) provides a unique way to observe nonlinear elastic features over an entire dynamic stress cycle including hysteresis and memory effects, detailing the full nonlinear ...behavior under tension and compression. This supplemental information cannot be observed with conventional nonlinear ultrasonic methods such as wave frequency mixing or resonance measurements, since they measure average, bulk variations of modulus and attenuation versus strain level. Where prior studies have employed DAE in volumetrically nonlinear materials (
e.g.
, rocks, bone with distributed micro-crack networks), here we report results of DAE on the application to a single localized nonlinear feature, a fatigue crack, to characterize the nonlinear elastic response in regions of the crack length, tip, and undamaged portions of an aluminum sample. Linear wave speed, linear attenuation and third order elastic moduli (i.e., nonlinear parameters) each indicate a sensitivity to the presence of the crack, though in unique manners. The localized nature of the DAE measurement and its potential for quantifying all of the third order elastic constants makes it a promising technique for both detecting cracks, as well as providing quantitative information on the effect of the cracks on the material integrity.
Recurrent croup (RC) is a common problem in the pediatric population. We theorize that reduced rhinorrhea and post-nasal drip as well as suppressed cough receptor activity by the anticholinergic, ...intranasal ipratropium bromide (IB), may lead to reduced inflammation and edema of the subglottis, decreasing RC symptoms. The aim of this study is to determine the effectiveness of IB in improving symptoms of RC and in reducing the need for alternative forms of management.
A retrospective chart review combined with survey data of patients with RC was conducted to assess demographic data, comorbidities, and treatment outcomes. Pediatric patients less than 10 years of age diagnosed with RC through the department of pediatric otolaryngology between 2018 and 2020 were included. Results were compared between one group treated with IB for RC and a second group treated with medications other than IB.
Among the 67 patients treated for RC, 34 completed survey data and were included in the study. Overall, patients who were treated with IB for RC had 1.83 less croup episodes per year (p = 0.046), a 0.5-point improvement in child symptoms (p = 0.017) and 1.3 fewer doses of steroids per year than the patients not treated with IB (p = 0.018). Patients treated with IB were significantly more likely to answer “yes,” that the use of medication helped improve symptoms (p < 0.01).
Intranasal IB is a novel therapeutic option that may reduce RC events, improve patient symptoms and reduce steroid use. Further prospective studies are needed to definitively characterize the benefits of IB in the treatment of RC.
Solenoid Siberian snakes have successfully maintained polarization in particle rings below 1 GeV, but never in multi-GeV rings, because the spin rotation by a solenoid is inversely proportional to ...the beam momentum. High energy rings, such as Brookhaven’s 255 GeV Relativistic Heavy Ion Collider (RHIC), use only odd multiples of pairs of transverse B-field Siberian snakes directly opposite each other. When it became impractical to use a pair of Siberian Snakes in Fermilab’s 120GeV/c Main Injector, we searched for a new type of single Siberian snake that could overcome all depolarizing resonances in the 8.9–120GeV/c range. We found that a snake made of one 4-twist helix and 2 dipoles could maintain the polarization. This snake design could solve the long-standing problem of significant polarization loss during acceleration of polarized protons from a few GeV to tens of GeV, such as in the AGS, before injecting them into multi-hundred GeV rings, such as RHIC.
Postoperative recovery after tonsillectomy using Coblation excision (CES) was compared with conventional electrosurgery (ES).
Patients aged 3 to 12 years from 3 clinical sites were randomly assigned ...and blinded to receive tonsillectomy using CES (n = 44) or ES (n = 45).
Operative parameters did not differ between groups. Return to normal diet, activity, and pain-free status were similar, although fewer CES patients contacted the physician regarding postoperative complications (33% vs 54%; p = 0.081), experienced nausea (35% vs 62%, p = 0.013), or had localized site-specific swelling (p < 0.05) during the 2 weeks after surgery. In addition, CES children tended to discontinue prescription narcotics 1 day earlier than ES patients (7 vs 8 days, p = 0.071) and took one half as many daily doses. More CES than ES parents rated the postoperative experience as 'better than expected' (79% vs 60%, p = 0.055).
Children who received CES tonsillectomy appeared to experience a better quality postoperative course, with no detriment to operative benefits of conventional electrosurgery.
To determine the pediatric incidence and association of superior semicircular canal dehiscence (SSCD) with inner ear (IE) anomalies.
Retrospective chart review.
Two tertiary referral centers.
...Children less than 18 years who received a 0.5 mm or less collimated computed tomography study including the temporal bones between 2010 and 2013 for reasons including, but not limited to, hearing loss, trauma, and infection.
Images were reformatted into Pöschl and Stenver planes. Five hundred three computed tomography studies (1,006 temporal bones) were reviewed by experienced, blinded neuroradiologists.
Incidence of SSCD and IE anomalies. Patient age, sex, and diagnosis were recorded. Statistical analysis was performed to compare outcome measures among patient demographics.
The incidence of SSCD was 6.2% (31/503) and an IE anomaly was 15.1% (76/503) of individuals. The incidence of SSCD with an IE anomaly was not significantly correlated (1.1%, 40/1,006; p = 0.23; LR = +1.29). The mean age of children with SSCD was lower (5.9 versus 9.8 yr; p = 0.002). SSCD incidence decreased with age (ages <2, 2-8, and 9-18 yr were 36.7%, 5.6%, and 3.2%; p<0.001) and SSC bone thickness nonsignificantly increased with age. Children with SSCD were commonly male (74.2%, p = 0.041).
SSCD and IE anomalies are unlikely related. SSCD incidence is highest in children <2 years, with SSC bone increasing until 2 to 8 years of age. This supports the theory of a congenital precedent to SSCD, with overlying bone maturation occurring during early childhood. Age <2 years was a significant predictor of SSCD.
Objectives/Hypothesis
To evaluate the correlation between surgical instrumentation and intraoperative surgical time, postoperative hemorrhage, and associated healthcare cost for pediatric ...adenotonsillectomy.
Study Design
Retrospective chart analysis.
Methods
Chart data were collected from pediatric patients who underwent adenotonsillectomy from 2011 to 2013. Monopolar electrocautery, radiofrequency ablation, and PlasmaBlade instruments were compared for intraoperative surgical time and postoperative hemorrhage rate. Univariate analysis of variance (ANOVA) and χ analysis was utilized to evaluate differences between instrumentation and variables. Cost analysis examining instrumentation and intraoperative anesthesia was also reviewed.
Results
A total of 1,280 patients who underwent adenotonsillectomy were evaluated. There was no significant overall difference in age, sex, or preoperative diagnosis identified between the three instrumentation groups. When examining the various instruments' effect on procedure time in minutes, univariate ANOVA demonstrated a significant difference overall among the three groups (F = 8.79; P < .001). Post‐hoc pairwise comparisons identified significantly faster surgical times for monopolar cautery than either PlasmaBlade (P = .03) or radiofrequency ablation (P < .001). The difference in the number of patients who experienced a postoperative bleed by instrument was not statistically significant (χ2 = 2.36; P = .31). After instrumentation expenses were added to anesthesia cost, the overall average costs by instrument and surgical time were estimated to be $30.04 for monopolar cautery, $246.95 for PlasmaBlade, and $244.32 for radiofrequency ablation.
Conclusions
The ideal surgical instrumentation should be cost and time efficient with a low complication rate. Monopolar cautery was associated with a statistically significant lower intraoperative surgical time, similar postoperative hemorrhage rates, and lower operative costs when compared to radiofrequency ablation and PlasmaBlade.
Level of Evidence
4 Laryngoscope, 125:475–479, 2015
Abstract Purpose To define the association between pre-operative general emergency department visits, gender, and pre-operative diagnosis with post-operative emergency department return following ...adenotonsillectomy. Methods Retrospective chart review of 1468 pediatric patients who underwent adenotonsillectomy at a tertiary pediatric hospital between 2011 and 2013. Results There was a significant relationship between patients who visited the ED pre-operatively, 25% ( N = 96) returned to the ED post-procedure, compared to 10% who did not have a pre-operative ED visit. There was an overall significant relation between having a pre-operative visit ( χ2 = 53.6, df = 1, p < 0.001), female gender (female = 56.9%; male = 43.1%; χ2 = 4.2, df = 1, p = 0.04), and having a preoperative diagnosis of recurrent strep tonsillitis (OSA and RST = 18%; RST = 17.5%; OSA = 11.8%; χ2 = 12.8, p = 0.002) and having a post-operative ED visit. Conclusion Generalized pre-operative visits along with gender and diagnosis of recurrent streptococcal tonsillitis were found to be positively associated with post-operative ED visits for common post-operative complaints.
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