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Our centre (Freeman Hospital, Newcatle Upon Tyne NHS Trust) has favoured primary surgery over chemoradiotherapy for specific advanced laryngeal cancer patients (e.g. large-volume tumours, airway compromise, significant dysphagia, T4 disease). This study reports the survival outcomes for a modern, high-volume head and neck centre favouring surgical management to determine whether this approach improves survival.
Method
Retrospective analysis of patient data over a seven-year period from a tertiary cancer centre.
Results
In total, 121 patients were identified with T3 (n = 76) or T4 (n = 45) laryngeal cancer (mean follow up 2.9 years). In the cohort treated with curative intent (n = 104, 86.0 per cent), the 2- and 5-year estimated disease-specific survival rates were 77.9 and 64.1 per cent. chemoradiotherapy had the highest 2-year disease-specific survival (92.5 per cent), followed by surgery with adjuvant therapy (81.8 per cent), radiotherapy alone (75 per cent) and surgery alone (72.4 per cent).
Conclusion
For a centre favouring primary surgery for certain advanced laryngeal cancers, the disease-specific survival appears no higher than that found in the published literature. To enhance survival, future research should focus on precision medicine to define treatment pathways in this disease.
This study aimed to translate and validate the Attitude towards Loss of Hearing Questionnaire into the Arabic language and explore attitudes of working-age adults towards their hearing loss and hearing aids.
Methods
A cross-sectional investigation was conducted of 237 middle-aged Jordanians (18-65 years old) who have hearing loss using an online questionnaire during the period of October to December 2023.
Results
The specialized experts in the field had an 88 per cent acceptance rate on all items of the Attitude towards Loss of Hearing Questionnaire. Five factors were loaded and explained a total of 58.37 per cent, confirming the validity of the Attitude towards Loss of Hearing Questionnaire Arabic version. All subscales of the Attitude towards Loss of Hearing Questionnaire surpass the normal values of Cronbach alpha. Several predictors of attitude towards loss of hearing were noted, including educational level, age, family members, income and marital status.
Conclusion
Addressing barriers to hearing aid use, such as psychosocial and economic, can improve hearing support and increase healthcare focus and collaboration among clinicians and stakeholders globally.
Surgical treatment of auricular concha, the helix root and the external auditory canal tumours, and their reconstruction, is a challenge because of the complexity of this anatomic region and the significant functional and aesthetic requirements of these treatments. The purpose of this study is to describe our experience with the retroauricular revolving door island flap technique.
Method
This was a retrospective descriptive study (series of nine clinical cases) conducted between 2020 and 2023 of revolving door island flap reconstruction of auricular conchal and external auditory canal defects caused by tumour removal.
Results
In all the cases, tumour-free margins and total reconstruction of the defect were achieved through the revolving door island flap intervention, with optimal aesthetic and functional results.
Conclusion
Revolving door island flap reconstruction is a viable surgical option for the reconstruction of auricular conchal and external auditory canal defects because of its versatility, reproducibility, low post-operative morbidity and optimal results.
Access to heterogeneous knowledge resources is suggested in the literature as an important explanation of firm innovation and performance. The exchange of knowledge, however, can be a complex managerial challenge, especially between different epistemic communities. Our research focuses on the concept of epistemic communities to illuminate the complexity of tensions that arise in heterogeneous knowledge exchange in alliances, thus filling a gap in the literature. Using the Straussian grounded theory case study approach, our research investigates the emergence of horizontal, vertical, and inter-organizational epistemic tensions and explores management controls as instruments to guide the knowledge exchange in intermediary-driven research and development alliances. We find that the source of multiple epistemic tensions is rooted in the natural social behaviors of epistemic community members and further shows how these behaviors influence the effective use of inter-organizational management controls in facilitating heterogeneous knowledge exchange.
This is the first of a two-part paper. We formulate a data-driven method for constructing finite-volume discretizations of an arbitrary dynamical system's underlying Liouville/Fokker–Planck equation. A method is employed that allows for flexibility in partitioning state space, generalizes to function spaces, applies to arbitrarily long sequences of time-series data, is robust to noise and quantifies uncertainty with respect to finite sample effects. After applying the method, one is left with Markov states (cell centres) and a random matrix approximation to the generator. When used in tandem, they emulate the statistics of the underlying system. We illustrate the method on the Lorenz equations (a three-dimensional ordinary differential equation) saving a fluid dynamical application for Part 2 (Souza, J. Fluid Mech., vol. 997, 2024, A2).
Over the past several years, socio-legal researchers have focused attention on the phenomenon of eviction, particularly in low-income communities and communities of color. One major aspect of the eviction phenomenon has been largely overlooked: how and why certain eviction filings result in forced, legally compelled tenant moves and others do not. Through coding of the legal documents associated with eviction filings and multi-level regression analysis, this article advances the analysis of evictions in two crucial ways. First, it identifies and describes the frequency of the distinct legal procedural pathways that result in forced tenant moves once an eviction case has been filed. Second, it identifies the case, tenancy, neighborhood, and property correlates of forced tenant moves and of distinct procedural pathways to forced tenant moves. The article demonstrates that move-out agreements are the primary procedural pathway by which tenants are forcibly moved, yet they have been largely overlooked in previous eviction research because they are not easily analyzable in administrative datasets. The regression analyses advance the growing work examining the role of landlord characteristics in shaping tenants’ housing stability and break new ground in identifying the characteristics of the different pathways through which tenants are forced out of their homes following eviction filing.
Drop attacks are described as an instantaneous fall to the ground, occurring without warning and without loss of consciousness, a consequence of abrupt deformation of the otolithic membrane due to high endolymphatic pressure. Drop attacks present significant injury risk, therefore effective treatment is imperative. This review is the first to examine all evidence for the management of drop attacks in Ménière’s disease, and make recommendations.
Methods
We conducted a systematic literature review. Inclusion criteria consisted of all published English language examining treatments of drop attacks in Ménière’s disease.
Results
One hundred and five articles were identified, 19 met criteria (case series and/or cohort studies). Two articles identified conservative treatments, eight examined intratympanic gentamicin, seven examined surgery, one examined all three and one examined intratympanic dexamethasone.
Conclusion
Evidence for the management of drop attacks in Ménière’s disease is limited due to small studies. Some surgical approaches have limited effect. Intratympanic dexamethasone remains a promising treatment; further research is recommended.
This study aimed is to analyse the quality of stapedotomy videos as an educational tool and to test the feasibility of the IVORY grading system (IVORY-GS) in an otological procedure.
Methods
YouTube was searched using the terms “stapedectomy”, “stapedotomy” and “otosclerosis surgery.” Video length, upload date, view count and likes were evaluated. The included videos were scored according to the IVORY-GS.
Results
Sixty-seven videos were evaluated. The mean IVORY-GS total score was 21.8. Video scores were higher in the ethics part. Case presentation items got the lowest scores in total. The total score showed a significantly positive correlation with like counts. No significant correlation was found between the total score and view count and video age.
Conclusion
The educational quality of most of the stapedotomy videos on YouTube is insufficient. The IVORY-GS is a comprehensive guideline in the otorhinolaryngology field. However, it may require some modifications based on the type of surgery.
Significant attention has been devoted to the problem of ‘divine hiddenness’ proposed by JL Schellenberg. I propose a novel response that involves denying part of the empirical premise in divine hiddenness arguments, which holds that nonresistant nonbelievers are capable of relationship with God. While Plantinga and others in ‘reformed’ epistemology have at times appealed to original sin as an explanation for divine hiddenness, such responses might seem outlandish to many, given the way that many find nonbelievers to be no more or less epistemically or morally blameworthy than believers. Further, such appeals to original sin seem to give a ‘just-so’ story that at least leaves the situation dialectically balanced. I show that a classically Augustinian notion of original sin can provide a sufficient response to those objections, and that appeal to original sin can form an empirically grounded response to the divine hiddenness problem, beyond a simple defense. If the possibility of original sin-type scenarios is compatible with God’s perfect love, then the phenomenon of apparently nonresistant nonbelievers would push us toward considering the possibility that humans have lost those capacities for relationship with God by a Fall-like event in the past.
With the development of the communication field, more and more communication devices need multiple single-frequency antennas to work simultaneously. However, using multiple single-frequency antennas results in larger sizes. The miniaturized and dual-band communication system has become a new development trend. This paper designs a dual-band filtering patch antenna based on a multimode resonator, which is cascaded. The filter resonator part adopts step impedance resonance for branch shunt design, which can flexibly control the center frequency of two frequency bands. The filtering antenna utilizes a dual-layer substrate structure and achieves an integrated design through coupling probe feeding. This reduces the horizontal dimensions and improves miniaturization. Multiple radiation nulls are introduced outside the two-passband, and roll-off characteristics are evident. In addition, this design realizes high selectivity in the operating band. The antenna has large gains of 1.71 dBi and 6.25 dBi. It has good filtering and radiation characteristics.
The neologism “mansplaining” captures an insidious dynamic in which men explain things to women that women already understand, assuming that, by virtue of being a woman, she lacks the man’s knowledge. Mansplaining has started to receive some attention in contemporary scholarship, conceptualizing the phenomenon and identifying its epistemic harm. My purpose is to consider mansplaining and its harms from the perspective of democratic theory. Setting the problem of mansplaining against the norms we expect of democracy—equality, inclusion, and recognition—I argue that mansplaining poses harms that are not only individual and epistemic but also collective and relational. I distinguish two types of mansplaining based on women’s expertise and experience to elaborate on its collective epistemic harms to decision making and its relational harm of political exclusion. Mansplaining poses further relational harms of inequality and misrecognition, undermining the equal social relations and social trust required for deliberation.
Ouster clauses have perennially borne the mantle of a ‘litigation minefield’, where clashes between legislative and judicial powers unfold in open fora. Recent jurisprudential advancements in the United Kingdom and Singapore demonstrate how judicial approaches to ouster clauses can evolve in the face of constitutional developments. Hong Kong has, however, remained muted while these jurisprudential advancements bear fruit in other parts of the common law world, notwithstanding the fact that its constitutional framework, umpired by the Basic Law, has been in existence for over twenty-five years. This article argues for the need to reconceptualise approaches to ouster clauses in Hong Kong, grounded firmly in its post-1997 constitutional framework. Drawing on comparative jurisprudence, it presents a spectrum of approaches, animated by the dynamic interplay between various ‘macrocontextual’ and ‘microcontextual’ factors, ranging from a localised version of Anisminic, remedial interpretation, and invalidation of ouster clauses on the grounds that they impermissibly affront the constitutional right of access to courts, allocation of judicial power, and constitutional supremacy.
This study demonstrates a national programme which has been accepted in Wales as a mandatory part of the induction process for the rotating ENT SHO cohort.
Methods
The ENT Induction Bootcamp was established based on the learning needs of ENT SHOs. Pre- and post-course assessment of the subjective and objective benefit of the 1-day course was captured.
Results
Between 2022 and 2024, 152 participants have attended the bootcamp; all of whom (100 per cent) found the course beneficial. The greatest improvements in participant confidence were observed in emergency tracheostomy management, flexible nasendoscopy and nasal examination (all p < 0.01). Based on objective assessment, participant knowledge improved from a mean of 68.5 per cent to 96.5 per cent.
Conclusion
This initiative highlights the value of a bootcamp approach to standardise junior doctors’ abilities to manage ENT emergencies. This bootcamp is now a mandatory component for all SHO entering ENT attachments in Wales, in an easily adoptable format.
Recent advancements in sensory research have brought to light the intricate relationship between taste perception and the oral microbiota, prompting investigations into their influence on human health, particularly in the context of dietary preferences and obesity. This review aims to update the current understanding of how oral microbiota influence taste perception and dietary choices, elucidating shared metabolic pathways between food processing and oral bacteria. Further, this review outlines the mechanisms underlying taste perception, emphasising the role of taste receptors and taste buds in shaping sensory experiences influenced by genetic and environmental factors. Notably, we explore the bidirectional relationship between oral microbiota and taste sensitivity, highlighting the potential impact of microbial composition on taste perception thresholds and implications for dietary habits and health outcomes, such as obesity and dental caries. However, significant research gaps remain, particularly in the understanding of the molecular mechanisms linking oral microbiota with taste sensitivity, as well as the long-term effects of microbiota-targeted interventions. Future research should focus on longitudinal studies and experimental interventions to explore these connections more deeply, offering insights into potential strategies for promoting healthier dietary behaviours and managing diet-related non-communicable diseases.
Successful employment outcomes are often beyond the reach of people with disabilities, but relatively little is known about the factors that best enable the achievement of this goal. Using survey data from 803 people with and without disabilities, we examine the association of eight factors with successful employment outcomes. Using regression tree analysis, five factors emerged as statistically significant predictors of successful employment outcomes for people with disabilities: corporate culture and climate, job characteristics, government support, employer attitudes, and societal attitudes. Key interrelationships between factors include: (1) government support linking with corporate culture and climate; and (2) job characteristics linking with corporate culture and climate. Findings are relevant to organisations and governments to inform policy and practice to improve employment outcomes for people with disabilities.
Social policies convey normative assumptions about how households should make ends meet and organise care, but how do these ideals withstand crises such as the coronavirus disease 2019 (COVID-19) pandemic? Previous research shows continuity of welfare state models in the crisis, but mostly looked at single policy fields and produced mixed findings regarding the role of pre-crisis reform trajectories. This paper contributes a detailed analysis of assumptions about the ‘standard productive household’ in terms of three dimensions: labour market participation, coverage of economic needs and coverage of care needs. Drawing on original policy documents enacted in 2020 in Germany – which had dismantled many of its institutional strongholds for the male-breadwinner model before the crisis – we provide two novel insights. First, social policy responses to the pandemic were relatively coherent regarding assumptions about labour market participation, but expectations towards households’ abilities to make ends meet and parents’ care involvement were less coherent. In addition to relaxing conditions on stable employment and income, policy responses normalised patchwork incomes and relied on parents to compress paid and unpaid work. Second, we propose that crises may slow down reform processes that are already underway by reverting to ideas that were dominant in the past.
Data show that an increase in the Gini coefficient is associated with a falling bottom $p_{B}$% income share and an increasing top $p_{T}$ % income share where, for example $p_{B}$ = 40 and $p_{T}$ = 1. This relationship, which we call the $X$ inequality relationship, is pervasive in the sense that it is observed in many countries, including the US, the UK, France and others. The purpose of this paper is (i) to construct a Schumpeterian growth model to explain the relationship, and (ii) to identify/quantify factors behind it via calibration of the US economy. Our model gives rise to a double-Pareto distribution of income as a result of entrant and incumbent innovations. Its advantage is that it allows us to develop iso-Gini loci and iso-income share schedules in a tractable way. Using a double-Pareto distribution as an approximation of an underlying income distribution, calibration analysis reveals that a declining business dynamism and fiscal policy changes in the past decades played a significant role in generating the $X$ inequality relationship in the US.
In this special issue titled ‘Sustainability and SMEs: Opening the black box’, we compile eight articles that dissect the multifaceted relationship between small- and medium-sized enterprises (SMEs) and sustainability. This special issue promoted interdisciplinary research at the intersection of the design, management, organisation, and reporting of sustainable actions in the context of SMEs. Stemming from the need to apply different theoretical and analytical lenses to the study of sustainability in SMEs than in large corporations, each paper provides unique insights into the formal and informal approaches, drivers, barriers, and enablers of sustainable practices in SMEs. The collection not only furthers the dialogue on the role of SMEs in sustainable development but also paves the way for future research directions and practical applications in this dynamic and still underexplored field.
Recurrent respiratory papillomatosis is a rare disease characterised by growth of papilloma within the respiratory tract. The disease course is variable but can require frequent surgical interventions alongside adjuvant medical treatments. There is no definitive curative treatment or gold-standard guidelines for management. We aimed to evaluate current and potential future adjuvant treatments and propose a management guideline for adult patients.
Methods
Relevant articles were identified through searching databases, reference lists and grey literature.
Results
Systemic bevacizumab appears to be the most effective adjuvant treatment currently available. However, intralesional cidofovir also achieves a high complete-response rate in adults and the Gardasil vaccine demonstrates preventative and therapeutic value. The INO-3107 DNA vaccine is a promising potential future adjuvant treatment.
Conclusions
This review provides a detailed examination of current and potential future adjuvant treatments. Based on the literature, we have developed a management guideline for adult patients with recurrent respiratory papillomatosis.
We give a simple, direct, and reusable logical relations technique for languages with term and type recursion and partially defined differentiable functions. We demonstrate it by working out the case of automatic differentiation (AD) correctness: namely, we present a correctness proof of a dual numbers style AD code transformation for realistic functional languages in the ML-family. We also show how this code transformation provides us with correct forward- and reverse-mode AD.
The starting point is to interpret a functional programming language as a suitable freely generated categorical structure. In this setting, by the universal property of the syntactic categorical structure, the dual numbers AD code transformation and the basic $\boldsymbol{\omega } \mathbf{Cpo}$-semantics arise as structure preserving functors. The proof follows, then, by a novel logical relations argument.
The key to much of our contribution is a powerful monadic logical relations technique for term recursion and recursive types. It provides us with a semantic correctness proof based on a simple approach for denotational semantics, making use only of the very basic concrete model of $\omega$-cpos.