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Dislocation of the cochlear implant magnet is an uncommon but recognised complication of magnetic resonance imaging in a patient with a cochlear implant.
This paper reports a case of cochlear implant magnet dislocation despite head bandaging. The patient subsequently underwent endoscopic repositioning of the magnet under general anaesthesia. The cochlear implant system was tested intra-operatively and confirmed to be functioning. The patient was well at follow up and the small wound healed well with no complications.
This report presents the endoscopic technique as a viable minimally invasive surgical approach to address cochlear implant magnet dislocation.
Despite evidence linking regular nut consumption with reduced chronic disease risk, population-level intakes remain low. Research suggests nut-promoting advice from doctors facilitates regular nut consumption. However, there is no information on current nut recommendation practices of health professionals. The aim of the present study was to examine the advice provided by health professionals regarding nut consumption.
In this cross-sectional study, participants were invited to complete a survey including questions about their nut recommendation practices.
New Zealand (NZ).
The NZ Electoral Roll was used to identify dietitians, general practitioners and practice nurses.
In total 318 dietitians, 292 general practitioners and 149 practice nurses responded. Dietitians were more likely (82·7 %) to recommend patients increase consumption of nuts than general practitioners (55·5 %) and practice nurses (63·1 %; both P<0·001). The most popular nuts recommended were almonds, Brazil nuts and walnuts, with most health professionals recommending raw nuts. The most common recommendation for frequency of consumption by dietitians and practice nurses was to eat nuts every day, while general practitioners most frequently recommended 2–4 times weekly, although not statistically significantly different between professions. Dietitians recommended a significantly greater amount of nuts (median 30 g/d) than both general practitioners and practice nurses (20 g/d; both P<0·001).
Dietitians were most likely to recommend consumption of nuts in accordance with current guidelines, but there are opportunities to improve the adoption of nut consumption recommendations for all professions. This may be a viable strategy for increasing population-level nut intakes to reduce chronic disease.
Background: Consumer perceptions of care are a key measure of service quality. The Consumer Perceptions of Care (CPoC) survey is often used to assess patients’ evaluations of the quality of services received. Aims: The study explored the factor structure of the CPoC, the relationships between perceived quality of care, empowerment, perceived treatment outcomes, and symptom change, as well as the effect of allowing patients to self-identify during the CPoC survey on their ratings of perceptions of care. Methods: In the first phase of the current study, 2,125 psychiatric inpatients were surveyed about their perceptions of care, and their symptoms were also measured at both admission and discharge. The second phase examined 720 inpatients who had given consent so that perceptions of care could be compared with outcome data. Results: Increased levels of empowerment were associated with favourable ratings of perceived treatment outcomes. Although perceived treatment outcomes and empowerment were correlated with actual symptom change, these correlations were small. Furthermore, the influence of self-identification on ratings of perceptions of care was found to be small. Conclusions: Examining patients’ perceived and actual treatment outcomes may provide mental health service providers with a more nuanced perspective of the hospital experiences of their patients.
Despite considerable evidence supporting the health benefits of regular nut consumption, nut intakes remain lower than recommended among many populations. Understanding how the general population perceives nuts could inform strategies to promote regular nut consumption and increase intakes among the general public.
Cross-sectional study. Participants were invited to complete a questionnaire which included information on nut consumption and knowledge and perceptions of nuts.
The study was set in New Zealand (NZ).
Participants (n 1600), aged 18 years or over, were randomly selected from the NZ electoral roll.
A total of 710 participants completed the questionnaire (response rate 44 %). More than half of the respondents believed that nuts are healthy, filling, high in protein and high in fat. The most common reason cited by consumers for eating nuts was taste (86 % for nuts, 85 % for nut butters), while dental issues was the most frequent reason for avoidance. About 40 % of respondents were not aware of the effects of nut consumption on lowering blood cholesterol and CVD risk.
Despite overall basic knowledge of the nutritional value of nuts, a substantial proportion of the general population was unaware of the cardioprotective effects of nuts. The present study identified common motivations for eating and avoiding nuts, as well as perceptions of nuts which could affect intake. These should guide the content and direction of public health messages to increase regular nut consumption. The public’s knowledge gaps should also be addressed.
Introduction: The risk of recurrent stroke following a transient ischemic attack (TIA) has been estimated to be as much as 5 percent in the first 48 hours and ten percent in the first week following initial TIA symptoms, but can be modified as a result of intensive risk factor management. Care pathways for these patients vary between different regions within Alberta with Edmonton admitting more TIA patients and Calgary using computed tomography angiography (CTA) based triage. To examine regional differences in the quality of care, the rate of admission for stroke within 90 days of an index ED visit for TIA/minor stroke was investigated. Methods: Data analysts from the Data Integration, Measurement and Reporting (DIMR) branch of Alberta Health Services (AHS) used the National Ambulatory Care Reporting System (NACRS) to identify patients in Alberta who were admitted for stroke within 90-days of an index emergency department (ED) visit for TIA/minor stroke from April 2010 to March 2016. Information extracted included patient demographics, region of residence (Edmonton, Calgary or non-major urban [NMU]), return diagnosis and timing of return ED visit. Analysis included descriptive summaries and proportions were compared using a χ2 test. Results: During the study period, there were 26,232 index visits to Alberta EDs for TIA/minor stroke. 5426 (26.1%) of patients were admitted on their index visit. Calgary (22.5%) had lower rates of admission on index visit followed by Edmonton (31.4%) and the NMU (46%). 20,806 (79.3%) were discharged home following their index visit. Of the patients discharged on their index visit 729 (3.5%) had an admission for stroke within 90-days of their index ED visit with rates in Edmonton (3.8%) and the NMU regions (3.8%) being significantly higher than Calgary (2.8%, p<0.01). Conclusion: Our study demonstrates significantly lower rates of admission for stroke within 90-days of ED visit for minor stroke/TIA in Calgary compared to Edmonton and the NMU. Further work should focus on validating this result and consideration of standardized care pathways that promote effective resource utilization and quality of care.
We describe the case of an infant who was a late presenter of transposition of the great arteries where we proceeded with ductal stenting to improve oxygenation and left ventricle training. Stenting improved the infant’s saturation while keeping the left ventricle well trained for 4 months after the procedure. This report demonstrates that intermediate-term left ventricle training can be achieved via ductal stenting.
To conduct the first nationwide population survey to examine the associations between changes in speed of eating and weight gain over 3 years. The study also explored whether faster eating at baseline was related to healthy-weight women becoming overweight after 3 years.
Longitudinal. At baseline, participants were randomly selected from a nationally representative sampling frame to participate in a prospective study. Women completed self-administered baseline questionnaires on demographic and health measures. Self-reported speed of eating, smoking status, physical activity, menopause status, and height and weight were collected at baseline and again 3 years later.
Nationwide study, New Zealand.
Women (n 1601) aged 40–50 years were recruited at baseline from New Zealand electoral rolls.
There was no evidence of associations between 3-year BMI adjusting for baseline BMI and either baseline speed of eating (slower and faster; P=0·524) or change in speed of eating (consistently faster eating, consistently slower eating, slower eating at baseline but not at 3 years, faster eating at baseline but not at 3 years; P=0·845). Of the 488 women with healthy BMI (18·5 to <25·0 kg/m2) at baseline, seventy-seven (15·8 %) became overweight (BMI≥25·0 kg/m2) after 3 years. Compared with those who were slower eaters at baseline, faster eating at baseline did not increase the risk of becoming overweight 3 years later (P=0·958) nor did change in speed of eating (P=0·236).
Results suggest that once women have reached mid-life, faster eating does not predict further weight gain.
The potential efficacy of antifungal agents (e.g. Mycostatin) in treating acute attacks of Ménière's disease was first suggested in 1983 but few data have been published. Oral Mycostatin has been used as second-line medical treatment for intractable Ménière's disease at our institution for many years.
This preliminary cohort study investigated the role of oral Mycostatin in intractable Ménière's disease.
A retrospective review of patients with intractable Ménière's disease who started oral Mycostatin treatment between 2010 and 2012 was conducted.
Of 256 patients presenting with vertiginous disorders, 26 had definite Ménière's disease and had not responded to standard first-line treatment. Following oral Mycostatin treatment, improvements were reported for vertigo (n = 8), aural fullness (n = 7), tinnitus (n = 3) and subjective hearing loss (n = 3). Half of those with symptom improvement persisted with oral Mycostatin for two years and continued to remain asymptomatic.
The use of oral Mycostatin to alleviate symptoms of intractable Ménière's disease showed promising results in this case series. Mycostatin may offer a safe and useful alternative for the management of Ménière's disease for patients with chronic unremitting symptoms in whom first-line treatment options have failed.
The simultaneous insertion of a ventilation tube or grommet during tympanoplasty is a well-recognised practice among otologists. It is used to reverse atelectasis and to repneumatise the middle ear. A troublesome problem which can occur is post-operative, intraluminal grommet obstruction by blood or viscous mucoid secretions. Routine post-operative use of eardrops may help prevent grommet obstruction but cannot be administered after tympanoplasty when the ear canal is packed with dressings for up to three weeks post-operatively. In this article, we describe a simple method to prevent post-tympanoplasty grommet obstruction.
The theoretically-predicted enhancement of metal-graphene contacts using the “end-contacted” configuration is studied. Graphene edges at the source/drain regions are created via a CMOS process compatible metal-assisted etching technique. The on-resistance of a graphene device with cobalt-etched-graphene contacts shows 6 times improvement compared to pristine graphene device. Apart from that, four-point contacted graphene devices with nickel-etched-graphene contacts were fabricated and tested under ambient conditions. The proposed graphene devices exhibit contact resistance as low as 14 Ωμm, with an average of 90 Ωμm. Thus, forming metal-etched-graphene contacts is a promising method to obtain low-contact resistance metal contacts to graphene.
Bilateral sensorineural hearing loss associated with recurrent urticarial skin lesions may be signs of underlying Muckle–Wells syndrome. Previous reports have described the hearing loss to be progressive in nature.
To our knowledge, this paper presents the first published case of sudden onset, bilateral sensorineural hearing loss associated with urticarial vasculitis due to underlying Muckle–Wells syndrome.
The patient underwent a cochlear implantation with a modest outcome.
Cochlear implantation may help to rehabilitate sudden hearing loss associated with this condition, but early diagnosis may allow treatment with interleukin-1β inhibitors such as anakinra.
Semiconductor nanocrystals or quantum dots are becoming increasingly popular in research fields as wide ranging as cancer therapies, solar energy and disease detection. Colloidal synthesis provides a low-cost method of producing high quality quantum dots with narrow size distributions. The controllable nature of colloidal synthesis allows researchers to design the size, shape and surface functionalization of the resulting particles.
Here we investigate a simple low temperature method to produce CdSe quantum dots. The quantum dots were grown in solution by dissolving the CdO precursor in a mixture of macadamia oil, and oleic acid. Elemental Se was heated separately before the two mixtures were combined under an inert atmosphere. The injection temperature, reaction temperature and oleic acid concentration were all varied.
Optical absorption and photoluminescence spectroscopies showed the size of the quantum dots increased with time, temperature and oleic acid concentration. Dynamic light scattering has shown the hydrodynamic particle size to range from 7 to 22nm and the samples for up to 6 months.
To analyze infectious complications that occur in patients who receive extracorporeal membrane oxygenation (ECMO), associated risk factors, and consequences on patient outcome.
Retrospective observational survey from 2005 through 2011.
Participants and Setting.
Patients who required ECMO in an Australian referral center.
Cases of bloodstream infection (BSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (YAP) that occurred in patients who received ECMO were analyzed.
A total of 146 ECMO procedures were performed for more than 48 hours in 139 patients, and 36 patients had a total of 46 infections (30.1 infectious episodes per 1,000 days of ECMO). They included 24 cases of BSI, 6 of them secondary to VAP; 23 cases of VAP; and 5 cases of CAUTI. The most frequent pathogens were Enterobacteriaceae (found in 16 of 46 cases), and Candida was the most common cause of BSI (in 9 of 24 cases). The Sequential Organ Failure Assessment score before ECMO initiation and the number of days of support were independenuy associated with a risk of BSI, with odds ratios of 1.23 (95% confidence interval [CI], 1.03-1.47; P = .019) and 1.08(95% CI, 1.03-1.19]; P = .006), respectively. Infected patients did not have a significantly higher mortality compared with uninfected patients (41.7% vs 32%; P = .315), but intensive care unit length of stay (16 days [interquartile range, 8-26 days] vs 11 days [IQR, 4-19 days]; P = .012) and hospital length of stay (33.5 days [interquartile range, 15.5-55.5] vs 24 days [interquartile range, 9-42 days]; P = .029) were longer.
The probability of infection increased with the duration of support and the severity of illness before initiation of ECMO. Infections affected length of stay but did not have an impact on mortality.
To determine the feasibility and safety of the Conquest Pro wire as an alternative to radiofrequency wire for perforation of atretic pulmonary valve and subsequent balloon dilatation and patent ductus arteriosus stenting in patients with pulmonary atresia with intact ventricular septum.
Radiofrequency valvotomy and balloon dilatation has become the standard of care for pulmonary atresia with intact ventricular septum in many institutions today.
We report eight consecutive patients in whom we used the Conquest Pro coronary guidewire, a stiff wire normally reserved for revascularisation of coronary lesions with chronic total occlusion, for perforation of atretic pulmonary valve and subsequent balloon dilatation, and stenting of the patent ductus arteriosus.
Perforation of atretic pulmonary valve was successful in seven out of eight cases. Radiofrequency valvotomy was employed after failure of perforation by the Conquest Pro wire in one case where the right ventricular outflow tract was broad based and tapered towards the pulmonary valve, and was heavily trabeculated. Failure of the Conquest Pro wire to perforate the pulmonary valve plate was mainly attributed by the failure to engage the wire at the correct position.
The Conquest Pro wire for perforation and subsequent interventions in the more straightforward cases of pulmonary atresia with intact ventricular septum is effective and safe, simplifying the entire procedure. However, the radiofrequency generator and wires remain essential tools in the paediatric interventional catheter laboratory.
In this work, Dopant Segregated Schottky Barrier (DSSB) and Schottky Barrier (SB) vertical silicon nanowire (VSiNW) diodes were fabricated on p-type Si substrate using CMOS-compatible processes to investigate the effects of segregated dopants at the silicide/silicon interface and different annealing processes on nickel silicide formation in DSSB VSiNW diodes. With segregated dopants at the silicide/silicon interface, VSiNW diodes showed higher on-current, due to an enhanced carrier tunneling, and much lower leakage current. This can be attributed to the altered energy bands caused by the accumulated Arsenic dopants at the interface. Moreover, DSSB VSiNW diodes also gave ideality factor much closer to unity and exhibited lower electron SBH (ΦBn) than SB VSiNW diodes. This proved that interfacial accumulated dopants could impede the inhomogeneous nature of the Schottky diodes and simultaneously, minimize the effect of Fermi level pinning and ionization of surface defect states. Comparing the impact of different silicide formation annealing using DSSB VSiNW diodes, the 2-step anneal process reduces the silicide intrusion length within the SiNW by ~ 5X and the silicide interface was smooth along the (100) direction. Furthermore, the 2-step DSSB VSiNW diode also exhibited much lower leakage current and an ideality factor much closer to unity, as compared to 1-step DSSB VSiNW diode.
The first Electrolyte-less dye sensitized solar cell (ELDSC) is proposed with the architecture of FTO-TiO2-dye-metal. In the ELDSC design, the most significant contact is the TiO2-dye-metal interface, whereby the metal electrode acts as the charge replenishment layer as well as the external electrode. In previous work, ELDSC has an inferior Fill Factor (FF) due to insufficient metal coverage from top-down physical vapor deposition. In this work, a three dimensional (3D) metal network plated through the mesoporous TiO2 network is achieved through bottom-up metal electroplating. This study focuses on the characteristics of electro deposition onto insulating planar TiO2 as well as mesoporous TiO2 network. For planar TiO2, gold (Au) islands form readily, becoming worm-like structures as they coalesce, subsequently becoming a continuous layer. (The plated metal on the insulating TiO2 layer is made possible by plane defects within the insulator layer that serve as the conductive supply path.) In contrast, electroplating carried out on a FTO-planar TiO2-mesoporous TiO2 substrate results in a 3D Au network within the mesoporous TiO2, where Au cords were observed as the connections among Au islands. This study demonstrates that a continuous metal layer can be electroplated onto an insulating TiO2 layer, borrowing its intrinsic planar defect network. Further, applying the same principle, a 3D metal network can be formed within mesoporous TiO2.
To examine the association between eating in response to hunger and satiety signals (intuitive eating) and BMI. A second objective was to determine whether the hypothesized higher BMI in less intuitive eaters could be explained by the intake of specific foods, speed of eating or binge eating.
Cross-sectional survey. Participants were randomly selected from a nationally representative sampling frame. Eating in response to hunger and satiety signals (termed ‘intuitive eating’), self-reported height and weight, frequency of binge eating, speed of eating and usual intakes of fruits, vegetables and selected high-fat and/or high-sugar foods were measured.
Nationwide study, New Zealand.
Women (n 2500) aged 40–50 years randomly selected from New Zealand electoral rolls, including Māori rolls (66 % response rate; n 1601).
Intuitive Eating Scale (IES) scores were significantly associated with BMI in an inverse direction, after adjusting for potential confounding variables. When controlling for confounding variables, as well as potential mediators, the inverse association between intuitive eating (potential range of IES score: 21–105) and BMI was only slightly attenuated and remained statistically significant (5·1 % decrease in BMI for every 10-unit increase in intuitive eating; 95 % CI 4·2, 6·1 %; P < 0·0 0 1). The relationship between intuitive eating and BMI was partially mediated by frequency of binge eating.
Eating in response to hunger and satiety signals is strongly associated with lower BMI in mid-age women. The direction of causality needs to be investigated in longitudinal studies and randomized controlled trials.
Obstructive sleep apnoea syndrome has been linked to obesity, nasal obstruction and adenotonsillar hypertrophy, but rarely to large thyroid goitres.
To study the possible association between multinodular retrolaryngo-pharyngeal or retrosternal goitres and obstructive sleep apnoea syndrome.
Subjects and methods:
Retrospective case series at a tertiary referral centre (2000–2010). Study parameters included body mass index, Epworth sleep score and polysomnographic index.
Five patients were diagnosed with obstructive sleep apnoea syndrome and managed with nasal continuous positive airway pressure ventilation. Computed tomography showed a retrolaryngo-pharyngeal or retrosternal goitre with significant tracheal compression, displacement and laryngeal oedema. After total thyroidectomy, obstructive sleep apnoea resolved in all patients.
Large, multinodular goitres with retrolaryngo-pharyngeal extension can cause obstructive sleep apnoea syndrome due to laryngeal compression and oedema. In such cases, total thyroidectomy enables resolution of symptoms. Patients with obstructive sleep apnoea syndrome should be screened for thyroid goitre.
In-situ dual-wavelength ellipsometry and laser light scattering have been used to monitor growth of Si/Si1−x,Gex heterojunction bipolar transistor and multi-quantum well (MQW) structures. The growth rate of B-doped Si0 8Ge0.2 has been shown to be linear, but that of As-doped Si is non-linear, decreasing with time. Refractive index data have been obtained at the growth temperature for x = 0.15, 0.20, 0.25. Interface regions ∼ 6-20Å thickness have been detected at hetero-interfaces and during interrupted alloy growth. Period-to-period repeatability of MQW structures has been shown to be ±lML.
Hylans (hyaluronan derivatives) retain the biological compatibility of the natural hyaluronan and have enhanced rheological properties which expands their utility in medical applications. Hylan materials (hylan A fluid, hylan B gel) were evaluated in a variety of tissue compartments for local and systemic tissue reaction (gross and microscopic), residence time and overall behavior in vivo. Hylan material was implanted into the subcutaneous, intradermal, submucosal, intramuscular, eye (vitreus, anterior chamber, trabecular meshwork), and neural (sciatic nerve) tissues at volumes ranging from 0.50 ml/kg to 20 ml/kg (2.5 mg/kg to 100 mg/kg). There was no difference in tissue response to hylan implants at the various ‘doses’ evaluated; all samples tested were observed to be biocompatible and did not elicit significant tissue response. Therefore, tissue reaction of hylan implants was not dependent on dose or concentration of hylan administered, since implantation of small amounts resulted in the same response as implantation of large amounts of material. In one of the most sensitive tests of biocompatibility, hylan was found to have no adverse effect on nerve regeneration (severed sciatic nerves in rat), and the results indicated that hylan materials “regeneration-friendly” environment for peripheral nerve growth as commatpearriaelds tpor othveid BedS Sa controls.
Hylan materials provide biologically and physically compatible intercellular matrices which are useful in a variety of medical applications, including use as viscosurgical and viscoprotective tools (to maintain space, separate and protect tissues) and as viscosupplementation devices and implants.