Oklo natural fission reactors and dynamical models of dark energy

Bounds on the cosmological variation of the fine structure constant α inferred from Oklo neutron capture data are sometimes taken cum grano salis. It is possible to quantify uncertainties related to the treatment of excitation, deformation and the Coulomb interaction. On the basis of this analysis, it is concluded that Oklo data imply the relative change in α over the last 1.9 billion years is < 0.01 ppm (95% CL). Accommodation of this constraint represents a challenge to dark energy models that predict that fundamental constants do change.

Trends in Academic Achievement Within Otolaryngology: Does Fellowship Training Impact Research Productivity?

BACKGROUND

Scholarly productivity and research output vary among different subspecialties. The h-index was developed as a more wholesome metric that measures an author's contribution to literature.

OBJECTIVE

Through a web-based cross-sectional analysis, we investigated the differences in scholarly impact and influence of both fellowship and nonfellowship-trained academic otolaryngologists in the United States. A secondary objective was to further understand the output among the larger fellowship fields.

METHODS

A cross-sectional analysis was performed for active faculty otolaryngologists. A total of 1704 otolaryngologists were identified as faculty in residency training programs across the United States. Their h-index and publication data were gathered using the Scopus database. The data were obtained in August 2019 and analysis occurred in January 2020.

RESULTS

Head and neck surgical faculty (25.5%) had the highest representation with fellowship experience. Among all faculty, there was no statistical difference in the overall average h-index scores when comparing faculty that had fellowship training with those who did not (12.6 and 12.1, respectively, P = .498). Rhinologists had the highest publication output per year at 3.90. Among fellowship-trained faculty, the highest average h-index and total publications were seen in head & neck surgery, while facial plastics had the lowest averages (P < .001).

CONCLUSIONS

In this study, fellowship-trained faculty had a greater but not significant scholarly impact than nonfellowship faculty. Furthermore, there were significant variations in output among the various subspecialties of otolaryngology. Growing fields, as academic rhinology, are continuing to flourish in robust research productivity and output. This study further demonstrates the potential, growing influence of fellowship training on research involvement and academic advancement within the otolaryngology subspecialties.

Exploring Balloon Sinuplasty Adverse Events With the Innovative OpenFDA Database

Background

Balloon sinuplasty (BSP) has become a common, minimally invasive treatment for chronic sinusitis. Like any surgical procedure, there are definite risks when using it as a stand-alone procedure or in conjunction with other revision procedures.

Objective

To explore the adverse events of BSP using the openFDA cloud with regard to malfunction and injury following surgery.

Methods

Between January 2015 and December 2018, the Food and Drug Administration’s (FDA) openFDA database was queried for adverse event use. Reports were further categorized by procedure location, injury type, device malfunction, procedure (stand-alone BSP vs hybrid), and source of complication (anatomical or surgeon related).

Results

Seventy-eight events were reported to the FDA in the study period. Majority of cases consisted of device malfunctions (64.1%), while patient injuries consisted of 43.5%. Frontal sinus procedures had the greatest presence of adverse events (47.4%) with the majority reporting significant cerebrospinal fluid (CSF) leaks ( P < .001) and device retention ( P = .021). Orbital complications ( P = .004) were found to be significantly associated with dilation of the maxillary sinus. Skull-based injuries were the only factor incident in which surgeon-reported anatomical complications were significant ( P = .018).

Conclusions

As balloon dilation procedure continues to rise in the United States, significant adverse events continue to occur. Frontal sinus BSP leads to the highest number of complications and a 4.75 reported CSF leaks yearly. Based on real data, surgeons performing the procedure should be acquainted with common BSP-related injuries so they can prepare for those circumstances and share informed consent with their patients.

Bounds on Time Reversal Violation From Polarized Neutron Capture With Unpolarized Targets

We have analyzed constraints on parity-odd time-reversal noninvariant interactions derived from measurements of the energy dependence of parity-violating polarized neutron capture on unpolarized targets. As previous authors found, a perturbation in energy dependence due to a parity (P)-odd time (T)-odd interaction is present. However, the perturbation competes with T-even terms which can obscure the T-odd signature. We estimate the magnitudes of these competing terms and suggest strategies for a practicable experiment.

New therapies for type 1 diabetes mellitus

Five to ten percent of patients with diabetes mellitus in the United States suffer from type 1 diabetes: approximately 1.5 million people. Type 1 diabetes occurs when there is no insulin production from the beta cells of the pancreas and has often been associated with younger patients and thin body habitus. Type 2 diabetes, often linked with obesity, is associated with impaired insulin secretion and insulin resistance. Although the therapeutic goal is to maintain strict glycemic control in both types, management of type 1 diabetes is of a dissimilar nature due to differences in pathophysiologic mechanisms and patient characteristics. Newer therapies are aimed at achieving better glycemic control with minimal compromise to lifestyle. Some of these treatment measures, such as insulin pump therapy, have been available for years but were not used frequently until the mid-1990s. The increased use of intensive insulin therapy became more readily acceptable after the Diabetes Control and Complications Trial showed a decrease in microvascular complications with better glycemic control (hemoglobin A1C value of 7% or less). Insulin pumps, along with meal timings and, to a certain extent, regulation of the amount of food consumed, have allowed diabetes patients a more flexible lifestyle. Newer insulins are structured to mimick the pharmacokinetics of the endogenous basal (peakless sustained activity) and bolus (short fast-acting) insulins. Development of continuous, noninvasive, glucose sensing devices may reduce the need for capillary blood glucose testing (needle pricks) and make diabetes management more patient friendly and effective.

Writing partnerships: a CNS and staff nurses write for publication

Writing for publication with staff nurses can provide CNSs with flexible and creative approaches to the challenges facing nurses in the restructuring health care environment. CNSs experience many rewards and satisfactions from writing and measurable outcomes for practice evaluation. Staff nurses gain clinical knowledge, professional and career development, and the excitement that accompanies completion of a scholarly endeavor. Being in the clinical arena gives the CNS unique opportunities to work with and mentor staff nurses and observe their special capabilities, including those of a potential writing partner. How one CNS selected writing partners and supported these staff nurse colleagues through the writing-for-publication process is described in this article.

Care of the diabetic patient who is NPO for a procedure

Nursing care of the diabetic patient who is NPO for a procedure presents many challenges. Unwise treatment and care decisions may be made because of misunderstanding about the body's basal need for insulin. "Hold-the-insulin" routines are dangerous. Guidelines for management of these patients can provide the necessary information and confidence for excellent nursing care.

Role of the diabetes nurse educator in improving patient education

Hospitalized patients learn from staff nurses as well as from specialized diabetes nurse educators. This paper examines the involvement of staff nurses in diabetes patient education and the useful roles of the specialist, particularly as change agent and consultant. It focuses on how the diabetes nurse educator bridges the knowledge gap between the expertise of the specialist and practices of the staff nurse in providing patient education for self-care.

Causes of errors in diabetic urine testing by hospital personnel

Errors in urine testing were studied using 119 health professionals who tested simulated urine specimens from six hypothetical patients. A record of the hypothetical patients' test results for 2 previous days accompanied each specimen. Five of the six records were loaded high or low to investigate testers' biases as a result of their knowledge of previous values. Testers demonstrated an aversion to extreme readings. At the lower concentration, 83% of erroneous readings were higher than the correct value. At the higher concentration, 70% of errors were below the true value. The results also revealed that readings were influenced by knowledge of past records. A higher reading for the sample with the biased-high record occurred 50% more often than a lower reading. Differences in error were nonsignificant for different educational levels and past experiences of the testers. Urine testing accuracy appears to be affected by a tendency toward avoidance of extremes and knowledge of previous results.

Comparative staff values on the community mental health ideology scale

The community mental health ideologies of groups composed of profession and nonprofessional mental health service providers were measured by use of the Baker-Schulberg Community Mental Health Ideology (CMHI) Scale. The study was designed to: (1) compare current CMHI scores with the original criterion scores of mental health workers, (2) compare CMHI scores of mental health workers from different disciplines who work in the same community mental health setting, and (3) measure CMHI scores for previously nonreported workers, ministers, and board and care operators. Results of the present study indicate that CMHI scores had not changed from the criterion scores over a series of studies, and that score consistency is such that the scale appears to be a reliable discriminatory tool. Contrary to previously reported findings, psychiatrists scored as high as other mental health professionals in the system, and no significant difference was found between disciplines within the professional group. The paraprofessional group, however, ranked significantly lower than the professional group. Clerical and administrative staff, and board and care operators had CMHI scores that were significantly lower than all other study groups. Interestingly, the minister group had a mean score higher than all other groups studied. Our findings suggest that the CMHI Scale differentiates, not only between disciplines of mental health workers who work in the same setting, but also between groups of human services providers in the community.

The Diagnosis and Treatment of Tumours of the Nasopharynx

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The Clinical Aspect of Lymphosarcoma of the Tonsil: (Sections of Laryngology and Otology)

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Chronic Hyperplasia or Focal Osteitis Fibrosa of the Maxilla: (Section of Laryngology)

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Two Specimens: Abscess in Frontal Lobe of Brain. Sinus Suppuration

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Four Cases Illustrating the Modified Toti's Operation for Lacrymal Obstruction

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Mal-developments of the Auricle, External Acoustic Meatus and Middle Ear

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