Vanessa Yee Jueen Tan MBBS (S’pore), MRCS (Glasgow), MMed (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalEdward Zhiyong Zhang MBBS (S’pore), MRCS (Glasgow), MMed (ORL), MCI, FAMS (ORL) Department of Otolaryngology – Head and Neck Surgery Sengkang General HospitalDan Daniel PhD Institute of Materials Research and EngineeringAnton Sadovoy PhD Institute of Materials Research and EngineeringNeville Wei Yang Teo MBBS (S’pore), MRCS (Glasglow), MMed (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalKimberley Liqin Kiong MBBS (S’pore), MRCS (Edinburgh), MMed (ORL), FAMS (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalSong Tar Toh MBBS (S’pore), MRCS (Edin), MMed (ORL), MMed (Sleep Med), FAMS (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalHeng Wai Yuen MBBS (S’pore), MRCS (Edinburgh), MMed (ORL), DOHNS (England), GDFM Ear Nose Throat, Head and Neck Surgery Changi General HospitalCorresponding author: Vanessa Yee Jueen Tan email@example.com
Background: Diagnosis of Severe Acute Respiratory Coranavirus-2 (SARS-CoV-2) infection is currently based on Real-Time PCR (RT-PCR) performed on either nasopharyngeal (NPS) or oropharyngeal (OPS) swabs; saliva specimen collection can be used, too. Diagnostic accuracy of these procedures is suboptimal, and some procedural mistakes may account for it.Methods and results: The video shows how to properly collect secretions from the upper airways for non-serologic diagnosis of COVID-19 by nasopharyngeal swab (NPS), oropharyngeal swab (OPS), and deep saliva collection after throat-cleaning manoeuvre, all performed under videoendoscopic view by a trained ENT examiner.Conclusions: We recommend to perform NPS after elevation of the tip of the nose in order to reduce the risk of contamination from the nasal vestible, and to let it flow over the floor of the nasal cavity in parallel to the hard palate in order to reach the nasopharynx. Then the tip of the swab should be left in place for few seconds, and then rotated in order to achieve the largest absorption of nasopharyngeal secretions. Regards OPS, gentle anterior tongue depression should be used to avoid swab contamination from the oral cavity during collection of secretions from the posterior pharyngeal wall. These procedural tricks would enhance diagnostic reliability.
Background: To show how to safely perform nasopharyngeal and / or oropharyngeal swabs for 2019-Novel Coronavirus. Methods: The video describes in detail the dressing and undressing procedures of health personnel, with the appropriate personal protective equipment. Technical notes for the execution of the nasopharyngeal and oropharyngeal swab are also provided, to avoid sampling errors. Results: The undressing phase is the procedure with the highest risk of self-contamination for the health worker. Following the various steps as shown in the video, there were no cases of contagion among the otolaryngology team appointed to perform the swabs for SARS-CoV-2 testing. Conclusions: This study demonstrates the technical feasibility of safely performing nasopharyngeal and/or oropharyngeal swabs for identification of SARS-CoV-2 viral RNA.
The COVID-19 pandemic is one of the most serious global challenges to delivering affordable and equitable treatment to children with cancer we have witnessed in the last few decades. This Special Report aims to summarise general principles for continuing multi-disciplinary care during the SARS-CoV-2 (COVID-19) pandemic. With contributions from the leadership of the International Society for Paediatric Oncology (SIOP), Children’s Oncology Group (COG), St Jude Global programme and Childhood Cancer International, we have sought to provide a framework for healthcare teams caring for children with cancer during the pandemic. We anticipate the burden will fall particularly heavily on children, their families and cancer services in low- and middle- income countries. Therefore, we have brought together the relevant clinical leads from SIOP- Europe, COG and SIOP-PODC (Pediatric Oncology in Developing Countries) to focus on the six most curable cancers that are part of the WHO Global Initiative in Childhood Cancer. We provide some practical advice for adapting diagnostic and treatment protocols for children with cancer during the pandemic, the measures taken to contain it (e.g. extreme social distancing) and how to prepare for the anticipated recovery period.
Microstegium Vimineum (Japanese Stiltgrass) is an invasive grass species that is currently dominating susceptible ecosystems across the eastern half of the United States. The presence of Japanese Stiltgrass can result in decomposition of plant available carbon (C) and nitrogen (N), limiting the variety of species that thrive within these habitats. N deposition has the ability to influence the composition of plant communities as it can change the concentration of nitrogen within the atmosphere and rhizosphere. Similarly, leaf litter quality influences microbial communities and therefore available nutrients to understory plants. In this study, we are examining the degree at which these factors influence the impact of Japanese Stiltgrass on soil degradation. The study is taking place in the Shawnee National Forest in southern Illinois. 20 pairs of plots consist of 10 low-quality litter (pine dominated) plots and 10 high-quality litter (6 maple-elm and 4 tulip-poplar dominated) plots. Within each pair, three one-square foot subplots are each receiving one of three nitrogen treatments: 8.65 kg N ha-1 yr-1 or high N, 3.46kg N ha-1 yr-1 or low N, and a control of 0 g N m-2 yr-1. It is anticipated that the highest N treatment levels will yield lesser impacts on the soil in all forest cover types. However, we expect to see the greatest suppression of SOM decomposition under pine-dominated forests, as the microbial communities within these stands are more sensitive to higher levels N additions.
This article introduces a methodological framework to compare online patterns of music usage, detected from dedicated online music services, with offline patterns of music performance, evinced from set lists of live concert sets. The presented comparative method is employed to explore the relationship between live concert and personal listening behavior of the Grateful Dead, an American band born out of the 1960s San Francisco, California psychedelic movement, that played music together from 1965 to 1995. Despite relatively little popular radio airtime, the Grateful Dead enjoyed a cult-like following from a fan base that numbered in the millions and, ten years after dissolution, its music is still heavily listened to on online music services, such as last.fm. This article presents a comparative analysis between 1,590 of the Grateful Dead's live concert set lists from 1972 to 1995 and 2,616,990 Grateful Dead listening events by last.fm users from August 2005 to October 2007. While there is a strong correlation between how songs were played in concert and how they were listened to by last.fm members, the outlying songs in this trend identify interesting aspects of the band and their fans 10 years after the band's dissolution.
IntroductionThe rapid spread of coronavirus disease 2019 (COVID-19) worldwide raised concerns about its heavy impact on the health care delivery system and forced significant changes in the realities of the clinical practice we are accustomed to. With these changes comes a need for a different approach to outpatient evaluation of common otolaryngology complaints in patients with new symptoms.Recently published set of guidelines for evaluation of head and neck during the COVID-19 pandemic recommended to postpone the management of benign disease including benign salivary or thyroid gland disease.1 In order to limit the chance of COVID-19 infection among patients or health care workers, surveying patients via telephone or telemedicine visit was advised, reserving in-person evaluation for the patients at risk for significant negative outcomes. The challenge is that these measures can only be applied in clear-cut clinical scenarios, when the disease process is most likely benign and the care delivery can be postponed.In cases with a high degree of uncertainty based on available clinical information, many physicians will have to decide how to proceed after initial telemedicine encounter. Clinicians will have to consider how to balance a potential delay in diagnosis, including cancer diagnosis, against the risk of COVID-19 exposure, and may need to exercise their best judgement knowing that for head and neck cancer the risk of progression with cancer care delay is high.2 In this communication, we present our approach to triaging and evaluation of patients with complaints concerning for salivary gland disease.
Introduction:The 2019 novel coronavirus disease (COVID-19) was initially identified in December 2019 in Wuhan, China. Following its spread across the globe within a matter of months, the World Health Organization classified COVID-19 as a pandemic.1 Its rapid transmission and high hospitalization rate have forced health professionals to drastically alter their practices in order to slow its proliferation. The rapid influx of COVID-19 related admissions in hospitals around the United States has led to a widespread shortage of crucial healthcare resources, particularly personal protective equipment (PPE), ventilators, and free ICU beds. Surgical procedures further deplete such resources in a time of acutely high need. Additionally, evidence has shown that healthcare workers may be particularly susceptible to infection from the causative pathogen, SARS-CoV-2, with roughly 20% of exposed professionals becoming infected in Italy.2Following these developments, the Centers for Disease Control and Prevention (CDC) recommended that all inpatient facilities postpone or cancel any elective surgeries.3 In the ensuing weeks, the American College of Surgeons and the American Academy of Otolaryngology-Head and Neck Surgery followed suit with this recommendation.4,5Furthermore, many hospitals and practices have opted to cancel in-person outpatient clinic visits, where patients oftentimes receive critical longitudinal care. Like other surgeons, otolaryngologists, and specifically head and neck surgical oncologists, have been deeply affected by these drastic measures. It is evident, however, that physicians must find ways to continue to monitor such patients’ conditions or treat them in some aspect. The popularity and prevalence of telemedicine has grown rapidly during this pandemic as many physicians have sought ways to maintain a continuum of care with their patients.6 Such initiatives have previously been shown to decrease costs, decrease visit time, and lead to high patient satisfaction in surgical fields.7,8Within otolaryngology specifically, certain telehealth assessments have been shown to allow for quicker examinations without compromising the communication of crucial information from the patient to the physician, or vice versa.9 However, the rapid implementation of telehealth has been a relatively new phenomenon during the COVID-19 pandemic, meaning that physicians oftentimes have to learn how to optimize their virtual visits to maximize their efficiency and effectiveness. In otolaryngology, telemedicine has not been routinely used to evaluate patients, despite estimates that 62% of otolaryngology patients would be amenable to virtual appointments.10Thus, it may be difficult for physicians to anticipate barriers to their care during a telehealth visit. Based on the authors’ experience, there exists a steep learning curve following the onset of such visits due to a variety of factors on both the patient’s and physician’s side.To our knowledge, there are no set guidelines or best practices for patients or head and neck cancer physicians conducting virtual visits. Drawing upon our experience, we aim to compile a set of guidelines for physicians and patients alike to navigate telehealth visits during the era of COVID-19. We also created a handout that can be distributed to patients prior to the visit, such that patients can familiarize themselves with general expectations and key examination steps that they may be asked to perform during the visit.