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The benefit of mandibular advancement devices in patients with sleep-disordered breathing and as a potential option for obstructive sleep apnoea syndrome is well recognised. Their use in the setting of epilepsy or other seizure disorders is typically contraindicated.
A 48-year-old patient with a history of poorly controlled epilepsy and obstructive sleep apnoea syndrome was referred for ENT review for possible tracheostomy. The patient was wheelchair-bound with 24-hour continuous positive airway pressure, but sleep studies demonstrated persistent, severe episodes of apnoea and notable sleep disturbance. Sleep nasendoscopy demonstrated marked improvement on capnography with the laryngeal mask airway in situ, and this was maintained with mandibular advancement using jaw thrust following removal of the laryngeal mask airway. A mandibular advancement device was subsequently trialled; this had no subjective benefit for the patient, but the seizures resolved and control of apnoea was achieved with the combination of a mandibular advancement device and continuous positive airway pressure.
This paper highlights a novel application of mandibular advancement devices, used in combination with continuous positive airway pressure, which resulted in complete resolution of sleep deprivation and apnoea-induced epileptic events.
This chapter describes the prospects for reducing the impact of aviation on the environment through operational changes, new airframe and engine technologies, and biofuels. The focus is on the in-flight impact on the environment with particular emphasis on climate change impact. Examples of operational changes include optimized profile descents, reduced vertical separation, multistage long-distance travel, formation flight, and large aircraft for short ranges. New airframe technologies described include active laminar flow control and novel aircraft configurations such as the double bubble and the blended wing-body. Various possible approaches to improve the efficiency of jet engines are described as well as means of reducing nitrogen oxide emissions, such as lean premixed combustion. Prospects for large-scale use of biofuels are discussed and the technical path that should be taken in developing and adopting alternative jet fuels is presented.
This chapter aims to present the EU perspective on the controversial issue of carbon emission trading and aviation. The article analyses how the EU advanced to the concrete implementation of emissions trading in the aviation sector. It analyses why the EU first proposed and then introduced GHG emissions trading while at the same time seeking multilateral solutions to the issue of climate change contributions from the aviation sector. It highlights the technical issues at stake, the global resistance to what was perceived as a unilateral act by the EU, and how the fact that the EU had introduced the system influenced the 2016 ICAO climate decision to adopt the CORSIA carbon offsets scheme. The article documents how the EU system eventually influenced the global debate and the global compromise that arguably respected the most important sustainable development principles. It reviews ongoing EU policy respecting sustainable development and ends with an outlook on the unlikely scenario that the new ICAO mechanism could fail, in which case the EU’s original scheme could be resurrected under EU law.
This article aims to present the dispute settlement mechanism established in Chapter XVIII of the Chicago Convention. To this end, the article will analyze how the Council could resolve a potential dispute involving a defense of sustainable development. For this exercise, purely hypothetical cases will be analyzed, in which the European Union (EU) decides to unilaterally implement its emissions trading scheme in the field of aviation or in which the EU or a major aviation state applies the GHS emissions scheme mandated by the ICAO Assembly in 2016 to a state that considers it should be exempted. These cases will serve as hypotheticals to consider whether the dispute settlement mechanism set out at Article 84 of the Chicago Convention could serve to resolve such a dispute. The ICAO dispute settlement mechanism has been criticized many times in the ICAO’s history. In fact, the five disputes brought under the present article have each been resolved through diplomatic channels, involving the good offices of the President of the ICAO Council. Therefore, despite the difficulties presented by the procedure and the peculiarity of the EU representation at the ICAO, this chapter seeks to demonstrate that a potential dispute with respect to sustainable development will most likely be resolved the same way as has been done previously.
International aviation is growing at a rate of roughly 5 percent per year. Its greenhouse gas (GHG) emissions are forecast to increase by 3–4 percent per year. At present, international aviation’s contribution to global GHG emissions is approximately 2 percent. However, these emissions are expected to increase considerably under a business-as-usual scenario.
Although the International Civil Aviation Organization (ICAO) has discussed environmental protection in connection with aviation since the 1970s, climate change issues are relatively new. Ever since the Kyoto Protocol entrusted the ICAO with handling GHG emissions from international aviation, the Organization has been at the center of the storm. This chapter seeks to explore the ICAO’s involvement in climate change issues, and its merits and shortcomings, as well as identifying better ways for the organization to handle GHG emissions from international aviation, in particular bearing in mind the recent agreement to develop a global market-based measure (MBM) scheme. Understanding the constraints under which the ICAO operates is central to determining its limitations and establishing realistic corrective actions to facilitate not only its adoption and implementation but, more importantly, participation in the ICAO’s global MBM.
To this end, the chapter discusses two main topics. First, it analyzes the suitability of the ICAO’s institutional setting to handle climate change issues. Secondly, the chapter studies the ICAO’s specific involvement in climate change issues. Although the ICAO has in the past taken many initiatives to tackle climate change, the chapter focuses on five key aspects: (1) the CO2 standard; (2) State action plans; (3) the aspirational goals; (4) the framework for MBMs; and, (5) the global scheme. These topics adequately illustrate the challenges faced and the political implications involved. Finally, the chapter provides some concluding observations with some suggested realistic corrective actions that the ICAO may take to better handle the issue of GHG emissions from international aviation.
In 1944 the Chicago Convention set out the foundations of public international law regulating international air transport, but until 2016 no international agreement existed to limit its environmental impact. Sustainable Development, International Aviation, and Treaty Implementation explains why the CORSIA scheme, adopted by the International Civil Aviation Organization in 2016, should be implemented in 2020 even though the adequacy of this scheme is still open to doubt and criticism. This book seeks to examine the many dimensions of the effort to contain greenhouse gas emissions from aircraft in a manner consonant with the principles of sustainable development, and examines the development of international law and policy in an area that has remained largely outside the general framework of international environmental law. International civil aviation is a significant polluter of the atmosphere, and in this volume, a group of air law and sustainable development law specialists considers how the international community can respond.
Integration of photonic devices on silicon (Si) substrates is a key method in enabling large scale manufacturing of Si-based photonic–electronic circuits for next generation systems with high performance, small form factor, low power consumption, and low cost. Germanium (Ge) is a promising material due to its pseudo-direct bandgap and its compatibility with Si-CMOS processing. In this article, we present our recent progress on achieving high quality germanium-on-silicon (Ge/Si) materials. Subsequently, the performance of various functional devices such as photodetectors, lasers, waveguides, and sensors that are fabricated on the Ge/Si platform are discussed. Some possible future works such as the incorporation of tin (Sn) into Ge will be proposed. Finally, some applications based on a fully monolithic integrated photonic–electronic chip on an Si platform will be highlighted at the end of this article.
Depression is one of the most prevalent mental illnesses worldwide and a leading cause of disability, especially in the setting of treatment resistance. In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative strategy for treatment-resistant depression and its clinical efficacy has been investigated intensively across the world. However, the underlying neurobiological mechanisms of the antidepressant effect of rTMS are still not fully understood. This review aims to systematically synthesize the literature on the neurobiological mechanisms of treatment response to rTMS in patients with depression. Medline (1996–2014), Embase (1980–2014) and PsycINFO (1806–2014) were searched under set terms. Three authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. Of 1647 articles identified, 66 studies met both inclusion and exclusion criteria. rTMS affects various biological factors that can be measured by current biological techniques. Although a number of studies have explored the neurobiological mechanisms of rTMS, a large variety of rTMS protocols and parameters limits the ability to synthesize these findings into a coherent understanding. However, a convergence of findings suggest that rTMS exerts its therapeutic effects by altering levels of various neurochemicals, electrophysiology as well as blood flow and activity in the brain in a frequency-dependent manner. More research is needed to delineate the neurobiological mechanisms of the antidepressant effect of rTMS. The incorporation of biological assessments into future rTMS clinical trials will help in this regard.
Studies of the rotation curve of our Galaxy at galactocentric radii, R, greater than the solar distance, Ro, from the center require the use of conventional optical techniques since the distances to as well as the radial velocities of Population I objects are needed.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.