Impact of Obesity on Timing of Tracheotomy: A Multi-institutional Retrospective Study.

OBJECTIVE: To examine the impact of increased body mass index (BMI) on (1) tracheotomy timing and (2) short-term surgical complications requiring a return to the operating room and 30-day mortality utilizing data from the Multi-Institutional Study on Tracheotomy (MIST). METHODS: A retrospective analysis of patients from the MIST database who underwent surgical or percutaneous tracheotomy between 2013 and 2016 at eight institutions was completed. Unadjusted and adjusted logistic regression analyses were used to assess the impact of obesity on tracheotomy timing and complications. RESULTS: Among the 3369 patients who underwent tracheotomy, 41.0% were obese and 21.6% were morbidly obese. BMI was associated with higher rates of prolonged intubation prior to tracheotomy accounting for comorbidities, indication for tracheotomy, institution, and type of tracheostomy (p = 0.001). Morbidly obese patients (BMI ≥35 kg/m2) experienced a longer duration of intubation compared with patients with a normal BMI (median days intubated [IQR 25%-75%]: 11.0 days [7-17 days] versus 9.0 days [5-14 days]; p < 0.001) but did not have statistically higher rates of return to the operating room within 30 days (p = 0.12) or mortality (p = 0.90) on multivariable analysis. This same finding of prolonged intubation was not seen in overweight, nonobese patients when compared with normal BMI patients (median days intubated [IQR 25%-75%]: 10.0 days [6-15 days] versus 10.0 days [6-15 days]; p = 0.36). CONCLUSION: BMI was associated with increased duration of intubation prior to tracheotomy. Although morbidly obese patients had a longer duration of intubation, there were no differences in return to the operating room or mortality within 30 days. LEVEL OF EVIDENCE: III Laryngoscope, 2024.

A review on existing and emerging approaches for textile wastewater treatments: challenges and future perspectives.

This comprehensive review explores the complex environment of textile wastewater treatment technologies, highlighting both well-established and emerging techniques. Textile wastewater poses a significant environmental challenge, containing diverse contaminants and chemicals. The review presents a detailed examination of conventional treatments such as coagulation, flocculation, and biological processes, highlighting their effectiveness and limitations. In textile industry, various textile operations such as sizing, de-sizing, dyeing, bleaching, and mercerization consume large quantities of water generating effluent high in color, chemical oxygen demand, and solids. The dyes, mordants, and variety of other chemicals used in textile processing lead to effluent variable in characteristics. Furthermore, it explores innovative and emerging techniques, including advanced oxidation processes, membrane filtration, and nanotechnology-based solutions. Future perspectives in textile wastewater treatment are discussed in-depth, emphasizing the importance of interdisciplinary research, technological advancements, and the integration of circular economy principles. Numerous dyes used in the textile industry have been shown to have mutagenic, cytotoxic, and ecotoxic potential in studies. Therefore, it is necessary to assess the methods used to remediate textile waste water. Major topics including the chemical composition of textile waste water, the chemistry of the dye molecules, the selection of a treatment technique, the benefits and drawbacks of the various treatment options, and the cost of operation are also addressed. Overall, this review offers a valuable resource for researchers and industry professionals working in the textile industry, pointing towards a more sustainable and environmentally responsible future.

Transcriptional subtypes of glottic cancer characterized by differential activation of canonical oncogenic programming.

BACKGROUND: There is a paucity of data concerning molecular heterogeneity among glottic squamous cell carcinoma, and the clinical implications thereof. METHODS: Data corresponding to glottic squamous cell carcinoma were derived from The Cancer Genome Atlas. The Onco-GPS computational methodology was levied to derive four patterns of transcriptional activity and three functional subtypes of glottic cancer. RESULTS: Thirty glottic cancer samples stratified to three distinct oncogenic states (S0-S2) based on a Onco-GPS model containing four transcriptional components (F0-F3). Membership in S2 and association with transcriptional component F0 conveyed an invasive phenotype, with transcriptional activity strongly reflecting EMT programming (including TGF-B and NF-KB signaling). S2 membership also correlated with inferior disease-specific survival (HR 9.027, 95% CI 1.021-79.767), and higher incidences of extracapsular spread and perineural invasion. CONCLUSIONS: We present a functional taxonomy of glottic cancer, with subtypes demonstrating differential upregulation of canonical oncogenic networks and survival implications.

Detecting Mild Phonotrauma in Daily Life.

OBJECTIVE: The aim of this study was to gain quantitative insights into the role of daily voice use associated with mild phonotrauma via the Daily Phonotrauma Index (DPI), a measure derived from neck-surface acceleration magnitude (NSAM) and difference between the first two harmonic magnitudes (H1 - H2). METHODS: An ambulatory voice monitor recorded weeklong voice use for 151 female patients with phonotraumatic vocal hyperfunction (PVH) and 181 female vocally healthy controls. Three laryngologists rated phonotrauma severity from each patient's laryngoscopy. Mixed generalized linear models evaluated the accuracy, sensitivity, and specificity of the original DPI trained on all patients versus a mild DPI version trained on only patients rated with mild phonotrauma. Individual contribution of NSAM and H1 - H2 to each DPI model was also evaluated. RESULTS: Reliability across the laryngologists' phonotrauma ratings was moderate (Fleiss κ = 0.41). There were 70, 69, and 12 patients with mild, moderate, and severe phonotrauma, respectively. The mild DPI, compared to the original DPI, correctly classified more patients with mild phonotrauma (Cohen's d = 0.9) and less controls (d = -0.9) and did not change in overall accuracy. H1 - H2 contributed less to mild phonotrauma classification than NSAM for mild DPI. CONCLUSIONS: Compared with the original DPI, the mild DPI exhibited higher sensitivity to mild phonotrauma and lower specificity to controls, but the same overall classification accuracy. These results support the mild DPI as a promising detector of early phonotrauma and that NSAM may be associated with early phonotrauma, and H1 - H2 may be a biomarker associated with vocal fold vibration in the presence of lesions. LEVEL OF EVIDENCE: Level 4, case-control study Laryngoscope, 133:3094-3099, 2023.

Identification of bacterial and fungal pathogens directly from clinical blood cultures using whole genome sequencing.

Bloodstream infections are a major cause of morbidity and mortality worldwide. Early administration of appropriate antimicrobial therapy can improve patient survival and prevent antimicrobial resistance (AMR). Whole genome sequencing (WGS) can provide information for pathogen identification, AMR prediction and sequence typing earlier than current phenotypic diagnostic methods. WGS was performed on 97 clinical blood specimens and matched culture isolate pairs. Specimen/isolate pairs were MLST sequence-typed and further characterization was performed on Streptococcus species. WGS correctly identified 91.7% of clinical specimens and 93.2% of matched isolates representing 35 different microbial species. MLST types were assigned for 89.9% of matched cultures and 21.7% of blood specimens, with higher success for blood culture specimens extracted within 3 days (52% characterized) than 7 days (9.3%). This study demonstrates the potential use of WGS for identification and characterization of pathogens directly from blood culture specimens to facilitate timely initiation of appropriate antimicrobial therapies.

Elucidating the impact of boron fertilization on soil physico-chemical and biological entities under cauliflower-cowpea-okra cropping system in an Eastern Himalayan acidic Inceptisol.

Information on the role of boron (B) on soil physico-chemical and biological entities is scarce, and the precise mechanism in soil is still obscure. Present field investigation aimed to assessing the implication of direct and residual effect of graded levels of applied-B on soil biological entities and its concomitant impact on crop productivity. The treatments comprised of five graded levels of B with four replications. To assess the direct effect of B-fertilization, cauliflower was grown as a test crop wherein, B-fertilization was done every year. For assessment of succeeding residual effects of B-fertilization, cowpea and okra were grown as test crops and, B-fertilization was phased out in both crops. The 100% recommended dose of NPK (RDF) along with FYM was uniformly applied to all crops under CCOCS. Results indicated that the direct effect of B had the edge over residual effect of B in affecting soil physico-chemical and biological entities under CCOCS. Amongst the graded levels of B, application of the highest B level (2 kg ha-1) was most prominent in augmenting microbiological pools in soil at different crop growth stages. The order of B treatments in respect of MBC, MBN, and soil respiration at different crop growth stages was 2.0 kg B ha-1 > 1.5 kg B ha-1 > 1.0 kg B ha-1 > 0.5 kg B ha-1 > 0 kg B ha-1, respectively. Moreover, maximum recoveries of potentially mineralizable-C (PMC) and potentially mineralizable-N (PMN) were noticed under 2 kg B ha-1. Analogous trend was recorded in soil microbial populations at different crop growth stages. Similarly, escalating B levels up to 2 kg B ha-1 exhibited significantly greater soil enzymatic activities viz., arylsulphatase (AS), dehydrogenase (DH), fluorescein diacetate (FDA) and phosphomonoesterase (PMA), except urease enzyme (UE) which showed an antagonistic effect of applied-B in soil. Greater geometric mean enzyme activity (GMEA) and soil functional diversity index were recorded under 2 kg B ha-1 in CCOCS, at all crop growth stages over control. The inclusive results indicated that different soil physico-chemical and biological properties CCOCS can be invariably improved by the application of graded levels of B up to 2 kg B ha-1 in an acid Inceptisol.

Antifungal compound from marine Serratia marcescens BKACT and its potential activity against Fusarium sp / Compuesto antifúngico de Serratia marcescens marina BKACT y su potencial actividad contra Fusarium sp

Ecofriendly biocontrol agents to control pathogenic fungi are in demand globally. The present study evaluated the antifungal potentials of marine bacteria Serratia marcescens BKACT against eight different Fusarium species. A highest 75.5 ± 0.80% of mycelial inhibition was observed against Fusarium foetens NCIM 1330. Structural characterization of the purified compound was analyzed by GC–MS and NMR techniques; based on the analysis, it is confirmed as 2, 4-di-tert butyl phenol (2, 4-DTBP) with chemical structure C14H22O. At 0.53 mM concentration, purified compound inhibited complete spore germination of F. foetens NCIM 1330. In vitro assay showed complete inhibition of F. foetens NCIM 1330 on the wheat seeds. Tested concentration does not show any toxic effect on germination of the seeds. By this study, we conclude that, 2, 4-DTBP is a suitable candidate to be used as biocontrol agent against Fusarium infection.(AU)

Antifungal compound from marine Serratia marcescens BKACT and its potential activity against Fusarium sp.

Ecofriendly biocontrol agents to control pathogenic fungi are in demand globally. The present study evaluated the antifungal potentials of marine bacteria Serratia marcescens BKACT against eight different Fusarium species. A highest 75.5 ± 0.80% of mycelial inhibition was observed against Fusarium foetens NCIM 1330. Structural characterization of the purified compound was analyzed by GC-MS and NMR techniques; based on the analysis, it is confirmed as 2, 4-di-tert butyl phenol (2, 4-DTBP) with chemical structure C14H22O. At 0.53 mM concentration, purified compound inhibited complete spore germination of F. foetens NCIM 1330. In vitro assay showed complete inhibition of F. foetens NCIM 1330 on the wheat seeds. Tested concentration does not show any toxic effect on germination of the seeds. By this study, we conclude that, 2, 4-DTBP is a suitable candidate to be used as biocontrol agent against Fusarium infection.

Experimental Investigation of Thermal Conductivity of Water-Based Fe3O4 Nanofluid: An Effect of Ultrasonication Time.

Nanofluid preparation is a crucial step in view of their thermophysical properties as well as the intended application. This work investigates the influence of ultrasonication duration on the thermal conductivity of Fe3O4 nanofluid. In this work, water-based Fe3O4 nanofluids of various volume concentrations (0.01 and 0.025 vol.%) were prepared and the effect of ultrasonication time (10 to 55 min) on their thermal conductivity was investigated. Ultrasonication, up to a time duration of 40 min, was found to raise the thermal conductivity of Fe3O4 nanofluids, after which it starts to deteriorate. For a nanofluid with a concentration of 0.025 vol.%, the thermal conductivity increased to 0.782 W m-1K-1 from 0.717 W m-1K-1 as the ultrasonication time increased from 10 min to 40 min; however, it further deteriorated to 0.745 W m-1K-1 after a further 15 min increase (up to a total of 55 min) in ultrasonication duration. Thermal conductivity is a strong function of concentration of the nanofluid; however, the optimum ultrasonication time is the same for different nanofluid concentrations.

Patterns of Failure After Definitive Treatment of T4a Larynx Cancer.

OBJECTIVE: Recurrence is known to predict laryngeal squamous cell cancer (LSCC) survival. Recurrence patterns in T4a LSCC are poorly characterized and represent a possible explanation for observed survival discrepancies by treatment rendered. STUDY DESIGN: Retrospective database review. SETTING: Veterans Affairs national database. METHODS: Patients with T4a LSCC between 2000 and 2017 were identified and stratified by treatment (chemoradiotherapy [CRT] vs total laryngectomy + neck dissection + adjuvant therapy [surgical]). Primary outcomes were locoregional and distant recurrence. Secondary outcomes of overall mortality, larynx cancer mortality, and noncancer mortality were evaluated in Cox and Fine-Gray models. RESULTS: A total of 1043 patients had comparable baseline demographics: 438 in the CRT group and 605 in the surgical group. Patients undergoing CRT had higher proportions of node positivity (64.6% vs 53.1%, P < .001). Locoregional and distant recurrence were less common in the surgical group (23.0% vs 37.2%, P < .001; 6.8% vs 13.3%, P < .001, respectively); however, distant metastatic rates did not differ within the N0 subgroup (P = .722). On multivariable regression, surgery demonstrated favorable locoregional recurrence (hazard ratio [HR], 0.49; 95% CI, 0.39-0.62; P < .001), distant recurrence (HR, 0.47; 95% CI, 0.31-0.71; P < .001), overall mortality (HR, 0.75; 95% CI, 0.64-0.87; P < .001), and larynx cancer mortality (HR, 0.69; 95% CI, 0.56-0.85; P < .001). CONCLUSION: T4a LSCC survival discrepancies between surgical and nonsurgical treatment are influenced by varying recurrence behaviors. Surgery was associated with superior disease control and improved survival. Beyond the known benefit in locoregional control with surgery, there may be a protective effect on distant recurrence that depends on regional disease burden.

A review of graphene-TiO2 and graphene-ZnO nanocomposite photocatalysts for wastewater treatment.

Technologies for wastewater remediation have been growing ever since the environmental and health concern is realized. Development of nanomaterials has enabled mankind to have different methods to treat the various kinds of inorganic and organic pollutants present in wastewater from many resources. Among the many materials, semiconductor materials have found many environmental applications due to their outstanding photocatalytic activities. TiO2 and ZnO are more effectively used as photocatalyst or adsorbents in the withdrawal of inorganic as well as organic wastes from the wastewater. On the other hand, graphene is tremendously being investigated for applications in environmental remediation in view of the superior physical, optical, thermal, and electronic properties of graphene nanocomposites. In this work, graphene-TiO2 and graphene-ZnO nanocomposites have been reviewed for photocatalytic wastewater treatment. The various preparation techniques of these nanocomposites have been discussed. Also, different design strategies for graphene-based photocatalyst have been revealed. These nanocomposites exhibit promising applications in most of the water purification processes which are reviewed in this work. Along with this, the development of these nanocomposites using biomass-derived graphene has also been introduced. PRACTITIONER POINTS: Graphene-TiO2 and graphene-ZnO nanocomposites are effective for wastewater treatment through photocatalysis. These nanocomposite photocatalysts have been used in the form of membrane as well as antibacterial agents. Synthetic strategies and design considerations of graphene-based photocatalyst play a major role. Biomass-derived graphene-TiO2 and graphene-ZnO nanocomposites have also found application in wastewater treatment.

Association of race and health care system with disease stage and survival in veterans with larynx cancer.

BACKGROUND: Black patients with laryngeal squamous cell carcinoma (LSCC) historically have inferior outcomes in comparison with White patients. The authors investigated these racial disparities within the Veterans Health Administration (VHA), an equal-access system, and within the Surveillance, Epidemiology, and End Results (SEER) program, which is representative of the US hybrid-payer system. METHODS: Patients with invasive (T1 or greater) LSCC were included from SEER (2004-2015) and the VHA (2000-2017). The primary outcomes of overall survival (OS) and larynx cancer-specific survival (LCS) were evaluated in Cox and Fine-Gray models. RESULTS: In the SEER cohort (7122 patients: 82.6% White and 17.4% Black), Black patients were more likely to present with advanced disease and had inferior OS (hazard ratio [HR], 1.37; 95% CI, 1.26-1.50; P < .0001) in a multivariable analysis. Black LCS was worse in a univariable analysis (HR, 1.42; 95% CI, 1.27-1.58; P < .0001), but this effect was attenuated by 83% when the authors controlled for the TNM category and was found to be insignificant in a multivariable analysis (HR, 1.05; 95% CI, 0.93-1.18; P = .42). In the VHA cohort (9248 patients: 79.7% White and 20.3% Black), the 2 racial cohorts presented with similar tumor characteristics and similar OS (HR, 0.95; 95% CI, 0.89-1.02; P = .14). Black LCS was similar in univariable (HR, 1.10; 95% CI, 1.00-1.22; P = .05) and multivariable analyses (HR, 1.02; 95% CI, 0.92-1.14; P = .67). CONCLUSIONS: Black patients with LSCC had a tumor burden at diagnosis and survival outcomes comparable to those of White patients within the VHA; this was counter to what was observed in the SEER analysis and prior national trends. This study's findings point toward the notable role of health care access in contributing to racial health disparities in the realm of larynx cancer.

Predictors of Quality-of-Life Improvements Following Global Head and Neck Surgery Trips to Underserved Regions.

OBJECTIVES/HYPOTHESIS: To conduct longitudinal postoperative follow-up and discern health-related quality-of-life (HR-QoL) changes using a validated questionnaire among patients undergoing head and neck surgeries during a short-term, global surgical trip in a resource-limited setting. To identify clinicodemographic predictors of post-operative HR-QoL improvements in this setting. STUDY DESIGN: Retrospective observational study with prospective follow-up. METHODS: Patients undergoing surgery at Moi Teaching and Referral Hospital in Eldoret, Kenya through the authors' short-term surgical trip (STST) between 2016 and 2019 were asked to complete preoperative Short Form-36 (SF-36) HR-QoL questionnaires, and postoperative SF-36 questionnaires during subsequent follow-up. Preoperative and postoperative SF-36 domain scores, and two composite scores (mental component summary [MCS] and physical component summary [PCS]) were compared. Linear regression models were fit to identify clinicodemographic factors predictors of general health (GH), MCS, and PCS scores. RESULTS: Among the 26 participating patients, significant improvements were seen in post-operative GH (mean change = 19.8) and MCS (mean change = 11.2) scores. Lower pre-operative GH, MCS, and PCS scores were predictive of greater improvement in the corresponding post-operative scores. Longer time to follow-up was associated with greater improvement in GH score. Mean follow-up interval was 23.1 months (SD = 1.8 months). CONCLUSIONS: Utilizing the SF-36 questionnaire, we found that patients' perception of their general and psychosocial health improved after undergoing head and neck surgeries through a global STST. This study provides important, preliminary evidence that that elective surgeries performed in low-resource settings convey substantial benefit to patient QoL. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2006-2010, 2021.

Rate and Factors Associated With Change in Surgeon for Revision Endoscopic Sinus Surgery.

OBJECTIVES/HYPOTHESIS: A subset of patients will undergo revision endoscopic sinus surgery (ESS) with a different otolaryngologist than the one who performed their primary surgery. The purpose of this study is to report the incidence of and clinicodemographic factors associated with a change in surgeon for revision ESS. STUDY DESIGN: Retrospective cohort study. METHODS: Adult patients who underwent at least two outpatient ESS procedures between 2009 and 2014 using the State Ambulatory Surgery Database for Florida were included in the study. Change in surgeon was defined by a change in a unique provider identifier for the revision procedure. Multivariable regression analysis was used to determine characteristics associated with a change in surgeon. RESULTS: A total of 2,963 patients were included. For the revision procedure, 47.7% of patients changed their surgeon. On multivariable logistic regression, a medium- (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.53-0.77) or high-volume (OR: 0.50; 95% CI: 0.42-0.61) surgeon performing the index surgery and advanced age (≥65 years) (OR: 0.79; 95% CI: 0.63-0.99) were associated with decreased odds of surgeon change for revision ESS. Longer time elapsed between index and revision surgery (OR: 1.15; 95% CI: 1.13-1.17) was associated with increased odds of surgeon change. CONCLUSIONS: Nearly half of patients who undergo revision ESS select a surgeon other than the one who performed their primary procedure. Surgeon volume, age, and time between surgeries affect the likelihood of a change in surgeon for revision ESS. These findings may provide introductory insights into patient preferences and decision making in the surgical management of recalcitrant chronic rhinosinusitis. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1049-E1053, 2021.

18Fluorine-fluorodeoxyglucose PET-CT findings in a case of rarely seen metastatic adult extrarenal Wilms' tumor of retroperitoneum presenting as lower limb edema.

Wilms' tumor also called as nephroblastoma is commonly seen extracranial solid tumor involving kidneys in children. Rarely, Wilms' tumor can arise from ectopic nephrogenic remnants located outside the kidneys. Extrarenal Wilms' tumor comprises 3% of total Wilms' tumor with its incidence even less common in adults. We report the staging and restaging fluorodeoxyglucose positron emission tomography-computed tomography findings in a case of locally advanced metastatic extrarenal adult Wilms' tumor involving the retroperitoneum.

Sonochemical preparation and characterization of Sm-doped GO/KSrPO4 nanocomposite photocatalyst for degradation of methylene blue dye.

The present work pertains to synthesis of Sm-doped GO/KSrPO4 (GO/KSrPO4 :Sm) nanocomposite using ultrasound-assisted method. Successful decoration of graphene oxide sheets with the KSrPO4 :Sm3+ phosphor was confirmed using analysis techniques including SEM, EDS, UV/visible spectrometry, XRD, and FTIR of the prepared GO/KSrPO4 :Sm nanocomposite. Further, photocatalytic activity of this nanocomposite material was studied by examining degradation of methylene blue (MB) dye from water. The effects of several parameters like concentration of Sm3+ in KSrPO4 :Sm3+ phosphor within the GO/KSrPO4 :Sm nanocomposite photocatalyst, photocatalyst loading, initial dye concentration, pH, and preparation method were evaluated. At a higher concentration of Sm3+ in the photocatalyst (1 mol.%), higher photocatalyst loading (1.5 mg/ml), lesser dye concentration (20 mg/L), and higher pH (11.4), the GO/KSrPO4 :Sm nanocomposite photocatalyst prepared using ultrasound-assisted method showed higher dye removal compared to other conditions. A maximum of 83.35% removal of MB dye was achieved by the use of ultrasonically prepared GO/KSrPO4 :Sm nanocomposite photocatalyst having a concentration of 1 mol.% of Sm3+ in the KSrPO4 :Sm3+ phosphor at a loading of 1.5 mg/ml, initial dye concentration of 20 mg/L, and a pH of 11.4. Rate constant for MB dye degradation using the GO/KSrPO4:Sm nanocomposite photocatalyst synthesized by ultrasonic-assisted method was found to be 0.0053 min-1 . PRACTITIONER POINTS: GO/KSrPO4 :Sm nanocomposite photocatalyst prepared by ultrasonic-assisted method. Higher Sm3+ doping in nanocomposite with the use of ultrasound assisted method showed better performance of photocatalyst. A maximum removal of 83.35% of methylene blue dye was achieved.

Prognostic Significance of HPV Status in Laryngeal Squamous Cell Carcinoma: A Large-Population Database Study.

OBJECTIVE: To explore the survival implications of human papillomavirus (HPV) positivity and subtype in larynx cancer through a national cancer database. To investigate staging discrepancies in larynx cancer associated with HPV status. STUDY DESIGN: Retrospective observational cohort study. SETTING: National Cancer Database. METHODS: Data were extracted concerning adults with known HPV status who were treated between 2010 and 2016 for laryngeal squamous cell carcinoma. Patients without known HPV subtype were excluded. Cox multivariable regression models were fit to evaluate the survival impact of HPV status, characterized as a binary variable (HPV+ vs HPV-) and by subtype. Two- and 5-year survival rates were calculated via the Kaplan-Meier method and compared by stage between the HPV+ and HPV- cohorts per the log-rank test. RESULTS: Patients with HPV+ larynx cancer were younger (60.5 vs 64.3 years, P < .001), more likely to have private insurance (37.2% vs 31.2%, P < .001), more commonly White (84.6% vs 82.4%, P = .013), and more likely to present with nodal disease (42.6% vs 33.0%, P < .001). HPV positivity and HPV subtype 16 were associated with improved overall survival. One-stage discrepancies in 5-year survival were observed between the HPV+ and HPV- cohorts: stage II HPV+ (69.45%) vs stage I HPV- (65.77%); stage IV HPV+ (47.67%) vs stage III HPV- (46.80%). CONCLUSIONS: HPV positivity and infection with HPV subtype 16 are correlated with improved overall survival in patients with laryngeal squamous cell carcinoma, manifesting with a 1-stage incremental survival advantage. Future prospective studies are indicated to corroborate the findings from this large-population database retrospective study.

Change in surgeon for revision rhinoplasty: The impact of patient demographics and surgical technique on patient retention.

OBJECTIVES: A subset of patients who require revision rhinoplasty will change surgeons for their second procedure. We sought to investigate the rate of surgeon change and identify associated predictors using a population-based, ambulatory surgery database. METHODS/STUDY DESIGN: In this retrospective review, 9172 rhinoplasty procedures over a 5-year period were analyzed using the Healthcare Cost and Utilization Project (HCUP) Florida State Ambulatory Surgery and Services Database (SASD). We identified 380 patients who had at least two rhinoplasty procedures between 2009 and 2014. Logistic regression analysis was used to identify predictors of patients changing surgeons for their second documented rhinoplasty. RESULTS: Among the 380/8531 (4.4%) patients who underwent a revision rhinoplasty, 117/380 (30.8%) patients changed surgeons for their subsequent procedure within a 5-year period. Multivariable logistic regression identified a lower likelihood of surgeon change in patients undergoing functional or cosmetic cartilage grafting procedures (OR 0.342, 95%CI 0.155-0.714, P = .006) and in patients who self-paid for their procedure (OR 0.476, 95%CI 0.225-0.984, P = .048). One hundred twenty-four patients underwent a cosmetic revision rhinoplasty and were twice as likely to change surgeons as those who underwent functional revision rhinoplasty (OR 2.042 95%CI 1.046-4.050, P = .038). Time elapsed (>2 years) was positively correlated with likelihood of surgeon change (OR 1.236, 95%CI 1.153-1.333, P < .001). CONCLUSION: In our analysis, 30.8% of patients changed surgeons for their revision rhinoplasty. Cartilage grafting at the time of index procedure and cash payment correlated with a decreased likelihood of surgeon change. Patients were more likely to change surgeons with increased time elapsed or for an aesthetic revision. Clarifying features associated with surgeon change may help improve patient satisfaction and retention.

Predicting COVID-19 Incidence Using Anosmia and Other COVID-19 Symptomatology: Preliminary Analysis Using Google and Twitter.

OBJECTIVE: To determine the relative correlations of Twitter and Google Search user trends concerning smell loss with daily coronavirus disease 2019 (COVID-19) incidence in the United States, compared to other severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. To describe the effect of mass media communications on Twitter and Google Search user trends. STUDY DESIGN: Retrospective observational study. SETTING: United States. SUBJECTS AND METHODS: Google Search and "tweet" frequency concerning COVID-19, smell, and nonsmell symptoms of COVID-19 generated between January 1 and April 8, 2020, were collected using Google Trends and Crimson Hexagon, respectively. Spearman coefficients linking each of these user trends to COVID-19 incidence were compared. Correlations obtained after excluding a short timeframe (March 22 to March 24) corresponding to the publication of a widely read lay media publication reporting anosmia as a symptom of infection was performed for comparative analysis. RESULTS: Google searches and tweets concerning all nonsmell symptoms (0.744 and 0.761, respectively) and COVID-19 (0.899 and 0.848) are more strongly correlated with disease incidence than smell loss (0.564 and 0.539). Twitter users tweeting about smell loss during the study period were more likely to be female (52%) than users tweeting about COVID-19 more generally (47%). Tweet and Google Search frequency pertaining to smell loss increased significantly (>2.5 standard deviations) following a widely read media publication linking smell loss and SARS-CoV-2 infection. CONCLUSIONS: Google Search and tweet frequency regarding fever and shortness of breath are more robust indicators of COVID-19 incidence than anosmia. Mass media communications represent important confounders that should be considered in future analyses.