Tympanostomy Tube Otorrhea: Microbiological Differences Between Children with and Without Cleft Palate.

OBJECTIVE: To characterize and compare microbiological profiles in tympanostomy tube otorrhea for children with and without cleft palate. DESIGN: Retrospective cohort study. SETTING: Pediatric otolaryngology and multidisciplinary cleft/craniofacial clinic at a single tertiary care center. PATIENTS: Children with and without cleft palate <18 years of age who underwent tympanostomy tube placement between 2017-2021. MAIN OUTCOME MEASURES: Otopathogen profiles and antibiotic resistance patterns in ear culture specimens obtained in children presenting for treatment of recalcitrant post-tympanostomy tube otorrhea. RESULTS: Of the 886 children with tympanostomy tubes placed between 2017-2021, 345 (38.9%) had clinically significant otorrhea defined as requiring at least one otolaryngology visit for treatment. Children with cleft palate had higher rates of otorrhea (50.0% versus 35.7%; P < .01). In the 128 cultures obtained, Staphylococcus aureus was the most common organism in both groups present in 39.8% of cultures; 49% were methicillin-resistant (MRSA). Pseudomonas aeruginosa was also frequently isolated (20.0% versus 23.4%, P = .69) in children with and without cleft palate. Collectively, fluoroquinolone resistance was observed in 68.6% and 27.6% of the S. aureus and P. aeruginosa isolates, respectively, however, no differences in fluoroquinolone resistance were observed between cleft and non-cleft cohorts. Corynebacterium species were isolated more frequently in children with cleft palate (26.7% versus 6.1%, P < .01), a finding of unclear significance. CONCLUSIONS: Recalcitrant post-tympanostomy tube otorrhea is more common in children with cleft palate. MRSA was the most common isolate, which was commonly resistant to first-line fluoroquinolone therapy.

Considerations on the application of a mutation model for Y-STR interpretation.

If Y-STR profiling is to be more effective in criminal casework, the methods used to evaluate evidential weight require improvement. Many forensic scientists assign an evidential weight by estimating the number of times a Y-STR profile obtained from a questioned sample has been observed in YHRD datasets. More sophisticated models have been suggested but not yet implemented into routine casework, e.g. Andersen & Balding [1]. Mutation is inherent to STR meiosis (or inheritance) and is encountered in practice. We evaluated a mutation model that can be incorporated into a method for assigning evidential weight to Y-STR profiles, an essential part of bringing any method into practice. Since an important part of implementation to casework is communication, the article is written in an accessible format for practitioners as well as statisticians. The mutation component within the MUTEA model by Willems et al. [2] incorporates the potential for multistep mutations and a tendency for alleles to revert towards a central length, reflecting observed mutation data, e.g. [3]. We have estimated the parameters in this model and in a simplified symmetric version of this model, using sequence data from father/son pairs [4] and deep-rooted pedigrees [5]. Both datasets contain multistep mutations, which may have an effect on models based on simulations [1]. We introduce Beta-Binomial and Beta-Geometric conjugate analyses for estimating rate and step parameters for the mutation models presented here, which require only summations and multiplications. We proved mathematically that the parameters can be estimated independently. We show the importance of reporting the variability of the parameters and not only a point estimate. The parameters can be easily incorporated into statistical models, and updated sequentially as more data becomes available. We recommend fuller publication of data to enable the development and evaluation of a wider range of mutation models.

Tuberculous Bronchopleural Fistula: A Rare and Life-Threatening Disease.

Tuberculous bronchopleural fistula (BPF) is a rare and potentially life-threatening complication of pulmonary tuberculosis, in which abnormal connections form between the bronchial tree and the pleural space. These abnormal connections allow air and secretions to pass from the lungs into the pleural space, causing a range of symptoms from benign cough to acute tension pneumothorax. The management of tuberculous BPF requires an individualized approach based on the patient's condition and response to treatment. Anti-tuberculosis therapy is essential for controlling the active tuberculosis infections. Intercostal drainage and suction are also commonly used to drain air and fluid from the pleural space, providing relief from the symptoms. For some patients, more invasive surgeries, such as decortication, thoracoplasty or pleuropneumonectomy are required to definitively close the fistula when medical management alone is insufficient. Herein, we describe a rare case of tuberculous BPF in a young adult female, who was treated with anti-tuberculosis medications and open thoracotomy.

Tumor and Nodal Disease Growth Rates in Patients with Oropharyngeal Squamous Cell Carcinoma.

Though specific growth rate (SGR) has potential prognostic value for oropharyngeal squamous cell carcinoma (OPSCC), there is sparse literature defining these rates. Our aims were to establish the SGRs of primary tumors (PTs) and lymph nodes (LNs) in OPSCC and to correlate SGR with oncologic outcome. A pilot study was designed with a retrospective analysis examining 54 patients from the University of California, Davis with OPSCC (diagnosed 2012-2019). Radiation oncology software and pretreatment serial CT scans were used to measure PT and LN volumes to calculate SGR and doubling time (DT). The mean PT-SGR was 1.2 ± 2.2%/day and the mean LN-SGR was 1.6 ± 1.9%/day. There was no statistically significant difference between slow-growing and fast-growing cohorts in terms of age, gender, smoking status, tumor subsite, HPV status (as determined with p16 staining), initial volume, or overall stage. SGR had no impact on 2-year overall survival, disease-free survival, or disease-specific survival. We found the average daily growth rates for OPSCC to be 1.2%/day and 1.6%/day. Our findings suggest PT- and LN-SGR are independent factors, not heavily influenced by known biomarkers and patient characteristics, without a statistical impact on prognosis. This information has value in patient counseling regarding tumor growth and in providing patients worried about fast-growing tumors the appropriate reassurance.

Identification of bullets fired from air guns using machine and deep learning methods.

Ballistics (the linkage of bullets and cartridge cases to weapons) is a common type of evidence encountered in criminal cases around the world. The interest lies in determining whether two bullets were fired using the same firearm. This paper proposes an automated method to classify bullets from surface topography and Land Engraved Area (LEA) images of the fired pellets using machine and deep learning methods. The curvature of the surface topography was removed using loess fit and features were extracted using Empirical Mode Decomposition (EMD) followed by various entropy measures. The informative features were identified using minimum Redundancy Maximum Relevance (mRMR), finally the classification was performed using Support Vector Machines (SVM), Decision Tree (DT) and Random Forest (RF) classifiers. The results revealed a good predictive performance. In addition, the deep learning model DenseNet121 was used to classify the LEA images. DenseNet121 provided a higher predictive performance than SVM, DT and RF classifiers. Moreover, the Grad-CAM technique was used to visualise the discriminative regions in the LEA images. These results suggest that the proposed deep learning method can be used to expedite the linkage of projectiles to firearms and assist in ballistic examinations. In this work, the bullets that were compared were air pellets fired from both air rifles and a high velocity air pistol. Air guns were used to collect the data because they were more accessible than other firearms and could be used as a proxy, delivering comparable LEAs. The methods developed here can be used as a proof-of-concept and are easily expandable to bullet and cartridge case identification from any weapon.

The efficacy of two commercially available devices for airway foreign body relief: A cadaver study.

Objective: Foreign body aspiration events are frequent in young children and in the geriatric population. They may result in several complications such as hypoxia, edema, cardiac arrest, and death. Recently, two commercially available devices, the LifeVac and DeChoker, have entered the market with the claim of relieving foreign body aspiration. Both devices are portable, nonpowered, suction devices that are being considered for use in large public spaces such as schools, airports, and malls despite previous studies detailing variable efficacy. In this study, we aim to contribute further data on the safety and efficacy of these devices through a fresh cadaver model. Methods: Commonly aspirated foods of three different sizes (saltines, grapes, and cashews) were placed at the level of the true vocal folds in a fresh cadaver. Three participants performed two trials with each food and device. Device use was performed to manufacturer specifications. Results: The DeChoker resulted in gross injury to the tongue and failed to remove the obstruction in all trials. LifeVac was successful in removing the barium-moistened saltines but failed to remove all other foreign bodies. Both devices applied significant pressure to the tongue. Conclusion: With the exception of the LifeVac removing saltine crackers, all trials were entirely unsuccessful in relieving foreign body aspiration. Additionally, both devices may cause significant pressure and injury to the oral cavity in a clinical setting. We conclude bystanders should continue to follow International Liaison Committee on Resuscitation's guidelines on resuscitation to aid with relieving foreign body aspiration. Level of Evidence: 4.

A ground truth data set of gas chromatography mass spectrometry (GCMS) analysed synthesised methylenedioxymethylamphetamine (MDMA).

Controlled drug samples are normally chemically analysed to determine their identity and in some cases, their purity. There are also circumstances where a more broad chemical characterisation of drug samples may also be required. This involves investigating the chemical impurities that may be present in a drug sample as a consequence of their synthesis. This impurity or drug profiling can be derived from drugs which are synthesised chemically or extracted from plant materials and then modified chemically. Impurity profiling can provide some insight into the synthetic methods used and sometimes the starting chemicals used. We report on the data generated from repetitive ( n = 18 ) synthesis of ecstasy (methylenedioxymethylamphetamine or MDMA) made by three different synthetic methods. Each data sample is expressed in multiple formats. This article uses the template for publishing GCMS data provided in Miller et al.(2022)[1]. The template provides a robust and systematic approach to organise GCMS data that is both useful for practitioners and amenable for automated data manipulation by data scientists.

Predictors of Health Care Utilization Following Major Head and Neck Oncologic Surgery in Older Patients.

OBJECTIVE: To identify patient factors in older patients associated with making posttreatment visits in the first year after major head and neck oncologic surgery. STUDY DESIGN: Retrospective cohort study. SETTING: Academic institution. METHODS: Patients aged ≥60 years who underwent a neck dissection with or without a free flap reconstruction were retrospectively analyzed. Data collected included patient demographics, comorbidities, social variables, perioperative course, and clinical visits. RESULTS: Within a 1-year postoperative period, the 181 patients in our cohort had a mean ± SD 6.37 ± 3.6 postoperative clinic visits; 70% attended at least 4 visits. Multivariable regression analysis showed a significant association with distance closer to the hospital (P = .013): for every 10-mile increase in distance, the number of visits decreased by 0.15 (SE = 0.06). Additionally, receiving adjuvant radiation therapy (P = .0096) demonstrated significant associations: when compared with no adjuvant therapy, radiation therapy had on average 1.5 (SE = 0.56) more visits, and chemoradiation had 0.04 (SE = 0.73) more visits. CONCLUSION: Older patients who undergo major head and neck oncology surgery are more likely to attend posttreatment visits in the 1 year following surgery if they are discharged home rather than to a skilled nursing facility, live closer to the hospital, and undergo adjuvant radiation therapy.

Utility of Screening for Obstructive Sleep Apnea with the Pediatric Sleep Questionnaire (PSQ) in Children with Craniofacial Anomalies.

OBJECTIVE: To determine the accuracy of the Pediatric Sleep Questionnaire (PSQ) as a screening tool for obstructive sleep apnea in children with craniofacial anomalies. DESIGN: Retrospective cohort study. SETTING: Multidisciplinary cleft and craniofacial clinic at a tertiary care center. PATIENTS: Children with craniofacial anomalies 2 to ≤18 years of age who both completed a PSQ screen and underwent polysomnography (PSG) without interval surgery. MAIN OUTCOME MEASURES: Sensitivity and specificity of the PSQ in detecting an obstructive apnea-hypopnea index (AHI) ≥ 5 events/hour. RESULTS: Fifty children met study criteria, with 66% (n = 33) having an associated syndrome. Mean patient age at time of PSQ was 9.6 + 4.0 years. Overall, 33 (64%) screened positive on the PSQ, while 20 (40%) had an AHI ≥ 5. The sensitivity and specificity for identifying AHI ≥ 5 was 70% and 40%, respectively. With subgroup analysis, the sensitivity and specificity were higher (100% and 50%) in children with non-syndromic palatal clefting but lower (65% and 31%) in children with a syndrome or chromosomal anomaly. There was no correlation detected between PSQ score and AHI severity (p = 0.25). The mean obstructive AHI in the study population was 10.1 ± 22.7 despite 44% (n = 22) undergoing prior adenotonsillectomy. CONCLUSIONS: The PSQ was less sensitive and specific in detecting an AHI ≥ 5 in children with craniofacial anomalies than in a general population, and particularly poor in for children with syndrome-associated craniofacial conditions. Given the high prevalence of OSA in this patient population, a craniofacial-specific validated screening tool would be beneficial.

Case report: Surgical resection of a retro-hepatic leiomyosarcoma involving atrial reconstruction, cardiopulmonary bypass, ex vivo tumor resection, and liver re-implantation.

Introduction: Leiomyosarcomas (LMS) involving the inferior vena cava (IVC) is a clinically rare entity, accounting for approximately 0.5% of all adult sarcomas. Case presentation: A 67-year-old male presented to the emergency department with mild back and lower abdominal pain. During the workup, a computed tomography scan without contrast showed an area of decreased attenuation within the liver adjacent to the intrahepatic IVC. Magnetic resonance imaging confirmed the involvement of the retro-hepatic IVC; biopsy confirmed the diagnosis of LMS. Given the location of the involvement of the retro-hepatic IVC, liver explantation was deemed necessary for adequate tumor resection. The superior extension of the tumor toward the heart necessitated Cardio-Pulmonary (CPB). The patient successfully underwent a complex surgical procedure involving liver explantation with ex vivo back-table resection of the retro-hepatic LMS, replacement of the retro-hepatic vena cava with a ringed Gore-Tex graft, liver re-implantation, and hepatic vein-atrial reconstruction under cardiopulmonary bypass. There were no intraoperative or post-op complications. Discussion: The role of vascular reconstruction of the IVC varies depending on the level and extent of the tumor, with options ranging from primary repair, ligation, or reconstruction dictated. Surgical resection with negative margins remains the treatment of choice due to the lack of efficacy of adjuvant therapies. Importantly, liver explantation offers a chance for complete surgical resection and reconstruction. Similarly, the complex nature of the tumor necessitated a pioneering approach involving direct hepato-atrial venous anastomosis. Conclusion: To the best of our knowledge, this is the first reported case in which the hepatic veins were anastomosed directly to the right atrium while also replacing the native vena cava with a separate graft.

A UK-based ground truth data set of GCMS analysed ignitable liquid samples - a template for making chromatographic data accessible as an open source data set.

Fire debris is often recovered as part of a fire scene investigation to determine whether an ignitable liquid might be present which may be evidence of a deliberate fire. The analysis of fire debris produces chromatograms that a forensic chemist uses to determine whether or not an ignitable liquid may be present. Currently there are very few publicly available data sets that can be used for training and statistical modelling in this area. The data set in this paper has been prepared with these two applications in mind and covers a wide range of ignitable liquids available in the UK. We created a data set of 35 ignitable liquids including petrol (gasoline), light, medium and heavy petroleum distillates (i.e diesel) from several retailers. Each ignitable liquid was systematically evaporated to produce six additional samples. Each sample was repetitively analysed to provide an overall data set of 751 analytical outputs (including chromatograms). Each data sample is expressed in multiple formats and the metadata containing any data used in the production of the samples is included. The folder and file names are designed to avoid misplacements and to manipulate folders and files systematically using computer code.

Clinical Characteristics and Post-Operative Outcomes in Children with Very Severe Obstructive Sleep Apnea.

Available information on clinical characteristics and post-operative outcomes in children with very severe obstructive sleep apnea (OSA) is limited. Our study evaluates the clinical features and polysomnographic (PSG) variables that predict post-operative outcomes in children with an obstructive apneal hypopnea index (AHI) of more than 25 events/hr. In this study from a single tertiary care center, we performed a retrospective chart review of patients with an AHI > 25/hr, who underwent tonsillectomy and adenoidectomy (T&A) between January 2016 and September 2021. In total, 50 children were included in the study: 26.0% (13/50) of children experienced post-operative respiratory events and four children needed intubation and ventilator support. Compared with children without respiratory events, children requiring post-operative respiratory interventions were younger (4.4 ± 5.2 vs. 8.0 ± 5.2 years; p = 0.04), had higher pre-operative AHI (73.6 ± 27.4 vs. 44.8 ± 24.9; p < 0.01), lower oxygen nadirs (70.0 ± 13.0% vs. 83.0 ± 7.0%; p < 0.01), and had lower body metabolic index Z-scores (−0.51 ± 2.1 vs. 0.66 ± 1.5; p < 0.04). Moderate to severe residual OSA was identified in 70% (24/34) of children with available post-operative PSG; younger children had better PSG outcomes. Our study shows that post-operative respiratory events are frequent in children with very severe OSA, particularly with an AHI > 40/h, younger children (<2 years of age), lower oxygen saturation (SpO2), and poor nutritional status, necessitating close monitoring.

Total laryngectomy negatively impacts sinonasal and olfactory-specific quality of life.

PURPOSE: The purpose of this study is to characterize deficits in olfactory-specific and sinonasal-specific QoL after total laryngectomy (TL) with validated patient reported outcome measures. METHODS: Thirty patients who had a TL were prospectively enrolled. Patient demographics, as well as scores from the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and the Sino-nasal Outcome Test-22 (SNOT-22) were collected. Univariate analysis was performed to assess associations between patient characteristics and QoL scores. RESULTS: The average QOD-NS score was 37.9 ± 11.4 (<38.5 is considered abnormal) and average SNOT-22 score was 32.0 ± 3.8 (>20 indicates a moderate/severe impact on QoL). The abnormal QOD-NS group had a greater percentage of former smokers compared to the normal group (77.8% vs. 58.1%; P = 0.56) and more median days from surgery compared to the normal group (904 vs. 477 days; P = 0.24). CONCLUSIONS: Olfactory dysfunction associated with TL results in blunting of olfactory-specific QoL.

Current Trends in Precision Medicine and Next-Generation Sequencing in Head and Neck Cancer.

OPINION STATEMENT: As the field of oncology enters the era of precision medicine and targeted therapies, we have come to realize that there may be no single "magic bullet" for patients with head and neck cancer. While immune check point inhibitors and some targeted therapeutics have shown great promise in improving oncologic outcomes, the current standard of care in most patients with head and neck squamous cell carcinoma (HNSCC) remains a combination of surgery, radiation, and/or cytotoxic chemotherapy. Nevertheless, advances in precision medicine, next-generation sequencing (NGS), and targeted therapies have a potential future in the treatment of HNSCC. These roles include increased patient treatment stratification based on predictive biomarkers or targetable mutations and novel combinatorial regimens with existing HNSCC treatments. There remain challenges to precision medicine and NGS in HNSCC, including intertumor and intratumor heterogeneity, challenging targets, and need for further trials validating the utility of NGS and precision medicine. Additionally, there is a need for evidence-based practice guidelines to assist clinicians on how to appropriately incorporate NGS in care for HNSCC. In this review, we describe the current state of precision medicine and NGS in HNSCC and opportunities for future advances in this challenging but important field.

Breast and thyroid cancer: A multicenter study with Accrual to Clinical Trials Network.

OBJECTIVE: To investigate a possible link between breast and thyroid cancer. METHODS: A multicenter retrospective review of patients in the electronic medical records of six Accrual to Clinical Trial (ACT) institutions with both breast cancer and thyroid carcinoma. Each center queried its data using a predefined data dictionary. Information on thyroid and breast cancer included dates of diagnosis, histology, and patient demographics. RESULTS: A random-effects model was used. There were 4.24 million women's records screened, 44 605 with breast cancer and 11 846 with thyroid cancer. The relative risks observed at each institution ranged from 0.49 to 13.47. The combined risk ratio (RR) estimate was 1.77 (95% confidence interval: 0.50-5.18). CONCLUSION: There was no association between the risk of developing thyroid cancer and being a breast cancer survivor compared to no history of breast cancer, but the range of relative risks among the participating institutions was wide. Our findings warrant further study of more institutions with larger sample size. Additionally, further analysis of the significance of regional RR differences may be enlightening.

Bereavement Practices Among Head and Neck Cancer Surgeons.

OBJECTIVES: Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons. METHODS: A 20-item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow-up. RESULTS: There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions (P ≤ .001) was associated with more frequent surgeon bereavement follow-up with the family of deceased patients. CONCLUSION: There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow-up. Having higher empathy was predictive of higher engagement. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1971-1975, 2022.

Reusability in visible light of titanate nanotubes for the removal of organic pollutants: role of calcination temperature.

Titanate nanotubes (NTs) were synthesised by the hydrothermal method and later calcined at temperatures between 100-500°C. The calcined NTs were characterised and evaluated in the physicochemical adsorption of the safranin dye and photocatalytic degradation of caffeine. The materials calcined at low temperatures displayed a tubular structure and the H2Ti3O7 crystalline phase, which was transformed into anatase nanoparticles at 400°C. The NTs treated at 100°C showed the highest adsorption capacity (94%). Safranin was adsorbed through an ion-exchange mechanism, following the Langmuir isotherm and a pseudo-second-order kinetic model. While NTs calcined at lower temperatures were better for adsorption, the photocatalytic degradation of caffeine increased in samples calcined at higher temperatures with a maximum removal of 72%. The photocatalytic behaviour of the NT samples confirmed that the crystalline anatase structure in conjunction with structural OH groups enhanced the photocatalytic activity. The addition of isopropanol as a scavenger confirmed the important role played by the •OH radicals in the photocatalytic process. NTs calcined at 300°C were efficient for both adsorption and photocatalytic processes. Due to its efficiency, this sample was reused after dye adsorption for the photocatalytic degradation of caffeine under visible light due to its enhanced absorbance in the visible region. This research work shows the potential of NTs for wastewater purification.

Influence of Bacillus safensis and Bacillus pumilus on the electrochemical behavior of 2024-T3 aluminum alloy.

In this work, electrochemical techniques were employed to evaluate the contribution to the corrosion and corrosion inhibition of 2024-T3 aluminum alloy by two Gram-positive bacteria. In addition, polarized impedance was used to determine the microbial effect on the cathodic and anodic reactions. These microorganisms were collected from a tropical environment due to the favorable bacterial growth of this kind of climate. The alloy was exposed to the sterile medium and inoculated for up to 12 days evaluating the microbiological and electrochemical behavior. The results by linear scanning voltammetry showed that the B. safensis and B. pumilus caused a dual effect of increase and decrease currents, and through electrochemical impedance spectroscopy, showed in some cases, inductive loop, which could be associated with local corrosion and another case, an increasing impedance could be related to protection. In addition, a morphological characterization was performed by scanning electron microscopy before and after exposure, showing an increase in copper precipitation in the vicinity of the intermetallic phases by bacteria, attributed to local corrosion, but, in general, a significant effect of damages was not observed.

Development of the National Otolaryngology Interest Group: Conception to Implementation.

Otolaryngology is a small and highly sought-after surgical subspecialty with sparse residency positions, making it competitive to match into. Allopathic (MD) students without home otolaryngology residency programs, osteopathic (DO) medical students, and underrepresented minorities have historically faced additional challenges in matching into otolaryngology. These specific populations generally experience limited opportunities in establishing mentors, engaging in scholarly activity, and gaining early exposure to clinical settings. Even though the American Osteopathic Association and the Accreditation Council for Graduate Medical Education merger was in part established to create equity among applicants, there remains a substantial disparity among the match rates of medical students of various educational and cultural backgrounds. The National Otolaryngology Interest Group is a student-led interest group created to provide all medical students, especially those facing barriers, with the resources needed to best prepare for matching into an otolaryngology residency program and ultimately a career in otolaryngology.

Calculation of likelihood ratios for inference of biological sex from human skeletal remains.

It is common in forensic anthropology to draw inferences (e.g., inferences with respect to biological sex of human remains) using statistical models applied to anthropometric data. Commonly used models can output posterior probabilities, but a threshold is usually applied in order to obtain a classification. In the forensic-anthropology literature, there is some unease with this "fall-off-the-cliff" approach. Proposals have been made to exclude results that fall within a "zone of uncertainty", e.g., if the posterior probability for "male" is greater than 0.95 then the remains are classified as male, and if the posterior probability for "male" is less than 0.05 then the remains are classified as female, but if the posterior probability for "male" is between 0.05 and 0.95 the remains are not classified as either male or female. In the present paper, we propose what we believe is a simpler solution that is in line with interpretation of evidence in other branches of forensic science: implementation of the likelihood-ratio framework using relevant data, quantitative measurements, and statistical models. Statistical models that can implement this approach are already widely used in forensic anthropology. All that is required are minor modifications in the way those models are used and a change in the way practitioners and researchers think about the meaning of the output of those models. We explain how to calculate likelihood ratios using osteometric data and linear discriminant analysis, quadratic discriminant analysis, and logistic regression models. We also explain how to empirically validate likelihood-ratio models.