Sinus Irrigation Penetration After Proposed Modified Draf IIa Technique in a Side-to-Side Cadaveric Model

Background Endoscopic sinus surgery (ESS) is an effective intervention for patients with medically refractory chronic rhinosinusitis. Frontal sinusotomy is the most challenging part of ESS, with one of the key outcomes being access for topical irrigations. Objective The purpose of this study is to compare irrigation penetration into the frontal sinus following Draf IIa versus modified Draf IIa frontal sinusotomy. Methods Four fresh cadaver heads were used in this experiment. Draf IIa was performed on one side of each head and a modified Draf IIa on the contralateral side. This proposed modification consists of a Draf IIa combined with an agger nasi punch-out procedure and partial trimming of the vertical lamella of the middle turbinate back to the posterior table of the frontal sinus without drilling the beak. Each head was irrigated with methylene blue-dyed water and recorded by rigid endoscopy through an endonasal view (EV) of the frontal sinus and frontal trephination view (TV). Two blinded rhinologists scored the extent of staining (using an ordinal scale of 0 to 3) for each side. A case report where the modified Draf IIa was performed is also described. Results After modified Draf IIa sinuosotomy, the mean score for the EV was 2.125 and for the TV was 2, versus 0.875 and 0.625 for traditional Draf IIa, respectively. There was a statistically significant increase for both EV (p = 0.019) and TV (p = 0.018) after modified Draf IIa. Conclusion In our cadaveric model, this procedural modification improved penetration of postoperative irrigations into the frontal sinus. This simple technique may be easily adapted into frontal ESS when indicated.

Pandemic Compassionate Release and the Case for Improving Judicial Discretion over Early Release Decisions

After decades of Bureau of Prisons’ maladministration of the sentence reduction authority authorized by 18 U.S.C. § 3582, Congress passed the First STEP Act of 2018 with the intention of expanding the use and transparency of compassionate release. Although the COVID-19 pandemic was not among the considerations when the First Step Act became law, it contains several important modifications that may protect thousands of federal prisoners from severe sickness and premature death while in custody. First, its procedural modification allowing federal prisoners to circumvent the often-artificial strictures of the Bureau of Prisons allows for a timely and proactive release decision from the sentencing court before a vulnerable individual is stricken with the deadly virus. Second, district courts are now permitted to grant release decisions to deserving individuals who were previously blocked from petitioning their sentencing court by the Bureau of Prisons. Importantly, courts are empowered to find grounds for release beyond those specifically enumerated in the now-outdated Sentencing Commission policy statement that formerly restricted compassionate release decisions. After observing the potential of the new compassionate release process as modified by the First Step Act, Congress should avoid concurrent systems of release and judicial discretion over early release should be expanded by statute or via an updated Sentencing Commission policy statement.

A Parent-Implemented Playdate Intervention for Young Children With Autism and Their Peers

Children with autism spectrum disorder (ASD) present with social skills difficulties, which can create barriers for them to develop friendships with their peers. Playdates are a common way that young children practice play and friendship skills in home and community environments. Few studies have trained parents to embed social skills instruction into playdates for children with ASD, and such studies have been comprised of children with mild to moderate needs. In the current study, we employed a concurrent single-case multiple probe across three parent–child–peer triads design to evaluate the effects of training and coaching in a parent-implemented playdate intervention on parental strategy use and cascading effects on child–peer social interactions during playdates. Parents also rated the social validity of the intervention. Results indicated that two of the three parents reached criterion on the strategies quickly, and the third triad required a procedural modification. Challenging behavior appeared to be a barrier to implementation. Implications and future directions are discussed.

A retrospective review of patients with massive and submassive pulmonary embolism treated with AngioJet rheolytic thrombectomy with decreased complications due to changes in thrombolytic use and procedural modifications

Objectives A retrospective review of treatment of patients with massive or submassive pulmonary embolism (PE) using AngioJet rheolytic thrombectomy (ART) system with procedural modifications to improve on the previously reported outcomes. Materials and Methods Thirteen patients underwent emergent pulmonary artery thrombectomy for massive and submassive PE using ART with pharmacological and procedural modification, in comparison to prior reports. The modifications included the selective use of the Solent Omni AngioJet device in all subjects, distal contrast angiography via the AngioJet catheter before device activation, and limited short run times. Thrombolytic therapy was not used in any patient. Patients were monitored for short- and long-term outcomes. Long-term clinical follow-up and evaluation for persistent pulmonary hypertension with echocardiography was performed. Results The pharmacological and procedural modifications resulted in a favorable clinical response without any major complications and without any mortality. Procedure-related anemia (mean hemoglobin drop of 0.49 g/dl) was the only significant minor complication noted. There were no bleeding complications and no transfusion requirement. On a six-month follow-up, there was no mortality, and there were significant reductions in the pulmonary artery pressures. Conclusion Major and minor complications were reduced compared to prior reports using ART. A modified ART approach towards treatment of high-risk PE appears promising both in terms of efficacy and safety.

Experimental testing and design of BRB with bolted and pinned connections

The recent series of damaging earthquakes in Christchurch, New Zealand has encouraged greater recognition of the post-earthquake economic impacts on New Zealand society and higher emphasis on low-damage earthquake resisting systems. Braced frames incorporating Buckling Restrained Braces (BRB) are seen as a significant contender for such a system. This research project focuses on the development of a reliable design procedure and detailing requirements for a generic BRB system. To gauge the performance of the designed system and to ascertain the reliability of the developed procedure, a series of static and dynamic sub-assemblage tests on the BRB frame with two different brace connection configurations were performed. The results are presented and discussed herein. The experimental tests generated stable and near symmetrical hysteresis loops, which is a principal characteristic of a well performing BRB system, albeit with the occurrence of slack in the connections. The experimental test results shows that several improvements need to be made to the proposed design procedure and detailing as outlined throughout the paper; especially the procedural modification to prevent slack from occurring in the two different connection systems. It is envisaged that applications will typically involve use of proprietary braces, however these need to be applied in accordance with the New Zealand design procedure; and determining the appropriate procedure was a key part of this project.

Modified AOAC Three Step Method (Official Method 2008.05): Consolidation of Fractions B and C

The AOAC Quantitative Three Step Method (TSM; AOAC Official MethodSM 2008.05) is validated for testing the efficacy of liquid sporicides against spores of Bacillus subtilis and Bacillus anthracis on selected hard, nonporous, and porous surfaces. The TSM uses 5 × 5 × 1 mm inoculated coupons (carriers), which are placed in 400 μL liquid sporicidal agent contained in a microcentrifuge tube. Following exposure of inoculated carriers to the test chemical and subsequent neutralization, viable spores are recovered in three fractions: A (gentle tapping), B (sonication), and C (gentle agitation). The spores in suspension are serially diluted and plated on a recovery medium for enumeration. The plate counts are summed over the three fractions to provide the number of viable spores per carrier, which is log10-transformed to generate a mean log density (LD) value across carriers. As a measure of product efficacy, a log reduction (LR) value is calculated by subtracting the mean LD for treated carriers from the mean LD for control carriers. This paper reports on the comparative evaluation of the current and modified versions of the TSM in order to support a modification to simplify the procedure. The proposed modified TSM (mTSM) consolidates fractions B and C in the same tube. Thus, the sonication (fraction B) and gentle agitation (fraction C) steps are carried out in the same tube, thereby reducing the number of tubes and associated resources and time necessary to complete the test. Glass, steel, pine wood, and ceramic tile carriers were included in the comparative study. Inoculated carriers were evaluated against two preparations of sodium hypochlorite to generate two presumed levels of efficacy (intermediate and high); the control LD and LR values associated with testing each carrier type for the TSM and the mTSM were compared. For control carriers, the mean log densities per carrier (for each carrier material) were not significantly different based on the TSM compared to the mTSM. Furthermore, the treated carrier data showed comparable LR values for the TSM and mTSM. The data provided in this report demonstrate equivalency between the TSM and mTSM and support the proposed procedural modification to consolidate fractions B and C.

Isolation of Light Filth from Ground Oregano and Ground Marjoram: A Modification Using Isopropanol as a Defatting Agent: In-House Study

A procedural modification of the AOAC Official Method for extracting light filth from ground oregano and ground marjoram was tested in an intralaboratory study. The modified method specifies isopropanol defatting, 975.49A(a), rather than chloroform–isopropanol defatting, 975.49A(b), followed by direct flotation as directed in AOAC Official Method, 975.49B(b). The modified method provided comparable results in less time while also providing safety, health, and financial benefits.