Dr. Solco Tromp and the Tromp Award.

The Tromp Award is the highest honor awarded by the International Society of Biometeorology (ISB). The award acknowledges outstanding research in biometeorology by a scientist under the age of 35 and was established in conjunction with the Tromp Foundation and the ISB. In honor of the 60th anniversary of the ISB, this article will provide a brief summary of the life of Dr. Solco Tromp and of the six awardees of the Tromp Award since the inaugural issuance of the award in 1999. The Tromp Award was established in part to recognize and support the efforts of young biometeorological professionals. As the brief summary of the awardees and a few of their selected subsequent publications have shown, the ISB and the Tromp Award has proven effective at identifying and supporting promising young scientists.

The application of the European heat wave of 2003 to Korean cities to analyze impacts on heat-related mortality.

The goal of this research is to transpose the unprecedented 2003 European excessive heat event to six Korean cities and to develop meteorological analogs for each. Since this heat episode is not a model but an actual event, we can use a plausible analog to assess the risk of increasing heat on these cities instead of an analog that is dependent on general circulation (GCM) modeling or the development of arbitrary scenarios. Initially, the 2003 summer meteorological conditions from Paris are characterized statistically and these characteristics are transferred to the Korean cites. Next, the new meteorological dataset for each Korean city is converted into a daily air mass calendar. We can then determine the frequency and character of "offensive" air masses in the Korean cities that are historically associated with elevated heat-related mortality. One unexpected result is the comparative severity of the very hot summer of 1994 in Korea, which actually eclipsed the 2003 analog. The persistence of the offensive air masses is considerably greater for the summer of 1994, as were dew point temperatures for a majority of the Korean cities. For all the Korean cities but one, the summer of 1994 is associated with more heat-related deaths than the analog summer, in some cases yielding a sixfold increase over deaths in an average summer. The Korean cities appear less sensitive to heat-related mortality problems during very hot summers than do large eastern and Midwestern US cities, possibly due to a lesser summer climate variation and efficient social services available during extreme heat episodes.

Vestibular Schwannoma Presenting with Cough-Induced Vertigo.

Vestibular schwannomas often present with unilateral hearing loss, tinnitus, or dizziness. Imaging is commonly pursued in individuals with unexplained unilateral sensorineural hearing loss, deterioration in word recognition scores, or persistent tinnitus. We present the case of a 76-year-old male with cough-induced vertigo as his primary presenting symptom. Vestibular testing suggested a right vestibular hypofunction, and a small right-sided vestibular schwannoma was discovered using magnetic resonance imaging. Cough-induced vertigo and associated nystagmus may be a presenting feature of vestibular schwannoma.

Standardizing the factors used in wind farm site suitability models: A review.

As global wind energy capacity continues to expand, the need to site commercial wind farms in productive, affordable, and technically feasible locations has become increasingly important. The use of wind farm site suitability models to identify these locations has grown consequently, thus increasing interest in standardizing certain aspects of these models' development. This systematic review of wind farm site suitability studies seeks to identify similarities and differences in the selection and representation of their enlisted siting factors. The review focuses on how subjective modeling decisions, such as vocabulary choices and dataset selection, occur in the literature, based on five identified themes: 1) Deciding Upon Siting Factors, which explains how a study's geographical context, selected modeling approach, and modeler decisions can influence siting factor selection; 2) Classifying Data and Siting Factor Terminology, which addresses the extent and the advantages of consistent siting factor vocabulary; 3) Implementing Siting Factors as Constraints or as Evaluation Criteria, which covers the importance of consistent implementation and of specifying logic when enlisting siting factors to assess potential wind farm sites; 4) Utilizing Primary and Secondary Data, which details how a study's reliance on external or self-collected datasets influences siting factor representation; and 5) Data Source and Accessibility, which highlights the inconsistent provision of citations and dataset sources, and the availability of datasets for siting factors to the broader scientific community. Standardizing the selection and representation of siting factors would benefit comparisons between wind farm site suitability studies and communication of model outputs to a wider audience.

Prevalence of "Reversal Nystagmus" in Benign Paroxysmal Positional Vertigo.

PURPOSE: To investigate the prevalence of reversal nystagmus in individuals with benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Prevalence of reversal nystagmus was assessed in 28 subjects with unilateral posterior canal BPPV, canalithiasis type. Six trials of Dix-Hallpike testing were completed for each subject. RESULTS: Reversal nystagmus was present in 129 out of 167 Dix-Hallpike maneuvers that were performed (77.2%). In 19 trials where nystagmus was absent with the dependent position of Dix-Hallpike testing, reversal nystagmus was nonetheless demonstrated in 11 trials (57.9%). CONCLUSION: Reversal nystagmus is commonly demonstrated in individuals with posterior canal BPPV, canalithiasis type. It is frequently evoked even when there is no nystagmus with the dependent position of Dix-Hallpike testing. Observation of reversal nystagmus may enhance the identification of BPPV during Dix-Hallpike testing.

Longitudinal Evaluation of Chronic Rhinosinusitis Symptoms in a Population-Based Sample.

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent and disabling condition of the nose and sinuses. The natural history of CRS symptoms in a general population sample has not been previously studied. OBJECTIVE: In a general population-based sample from Pennsylvania, we used 2 questionnaires mailed 6 months apart to estimate the prevalence of, and identify predictors for, stability or change in symptoms over time. METHODS: We mailed the baseline and 6-month follow-up questionnaires to 23,700 primary care patients and 7,801 baseline responders, respectively. We categorized nasal and sinus symptoms using European Position Paper on Rhinosinusitis (EPOS) epidemiologic criteria. We defined 6 symptom groups over time on the basis of the presence of CRS symptoms at baseline and follow-up. We performed multivariable survey logistic regression controlling for confounding variables comparing persistent versus nonpersistent, recurrent versus stable past, and incident versus never. RESULTS: There were 4,966 responders at follow-up: 558 had persistent symptoms, 190 recurrent symptoms, and 83 new symptoms meeting EPOS criteria for CRS. The prevalence of persistent symptoms was 4.8% (95% CI, 3.8-5.8), whereas the annual cumulative incidence of new symptoms was 1.9% and of recurrent symptoms was 3.2%. More severe symptoms at baseline were associated with persistence, whereas minor symptoms, allergies, and multiple treatments were associated with the development of new symptoms. CONCLUSIONS: Less than half with nasal and sinus symptoms meeting CRS EPOS criteria in our general, regional population had symptom persistence over time, with symptom profiles at baseline and age of onset being strongly associated with stability of symptoms.

Climatic impacts on winter wheat in Oklahoma and potential applications to climatic and crop yield prediction.

Climatic anomalies can pose severe challenges for farmers and resource managers. This is particularly significant with respect to gradually developing anomalies such as droughts. The impact of the 1995-1996 drought on the Oklahoma wheat crop, and the possibility that predictive information might have reduced some of the losses, is examined through a combined modeling approach using climatological data and a crop growth model that takes into account an extensive range of soil, climatic, and plant variables. The results show potential outcomes and also illustrate the point at which all possible climatic outcomes were predicting a significantly low wheat yield. Based on anecdotal evidence of the 1995-1996 drought, which suggested that farmers who planted at different times experienced different yields, the model was run assuming a variety of different planting dates. Results indicate that there is indeed a noticeable difference in the modeled wheat yields given different planting dates. The information regarding effectiveness of planting date can be used in conjunction with current long-range forecasts to develop improved predictions for the current growing season. This approach produces information regarding the likelihood of extreme precipitation events and the impact on crop yield, which can provide a powerful tool to farmers and others during periods of drought or other climatic extremes.

Chronic invasive fungal sinusitis: characterization and shift in management of a rare disease.

BACKGROUND: Chronic invasive fungal sinusitis (CIFS) is a rare subtype of mycotic diseases involving the paranasal sinuses. It is characterized by a slow onset and invasive organisms with non-granulomatous inflammation seen on histopathology. Historically, treatment has involved radical surgical resection. The purpose of this study was to describe the presentation, comorbidities, and role of more conservative treatment options. METHODS: This is a multi-institutional retrospective case series of 6 patients with CIFS over 15 years. Patients' medical comorbidities, imaging results, operative procedures, pathological findings including organisms identified, antimicrobial medications used, and outcomes were reviewed. RESULTS: The mean time from onset of symptoms to diagnosis was 6 months. Cultures and fungal PCR identified Aspergillus species in every case. All 6 patients were found to have systemic comorbidities, with many being diabetic. Imaging findings ranged from thickening of sinus mucosa to invasion of the orbit and skull base. Treatment included long-term antifungal therapy and conservative endoscopic surgery in all but 1 patient, who had an open approach. Every patient was free of invasive fungal disease at last follow-up, with a range of 1 to 27 months. CONCLUSION: CIFS is an insidious disease often with months between symptom onset and diagnosis. It is differentiated from chronic granulomatous invasive fungal sinusitis (CGIFS) by a lack of granulomas on histopathology and an association with diabetes mellitus. Endoscopic debridement combined with long-term oral voriconazole was an effective treatment strategy in this series.

Persistent cervical lymphadenopathy in an adolescent with Epstein-Barr induced hemophagocytic syndrome: manifestations of a rare but often fatal disease.

Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) is a non-malignant proliferative disorder characterized by histiocytic proliferation and hemophagocytosis following Epstein-Barr virus infection. Though quite rare, this condition represents an often fatal disease primarily affecting the pediatric population. We discuss the case of an adolescent female who presented initially with persistent cervical lymphadenopathy and the typical findings of tonsillar hypertrophy, pharyngitis, and splenomegaly associated with infectious mononucleosis. This case study outlines the pathogenesis, common clinical findings, diagnostic criteria, and a review of the HLH-94 treatment protocol. Early recognition and treatment is emphasized because of the fulminant course of the disorder.

Does body mass index predict tracheal airway size?

OBJECTIVES/HYPOTHESIS: To determine the relationship between body mass index along with other anthropomorphic variables as they relate to tracheal airway dimensions. STUDY DESIGN: Retrospective case series. METHODS: This was a radiographic study of 123 consecutive hospitalized patients undergoing tracheotomy over a 4-year period (2007-2011). We measured airway dimensions in axial computed tomography imaging and made comparisons with height, weight, body mass index, gender, and age. Measurements were taken at the first tracheal ring level including anterior-posterior length, width, and calculated area. We expected higher body mass index not to be a good predictor of larger airway dimensions. RESULTS: The linear regression model showed body mass index was significantly inversely related to tracheal width after controlling for gender and age (P = .0389). For every 1 kg/m(2) increase in body mass index, the tracheal width decreased by 0.05 mm. There was a trend for airway area to diminish with increasing body mass index. CONCLUSIONS: These results are consistent with the hypothesis that obese patients do not have larger airways. Our study indicated a trend toward smaller airways as body mass index increased. Specifically, as body mass index increases, tracheal width appears to decrease. This information should help medical professionals avoid the tendency to use a larger tube to secure the airway of an obese patient. Hopefully, this will result in further research into the field and may prevent future airway injuries in a society where obesity has become epidemic. LEVEL OF EVIDENCE: 4 Laryngoscope, 125:1093-1097, 2015.

FNA biopsy of pediatric cervicofacial masses and validation of clinical characteristics of malignancy.

INTRODUCTION: Pediatric head and neck masses can pose a diagnostic challenge due to their ubiquitous nature. The vast majority of masses are inflammatory, however malignancies do occur. This study is a review of fine needle aspiration biopsy (FNA-B) as a diagnostic technique at a single institution over a 13 year period. The objectives were to examine the sensitivity and specificity of FNA-B, correlate these results with clinical characteristics of each mass and determine if such characteristics are associated with malignancy. METHODS: This was a retrospective case series of 143 consecutive pediatric patients who underwent FNA-B of 146 head and neck masses with subsequent follow up examinations from 2000 to 2012 (inclusive). We expected FNA-B to be a sensitive and specific method for determining malignancy. FNA-B diagnoses were confirmed with open biopsy pathology results and clinical follow up greater than 1 year. Physical exam characteristics of each mass including location, tenderness, firmness, and mobility were documented. Chi square and Fisher exact tests were used to determine statistical significance. RESULTS: The sensitivity and specificity of FNA-B in determining malignancy were 87.5% and 100% respectively. Positive and negative predictive values were 100% and 99.1%, respectively. On univariate analysis of clinical descriptors associated with malignancy, non-mobile masses significantly correlated (p=0.0025), while the firmness and tenderness of a mass did not reach statistical significance. Of mass locations, the lateral neck had the strongest association with malignancy, but this relationship only demonstrated statistical significance when lymphomas were considered independently (p=0.0428). CONCLUSIONS: Results demonstrate FNA-B to be an effective method for the diagnosis of pediatric head and neck masses. It maintained a high sensitivity and specificity with a large sample size, to date one of the largest in the pediatric otolaryngology literature. Also, the data offered statistical validation of classical signs of malignancy and showed fixed masses to have the highest correlation. Finally, the findings support lateral neck masses to warrant a higher degree of suspicion for malignancy compared to other compartments.

Occupational and environmental risk factors for chronic rhinosinusitis: a systematic review.

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease, with a likely multifactorial etiology potentially including hazardous occupational and environmental exposures. We completed a systematic review of the occupational and environmental literature to evaluate the quality of evidence of the role that hazardous exposures might play in CRS. METHODS: We searched PubMed for studies of CRS and following exposure categories: occupation, employment, work, industry, air pollution, agriculture, farming, environment, chemicals, roadways, disaster, and traffic. We abstracted information from the final set of articles across 6 primary domains: study design; population; exposures evaluated; exposure assessment; CRS definition; and results. RESULTS: We identified 41 articles from 1080 manuscripts: 37 occupational risk papers, 1 environmental risk paper, and 3 papers studying both categories of exposures. None of the 41 studies used a CRS definition consistent with current diagnostic guidelines. Exposure assessment was generally dependent on self-report or binary measurements of exposure based on industry of employment. Only grain, dairy, and swine operations among farmers were evaluated by more than 1 study using a common approach to defining CRS, but employment in these settings was not consistently associated with CRS. The multiple other exposures did not meet quality standards for reporting associations or were not evaluated by more than 1 study. CONCLUSION: The current state of the literature allows us to make very few conclusions about the role of hazardous occupational or environmental exposures in CRS, leaving a critical knowledge gap regarding potentially modifiable risk factors for disease onset and progression.

The effect of uvulopalatopharyngoplasty on the nasality of voice.

We prospectively studied the effect of uvulopalatopharyngoplasty (UPPP) on several speech and vocal parameters in 15 patients. Preoperative, 1-month postoperative, and 6-month postoperative assessments were made. Specific parameters included maximum phonation time, mean speaking fundamental frequency, mean frequency perturbation, intensity, and nasalance. Psychoacoustic analysis included pitch, quality, rate, resonance, and loudness. The primary outcome measure was the nasality of voice. At the 1-month postoperative assessment, one patient exhibited mild hypernasality by psychoacoustic analysis and a mildly elevated measured nasalance. At 6 months, both the psychoacoustic hypernasality and the measure nasalance had normalized. Consequently, no subjects exhibited hypernasality at the final assessment. Although abnormalities by psychoacoustic analysis were exhibited by 3 subjects at the 6-month postoperative assessment, none could be attributed to the surgery, but rather to concurrent illnesses. This study adds further data and support that UPPP done in standard fashion does not result in significant changes in voice either by measured parameters or by clinical assessment. Although this study does not obviate the need for preoperative counseling of patients about the potential effect of UPPP on voice, they can be counseled that the risk of hypernasality after UPPP is low.

Strobovideolaryngoscopy in the management of acute laryngeal trauma.

Surgical intervention in the management of acute laryngeal trauma can sometimes pose a difficult decision. The objective of this study is to evaluate the effectiveness of strobovideolaryngoscopy (SVL) in determining the course of management for patients sustaining acute laryngeal trauma. A 20-year retrospective study of patients presenting with acute laryngeal trauma was performed in order to determine if the addition of SVL during the study period changed the management of certain acute laryngeal injuries. Patients sustaining blunt laryngeal trauma evaluated at our institution from 1981 to the present were reviewed. There were 40 patients identified that were grouped by severity according to the Schaefer classification. Analysis included mechanism of injury, clinical presentation, assessment, treatment, and outcome. Group 1 injuries were the most common, with motor vehicle accident (MVA) the most frequent mechanism of injury. Initial assessment included fiberoptic laryngoscopy and computed tomography (CT) imaging in all patients not requiring immediate exploration. SVL was used in 20 patients, with 7 undergoing stroboscopy within 24 hours of presentation. All 7 patients were managed conservatively without surgical intervention or the need to establish an alternative airway. SVL improves the clinical assessment of patients with acute laryngeal injury. This study supports its use and found it to be an important factor in determining the need for surgical intervention. SVL may also shorten the hospital stay in these patients.

Traumatic unilateral vasomotor rhinitis.

Vasomotor rhinitis (VMR) is a commonly encountered entity that may be difficult to diagnose. The classic symptoms are clear rhinorrhea and nasal congestion, commonly brought on by exercise, stress, heat, cold, and environmental irritants. The diagnosis is one of exclusion, and management usually involves avoidance of inciting agents and treatment with an anticholinergic nasal spray. We describe a case of VMR in a 22-year-old woman who presented with symptoms of clear, left-sided rhinorrhea and epiphora that had begun shortly after a motor vehicle accident approximately 1.5 years earlier, but which she had not reported at that time. The patient's left carotid canal had been fractured and the surrounding sympathetic plexus injured in the accident, resulting in an overactive parasympathetic system. Both exercise and heat exacerbated her symptoms. Allergy was excluded by negative allergy testing, and the patient did not respond to fluticasone nasal spray. Given the mechanism of injury, the unilaterality of symptoms, and the patient's lack of response to nasal steroids, it was thought that the VMR was due to the earlier traumatic injury, which had resulted in imbalance of the autonomic neural input. A trial of ipratropium was given to directly treat the parasympathetic overactivity. This treatment resulted in immediate improvement in both the nasal and lacrimal secretions.