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CONCLUSIONS Various treatment modalities have been evaluated for preventative treatment of VM. Physician familiarity, patient comorbidities, and the side-effect profiles of various interventions likely influence the selection of intervention. Future randomized controlled trials with restrictive inclusion criteria and generalizable standardized outcome measures will allow for more robust meta-analyses and for more evidence-based treatment of vestibular migraines. Laryngoscope, 2020. © 2020 The American Laryngological, Rhinological and Otological Society, Inc.OBJECTIVE The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established nutritional assessment tool and is a significant prognostic factor in various cancers. However, the role of the GNRI in predicting clinical outcomes in patients with advanced head and neck cancer (AHNC) has not been investigated. The aim of the present study was to examine the association between the GNRI and prognosis in patients with AHNC. STUDY DESIGN Retrospective cohort study. METHODS Data collected between 2002 and 2013 from Tsukuba University Hospital were reviewed. The GNRI was calculated according to the equation, 1.489 × serum albumin (g/l) + 41.7 × (body weight/ideal body weight). Characteristics and prognosis were compared among three risk groups high (GNRI 98). The primary endpoint was overall survival. RESULTS A total of 248 AHNC patients were enrolled, among whom 134 (54%) exhibited no nutritional risk, 53 (21%) had an intermediate risk for malnutrition, and 61 (25%) exhibited a high risk for malnutrition. Three-year survival rates according to the three-group GNRI scores for normal, intermediate, and high risk were 76.6%, 56.3%, and 19.5%, respectively. As the three-group GNRI score increased, the risk for mortality significantly increased (adjusted hazard ratio [HR] for intermediate to normal, 1.73 [95% CI, 1.02-2.92]; adjusted HR for high to normal, 4.31 [95% CI, 2.71-6.84]). CONCLUSIONS The GNRI could be considered a useful prognostic factor in patients with AHNC. LEVEL OF EVIDENCE 4 Laryngoscope, 2020. © 2020 The American Laryngological, Rhinological and Otological Society, Inc.OBJECTIVES The purpose of this study was to investigate the grades of endolymphatic hydrops determined by gadolinium-contrast magnetic resonance (MR) and correlation to the clinical features in patients with Meniere disease. STUDY DESIGN Prospective study. METHODS A total of 24 patients suffering from unilateral Meniere disease with either definite or probable clinical diagnosis were included. The duration of vertigo, duration of tinnitus, duration of vertigo attacks, hearing thresholds, and canal paresis (CP) value of caloric tests were assessed. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (MRI) was performed 4 hours after intravenous injection of double dose of gadobutrol (Gd) to show endolymph and perilymph, and the grades of endolymphatic hydrops were measured. Nintedanib Additionally, the correlation between clinical features and the grades of endolymphatic hydrops of cochlea and vestibular were evaluated. RESULTS Different grades of the endolymphatic hydrops in the impaired ear were revealed by MRI. The Spearman correlation showed a strong correlation between the hearing thresholds of low, middle, and high tone and the grades of cochlea and vestibular hydrops (P  .05). CONCLUSION By visualizing the endolymph and perilymph of inner ear in patients with Meniere disease assisted with intravenous injection of double doses of Gd, the grades of endolymphatic hydrops could be assessed. As a result, the grades of endolymphatic hydrops in patients with Meniere disease can be used to predict the level of hearing impairment. LEVEL OF EVIDENCE 4 Laryngoscope, 2020. © 2020 The American Laryngological, Rhinological and Otological Society, Inc.The 2020 International Year of the Nurse and the Midwife is an important opportunity to marry nursing science and health policy globally. Nurses and midwives are demonstrating strong intent towards evidence-based practice but often feel they lack the skills to implement it. Examples are provided of ways in which general and advanced practice nurses have succeeded in bringing evidence into practice and then into local and global policy. © 2020 International Council of Nurses.The next decade is likely to produce any number of global challenges that will affect health and health care, including pan-national infections such as the new coronavirus COVID-19 and others that will be related to global warming. Nurses will be required to react to these events, even though they will also be affected as ordinary citizens. The future resilience of healthcare services will depend on having sufficient numbers of nurses who are adequately resourced to face the coming challenges. © 2020 International Council of Nurses.Global healthcare expenditure is increasing, along with the numbers of older patients with multiple comorbidities, while the numbers of health workers are hugely decreasing, and many nursing and midwifery vacancies remain unfilled. With the World Health Organization declaring 2020 the Year of the Nurse and Midwife, and commencing the Nursing Now campaign with partners including the International Council of Nurses and the International Confederation of Midwives, has allowed these professions to unite, encourage advocacy and the call for global investment in nursing and midwifery. These actions will permit these professions to address universal health coverage, global inconsistencies of professional practice, and recruitment and retention. The Nightingale Challenge seeks to place early career nurses and midwives at the forefront of transformation, calling on employers worldwide to invest and provide nursing leadership development, and to become a key part of the solution to address the issues of providing universal health coverage, promoting gender equality and supporting economic growth. This will help place them at the heart of tackling 21st century health challenges. © 2020 International Council of Nurses.Systemin, a peptide plant hormone of 18 amino acids coordinates local and systemic immune responses. The activation of the canonical systemin-mediated systemic signaling pathway involves systemin release from its precursor prosystemin, systemin binding to its membrane receptor SYSTEMIN RECEPTOR1 (SYR1), and the transport of long-distance signaling molecules, including jasmonic acid, the prosystemin mRNA, volatile organic compounds and possibly systemin itself. Here, we review emerging evidence that the disordered structure and unconventional processing and secretion of systemin contribute to regulation of systemin-mediated signaling during plant defense. We highlight recent advances in systemin research, which elucidated how cells integrates multiple long-distance signals in the systemic defense response. In addition, we discuss the perception of systemin by SYR1 and its mediation of downstream defense responses. This article is protected by copyright. All rights reserved.OBJECTIVES Parental low oral health literacy is thought to contribute to child oral health disparities. Few large-scale interventions can improve oral health literacy for diverse, high-risk populations. We sought to determine whether an oral health literacy intervention aimed at parents of children attending Head Start programs improved oral health literacy and behaviors. METHODS Staff from 29 Head Start agencies across the country were trained to deliver a parent oral health literacy intervention. Parent surveys were conducted at baseline and approximately 6 months later, following intervention completion. Surveys measured parent and child demographics, oral health knowledge, behaviors, information sources, and health care utilization. Paired t tests and mixed-effects regression models controlling for agency, child age, and race/ethnicity evaluated whether measures improved after the intervention. In addition, at follow-up, agency staff were asked to complete an open-ended survey reporting how the intervention impacted their site. Responses were coded using a grounded theory approach. RESULTS A total of 2,011 (87%) parents completed both the baseline and follow-up surveys. All oral health knowledge and behaviors improved significantly from baseline to follow-up. In addition, parents reported using more oral health information sources, using more preventative oral health care, and less emergency room (ER) use for child dental problems. Head Start staff perceived that the intervention increased parental oral health literacy, enhanced parental oral health engagement, improved child oral health behaviors, and facilitated health communication with parents. CONCLUSIONS Findings suggest that this intervention successfully improved oral health literacy for diverse parents of children at high risk for dental caries. © 2020 American Association of Public Health Dentistry.Introduced populations often experience lag-times prior to invasion, but the mechanisms constraining rapid expansions of introduced populations are unclear. Solidago altissima is a North American native plant with highly invasive Japanese populations, and introduced Australian populations that are not invasive despite the climatic and ecological suitability of the region. By contrasting Australian with Japanese populations, we tested the hypothesis that Australian population growth is limited by a lack of long-distance dispersal via seeds due to limited number of compatible mates. In the field, Australian populations rarely produced viable seeds. A cross-pollination experiment found that Australian plants are fertile, yet lack compatible mates within Australia. Genetic analysis revealed that Australian individuals descend from a small set of self-incompatible genetic clones, which explains the negligible seed set within Australia. Our results show that low genetic diversity, leading to mate incompatibility, inhibits invasiveness of Australian S. altissima, and provides compelling evidence for genetic, rather than ecological, factors constraining invasion in Australia. This article is protected by copyright. All rights reserved.OBJECTIVES Alteration in positioning or head manipulation during thyroid surgery can lead to endotracheal tube movement and potentially a change in intraoperative neural monitoring readings. We sought to study the impact of positional changes on two different commercially available recording electrode arrays. MATERIALS Eight pigs divided equally into two study groups based on recording electrode arrays were used Neurosign Lantern Laryngeal Electrode (LLE) (Neurosign_Technomed, The Netherlands) and Medtronic NIM EMG [neural integrity monitor electromyogram] endotracheal tube (ETT) (Medtronic, Jacksonville, FL). Neck movement and reposition were performed for all pigs. Signal data, including amplitude and latency, were collected for vagus nerve, recurrent laryngeal nerve (RLN), and external branch of superior laryngeal nerve (EBSLN) before and after repositioning. The differences of amplitude and latency by pre- and post-repositioning were compared for all animals. RESULTS Eight pigs were included in the current study.