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The predominantly carbonate nature of the mountains near the coast of Málaga and Marbella (Costa del Sol, southern Spain) and the presence of springs have favored the formation of travertine buildups during the Quaternary. The geomorphic characteristics of the slopes and the location of the springs have determined the development of three types of travertine growths: (1) spring travertines, located preferentially on the south mountainside, where the slope is steepest; (2) pool-dam-cascade travertines, which form along the north and east edges, far from the carbonate relief and with a gentler slope; and (3) river-valley travertines, formed in the courses of the springs of any sector. Field observations combined with new amino acid racemization (AAR) dating of Helicidae gastropods show that most of the travertine formations are polyphasic and that their development was interrupted by stages of erosion and incision. Five stages of travertine development are evident, most of which are related to warm, moist episodes corresponding to marine oxygen isotope stages (MIS) 7, 5, 3, and 1, although local travertine growth also occurred during MIS 6 and during the transition from MIS 3 to 2.
To determine: (1) the incidence of incidental ‘mastoiditis’ reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a reporting practice.
Retrospective case series.
Between October 2015 and November 2016, 500 patients underwent magnetic resonance imaging of the internal auditory meatus to rule out cerebellopontine angle lesions. There was an incidental finding of increased mastoid signalling in 5.8 per cent (n = 29), of which 20.7 per cent (6 of 29) were reported as bilateral cases. The diagnosis of ‘mastoiditis’ was found in 39.7 per cent (29 of 73). None of these patients had any pathology identified clinically. Other significant pathology was identified in a further 8.8 per cent (n = 44).
The diagnosis of mastoiditis is primarily clinical. An incidental finding of high signalling in the mastoid region on magnetic resonance imaging is highly unlikely to represent actual clinical disease. In patients who are scanned for other reasons and who do not complain of otological symptoms, such findings are unlikely to require otolaryngology input.
To determine whether patients within an otolaryngology department presenting with asymmetrical sensorineural hearing loss and/or unilateral tinnitus can be safely and cost-efficiently screened for acoustic neuroma by audiologists as a first or only point of contact.
A prospective case series and cost analysis were conducted at a tertiary referral centre. Between April 2013 and March 2017, 1126 adult patients presented to the audiology department with asymmetrical sensorineural hearing loss and/or unilateral tinnitus. All were screened for acoustic neuroma with magnetic resonance imaging, based on pre-determined criteria. The main outcome measure was the presence of acoustic neuroma or other pathology on magnetic resonance imaging.
Twenty-five patients (2.22 per cent) were found to have an acoustic neuroma (size range: 3–20 mm) and were referred to the otolaryngologist for further assessment. The remaining patients were appropriately managed and discharged by the audiologists without ENT input. This resulted in an overall cost saving of £164 850.
Patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus can be safely screened for acoustic neuroma and independently managed by audiologists as a first or only point of contact, resulting in considerable departmental cost savings.
Self-Determination in Disputed Colonial Territories addresses the relationship between self-determination and territorial integrity in some of the most difficult decolonization cases in international law. It investigates historical cases, such as Hong Kong and the French and Portuguese territories in India, as well as cases that remain very much alive today, such as the Western Sahara, Gibraltar, the Falkland Islands and the Chagos Islands. This book provides a comprehensive analysis of colonial territories that are, or have been, the subject of adverse third-party claims, invariably by their neighbouring states. Self-Determination in Disputed Colonial Territories takes a contextual, historical approach to mapping the existing law and will be of interest to international lawyers, as well as scholars of international relations and students of the history of decolonization.
Self-regulation on behalf of the student is crucial in learning Mathematics through hypermedia applications and is an even greater challenge in these IT environments. Two aims are formulated. First, to analyze the effectiveness of a hypermedia tool in improving perceived knowledge of self-regulatory strategies and the perceived usage of the planning, executing and assessment strategy on behalf of students with low, medium and high levels of academic performance. Second, to analyze the effectiveness of the hypermedia tool in improving perceived usage of the strategy for planning, monitoring and evaluating on behalf of students with a perceived knowledge (low, medium and high). Participants were 624 students (aged 10–13), classified into a treatment group (TG; 391) and a comparative group (CG; 233). They completed a questionnaire on perceived knowledge (Perceived Knowledge of Self-Regulatory Strategies) and another one on perceived usage of the strategy for planning, performing and evaluating (Inventory of Self-regulatory Learning Processes). Univariate covariance analyses (ANCOVAs) and Student-t tests were used. ANCOVA results were not statistically significant. However, the linear contrast indicated a significant improvement in perceived knowledge of strategies among the TG with low, medium and high academic performance (p ≤ .001). Results are discussed in the light of past and future research.