The Philippine Journal of Otolaryngology Head and Neck Surgerypreviously co published two guest editorials, on “Reducing the Risks of Nuclear War— the Role of Health Professionals”¹and “Time to Treat the Climate and Nature Crisis as One Indivisible Global Health Emergency”²that addressed dual potentially catastrophic concerns that both place us “on the brink.”³

By co-publishing these guest editorials, the Philippine Journal of Otolaryngology Head and Neck Surgery joined the call for “health professional associations to inform their members worldwide about the threat to human survival and to join with the International Physicians for the Prevention of Nuclear War (IPPNW) to support efforts to reduce the near-term risks of nuclear war.”¹As enumerated in the editorial,¹we urged three immediate steps that should be taken by nuclear-armed states and their allies: 1) adopt a no first use policy;⁴2) take their nuclear weapons off hair-trigger alert; and 3) urge all states involved in current conflicts to pledge publicly and unequivocally that they will not use nuclear weapons in these conflicts.It is alarming that noprogress has been made on these measures.

Thus, on our 44th Anniversary, we join over 150 scholarly scientific journals worldwide in co-publishing another Guest Editorial on “Ending Nuclear Weapons, Before They End Us.”⁵We call on the World Health Assembly (WHA) to vote this May on re establishing a mandate for the World Health Organization (WHO) to address the consequences of nuclear weapons and war,6and urge health professionals and their associations (including otolaryngologists – head and neck surgeons, all surgeons and physicians, and the Philippine Society of Otolaryngology – Head and Neck Surgery, Philippine College of Surgeons, Philippine College of Physicians,
Philippine Academy of Family Physicians, Philippine Pediatric Society, Philippine Obstetrical and Gynecologic Society, Philippine Society of Anesthesiology, Philippine College of Radiology, Philippine Society of Pathologists, other specialty and subspecialty societies, and the Philippine Medical Association) to urge the Philippine Government to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war.⁷

War ; Atomic Energy ; Radiation ; Nuclear Weapons

war ; armed conflicts ; Nuclear Energy ; Atomic Energy ; Radiation ; Nuclear Weapons

war ; Armed Conflicts ; Nuclear Energy ; Atomic Energy ; Radiation ; Nuclear Weapons

The Russian military invasion of Ukraine on February 24, 2022, and Hamas’ terror attack on Israel on October 7, 2023, signaled the beginning of two of the most recent wars to make international headlines. To date, over 110 armed conflicts are taking place: over 45 in the Middle East and North Africa (Cyprus, Egypt, Iraq, Israel, Libya, Morocco, Palestine, Syria, Turkey, Yemen, Western Sahara); over 35 in Africa (Burkina Faso, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Ethiopia, Mali, Mozambique, Nigeria, Senegal, Somalia, South Sudan, Sudan); 21 in Asia (Afghanistan, India, Myanmar, Pakistan, the Philippines); seven in Europe (Russia, Ukraine, Moldova, Georgia, Armenia, Azerbaijan); and six in Latin America (three each in Mexico and Colombia); with two more international armed conflicts (between India and Pakistan, and between India and China) in Asia.1 This list does not even include such problematic situations as those involving China and the South East Asia region. As though these situations of armed violence were not enough, mankind has already passed or is on the verge of passing several climate tipping points – a recent review lists nine Global core tipping elements (and their tipping points) - the Greenland Ice Sheet (collapse); West Antarctic Ice Sheet (collapse); Labrador-Irminger Seas / SPG Convection (collapse); East Antarctic Subglacial Basins (collapse); Amazon Rainforest (dieback); Boreal Permafrost (collapse); Atlantic M.O. Circulation (collapse); Arctic Winter Sea Ice (collapse); and East Antarctic Ice Sheet (collapse); and seven Regional impact tipping elements (and their tipping points) – Low-latitude Coral Reefs (die-off); Boreal Permafrost (abrupt thaw); Barents Sea Ice (abrupt loss); Mountain Glaciers (loss); Sahel and W. African Monsoon (greening); Boreal Forest (southern dieback); and Boreal Forest (northern expansion).2 Closer to home, how can we forget the disaster and devastation wrought by Super Typhoon Haiyan (Yolanda) 10 years ago to date? Whether international or non-international, armed conflicts raise the risk of nuclear war. Russia has already “rehearsed its ability to deliver a ‘massive’ nuclear strike,” conducting “practical launches of ballistic and cruise missiles,” and stationed a first batch of tactical nuclear weapons in Belarus,3 and the possibility of nuclear escalation in Ukraine cannot be overestimated.4 Meanwhile, in a rare public announcement, the U.S. Central Command revealed that an Ohio- class submarine (560 feet long, 18,750 tons submerged and carrying as many as 154 Tomahawk cruise missiles) had arrived in the Middle East on November 5, 2023.5 Indeed, “the danger is great and growing,” as “any use of nuclear weapons would be catastrophic for humanity.”
Armed Conflicts ; Nuclear Energy ; Radiation ; Climate Change ; Global Warming

Objective: The mandible is the most common fractured craniofacial bone of all craniofacial fractures in the Philippines, with the mandibular body as the most involved segment of all mandibular fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and management of mandibular body fractures in particular. General guidelines include the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic Review on interventions for the management of mandibular fractures. On the other hand, a very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and management, this clinical practice guideline focuses on the management of isolated mandibular body fractures in adults. Purpose: This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as well as primary care and specialist physicians, nurses and nurse practitioners, midwives and community health workers, dentists, and emergency first-responders) who may provide care to adults aged 18 years and above that may present with an acute history and physical and/or laboratory examination findings that may lead to a diagnosis of isolated mandibular body fracture and its subsequent medical and surgical management, including health promotion and disease prevention. It is applicable in any setting (including urban and rural primary-care, community centers, treatment units, hospital emergency rooms, operating rooms) in which adults with isolated mandibular body fractures would be identified, diagnosed, or managed. Outcomes are functional resolution of isolated mandibular body fractures; achieving premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing use of ineffective interventions; avoiding co-morbid infections, conditions, complications and adverse events; minimizing cost; maximizing health-related quality of life of individuals with isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in patients and occurrence in others. Action Statements The guideline development group made strong recommendationsfor the following key action statements: (6) pain management- clinicians should routinely evaluate pain in patients with isolated mandibular body fractures using a numerical rating scale (NRS) or visual analog scale (VAS); analgesics should be routinely offered to patients with a numerical rating pain scale score or VAS of at least 4/10 (paracetamol and a mild opioid with or without an adjuvant analgesic) until the numerical rating pain scale score or VAS is 3/10 at most; (7) antibiotics- prophylactic antibiotics should be given to adult patients with isolated mandibular body fractures with concomitant mucosal or skin opening with or without direct visualization of bone fragments; penicillin is the drug of choice while clindamycin may be used as an alternative; and (14) prevention- clinicians should advocate for compliance with road traffic safety laws (speed limit, anti-drunk driving, seatbelt and helmet use) for the prevention of motor vehicle, cycling and pedestrian accidents and maxillofacial injuries.The guideline development group made recommendations for the following key action statements: (1) history, clinical presentation, and diagnosis - clinicians should consider a presumptive diagnosis of mandibular fracture in adults presenting with a history of traumatic injury to the jaw plus a positive tongue blade test, and any of the following: malocclusion, trismus, tenderness on jaw closure and broken tooth; (2) panoramic x-ray - clinicians may request for panoramic x-ray as the initial imaging tool in evaluating patients with a presumptive clinical diagnosis; (3) radiographs - where panoramic radiography is not available, clinicians may recommend plain mandibular radiography; (4) computed tomography - if available, non-contrast facial CT Scan may be obtained; (5) immobilization - fractures should be temporarily immobilized/splinted with a figure-of-eight bandage until definitive surgical management can be performed or while initiating transport during emergency situations; (8) anesthesia - nasotracheal intubation is the preferred route of anesthesia; in the presence of contraindications, submental intubation or tracheostomy may be performed; (9) observation - with a soft diet may serve as management for favorable isolated nondisplaced and nonmobile mandibular body fractures with unchanged pre - traumatic occlusion; (10) closed reduction - with immobilization by maxillomandibular fixation for 4-6 weeks may be considered for minimally displaced favorable isolated mandibular body fractures with stable dentition, good nutrition and willingness to comply with post-procedure care that may affect oral hygiene, diet modifications, appearance, oral health and functional concerns (eating, swallowing and speech); (11) open reduction with transosseous wiring - with MMF is an option for isolated displaced unfavorable and unstable mandibular body fracture patients who cannot afford or avail of titanium plates; (12) open reduction with titanium plates - ORIF using titanium plates and screws should be performed in isolated displaced unfavorable and unstable mandibular body fracture; (13) maxillomandibular fixation - intraoperative MMF may not be routinely needed prior to reduction and internal fixation; and (15) promotion - clinicians should play a positive role in the prevention of interpersonal and collective violence as well as the settings in which violence occurs in order to avoid injuries in general and mandibular fractures in particular.
Mandibular Fractures ; Jaw Fractures ; Classification ; History ; Diagnosis ; Diagnostic Imaging ; Therapeutics ; Diet Therapy ; Drug Therapy ; Rehabilitation ; General Surgery

Objective: To review available resources and provide evidence-based recommendations that may optimize otorhinolaryngologic out-patient health care delivery in the “post”-COVID-19 era while ensuring the safety of our patients, healthcare workers and staff. Data Sources: Relevant peer-reviewed journal articles; task force, organizational and institutional, government and non-government organization recommendations; published guidelines from medical, health-related, and scientific organizations. Methods: A comprehensive review of the literature on the COVID-19 pandemic as it pertained to “post”-COVID 19 out-patient otorhinolaryngologic practice was obtained from peer-reviewed articles, guidelines, recommendations, and statements that were identified through a structured search of the data sources for relevant literature utilizing MEDLINE (through PubMed and PubMed Central PMC), Google (and Google Scholar), HERDIN Plus, the World Health Organization (WHO) Global Health Library, and grey literature including social media (blogs, Twitter, LinkedIn, Facebook). In-patient management (including ORL surgical procedures such as tracheostomy) were excluded. Retrieved material was critically appraised and organized according to five discussion themes: physical office set-up, patient processing, personal protection, procedures, and prevention and health-promotion. Conclusion These recommendations are consistent with the best available evidence to date, and are globally acceptable while being locally applicable. They address the concerns of otorhinolaryngologists and related specialists about resuming office practice during the “post”-COVID-19 period when strict quarantines are gradually lifted and a transition to the “new” normal is made despite the unavailability of a specific vaccine for SARS-CoV-2. While they target practice settings in the Philippines, they should be useful to ENT (ear, nose & throat) surgeons in other countries in ensuring a balance between service and safety as we continue to serve our patients during these challenging times.

Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients. Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed. Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality. Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.
tracheotomy ; tetanus ; trismus ; Neck Pain ; Muscle Rigidity

Authorship, "the state or fact of being the writer of a book, article, or document, or the creator of a work of art,"1 derives from the word author, auctor, autour, autor "father, creator, one who brings about, one who makes or creates," from Old French auctor, acteor "author, originator, creator, instigator," directly from the Latin auctor "promoter, doer; responsible person, teacher," literally "one who causes to grow."2  It implies a creative privilege and responsibility that cannot be taken lightly.  In the biomedical arena, the International Committee of Medical Journal Editors (ICMJE) "recommends that authorship be based on the following four criteria: 1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND 2. Drafting the work or revising it critically for important intellectual content; AND 3. Final approval of the version to be published; AND 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work are appropriately investigated and resolved."3

 

Thus, all persons designated as authors should qualify for authorship, and all those who qualify as authors should be so listed.3 The first of these general principles means that all persons listed as authors should meet the four ICMJE criteria for authorship; the second principle means that all those who meet the four ICMJE criteria for authorship should be listed as authors.3 The first part of the statement disqualifies honorific "gift" authors, complementary "guest" authors, and anonymous "ghost" authors from being listed as authors. The second part ensures the listing of all those who qualify as authors, even if they are no longer part of the institution or group from which the work emanates (such as students who have graduated or residents and fellows who have completed their postgraduate training).

 

Honorific or "gift" authorship takes place when a subordinate (or junior) person lists a superior (or senior) person as an author, even if that person did not meet the four ICMJE authorship criteria.4,5 Bestowing the gift on a Chief, Chair, Department Head, Director, Dean, or such other person is often done in gratitude, but carries an unspoken expectation that the favor will be returned in the future. It can also be bestowed under coercive conditions (that may overlap with those of guest authorship discussed next).4.5 It is unethical because the gifted person does not qualify for authorship when at most only acknowledgement is his or her due. In the extreme, such a person can be put in the uncomfortable and embarrassing situation of being unable to comment on the supposedly co-authored work when asked to do so. Moreover, the unqualified co-author(s) may actually attempt to wash their hands of any allegations of misconduct, claiming for example that the resident first author "plagiarized the material" or "fabricated or manipulated the data" but "I/we certainly had nothing to do with that" - - hence the fourth criterion for authorship came to be.3 Reviewers and Editors may suspect "gift" authorship when for instance, a resident listed as first author writes the paper in the first person, using the pronoun "I" instead of "we" and thanks the consultant co-author under the "acknowledgements" section. The suspicions are further reinforced when the concerned co-author(s) do not participate in, or contribute to revising the manuscript critically for important intellectual content during the review and editing process.

 

Guest authorship takes place when influential or well-known individuals "lend" their name to a manuscript to boost its prestige, even though they had nothing to do with its creation.6,7 They may have been invited to do so by one or more of the actual authors, but they willingly agree, considering the arrangement mutually-beneficial. Thus, a student or resident may knowingly invite an adviser or consultant to be listed as co-author, even if the latter did not meet authorship criteria. The former perceives that having a known co-author increases the chances of a favorable review and publication; the latter effectively adds another publication to his or her curriculum vitae. It is not difficult to see how such symbioses may thrive in the "publish or perish" milieu of academe. Research advising alone, even if editing of the research paper was performed, do not qualify one for authorship (Cf. "gift" authorship). This is not to say that a research, thesis or dissertation adviser may not be listed as co-author - as long as he or she meets the 4 ICMJE criteria for authorship.3 A related misconduct is the practice by certain persons with seniority of insisting their names be listed first, even if more junior scholars did all the innovative thinking and research on a project. Indeed, the order of authorship can be a source of unhappiness and dispute. Authors be listed in the order of their contributions to the work - the one who contributed most is listed first, and the order of listing should be a joint decision of all co-authors at the start of the study (reviewed periodically).

 

Ghost authorship usually pertains to paid professional writers who anonymously produce material that is officially attributed to another author.7,8 They may operate out of establishments that manufacture term papers, theses, and dissertations for the right price (such as the infamous C.M. Recto district in downtown Manila, now replaced by numerous online services). They may also be employed by the pharmaceutical industry to write promotional, favorable studies that will list well-known persons (professors, scientists, senior clinicians) as authors, often with consent and adequate compensation.8 Examples include "a professor at the University of Wisconsin" being paid "$1,500 in return for putting his name" on "an article on the 'therapeutic effects' of their diet pill Redux (dexfenfluramine)," that was "pulled from the market" a year later "as doctors began reporting heart-valve injuries in as many as one-third of patients taking the drug" and the drug "later linked to dozens of deaths."9 Similar cases involved the "deadly drug" rofecoxib (Vioxx) "eventually blamed for some 60,000+ deaths," that "was also linked to a number of shameful scandals relating to fraudulent studies and the use of ghostwriters to boost sales."9 The costs involved are not meager; Parke-Davis paid "a medical education communication company (MECC) to write articles in support of the drug" Neurontin (gabapentin) "to the tune of $13,000 to $18,000 per article. In turn, MECC paid $1,000 each to friendly physicians and pharmacists to sign off as authors of the articles."9 Pfizer (who acquired Neurontin form Parke-Davis) "was found guilty of illegally promoting off-label uses of Neurontin," and "fined more than $142 million in damages."9 Whether or not morbidities or mortalities ensue from the practice, both ghosts and beneficiary-authors should be held liable in such situations.

 

Clearly, the practice of "gift," "guest," and "ghost" authorship should not be entertained by authors or tolerated by editors and reviewers. Authorship should be based on the ICMJE authorship criteria. Our editors and reviewers vigilantly strive to uphold and protect the rights and welfare of our authors and the integrity and soundness of their research. We call on all fellows, diplomates and residents in training to do the same.

Human ; Authorship ; Authorship Standards ; Trends ; Ethics ; Gift Authorship ; Guest Authorship ; Ghost Authorship

"Those with access to these resources -- students, librarians, scientists --

you have been given a privilege. You get to feed at this banquet of knowledge

while the rest of the world is locked out. But you need not -- indeed, morally,

you cannot -- keep this privilege for yourselves. You have a duty to share it

with the world."

Aaron Swartz1 (who killed himself at the age of 26,

facing a felony conviction and prison sentence

for downloading millions of academic journal articles)

 

The Philippine Journal of Otolaryngology Head and Neck Surgery was accepted into the Directory of Open Access Journals (DOAJ) on October 9, 2019. The DOAJ is "a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals"2 and is often cited as a source of quality open access journals in research and scholarly publishing circles that has been considered a sort of "whitelist" as opposed to the now-defunct Beall's (black) Lists.3

As of this writing, the DOAJ includes 13,912 journals with 10,983 searchable at article level, from 130 countries with a total of 4,410,788 articles.2 Our article metadata is automatically supplied to, and all our articles are searchable on DOAJ. Because it is OpenURL compliant, once an article is on DOAJ, it is automatically harvestable. This is important for increasing the visibility of our journal, as there are more than 900,000 page views and 300,000 unique visitors a month to DOAJ from all over the world.2 Moreover, many aggregators, databases, libraries, publishers and search portals (e.g. Scopus, Serial Solutions and EBSCO) collect DOAJ free metadata and include it in their products. The DOAJ is also Open Archives Initiative (OAI) compliant, and once an article is in DOAJ, it is automatically linkable.4

Being indexed in DOAJ affirms that we are a legitimate open access journal, and enhances our compliance with Plan S.5 The Plan S initiative for Open Access publishing launched in September 2018 requires that from 2021, "all scholarly publications on the results from research funded by public or private grants provided by national, regional, and international research councils and funding bodies, must be published in Open Access Journals, on Open Access Platforms, or made immediately available through Open Access Repositories without embargo."5 Such open access journals must be listed in DOAJ and identified as Plan S compliant.

There are mixed reactions to Plan S. A recent editorial observes that subscription and hybrid journals (including such major highly-reputable journals as the New England Journal of Medicine, JAMA, Science and Nature) will be excluded,6 quoting the COAlition S argument that "there is no valid reason to maintain any kind of subscription-based business model for scientific publishing in the digital world."5 As Gee and Talley put it, "will the rise of open access journals spell the end of the subscription model?"6

If full open access will be unsustainable for such a leading hybrid medical journal as the Medical Journal of Australia,6 what will happen to the many smaller, low- and middle-income country (southern) journals that cannot sustain a fully open-access model? For instance, challenges facing Philippine journals have been previously described.7

According to Tecson-Mendoza, "these challenges relate to (1) the proliferation of journals and related problems, such as competition for papers and sub-par journals; (2) journal funding and operation; (3) getting listed or accredited in major citation databases; (4) competition for papers; (5) reaching a wider and bigger readership and paper contribution from outside the country; and (6) meeting international standards for academic journal publications."7  Her 2015 study listed 777 Philippine scholarly journals, of which eight were listed in both the (then) Thomson Reuters (TR) and Scopus master lists, while an additional eight were listed in TR alone and a further twelve were listed in Scopus alone.7 To date, there are 11,207 confirmed Philippine periodicals listed on the International Standard Serial Number (ISSN) Portal,8 but these include non-scientific and non-scholarly publications like magazines, newsletters, song hits, and annual reports. What does the future have in store for small scientific publications from the global south?

I previously shared my insights from the Asia Pacific Association of Medical Journal Editors (APAME) 2019 Convention (http://apame2019.whocc.org.cn) on the World Association of Medical Editors (WAME) Newsletter, a private Listserve for WAME members only.9 These reflections on transformation pressures journals are experiencing were the subject of long and meaningful conversations with the editor of the Philippine Journal of Pathology, Dr. Amado Tandoc III during the APAME 2019 Convention in Xi'an China from September 3-5, 2019. Here are three main points:

the real need for and possibility of joining forces- for instance, the Journal of the ASEAN Federation of Endocrinology Societies (JAFES) currently based in the Philippines has fully absorbed previous national endocrinology journals of Malaysia and the Philippines, which have ceased to exist.  While this merger has resulted in a much stronger regional journal, it would be worthwhile to consider featuring the logos and linking the archives of the discontinued journals on the JAFES website. Should the Philippine Journal of Otolaryngology Head and Neck Surgery consider exploring a similar model for the ASEAN Otorhinolaryngological - Head and Neck Federation? Or should individual specialty journals in the Philippines merge under a unified Philippine Medical Association Journal or the National Health Science Journal Acta Medica Philippina? Such mergers would dramatically increase the pool of authors, reviewers and editors and provide a sufficient number of higher-quality articles to publish monthly (or even fortnightly) and ensure indexing in MEDLINE (PubMed).the migration from cover-to-cover traditional journals (contents, editorial, sections, etc.) to publishing platforms (e.g. should learned Philippine societies and institutions consider establishing a single platform instead of trying to sustain their individual journals)? Although many scholarly Philippine journals have a long and respectable history, a majority were established after 2000,7 possibly reflecting compliance with requirements of the Commission on Higher Education (CHED) for increased research publications. Many universities, constituent colleges, hospitals, and even academic and clinical departments strove to start their own journals. The resulting journal population explosion could hardly be sustained by the same pool of contributors and reviewers.

In our field for example, faculty members of departments of otorhinolaryngology who submitted papers to their departmental journals were unaware that simultaneously submitting these manuscripts to their hospital and/or university journals was a form of misconduct. Moreover, they were not happy when our specialty journal refused to publish their papers as this would constitute duplicate publication. The problem stemmed from their being required to submit papers for publication in department, hospital and/or university journals instead of crediting their submissions to our pre-existing specialty journal. This escalated the tension on all sides, to the detriment of the new journals (some department journals ceased publication after one or two issues) and authors (whose articles in these defunct journals are effectively lost).

The older specialty journals are also suffering from the increased number of players with many failing to publish their usual number of issues or to publish them on time. But how many (if any at all) of these journals (especially specialty journals) would agree to yield to a merger with others (necessitating the end of their individual journal)? Would a common platform (rather than a common journal) provide a solution?

more radically, the individual journal as we know it today (including the big northern journals) will cease to exist- as individual OA articles (including preprints) and open (including post-publication) review become freely available and accessible to all. However proud editors may be of the journals they design and develop from cover to cover, with all the special sections and touches that make their "babies" unique, readers access and download individual articles rather than entire journals. A similar fate befell the music industry a decade ago. From the heyday of vinyl (33 and 78 rpm long-playing albums and 45 rpm singles) and 8-tracks, to cassettes, then compact disks (CD's) and videos, the US recorded music industry was down 63% in 2009 from its peak in the late 70's, and down 45% from where it was in 1973.10 In 2011, DeGusta observed that "somewhat unsurprisingly, the recording industry makes almost all their money from full-length albums" but "equally unsurprising, no one is buying full albums anymore," concluding that "digital really does appear to have brought about the era of the single.10 As McDowell opines, "In the end, the digital transforms not only the ability to disrupt standard publishing practices but instead it has already disrupted and continues to break these practices open for consideration and transformation."11

Where to then, scientific journals? Without endorsing either, will Sci-Hub (https://sci-hub.se) be to scholarly publishing what Spotify (https://www.spotify.com) is to the music industry? A sobering thought that behooves action.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Open Access Publishing ; Open Access Publishing ; Journalism

OBJECTIVE: To determine if there is a difference in the duration of mechanical ventilation and hospitalization between patients who underwent early compared to late tracheostomy.

METHODS:

Design:                Causal-Comparative (ex post facto) Chart Review

Setting:                Tertiary National University Hospital

Participants:                   Records of 68 pediatric patients who underwent elective tracheostomy from January 1, 2013 to June 30, 2018 were considered for inclusion. Patients were excluded if invasive mechanical ventilation was not done prior to tracheostomy, if they underwent emergency tracheostomy or had incomplete records. Selected patients were categorized in the early tracheostomy group if the procedure was performed within 14 days of mechanical ventilation and late tracheostomy group if performed beyond 14 days. Early post-tracheostomy weaning from mechanical ventilation was defined as less than 7 days from time of tracheostomy.

RESULTS: A total of 21 patients were included, 6 in the early tracheostomy group and 15 in the late tracheostomy group. Although early tracheostomy did not show significant association with shortened post-tracheostomy duration of mechanical ventilation (O.R. 6; C.I. 0.276 to 130.322; p = .476), two-sample t-tests showed the early tracheostomy group had a significantly shorter mean duration of mechanical ventilation and hospitalization compared to the late tracheostomy group (13.17 vs. 54.13 days, p = .0012; 21.17 vs. 66.67 days, p = .0032).

CONCLUSION: Although early tracheostomy does not shorten post-tracheostomy mechanical ventilation support, there is a significant difference in the duration of mechanical ventilation and hospitalization between early and late tracheostomy groups and this may suggest potential benefits of performing tracheostomy earlier in children.

 

KEYWORDS: tracheotomy; pediatric; mechanical ventilation; hospitalization

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Child Preschool (a Child Between The Ages Of 2 And 5) ; Tracheotomy ; Ventilation ; Hospitalization