Type 1 thyroplasty treats glottic insufficiency (GI) through vocal fold medialization. The safety of type 1 thyroplasty and its efficacy in an outpatient setting have not been investigated in ...patients with mobile vocal folds.
The purpose of this study was to investigate efficacy and safety of outpatient type 1 thyroplasty using Gore-Tex for mobile vocal folds.
Patients from our voice center who had vocal fold paresis, had not had prior thyroplasty, and who underwent type 1 thyroplasty using Gore-Tex implants and were followed for at least 3 months were included in this retrospective study. Strobovideolaryngoscopy footage from each patient's preoperative and postoperative visits was compiled and de-identified. Three blinded physician raters reviewed and evaluated the videos to determine glottic closure and complications. Interrater reliability was moderate and intrarater reliability was good for GI.
A total of 108 patients with an average age of 49.6 years were included in the retrospective cohort. GI improved significantly in patients from preoperative to first postoperative visit and from preoperative to second postoperative visit. The GI improvement from the second to third visit was not significant. In total, 33 patients underwent additional Thyroplasty, 12 due to revision from a complication and 25 for further voice improvement. There were no major complications seen. Within 1 month of surgery, the most frequent findings were edema and hemorrhage. Long-term complications evaluated by raters were reported inconsistently with poor interrater and intrarater reliability, and therefore were excluded.
Overall, outpatient type 1 thyroplasty using a Gore-Tex implant is safe and effective in treating dysphonia due to GI in patients with vocal fold paresis and mobile vocal folds. There were no major complications within 1 week of surgery requiring hospitalization, supporting the literature that type 1 thyroplasty is safe to perform in the outpatient setting.
Objective The purpose of this study was to identify risks for mesh/suture erosions following abdominal sacral colpopexy (ASC). Study Design We analyzed demographic, perioperative variables, and ...erosion status in 322 participants in the Colpopexy and Urinary Reduction Efforts study 2 years after sacral colpopexy. Results The predominant graft used was synthetic mesh: woven polyester (Mersilene; Ethicon, Inc, Somerville, NJ) (42%) or polypropylene (48%). Twenty subjects (6%) experienced mesh/suture erosion. Unadjusted risk factors for mesh/suture erosion were expanded polytrafluroethylene (ePTFE) mesh (ePTFE 4/21 19% vs non-ePTFE 16/301 5%; odds ratio OR, 4.2), concurrent hysterectomy (OR, 4.9), and current smoking (OR, 5.2). Of those with mesh erosion, most affected women (13/17) underwent at least 1 surgery for partial or total mesh removal. Two were completely resolved, 6 had persistent problems, and 5 were lost to follow-up. No resolution was documented in the 4 women who elected observation. Conclusion Expanded PTFE mesh should not be used for sacral colpopexy. Concurrent hysterectomy and smoking are modifiable risks for mesh/suture erosion.
Purpose To assess the clinical outcomes of symblepharon release in patients with ocular surface chemical injury using Gore-Tex as a novel treatment option. Methods This was a retrospective analysis ...of 23 eyes of 22 chemical injury patients done during a period of January 2014 to December 2021 at a tertiary eye care centre in South India. All patients underwent symblepharon lysis along with Gore-Tex application over the sclera with minimum 1 year follow up. The patients were assessed for demographic details, visual acuity, intraocular pressure, anterior and posterior segment details, photographic documentation, preoperative diagnosis, previous surgical details in recurrent cases, surgical procedures, final visual acuity, surgical outcomes, and complications. The clinical outcomes were assessed and outcomes were defined as success, partial success, or failure. Results The median age was 17 years (IQR, 12–39 years). Among them 10 eyes with symblepharon had grade 3 length, 12 eyes grade 3 width and 12 eyes had grade 3 loss of palisades of Vogt. The success was achieved in 52.2% of the patients; partial success in 34.8% and 13.3% had failure. The mean duration of recurrence was 6.75 ± 3.6 months. Failure was noted in young patients with mean age 9.75years and with grade 3c symblepharon. There was no sight threatening complications noted. Conclusion The study showed very good results with Gore-Tex as a novel treatment option for chemical injury patient with symblepharon formation. It can be easily employed to prevent the symblepharon recurrence of various ocular surface disorders.
Resumen: Utilizando los aparatos teóricos de Giorgio Agamben y de Sayak Valencia, en el presente trabajo demuestro que el narcotráfico actúa en la novela Perra Brava de Orfa Alarcón como un ...dispositivo de poder sexo-genérico e induce la reproducción de masculinidades endriagas y que reafirman un sistema necropolítico, heteropatriarcal y violento. Esto explica que la heroína, Fernanda Salas, al transformarse en un sujeto endriago y alcanzar la cima de la organización criminal no se libere ni subvierta el sistema que la oprime sino que lo retroalimente, con lo cual asistimos a su resurrección o renacimiento fallido.
This paper demonstrates that some non-classical models of human decision-making can be run successfully as circuits on quantum computers. Since the 1960s, many observed cognitive behaviors have been ...shown to violate rules based on classical probability and set theory. For example, the order in which questions are posed in a survey affects whether participants answer 'yes' or 'no', so the population that answers 'yes' to both questions cannot be modeled as the intersection of two fixed sets. It can, however, be modeled as a sequence of projections carried out in different orders. This and other examples have been described successfully using quantum probability, which relies on comparing angles between subspaces rather than volumes between subsets. Now in the early 2020s, quantum computers have reached the point where some of these quantum cognitive models can be implemented and investigated on quantum hardware, by representing the mental states in qubit registers, and the cognitive operations and decisions using different gates and measurements. This paper develops such quantum circuit representations for quantum cognitive models, focusing particularly on modeling order effects and decision-making under uncertainty. The claim is not that the human brain uses qubits and quantum circuits explicitly (just like the use of Boolean set theory does not require the brain to be using classical bits), but that the mathematics shared between quantum cognition and quantum computing motivates the exploration of quantum computers for cognition modeling. Key quantum properties include superposition, entanglement, and collapse, as these mathematical elements provide a common language between cognitive models, quantum hardware, and circuit implementations.
Objectives
Redo sternotomy and explantation of left ventricular assist devices (LVAD) for heart transplantation (HT) involve prolonged dissection, potential injury to mediastinal structures and/or ...bleeding. Our study compared a complete expanded polytetrafluoroethylene (ePTFE) wrap versus minimal or no ePTFE during LVAD implantation, on outcomes of subsequent HT.
Methods
Between July 2005 and July 2018, 84 patients underwent a LVAD implant and later underwent HT. Thirty patients received a complete ePTFE wrap during LVAD implantation (Group 1), and 54 patients received either a sheet of ePTFE placed in the anterior mediastinum or no ePTFE (Group 2).
Results
Baseline characteristics were similar between Groups 1 and 2. Surgeons reported subjective improvements in speed, predictability, and safety of dissection with complete ePTFE compared with minimal or no ePTFE. Time from incision to initiation of cardiopulmonary bypass (CPB) were similar between groups (97 ± 38 vs. 89 ± 29 min, p = .3). Injury to mediastinal structures during the dissection was similar between groups (10% vs. 11%, p > .9). While surgeons reported less intraoperative bleeding in Group 1 (43% vs. 61%), this trend did not reach significance (p = .1). In‐hospital mortality, intensive care unit length of stay and hospital length of stay were similar between both groups.
Conclusions
In patients undergoing LVAD explant‐HT, there was a trend toward reduced surgeon reported intraoperative bleeding with ePTFE placement. Despite qualitatively reported greater ease and speed of mediastinal dissection with ePTFE membrane placement, time to initiation of CPB did not differ, likely because surgeons remained cautious, allowing extra time for unanticipated difficulties.
The 2000 Presidential election ended in a collision of history, law, and the courts. It produced a deadlock that dragged out the result for over a month, and consequences--real and imagined--that ...promise to drag on for years. In the first in-depth study of the election and its litigious aftermath, Judge Posner surveys the history and theory of American electoral law and practice, analyzes which Presidential candidate ''really'' won the popular vote in Florida, surveys the litigation that ensued, evaluates the courts, the lawyers, and the commentators, and ends with a blueprint for reforming our Presidential electoral practices.The book starts with an overview of the electoral process, including its history and guiding theories. It looks next at the Florida election itself, exploring which candidate ''really'' won and whether this is even a meaningful question. The focus then shifts to the complex litigation, both state and federal, provoked by the photo finish. On the basis of the pragmatic jurisprudence that Judge Posner has articulated and defended in his previous writings, this book offers an alternative justification for the Supreme Court's decision in Bush v. Gore while praising the Court for averting the chaotic consequences of an unresolved deadlock.Posner also evaluates the performance of the lawyers who conducted the post-election litigation and of the academics who commented on the unfolding drama. He argues that neither Gore's nor Bush's lawyers blundered seriously, but that the reaction of the legal professoriat to the litigation exposed serious flaws in the academic practice of constitutional law. While rejecting such radical moves as abolishing the Electoral College or creating a national ballot, Posner concludes with a detailed plan of feasible reforms designed to avoid a repetition of the 2000 election fiasco.Lawyers, political scientists, pundits, and politicians are waiting to hear what Judge Posner has to say. But this book is written for and will be welcomed by all who were riveted by the recent crisis of presidential succession.
Over the last two decades, much attention has been paid to the area of goal-oriented requirements engineering (GORE), where goals are used as a useful conceptualization to elicit, model, and analyze ...requirements, capturing alternatives and conflicts. Goal modeling has been adapted and applied to many sub-topics within requirements engineering (RE) and beyond, such as agent orientation, aspect orientation, business intelligence, model-driven development, and security. Despite extensive efforts in this field, the RE community lacks a recent, general systematic literature review of the area. In this work, we present a systematic mapping study, covering the 246 top-cited GORE-related conference and journal papers, according to Scopus. Our literature map addresses several research questions: we classify the types of papers (e.g., proposals, formalizations, meta-studies), look at the presence of evaluation, the topics covered (e.g., security, agents, scenarios), frameworks used, venues, citations, author networks, and overall publication numbers. For most questions, we evaluate trends over time. Our findings show a proliferation of papers with new ideas and few citations, with a small number of authors and papers dominating citations; however, there is a slight rise in papers which build upon past work (implementations, integrations, and extensions). We see a rise in papers concerning adaptation/variability/evolution and a slight rise in case studies. Overall, interest in GORE has increased. We use our analysis results to make recommendations concerning future GORE research and make our data publicly available.
Objective:
To compare voice-related outcomes of type 1 thyroplasty using Gore-Tex® between patients with and without augmentation injection laryngoplasty (IL) prior to surgery.
Methods:
Forty-five ...patients who underwent Gore-Tex® thyroplasty at a single institution by a single surgeon between November 2016 and February 2019 were identified as those who previously had IL (n = 20) and those without IL (n = 25). Pre- and post-operative voice-related primary outcomes were evaluated using the GRBAS, and CAPE-V auditory-perceptual rating scales and secondary outcome were evaluated using the VRQOL. Pre- and post-operative voice samples were blinded, randomized, and analyzed by 3 voice-specialized speech pathologists to obtain CAPE-V scores. The VRQOL and GRBAS scores were obtained from retrospective chart review. Student’s t test with a paired one-tailed distribution was used for comparisons within groups and 2-sample equal variance for comparisons between groups. Intraclass correlation coefficient determined interrater agreement.
Results:
GRBAS, and VRQOL significantly improved post Gore-Tex® thyroplasty. There was no difference in improvement between patients who received pre-surgery IL and those who did not in either GRBAS or VRQOL scores, but CAPE-V showed significant improvement in the IL group. A strongly positive correlation was demonstrated between the severity of CAPE-V pre-op score and the overall improvement following surgery for both groups combined.
Conclusion:
Patients with vocal fold paralysis have a significantly better voice after Gore-Tex® thyroplasty by self-report (VRQOL) and assessment by trained voice professionals (GRBAS). Having IL prior to surgery does not adversely affect later surgical outcomes. This paper represents one of the largest analyses of voice quality outcomes of Gore-Tex® thyroplasty using validated patient scales and randomized blinded analyses.
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