Academic literature on the topic '14 point Goudy Old Style'

To validate survival of Lactobacillus casei strain Shirota (LcS) during passage through the gastrointestinal tract of healthy Singaporean young adults, 21 participants (18-25 years old) were asked to consume a 100 ml of fermented milk drink containing 1.0×108 cfu/ml of LcS daily for 14 days, and to maintain their dietary habit and life style. During and at the end of the ingestion period, both culture method (identity confirmed by ELISA) and 16s rRNA sequencing results revealed that viable LcS (7.27 and 7.64 log10 cfu/g of faeces at the ingestion period Day 7 and Day 14, respectively) and Lactobacillus could be recovered from the faeces of all the subjects. The viable LcS count from male and female were comparable for each time point. Before consumption (baseline) and 14 days after cessation of consumption of the fermented milk, LcS was not detected in most of the subjects. In this study condition, the composition of the major gut microbiota (>0.1% in relative abundance of genus) and characteristics of defaecation such as stool consistency and frequency of defecation did not change throughout the study before and after ingestion of LcS. LcS was able to survive passage through the gastrointestinal tract of Singapore adults without sustainable colonisation, but the effect of LcS on microbiota modulation, stool consistency and frequency was not observed under this study condition.

AimsIdentifying factors that contribute to mental health difficulties in young people as early in life as possible are needed to inform prevention strategies. One area of interest is attachment. Although existing research has suggested an association between insecure attachment styles and mental health difficulties, these studies often have small sample sizes, use cross-sectional designs, and measure attachment as a discrete variable at a single point or use romantic relationship attachment as a proxy for childhood attachment. It is also unclear whether these associations persist into late adolescence. In this large prospective study we aimed to determine whether an insecure attachment style measured at repeated points in early childhood, is associated with depression and self-harm at 18 years.MethodWe used data from the Avon Longitudinal Study of Parents and Children cohort. Mothers completed attachment related questionnaires when their child was 18, 30, and 42 months old. Offspring depression and lifetime self-harm was assessed at 18 years in clinic using the Clinical Interview Schedule-Revised. Attachment was derived as a continuous latent variable in a structural equation modelling framework. Logistic regression was performed on participants with complete attachment data (n = 7032) to examine the association between attachment style and depression and self-harm, with adjustment for potential confounders. Differential dropout was accounted for using multiple imputation.ResultWe found some evidence for an association between a more insecure attachment style in childhood, and a diagnosis of depression and life-time self-harm at age 18. In the fully adjusted imputed model, a one standard deviation increase in insecure attachment was associated with a 13% increase in the odds of depression (OR = 1.13; 95%CI = 1.00 to 1.27) and a 14% increase in the odds of self-harm at age 18 (OR = 1.14; 95%CI = 1.02 to 1.25), for children who had more insecure attachment in early childhood, compared with children who had more secure attachment.ConclusionThis is the largest longitudinal study to examine the prospective association between childhood attachment and depression and self-harm in late adolescence. Our findings strengthen the evidence suggesting that a childhood insecure attachment style is associated with mental health difficulties in late adolescence. Policies and interventions to support parenting behaviours that foster the development of secure attachment styles, or attachment-based therapies to improve attachment quality, could help reduce depression and self-harm in adolescence/young adulthood.Philippa Clery is supported by the Elizabeth Blackwell Institute for Health Research at the University of Bristol and the Wellcome Trust Institutional Strategic Support Fund.

Subject actuality. The article highlights the evolution of the compositional style of the Hungarian composer, taking into account the performance component of Bartok as a pianist. Based on existing musicological sources (works by A. Alekseev, B. Sabolcha, S. Sigitov, J. Uyfalushi, I. Martynov, I. Nestev, A. Malinkovskaya) the historical periodization of the general interest in Bartok’s work is indicated. Despite the study of many aspects of his creative activity, the performance of B. Bartok still remains without special analysis. Therefore, the process of studying the work of B. Bartok today can not be considered completed. The issues of interaction between the compositional and performance style of B. Bartok, modern interpretations of his works remain opened. The Ukrainian listener is familiar with a limited range of B. Bartok’s works, so the emphasis on the artist’s performance serves as an additional stimulus for the actualization of his art in our time. The main presentation of the material. The evolution of B. Bartok’s piano style was identified as a problem by L. Gakkel through the constituent parameters of the piano style: 1) the “realistic-non-pedal” sound image of the piano; 2) coloristic shock-noise method of sound construction; 3) textured accentuated tone as a tonal-harmonic ground. Indeed, many works of the composer testify to this interpretation of the piano: “Two elegies op. 8 / b, Burlesque three pieces op. 8c, Suite op. 14, Etudes op. 18, Sonata; three concertos for piano and orchestra. However, there are a number of works written quite traditionally, in the classical key. In these works B. Bartok uses the coloristic possibilities of the piano quite avariciously (wide range of registers, pedal effects), a striking example is the “Romanian folk dances” op. 8-a). Milestones of the piano evolution of the artist’s style are marked: Rhapsody, cycles “Romanian folk dances”. Etudes op. 18 – a sample of expressionist aesthetics, extremely complex in pianistic terms. They use extreme technical difficulties that require maximum arm stretching and great physical strength.Most of Bartok’s piano works were written in the first two creation periods – early and experimental. The composer’s attention was focused on three genre areas: folklore, pedagogics, innovation. The communicative semantics of these spheres, of course, influenced the composer’s decisions in the formative field, texture, piano technique, the level of virtuosity. The regularities are traced: B. Bartok’s “commitment” to primary (song and dance) and romantic genres (elegy, rhapsody, rich people), program cyclicity; constant interest in creating a repertoire for children, which solves two tasks at once: the promotion of folk music and the children involvement into a new musical language. Note as a contradiction the fact that the analysis of the works of B. Bartok, created in the first and second period, does not fully confirm the version of L. Gakkel, about a radicalistic change in the sound image of the piano. Probably, in B. Bartok’s work the new did not exclude the old one. The basic quality of B. Bartok’s piano style is its national characteristic, which is shrouded in the resources of the latest technique of musical composition. Conclusions. B. Bartok-pianist by genotype belongs to the Liszt’s branch of European pianism. The Liszt’s tradition is a combination of classical-romantic performing principles, which is especially evident in the works of disciples and followers of F. Busoni, K. Martinsen, K. Arrau, and G. Gould. In general, the evolution of B. Bartok’s piano style can be seen as a movement from the romantic – through folklore – to the neoclassical tradition, which is manifested in the change of musical-linguistic resources (rhythm, harmony, features of musical form, texture, melody). As a result, also the sound image of the piano was being changed. Auditory analysis of B. Bartok’s performing style allowed us to conclude that, unlike many pianists of the romantic tradition, B. Bartok uses pedal effects very avariciously, preferring clear and precise pronunciation (utterance) of all elements of the texture. We state the «imposition» of the classical tradition, which originates from harpsichordists, and new trends associated with the percussive understanding of the piano. From the point of view of the temporal organization of the musical form, his works are distinguished by metrical variability and polyrhythm; rhythmic discrepancy of textured layers; extensive use of repetition techniques and ostinato techniques. The foundations of Bartok’s mode-harmonic mentality (reliance on ancient modes of folk music; mode variability in the conditions of chromatic tonality) determine the difficulties of mastering the «intonation dictionary» of his piano works, and in general the technical equipment of the texture. Thus, Bela Bartok’s piano writing style is an expression of the artist’s innovative thinking, in which the performing component of his own abilities played a key role.

Case: A shy, depressed 30 year old male discussed his frequent ego-syntonic indoor prostitution consumption in small peer groups. Several distinctive non-sexual functions of this paid sex habit were identified.Design and method: The patient had 40 hourly psychiatric sessions in the private practice setting over 14 months. The Arizona Sexual Experience Scale was applied to compare the subjective appraisal of both paid sex and sex in a relationship. The informal Social Atom elucidates social preferences and the Operationalized Psychodynamic Diagnostic-procedure was applied to describe a dominant relationship pattern.Results: The paid sex consumption functioned as a proud male life style choice to reinforce the patients fragile identity. The effect on self esteem was a release similar to his favorite past-time of kick-boxing. With paid sex asserted as a group ritual, it was practiced even with frequent erectile dysfunction and when sex with a stable romantic partner was more enjoyable and satisfying. The therapeutic attitude of the female psychiatrist, with her own ethical values, is put in to context with two opposing theories about prostitution: the ‘Sex-Work-model’ and the ‘Oppression-model’. The therapist’s reaction to the patients’ information was seen as a starting point to understanding the intrapsychic function of paid sex as a coping mechanism against depressive feelings.Conclusions: Exploring and understanding prostitution consumption patterns in young men can benefit the treatment of psychiatric disorders in the private practice setting. It is the psychiatrists task to investigate the patients hidden motives behind paid sex use to help patients achieve a greater inner and relational freedom.

The presented article is a study dealing with the role and characteristics of youth political online activism in modern Russia. The relevance, main aspects and criteria of the effectiveness of youth policy in the field of communication are considered. There are following basic steps suggested: to improve the effectiveness of such communication associated with a clear articulation of the needs of various groups of people through competent socio-political monitoring with independent quantitative and qualitative research. Building a constructive dialogue to promote positive, constructive and conventional activation of the political behavior of youth groups; work to overcome the apolitical and absentee tendencies of young people, as well as the expansion of the political and managerial concept of Electronic state not only formally, but also substantively, are among these steps. Further, the study analyzes the structure of protest behavior, distinguishes several levels of protest consideration, each of which has its own specifics and features for the analysis. This is the level of deep reasons and specific motive for the emergence of a public protest; the level of the dominant style of public manifestation of any protest moods, which has its basis in the predominantly psycho-emotional sphere; and, finally, the level of peculiarities of political behavior with very specific tactics and strategies of protest behavior. It draws attention to the fact that youth as a social group is heterogeneous and it seems appropriate to divide its age structure into three stages (from 14 to 20, years old, from 21 to 24 years old, and from 25 to 30 years old). The final part of the article deals with the models of virtual protest behavior. The model of a complete unstructured protest is highlighted; activity-target co-optation; proactive-loyalist; adaptation and frustration; politicized civil and local models. The results obtained to date make it possible to record the essential features of online mobilization, both based on the features of the functioning of the virtual space, and from the point of view of the main object of research: youth and the specifics of its identity and algorithms of political behavior. All this allows us to speak about the relevance of the constructed classification models for various mobilization mechanisms, which determines the practical significance of the study.

AbstractChildren's behavior problems may stem from ineffective cortical mechanisms for regulating negative emotions, and the success of interventions may depend on their impact on such mechanisms. We examined neurophysiological markers associated with emotion regulation in children comorbid for externalizing and internalizing problems before and after treatment. We hypothesized that treatment success would correspond with reduced ventral prefrontal activation, and increased dorsomedial prefrontal activation, at the time point of an event-related potential (ERP) associated with inhibitory control. Twenty-seven 8- to 12-year-old children (with usable data) were tested before and after a 14-week community-based treatment program and assessed as to improvement status. Fifteen 8- to 12-year-olds from the normal population (with usable data) were tested over the same interval. All children completed an emotion-induction go/no-go task while fitted with a 128-channel electrode net at each test session. ERP amplitudes, and estimates of cortical activation in prefrontal regions of interest, were measured at the peak of the “inhibitory” N2 and compared between improvers, nonimprovers, and nonclinical children. ERP amplitudes showed no group differences. However, improvers showed an overall reduction in ventral prefrontal activation from pretreatment to posttreatment, bringing them in line with nonclinical children, whereas ventral activation remained high for nonimprovers. Both improvers and nonimprovers showed high dorsal activation relative to nonclinical children. Supplementary analyses indicated that only ventral prefrontal regions, and only within the N2 time window, showed decreased activity from pre- to posttreatment, suggesting changes in regulatory processes rather than in overall emotional arousal. These cortically mediated changes may permit a reduction in the overengaged, rigid style of emotion regulation characteristic of children with behavior problems.

A group of mounds near Kvindvad in Western Jutland The group of mounds in question is situated near Kvindvad in Western Jutland, a little more than ten kilometres from the town of Herning (Figs. 1-3). It is the only known group of mounds from the late Neolithic Age in Denmark. It consists of four mounds situated close together on the western side of a ridge. All the graves are dagger graves, and two of them are tiered graves.In mound no.1 (Figs. 4-6), a rectangular east-west orientated tiered grave was identified. It had been dug 0.6 metres into the subsoil and had a filling of earth and stones. The grave structure was covered by a stone paving. Grave A, which contained a flint dagger of type IA, was dug 0.4 metres into the subsoil. Grave B, also containing a flint dagger of type IA, was found at the bottom of grave A. This grave had faint traces of a wooden coffin.Mound 2 (Figs. 7-8) had been built over just one burial. This grave had a northeast-southwest orientation and was filled with stones. Colouring of the earth showed that the grave had contained a wooden coffin. The grave contained a flint for striking fire, recycled from a flint dagger of type Ix.Mound 3 (Figs. 9-10) had a diameter of 8 to 10 metres and a height of 0.25 to 0.30 metres. It had been constructed above a deep dagger grave with the faint remains of a wooden coffin. The grave was filled in with earth and stones. In the southwestern corner of the grave, a small heap of cremated bones and a pottery sherd were found a little above the bottom of the grave.Mound 4 (Figs. 11-15) had a diameter of 10 metres and a height of 0.25 to 3.0 metres. It had been constructed over a stone paving, which covered a tiered grave. The grave had a northwest-southeast orientation and was filled with stones. At a depth of 0.4 metres were the faint remains of a wooden coffin (grave A). It contained a flint dagger of type IA/B and a slate whetstone pendant. At the bottom of the grave (grave B) was a carefully made stone paving, on top of which yet another coffin had been resting. Two arrowheads with a concave base belong to this grave. The construction of the mounds corresponds to the older mounds known from the single grave culture. All four mounds contained so-called “deep dagger graves,” i.e. graves dug at least 1 metre into the subsoil. Almost all deep dagger graves are found in Northern and Central Jutland, with a marked concentration in Northwestern Jutland. Almost all deep dagger graves date from the late Neolithic Age A, with just a few dating from the late Neolithic Age B.The structures in two of the mounds are so-called tiered graves, which are characterized by having two burials in the same hole, one on top of the other. This is a very special burial custom, which occurs sporadically in the early and the late Neolithic Age across large parts of North and Central Europe.As is the case in the mounds at Kvindvad (Figs. 16-18), flint daggers are in general the most common grave goods in late Neolithic male graves. Slate pendants, on the other hand, occur only sporadically. The arrowheads with a concave base probably represent yet another weapon, i.e. the bow and arrow. These arrowheads are defined by a length not exceeding 8 cm, and by their concave base. This type occurs at the beginning of the late Neolithic Age and continues until period V of the Bronze Age (2400-600BC). So far, no one has succeeded in creating a typological and chronological classification of them. Generally, the arrows have a length of 2 to 6 cm and a thickness of 5 mm.Arrowheads with a concave base often occur in graves (some may even be the cause of death). Their numbers vary from one to twelve (Fig. 21). They occur in at least 57 late Neolithic closed graves. In 31 cases they occur together with flint daggers of type I, in seven cases in combination with daggers of type II.The burial custom of sending the dead to the grave with a bow and arrows thus seems to be primarily from the late Neolithic period A, but it continues into period B. In the later periods, the arrows occur more sporadically as grave goods. Graves containing arrows with a concave base show a clear concentration in Northern Jutland, where they occur mainly in the area surrounding the western Limfjord (Figs. 19-20).Ebbe Lomborg (1973 – cf. 1959 and 1968) divided the country into two geographic zones. Zone I comprised Northern Jutland and the islands, zone II comprised Southern Jutland and Schleswig-Holstein. The boundary between the two areas ran across Central Jutland.The grave types and burial customs described here occur across this boundary and in both zones. Moreover, neither the distribution nor the use of late Neolithic jewellery provides any evidence to support the traditional zone division.The same applies to grave forms and burial customs.The most frequently found burial custom in the late Neolithic Age is the burial of the dead in the old megalith graves. This burial custom is known from all over the country and throughout the age.Stone cists can be divided into at least two different types, which can be separated chronologically and geographically: 1. Small, north-south oriented stone cists (“stenkister” in Danish), which occur only in Northern Jutland during the early part of the late Neolithic Age. They probably originate from the early Neolithic stone cists, and were also built during the late Neolithic Age. 2. The so-called “Zealandic stone cists”, which are known only from Eastern Denmark, with a marked concentration in Northern Zealand. Almost all date from period C of the late Neolithic Age. These stone cists should be regarded as part of a larger context including Western Sweden and other areas of the Scandinavian Peninsula. They are connected to the late Western European megalith tradition, which became widespread in Western Sweden primarily during the end of the late Neolithic Age, but which also involved nearby parts of Denmark. It is noteworthy that these Western European contacts passed directly from Western Europe to Western Sweden – for the most part without passing through Denmark.Late Neolithic burial mounds are almost exclusively a Jutland phenomenon, although primary mound graves are rare. Among these, the deep dagger graves have an important position, as shown above.Among the “secondary” mound graves, the so-called “upper graves” are the most frequent form. In these, the coffin is surrounded by stone packing and is placed in the upper part of an old burial mound, usually an old single grave mound. The type is therefore almost exclusively found in the area where single grave mounds occur.Flat burials occur sporadically all over the country, with a characteristic concentration in Eastern Zealand.Late Neolithic cremation graves occur only randomly in Northern Jutland, and in an early part of the age.As neither the grave types nor the burial customs support Ebbe Lomborg’s zone grouping, this has to be rejected as regards the late Neolithic Age. As regards the early Bronze Age, the division of Denmark into zones has been justified by the fact that Southern Jutland had connections with the Sögel-Wohlde-circle and the western mound grave culture, whereas the rest of the country had direct contacts to Central Europe. The regional differences known from Northern Germany, as recognized from the bronze objects, thus applied in Denmark as well during the Bronze Age. In relation to the period prior to this they must be rejected.During the late Neolithic Age, Denmark consisted of small geographical ­areas, each with its own characteristics, just as was the case during the early and middle Neolithic Age. By the beginning of the late Neolithic Age, the area surrounding the Limfjord was the most important of these local ­areas. This is mainly expressed in the pottery, which is decorated in the Myrhøj style. It is possible that important elements of the late Neolithic culture came into existence in the area by the beginning of this age.The late Neolithic Age spans a very long period of time with a very rich and versatile source material. According to the C-14 datings, this age lasted for approximately 700 years, from c.2400 to c.1700 BC.The flint daggers which appear at the beginning of this age dominate. They are used as a stabbing weapon, as a stone for striking fire, and as a knife. The spearheads also represent a new weapon type. Other new items by the beginning of the age are spoon-shaped scrapers, and food knives. Crescent-shaped flint sickles (type I is symmetrical, type II is asymmetrical, i.e. they have their widest point near one of the tips) replace flint flake sickles. An important novelty by the early Neolithic Age is also the vertical loom and a general change in style of dress. By and large, the early Neolithic houses are unknown, and so it is impossible to determine whether the large longhouses from the late Neolithic Age also represent a novelty.The evidence suggests that the changes at the beginning of the late Neolithic Age happened very quickly, probably within a generation. After that, late Neolithic society was marked by conservatism that was extreme, even in the context of Stone Age peasant society. The changes during the nearly 700 year long period are few and insignificant.Denmark in the late Neolithic Age must be characterized as a tribal society. No decisive social differences are recognizable. The basic occupation was farming, primarily animal husbandry. Apart from this, a small late-Neolithic element known from the old kitchen middens from the Ertebølle culture provides indications of some sea hunting and fishing. The very large late-Neolithic houses indicate that all inhabitants of a settlement lived under the same roof.Most likely, power within the society lay in the hands of the old men, which would explain the extreme conservatism. Development was slow and kept within the framework already created during period A of the late Neolithic Age. Bronze Age phenomena from Western and Central Europe were adopted with huge delays and adapted to local traditions.These conditions only changed slowly during C/Per I of the late Neolithic Age. It was not until Bronze Age period II that the old pattern was broken and Danish society developed into a new society ruled by chieftains.Klaus EbbesenHørsholmTranslated by Annette Lerche Trolle

AbstractThe precise relationship of The Three Maries at the Tomb (Fig. 1) in the Boymansvan Beuningen Museum in Rotterdam to the work of Hubert and/or Jan van Eyck has proved difficult to establish, mainly because relatively little is known about their output apart from Jan van Eyck's signed paintings of 1432-41. The provenance of the Rotterdam picture has been traced back to the mid 18th century (Note 2), while the coat of arms, a later addition at bottom right, has been identified as that of Philippe de Commines, who has thus been posited as the earliest known owner (Note 3). Since the beginning of this century the panel has generally been ascribed to Hubert van Eyck on the basis of a comparison with his contribution to the Ghent Altarpiece, but doubts have also been expressed about the attribution to the Van Eycks (Note 5), while later dates have been suggested on the grounds of the view of Jerusalem (Note 6, 7) or the arms and armour (Notes 8, 9) . However, Panofsky remained convinced of the early date and kept to the attribution to Hubert, while suggesting that Jan had worked over certain details (Note 10). The restoration of 1947 (Note 11) revealed some gilded rays on the right side, which gave rise to suggestions that the panel had once formed part of a friezelike composition or a triptych (Notes 12-14). Recent opinion still remains divided, Sterling seeing the panel as having been painted by Jan van Eyck after 1426 (Note 15), Dhanens as the work of a follower around 1450-60 (Note 16). Scientific examination appeared to be the only way of obtaining new data, while the recently published results of a similar examination of the Ghent Altarpiece (Note 17) offered an additional incentive. An earlier scientific examination was carried out by Coremans in 1948 (Note rg), while the work had previously been examined by infrared reflectography by the authors in 1971 (JV ote zo) . Tfie 1)(inel on which the picture is painted consists rf three horizontal planks with dowelled joints (Note 21). The four corners are bevelled off at the back, which suggests that any later reduction in the panel can only have been slight. On the back is a sealed statement by D. G. van Beuningen to the effect that the painting had not suffered from being stored underground during the war (Fig. 2, Appendix 2) . The paint surface is in a reasonably good state, but exhibits heavy craquelure, which has played a part in the aesthetic assessment of the picture (Note 23) . Dendrochronological examination (Appendix I) showed that the two oaks from which the planks came were probably not felled before 1423. Since recent research has shown that the gap between felling and usage was not likely to have been much more than fifteen years in the 15th century (Note 25) and there is nothing to support the hypothesis that an old panel was reused here (Note 26), it is highly improbable that the picture was painted at the end of the 15th century. The most likely date is C. 1425-35 i.e. the period when the Ghent Altarpiece was painted or slightly later. No other results of dendrochronological examination on Van Eyck panels are available for comparison as yel. Examination by infrared reflectography (Note 28) revealed detailed underdrawing in virtually all parts of the picture and this was very carefully followed during painting with changes only in small details (cf. Figs.3, 5, 7). Stylistically the underdrawing accords with what is known about underdrawing in Van Eyck paintings today, this exhibiting a considerable difference from that of other Flemish Primitives, so that the Rotterdam panel is certainly a Van Eyck work. Among the most striking similarities to the central panel (x) and that with the Knights of Christ (IX) in the Ghent Altarpiece (Note 30) are the underdrawing of the drapery of the angels (Figs. 7-9), the city in the distance (Figs. 3,4, Note 31) and the minutely detailed armour (Figs. 14, 15, Note 33). Types of hatching that appear to be characteristic of the Van Eyck style are that of the shadows, which is sometimes overlapping and generally parallel to the main contours (Figs. 5,8) and a more rarely used type with short lines at an angle to contours (Fig. 9). The x-radiographs (Note 35) give a good idea of the damage to the paint surface (Figs. 16, 17) , which isfound mainly in the sky, along the crack in the top plank and on the bottom edge on the left. There is also a great deal of abrasion on the edges of the craquelure. The x-radiographs confirm the fact that no radical changes were made in the original, generally underdrawn, composition and reveal that the soldiers and their arms were left in reserve during the painting of the rocks and ground, a detail which likewise indicates continuity during the painting process. The underpainting of the rocks in large light blocks with simple contours shown up by x-ray photography is very close to that in panel IX in the Ghent Altarpiece (Note 38). Examination by stereomicroscope (Note 40) generally already gave an impression of the layered structure of the paint. It also showed up some minute details scarcely distinguishable by the naked eye : two horsemen and somefigures in tlae square on tlte leji qlthe city, a .slalue in a niche in the doorway in the zvall in tlae certtre (Fig. 18; possibly a reminiscence of the Golden Gate, Note 56) and a number of ship's masts with crow's nests on the horizon on the right (Fig. 19). Part of the vegetation was shown to be very finely and precisely rendered (Figs. 20, 21), while the rest was not so fine. Similar differences appear in the two bronze-coloured ointment jars in this painting and also in the bottom zone of the Ghent Altarpiece (Note 41). These may reveal two different hands or the somewhat hasty finishing of some areas. The paint samples (Note 42) revealed the presence of an oleaginous isolating layer over the chalk and glue ground comparable to, but thinner than that on the Ghent Altarpiece (Note 45). The only other Flemish Primitive in whose work such a layer is found is Dirc Bouts (Note 50). The paint layer also exhibits many similarities to that of the Ghent Altarpiece, not only in the number and thickness of the layers, but in the composition and overall structure of the paint. For example, the skies in both works are built up in three layers from light to dark on the basis of lead white with increasing amounts of azurite and sometimes a bit of lapis lazuli, the vegetation consists of two layers of green with a glaze over them and the structure of the red mantle of one of the Maries resembles similar areas in the Ghent Altarpiece. This technique again makes it very unlikely that the panel was painted at the end of the 15th century or later. A final point is that the gilded rays ( Fig. 22), like the coat of arms (Fig. 23), prove to be a later addition. Finally, renewed consideration was given to certain iconographical aspects which have been used as dating criteria. The arms and armour have been seen as grounds for a later dating by Squilbeck in particular, but it seems quite likely that many of the forms are purely imaginary, while other experts do not agree with Squilbeck in dating certain elements to the 16th century (Note 53). The arms and armour are in any case an integral part of the painting. The detailed view of Jerusalem is regarded by some as impossible before Erhard Reuwich's print of 1486, while others express surprise that it was not copied by other artists. In fact, however, it is strikingly close in many details to the view in the Ghent Altarpiece, although the latter is firmer in its spatial construction and more convincing. Whole sentences have been read into the texts on the hems of two of the Maries' garments and the soldier's cap (Note 57 ) and it has been argued that the letters are Roman, not Hebrew (Note 58), but in fact they are indispulably Hebrew and although words can sometimes be recognized, they do no form a sentence or text (Note 59). The coat of arms is certainly that of a nobleman of the Order of St. Michael, but whether he was Philippe de Commines is uncertain. The Van den Woesteyne and Van Meaux van Vorsselaer families also bore these arms, albeit in different tinctures (Note 6o). Since the arms are done, in a brownish-grey, they cannot be more precisely identified. The presence of no less than five layers of varnish between the green meadow and the coat of arms could indicate that the arms were added much later than previously thought, possibly in the 16th or even the 17th century (Note 47). While the present study has shown that the Rotterdam painting is quite an early Van Eyck, its precise position in the Van Eyck oeuvre cannot be determined until results of examinations of other works in the group are available.

A magnificent casket in a woman’s grave from the Viking AgeIn 2004 and 2006, Moesgård Museum excavated 21 Viking Age graves – 16 inhumation graves and five cremation graves – at Haldum Church, 20 km northwest of Århus in Eastern Jutland (fig. 1). All the graves with datable finds are from the 10th century; only one example will be presented here.The grave is a simple inhumation burial. The skeleton had completely disappeared and there were no signs of a coffin (fig. 2). About 40 cm from the western end of the grave base lay 16 glass beads scattered around over an area of about 20 x 30 cm. These comprised one red and one orange bead of opaque glass, one bead of white glass and 13 small beads of yellow glass. In the centre of the grave was a slate whetstone (fig. 3). At the eastern end was a concentration of iron fittings, and it soon became clear that these represented the remains of a casket.During excavation of the fittings a well-preserved lock turned up (fig. 4). One end of the lock’s cover plate terminates in a point with concave flared sides, while the other (broad) end divides into two prongs, between which a transverse, semicircular fitting has rusted fast. An iron band has been mounted across the pointed end; this is possibly a repair. The cover plate curves slightly along its length, which means that the lock must have been fitted on to a curved surface. The back of the lock is covered by a quadrangular plate. The distance between front and back plates is 15 mm, showing the thickness of the material within which the lock was fitted. On removing the back plate the lock construction can be seen; this is of well-known Viking Age type. It operates in such a way that the key – after having been placed into the keyhole – is pushed a little to the side so that it squeezes together the two springs of the bolt. The bolt is hereby disengaged and can be pulled back by means of a slide bar, which sits in continuation of the keyhole (fig. 5).The lock bolt is pushed into the above-mentioned, semicircular fitting. The latter comprises two plates separated by a c. 10 mm wide side piece, which gives the fitting the appearance of a small box. Three fittings of this type were found (fig. 6).Further to these components are edge and corner plates. The edge fittings all have the form of narrow, indented borders with small holes between the points. A fragment is shown lowermost on fig. 6. The corner plates have been bent back around the corner joints of the casket and are pointed at both sides.Certain other fittings were at first inexplicable. These mysterious pieces include three triangular fittings with small slide bars on their upper surface and 30 mm long bolts below (fig. 7). There are also fragments of some zip-like iron bands. These are slightly curved along their length and have a roof-shaped cross-section (fig. 8). Finally, there was a robust rivet with a square head, ingeniously worked with inwardly flared, tapered sides and crowned by a small boss.Wood imprints on the back of the fittings show that the casket was made of oak. The imprints were very useful when reconstructing the casket as they clearly show both the longitudinal direction of the wood and the depressions within it. There were imprints from a textile of coarse linen weave on the exterior of some of the edge fittings.It seems that the casket from Haldum had the same construction as the Bamberg casket (figs. 9 and 10). Each of the four sides of the Bamberg casket has, at its centre, a raised semicircular area covered by fittings. The exterior is decorated with a mask and there is a hole on the inside. The bolts of the lid presumably engaged with these holes when the casket was locked. Carved grooves in the wood under the ornamental plates of the lid lead out by way of the holes into the four semicircles. The semicircular fittings of the Haldum casket are, with regard to size and shape, completely identical to the mask fittings seen on the Bamberg casket. One of them is, as mentioned above, rusted to the lock, the bolt of which has been pushed into a hole on its inner surface. Consequently, its function is clear; it is also clear that the casket was locked when placed in the grave.The lid of the Bamberg casket is divided by ornamental bands into four triangular fields (fig. 11). In one of these fields (A), a T-shaped keyhole is apparent, and in continuation of this there is a slot for a slide bar. In the field opposite (C), there is a small hole and each of other fields (B and D) has a partly damaged slide-bar slot. We are so fortunate that the fittings surviving from the Haldum casket include slide bars, bolts and other lock parts that have been lost from the Bamberg casket.It is possible to place the lock and the various fittings from the Haldum casket in a square of the same dimensions as the lid of the Bamberg casket. In the fields created by arranging the zip-shaped fittings to form a diagonal cross, there is space for the lock and the three triangular fittings (fig. 11). The excavation photo in fig. 12 shows the three types of fittings in their original positions. In continuation of the keyhole, the lock has a small slide bar whereby the bolt was pushed into one of the semicircular fittings (side A). The forks of the lock plate extend down on either side of this fitting, demonstrating that there was a central depression in the four sides of lid in order to accommodate the semicircular fittings, as seen on the Bamberg casket. In the triangular fitting, which was located opposite the lock (side C), there is also a small slide bar but no slot in which it could move. Similarly, the wood imprint on the back shows that there was no depression to allow a bolt to be pushed back and forth. On the corresponding side of the lid of the Bamberg casket, the carved depression for the bolt is less marked than on the other sides. On the two remaining triangular fittings from the Haldum casket, the slide bars are located in 15 mm long slots (sides B and D). On the reverse, clear depressions are seen in the wood imprint in which the bolts were slid back and forth (fig. 13). If the fittings are arranged in this way, all the pieces show the same longitudinal direction of the wood imprints on their reverse. This indicates that the casket lid was made from one piece of wood.As is apparent from the carvings on the Bamberg casket, the slide bars of the closing mechanism were located close to the centre of the lid. The hidden grooves for the bolts run from here, under the ornamental plates, and emerge at the edge of the lid. Apparently, the Haldum casket did not have ornamental plates screening the grooves for the bolts. As a consequence, the triangular fittings with the slide bars were placed close to the edge of the lid so that they met the semicircular fittings. In this way it was only necessary to have short grooves for the bolts, and these were covered by the fittings.The way in which the lid and the casket are fitted to one another, together with the absence of hinges, indicates that the lid was loose and was lifted completely off in order to open the box. The bolt opposite the lock (side C) was permanently pushed forwards and was the first to be pushed into the matching semicircular fitting, after which the lid was tilted down into place. After this, the two bolts at the sides (B and D) were extended to keep the lid fastened. Finally, the lock’s bolt was pushed into place and the casket was then locked.By observing the curvature of the striker plate, the triangular fittings, the zip-shaped fittings and some of the edge fittings, which have a curved cross-section, it is possible to reconstruct the shape of the lid (see fig. 10). Its height was c. 45 mm. The rivet must have marked the centre of the lid, corresponding to the cruciform fitting on the lid of the Bamberg casket.The body of the Bamberg casket was assembled by pushing the end surface of one side against the side surface of the next. The wood imprints on the corner plates of the Haldum casket show that the same technique was also used here. It is apparent from these wood imprints, as well as the distance between front and back of the semicircular fittings, that the sides were about 10 mm thick. The wood imprints on the inner side of the semicircular fittings show that the tree rings on the side pieces ran vertically. Had they run horizontally, this would have rendered these curves a weak point.The surviving remains of the Haldum casket show a surprising similarity to the Bamberg casket. There is, however, nothing to indicate that the casket from Haldum was as magnificently decorated, but the now completely vanished oak wood casket may possibly have been decorated with both carvings and paintings. Furthermore, the casket originally had edge fittings greater than 3 mm in width which, in themselves, would also have constituted considerable ornamentation. This fact became evident from construction of the replica (fig. 14). The latter also confirmed the reconstruction of the Haldum casket and its complicated closing mechanism.The Haldum find shows that the Bamberg casket, with its special construction, is not unique, and two further finds kept at Danmark’s National Museum indicate that caskets of this type were perhaps more widespread than previously assumed. One is a cruciform fitting of gilt bronze (fig. 15). The four transepts end in stylised animal heads, and at the centre is a hemispherical raised area. At the centre of the lid of the Bamberg casket there is a cruciform fitting also with animal heads at the ends of the transepts, and in the middle sits a hemispherical rock crystal (fig. 16). The similarity to the former fitting is striking, and it seems likely that the artefact represents a lid fitting for a casket of Bamberg type. The other artefact is a cruciform fitting of sheet bronze with open-work sections between the limbs of the cross and a circular hole at its centre (fig. 17). The fitting is part-finished and of the same type as the first mentioned, but a somewhat different variant. The two fittings were found in an old ford across Halleby Å in Western Zealand near the rich Viking Age settlement at Tissø. They were recovered together with the remains of a tool chest.The grave in which the Haldum casket was found is presumed to be that of a woman because beads and small locked caskets are typical woman’s equipment in Viking Age graves. However, such grave goods have also been found in a few cases in men’s graves. The whetstone gives no indication of the sex of the deceased because this type of artefact was commonly included as grave goods in both men’s and women’s graves. The great similarity of Haldum casket to the Bamberg casket dates the grave to the second half of the 10th century.The style of the Bamberg casket indicates that it was produced in Denmark or Southern Scandinavia. Recently, however, attention has been drawn to the fact that the Mammen style also appears over a wider area. Finds from areas where the Vikings settled outside Scandinavia– from The British Isles to Russia – indicate that craft work in the Mammen style could also have been produced there. The finding of the Haldum casket does, however, add weight to the conclusion that the Bamberg casket was produced in Denmark. This is also the case for the two fittings from Halleby Å if the interpretation presented here is correct. However, whether boxes of this type were produced in one particular place or are the work of one or more travelling craftsmen remains to be ascertained.Jens JeppesenMarianne SchwartzMoesgård Museum

Immobility, fixation, or paralysis of the vocal folds is an ominous sign when encountered in the clinics. This may be due to a variety of diseases, lesions, injuries, or vascular compromise which may affect the integrity and physiologic mechanism of the vocal folds. The common etiologies include infectious processes such as laryngeal or pulmonary tuberculosis (PTB), malignancy or neoplasms, central problems such as cerebrovascular accidents (CVA), stroke and others.1,2,3 The problem should be addressed immediately because this potentially life threatening and imminent narrowing of the glottic opening may lead to respiratory distress. Vocal fold paralysis due to compression of the recurrent laryngeal nerve from PTB and laryngeal cancer are perennially seen in clinical practice, but immobility of the vocal folds due to cricoarytenoid joint fixation or ankylosis is seldom seen and appreciated.
 Hence, we present a case of bilateral cricoarytenoid joint ankylosis and discuss its etiology, pathophysiology, differential diagnoses, ancillary procedures, and management.
 
 CASE REPORT
 A 60-year-old man was admitted for the first time because of difficulty of breathing and stridor. One week prior to admission he started to experience difficult breathing associated with productive cough and colds. He consulted in a primary private hospital and was managed as a case of bronchial asthma in exacerbation. Nebulization with salbutamol afforded temporary relief.
 A few hours prior to admission, difficulty of breathing and productive cough worsened, prompting emergency room consult. He was referred to us for further evaluation of stridor.
 The patient had no diabetes mellitus, hypertension or allergies to food and drugs. He was diagnosed with refractory bronchial asthma during childhood and had frequent hospitalizations for pulmonary infections. He had no maintenance medication for bronchial asthma and was nebulized with salbutamol during exacerbations. He had PTB and completed six months’ anti-TB medications in 2013. The patient claimed that he had no dyspneic episodes during routine daily activities or upon exertion. No history of hoarseness or joint pain was noted either. A golf caddy, he was a previous 15-pack-year smoker, occasional alcoholic beverage drinker and denied use of illicit drugs.
 Upon admission, the patient was awake, coherent, not in cardiorespiratory distress. Blood pressure was 110/70 mmHg, pulse rate was 74/minute, respiration was tachypneic at 24 cycles per minute, afebrile. Ear examination showed normal pinnae, no tragal tenderness, patent external auditory canals with no discharge and 80-90% dry central perforations of both tympanic membranes. Anterior rhinoscopy, nasal endoscopy and the oral cavity examination were unremarkable. Head and neck examination showed no cervical lymphadenopathy or palpable mass.
 Video laryngoscopy showed both vocal folds were immobile and fixed in paramedian position upon inspiration, with a 1–2 mm glottic opening and no mass or lesion appreciated. (Figure 1)
 The initial impression was impending upper airway obstruction secondary to bilateral vocal fold paralysis. Under general anesthesia, direct laryngoscopy revealed no mass or lesion on both vocal folds and passive mobility test demonstrated resistance and limitation of lateral rotation and movement of the arytenoids on both sides. (Figure 2) The vocal folds did not abduct on lateral retraction of the arytenoids. Tracheostomy was performed and he was discharged after a few days.
 A subsequent laryngeal electromyography (EMG) study showed no signs of myopathy or acute or chronic denervation changes of the thyroarytenoid muscles, and rheumatoid factor was normal. At this point, bilateral cricoarytenoid fixation or ankylosis was considered and posterior interarytenoid web and bilateral vocal fold paralysis were ruled out. 
 We recommended a lateralization procedure such as unilateral arytenoidectomy with cordectomy. The patient is currently well while he and his family are still contemplating whether he will undergo the surgical procedure.
 
 DISCUSSION
 Respiratory stridor is always considered an ominous sign which implies upper airway obstruction. If severe, stridor may compromise breathing and in some instances is life threatening and a telltale sign of imminent danger requiring immediate endotracheal intubation. Stridor is a musical, high-pitched sound which may be elicited in the presence of laryngeal and upper tracheal obstruction while wheezes are defined as high-pitched, continuous, adventitious lung sounds.4,5
 Stridor may be due to several reasons such as immaturity of the laryngeal structures seen in laryngomalacia in newborns, laryngeal infection, foreign body in the airway, and chronic obstructive pulmonary disease.3,6 This may be the reason why bronchial asthma was entertained in the clinical course of our patient and initially at the emergency room. It is unfortunate that despite the non-responsiveness of bronchial asthma to medical therapy and persistence of stridor, no ENT referral to evaluate the upper airway was made until recently. It should be emphasized that patients who develop stridor need to be evaluated by otolaryngologists specifically to ascertain the status of the vocal folds, which in this case turned out to be fixed or ankylosed, a condition which is rarely seen and encountered in clinical practice.
 Among the differential diagnoses considered in this case were laryngeal cancer, vocal fold paralysis, interarytenoid web, and arthritis.7,8,9
 Initially, laryngeal cancer was entertained because of his age, however no mass or suspicious lesion was appreciated on video laryngoscopy and this was ruled out. Because the vocal folds were immobile and fixed in paramedian position upon inspiration, bilateral vocal fold paralysis was considered with the etiology to be determined.
 Vocal fold paralysis occurs when nerve impulses to the laryngeal muscles are disrupted in case of CVA or stroke, recurrent nerve injury after thyroid surgery or compression of the inferior laryngeal nerve due to pulmonary TB or lung cancer.8,11 On the other hand, vocal fold fixation occurs when movement of the cricoarytenoid joint is compromised in cases of rheumatoid arthritis provided that the innervation is intact.10,11
 Another common differential diagnosis which may be entertained is laryngeal TB in which nodular lesions may be seen in the vocal folds, granulation tissues are usually present in the posterior commissure and histopathology shows Langhans cells and caseation necrosis.8 Paralysis is oftentimes unilateral due to compression of the recurrent laryngeal nerve from apical PTB. Although the patient has a history of TB, he was asymptomatic and close examination of the vocal folds revealed no lesions except for bilateral fixation, and this was ruled out.
 Direct laryngoscopy (DL), the gold standard in the evaluation of laryngeal anatomy especially when dealing with the vocal folds,3 showed smooth, normal-looking vocal folds with no lesions. The passive mobility test is done to differentiate vocal fold paralysis from cricoarytenoid ankylosis, by retracting or pushing the arytenoid laterally. If there is limitation of rotation and movement of the arytenoid laterally and the vocal folds do not abduct, then cricoarytenoid ankylosis or fixation is considered. On the contrary, if the arytenoid rotates and abducts laterally when retracted by forceps, then vocal fold paralysis is considered.1,6 Hence, because there was limitation of rotation and movement of the arytenoids, cricoarytenoid joint fixation was entertained and vocal fold paralysis was ruled out.
 Interarytenoid web was excluded because the vocal folds had no mucosal adhesions, synechiae, or any scarring within the posterior portion of the glottis. In addition, although the patient’s glottic opening was restricted, no difficulty was encountered during endotracheal intubation since a smaller caliber tube was used.
 To further confirm the diagnosis of cricoarytenoid fixation, laryngeal electromyography (EMG) revealed no paralysis of the thyroarytenoid muscles with no signs of myopathy and acute or chronic denervation, making bilateral vocal fold paralysis unlikely in this case. Laryngeal EMG is indicated to determine the integrity of the laryngeal muscles and innervation especially in cases of vocal fold paralysis.11 In post-thyroidectomy patients, laryngeal EMG is done 6 months after surgery to determine if the laryngeal nerve injury may recover or is irreversible. The 6-month waiting period is to allow swelling or inflammation to subside and to observe whether the injured nerve will recover prior to further intervention.12
 The findings on direct laryngoscopy, passive mobility test and laryngeal electromyography clearly favor the diagnosis of cricoarytenoid joint ankylosis. Other ancillary procedures such as a CT scan may show sclerosis of the arytenoids1,11 in elderly patients and videostroboscopy may be useful in determining the relative vertical height and tension of the vocal folds for assessing the cricoarytenoid function.1 A CT scan was not done because there was no palpable neck mass and no other lesion was entertained that would warrant CT imaging. Videostroboscopy may help and may further show and magnify the movement of the vocal folds for observation however, the findings seen on direct laryngoscopy and laryngeal EMG were deemed enough to support and confirm the diagnosis.
 The patient may be classified under type IV posterior glottic stenosis - congenital or acquired bilateral cricoarytenoid fixation with or without interarytenoid scarring - based on the classification by Bogdasarian and Olson which was later modified by Irving and associates.3 Interarytenoid web and scarring presents as bilateral impaired abduction but adduction is normal and patients affected tend to have a normal voice while the main presenting symptom is airway compromise. In cricoarytenoid joint ankylosis, adduction and abduction of the vocal folds are limited.3 As previously mentioned, to distinguish cricoarytenoid joint ankylosis from vocal fold paralysis, palpation of the cricoarytenoid joint on rigid endoscopy and laryngeal EMG are necessary for definitive diagnosis.6
 The patient’s voice was normal because the vocal folds approximate each other with a 1 to 2 mm glottic opening while no history of aspiration was apparent because the vocal folds are fixed in paramedian position which may prevent fluid from entering the larynx during swallowing. Although the patient’s voice is normal, respiration is compromised manifested as stridor and difficulty of breathing requiring tracheostomy. 
 In contrast, patients with acute or recent unilateral vocal fold paralysis in post-thyroidectomy or post-CVA (stroke) conditions may initially manifest with aspiration. This is because the vocal fold assumes an intermediate position in which the glottic opening is relatively wider compared with the paramedian position. In a few months’ time, the paralyzed fold will compensate, move medially, and assume a paramedian position and aspiration may eventually resolve.13
 Cricoarytenoid ankylosis has several etiologies which include arthritides, bacterial infection and trauma. Rheumatoid arthritis may account for numerous clinical diagnoses of cricoarytenoid ankylosis.2 Other causes include gout, Reiter Syndrome, and ankylosing spondylitis. Some anecdotal evidence suggests a mump-associated laryngeal arthritis and fixation secondary to radiation therapy.2, 8 Bacterial involvement of the joint space with infectious microorganisms such as streptococcal species, with resultant ankylosis is also well established.8 External and direct laryngeal trauma may also result in cricoarytenoid joint injury.8 Documented and retrospective studies suggest intubation-related joint injury and posterior or anterior arytenoid displacement secondary to the distal tip of the endotracheal tube engaging the arytenoid during intubation.8 Traumatic obstetric delivery using forceps and postpartum newborn care through vigorous cleansing and suctioning the mouth and pharynx of the newborn are also mentioned in the literature.11 Posterior dislocation resulting from extubation with a partially inflated endotracheal tube cuff is another probable cause.7, 8 Another potential etiology is arytenoid chondritis secondary to prolonged endotracheal intubation, which results in fibrosis.8, 16 Reviewing the patient’s history, however, showed no history of trauma, previous intubation, signs and symptoms of arthritis and serious laryngeal infections. The patient was delivered via normal spontaneous delivery by a traditional birth attendant (“hilot”) and no apparent respiratory distress or postpartum hospitalization was known of by the patient.
 Cricoarytenoid ankylosis is usually associated with cases of rheumatoid arthritis with 17 to 33% incidence among RA patients.9 House et al. in 2010 described approximately 0.1% incidence of cricoarytenoid joint ankylosis in endotracheal intubations.16 Most cases of vocal fold immobility seen under the service is secondary to vocal fold paralysis due to cerebrovascular accident (stroke), pulmonary problems such as PTB, or laryngeal malignancy and to our knowledge, this is the first reported case of cricoarytenoid joint ankylosis in our institution. 
 Chronic cricoarytenoid joint ankylosis may be mistaken for asthma or chronic bronchitis, with symptoms of dyspnea, hoarseness, or stridor.3 In rheumatoid arthritis, laryngoscopy may show rough and thick mucosa and narrowed glottic chink which were contrary to the recent endoscopic findings. If the etiology is bacterial, there is direct involvement of the joint space with infectious agents, such as streptococcal species, which leads to scarring and thickening of the cricoarytenoid joints.8 Airway compromise occurs most commonly in patients with long-standing cricoarytenoid ankylosis and laryngeal stridor has been described as the sole presentation of the disease as manifested in this case.8, 14, 17 To rule out RA in this case, rheumatoid factor (RF) was done with negative results.
 
 Finally, when it comes to upper airway obstruction, the glottic opening or opening of the vocal folds should be thoroughly evaluated. The normal glottic opening in newborns opens approximately 4 mm in a lateral direction. Congenital subglottic stenosis is defined as a subglottic diameter of less than 4 mm.13 In retrospect, it may be presumed that the patient’s glottis may not be seriously compromised since birth because he was able to thrive and breathe with no apparent difficulty. It may be conjectured that narrowing of the glottic opening occurred only later in life. Although asymptomatic, rheumatoid factor was negative, and the etiology of the patient’s ankylosis remains perplexing and elusive.
 The management of cricoarytenoid ankylosis includes tracheostomy to address the upper airway obstruction. Surgical management includes open arytenoidectomy, arytenoidpexy and endoscopic arytenoidectomy or transverse cordectomy and all have their advantages and disadvantages.6, 11, 16 These are lateralization procedures which aim to widen the glottic opening and wean the patient from tracheostomy afterwards.
 In closing, when bronchial asthma remains refractory to treatment, the physician should not hesitate to refer to otolaryngologists to rule out other probable upper airway pathologies. Although rare, ankyloses of the cricoarytenoid joint should be considered especially when the movement of the vocal folds is compromised. Although direct laryngoscopy, passive mobility tests and laryngeal EMG are indispensable in clinching the diagnosis, the clinical history is important in determining etiology which in this case remains elusive and perplexing.
 
 
 
 
 
 
 REFERENCES
 
 Woo Peak M. Laryngeal Trauma in Woo Peak Stroboscopy. 1st California: Plural Publishing Inc. 2010. p. 221-226..
 Bryson PC, Buckmire RA. Medscape. Arytenoid Fixation. [Updated 2016 Mar 30; cited 2013 Apr]. Retrieved from: https://emedicine.medscape.com/article/866384-overview#a6.
 Albert D, Boardman S, Soma M. Evaluation and Management of the Stridulous Child.
 
 In Flint PW, Haughey BH, Lung VJ, Niparko JK, Richardson MA, Robbins T, et al (editors). Cummings Otorhinolarynglogy Head and Neck Surgery. 5th ed. Philadelphia: Mosby Elsevier. 2010. p. 2896-2897.
 
 Lechtzin NM. Stridor. Merck Manual Professional. 2014 [cited 2014 Apr]. Retrieved from Merck Manuals: http://www.merckmanuals.com/professional/pulmonary-disorders/symptoms-of-pulmonary-disorders/stridor
 Lechtzin NM. Wheezing. Merck Manual Professional. 2014 [cited 2014 Apr]. Retrieved from Merck Manuals: http://www.merckmanuals.com/professional/pulmonary-disorders/symptoms-of-pulmonary-disorders/wheezing
 Jackson C, Jackson CL. Direct Laryngoscopy in Bronchoesophagology. 5th Philadelphia: W.B. Saunders. 1950. p. 116-117
 Cooper R. Extubation and Changing Endotracheal Tubes. In Benumof J, Hagberg CA (editors). Benumof's Airway Management: Principles and Practice. 2nd Philadelphia: Mosby Elsevier. 2007. p. 1160.
 Heman-Ackah Y, Kelleher K, Sataloff R. Inferior Glottic Ridges That Prevent Vocal Cord Closure. In Sataloff RT, Chowdhury F, Joglekar S, Hawkshaw MJ (editors). Atlas of Endoscopic Laryngeal Surgery. 1st New Delhi: Jaypee Brothers Medical Publishers. 2011. p. 45.
 Kamanli A, Gok U, Sahin S, Kaygusuz I, Ardicoglu O Yalcin S. Bilateral cricoarytenoid joint involvement in rheumatoid arthritis: a case report. Rheumatology (Oxford). 2001 May; 40 (5): 593-594. PMID: 11371675.
 Zakaria HM, Al Awad NA, Al Kreedes AS, Al-Mulhim AM, Al-Sharway MA, Hadi MA, et al. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J. 2011 Jan; 26(1): 34–38. DOI: 10.5001/omj.2011.09; PMID: 22043377 PMCID: PMC3191623.
 Remacle M, Sandhu G. Bilateral Vocal Fold Immobility. In Oswal V, Remacle M, Jovanvic S, Zeitels SM, Krespi JP, Hopper C (editors). Principles and Practice of Lasers in Otorhinolaryngology and Head and Neck Surgery. 2nd Amsterdam: Kugler Publication. 2014. p. 250-251.
 Chauhan A, Badhwar S, Patel M, Tiwari S. Post - Intubation Bilateral Arytenoid Dislocation with Acute Respiratory Distress. J Anaesth Clin Pharmacol. 2009 Aug; 25(3):361-62.
 Banovetz J. Benign Laryngeal Disorders. In Adams GL, Boies LR (editors). Boies Fundamentals of Otolaryngology - A Textbook of Ear, Nose, and Throat Diseases. 6th Singapore: W.B. Saunders. 1989. p. 406-408.
 Stojanovic SP, Zivic L, Stojanovic J, Belic B. Total fixation of cricoarytenoid joint of a patient with rheumatoid arthritis and Hashimoto thyroiditis. Srp Arh Celok Lek. 2010 Mar-Apr; 138(3-4): 230-2. PMID: 20499506.
 Hamdan AL, Sarieddine D. Laryngeal Manifestations of Rheumatoid Arthritis. Hindawi Autoimmune Diseases. 2013; 2013: 4-6. DOI:10.1155/2013/103081.
 Polisar IA, Burbank B, Levitt LM, Katz HM, Morrione TG. Bilateral midline fixation of cricoarytenoid joints as a serious medical emergency. JAMA. 1960; 172(9): 901-906. DOI:10.1001/jama.1960.03020090013003
 Burkey B, Goudy S, Rohde S. Airway Control and Laryngotracheal Stenosis in Adults. In Snow JB, Ballenger JJ (editors). Ballenger's Manual of Otorhinolaryngology Head and Neck Surgery. 17th Ontario: BC Decker. 2009. p. 911.