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The Cities Portal
The city of Arbil in Kurdistan has a radial urban structure centred on an ancient fortress.
A city is a large human settlement. It can be defined as a permanent and densely settled place with administratively defined boundaries whose members work primarily on non-agricultural tasks. Cities generally have extensive systems for housing, transportation, sanitation, utilities, land use, production of goods, and communication. Their density facilitates interaction between people, government organisations and businesses, sometimes benefiting different parties in the process, such as improving efficiency of goods and service distribution.
Historically, city-dwellers have been a small proportion of humanity overall, but following two centuries of unprecedented and rapid urbanization, more than half of the world population now lives in cities, which has had profound consequences for global sustainability. Present-day cities usually form the core of larger metropolitan areas and urban areas—creating numerous commuters traveling towards city centres for employment, entertainment, and education. However, in a world of intensifying globalisation, all cities are to varying degrees also connected globally beyond these regions. This increased influence means that cities also have significant influences on global issues, such as sustainable development, global warming and global health. Because of these major influences on global issues, the international community has prioritized investment in sustainable cities through Sustainable Development Goal 11. Due to the efficiency of transportation and the smaller land consumption, dense cities hold the potential to have a smaller ecological footprint per inhabitant than more sparsely populated areas. Therefore, compact cities are often referred to as a crucial element of fighting climate change. However, this concentration can also have significant negative consequences, such as forming urban heat islands, concentrating pollution, and stressing water supplies and other resources. (Full article...)
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Downtown Vancouver skyline from Fairview
Vancouver (/vænˈkuːvər/ ( listen) van-KOO-vər) is a major city in western Canada, located in the Lower Mainland region of British Columbia. As the most populous city in the province, the 2016 census recorded 631,486 people in the city, up from 603,502 in 2011. The Greater Vancouver area had a population of 2,463,431 in 2016, making it the third-largest metropolitan area in Canada. Vancouver has the highest population density in Canada, with over 5,400 people per square kilometre. Vancouver is one of the most ethnically and linguistically diverse cities in Canada: 52 percent of its residents are not native English speakers, 48.9 percent are native speakers of neither English nor French, and 50.6 percent of residents belong to visible minority groups.
Vancouver is one of the most livable cities in Canada and in the world. In terms of housing affordability, Vancouver is also one of the most expensive cities in Canada and in the world. Vancouver plans to become the greenest city in the world. Vancouverism is the city's urban planning design philosophy. (Full article...)
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... that a former department store building in New York City was converted into a graduate school, publisher's offices, and research library?
... that actor Charlie Condou was offered the role of Ben Sherwood in Holby City without an audition?
... that after New York City's Q79 bus was discontinued due to low ridership, a private car service was provided, which was later also discontinued for the same reason?
... that the Lyceum Theatre is New York City's oldest continuously operating legitimate theater?
... that Kansas City Union Station was constructed using cement manufactured by a mill in Yocemento?
... that the 1940 NCAA Basketball Championship Game began a run of three straight NCAA Men's Basketball Tournament title games held at the Municipal Auditorium in Kansas City, Missouri?
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Clockwise from top left: Downtown Minneapolis at night, U.S. Bank Stadium, the skyline from Lake Nokomis, Minneapolis skyline and Minnehaha Falls
Minneapolis (/ˌmɪniˈæpəlɪs/ ( listen)) is a city in the U.S. state of Minnesota. With a population of 429,954 as of 2020, it is the most populous city in the state and the 46th most populous in the nation. The county seat of Hennepin County, Minneapolis lies along both banks of the Mississippi River, just north of its confluence with the Minnesota River, and adjoins Saint Paul, the state's capital.
With one of the nation's best park systems, the city is abundant in water, with thirteen lakes, wetlands, the Mississippi River, creeks and waterfalls, many connected by parkways in the Grand Rounds National Scenic Byway. The city and surrounding region is the largest population and primary business center between Chicago and Seattle. Minneapolis was historically a marketplace for timber, became the flour milling capital of the world, and, to the present day, preserved its financial clout. (Full article...)
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In United States local government, a consolidated city-county is formed when one or more cities and their surrounding county (parish in Louisiana, borough in Alaska) merge into one unified jurisdiction. As such it has the governmental powers of both a municipal corporation and an administrative division of a state.
A consolidated city-county is different from an independent city, although the latter may result from consolidation of a city and a county and may also have the same powers as a consolidated city-county. An independent city is a city not deemed by its state to be located within the boundary of any county and recognized by its state as a legal territorial entity separate from surrounding or adjoining counties. A consolidated city-county differs from an independent city in that the city and county both nominally exist, although they have a consolidated government, whereas in an independent city, the county does not even nominally exist. Furthermore, a consolidated city-county may still contain independent municipalities maintaining some governmental powers that did not merge with the rest of the county. (Full article...)
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Image 1Aerial photograph shows the remains of the Sumerian city Ur, near Nasiriyah, Iraq. (from History of the city)
Image 2The Avenue of the Dead in Teotihuacan originates with the Pyramid of the Moon, forming the basis of the city grid. (from History of the city)
Image 3Mohenjo-daro, a World Heritage Site that was part of the Indus Valley Civilization (from History of the city)
Image 4This woodcut shows Nuremberg as a prototype of a flourishing and independent city in the 15th century. (from History of the city)
Image 5Glasgow slum in 1871 (from History of the city)
Image 6The "Great Colonnade" marks the cardo maximus of Apamea, Syria. (from History of the city)
Image 7Extent and major sites of the Indus Valley Civilization of ancient India (from History of the city)
Image 8Cain founding the city of Enoch (from History of the city)
Image 9Daily life of people from the Song period at the capital, Bianjing, today's Kaifeng (from History of the city)
Image 10Palmanova, Italy, constructed in 1593 according to the defensive ideal of the star fort, today retains its distinctive geometry. (from History of the city)
Image 11View of the Agora of Athens with the temple of Hephaestus to the left and the Stoa of Attalos to the right (from History of the city)
Image 12Gdańsk in the 17th century (from History of the city)
Image 13Excavated foundations of Çatalhöyük, Turkey. An Anatolian town dated to 7000 BC. (from History of the city)
Image 14New York City, one of the largest urban areas in the world (from Urban geography)
Image 15Constantinople, the largest and wealthiest city in Europe from the 9th through the 12th century (from History of the city)
Image 16The Round city of Baghdad, the capital of Iraq (from History of the city)
Image 17The city of Arbil in Kurdistan has a radial urban structure centred on an ancient fortress (from Urban structure)
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Woman Reportedly Leaves Mascara On Too Long, Almost Loses Her EyesightA woman in Australia who had a habit of not washing off her mascara developed serious eye problems that could have taken her vision.
2 Doctors Make Mission To Eradicate Blindness In The Third WorldEye surgeons Sanduk Ruit and Geoffrey Tabin have restored eyesight to more than 150,000 patients in 24 countries.
Court Deals Price-Fixing Blow To Contact Lens MakersA federal appeals court is dealing a blow to contact-lens makers who tried to set minimum charges for their products amid bitter price wars in the $4 billion industry.
Tenants Possibly Got Rare Eye Infection From Community PoolFirst, two tenants at a Bedford apartment complex develop a rare eye infection. Now, doctors want others to be on the lookout for more people with the illness, because it likely came from a communal swimming pool.
Younger Kids Reporting More Eye ProblemsIs your child having problems with their eyesight? Younger kids are reporting eye problems, and now doctors think that they might know one reason for the increase in patients.


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A Board Member's Call to Action
Michael remembers feeling helpless the first time he saw images on the news of refugees in ramshackle boats washing ashore in Greece.
"I realized I didn't really even know what was going on with the refugee crisis," he said. "I was so frustrated because I wanted to learn more and help and do something."
In 2016, he visited Amman to meet with several organizations that assist displaced persons. Though all the groups shared a similar mission, Michael was drawn to CRP because he felt a strong sense of community at the center in Hashemi Shamali. He also liked the nonprofit's holistic approach to helping people heal.
"It wasn't just about handing out food vouchers; There seemed to be a genuine desire to take care of the whole person," he said.
CRP's community center offers many programs to care for people's physical needs, like food and medical support, but also provides services to help beneficiaries recover from emotional wounds. Art classes, music lessons and trauma-sensitive yoga provide creative outlets, and a variety of support groups offer a safe space to talk and share.
After his trip ended, Michael decided to support CRP by donating and volunteering with the eLearning Skype language-exchange program, which allows advanced students to practice their foreign language skills with a native English speaker over Skype. Michael said volunteering as an English conversation partner was a rewarding experience, and he continues to stay in touch with several of his former students.
"The advanced students really want to learn because they know that they're close and they just need extra practice," he said. "Their only other option sometimes is watching television."
Earlier this year, Michael took on a new role by joining CRP's board. As a board member, he said he hopes CRP will continue growing so it can offer its services to more people in need.
Although Michael once felt helpless as he watched the news, he now realizes there are many ways to support those affected by the refugee crisis — and he urges others to step up and get involved.
"The refugee crisis receives less attention today because it's been an ongoing problem for years," he explains. "But that doesn't make it any less urgent–it's still a crisis. It's still affecting millions of people. Yet in some countries, like in the US, it's barely felt. That boggles my mind."
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Home 2015 November 30 Is Disney a Value Investment?
America's venerable entertainment conglomerate The Walt Disney Company (NYSE: DIS) has long had a reputation as a value investment. Investing legend has it that Warren Buffett, who once owned some Disney shares, coined the term "moat" while referring to Disney's castles.
Yet times are changing drastically in the entertainment business as streaming video decimates traditional broadcast and cable television. Some of those changes are causing Disney's moat to dry up and the float revenue from subscriptions to disappear. Naturally, many people will be wondering if Disney is still a value investment in today's world as some of its traditional markets dry up.
One of Disney's biggest cash cows, the American sports cable channel ESPN, has lost seven million subscribers in the past two years and three million subscribers between third quarter 2014 and third quarter 2015, Forbes reported. That's a real problem for Disney because ESPN is the company's biggest moneymaker. ESPN's subscription revenue for the past year was $5.1 billion (€4.81 billion).
Nor were the losses confined to ESPN. Two other American cable operations, the Disney Channel and the U.S. version of Disney XD, each lost four million subscribers in the past two years, according to The Hollywood Reporter. Another Disney cable channel, ABC Family, lost five million subscribers in the same period.
Subscriptions are down because more and more people are turning to streaming video, which allows them to buy only the programming they want to watch. Streaming video is a major threat to ESPN because it allows sports fans to buy only the events they want see. It also lets sports leagues bypass ESPN and sell programming directly to fans.
Streaming video is a double-edged sword for Disney. It opens up new markets for Disney programming but reduces the float from cable subscriptions. Disney participates in Hulu, a popular streaming service that is a joint venture with 21st Century Fox and Comcast's NBC Universal.
Float is a steady stream of cash that a company like Disney can tap for a wide variety of purposes. Loss of float is potentially destructive because Disney's current business model is based on using float from its cable subscriptions to finance its other operations, such as movie production and the theme parks.
Despite the loss of float, Disney still has some of the characteristics of a value investment. The company is well managed, and it makes a lot of money.
Disney reported a net income of $8.382 billion (€7.91 billion), a profit margin of 11.91% and a free cash flow of $2.124 billion (€2 billion) on September 30, 2015. The company also held cash and short-term investments of $4.269 billion (€4.03 billion) and reported generating $10.91 billion (€10.3 billion) in cash from operations in the third quarter of 2015. The loss of subscriptions is not hurting Disney's bottom line or its cash flow.
Nor has the loss of subscriptions affected Disney's revenues. Disney reported a TTM revenue of $52.47 billion (€49.52 billion) on September 30, 2015, a $3.66 billion (€3.45 billion) increase over the same date in 2014 when it reported revenues of $48.81 billion (€46.06 billion). The revenue figures show us that Disney has figured out how to adapt to the changing entertainment landscape.
One reason why Disney is still making money is that it has aggressively expanded its programming and licensing operations in recent years. CEO Bob Iger's decisions to buy comic book powerhouse Marvel Entertainment for $4 billion (€3.77 billion) in 2009 and George Lucas's Star Wars empire for another $4 billion (€3.77 billion) look smart in retrospect.
Star Wars in particular gives Disney an opportunity to use its expertise in generating corporate synergy through marketing to expand its other ventures, such as theme parks. The upcoming release of the new Star Wars film has generated a vast amount of publicity and news coverage, which amounts to almost unlimited free advertising for Disney's Star Wars products.
This helps attract the attention of fans and potential viewers, including cord cutters that might ignore traditional advertising. It also reaches potential consumers of other Disney products, such as parents shopping for toys and visitors to the theme parks.
At the end of the day, Disney is still a very good company with an effective business model. It has been able to use the float generated by subscriptions to expand its core entertainment business and its all-important programming and character libraries.
Equally important is the fact that Disney still reaches a vast audience and generates a lot of float from its subscriptions. ESPN alone still had 92 million subscribers in 2015, according to The Hollywood Reporter. Disney is in the unique position of being able to take advantage of both old and new media.
It can generate float from traditional subscriptions while selling programming through streaming video at the same time. More importantly, the company can use the revenue from subscriptions to build up a programming library to generate more revenue through streaming video in the future.
Disney is still a value investment because of all the cash that it generates. It is also an undervalued company with a market capitalization of $190.04 billion (€179.34 billion) and an enterprise value of $213.38 billion (€201.37 billion) on November 27, 2015. That and the cash make Disney a rare value investment in the entertainment arena.
Are American Credit Card Companies Recession Proof?


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28 Apr, 2015 14:06
Top investigator seeks primacy of Russian law
RIA Novosti / Alexey Panov © RIA Novosti
The head of Russia's Investigative Committee has stated that Russian laws should take precedence over international legal acts and blamed the US for imposing the reverse situation.
On Tuesday Aleksandr Bastrykin suggested changing the Russian Constitution so as to exclude it from recognizing the precedence of international laws in an interview published by the government daily Rossiiskaya Gazeta. He said that the principle of the superiority of international law over domestic had been added to Russian legislation back in 1993 with the strong backing of US advisors, who helped Boris Yeltsin and his allies in building the new state.
"I think it was under their influence that the provisions of automatic implementation of international norms into Russian legal practice and the priority of the former became included in the chapter on the basis of Russian constitutional order," Bastrykin said. He went on to call this move a possible act of legislative sabotage against Russia.
"Even a quick analysis of these principles allows for the conclusion that they have no place in the mentioned chapter [of the Russian Constitution] because they do not directly define the constitutional order of the state. This was done only to give these provisions an unshakeable legal power, I would even say to artificially seal it within the foundation of our state," Russia's top investigator added.
Bastrykin also said that despite imposing the supremacy of international law on Russia, the United States itself was not following this principle in their legal system.
"Article 6 of the US Constitution provides that in case of a clash between the norms of an international treaty and an internal law of equal legal power they use the act that last came into force. This allows the US authorities to easily stop the powers of international law simply by passing a corresponding internal bill. And despite overriding international treaties through this trick the US formally remains a party in these treaties," he said.
READ MORE: Investigators launch criminal case against US agents over pilot kidnapping, torture
The top Russian investigator said that the primacy of international law was not recognized as valid or was only partially implemented in the United Kingdom and some other countries that use the Anglo-Saxon (precedent) legal system. Nations such as Brazil and India simply consider national law as taking precedent, Bastrykin said.
He then suggested eliminating the principle that makes international law an integral part of the Russian legal system, changing the Constitution so as to introduce the priority of the national law. Every conflict between international and national laws must be resolved by the Constitutional Court in separate cases, Bastrykin added.
The investigator also suggested that in cases when an international treaty contradicts Russian domestic laws the parliament should withdraw from this treaty in full or in part, or make changes to the national laws. He says these reforms should be implemented as soon as possible.
"In this difficult period the Russian Society is consolidated like never before and most importantly the society now understands that the time for constitutional reform is ripe. This is why I believe that gradually, step by step, these ideas will be implemented into life in the interests of our sovereignty and prosperity," he concluded.


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Red Sox third baseman Rafael Devers joins Ted Williams, Bobby Doerr, and Jim Rice in elite club
Marty Fenn
Not only did Boston Red Sox third baseman Rafael Devers become the first player to reach 100 RBI in 2019, but he also joined an elite group in the process.
After Devers homered in the seventh inning of Boston's 13-7 win over the Baltimore Orioles on Sunday, he joined Ted Williams, Bobby Doerr, and Jim Rice as the only players in Red Sox history to record 100+ RBI in a season before the age of 23:
Rafael Devers joins Ted Williams (3x), Bobby Doerr, and Jim Rice as the only @RedSox players to reach 100+ RBI in a season before turning 23. pic.twitter.com/yvL1hjCVjP
— MLB Stats (@MLBStats) August 18, 2019
Devers also became the first player (from any franchise) since Miguel Cabrera to reach 100+ RBI and 100+ runs scored in a single season before that age. Cabrera accomplished the feat as member of the Florida Marlins in 2005.
Although the Red Sox have had one of the most disappointing seasons in franchise history, Devers has had an MVP-level season. Devers leads the Red Sox in batting average, hits, doubles, RBI, slugging, and OPS, and he ranks seventh among position players in fWAR.
Trying to explain Devers' success is somewhat difficult. Despite notable increases in his chase rate and overall swing rate, Devers' contact percentage has risen significantly along with his average exit velocity and line-drive percentage. In fact, Devers ranks fifth in the MLB with a 92.8 average exit velocity, according to MLB Statcast.
Devers has bought into his pull power while still spreading the ball to all fields, and his plate coverage has been tremendous. He is also not getting beat by fastballs this season, hitting over 100 points higher (.333) against heaters.
Aside from a prolific offensive season, Devers has made massive strides at the hot corner. His Ultimate Zone Rating has gone from -4.5 in 2018 to 1.5 so far this year, according to FanGraphs.
Boston might not make the playoffs, but Devers deserves to be applauded as he continues to make Red Sox history.
JUST IN: Red Sox pitcher Chris Sale does not need Tommy John surgery
Related TopicsRafael DeversRed Sox


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О́сса ():

 Осса — гора в северо-восточной части Фессалии;
 Осса — гора на острове Тасмания, названная в честь фессалийской.
 Осса, или Фама — в древнегреческой и древнеримской мифологии божество, персонификация вещего голоса, слухов, молвы. Упоминается, в частности, в «Илиаде» Гомера.
 Осса, Мельхиор фон (Melchior von Ossa; 1506—1557) — немецкий правовед и государственный деятель.

Примечания

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Tag Archives: singing competition
American Idol To End After Season 15
AMERICAN IDOL will begin its 15th – and final – season this January on FOX. A season-long celebratory event, AMERICAN IDOL XV will feature host Ryan Seacrest and judges Jennifer Lopez, Keith Urban and Harry Connick, Jr., as they search for the final IDOL superstar and pay tribute to the past 14 seasons of amazingly talented contestants and the millions of fans who tweeted, texted and championed their IDOLs.
See more at: http://www.fox.com/article/fox-announces-new-primetime-series-for-2015-2016-season#sthash.SYlimfN2.dpuf
By Roy • Posted in Music, Reality Television	• Tagged American Idol, cancellation, Harry Connick Jr, Jennifer Lopez, Keith Urban, low ratings, Reality Television, Ryan Seacrest, Season 15, series finale, singing competition
Lancaster's James Wolpert Eliminated On 'The Voice'
Map of Pennsylvania highlighting Lancaster County (Photo credit: Wikipedia)
James Wolpert's run on 'The Voice' came to an end Tuesday evening.
The young man from Lancaster advanced to the final five last week via an instant save.
But on this week's elimination show to determine the three Voice finalists, he was the first contestant sent home.
Read more: http://www.yorkdispatch.com/entertainment/ci_24696303/lancasters-james-wolpert-eliminated-voice?source=most_viewed
By Roy • Posted in Lancaster, Music, Reality Television	• Tagged Adam Levine, Blake Shelton, Cee Lo Green, Christina Aguilera, elimination, James Wolpert, Lancaster County, Lancaster PA, NBC, Reality Television, singing competition, The Voice, With or Without You
Lancaster County Native James Wolpert Sings "Somebody To Love" By Queen On 'The Voice'
Lampeter-Strasburg High School graduate, James Wolpert is one the competitors on NBC's "The Voice" and sang the heck out of Queen's power ballad, "Somebody To Love".
By Roy • Posted in Entertainment, Lancaster, Music, Reality Television	• Tagged Adam Levine, Blake Shelton, CeeLo Green, Christina Aguilera, Freddie Mercury, Lampeter-Strasburg High School, Lancaster County, Lancaster PA, Queen, Reality Television, singing competition, Somebody To Love, The Voice
'American Idol' Taps Lopez, Connick As Judges
LOS ANGELES — "American Idol" is betting that a judges' remix with Jennifer Lopez, Harry Connick Jr. and Keith Urban will fare better with viewers than bickering divas Mariah Carey and Nicki Minaj did last season.
The rumored addition of Lopez and Connick as judges for season 13 was announced Tuesday by Fox. They'll join Urban to make up the talent show's first panel consisting solely of singers — a la NBC's successful 2011 upstart "The Voice."
Pop star and actress Lopez will be back on "American Idol" after a two-season run as judge in 2011 and 2012 that was a boon for the show and her career. Connick, a respected jazz singer and musician, proved adept as a mentor in several "Idol" appearances.
Urban's return to the contest was announced last month by Fox Chairman Kevin Reilly, who said the singer didn't get a chance to show his personality in his first turn as a judge. Urban appeared overwhelmed last season by the Carey-Minaj crossfire that drew complaints from some viewers.
Read more: http://www.pottsmerc.com/article/20130903/ENTERTAINMENT01/130909881/-american-idol-taps-lopez-connick-as-judges#full_story
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, Harry Connick, Jennifer Lopez, Jimmy Iovine, Keith Urban, Kevin Reilly, Music, NBC, new judges, Randy Jackson, Reality Television, Ryan Seacrest, singing competition
Fox Confirms Keith Urban Will Return To 'American Idol'
It's official: Keith Urban is returning to "American Idol" as a judge next season, Fox announced Thursday at the Television Critics Association summer press tour in Los Angeles.
"I will confirm one thing: Keith is going to return to the show," said Kevin Reilly, Fox Chairman of Entertainment, as he addressed a room full of reporters. "Keith's a really funny guy, and I didn't think he was able to let his full personality shine through" last season, due to the diva drama [between former judges Mariah Carey and Nicki Minaj] that overshadowed not just Urban, but also the contestants.
Read more: http://xfinity.comcast.net/blogs/tv/2013/08/01/fox-confirms-keith-urban-is-returning-to-american-idol/
By Roy • Posted in Music, Reality Television	• Tagged American Idol, format changes, Fox, Jennifer Lopez, Keith Urban, Kevin Reilly, Los Angeles, Mariah Carey, new judges, Nicki Minaj, Reality Television, singing competition, Television Critics Association
Randy Jackson Leaving 'American Idol'
LOS ANGELES — Jackson out. Randy Jackson, the lone original "American Idol" judge, says he won't be returning to the Fox talent competition.
"To put all of the speculation to the rest, after 12 years of judging on 'American Idol,' I have decided to leave after this season," Jackson said in a statement Thursday. "I am very proud of how we forever changed television and the music industry."
The 56-year-old record producer and bassist called the experience a "life-changing opportunity." He said he's leaving "Idol" to focus on his record label and other business opportunities.
Read more: http://www.pottsmerc.com/article/20130509/ENTERTAINMENT01/130509227/later-dawg-randy-jackson-leaving-american-idol-#full_story
By Roy • Posted in Music, Reality Television	• Tagged American Idol, Fox Broadcasting Company, FremantleMedia, judges, Mariah Carey, Music, Nicki Minaj, Paula Abdul, Randy Jackson, Reality Television, Simon Cowell, singing competition
'American Idol' Ratings Plummet In Season 12 Premiere
The Mariah Carey–Nicki Minaj feud might not be enough to rescue "American Idol"s" ratings.
Fox's singing competition entered its 12th season Wednesday with three new judges and sharply lower viewership. An average of 17.8 million total viewers tuned in to the two-hour premiere, slumping 19% compared with last season, according to Nielsen.
Read more: http://www.mcall.com/entertainment/la-et-st-american-idol-ratings-plummet-20130117,0,4166712.story
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, Fox, Fox Broadcasting Company, Keith Urban, Mariah Carey, Music, Nicki Minaj, Nigel Lithgow, Randy Jackson, ratings, Reality Television, singing, singing competition, television
Judges Steal Most Of Screen Time In New 'American Idol' Season
Logo of the Fox Broadcasting Company (Photo credit: Wikipedia)
FORT WASHINGTON — If the first two episodes of the new Season 12 of "American Idol" are any indication, the show is looking to make big stars of two talented female singers who are great performers and have big personalities.
That would be new judges Mariah Carey and Nicki Minaj.
That's because the episodes, shown Wednesday night in special sneak peek theater presentations for an invited Philadelphia-area crowd and at eight other cities nationwide, focused far more on the show's new judges than on any – or all – of the contestants.
The new season of "Idol" starts with the two-night premiere on Fox at 7 p.m. Wednesday-Thursday.
Read more: http://www.mcall.com/entertainment/tv/mc-american-idol-preview-20130110,0,3751780.story
By Roy • Posted in Entertainment, Music, Philadelphia, Reality Television	• Tagged American Idol, Fox Broadcasting Company, Keith Urban, Mariah Carey, new judges, Nicki Minaj, Philadelphia, Randy Jackson, Reality Television, singing competition
Christina Aguilera And Cee Lo Green Taking 'Voice' Hiatus; Shakira And Usher To Fill Their Chairs
You have to hand it to "The Voice. " Last week, the show added a third Wednesday episode to ruin "The X Factor's" big premiere night. And now, with the new "American Idol" and "X Factor" judges having had hardly any time to bask in their publicity, already "The Voice" is stealing both shows' thunder once again–with breaking news that two new singularly named superstar judges, Shakira and Usher, will replace Christina Aguilera and Cee Lo Green for Season 4. Both Christina and Cee Lo will be back for Season 5 in fall 2013, according to NBC.
Rumors have swirled for months that NBC's overkill decision to air "The Voice" twice yearly would at least temporarily drive away some or all of the show's regular judges, causing the lineup to be revamped for the spring 2013 season. Apparently such is the downside of hiring judges who, you know, are still relevant hitmakers and have other important things to do with their time, like touring and recording, besides sitting on an NBC soundstage six months out of the year. (And this is why talent shows should consider hiring non-celebrity judges, but I digress.) In fact, just last week when talking to Ryan Seacrest, Christina admitted that she'd first assumed her "Voice" gig would be "kind of like a side project…then it kind of took off, and there goes my free time!"
With Christina getting ready to release her comeback album, Lotus, in November (her new single, "Your Body," debuted last week to positive reviews), and the ubiquitous Cee Lo working on a Christmas album and a new sitcom, it's no surprise that they are the first "Voice" judges to take official leaves of absence.
Read more: http://music.yahoo.com/blogs/reality-rocks/christina-aguilera-cee-lo-green-voice-hiatus-shaira-231943068.html
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged Adam Levine, American Idol, Blake Shelton, Carson Daly, Cee Lo Green, Christina Aguilera, judges, NBC, new judges, Reality Television, Shakira, singing competition, Usher, voice
Katie Couric: 'American Idol' Judges Include Nicki Minaj, Keith Urban, Randy Jackson
We don't know how she knows, but Katie Couric, during the taping of Friday's "Katie," told former "American Idol" judge Jennifer Lopez who will be filling the panel in the singing competition's upcoming season: Nicki Minaj, Keith Urban, Mariah Carey and Randy Jackson.
Bing: Katie's new talk show draws big numbers
So far, only Carey has been confirmed by FOX, which has not responded to TheWrap's request for comment or made any public announcement.
"What do you think about the new group of judges?" Couric asked Lopez, according to a Thursday morning press release from "Katie."
Read more: http://tv.msn.com/tv/article.aspx?news=757303
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, Fox Broadcasting Company, Jennifer Lopez, judges, Katie Couric, Keith Urban, Mariah Carey, Music, new judges, Nicki Minaj, Randy Jackson, Reality Television, singing competition, Steven Tyler
Randy Jackson Returning To "American Idol" — Simon Cowell Says
Randy Jackson is returning to "American Idol," according to former judge Simon Cowell.
"Just heard randy is back on idol," the "X Factor" executive producer, who judged "Idol" for nine seasons alongside Jackson, tweeted today (Sept. 10). "Right decision," he added.
Just heard randy is back on idol. Right decision.
Read more: http://www.mcall.com/entertainment/zap-randy-jackson-returning-to-american-idol—-si-20120911,0,5635482.story
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, Enrique Iglesias, Keith Urban, Mariah Carey, new judges, Nicki Minaj, Randy Jackson, Reality Television, Simon Cowell, singing competition, X Factor
'American Idol': Nicki Minaj Nailing Down Judging Deal
According to two sources that have confirmed it to US Weekly, Nicki Minaj has signed on to be the newest judge for American Idol.
One source says, "I'm not sure the deal is completely done yet, but yes, she is definitely doing it. A few more slight things to sign off on but it is happening."
A second source adds the R&B star is "100% confirmed to judge American Idol."
Read more: http://www.mcall.com/entertainment/zap-american-idol-nicki-minaj-nailing-down-judging-20120820,0,560597.story
By Roy • Posted in Music, Reality Television	• Tagged American Idol, Mariah Carey, new judges, Nick Jonas, Nicki Minaj, Pharrell Williams, Randy Jackson, Reality Television, singing competition, television, Us Weekly
Mariah Carey Joins 'American Idol'
Paula Abdul, Jennifer Lopez and now … Mariah Carey.
Fox just made it official: Carey is the latest successful pop diva to join American Idol. The 42-year-old will join the judges table for season 12.
As reported in this week's issue of EW, Carey has been the leading contender to join the panel this summer, which has seen a flurry of celebrity names floated in the press as possible candidates. Her salary is expected to be somewhere north of $12 million — the sum paid Jennifer Lopez during her first year on the show — and possibly as high as $17 million.
Previously, Simon Cowell was courting Carey as a mentor for X Factor's second season, though it's not clear if her Idol announcement precludes an appearance on Fox's other show.
Read more: http://insidetv.ew.com/2012/07/23/mariah-carey-american-idol/
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, Jennifer Lopez, judges, Mariah Carey, Music, Paula Abdul, Randy Jackson, Reality Television, Simon Cowell, singing competition, Steven Tyler, X Factor
Steven Tyler Exiting As 'American Idol' Judge
Tyler leaving 'American Idol' after 2 seasons; Lopez says his exit will affect her decision
NEW YORK – Steven Tyler says he's exiting "American Idol" to put rock `n' roll first.
Tyler said he's leaving the hit show after two seasons to rededicate himself to Aerosmith, the band he fronts. The rock star said he loved every minute on the hit Fox singing contest but added, "it's time to bring rock back."
"After some long … hard … thoughts … I've decided it's time for me to let go of my mistress `American Idol' before she boils my rabbit," Tyler said in a statement, making a joking reference to the 1987 Michael Douglas-Glenn Close thriller "Fatal Attraction."
"I strayed from my first love, Aerosmith, and I'm back but instead of begging on my hands and knees, I got two fists in the air and I'm kicking the door open with my band."
By Roy • Posted in Music, Reality Television	• Tagged Aerosmith, American Idol, depatures, Fox, Fox Broadcasting Company, Jennifer Lopez, judges, Music, Phillip Phillips, Randy Jackson, Reality Television, singing competition, Steven Tyler
Britney Spears, Demi Lovato Are New 'X Factor' Judges
REUTERS – Britney Spears and former Disney Channel star Demi Lovato will join talent show "The X Factor" as judges when the U.S. version of the contest returns to television in September, Fox television and the show's creator Simon Cowell said on Monday.
Cowell said in a Twitter message that Spears, 30, the world's biggest pop phenomenon of the 2000s, will join him on "X Factor," which searches for a new pop star from tens of thousands of ordinary Americans.
Spears will be joined by singer and actress Lovato, 19, to fill the judge's seats left by Paula Abdul and Nicole Scherzinger, who were both fired by Cowell after a disappointing first season in 2011.
Cowell announced the news on Twitter, sending a photo of himself with record producer Antonio "L.A." Reid, Spears and Lovato and saying "Can't believe it's finally happening. Very exciting!"
Read more: http://in.reuters.com/article/2012/05/14/britneyspears-xfactor-idINDEE84D0KN20120514
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged Britney Spears, Demi Lovato, judges, LA Reid, Music, Reality Television, Simon Cowell, singing competition, X Factor
Hollie Cavanagh Goes Home On American Idol
With the coveted home town hero visit on the line, four became three tonight on the "American Idol" results show.
But before their fate was revealed the foursome kicked the show off with a snoozy version of "California Dreamin"" by the Mamas and Papas.
Then, we got down to business, or so we thought. First up, double P as Ryan said. Jimmy called Phillip's performance the beginning of Phillip coming into his own. But Ryan didn't reveal a thing. He told Phillip to return to "the couch," but said, those are not the results. Which means what?
Next up was Hollie, who struggled on her second showing last night. Jimmy understood why the judges were okay with Hollie's Journey showing, but he didn't agree. And of her Bonnie Raitt performance, Jimmy said, "she hit the opera button" and "crashed and burned." But still, the torture for us and them continued as she too was sent back to the couch.
Read more: http://blogs.wsj.com/speakeasy/2012/05/10/american-idol-season-11-who-was-voted-off-tv-recap-4/?mod=google_news_blog
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, American Idol tour, David Cook, elimination night, Hollie Cavanagh, hometown hero visits, Jennifer Lopez, Jessica Sanchez, Joshua Ledet, Music, Phillip Phillips, Randy Jackson, Reality Television, results night, singing competition, Steven Tyler
Christina Aguilera Apologizes To Tony Lucca, May Still Lose Job
Editor's note: GOOD, she should lose her job!
Christina Aguilera has apologized to The Voice contestant Tony Lucca for being a little more catty than judge-like. That however may not be enough to save the diva, who is reportedly disliked by many crew members working at the show.
Christina Aguilera and Tony Lucca are both former "Mickey Mouse Club" stars, but long lost history didn't seem to go far between the two, who kept up a steady back and forth battle during season two of The Voice.
After Lucca's Monday night performance of "99 Problems" Aguilera charged that the singer's song pick was "derogatory towards women" adding "if that's what you have to do." Later when her own contestant Michael Kiwanuka performed, she remarked "Now that's how a real man sings."
Read more: http://global.christianpost.com/news/christina-aguilera-apologizes-to-lucca-may-still-lose-job-video-74669/
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged 99 Problems, Christina Aguilera, contestant, feud, judge, Michael Kiwanuka, Mickey Mouse Club, Music, Reality Television, singing competition, The Voice, Tony Lucca
Team Blake Shelton Wins "The Voice" As Jermaine Paul Is Crowned Season 2 Winner
Blake Shelton earned bragging rights this year as the judge who picked the winning contestant on Season 2 of The Voice. Last year you may recall Adam Levine's contestant won.
The final four contestants were Jermaine Paul, Tony Lucca, Juliet Sims and Chris Mann. Second place went to Juliet Simms, third place went to former Mickey Mouse Club star Tony Lucca and fourth place went to opera singer Chris Mann.
Jermaine Paul was a backup singer for Alicia Keys before auditioning for The Voice. Congratulations to Jermaine for realizing his dream to move to the front of the stage 🙂
BTW – Christina Aguilara was pretty hard on her former Mickey Mouse Club costar, Tony Lucca for the duration of the competition. Not really liking her much this season. BOO!
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged Adam Levine, Blake Shelton, Cee Lo Green, Chris Mann, Christina Aguilera, Jermaine Paul, Juliet Simms, Music, Reality Television, singing competition, The Voice, Tony Lucca, winner Season 2
Skylar Laine Goes Home On American Idol
And then there were four! Things are winding down on Idol and the final show is only a few weeks away. Tonight, Skylar went home. She found herself in the bottom two along with Hollie Cavanagh. I was rather surprised. I thought surely Holly would get sent home tonight but America had other ideas.
As usual, Vote For The Worst is taking credit for keeping Phillip Phillips on the show. I think they give themselves too much credit.
So we are left with Joshua Ledet, Holly Cavanagh, Jessica Sanchez and Phillip Phillips.
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, Hollie Cavanagh, Jennifer Lopez, Jessica Sanchez, Joshua Ledet, Music, Phillip Phillips, Randy Jackson, reality tele, Reality Television, singing competition, Skylar Laine, Steven Tyler
Elise Testone Goes Home On American Idol
And then there were five…
America sent Elise Testone home after two less than stellar performances and poor song choices. Elise was argumentative with the judges as well… a turn off to voters.
According to Starpulse.com, their ranking of the final five is:
Phillip Phillip
Skylar Laine
Holly Cavanagh
By Roy • Posted in Entertainment, Music, Reality Television	• Tagged American Idol, elimination night on Idol, Elise Testone, Jennifer Lopez, Music, Randy Jackson, Reality Television, Ryan Seacrest, singing competition, Steven Tyler


text:
Year : 2021 | Volume : 14 | Issue : 1 | Page : 28--32
An assessment of management strategies for adult patients with foreign-body sensation in the neck
Nidhi Garg1, Ryan N Lee2, Renee Pekmezaris3, Sanjey Gupta1,
1 Department of Emergency Medicine, Southside Hospital, Bay Shore, New York, USA
2 Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, USA
3 Department of Medicine, Northwell Health, Manhasset, New York, USA
Dr. Nidhi Garg
Department of Emergency Medicine, Southside Hospital, 301 East Main Street, Bay Shore, New York 11706
Objectives: Patients come to the emergency department (ED) for the evaluation of foreign-body sensation in the neck. Given the dearth of clinical studies for this complaint, these patients are treated subjectively by different providers. We aim to propose a treatment approach that results in the timely diagnosis and removal of foreign bodies by comparing the common radiologic studies used in the ED for this complaint, determining the utility of consults, and providing an approach that minimizes length of stay. Methods: We conducted a retrospective cohort study of adults between January 2014 and December 2015 presenting to LIJ and NSUH EDs with a chief complaint of foreign-body sensation in the pharynx, larynx, or esophagus. Fifty unique cases were studied. Consultations with ear, nose, and throat (ENT) and/or gastrointestinal, any imaging studies used, and time until discharge from the hospital were the primary exposures studied. The time for each diagnostic path for successful removal of a foreign body was compared for each case. Results: Three common diagnostic approaches were identified. The most common pathway (six cases) had an ENT consult for removal of the foreign body, with an average time to discharge of 188 min. Another common pathway (four cases) began with a neck X-ray followed by an ENT consult, with an average time of 327 min. The third common approach (6 cases) involved no imaging studies or consults, with an average time of 166 min. Neck X-ray (20 cases) was found to have a sensitivity of 43% and a specificity of 83%. The sensitivity of neck computed tomography (CT) (15 cases) had a sensitivity of 91% and a specificity of 50%. Chest X-ray (15 cases) was found to have a sensitivity of just 17%. Chest CT (3 cases) had a sensitivity of 67%. Conclusion: Based on our data, we recommend that an attempt to localize the foreign body be completed by the emergency physician. If an initial attempt does not resolve the sensation, an ENT consult to remove the possible object should be initiated. Only after failure by ENT should radiological imaging be considered.
Garg N, Lee RN, Pekmezaris R, Gupta S. An assessment of management strategies for adult patients with foreign-body sensation in the neck.J Emerg Trauma Shock 2021;14:28-32
Garg N, Lee RN, Pekmezaris R, Gupta S. An assessment of management strategies for adult patients with foreign-body sensation in the neck. J Emerg Trauma Shock [serial online] 2021 [cited 2022 Jan 22 ];14:28-32
Available from: https://www.onlinejets.org/text.asp?2021/14/1/28/311789
Background/rationale
Although foreign-body sensation in the neck is a common presenting symptom among patients reporting to the emergency department (ED), there are no specific studies that evaluated the best diagnostic and management strategies for this chief complaint.[1],[2] Case studies have revealed that laryngeal foreign bodies can present with less severe symptoms as compared with lower respiratory tract foreign bodies.[3] This can result in misdiagnosis, confusion, and delay in diagnosis. This is confounded by the observation that patients are generally unable to determine the exact location of the foreign body based on the pain.[4] Given the dearth of clinical studies and recommendations on how to manage patients with foreign-body sensation in the neck, treatment of these patients is widely variable. Past studies have suggested that lateral neck radiographs had a low sensitivity and were not useful in the diagnosis of foreign-body ingestion.[5],[6] Other prior studies have suggested that noncontrast computed tomography (CT) could be sufficient in guiding management. However, these studies did not consider the time-cost in management.[7],[8],[9]
We aim to study the various diagnostic pathways currently utilized by emergency medicine physicians. By examining the different strategies for evaluating foreign-body sensation in the throat, we hope to determine the radiologic studies that are most beneficial for the patient. We hypothesize that X-rays of the head and neck will have low utility in evaluating and diagnosing foreign body sensation in the throat. Additionally, we aim to study how ear, nose, and throat (ENT) and gastrointestinal (GI) consults can be best utilized emergently or in the outpatient setting. The goal is to suggest a workup for this chief complaint that results in timely diagnosis and removal of any foreign bodies in the throat.
A retrospective cohort study was performed to evaluate current management trends in patients presenting with foreign-body sensation of the throat. All adults (≥18 years old) who presented to two academic, tertiary EDs with a combined ED volume of 184,000 with a chief complaint of foreign-body sensation in the pharynx, larynx, or esophagus were included in the study.
Patients were identified by review of International Classification of Diseases (ICD)-9 and ICD-10 codes. This complaint corresponds to the ICD-9 codes 933.0 for foreign body in the pharynx, 933.1 for foreign body in the larynx, and 935.1 for foreign body in the esophagus. Due to overlap with ICD-10 codes, any cases with an equivalent ICD-10 code that fell within this time period were also included.
All cases identified between January 1, 2014 and December 31, 2015 were included in this study. All cases included in this study presented at urban academic hospitals, either North-Shore University Hospital or Long Island Jewish Medical Center.
For each patient that met the inclusion criteria, variables corresponding to the basic steps in evaluation and management were collected as well as basic patient demographics (age, race, and gender). Clinical factors, including vital signs and examination findings, such as the presence or absence of respiratory distress were abstracted.
All imaging studies, including neck CT, neck X-ray, chest CT, and chest X-ray were analyzed. Sensitivities, specificities, positive predictive values, and negative predictive values (NPVs) were calculated for each of these radiologic studies. The gold standard for these calculations was the successful removal of a foreign body in the ED or in the operation room (OR). If no foreign body was removed, it was assumed that none was present, and the foreign body sensation was simply an abrasion. Additionally, the success rate of foreign-body removal was compared between patients with GI or ENT consults. Visualization and removal techniques, including flexible laryngoscopy and flexible endoscopy, were compared as well. A finding of the scope was considered positive if a foreign body was identified using the procedure, while a finding was negative if no foreign body was found. Other data collected included the number of attempts at foreign-body removal and any ED return visits with the same chief complaint. Additionally, the time between imaging studies, consults, and any invasive procedures was collected to find possible optimal management pathways in the ED.
There was very little potential for bias in this retrospective chart review. There was no direct contact with patients during the study, and there were no changes of management throughout the review. The data were objectively collected and analyzed.
Study size
There were a total of 51 adult patients in this study. Although 53 patients fit the inclusion criteria of the study, two patients were excluded. In one case, the foreign-body sensation was relieved with the utilization of glucagon. In the other case, the chief complaint was actually chest pain.
Descriptive statistics (mean ± standard deviation for continuous variables; frequency and percent for categorical variables) were used to describe the data collected. The project was IRB approved, and the data were stored in Health Insurance Portability and Accountability Act-approved Research Electronic Data Capture database.
[Table 1] describes the general demographics and clinical factors of the 51 adult patients:{Table 1}
There were 29 patients (56.86%) who had a foreign body visualized in the ED on radiologic imaging (either CT or X-ray); 14 (51.85%) were located above the cricoid, and 15 (55.56%) were located below the cricoid.
There were a total of 30 patients (58.82%) with an ENT consult. Among the n = 30 with an ENT consult, 27 (90%) used a flexible fiber-optic laryngoscopy. Of these, 13/27 (48.15%) had positive findings and 14/27 (51.85%) had negative findings.
There were a total of 15 patients (29.41%) with a GI consult. Among the n = 15 with a GI consult, 14 (93.33%) used a flexible endoscope. Of these, 11/14 (78.57%) had positive findings and 3/11 (21.43%) had negative findings.
There were 22 patients that had at least one attempt of removal in the ED; 81.82% (n = 18) had successful removal in the ED, and 18.18% (n = 4) did not have successful removal in the ED.
Successful removal in the ED by consult status is shown in [Table 2] (Fisher's exact, P = 0.6206).{Table 2}
Among all patients, 62.75% (n = 32) had a foreign body successfully removed at some point during their hospital visit, either in the ED or in the OR, and 37.25% (n = 19) did not have a foreign body removed during their hospital visit.
[Table 3] describes the predictive and statistical values for the radiologic studies collected.{Table 3}
Outcome data
[Table 4] describes the average time from triage until discharge from the ED. These values do not include any time that a patient may have spent as an inpatient or in the OR. The appendix lists the times between key activities such as imaging, invasive procedures, and discharge for each case. There were ten cases in which patients were transferred from one hospital to another.{Table 4}
Key results
There were three common approaches to foreign-body sensation in the throat identified in these 51 cases. One common approach is initial ENT consultation without any accompanying radiologic imaging studies. The consult is followed by ED discharge (this is seen in cases 1 [with a follow-up neck X-ray], 4, 11, 29, 34, and 38). All of these cases were successful as the foreign body was either removed or not found. None of these cases had a repeat visit to the ED. The average time from triage until discharge for a patient seen only with ENT, and no imaging studies were 188 min.
Another common pathway begins with a neck X-ray followed by an ENT consult for removal and discharge (this is seen in cases 16, 17, 23, and 33). In these cases, imaging was not always helpful. For example, in cases 16 and 33, the neck X-ray was falsely negative. The ENT was still able to visualize and remove a foreign body despite the negative X-ray. Utilization of a neck X-ray was noncontributory in half of these cases. The average time until discharge for this pathway was 327 min.
Comparing these two approaches, it is clear that adding one imaging study can greatly lengthen the time spent in the ED. The addition of 1 simple imaging technique (neck X-ray) led to an average increase of 139 min of extra time in the ED. This may be related to waiting for a preliminary or official read to return with the X-ray before further evaluation is taken. The low sensitivity of the neck X-ray (43%) and low NPV (38%) suggest that further attempts at visualization should be taken if nothing is seen on the X-ray. Moreover, given that the approach using ENT with and without neck X-ray both led to discharges without readmission for the same chief complaint, it may be that imaging only contributes to the crowding of the ED and longer wait times for other patients.
In multiple cases (3, 7, 13 [a transfer], 19, 20 [another transfer], 25, 26, 30, 37, 44, 49 [transfer], and 50), both chest X-ray and neck X-ray were done, followed either by an invasive technique or discharge. Looking at the results of both imaging studies, chest X-ray provides little added value if a neck X-ray has been completed. The low sensitivity of chest X-ray (17%) already suggests that this form of imaging does contribute to the identification of a foreign body in the neck. Further, in every case in which both neck X-ray and chest X-ray were done concurrently, the chest X-ray did not provide any further diagnostic value. The percentage of identification of a foreign body in cases when both imaging studies were done was not higher compared to cases where only neck X-ray was done. Additionally, there were no cases where the chest X-ray picked up a foreign body when the neck X-ray did not.
In the cases utilizing a neck CT, the sensitivity of the imaging study improves over plain films. In the cases where only a CT was done (cases 9, 12, and 14), the CT was able to visualize the foreign body before ENT removed the object. Still, since the rate of overall success did not change compare to cases with an X-ray only, the increased sensitivity of CT may not outweigh the risks of increased radiation. Additionally, the average time until discharge was 649 min. It is unclear; however, if this greatly increased length of stay is due to other factors. For example, these patients may have appeared more unstable, warranting a CT instead, and hence, longer ED stay.
Finally, the other common pathway involves no imaging studies and no consults. The patient is examined by the EP solely. In these cases (5, 8, 18, 21, 28, and 46), either the EP was able to remove the foreign body, no foreign body was found, or the sensation resolved spontaneously while in the ED. The average time in these encounters was 166 min. Not surprisingly, this represents the shortest time among the four common diagnostic pathways. Again, the success rate for these cases was good. There were no noted return visits to the ED for the same complaint. The Choosing Wisely campaign has 140 guidelines regarding imaging recommendations, all with the goal of reducing extraneous imaging procedures that provide little or no benefit to the patient. Importantly, any imaging studies with radiation are particularly scrutinized. Given the discussion on the limited role of neck X-ray, chest X-ray, and neck CT, an evaluation of foreign bodies in the neck with only EP visualization possibly with ENT consultation may be the safest and quickest approach for the patient.
The transfer cases in this study further support an initial ENT consult. In the majority of transfer cases, the reason for transfer was availability of ENT at the receiving hospital. This can be seen in cases 2, 13, 20, 32, 35, 36, and 41. Although an imaging study at the initial hospital may be required to justify a transfer, the utility of the imaging study itself, especially X-ray, is marginal. In a few cases (2, 31, 32, and 49) in which an imaging study was done at the initial hospital, a follow-up imaging study was still done at the receiving ED. In two of the four cases (31 and 49), the results of the imaging study changed, with the receiving hospital providing the accurate interpretation. The course of management for these patients also did not seem to differ between patients who had a prior imaging study and those who did not. In the sole case (36) where a transfer was done without imaging, the patient was still successfully treated. Given that the majority of patients were transferred due to specialist availability, the best course of action should be to use imaging studies minimally, whether at the initial or receiving ED (note that the full list of transfers are seen in cases 2, 13, 20, 31, 32, 35, 36, 41, 42, and 49).
With regard to the imaging studies, it is important to note that the analysis of imaging studies is limited because not all patients received all types of imaging. Cases may have been sent for different types of imaging depending on the perceived complexity and/or location of the foreign body. While the sensitivity of neck CT was found to be much higher than the sensitivity of neck X-ray (91% vs. 43%, respectively), the choice to use one form or another did not appear to change the outcome of the case. A more detailed cost-benefit analysis would be required to determine which imaging type should be used in this diagnostic setting.
As a retrospective chart review, this study has several limitations. All information collected was limited by documentation. Some charts did not have a complete description of the full course of care. There may have been other clinical factors not documented that led the physician to choose a specific radiologic study. Recognizing that just 53 cases were isolated during the study's duration, there may have been missed cases as cases were identified using the ICD-9 and ICD-10 codes. Additionally, collection of the length of stay in the hospital was based on the notes written in the Electronic Medical Record and may not fully represent the exact times when a patient is triaged or discharged. Additionally, only a few of the charts specifically documented the method of removal of the foreign body, whether with laryngoscopy or video laryngoscopy or simple tongue blade exam. However, from anecdotal practice, Emergency Physicians (EPs) often utilize direct laryngoscopy using cetacaine spray to visualize the epiglottis and tonsillar pillars for patients with a Mallampati score of 0–3 with a presumed simply airway based on mouth opening and the American Society of Anesthesiologists physical status classification system.
Generalizability
This study findings have implications for emergency medicine physicians who want to efficiently evaluate patients coming to the ED with foreign body sensation in the throat. Based on the information collected from 51 cases on foreign-body sensation, the following recommendations can be made. For patients with foreign-body sensation in the neck, localization of the object should first be attempted by the emergency physician. As expected, the cases with no imaging studies and no consults had the shortest length of stay. If an initial attempt does not resolve the sensation, an ENT consult to localize and remove the possible object should be obtained next.
Further suggestions are relevant in instances in which a specialist is not readily available. In these cases, a transfer to another hospital without performing an imaging study is not unreasonable. However, the risk and cost-benefit analysis of transfer without imaging should be considered. In cases where CT neck can be done readily but ENT consult is not available, the foreign body can be visualized, and appropriate cases can be transferred. However, if transfer within the system can be arranged readily, then patients can be transferred before imaging. The rate of success with an ENT consult only compared to an ENT consult with imaging study was comparable. Only after unsuccessful attempts to retrieve the foreign body by the ENT, despite persistent clinical symptoms, should any imaging be ordered. It is not recommended that chest X-rays be ordered, as our data suggest that chest X-rays provide no added diagnostic value.
1 Park S, Choi DS, Shin HS, Cho JM, Jeon KN, Bae KS, et al. Fish bone foreign bodies in the pharynx and upper esophagus: Evaluation with 64-slice MDCT. Acta Radiol 2014;55:8-13.
2 Eliashar R, Dano I, Dangoor E, Braverman I, Sichel JY. Computed tomography diagnosis of esophageal bone impaction: A prospective study. Ann Otol Rhinol Laryngol 1999;108:708-10.
3 Marçal N, Soares JB, Pereira G, Guimarães J, Gonçalves M, Godinho T. The management of ingested foreign bodies in an Ear Nose and Throat Emergency Unit: Prospective study of 204 cases. Acta Otorrinolaringol Esp 2013;64:197-203.
4 Yang CY, Yang CC. Subjective neck pain or foreign body sensation and the true location of foreign bodies in the pharynx. Acta Otolaryngol 2015;135:177-80.
5 Hone SW, Fenton J, Clarke E, Hamilton S, McShane D. The radio-opacity of fishbones: A cadaveric study. Clin Otolaryngol Allied Sci 1995;20:234-5.
6 Sundgren PC, Burnett A, Maly PV. Value of radiography in the management of possible fishbone ingestion. Ann Otol Rhinol Laryngol 1994;103:628-31.
7 Kim JP, Kwon OJ, Shim HS, Kim RB, Kim JH, Woo SH. Analysis of clinical feature and management of fish bone ingestion of upper gastrointestinal tract. Clin Exp Otorhinolaryngol 2015;8:261-7.
8 Kim HU. Oroesophageal fish bone foreign body. Clin Endosc 2016;49:318-26.
9 Das D, May G. Best evidence topic report. Is CT effective in cases of upper oesophageal fish bone ingestion? Emerg Med J 2007;24:48-9.


Brussels Sprouts are an excellent source of nutrition, and they are particularly easy to grow. Our Long Island Improved variety provides sprouts that are large and easy to harvest. A cool weather crop, Brussels Sprouts can stand a freeze, and often the most delicious when they mature after the first fall frost. Good freezing variety. Matures 90-110 days.
Garden tip: The sprouts form at the base of the leaves. To promote more sunlight, remove the leaves a few at a time. Be sure to leave the top foliage. At the end of summer, pinch out the growing tip of the plant to promote sprout growth and not plant height.


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The Madrid all-girl quartet impressed on their Glastonbury debut this summer following popular tracks like 'Bamboo' and 'Trippy Gum'. While technically not a new band, with Ana Perrote and Carlotta Cosials forming 'Deers' in 2011. The band had to change their name to Hinds at the end of 2014 after threat of legal action from a similarly named band.
Hinds first made an appearance on the British indie scene when supporting the likes of The Libertines, The Vaccines and The Flaming Lips on UK tours. With their debut album scheduled for release in January 2016, it could be a big year for the Spaniards.


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Share this Story: Barbara Kay: Be careful about calling it 'death with dignity'
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Barbara Kay: Be careful about calling it 'death with dignity'
Quebec commissioners have made up their minds: They are picking their data to suit their pro-euthanasia convictions
Jacques Demarthon / AFP / Getty Images
I have always found it odd that the same people who feel the death penalty is barbaric often look benignly on euthanasia. And it does show that words matter. One person's stark "state killing" is to another, as in Quebec's pitch to legalize euthanasia, "dying with dignity." But the final result is still a human being's life purposefully ended by his fellow human being.
Euthanasia and assisted suicide raise existential moral questions. (Euthanasia is the killing of a patient, for humanitarian reasons, by another person. In cases of assisted suicide, another person provides the patient with the means to kill himself, but does not perform the final lethal act himself.) Yet I find pundits' discussion around the issue in Canada's mostly sympathetic mainstream media (including the National Post editorial board) to spring more from vicarious terror of a bad death than critical investigation into assisted suicide/euthanasia as public policy.
Barbara Kay: Be careful about calling it 'death with dignity' Back to video
Now taken for granted are: the "right" to state-assisted suicide; "dignity" narrowly understood as physical autonomy; "intolerable suffering," the individual's to define, the state's agency in ending to command. None of these assumptions seem self-evident to me.
Also taken for granted: that it is the task of the physician — sworn to heal, relieve suffering and comfort the afflicted — to assist in ending lives. But why doctors, who are passionately divided on the subject? Why not death technicians or even, as one critic sarcastically mused in an October Wall Street Journal op-ed, the police (with a strategically placed loaded gun and instructions on how best to deploy it)?
In fact, most physicians are at odds with public opinion. A 2009 survey in Britain found that while over 80% of the public approved euthanasia, 73% of the members of the British Royal College of Physicians opposed it. In hearings for Quebec's "Dying with Dignity" Commission, most intervenors rejected euthanasia.
In their report, Quebec's commissioners boasted of satisfactory fact-finding missions to three European countries where euthanasia is legal. But they did not reveal that euthanization without consent is a growing concern in Belgium; or that in 2009, a UN committee on human rights singled out the Netherlands for its disturbing rates of euthanasia (4,050 in 2010; euthanasia and assisted-suicide rates have jumped 73% in just eight years). Euthanasia opponents also argue that some seniors in euthanasia-legal countries are moving in significant numbers to neighboring non-euthanasia-legal countries, because they fear being pressured to relieve the state or families of the perceived burden they now apparently represent. The reality is that the Quebec commissioners had already made up their minds; they then cherrypicked their data to suit their convictions.
Intractable pain during terminal illness is the issue for most euthanasia proponents. But virtually any pain can be managed, and strictly controlled palliative sedation (which eases passage to, and may hasten death) is already legal in Quebec. Thus, actual pleas for active euthanasia are uncommon. Oncologist Caroline Girouard of the Jewish General Hospital in Montreal testified that "In all my years of practice, I never got one request for euthanasia."
Hard cases make bad law. Take, for example, the case of the 45-year old identical twin men who were put to death last month in Belgium. The deaf twins were inseparable companions. Upon finding out that they were going blind as well, they concluded that life without the ability to see each other was intolerable. The state concurred.
Such a case has strong emotional appeal to ordinary people who can identify with the mingled physical and psychological trauma the brothers were enduring. But consider an equally plausible hypothetical case of inseparable twin deaf brothers. One of them is struck by lightning and dies. The surviving twin, bereft but otherwise healthy, also feels life without ever "seeing" his brother again is intolerable. Will the state concur and agree to euthanize him? Would you? Since I am not a "progressive," I would not, but I suspect Belgium would.
Quebec patients already have the right to refuse treatment, withdraw treatment, withhold treatment and request medical assistance in dying. The new law would add one element: active euthanasia, which will effectively suppress interest in enhancing palliative care. There is no dignity in this law. It should be euthanized.
bkay@videotron.ca


It's a long drive from Raleigh, North Carolina to Nashville, Tennessee. Before Interstate 40 was cut through North Carolina, driving west from Raleigh meant winding through such towns as Siler City, Mocksville, Statesville, Hickory, and Old Fort. Bill Monroe is no stranger to that road. In the forty odd years he has been performing, he has worn out many a set of tires driving that road. Being a bluegrass musician has meant accepting show dates spread out all over the country; it never seems to matter how many miles lie between.
To pass the time, Monroe has often tuned in the nearest radio outlet in hopes of catching a country music station. One day in early 1943, while driving near Hickory, North Carolina, Monroe chanced to pick up WHKY, broadcasting from downtown Hickory. It was noon time and Don Walker was doing a live show with his Blue Ridge Boys.
The program presented by Don Walker and his group was typical of many country bands during that period. There were two guitars, a mandolin, fiddle and banjo. Along with the usual comedy routines and skits, their show featured both sacred and secular songs interspersed with fiddle tunes like "Katy Hill" and "Grey Eagle." It was the fiddling that especially caught Monroe's ear as he was traveling down Highway 64 & 70 headed toward Nashville. Before the program was over, Walker had introduced all the band members, and Monroe did not forget the name of the fiddler: Jim Shumate. It was not long after Monroe reached Nashville that he put in a call to the twenty-year old musician. Howdy Forrester, who had been Monroe's fiddler, had just given his notice. It was war time, and the Navy had plans for Howard Forrester. Suddenly needing a fiddle player, Monroe chose Shumate.
"One day I got a call from Bill Monroe. 'Course all my life I'd always wanted to be at the Grand Ole Opry. That was my idol. I'd listened to those guys ever since I first started playing the fiddle, but never dreamed I'd ever be there. So the telephone rang and a voice said, 'This is Bill Monroe.' That shook me up, you know. He said, 'Now you play the fiddle, don't you? You've got Howdy Forrester, Tommy Magness, and three or four others all mixed up together. If you play that type of fiddle, that's what I want'." So Monroe offered Shumate the job as fiddler with the Bluegrass Boys. Within days, Shumate packed his bags, tucked his fiddle under his arm, and caught the bus to Nashville.
"I never got to see Smith in person but one time. It was at the Grand Ole Opry when he was playing fiddle with Jimmy Wakely. I admired him all of my life, from the time I was a little shaver on up. He was considerably older than I was. I didn't even get to talk to him. The dressing room was so full, so many people crowding around. Jimmy Wakely was a pretty big movie star at that time, and I just got close enough to see Smith. He was a genius, a flat genius, when it comes to playing the fiddle. He fiddled stuff like nobody else, like nobody you ever heard. Smooth…he didn't fiddle a whole lot of fancy stuff, he was flat, down to earth. Like Earl (Scruggs) on the five string. Earl don't playa lot of fancy banjo, but what he plays is right; it's there. And that's the way Smith's fiddlin' was. He didn't do a lot of fancy, show-off, kick-up-the-dust stuff, but when he fiddled a tune, it was fiddled just like it ought to be.
In addition to Bill Monroe and Jim Shumate on fiddle, there was a comedian and banjo player in the Blue Grass Boys named Stringbean (the late David Akeman). "When I sang bass on the gospel numbers," Shumate recalls "String would sing the baritone. String and me also did a comedy act together. I worked (as the) straight man. People use to come up to Stringbean after he'd left Monroe and say `you know that Earl Scruggs can really pick a banjo.' String would say 'Yeah, but you ought to hear both me and him play at the same time.' He never would let himself down, and he never would say that Earl could pick. String and I used to room together in the hotel. We buddied around together quite a bit.
Rounding out the Blue Grass Boys was Andy Boyette, from Florida. Boyette was a comedian and worked a blackface act along with Stringbean.
Like many fiddlers before him, Jim Shumate was surprised to discover that Bill Monroe does not often sing in the keys in which most musicians are used to playing. While most singers stick to the keys of G, A, D, and C, Monroe prefers B, Bb and E. Shumate recalls his experiences playing with Monroe: "Oh my! That was the first time I'd ever hit B, Bb and I'd never played anything in E 'til I got on the stage of the Opry. The one thing about Monroe, you didn't know what to expect. Sometimes when we was getting ready to play a tune, he'd whisper over to me 'This is going to be in Bb or B natural.' With Monroe, you had to be set and ready for anything. But one thing about him he'd never let me down. He'd always kick it off with the mandolin, which gave me a chance to feel out the first verse and be ready, 'cause he'd always expect me to come in to kick off the second break. I had to do the second break, always. If there was any doubt in my mind, why there was a look I'd give him, and he'd take it himself, because he knew I wasn't ready. On some of those ones I'd never played, me being a rookie to start with, why sometimes he'd have to make two rounds before I'd have it figured out.
It was in one of the rare practice sessions that Shumate came up with the fiddle kick off.
"Lester had a funny lick on the guitar. Bill would kick it off with the mandolin, but he couldn't turn him in. When Lester would come in to pick up the rhythm to sing, somehow or another they'd miss a beat. I kept standing and listening and I knew right off the bat what was happening, 'cause one of them was coming in a lick ahead of the other. Flatt turned around and said, 'Jim, see if you can kick that thing off with the fiddle.' He'd been hearing me in the background, I was kinds kickin' it off a little. So I just kicked if off and when I wound it up and turned him in, he hit that thing right on the button. So we kicked it off three more times before we hit the stage, and man, it was right. From then on, we kicked off everything with the fiddle; everything that we did, of course. If Monroe had something that he wanted to kick off, he did. If Lester had one he wanted to sing, Monroe left it usually up to the guys, because he was straight with us, Bill was, all the way through. If he thought we could handle one better the way we wanted to do it, why that's the way he let us do it. After all, if we flubbed, he was the one that took the rap.
What with working tent shows, keeping a bluegrass band and a baseball team together, plus doing his own booking, Monroe did not find time to make any recordings in the period from October 1941 until February 1945. Unfortunately, this was when Shumate was working with the Blue Grass Boys.
Shumate had met Earl Scruggs in Hickory, North Carolina some years before. "We used to have a thing in the city auditorium in Hickory called the Carolina Jamboree. Earl came up there one night with a bunch of boys from Shelby and Earl was back in the dressing room picking banjo with a fella named Grady Wilkie, who was singing and picking the guitar. And that's where I met him. I liked his banjo pickin' and I hadn't forgot it. I remembered how good I liked it, and that's how come I knew where he was.
Even though Jim Shumate had left the Blue Grass Boys and had returned to North Carolina, he was still very much active in country music. It wasn't long after returning to Hickory that he joined up with Dwight Barker and the Melody Boys who had a regular television program on WSJS. He also managed a country music park and had his own bluegrass show on radio WHKY.
Lester Flatt, Earl Scruggs and the Foggy Mountain Boys seemed to be taking the country by storm. Their days of hustling for jobs were well in the past. As Shumate recalls "We had no trouble at all getting work. Goodness gracious! If we did anything, we turned 'em down." Before long, Lester and Earl were signing their first contract together to record for Mercury records.
When Lester, Earl, and the Foggy Mountain Boys were in their first recording session, Shumate remembers that "Everybody was very calm; we knew what we were doing. We'd done it time and time again on radio, and we knew how we were going to do it. Some people come to a session not knowing what they're going to do. It's not a good idea to practice on a record. You should know what you're going to do. I don't mean you should try to play the same break over and over every time. Every time I'd take a break I'd try to play it a little bit different. I never did try to play it the same way over and over. I like to try to add a little something to it, or take something away, to give it a little contrast.
Although Shumate had passed up a chance to work with the Stanley Brothers, he did eventually work with them for one week, on one of his vacations from his regular job. Playing fiddle with the Stanleys up until the time that Shumate joined them was Leslie Keith. Shumate had met Keith some years before while Shumate was fiddling with Flatt and Scruggs.
"That Keith was some fiddler. But the worst I ever saw Keith hurt was when I beat him in a fiddler's convention. He'd take that 'Black Mountain Blues' and win every convention in the country. He could do that thing. When a man writes a song, it's his, you know, and he could handle it like nobody else. So we did a show at the National Fiddler's Convention at Richlands Virginia, in 1949. We had Buck Ryan on the program who was playing fiddle for Jimmie Dean at that time, Leslie Keith, who was doing a show out of Bristol, Chubby Wise, who was working with Hank Snow in Nashville, and myself. I was fiddling with Lester and Earl. There was a huge crowd, about 9,000 best I can remember.
"They run a fiddler's convention sort of like a beauty contest. They started off and matched to see who was going to go first, and I came out last. I usually like to get in the middle, or pretty close to the first. That gives you a chance to pick you rtune. I would have picked 'Orange Blossom' if I could have got on first. But Chubby Wise got to play first, so he played 'Orange Blossom.' Keith came up next and he did the 'Black Mountain Blues.' Then Buck Ryan came up and did 'Listen to The Mockingbird.' He really laid the timber to that thing. He could really play it. So I said, 'Cedric, what in the dickens am I going to play? They've done played everything.' He said 'Play the 'Lee Highway Blues,' and them fellows can't touch you with a ten foot pole.' That made me feel more confident, because those boys were good fiddlers-they were the best. So I played 'Lee Highway,' and just laid them boys in the shade. So the first round the judges dropped off Keith. The next round they dropped off Chubby. The next one they dropped off Ryan, and that left me standing there. That made me feel good. I'd taken that thing by a landslide.
Jim Shumate is long overdue to receive credit for the changes he helped to create in bluegrass music. At age 90, he still resides in Hickory, North Carolina and can still fiddle nearly as good as in his earlier years. He is without question a bluegrass fiddler supreme.